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Initiated on August 20, at Columbia University College of Physicians and Surgeons, this annual ceremony or a similar rite now takes place for first-year medical students at about 90 percent of schools of medicine and osteopathy in the United States, and is supported by the Arnold P. Gold Foundation. According to the Arnold P. Gold Foundation, the White Coat Ceremony helps establish a psychological contract for the practice of medicine. Physicians dressed in black until the late 19th century, due to the association of black attire as formal. Physicians adopted the white coat as a symbol of purity at the beginning of the 20th century.