Adam Iddriss dons his first physician's white coat, which was presented by Rafael Llinas, associate professor of neurology and a Sabin College faculty adviser. Photo by Will Kirk / HIPS

Rite of passage marks med students' transition into clinical training

By Greg Rienzi
The Gazette

Throngs of family and friends filled East Baltimore's Turner Auditorium on May 27 to witness an annual rite of passage, the School of Medicine's White Coat Ceremony.

The symbolic event celebrates first-year medical students' completion of the basic science curriculum and their transition into clinical training. The program notably includes the presentation of a physician's white coat, with the student's name embroidered on it, and a stethoscope given by the Johns Hopkins Medical and Surgical Association.

From its modest beginnings in 1995, the event has grown in size and stature each year, and the 14th annual White Coat Ceremony featured two new elements: an afternoon presentation for guests and the reading of a Profession of Values, an ethical statement created by the 120 members of the Class of 2011 (see below).

The White Coat Ceremony was created in 1993 at Columbia University by Arnold P. Gold, a teacher and pediatric neurologist there for more than 40 years, and his wife, Sandra, an internationally acclaimed patient counselor. The Golds believed that medical students should be given well-defined guidelines regarding the expectations for and responsibilities appropriate to the medical profession prior to their first day of clinical rotations. Medical schools nationwide have since adopted the tradition.

This year's ceremony began with one of three musical performances by members of the talented class. Nancy Cheng and Edmund Hong performed a medley for piano and violin that incorporated a classical interpretation of the disco-era anthem "I Will Survive." The number, hauntingly played, drew a standing ovation.

In the opening address, Edward Miller, dean of the medical faculty and CEO of Johns Hopkins Medicine, welcomed the large audience and noted both the magnitude of the occasion and the responsibility the students were about to assume.

"When you started, you probably were not quite sure what medical school was going to be like. But now you take on a new look of responsibility: one where society looks to you and turns to you for advice. They will look to you to set an example," Miller said. "You will also be scrutinized more than ever before. So, when you are out on the wards, or out in your social life, people will look at how you act, how you behave and how you treat others. Whenever you have the white coat on — and as time goes on, you don't need the white coat É people will know you're a doctor — they will expect you to behave as a physician. I wish you well in that."

A somewhat somber moment followed Miller's address as Sujay Pathak, a member of the Class of 2011, took to the stage to perform on guitar and vocals "Somewhere Over the Rainbow," a song he dedicated to his mother, Radha, a faculty member who passed away only a week before the ceremony. David Nichols, vice dean for education, had earlier in the evening led those in attendance in a moment of silence to honor Radha Pathak, a School of Medicine graduate and instructor in the Department of Pediatrics.

The keynote speaker for the 2008 ceremony was Robert Arceci, a professor in the Department of Pediatric Oncology and the inspiration for the Emmy-winning film A Lion in the House, which examines six years in the life of pediatric cancer patients and their families. Arceci focused his talk on the physician-patient relationship, and the students' moral obligations.

"Like Dr. Miller said in his earlier remarks, remember that you are treating individuals not diseases," he said. "Keep in mind as you are going on the wards that a 14-year-old with leukemia is not a 14-year-old leukemic, and a 30-year-old with sickle cell disease is not a 30-year-old sickler. If you haven't already had the wonderful experience, remember that you will be patients at one point of your lives, guaranteed. Keep all this in mind."

He also reminded the students just how much education lies ahead.

"First of all, you will learn more about diseases than you ever thought you could put in your head. But most of your learning will come from patients and their families and by sitting with them and listening to their stories," he said.

For the presentation portion of the ceremony, the students stepped onstage in single file to receive their white coats, handed to them by Miller and then placed on by a faculty member from his or her advisory college. The students are divided into four colleges, which are named after notable figures in Johns Hopkins history: Dan Nathans, Florence Sabin, Helen Taussig and Vivien Thomas. The official naming of the colleges, previously known as A, B, C and D, took place during the 12th annual White Coat Ceremony.

Following the presentation period, the now white-coated students turned to face family, friends and faculty to read their Profession of Values, a statement that Nichols said is a significant addition to the ceremony.

"The profession of and adherence to values that support the individual patient and society as a whole is the most important thing a physician can do. It is extremely important that the Class of 2011 had the courage to wrestle with a profession of what they believe, and to declare it publicly in front of their parents, family and friends," he said.

The event concluded with a performance by the Note-A-Chords, the School of Medicine's a cappella group, that sang Coldplay's hit song "Fix You." After the performance, the crowd once again took to its feet to salute the students.

In the closing remarks, Nichols said how impressed he was by this group of students and this particular ceremony.

"Family, friends and faculty, I think you can see why it is easy to become overwhelmed by the talent of the Class of 2011," he said.

He then directly addressed the students.

"I don't know if you will be celebrated publicly, or have colleges named after you, but I do know that if you stick by the values that you have so eloquently expressed today, you will be heroes to someone," Nichols said. "Your values inspire us, and we congratulate you on your accomplishment. Somewhere over the rainbow, bluebirds fly. Class of 2011, you are now free to fly."

Dan Hudson said he's honored to wear the coat that gives him wings.

"It's a big deal," said Hudson, still wearing the coat at the reception that followed the ceremony. "I truly believe what the white coat symbolizes. With wearing the coat comes a lot of responsibility, and it's nice to now be able to interact with patients and uphold that."

Earlier that day, guests attended a presentation where they learned the history of Johns Hopkins Medicine from Randall Packard, director of the History of Medicine Department, and about the school's community values from Robert Shochet, director of the Colleges Advisory Program. The afternoon also included student-led tours of the ongoing construction of The Johns Hopkins Hospital's two new clinical care towers, the largest and most expensive hospital project in Maryland history.

 

Forging a New Tradition

At the suggestion of the Colleges Advisory Program, the School of Medicine's Class of 2011 created Johns Hopkins' first-ever Profession of Values, a statement to be read by the class at its White Coat Ceremony.

Modeled after the Hippocratic oath, which relates to the ethical practice of medicine, the document reflects the shared values of the class and how its members wish to act during their clinical training as medical students, said Robert Shochet, director of the Colleges Advisory Program and an assistant professor in the school's Department of Medicine. The concept, he said, was inspired by a similar tradition at Case Western Reserve.

First-year student Sophie Strike coordinated the effort, which began in January. Students initially shared their thoughts about what values should be included and later a 12-member committee was formed to steer the creation of the statement. Mark Hughes and Rachel Levine, advisers in the Colleges Program, assisted the students in their efforts.

If the tradition holds, Shochet said, each School of Medicine class from here on in will be asked to craft its own Profession of Values.

 

Profession of Values

We, the Johns Hopkins University School of Medicine Class of 2011, profess to our peers, educators, families, friends and the community of Baltimore our aspiration to uphold the values we attribute to this white coat.

As students of medicine, we will embrace honesty and integrity. In our roles as scholars, caregivers and community members, we will passionately pursue excellence, continually inspired to contribute to the expanding knowledge of medicine. We will strive to know ourselves, our abilities and limits, allowing this insight to guide our actions. As we face challenges, we will draw on our strength, optimism and patience. In our successes, we will hold humility before pride.

We recognize that skill without empathy is inadequate. We will approach every patient with open-mindedness and without judgment, respecting cultural and personal differences. We will honor the dignity and humanity of each patient. As time passes and novelties wane, we will not forget compassion and caring but will remain dedicated to the ultimate goal of helping others. We will learn from every person, with new understanding gained from each interaction.

We accept our responsibility, one which extends beyond the walls of our institution, to lead and serve with dedication. We will be diligent and responsible, not complacent or timid, and always respectful of the trust placed in us. As members of the community, we will not exploit or neglect those around us but rather will embrace our social responsibility to advocate for positive change. As physicians, we will commit to advancing knowledge and improving practice. As individuals, we will be mindful of the impact of our decisions and our duty to serve selflessly.

This profession of values declared on the 27th of May 2008 is an acknowledgment of our commitment to the tradition of excellence in clinical care and scholarship at The Johns Hopkins University School of Medicine.

Class of 2011 Profession of Values Writing Committee: Sophie Strike (coordinator), Shamik Bhattacharyya, Ashley Campbell, Nancy Cheng, Matt Crim, Swathi Eluri, Stephen Juraschek, Allie Kaeding, Irene Kim, Sujay Pathak, Jeremy Schneider, Nathan Skelley and Bridget Wild.

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