Mediating the gap between the white coat ceremony and the ethics and professionalism curriculum.

OBJECTIVE: Like many other medical schools, the University of California, Irvine annually conducts a White Coat ceremony in which incoming students take a professional oath of ethical conduct.(1) We report a new educational activity to connect the values expressed in the oath taken to the Ethics and Professionalism (EP) curriculum for first-year medical students(2) and its potential impact on physician training.

DESCRIPTION: Following the White Coat ceremony, students participated in the Patient Doctor Society course that integrates diverse curricular topics centered on physician-patient communication. During this course, the students were introduced to EP content through a collaborative peer exercise. With the assistance of background readings on professional values and ethics concepts, small groups of students were asked to construct their own codes of ethics. The process of working in a group became part of the learning. After developing a code of ethics, each group was asked to identify primary values embodied in its code; primary obligations to patients and their families, other members of the health care team, and the community; key factors influencing code development; and likely effects of the code on the conduct of medical students and physicians. The goals of the session were to recognize formally both individual values and the values to which students commit themselves during the White Coat ceremony, to facilitate understanding of those values, and to begin to reconcile differences between personal and professional values. The small groups convened to report their findings in a three-hour session. Common values expressed by the students included patient autonomy, respect, beneficence, and professionalism. The delivery of quality health care, communication, education, and the equitable distribution of health care were among the most often listed obligations. The students reported that culture, societal values, family, experience, religion, education, and assigned readings were the key sources of the values in their codes. Most of the students enjoyed and learned from the exercise, believing that a code of ethics will serve as a helpful educational guide while they are students and as an action guide in their future practices. Student evaluations, narrative feedback, and faculty observation indicated that the students appreciated the opportunity to work in teams and to explore professional values. The students' most common suggestion for improvement involved incorporating analysis of clinical cases in which questions about professional values arise.

DISCUSSION: Medical educators suggest that students' values and professional behaviors change throughout medical school, but such change is difficult to assess. The code-development exercise established a baseline of values at entry to medical school. We plan to track this cohort of students by reintroducing this exercise in their fourth year and will compare the codes developed in their first and fourth years to identify changes in values and to suggest what the students have learned about values during medical school. The comparison will be used to inform further development of the EP curriculum toward the goal of shaping and supporting the positive professional growth of our student-physicians.