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The Inner and Outer Garments of Integrity

Commencement is the most special event for students and faculty. A couple months ago I participated in the 2012 Nova Southeastern University Health Professions Division commencement exercises. (Question: Why are they called commencement exercises when they aren’t held in the gymnasium?) Dressed in full regalia, I marched along with fellow faculty in the academic procession. My chronically hunched shoulders and shuffling gait were miraculously cured hearing the dramatic chorus of Pomp and Circumstance played by NSU’s own Ars Flores Symphony Orchestra.

Seated on stage, we looked out at a sea of graduates from the College of Health Sciences and the College of Nursing. I couldn’t help but think of the old joke that goes something like, "The definition of a graduation ceremony is an event where the commencement speaker tells hundreds of students dressed in identical caps and gowns that individuality is the key to success.” The commencement speaker, former U.S. Surgeon General Dr. David Satcher, and the president of Nova Southeastern University, Dr. George Hanbury II, both spoke about the key to success; but each spoke of success not in terms of individuality but in terms of integrity.

The word integrity comes from the Latin integritas, which is also the root of the word "integer.” That’s not to infer that just because every graduate wears the same funny four-cornered hat that they are just a number. The word "integer,” in the philosophical sense of the word, means intact or perfect, whole and unabridged. Drs. Satcher and Hanbury described integrity as a personal state of "wholeness” and "being true to oneself.”

So, how exactly does a health professional demonstrate integrity? Is it just the outward display of a specific behavior such as honesty, loyalty, bravery, or any of the other virtues that can be found in the Boy Scout Law? Does integrity mean always doing the right thing? Dr. Satcher and President Hanbury did not limit their definitions of integrity to the demonstration of any specific external behavior; instead, their speeches reminded the graduates about the inner attitudes that inspire outer ethical behavior. President Hanbury even quoted Shakespeare’s Lothario, saying, "This above all: to thine own self be true, and it must follow as the night the day, Thou canst not then be false to any man.”

The commencement speakers inspired the graduates to, above all else, have integrity. Which raised the question in my mind as to how exactly I, and the other faculty sitting up on the stage, may foster student development of integrity. I suppose I could reduce my entire medical ethics curriculum to simply teaching this one thing: integrity. No need to worry about teaching beneficence and nonmaleficence, respect for autonomy and dignity, HIPAA and patient confidentiality, social justice, or any other bioethical principle. Integrity alone should motivate health professionals to automatically do the right thing. Unfortunately, the real world has a way of challenging simplified notions of right and wrong. Honesty may not be the best policy if you are, for example, divulging confidential patient information without expressed permission. A better approach for retaining integrity in this case may be less open honesty and more "iron curtain.” Likewise, we all have heard how misplaced loyalty can leave even the most well-intentioned person holding the bag. Students may be taught that integrity is the outward demonstration of honesty, trustworthiness and other behaviors that can be worn like an outer garment, but they must also be inspired to look within for motivation.

Teaching integrity, it if can be done at all, recognizes that the best that instructors can do is to inspire students to own the learning process. The responsibility for developing a sense of integrity is on the learner, not the teacher. To begin with, instructors, like all human beings, are subject to personal biases, prejudices, talents, and flaws. Anyone who knows me will say I’d die for my country, but as a teacher, it wouldn’t be fair to say that a student hasn’t learned integrity unless he or she is willing to do likewise. So, to teach integrity, an instructor can only provide the tools for students to assess and develop a sense of integrity of their own. There are pedagogically sound methods that can be used to initiate and monitor this type of learning as a process of affective development by convincing students that happiness and success are directly related to having integrity. People internalize new values only when they discover that the old ones aren’t as effective.

So, it made perfect sense for Dr. Satcher and President Hanbury to foster and praise integrity in the graduates of the 2012 Nova Southeastern University Health Professions Division. You see, not only does the word integrity come from the root word for "wholeness,” wholeness relates to the word "holy,” from the Old English word hal, which means "uninjured” or "healthy.” So, in a very real way, health professionals can be thought of as "wholeness” professionals – unique individuals who have cultivated personal integrity to a level warranting the respect and admiration of our patients and colleagues.

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