'Into Your White Coat' curriculum prepares medical students for White Coat Ceremony
October 15, 2018
As Donald Steinweg comforted the family of one of his favorite patients who passed away from complications due to progressive heart failure, his daughter said there was one doctor who stood out from the rest during his final stay at the hospital.
“'It was the senior resident,’” recalled Steinweg, associate professor of internal medicine at the Virginia Tech Carilion School of Medicine and retired physician. “I had to swallow my pride a little bit after seeing him so frequently over the last several years especially. I asked, why? The daughter said, ‘she brought my dad watermelon.’"
Steinweg asked why that made a difference to the daughter. “'She would come by later in the shift after rounds and ask my dad how she can help him the most today? Twice, my dad said watermelon. She brought it to him both times,’” Steinweg recalled her saying.
Steinweg shared this story with the 43 students who make up the Virginia Tech Carilion School of Medicine's Class of 2022. The students subsequently discussed how sometimes a doctor can bring to the bedside something far more important than medicine. It’s part of a special curriculum to prepare the new students for their upcoming White Coat Ceremony.
Columbia University held one of the first White Coat Ceremonies in 1993. Now, almost all medical schools in the country have the ceremonies, which are intended to ensure students understand the expectations and responsibilities of the profession. The Arnold P. Gold Foundation helps support White Coat Ceremonies as well to emphasize humanism in the practice of medicine.
When the Virginia Tech Carilion School of Medicine welcomed its first class in 2010, school leadership wanted to make sure the ceremony was not just a photo op.
They created a special preparatory curriculum called, “Into Your White Coat.” It would occur during the first block of the medical student curriculum. Soon after the first block is complete, the first-year students have their White Coat Ceremony, instead of having one within the first week of school.
The curriculum includes talks from senior physicians. This year, in addition to Steinweg, the Class of 2022 heard stories and advice from Vice Chair of the Department of Family and Community Medicine Mark Greenawald, Professor of Surgery Sandy Fogel, and Founding Dean Cynda Johnson.
“Most of us are aware of someone in our immediate or extended family or social circle who is experiencing a serious health condition. People in the emergency room or hospital are often having the worst day of their life. Out of each of these will come part of their life story going forward. It’s about stories,” Greenawald told the class. “Soon you will be experiencing or you’ll be part of those stories. Some will not only shape you but define your professional lives.”
Fogel shared some of the hard decisions he, as a surgeon, makes daily. When is the right time to take a patient off life-support? When should you prescribe narcotics? How do you make the “right” decision in the moment when “right” is not clear cut?
“If I’m doing surgery and find the tumor is larger than expected, what do I do? Continue and try to take it all out? He could die on the table, or survive and have a longer life. If I stop, I have allowed the patient to get their affairs in order, but I have not taken the tumor out.” Fogel debated.
While sometimes there is no clear answer, Fogel remained committed to the profession. “It is an honor and privilege to care for others,” Fogel said. “You have earned the right to be here, but haven’t earned the right to be a physician yet. You can choose today, however, what kind of physician you will be.”
For Johnson, she reminded the class that the profession they have chosen will be part of them at all times, overlapping with their other roles as a friend, family member, or even as a patient themselves.
Johnson told a story about being headed to vacation, but her training required her “put on her white coat” in the moment. She was on an overseas flight to Sweden for a wedding when the pilot asked if there was a doctor on the plane. Johnson and a Swedish pediatrician responded. A passenger was unconscious in first class.
“My job was to tell the pilot if we needed to turn the 747 around or not, with 500 people on board. I had 10 minutes to decide because of the amount of fuel left,” Johnson said. “At the last minute, the patient began to wake up. Later, we found his diabetic supplies around his waist. It was under control and he did well.”
After it was all over, Johnson found out why one flight attendant kept pressing her to decide quickly about whether or not to turn around. “She told me a similar situation had happened before and the passenger died. So, sometimes you will be called on to make a decision that impacts not only the patient, but the hundreds of people on board the flight.”
After hearing from senior clinicians, students are required to write an essay about “What’s in Their White Coat.” Johnson shares portions of the essays during their White Coat Ceremony.
In addition to the speaker series and individual essays, the class develops its own set of guiding principles, which affirm the humanistic qualities that the class deems most important as they move forward in their practice of medicine. Those will also be shared during the ceremony.
The Class of 2022 will earn their white coats during their White Coat Ceremony the evening of Friday, Oct. 19.