2019 UCD Medicine Clinical Commencement ‘White Coat’ Ceremony
The 2019 UCD Medicine Clinical Commencement ‘White Coat’ Ceremony took place in UCD O’Reilly Hall on Wednesday 13th February 2019. A key milestone for our medical students, the ceremony marks the formal transition from a predominantly class room-based education to full immersion into clinical training at our affiliated teaching hospitals and with general practices in the community.
The proceedings were led by Professor Michael Keane, Dean of Medicine and Head of School, supported by a selection of our academic faculty. Students from Stage 4 of our direct entry undergraduate and Stage 2 of our graduate entry medicine programmes took part in the ceremony which was attended by many friends and family. As part of the ceremony, students are ‘robed’ with white coats by members of faculty as an important symbol of their transition into the role of doctor in training.
In opening the event, Prof Keane noted that this transition represents a landmark in the students’ education and one which he felt sure they would look back on fondly. He noted that with the privilege of clinical training comes great responsibility as our students are expected to exhibit empathy, dedication and the highest standards of professionalism.
The White Coat Ceremony is an important recognition of the extensive knowledge of biomedical science that has been mastered to date which puts the students in a position to apply this knowledge of the scientific basis of health and disease in the clinical arena. In UCD, we think it is important to mark this transition formally, and this tangible marker of career progression is very much appreciated by students, their families and their friends.
The awarding of a white coat is both practical and symbolic ; In addition to protection of clothing and infection control, the white coat represents the increased professional privileges and responsibilities that accompany this transition. In addition to meeting the expectations for professional practice, conduct and ethics, our students are joining a medical community in which it is the doctor’s primary responsibility to be a strong advocate for their patients, above all other considerations.
This advocacy is particularly important in a period of shrinking healthcare resources, which reinforce the need for evidence-based best practice to guide patient care. This role also mandates development of leadership and teamwork skills, which our students will continue to seek to develop right up to their graduation and beyond. Our students’ behaviour in the clinical setting is geared toward protecting patients and optimizing their outcomes, whether it be by rigorous hand hygiene, up to date vaccination against communicable diseases, or other aspects of evidence-based clinical practice.
Prof Keane welcomed UCD Medicine alumna Dr Rita Doyle, President of the Medical Council of Ireland who gave the keynote presentation. The Co. Wicklow general practitioner gave a thoughtful, reflective address which touch on many of the key lessons for our students as they embark upon full-time clinical training. She highlighted the privileged responsibility, the nature of the doctor-patient relationship and the need for each student to develop their own particular communication style.
You are now going to enter into the really sacred world of both doctor and patient. You and I are privileged, and I emphasize that word privileged, to be allowed to enter in this world. We must never abuse that privilege. The doctor-patient relationship is a truly unique and special one. It is never an equal relationship and you must always remember that. Never presume it's your right.
Dr Doyle described the formative early experience of the family doctor visiting her home to care for a loved one. She remembered how influential that doctor’s domiciliary visit was on her subsequent career choice as a family doctor. Dr Doyle offered a persuasive, passionate endorsement of her specialty which has an important gatekeeper role in healthcare.
Let me give you an example so that you can understand this. A patient comes in to me with a lump. I listen to their story, elucidate their belief around that lump and then examine them. I find it to be a benign cyst, reassure them and they go back to normal living. I examined that lump and alarm bells go off in my head. I don't know what it is and I decide to investigate it myself, maybe with a scanner maybe, taking a biopsy. The patient is anxious and may become a little dependent while awaiting results. I examined the lump and from the very beginning I know it to be neoplastic and I need to refer them to secondary or tertiary care. Their lives are now changed. They become a sick patient and my role is to support them through their diagnosis and their journey into the world of hospital medicine.
Dr Doyle, who became the first female President of the Medical Council last July, reflected on the changing gender balance of the Class of 2021 compared with her class in which she was one of only 18 women among a class of 120 students. She described her postgraduate training in the days before a formal GP training scheme, her time spent in St Ultan’s Children’s Hospital, learning about the effects of deprivation on people’s health. Highlighting the late Professor Julian Tudor Hart’s Inverse Care Law, Dr Doyle observed,
The inverse care law is the principle that the availability of good medical and social care tends to vary inversely with the need of the population served. Proposed by Julian Tudor Hart way back before I even qualified the term has since been widely adopted. It is a pun on the ‘inverse-square law’, a term and concept from physics. The deprived areas have half the number of doctors that they need and the wealthy have twice the number. The disparity between the life expectancy is truly staggering. Often even in this city, oh but four kilometers apart there can be twenty years in the difference of life expectancy.
Dr Doyle reflected on how her patients and their conditions changed as they both aged, from paediatrics and antenatal care through to chronic diseases and complex co-morbidities.
I've been in the same practice now for nigh on 35 years. so I've had have at times three generations of the one family under my care. When I was young in practice most of my patients were young and I have aged with them. I was an expert in paediatrics at that stage as well as antenatal care, sexual health and contraception as I aged so did they and I became an expert routine health and gynaecology. Then began to care for a lot of older patients with chronic diseases and complex comorbidities such as diabetes, hypertension, coronary heart disease, rheumatoid arthritis, chronic obstructive airways disease but only all in the one patient. So medically speaking the job has got harder.
Drawing on the works of the late Professor James McCormack and late Professor Peter Skrabanek, authors of the influential 'Follies and Fallacies of Medicine', Dr Doyle invited the students to always remain inquisitive.
I know if James were here today he would be wishing you all a healthy dose of skepticemia. He defined it as a condition almost unheard off in medical students, an uncommon, generalized disorder of low infectivity. And he stated medical school education is likely to confer lifelong immunity! Really what he was saying was you must never stop questioning.
In closing, Dr Doyle described the role of the Medical Council and the importance of investing in people in healthcare.
Our role (Medical Counci) is dual one - patient safety and the support of doctors in delivering best care. Our vision is 'Excellent Patient Care, Public Confidence in the Medical Profession and Leadership in Healthcare'.
Our health service is in crisis. Mainly because we have not invested enough in people. We've had the Cervical Check controversy, the Scally Report, Open Disclosure, Repeal of the Eighth Amendment, commencement of the termination of pregnancy act bringing with it all the ethical issues around conscientious objection. All since I took over (as President of the Medical Council) last July. So my life is busy!
If I were to give you one piece of advice, and I might, it would be this. Always but only always keep the patient at the top of your agenda and you won't go far wrong. Whatever argument you have put your patients first and you will be safe and they will be safe. There is a small part of me that really envies you just starting your career. Would I do it again? Absolutely!
We extend our sincere thanks to Dr Doyle for her excellent address and her inspiring words.