A University of Minnesota medical student defaced a George Floyd memorial with spray paint right near the spot where Floyd was killed by police, a gut punch to many medical students across the country.

It laid bare a long-simmering trust issue.

“How can Black people or other marginalized groups trust doctors when they hear this news?” said Tito Onyekweli, a first-year medical student at the University of Pittsburgh School of Medicine who, full disclosure, is my brother.

When Tito heard about the incident with the memorial, he was on the cusp of his “white coat” ceremony — a tradition in which incoming students often take the historic Hippocratic oath and pledge the highest ethics in their medical career.

He said the incident weighed on him and his classmates, and made them think deeply about the Hippocratic oath of “do no harm” that new medical students would be taking across the country. The oath, in part, is a pledge to treat the sick, preserve a patient’s privacy and pass medical knowledge to the next generation.

At the suggestion of one of the assistant deans at the medical school, the incoming students at the University of Pittsburgh School of Medicine decided to update their oath for the first time in the 137-year history of the school. As they rewrote it, it became more explicitly inclusive of all people, including those historically overlooked by the medical community. It was embraced full-heartedly by the administration.

The oath, which was taken by the entire 149-member class last month, acknowledges the lives lost to covid-19, the killings of Breonna Taylor, George Floyd and Ahmaud Arbery, and the history of the “fundamental failings of our health care and political systems in serving vulnerable communities.”

The students then pledged to “champion diversity in both medicine and society,” “be an ally to those of low socioeconomic status,” as well as Black people and other people of color, and also the gay and transgender community and other underserved groups.

The oath seeks to start restoring the trust marginalized communities have in medical professionals.

Tito, who used to work at the National Institutes of Health as a researcher, said he got involved in rewriting the oath because “when you are looking at the big picture, medical institutions are part of the racist system,” he said, adding that minorities are often overlooked or denied adequate medical care.

Recent studies have shown racial health-care disparities. Black women die in childbirth 2.5 times more often than White women, and Black newborn babies are more likely to survive childbirth if they are cared for by Black doctors — though just 5 percent of doctors in the United States are Black.

Covid-19’s racial impact has been devastating: Black Americans are up to six times more likely to die of the coronavirus than White Americans.

Historic sanctioned abuses of Black people also were taken into account while writing the oath.

During slavery, for example, physicians performed widespread experimentation on enslaved people — including brain surgery and amputations on people while they were still alive. Later, medical schools allowed students to experiment on Black bodies that had been snatched from cemeteries by grave robbers. Legislation and state-sanctioned polices allowed dead Black people to be used for medical purposes even after slavery was abolished.

From 1932 to 1972, the U.S. Department of Health carried out the Tuskegee Study in which 399 Black men went untreated for syphilis, unbeknown to them, so doctors could observe the disease. In the 1950s, Henrietta Lacks’s genes were famously used and her genome was sequenced without doctors getting the consent of her or her family.

Tito said these and other atrocities prompted him to join his medical school’s oath committee so he could “help set the stage for how the medical students in their class should approach their education.”

He added: “As a Black man I thought I had a necessary perspective.”

Medical students across the country often recite a variation of the Hippocratic oath at their graduation. In the past two decades, it has become increasingly common for entering medical students to recite the oath at their white coat ceremony.

Oath-taking among medical students became more popular after World War II in part as a reaction to physicians who were critical actors in Nazi war crimes. The oath was an effort to reignite public confidence in physicians.

Almost all American medical schools use an oath at their white coat ceremony or commencement — some use it at both. Some schools have an oath unique to them and others allow students to be a part of the oath writing process.

This is the first time University of Pittsburgh School of Medicine has updated its oath since its inception in 1883.

The idea to write a new oath was proposed by Chenits Pettigrew, associate dean at the medical school. Soon after his proposal, an oath committee was formed and dozens of Zoom calls commenced.

“Drafting the oath was an exercise in displaying the values that we want to exhibit as doctors,” Tito told me. “We worked collaboratively but disagreed at times, we brought up topics that were triggering for some but did not push the status quo enough for others. We were diverse in the most collective sense.”

He said every word was debated, from the use of the BIPOC (Black, Indigenous and people of color) and “differently-abled individuals” to “personal biases.” The students chose BIPOC because they wanted to separately call out the institutional racism that Black and Indigenous people face.

The students chose “differently-abled individuals” to cover the spectrum of abilities and the students selected “personal biases” to acknowledge that they have all lived their own individual lives and developed their own biases.

Once the oath committee created a draft, they circulated it to their entire medical class for feedback.

Ashley Whited, another first-year student on the oath committee, explained that this process forced the committee to explain each of their word choices, and also encouraged them to include more about the pandemic.

“Although it is a current crisis, the pandemic is reshaping medicine and the way we see it,” Whited said. “Its impact will be long-lasting and it needed more than a passing mention.”

The oath was finalized before the Aug. 23 white coat ceremony, where students presented it to the dean of the school of medicine, Anantha Shekhar, and recited the oath as a class.

Tito said in the end, the class was proud of its oath. “We simply used the past and present to clarify our future goals as physicians.”

Together, they recited:

“The oath is the first step in our enduring commitment to repairing the injustices against those historically ignored and abused in medicine: Black patients, Indigenous patients, Patients of Color and all marginalized populations who have received substandard care as a result of their identity and limited resources.”

The oath can be read here.

Nonny Onyekweli is a New York-based lawyer.

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