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This special issue connects discussion articles with themes in Louis Lasagna's 1964 revision of the Hippocratic Oath.[1] It is fitting that the Oath begins by noting that a doctor swears ‘to fulfill, to the best of my ability and judgment, this covenant.’ This language recognises that the ideals and responsibilities articulated in the Oath rest on a human exercise, which is necessarily prone to imperfection. Although historic and arguably quixotic, the Hippocratic Oath is not an antiquated reference. It is the headwater of the doctor's professional identity and represents his or her social contract with the public.[2] The articles in this issue attempt to examine the currents that flow from the Oath and consider how the advancement of medical education helps to cut new directions while remaining true to its source. This special edition of Medical Education punctuates the continued relevancy of the Hippocratic Oath and reinforces how theory guides and provides coordination for future educational advances. The state of the science of medical education and its attempt to match the promise of the Hippocratic Oath have surfaced several timely lines of investigation, such as the emerging importance of communities of practice and interprofessionalism,[3] the utility of accreditation, licensure and specialty certification,[4] and the juxtaposition of the human element with increasingly complicated systems.[5]

The responsibilities articulated in the Oath rest on a human exercise, which is prone to imperfection

The reader may consider a few salient points that emerge from this collection of articles. Firstly, medical education has emerged as a scientific discipline that first and foremost asks questions about the implementation of education across the continuum, including that of medical students, residents and practising doctors. Moreover, many who investigate medical education fix their questions on how education translates to the reality of health care and patient outcomes.[6] You may consider how the questions targeted in these articles continue to give weight and significance to the Hippocratic Oath. You may also consider what questions remain to be asked. The Hippocratic Oath is an elegant collection of expectations, which continues to supply important questions about the calling, education and practice of the medical profession.

Medical education has emerged as a discipline that asks questions across the continuum

Another consideration is that the enormity of questions that spring from the Hippocratic Oath may trigger paralysis in some, but the brave reader knows that the ideas shared in this edition will remain only on the page until we take action. For example, ‘Humility and respect: core values in medical education’ examines our shared responsibility to value humility, relationships and respect.[7] Much like the Hippocratic Oath, the questions we ask and ideas we consider must have an inspirational bent and serve to persuade. This does not mean that we abandon intellectual criticism. Instead, we pit ideas in a contest guided by scientific underpinnings, and then accomplish a way forward that is both informed and deliberate. The articles challenge us to engage and play a role in education, lest we ultimately fail the spirit of the Oath.

The questions we ask and ideas we consider must have an inspirational bent and serve to persuade

This issue also suggests that although doing the right thing is often conceptualised as self-evident, educational implementation does not benefit from margins that always distinguish the correct way forward. The Hippocratic Oath speaks to general truths, which do not lend themselves well to dispute. Who among us, for example, would quarrel against the patient's right to privacy? The details of applying education, however, are fraught with uncertainty. ‘Ensuring high-quality patient care: the role of accreditation, licensure, specialty certification and revalidation in medicine’ is one article in particular that highlights the fact that efforts to do the right thing are not always easy to ascertain.[4] We do not have an innate sense of self-regulation. It's a struggle, but we keep at it in the hope that we carry out the ideals of educational quality.

The Hippocratic Oath speaks to general truths, which do not lend themselves to dispute

The reader may also be struck by some of the articles that consider the balance between clinical competency and attention towards human relationships. When issues such as the maintenance of licensure or specialty certification are addressed, the emphasis seems to be on knowledge and skills. Examinations, patient surveys and performance-based assessment often tap the construct of fitness for practice. It may be fair to suppose that the one and only time a doctor recites the Hippocratic Oath is during graduation, the transition between medical school and residency education. It may be time to configure a reaffirmation of the Hippocratic Oath into the credentialing process. In the article ‘Updating the Hippocratic Oath to include medicine's social contract’, the authors underscore the importance of publicly affirming the Hippocratic Oath.[2] Symbolism and ceremony are important tools. Additional opportunities to declare a devotion to the profession of medicine and reaffirm a commitment to patients may be just as important as when doctors supply evidence of a sustained knowledge and skills base.

It may be time to configure a reaffirmation of the Hippocratic Oath into the credentialing process

Finally, the articles in sum remind us that we are a community of learners. It is certain that education requires competence across a team perspective. We are accountable to one another. Although our expertise differs and varies, each of us can make a legitimate contribution. This issue of Medical Education provides a snapshot of how our colleagues target a range of timely issues from places of unique understanding. The central quality of our community is variation, which may indeed be the source of educational scientific excellence. This issue leaves a remarkable impression of how we can work together against the pull towards mediocrity and instead find a way to better fulfil our obligation to patients, their families and our society.

References

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  2. References
  • 1
    Eva KW. Trending in 2014: Hippo-crates. Med Educ 2014;48:13.
  • 2
    Cruess R, Cruess S. Updating the Hippocratic Oath to include medicine's social contract. Med Educ 2014;48:9499.
  • 3
    Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative 2011.
  • 4
    Boulet J, van Zanten M. Ensuring high-quality patient care: the role of accreditation, licensure, specialty certification and revalidation in medicine. Med Educ 2014;48:7485.
  • 5
    Fenwick T. Sociomateriality in medical practice and learning: attuning to what matters. Med Educ 2014;48:4452.
  • 6
    McGaghie WC. Medical education research as translational science. Sci Transl Med 2010;2:13.
  • 7
    Gruppen LD. Humility and respect: core values in medical education. Med Educ 2014;48:5358.