“The White Coat Ceremony is a milestone in your professional formation. It marks the point in time when you take your first steps towards becoming a clinician. We needed to physically bring you together in one place to mark that occasion.”
Yale School of Medicine’s (YSM) Physician Associate (PA) Program Director Alexandria Garino, PhD, PA-C, shared these remarks with the 36 members of the Class of 2022 at their in-person White Coat Ceremony on August 17, 2020, held in Harkness Auditorium.
After weighing the pros and cons of bringing the class together in one place, the PA Program faculty and staff structured the ceremony to greatly reduce risk from a COVID-19 perspective. Only the Class of 2022 and PA faculty and staff were physically present. Family, friends, and other members of the YSM community joined by Zoom. Everyone wore masks, were socially distanced, and hand sanitizer was on the podium.
The biggest symbolic difference revolved around the white coat. Unlike in the past when faculty, or in more recent years second-year PA students, helped first-year students put on their new white coats, the first-year students, one-by-one, came onto the stage and put on their own white coat, to much applause, but without the usual handshakes and hugs. While on stage, each student picked up a stethoscope, which was donated by individual Yale PA Program alumni.
As Garino explained, when the PA White Coat Ceremony began at YSM, “faculty helped the students on with their coats in a gesture that symbolized our commitment to your professional development. Because of safe distancing, the faculty will not be helping you don your white coat, but our presence on stage and in the auditorium is a reminder that we are a community that pledges to help one another grow to be our best selves.”
The ceremony included much reflection on the meaning of the white coat.
Garino stated “the white coat and stethoscope have become the symbols of the healer. It is a reminder that our profession puts the care of patient above one’s own interests. So, it is a little ironic that, in these pandemic times, few of those caring for patients with COVID actually wear a white coat. The uniform has changed to include mask and face shield, isolation gown, and gloves. The uniform has changed, but the clinician has not.”
Associate Program Director, David Brissette, MMSc, PA-C, who had been called into service at Yale New Haven Hospital as COVID-19 was peaking in Connecticut in the spring, shared what his white coat has meant to him, including during the pandemic. He recalled the first time he wore his white coat, during his pre-clinical training when he was seeing his first patient to conduct an interview and physical exam. He remembers the long walk to the hospital room, “sweating bullets” before entering, and asking himself “can I do this?” At that moment, in addition to his knowledge and skills from his training, he viewed his white coat as his “shield of armor, where nothing could stop me from achieving my goal of becoming the best that I could be, not even my psyche.” His coat gave him confidence and reminded him that being there for the patient “is what I came here to do.”
He then described how in spring 2020, his white coat again reminded him of his calling and that “there were patients in need.” He explained this “far exceeded any flicker of COVID-related apprehension I may have had,” adding “caring for patients is what we do.”
Brissette told the students, “I hope that you will find your individual meaning of what the white coat means to you,” noting that in good times they may not think much about their white coat, but that when times are stressful or if they second guess themselves, “it does have a special energy to it.”
Director of Didactic Education Elizabeth Roessler, MMSc, PA-C, also reflected on the white coat. Roessler, who does not wear a white coat when she practices at the Fair Haven Community Health Center, shared that a patient recently said to her “what, no white coat?,” but then continued “you could be wearing pajamas. I don’t care as long as you take good care of me.”
Roessler told the students that while the white coat often is viewed as a symbol of professionalism, integrity, and the highest commitment to caring for our patients, it also can be viewed as a symbol of hierarchical elitism and can be a barrier to patients. However, she emphasized that the White Coat Ceremony “is the first step in a path to what I feel like is the noblest profession, being a physician assistant.”
Associate Director of Didactic Education Jonathan Weber, MA, PA-C, joined in the white coat commentary, “the plain white coat only becomes unique after you put it on day in and day out, as you add your unique commitment to training and care of patients like brushstrokes to the white canvas.”
Weber then turned to a discussion of the PA Oath, describing it as focused “on humanism.” Weber noted he was echoing Brissette, who earlier in the ceremony had discussed how in the midst of COVID-19, some people refer to what health care providers are doing as “heroism, but to me it’s more like true and authentic humanism at its best.” Weber described how the oath addresses many subjects, including listening to each patient’s unique story and treating them with care and compassion, minding one’s own biases, and forgiving oneself for mistakes and learning from them. Weber recited the oath out loud, and asked students to join silently, due to COVID-19.
Listening to the enthusiastic applause, one could have thought it was a traditional White Coat ceremony. But as Garino stated in her opening remarks, next year the PA Program is going to celebrate its 50th anniversary and “in 50 years, no one could have imagined the current environment or this ceremony. Class of 2022, you are a historic class. All that you do in the program will be a first.”