Professionalism

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This material is presented to first year medical
students prior to small group sessions in which
they develop their own version of the Hippocratic
Oaths. For further information contact
lnixon_at_hsc.usf.edu.
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OathsThe Hippocratic Tradition
Lois LaCivita Nixon, PhD, MLitt, MPH
College of Medicine University of South
Florida
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Purpose of Class

• To review characteristics associated with the
  medical profession. (theology, medicine, and law
  the learned professions)
• To consider the symbolic nature of an oath,
  specifically the Hippocratic Oath, USFs revised
  version, and excerpts from various other oaths.
• To meet in small groups to draft a working
  declaration, affirmation, or oath for
  presentation at the White Coat Ceremony.

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Professionalism
Seven characteristics described
by Abraham Flexner in 1910.

His report (Flexner Report) led to the
standardization of medical education. Considered
to be the most important change event in modern
medicine.
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Characteristics
-Flexner-

• Essentially intellectualor learned
• Special body of knowledge
• continuously expanded by research
• Practical end (service)
• Specialized training of techniques

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Characteristics -Flexner-

• Moral commitment, a brotherhood (sic)
• Self-organization and self-regulation
• Altruistic motivations (unselfish regard for
  welfare of others)

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Project Professionalism ABIM

• ALTRUISM
• DUTY
• EXCELLENCE
• HONOR

• INTEGRITY
• ACCOUNTABILITY
• RESPECT FOR OTHERS

John Stone, MD,
cardiologist, poet For the heart will lead
For the head will
explain but the final common pathway is the
heart whatever kingdom may come For what
matters finally is how the human spirit is spent.
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In recent years additional attention has been
given to the following concerns

• Just distribution of finite resources

• Maintenance of trust by managing
• conflict of interest

• Improved access

These suggest a shift from physician-to-patient
and patient-to-physician concerns to a broader
physician-to-society focus.
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Class of 2006
committed to learning
humility
integrity
open/honest
communicator
generosity of spirit
respect/courtesy
accountability
competent
listener
empathy
confidentiality
considerate
non-condescending
maturity
teaching skills
tolerance for difference
culturally sensitive
current knowledge
humor
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Bonding Declarations/ Commitments

• Promises
• Codes
• Oaths

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Oaths

• Performative utterance (before others)
• Solemn declaration
• Validated by transcendent appeal, something
  sacred
• Moral weight, never trivial

• Extended timeframe (or lifetime)
• Involves relationships with other

and..
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• Proscribes consequences for failure

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Cross my heart and hope to die..
Oath breaker?!
Curtains!!
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Examples or illustrations of the range of sworn
oaths
I swear
I solemnly declare
I hold these truths
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The Oath of the Horatii by David (French painter)
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Maimonides, Rabbi, Physician, Philosopher
RaMBaM, 1135-1204
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Mecca
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On my honor, I will do my duty to God and my
Country.
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Consecration of Bishops
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West Point
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So help me God.
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Film excerpt Extreme Measures
Two physicians Hugh Grantgood Gene
Hackmanbad
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(No Transcript)
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• An oath is not universal, it is not a legal
  obligation, and it does not guarantee morality.
• Affirmations work to strengthen resolve to behave
  with integrity in extreme circumstances.
• An oath encourages examination of core values.
• An oath is a declaration of commitment and
  intention.

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College of Medicine Graduation
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Film clip Extreme Measures (Gene Hackman as
arrogant physician who uses homeless and others
to harvest organs for more worthwhile members
of society. Hugh Grant provides the
challenge) http//hscvideo2.hsc.usf.edu/asxroot/h
sc/jkeats/xmeasure.asx
Life is short, the art of medicine is long,
experience difficult.
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Apollo, Dionysus, Proteus The Staff of
Aesculapius
Slides Film Excerpt Small Group
Discussion