In early September I had the opportunity to attend the Stethoscope Ceremony at University of Toronto for incoming Class of 2019 as part of their welcoming ceremony. This is a relatively new initiative, one of which University of Manitoba, Master’s of PA Studies held a Stethoscope Ceremony for their incoming class as well.

We were huddled in Hart House East Commons Room at University of Toronto on a Tuesday evening. Incoming PA students were surrounding by friends and family members who they brought to witness the event. I learned that the PA Student Association at UofT had organized the event and really made an effort to make the Stethoscope Ceremony special for students. There was a line up of short speeches from Faculty at University of Toronto and the PA Consortium Program, the Northern Ontario School of Medicine and from the Canadian Association of Physician Assistants (CAPA).

Why the Stethoscope and Not the White Coat?

Although most traditional Physician Assistant and medical school programs host a white coat ceremony, some schools are moving away from this and opting to do the Stethoscope Ceremony instead. Many health care providers, physicians and physician assistants alike do not wear a white coat on a day to day basis. Many wear business casual or more casual wear. Ever heard of “white coat hypertension?” This occurs when patient’s blood pressure readings are higher when taken in a medical setting than when it is taken at home. Being in a clinical setting for patients can be anxiety provoking, and as much as the white coat represents clinical knowledge, training and prestige of medicine, it can also be intimidating and create a barrier for patients.

White coats are also excellent ways to hold onto pens, pocket books and were extremely helpful for my rotations in Internal Medicine as a student. However, scrubs with pockets and handbags suffice just as well.

“Formally presenting students with their first stethoscope symbolizes that the most important part of health care is listening to the patient,” quotes Manitoba MPAS program director Ian Jones in a recent article from UM Today.

Each 1st year PA student is called up one by one and is donned their stethoscopes.

With exception of some specialties, stethoscopes are used quite regularly to auscultate patients. You sling it around your  neck, and when conducting your physical examination, you place the eartips in your ears, and use the diaphragm to listen to the patient. We usually listen to the different chambers of the heart to ensure there are no unusual heart sounds or murmurs. We then listen to the patient’s back, asking them to breathe in and out to listen to their breath sounds. We switch from the diaphragm to the bell to listen to sounds of different pitch. We use the stethoscope to measure blood pressure with a blood pressure cuff. We listen to abdominal sounds. Welook for bruits caused  by increased or obstructed blood flow (and occasionally as a reflex hammer when one is not readily available).

In addition to being used as a tool to assist in the diagnosis of disease and assessment of health, the stethoscope represents clinical expertise and the professional relationship between the patient and the PA. PAs use it during their 1st year of didactic learning as they are acquiring skills, and throughout 2nd year during their various clinical rotations. It’s appropriate to have the stethoscope donned on PAs at the beginning of their medical education.

Speeches at the Welcoming Ceremony

Speeches included faculty at the PA Consortium, the PA Student Association representative at UofT and the Canadian Association of Physician Assistants (CAPA) representative. These speeches welcomed students, gave an overview of what to expect and what resources were available to students.

Academic coordinator Sharona Kanofsky reminded students that the stethoscope is a tool that reminds you to be, “humble, respectful and to listen to your patients”.

Reading the Hippocratic Oath

The stethoscope ceremony also involves the PA students, in unison, citing the Hippocratic Oath cited by many students in the medical field (pharmacists, physicians, dentists, etc.).

Here is the modern translation of the Hippocractic Oath (a la Wikipedia):

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

The stethoscope ceremony was a wonderful opportunity to formally welcome PA students to the PA program and to the PA profession while they were surrounded by the people who helped get there – friends and family.

As a practicing PA it was a privilege to bestow the stethoscope on incoming students at the beginning of their PA journey who, after their 24 month program, would be joining the ranks of PAs practicing medicine on the front lines of Canadian health care.

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