Students Forever: Must We Swear It?

Hippocrates examining urine

With this post I begin a series on continuing medical education (CME). Patients and physicians alike recognize the need for ongoing education for health care providers, but very few in either group likely know much about the process. Over several posts we will review the history, organization, and other aspects of the US CME enterprise, including the current movement to reform it.

No one reading blogs at Scientopia should be surprised that science changes daily. New knowledge and interpretations of old findings come available at ever increasing frequency, and these strides in science alter the practices of those who apply it, like physicians. From my first day of medical school, instructors at all levels made it clear that we were never really out of class. Sure, we would graduate and receive diplomas. We would be licensed and start treating patients. But throughout it all we had to be vigilant to new knowledge, lest we become "dated" and practice badly. Part of our profession, our calling, our responsibility was maintaining our knowledge and skills.

Very few medical oaths through the years have actually spelled out a commitment to ongoing education. Many doctors and bioethicists find the commitment to continuing education within the Hippocratic principles of beneficence (working for the good of the patient) and nonmaleficence (doing no harm). After all, if our skills are not current, our performance may not conform to these guiding pillars of medical practice. Others argue that this commitment should be included in our medical oaths.

In 2005, Rancich et al examined historic and contemporary oaths of physicians for specific references to ongoing professional development. From the 125 professional oaths identified, they selected 48 oaths representing different historical periods, geographical locations, renowned medical schools of different eras, and other factors of interest. Twenty (42%) express the commitment to life-long learning; 90% of these were considered modern and contemporary, paralleling the rate of advances and publications in science.

Hippocrates: Original Oath

Of the 20 texts with a commitment to continuing education, 80% also included the principle of beneficence; however, only 3 documents linked these concepts directly. While these principles seem related intuitively, very few of the oaths clearly link life-long learning with doing good for patients.

Lifelong learning is necessary is the quality of medical care is to improve over time. Physicians must be committed to ongoing professional development; it seems amazing to me that it is not included explicitly in all of the medical oaths administered to graduating students.

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