2. 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@hsc.usf.edu.

3. Oaths:The Hippocratic Tradition Lois LaCivita Nixon, PhD, MLitt, MPH College of Medicine University of South Florida

4. 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, USF’s 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.

5. Professionalism His report (Flexner Report) led to the standardization of medical education. Considered to be the most important change event in modern medicine. Seven characteristics described by Abraham Flexner in 1910.

6. 1.Essentially intellectual—or “learned” 2.Special body of knowledge continuously expanded by research 3.Practical end (service) 4.Specialized training of techniques Characteristics -Flexner-

7. Characteristics -Flexner- 5.Moral commitment, a brotherhood (sic) 6. Self-organization and self-regulation 7. Altruistic motivations (unselfish regard for welfare of others)

8. 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.

9. In recent years additional attention has been given to the following concerns: 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. Just distribution of finite resources

10. Class of 2006 integrity respect/courtesy competent communicator empathy open/honest committed to learning listener maturity non-condescending accountability considerate culturally sensitive teaching skills humility confidentiality current knowledge generosity of spirit humor tolerance for difference

11. Bonding Declarations/ Commitments Promises Codes Oaths

12. 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………..

13. Proscribes consequences for failure

14. Cross my heart and hope to die…….. Oath breaker?! Curtains!!

15. I solemnly declare… I swear… I hold these truths… Examples or illustrations of the range of sworn oaths:

16. The Oath of the Horatii by David (French painter)

17. Maimonides, Rabbi, Physician, Philosopher RaMBaM, 1135-1204

18. Mecca

19. On my honor, I will do my duty to God and my Country….

20. Consecration of Bishops

21. West Point

22. So help me God….

23. Film excerpt Extreme Measures Two physicians *Hugh Grant…good *Gene Hackman…bad

25. 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.

26. College of Medicine Graduation

27. Life is short, the art of medicine is long, experience difficult. 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/hsc/jkeats /xmeasure.asx

28. Slides Film Excerpt Small Group Discussion Apollo, Dionysus, Proteus The Staff of Aesculapius NEXT