‘Class of the First Oath’ addresses health care disparities, social justice issues

Abigail Rubio, a first-year medical student, said the School of Medicine was so receptive to the class of 2024’s new oath that it only had one, misplaced edit.

“Their extent of editing was fixing a spelling error, which, ironically, wasn’t an actual spelling error — it was intentional,” Rubio, a member of the 12-person oath-writing committee, said. “We spelled womxn with an ‘x’ instead of an ‘e,’ and they thought it was an accident.”

The current first-year class of Pitt’s School of Medicine, now dubbed the “Class of the First Oath,” took a nontraditional oath on Aug. 14 in addition to the modern Hippocratic oath during the Aug. 16 White Coat Ceremony. The new oath — created entirely by first-year medical students — addressed the COVID-19 pandemic, racial injustice and health care inequities. Medical school students usually only recite the modern Hippocratic oath, which relays the ethical code they will follow for the rest of their careers.

At first, Rubio said she didn’t understand why Pitt was trying to reinvent the Hippocratic oath, but then she realized this oath didn’t include modern themes.

“But as we started getting into more of the process, I realized we were blessed with a platform where we can push progressive ideals that aren’t normally accepted in a medical setting,” Rubio said. “Physicians have historically been more conservative, so as we began writing, we learned how prolific this could be.”

The oath has come after a summer of active protests for justice by Pitt’s medical community. Pitt students were involved in nationwide protests as a part of the organization #WhiteCoatsForBlackLives. Pitt’s School of Dental Medicine also organized and planned a protest on Juneteenth that was widely attended by health care workers and students.

Pitt’s School of Medicine agreed in June to address numerous demands made by Black student leaders, including additional scholarships for Black students, an overhaul of the School’s Honor Council and an investigation into the selection process of the medicine honor society Alpha Omega Alpha. The University decided not to rename Scaife Hall, though — one of the students’ demands.

First-year medical students received an email over the summer saying they would write the new oath this year as part of their orientation week. Students are split into advisory houses every year, and then into Faculty and Students Together groups, which are mentorship groups for first-years to become better acclimated to the Pitt environment.

FAST groups had an additional purpose this year — before discussions in the larger advisory houses, students brainstormed ideas for the oath. Arnab Ray, a second-year medical student, volunteered to facilitate one of the FAST groups.

“We were there in terms of facilitating meetings, making sure the discussion moved along,” Ray said. “We wanted the oath to not only be a crystallization of what values they wanted as physicians, but also where they hoped medicine would go.”

In their FAST groups, students brainstormed themes they wanted the oath to include and elected a representative to relay that to the larger advisory house.

Nathalie Chen, a first-year medical student, was one of these representatives. After discussing points in her FAST group, Chen volunteered to work on the oath-writing committee.

“We had a lot of conversations with our whole class to make sure all these themes represented what our class wanted,” Chen said. “We asked a lot of questions, like, ‘Was there anything we left out, or any wording you didn’t like?’”

Many of the ideas discussed aren’t included in the standard modern Hippocratic oath. After participating in social justice initiatives related to Black Lives Matter this past summer, Rubio said she wanted the oath to show that the medical community is becoming more cognizant of issues that disproportionately affect the BIPOC community.

“We were all happy to say Breonna Taylor, Ahmaud Arbery and George Floyd and recognize the impact of these names, that they are important,” Rubio said.

Rubio added that she also wanted the oath to reflect the hardships health care workers have endured because of the coronavirus pandemic.

In terms of COVID-19, there’s been so much the health care community has endured, people who have given up their lives, that made the oath so much stronger than if we had written it any other year,” Rubio said. “It’s terrible this had to happen, but we’re fortunate this platform was able to be as big as it is.”

Anantha Shekhar, the senior vice chancellor for the health sciences and dean of the School of Medicine, said the new oath represents the class’s commitment to improving medicine.

“Their class oath, the first of its kind in our program’s history, speaks to the power and importance of clinical care and research in creating a more inclusive and just society,” Shekhar said. “I am excited to watch them put this promise into practice.”

Getting to the final product took longer than originally anticipated — the oath-writing committee spent 50 hours writing the oath during orientation week. Even though it took many discussions to decide what themes the students wanted, Rubio said the majority of the work came down to the syntax that would be used in the final oath.

“We struggled with deciding minor things like, ‘How much attention can we bring to a group without upsetting the more conservative side of our class?’” Rubio said. “Or if certain themes overlapped, what was valuable about the phrasing of one over the other?”
Ray said facilitating the oath-writing discussions were worthwhile for him, even as a second-year student.

“I only have a year and a couple of months under my belt, but even in that time, your view of medicine changes,” Ray said. “To a certain degree, it matures as we’re exposed to some of medicine’s realities, but I don’t think it’s a stretch to say you get a little big jaded in terms of what your preconceptions are. Seeing the first-years refreshed my own mindset.”

Though the School of Medicine’s administration started this effort, Ray said their participation was largely hands-off. Ray said consciously keeping out any external input was important to both the administration and students helping facilitate the oath-writing.

“Saying ‘look aside from the Hippocratic oath, look internally, do some retrospection’ — which is difficult — was key to helping the students find the future they see for themselves,” Ray said. “In the end, they reached a place where they were able to comfortably discuss values that were important to them in medicine, long term.”

But Chen said the oath is ultimately just a group of words. Though a strong starting point, she said she looks forward to seeing other initiatives from Pitt to advance diversity and inclusion at the school.

“I was excited to see we had specific training during orientation to learn about different neighborhoods in Pittsburgh and what challenges they face,” Chen said. “I did not know how living in certain areas would affect their access to health care and food, for example.”

Ray said he believes the student-written oath is just one step to improving the medical school experience overall, for both faculty and students. He also said the success from this year’s oath means the School of Medicine will likely continue the process next year, though the University has not officially committed to this.

“The faculty are seeing the values of the new class. Aside from the science we learn, we also learn how to apply this knowledge in the clinic, how we’re going to speak with patients,” Ray said. “If we can see the values, we can incorporate and express them in the students’ coursework.”

Chen said writing the oath was a great way to begin the year, as studying medicine can often become too focused on just science.

“When you’re in anatomy and there’s nothing but anatomy in your life, it’s easy to lose focus on what brought you in,” Chen said. “The oath helps us keep these issues in our mind.”