Medical students and schools put a modern spin on the age-old Hippocratic Oath

The Hippocratic Oath is a long-standing tradition. But as the practice of medicine has evolved over the two millennia since the oath’s inception, the ancient text seems less and less applicable to medical students today.

Instead of swearing by Apollo, medical school administrators, including those at Columbia, Yale, the University of Washington and the Icahn School of Medicine at Mount Sinai, are putting a contemporary spin on oaths, putting update the language and add relevant context, often with input from the Student Council.

Although this approach is sometimes met with backlash, such as concerns about free speech, school leaders say it is worth turning the swearing into a more meaningful and personalized experience.

And without a national oath standard—neither the American Medical Association nor the American Association of Medical Colleges has an official oath requirement or position on adapting the Hippocratic Oath—many medical schools have already adopted a more modern promise.

“The earliest version we have of the Hippocratic oath is about 150 or 200 years after Hippocrates’ death, and no school uses this one,” says Steven Scheinman, MD, former dean of the Geisinger Commonwealth. School of Medicine in Pennsylvania and author of a 2018 study that analyzed the content of the oath.

Today, schools generally use one of three main oaths:

• An “oath that bears the name of Hippocrates”, which is a more recent interpretation of the traditional Hippocratic oath;

• “A Modern Oath”, written in 1964 and often attributed to Dr. Louis Lasagna; and

• The Geneva Declaration, first published in 1948 by the World Medical Association and updated in 2017.

When Scheinman performed a textual analysis of 111 school oaths, he found that less than half used any of the three oaths in their commencement ceremonies.

On the contrary, the majority (approximately 53%) wrote a unique oath each year or used a school-exclusive one, while only 9% of schools granting medical doctorates recited personalized opening oaths in 1982 and about 25% in 2000.

Scheinman says white coat ceremonies have followed a similar trend. In the same study, he found that most schools (70%) incorporated student-written or school-specific white coat oaths, and only 11% used a variation of the Hippocratic oath.

A mix of old and new

At the University of Pittsburgh Medical School, students recite a version of the Hippocratic Oath during white coat and graduation ceremonies, agreeing “to practice my art only for the healing of my patients” and “[hold] myself away from evil, corruption and the temptation of others to vice.”

But, starting with the class of 2024, students take the initiative to write a unique class oath.

In the weeks leading up to orientation, new freshmen meet virtually to discuss the key elements their oath should contain, develop a word cloud, and select authors to write the draft. They also examine a patient case study highlighting the role of physicians in global health.

Eventually, after several iterations, the oath is printed on reminder cards for students to carry in their badge caddies and recite during the pinning ceremony before students embark on their externship.

The creation of the class oath drives home the scope of physicians’ evolving responsibilities, says Chenits Pettigrew Jr, EdD, associate dean for diversity, equity and inclusion at the university.

“We are not replacing the Hippocratic Oath. We do so because we are committed to helping students intentionally begin to develop their professional identity, so that they don’t just learn about medicine through their observations and lectures; they have the opportunity to reflect on the commitment they are making,” he says.

Specifically, the oath calls on students to honor their physical, mental, and emotional health, champion a more equitable healthcare system, and champion diversity in medicine and society.

Tito Onyekweli, a third-year Pitt medical student involved in the writing process, says the traditional Hippocratic oath is timeless, but modern oaths also have their place.

“We had to develop something that represented our whole class [so] we had intimate conversations with our peers to understand how their lived experiences have shaped them and will guide their practice,” he says. “Our new oath represents our values ​​and what is most relevant to our generation of medical students.

Similarly, incoming students at the University of Minnesota (UoM) School of Medicine collaborate with their peers and faculty to write oaths for the commencement and white coat ceremonies.

These oaths “build on the intent of the Hippocratic oath to promote humility, integrity and benevolence” and “reflect the fundamental elements, values ​​and ethics that the class aspires to uphold”, a said Kat Dodge, the university’s media relations manager. statement to Medscape Medical News.

At last year’s white coat ceremony, UoM students pledged to “care for patients with cultural competence and respect” and “to pursue excellence through innovation in evidence-based medicine, respecting its usefulness and recognizing its limitations”.

Meanwhile, students at Georgetown University School of Medicine in Washington, D.C. recite an adaptation of the Hippocratic Oath during the white coat and graduation ceremony, vowing to “abstain from anything that may be harmful or dangerous to [patients]”and promising “to esteem and venerate the teachers who have trained me in the science and art of medicine”.

However, in a new custom that reflects the changing times, several students then take turns reading a line from the oath in their native language.

“For the class of 2026, we had a total of 24 students spanning 13 distinct languages ​​volunteering to recite a line,” says Tom Guarino, MA, CHES, associate dean for medical student support and welfare at Georgetown. . He says the practice embodies the school’s core value of “cura personalis,” or caring for the whole person, and demonstrates a commitment to diversity and inclusion.

Badr Abdullah, a medical student from Georgetown who emigrated from Oman 3 years ago, says that although it’s just a small step, the updated ceremony has had an impact. “Knowing that I have proclaimed my commitment to serve all, including those outside the English-speaking community, and that they can listen to it and connect directly to it, has been incredibly empowering,” he says. . “I hope that by encouraging linguistic diversity among our physicians, we can move toward providing more personalized and meaningful care to our patients.”

What is an oath without education?

Although there is less uniformity between custom oaths, many still share similarities. Respecting confidentiality, preventing harm and maintaining the integrity of the profession featured in more than 80% of the texts examined in Scheinman’s study.

Lauris Kaldjian, MD, PhD, director of the bioethics and humanities program at the University of Iowa Carver College of Medicine (CCOM), found common themes in a 2018 analysis of the oaths, with wellness of patients, social justice and non-discrimination reflected in most texts .

While student-written oaths provide an opportunity for personalization, the incorporation of curricular content about oath-taking can deepen students’ understanding of commitment and the core principles that remain.

For example, CCOM offers an ethics curriculum that emphasizes the virtues, such as benevolence, nonmaleficence, justice, and self-reliance, described in the school’s separate version of the Hippocratic Oath. They also offer an elective that delves into the history of swearing.

When Scheinman first arrived at Geisinger in 2012, the school needed an oath for its inaugural class, so he handed the responsibility over to the older students. During the week of the match, the students studied the existing oaths and their historical context.

Based on their findings, a student delegation drafted an oath that included a pledge to “let go of my prejudices to walk with [my patients] about their journey through life and its crucial transitions,” says Scheinman. The oath was later adopted as the school’s usual commencement oath, and Scheinman continued to conduct an annual oath-taking seminar throughout his tenure.

Unfortunately, Scheinman said, his study found that less than half of all schools surveyed incorporate oath-related content into their curriculum, typically in the form of professionalism or bioethics courses or through sessions and lectures on writing oaths.

“In half the schools, the only time students think of an oath is when they get up at the start and take an oath that someone else tells them to take. They do it for the first times, then they may never come back to that oath,” he says.

Regardless of the commitment adopted, Kaldjian asserts that “medical education [should establish] a significant correspondence between what is professed and what is practiced.

Steph Weber is a Midwest-based freelance journalist specializing in health care and law.

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