A More Inclusive Medical School Graduation Ceremony`

Author: Eileen Barrett, MD, MPH, SFHM, MACP

Keywords: diversity, inclusion, language concordance, advocacy

In 2017 I had the privilege of working with two medical students whose first languages were different from my own; I was raised in an English speaking home (and only speak English), whereas one of them was raised in a Spanish-speaking home and the other was raised in a Navajo- and English-speaking home. We spoke about what a gift it is to speak several languages, and how important it is to feel like we belong. Having recently read an article about a medical school planning to say the Hippocratic Oath in several languages during graduation, I asked if I pursued something like that locally if that could help graduation be more inclusive and they both said yes.

When I was on faculty at the University of New Mexico, graduating students recited the Physician’s Pledge that is maintained by the World Medical Association (WMA). The WMA has long had the Physician’s Pledge available in French, Spanish, and English, and in more recent years it was translated into multiple other languages - but not yet in Navajo. To try to get this translated into Navajo (and then advocate for adoption by the WMA) a colleague connected me with a senior bilingual Navajo educator affiliated with Diné College, Mr Frank Morgan. Mr Morgan graciously supported moving forward with this effort, and quickly provided a culturally relevant translation and interpretation he had performed.  

Receiving a copy of Mr Morgan’s translation, I shared it with the WMA and requested it be accepted as an official translation. After several months' time, follow up, and explanations, the Navajo language interpretation of the Pledge was officially adopted - with Mr Morgan receiving the credit he is due. Soon afterward, I approached the medical school where I was faculty if the Navajo and Spanish language versions of the Pledge could be included in graduation. I cited how this is relevant to our patients, learners, and staff, and could help us be more inclusive of New Mexicans in general.  Unfortunately, leadership didn’t agree this should happen - including citing that graduation could be too long if others wanted their first languages represented.

I was profoundly disappointed when I heard the decision, but fortunately my husband (and my biggest supporter) recommended I not give up, and that I build a team that can double down on educating the senior leadership on the experiences of our learners from Spanish-speaking and Navajo-speaking communities. A senior leader in DEI supported this idea and offered her support and recommended I reconnect with the students who inspired the work. I was embarrassed I hadn’t done this the first time, as I had made the wrong assumption that adopting this would be an obvious positive change to graduation. 

Connecting with those students was inspiring - they led the charge hereafter, speaking with senior leaders in multiple venues. Their work culminated in the Physician’s Pledge being read in English, Spanish, and Navajo during graduation starting in 2019 and every year since. Since then, I’ve collaborated with a now former resident on getting the Pledge translated into Arabic, and I’m now working with a leader in Zuni Pueblo to translate it into the Zuni language (another Indigenous language in our state). We are hoping we can complete this work and submit it for approval by the WMA in time for graduation in 2023.

It is a minor but meaningful change to medical school graduation to include content such as saying the Physician’s Pledge in the languages spoken by students. For me this was brought home when one of former students who led getting the pledge said in Navajo during graduation led its recitation during graduation in 2019. It was reinforced just last month when the other student who helped inspired this work told me the only part of any of her graduations her mother has ever understood was when the Pledge was said in Spanish at her medical school graduation in 2019.  

About the author: Eileen Barrett, MD, MPH, SFHM, MACP, is an internist in Albuquerque. She is a former Governor and Regent in the American College of Physicians, a multi-state District Chair of the Society of Hospital Medicine, and the Chair of the American Medical Women's Association’s Advocacy Committee (Twitter: @EileenBarrettNM)