Thank you Dr. Dallas for inviting me to this year's symposium. It is truly an honor to be with you this morning!
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Charles L. Crockett, Jr., Lecture
Carilion Clinic 71st Annual Spring Symposium
“The Last Lecture”
Lee A. Learman, MD, PhD
Dean, Virginia Tech Carilion School of Medicine
Thank you Dr. Dallas for inviting me to this year’s symposium. It is truly an
honor to be with you this morning!
1
Learning Objectives
By the end of this presentation participants will be
able to:
• Identify factors that bring meaning to a career in
medicine
• Appreciate aspects of practice that best support
their personal mission
• Discuss how the impact of their work extends
beyond the health care setting
Even a talk like this one needs to have learning objectives. Here are the ones I
sent in. They are general enough that I hope each of you will take away
something meaningful and personal. The virtual format does not lend itself to
discussion throughout my talk. Along the way I’ll pose a few question for you
to ponder, and then at the end I’d love to hear your comments, questions, and
reflections.
2
Disclosures
• No conflicts, financial or other
• My personal reflections are humbly offered to
encourage others, and not as expert guidance
I have no financial disclosures or other conflicts.
3
At the State Capitol in Richmond, March,1969
Va., Doctor Charles L. Crockett,
Jr., director of medical education
at Roanoke Memorial Hospital,
tells WSLS-TV about a legislative
proposal concerning medical
education in Roanoke, Va. Dr.
Crockett and Dr. Kenneth R.
Crispell, dean of the School of
Medicine at the University of
Virginia, have been working toward
passing a proposal in the Virginia General Assembly that
would create a program affiliating the School of Medicine at
the University of Virginia with the health facilities in the
Roanoke, Va., area.
Dr. Charles Crockett was an historic and visionary leader – one of the first to
identify the potential value of Roanoke’s hospitals to be a source of medical
education for the Commonwealth. Seen here more than 50 years ago, when
he was director of medical education at Roanoke Memorial Hospital Dr.
Crockett worked to establish the hospital’s first medical school affiliation, with
the University of Virginia.
About 40 years later Roanoke developed its own medical school, a partnership
between Carilion Clinic and Virginia Tech. As the dean of that new medical
school, I appreciate being asked to give this year’s Crockett lecture.
4
The 1st Last Lecture
• Randy Pausch, PhD
– Professor of computer science, human‐
computer interaction, and design at
Carnegie Mellon University
• Sep 2006: pancreatic cancer found
• Aug 2007: told “3‐6 months of good
health left”
• Sep 2007: “The Last Lecture: Really
Achieving Your Childhood Dreams”,
NYT best‐seller: 112 weeks, >5 million
copies, 48+ languages
• July 2008: death, age 48
The title of my talk is the Last Lecture, and that bears some explanation. This
is not your standard CME lecture. It is named for a talk given by a scientist
named Randy Pausch, a professor at Carnegie Mellon who was diagnosed
with pancreatic cancer when he was 46 years old. A year later, after the
cancer had progressed and he was given a 3‐6 month window of good health,
Dr. Pausch presented the very first “Last Lecture”.
It emphasized how to pursue joy during the remaining days of one’s life – for
him a life that included a loving wife and 3 adorable children. He wrote a
book by the same name, which achieved enormous success prior to his death
in July 2008.
5
“If you had but one lecture left to give,
what would you say?”
YOUR NAME
HERE
AN EVENING IN THE FUTURE
The challenge of the Last Lecture is to consider how to answer this question:
“If you had but one lecture left to give, what would you say?”
This challenging question is similar to one we use in the context of physician
mentoring.
Imagine that your family, friends, and closest professional colleagues are
invited to your retirement party 10, 20 or 30+ years from now. After a
celebratory dinner and a few appreciative toasts, the person who knows you
and your work the best steps up to the podium.
The question is, what would you want that person to say you accomplished in
your career? What legacy would you want to leave?
When I think about this question, my answer would include the legacy of
supporting the careers of other physicians. Their careers, like my own, might
involve taking care of patients, teaching the future generation of physicians,
doing research to improve the knowledge we use to provide the best care
possible. How many of these things a physician does will vary from person to
person, but my goal is to support their success in every way, so they can make
the largest possible impact in their careers.
My Last Lecture (which hopefully isn’t really my LAST lecture) will focus on the
inspiring leaders I have been so lucky to work with in my career, and the
lessons I learned along the way that I hope can help other physicians along
their way.
6
I’d like everyone with us this morning to think for a moment on what you
would describe is your purpose in a sentence of two. This is the difference you
would like to make during your life and career.
Once you’ve found the words to describe your purpose, please consider why
is that your purpose. Where does it come from?
PAUSE
Religious, secular, family and other group traditions and identities play a role
for many people in defining the origins of their purpose.
I suspect the purposes we personally hold have a lot of similarities but also
speak to our individuality.
I hope you had no difficulty connecting with the purpose of improving the
health of patients and communities, among the other goals on your list.
But you may also know colleagues who seem lost, searching for a purpose, or
trying to find their way back to that connection.
I’d like to share a personal story of the first time I encountered physicians who
had lost their connection to purpose.
7
January, 1986
It’s January 1986. I had just married my beautiful bride Beverly in Marina del
Rey, California. The following morning we boarded a flight to Honolulu and
then a local flight to Maui. We had never been to Hawaii or any other tropical
resort, and we were looking forward to the adventure. We were also going to
be staying at a world‐class resort courtesy of our generous parents – who had
never stayed in such a place themselves but wanted us to have a special
honeymoon.
8
We arrived a the hotel on Wailea beach in the late afternoon and decided to
change quickly and enjoy a few minutes in the hot tub facing the beach. We
envisioned a relaxing and romantic end to our long travel day quietly enjoying
the sunset.
Another couple was in the hot tub, but there was plenty of room for all of us
to be comfortable and we joined them.
ANIMATE
Well, it didn’t take too long to figure out that we were sharing a hot tub in the
middle of paradise with an unhappy couple. Although we were in earshot,
they spoke freely to each other about how unhappy they both were with the
practice of medicine. It wasn’t obvious what kinds of hassles had led to their
dissatisfaction. They had decided at the last minute to travel to this resort.
From what they were saying it seemed that their careers as emergency
medicine physicians had enabled them to travel to many nice places. Here
they were in a tropical paradise. Rather than using its peace and beauty for
enrichment they could not help but to express their unhappiness. While we
introduced ourselves and made polite conversation I did not feel comfortable
letting them know of my intended career and that that they were casting a
very long shadow on that decision.
By the time they had left the hot tub, the sun had set and it was getting pretty
dark.
9
Where Am I in January, 1986?
Bruce Baker, PhD
Leon Eisenberg, MD Arthur Kleinman, MD
Bert Raven, PhD Beverly Listick
MD‐PhD Encouragers & Supporters
Here, I need to take a detour and explain where I was in my career
development when Beverly and I married in January 1986.
Bev and I grew up in the greater Los Angeles area, and met each other at
UCLA, where we both took 6 months during our junior year to become part of
an off‐campus experiential learning opportunity – the Developmental
Disabilities Immersion Program. The program was truly immersive – classes,
preceptorships in schools and state hospitals for the disabled, and a research
project. We also lived together with 25 other students at an off‐campus site
closer to where the program was situated in Pomona. The lead psychology
faculty member for the program was Bruce Baker.
In my senior year, as one of the first cadre of psychobiology majors at UCLA, I
took upper division courses ranging from advanced developmental biology to
advanced courses in psychology. One of these was health psychology taught
by Professor Raven, an expert in interpersonal influence. Dr. Raven’s course
surveyed how psychological principles could be used to improve health and
health care. Through these experiences I realized that the study of psychology
had a lot to offer a future physician. I had done some research as an
undergraduate and also realized that there were many unanswered questions
at the intersection of psychology and medicine.
I applied to medical schools I felt could support my interest, including several
that offered MD/PhD programs. My interest was welcomed by several schools
and I ultimately decided to attend Harvard Medical School where Drs.
Eisenberg and Kleinman had just submitted a grant to the MacArthur
Foundation to fund an MD/PhD program specifically targeting the social
sciences to parallel the federally funded Medical Scientist Training Program in
the biomedical sciences.
10Social Psychology?
A branch of psychology that studies the effect of social
variables on individual behavior, attitudes, perceptions,
and motives; also studies group and intergroup
phenomena.
• Self‐fulfilling prophecy (Merton 1948)
• Observer/experimenter expectancy bias (Rosenthal 1966)
• Interpersonal expectancy “Pygmalion” effect (Rosenthal 1968)
• Groupthink (Whyte 1952)
• Cognitive dissonance (Festinger 1957)
• Obedience to authority (Milgram 1963/Zimbardo 1971)
• Learned helplessness (Seligman 1967)
My disciplinary area for the PhD was Social Psychology, which pursues
knowledge about how physical, social and interpersonal environments
influence individuals. Some of the better known phenomena in social
psychology are listed here.
The social psychology faculty at Harvard included experts in mindfulness,
conflict resolution, group dynamics, nonverbal behavior, and interpersonal
expectancy effects including experimenter bias. The program focused on
advanced quantitative methods to test hypotheses and advance knowledge in
multifactorial experimental and observational studies.
11“The Science of the Art of Medicine”
• Patient health behaviors and habits
• Patient preferences for tests or treatments
• Doctor‐patient communication (verbal, nonverbal)
• Influences on medical decision‐making
• Implementation of practice guidelines
• Health care team performance, group dynamics
• The hidden (informal, implicit) curriculum
• A cousin of organizational psychology and educational
psychology
As I learned more about social psychology and how it could be applied to
medicine I developed a short‐hand for my family and friends. It was an
oversimplification, but true enough to help. I called what I was studying “the
science of the art of medicine” and when people were interested in some
examples of that I shared some of the applications on this list. Doctor‐patient
communication, factors that influence patient preference and adherence to
medical advice, factors that influence physician decision‐making, team
performance, group dynamics and conflict management.
In medical education social psychology plays a role in understanding the
development of attitudes, beliefs and professional identify among medical
students, as well as how communication skills can be used to enhance the
rapport and trust between doctors and patients.
Social psychology also helps explain the hidden curriculum, how medical
students learn the professional behavior expected of physicians more by
example than by anything that is explicitly taught.
12M1 Tutor: Ed Frank, MD
By the time I encountered the unhappy couple in the hot tub I had completed
the first two years of medical school and a year and a half of PhD studies. My
exposure to the hidden curriculum had already begun.
In the first year of medical school we could sign up for tutorial groups, and I
was fortunate enough to be 1 of the 8 students assigned to Dr. Ed Frank. I
wish I had a photo of Dr. Frank to show you. Recently retired from a
distinguished career in vascular surgery, he had the sensibilities and
graciousness of a Boston primary care physician. Kind, soft‐spoken, and
usually found wearing a tweed jacket, even when took us out for ice cream
after exploring one of the units of the hospital. As a tutor his task was to
demystify the hospital setting. We visit the blood bank and laboratories. We
entered the operating room, and also spent time in the ICU.
Our visit to the ICU was memorable because something unexpected
happened. We were seated at the nurses’ station and Dr. Frank was quietly
explaining the history of ICU’s and the kinds of patients who need that level of
care. He interrupted his explanation and abruptly excused himself, got up and
approached one of the patients. He whispered something in her ear, then
listened for her answer. He approached her nurse and then he found
something in a drawer to bring back to the patient. We saw him dipping a
swab in water and applying it to the patient’s lips. When he came back he
mentioned how common it is for lips to dry out in the ICU, and that the
patient’s lips looked dry and uncomfortable.
In the middle of all of the lines, monitors, other devices, and health care
personnel, he showed us how to not lose track of the patient. He did not tell
us he was doing that. HE JUST DID IT.
13Inspiring Mentors
Robert Rosenthal, PhD
Jerry Avorn, MD
Allan Goroll, MD
There were other inspiring examples in my head while listening to the
unhappy couple in Maui. Allan Goroll was the lead clinician in the General
Internal Medical practice at Mass General and the leader for the Introduction
to Clinical Medicine course there. He graciously agreed to let me shadow him
in his busy practice during my PhD years so I could stay in touch with clinical
medicine. The hallway in his practice was a buzz with questions and the
comings and goings of patients into and out of his 3 exam rooms. But when
we entered the room and door closed, the patient was at the center of his
world. His knowledge was vast, and he ordered consults sparingly. He
exemplified the fusion of communication skills, evidence‐based care, and
clinical acumen that was inspiring. Rather than being exhausted at the end of
the day he was energized. The work itself seemed to be its own reward.
Social psychologist Bob Rosenthal and geriatrician Jerry Avorn were the
mentors for my doctoral dissertation – a multicenter randomized trial of
expectancy effects in elderly nursing home patients. Bob was a senior
professor who had become famous describing interpersonal expectancy
effects starting with his famous Pygmalion in the Classroom study. He
implemented his findings with his graduate students. He communicated his
high expectations for us, gave us lots of very detailed feedback, and helped us
feel supported through all sorts of challenges. Unlocking the potential of his
students was what motivated him the most.
Jerry Avorn was an up and comping geriatrician who cared deeply about
polypharmacy, evidenced‐based medication use, and the need to
counterbalance the influence of drug company “detailing” on clinical
decisions. He was wonderful at putting together research teams of
physicians and PhD scientists to develop and implement interventions to
improve health care. Making a difference through his research was what
motivated him the most.
14So, by the time we were honeymooning in Maui, my exposure to mentors and
role models had been uniformly positive – with some rock stars included. Each
was beaming with internal motivation to make a difference ‐ in patient care,
in teaching, and in research, and in caring for patients, students, and
professional colleagues.
The disgruntled physicians in the hot tub seemed to come from another
universe. Doing well enough financially to travel to this world class resort on
the spur of the moment, but miserable about their work.
My naïve brain could not imagine why making a difference in the lives of their
patients in the ER would not bring them happiness. Of course, we are all
older and wiser now. If we were to come up with some potential reasons for
their misery, they might include burnout, sleep deprivation, the trauma of
tragic outcomes, and other situational problems that could potentially heal
and improve over time. After all, we’re only human.
But weren’t the role models I had worked with and who inspired me human
too? They appeared to be working really hard, often in challenging
circumstances, and yet they seemed to have a north star to help them never
lose sight of their purpose.
151990
The rest of our honeymoon was wonderful. Let’s fast forward 4 years to 1990.
Germany was reunified after 45 years of separation, the Worldwide Web was
born, and the seemingly impossible Human Genome Project had been
launched.
16MD/PhD Mentors
Robert Rosenthal, PhD
Jerry Avorn, MD
Allan Goroll, MD
It was also the year I graduated from medical school!
Our 7‐month old, Becca, joined me as I shook hands with Dean Tosteson and
collected my diploma as a newly minted physician. I was a little worried
about bringing her with me because she could be fussy at times. But not that
day. She was alert and adorable – I had never seen the Dean smile so broadly.
17A Warm Welcome to Academic OBGYN
1990‐94 1994‐2008
Roy Pitkin David Grimes Gene Washington
Kenneth Ryan
As Becca was growing up over the next 18 years, I was completing my
residency in OBGYN at UCLA, and then joining the faculty at UCSF.
I continued to hit the mentoring jackpot. My role models included Ken Ryan
from Harvard, a leading OBGYN and medical ethicist, who embraced my
interest in social science and was confident it would find a home in our
specialty. Roy Pitkin, the chair at UCLA, set a high bar for excellence in the
department, and inspired the faculty and residents to bring their best effort to
the care of patients. And when I joined the faculty at UCSF I quickly gravitated
toward the exceptional leaders David Grimes and Gene Washington.
David and Gene were triple threats. They excelled in each area of the 3‐legged
stool called academic medicine. Thoughtful, humanistic physicians who
modeled the highest standards of patient care, inspiring educators who
sparked the creativity in others by their example, and highly productive and
well‐funded researchers who answered important clinical questions to guide
practice.
David was the chief of OBGYN at San Francisco General Hospital, my clinical
home. When I arrived in 1994 Gene had been selected as the chief at UCSF’s
Mount Zion medical center. Over the next 14 years we collaborated on
multiple grants and initiatives. He went on to be our department chair at
UCSF, the Provost and Vice Chancellor at UCSF, the Dean and CEO of UCLA
Health, a member of the National Academy of Medicine, and most recently
Chancellor for Health Affairs at Duke University and President and CEO of the
Duke University Health System.
18Leaders like David Grimes and Gene Washington introduced me to academic
medicine and the multiple ways to make a difference. It was like being a kid in
a candy store.
And I wanted to taste as much as I possibly could.
19Teams and Collaborations
• Clinical
– High risk obstetrics, resident continuity clinics
– Comprehensive care of chronic pelvic pain in women
• Educational
– Interdisciplinary women’s health, geriatrics electives
– Interprofessional research on reflective practice
– Cross‐departmental collaborations on how to teach shared
competencies in GME
– Team educational research
• Research
– NIH/AHRQ‐funded multicenter trials
– Team teaching and mentoring (epi, biostats, research)
I said YES to lots of things as a clinician, educator, and
researcher, and I enjoyed the creative energy of working with
teams of colleagues across different medical specialties and
disciplinary backgrounds.
Over time I developed a clinical niche and a respected role on
research teams, and I pursued leadership opportunities in
education. I started out as the OBGYN site director for student
and resident education, then became the residency program
director, a member of the medical school’s curriculum
committee and the chair of the scholarship committee in the
UCSF academy of medical educators.
I worked in the Dean’s office as the director of curricular affairs
for GME and explored how best to support departmental efforts
teaching research skills and other shared competencies to
residents across the specialties.
20Early in one’s career it is okay to say
“yes” to opportunities. Explore and
discover your deepest connection to
purpose, and then start saying “no”.
You may have heard the common advice to learn how to say “no” – but my
experience supports a different recommendation for junior faculty.
Like the kid in the candy store it’s helpful to try lots of different flavors before
choosing a favorite. Focus is definitely needed to hone one’s skills over those
10,000 hours we hear about, but early on it can be difficult to understand
which opportunities best connect us to our purpose.
Saying yes allows us to truly explore and discover aspects of our professional
selves that even we didn’t know.
When I was being interviewed at UCSF the department chair asked me to
envision what would be my dream job in 5‐10 years. I answered that I’d love
to become the residency program director, and I started down that path.
But I also said YES when my service chief offered me the opportunity to be the
medical director of the San Francisco Rape Treatment Center, and he asked
me to direct the OBGYN ambulatory care practice at our hospital. I learned a
lot through these roles and I believe they helped be a better clinician and
leader when I eventually became the residency director.
21So You Wanna Be An Educator?
John Mattox Doug Laube Diane Hartmann Hal Lawrence
Bridget O’Brien, Dave Irby, Molly Cooke, Pat O’Sullivan, Robert Baron
Becoming an educator introduced me to a new cadre of inspiring role models.
Some, like the top row on this slide, were leaders of educational initiatives
within OBGYN. They saw something in me that allowed them to say YES and
to involve me in my first national service roles. The doors they opened
allowed me to become the chair of the Step 2 exam‐writing committee for
OBGYN, the chair of our national program directors organization, a member of
the ACGME residency review committee for OBGYN, and an author of the
milestones for my specialty.
The second row in this slide includes the wonderful educators at UCSF who
helped me grow there in administration and as member of the academy of
medical educators. They also introduced me to national opportunities in
educational research and collaboration.
These medical education leaders, administrators, and researchers came from
very different professional backgrounds and experiences but shared a deep
connection to the awesome responsibility of training the next generation of
physicians.
222008
• Family
– One daughter off to college, the other completing middle school
– Bev contemplating career options in education
• Community
– Samaritan House Free Clinic
– Congregational Board of Trustees, Choir
• Career
– Happy at UCSF with several “reinventions” since 1994
– Promoted to professor in 2004
– Dept and institutional leader in education, clinical admin
– Productive member of several research teams: grants, pubs
– National leadership in OBGYN education
Well, after 14 years, even though I had narrowed my focus some, I still felt
like a kid in candy store. I was happy and fulfilled with family life, connected
to my community working at our version of the Bradley Free Clinic, on the
board of our religious congregation, and enjoying the world of medical
education I was still getting to know.
When the search committee from Indiana University reached out to me to
consider the position of OBGYN department chair, I must admit I hadn’t really
thought about being a chair yet.
Before embarking on the adventure of looking at this position I consulted with
my mentors. They encouraged me to seek the position but one added a
cautionary note. He said that just the process of looking at the position in
detail could fill me with a new sense of the possible, and that if didn’t work
out I might be restless and look at our opportunities.
23The UCSF Years: A Retrospective
Although we didn’t know what to call it at the time, I now understand that the
UCSF years revealed that I used a “Growth Mindset” to understand success,
bounce back after failure and seek new opportunities. Growth mindset is
depicted here as the opposite of a fixed mindset. This is helpful for
contrasting the two extremes, but like most other human characteristics there
is a continuum here between the two extremes.
I started my career leaning toward a growth mindset, and over the next 14
years my needle moved even further in that direction. That’s why I could be
both happy with my position as a professor at UCSF and interested in further
growth as a department chair.
24Tune in to how where you are on the continuum of
fixed mindset vs growth mindset. A growth mindset
creates its own purpose, as well as the challenge of
finding opportunities to stretch, grow and reinvent.
The insight I gained is summarized here. I realized that I had reinvented
myself several times while at UCSF in ways that had helped me learn new
things and grow, and that I would do best in my career knowing this was an
important part of what satisfied me – the opportunity to learn and grow in
ways that expanded my opportunity to make a difference.
25So You Wanna Be Chair?
Dave Irby Gene Washington Nancy Ascher
William
Doug Laube Bill Herbert
Droegemueller
The inspiring leaders on this slide provided extremely helpful insights into my
decision to pursue the chair position at IU. They included leaders in my
specialty who were or had been academic chairs, as well as other leaders in
academic medicine like Nancy Ascher – a transplant surgeon and department
chair at UCSF who’s surgery department had a reputation for the best
financial team in the medical school. Her team schooled me on the issues to
look out for in evaluating the Indiana University department’s fiscal health.
26Identify the inspiring people in your life and let
them know. Being inspired by others can help
you find your own, authentic inspiring self.
As I reflected on why the academic soil was so fertile at UCSF, I realized that
my success there was fueled by the inspiration of others.
I knew that to be my best self as a department chair I would need to identify
inspiring colleagues, supervisors and other role models.
This insight helped me see some exciting possibilities at Indiana University.
27The search committee for the OBGYN chair was led by Jim Lemons, a beloved
Professor of Pediatrics who led IU’s Neonatology division over several decades
to become one of the best in the country. He was also deeply involved in a
major partnership initiative between Indiana University and a Kenyan medical
school through a USAID‐funded program called AMPATH. Jim’s fundraising
efforts paid for the construction of a mother‐baby hospital and intensive care
nursery in Kenya that transformed care and improved the survival of mothers
and neonates in the region.
28D. Craig Brater, MD
Dean, IU School of Medicine 2000‐2013
President and CEO
Alliance for Academic Internal Medicine, 2007‐2021
Acad Med. 2007; 82:1094–1097.
J Gen Intern Med. 2008;23(6):715–22
The Dean at the time was the inspiring Craig Brater, an internist and clinical
pharmacologist. He had launched an organizational culture change initiative
at the medical school a few years before the OBGYN chair position opened up.
The initiative focused on humanism, professionalism and the power of the
informal or “hidden” curriculum in the professional identity formation of
medical students.
As Dean Brater came to understand my background in social psychology, he
made sure I met the leaders of this humanism initiative as part of my
interview process.
29Humanism
• Leverages inclusion of diverse ideas and perspectives
• Fosters curiosity, engagement, connection
• Promotes a growth mindset, sense of agency
• Refills our tank of compassion to share with others
• Defines what is to be a physician for our patients,
staff, students, residents, and society
Valuing each individual, their autonomy, their dignity and their unique
perspective on the world makes humanism a cornerstone of many other
aspirations for a medical school and health system.
Humanism supports inclusion, curiosity, engagement, connection. It promotes
a growth mindset and sense of agency, refills our tank of compassion and
defines the essence of what it means to be a physician.
Humanism means seeing past people’s labels. Our brains are hard‐wired to
simplify the world around them by using salient characteristics to identify
groups of people. These groupings come at a cost – stereotypes that treat
each individual in the group as more the same than they are different.
The simple ways of understanding gender, skin color, ethnicity, sexual
identity, sexual orientation, age, height, weight and other labels IGNORE the
wide range of individual differences that exist within all of these groups.
Humanism is the countermeasure we can use to free our brains of the biases
that come with stereotypes. Each person may be identified or self‐identify in
certain ways, but is an individual. The key to humanism is being curious, and
realizing what a holistic understanding of other people enriches our lives and
helps us in our work in health care.
30Building Humanism at IU: 2008‐15
Tom Inui
Rich Frankel Deb Litzelman
Jeff Rothenberg Mark DiCorcia Joe Mamlin
Rich Frankel (a social psychologist) and Tom Inui (a general internist and
health services researcher) led the culture change initiative at IU. Their
scholarly work included studies on professionalism, relationship‐centered care
and the value of reflection and narrative medicine to support professional
identity formation for medical students. They partnered with allies in the
office of medical education like curriculum dean Deb Litzelman (also a general
internist). Before I was recruited they had found an ally in OBGYN ‐ Jeff
Rothenberg – who was also involved in my recruitment.
The humanism team expanded when I recruited Mark Di Corcia soon after my
arrival as chair. Mark started his career as an occupational therapist and
became the clinical administrator of a behavioral health facility before
obtaining a master’s degree in education and a PhD in health communication.
Joe Mamlin is listed last – I tell you all about Joe in a few minutes.
31A Rose By Any Other Name
Inui TS et al. In Creuss R. Teaching Medical Professionalism. Cambridge University Press,
2009.
One of Tom Inui’s many contributions to the field was to compare 4 related
constructs and analyze where they overlapped and where they were unique.
Humanism, Professionalism, Morality, and Spirituality share 35% of their
qualities in common, and pairs of these constructs share another 31 making
the total overlap equal 66%.
This makes sense when you think about it, and allows multiple “ways in” for
our students to make a philosophical connection to one or more of these 4
perspectives.
Think for a moment of which of these you use most often use to anchor the
expectations you have for yourself and others, and help you be your best self
and best physician.
They all resonate with me, but humanism seems the most universal. To me,
truly seeking to know and understand another person helps me fulfill the
expectations of our profession, as well as aspects of my spirituality and sense
morality. For you, which was resonates the most?
32As the new chair I tried to catch up quickly to the culture‐change initiative
that had permeated many of the clinical departments, but not the
department I was leading. There were two key elements of the initiative.
Appreciative inquiry focuses on how assets can be used and built‐upon to
achieve an envisioned goal. The opposite is to focus on problems and deficits
that need to be fixed.
Emergent design acknowledges that the intended or top‐down strategy rarely
materializes as planned. Parts of it survive and are joined by a bunch of
emergent strategies. These emergent strategies bubble up from various units
across the organization.
Putting these two concepts together, instead of one size fits all, an
appreciative approach and emergent design thinking encourage the local
units of a medical school (its departments, centers and institutes) to identify
their own unique strengths and build on them.
33In the OBGYN department we held a faculty retreat following pretty closely to
the format on this slide.
To help with Discovery we conducted a survey and presented the results at a
nice dinner the night before the retreat.
The next day we used a Deep Sleep exercise to Dream about the perfect
future environment for our work. We discussed what we saw, what we heard
and what we felt in our dreams for the future.
Design began with faculty signing up to work on a variety of strategies they
selected to prioritize as initiatives that would help get us to our envisioned
future.
We then set out to communicate our shared Destiny, and developed a new
Vision and Values statement to memorialize it.
The Retreat engaged faculty from different backgrounds and factions to work
on a shared goal together. It created greater understanding, cohesion and
respect, bridging divides in identity (generalist vs subspecialists) and in
practice location.
The Retreat also helped identify a handful of faculty with a fixed mindset who
were not interested in being part of the change.
34What Grew in the Garden
• Learning climate and hidden curriculum
– Improved teaching performance by faculty and residents
– OBGYN Residents winning 1/3 of GHHS awards
• Workplace climate
– Resiliency, cohesion and mutual support during a period
of externally imposed changes
– Avoidance of compassion fatigue, burnout
DiCorcia MJ, Learman LA. Changing the educational environment to better support professionalism and
professional identity formation (Chapter 18). Teaching Medical Professionalism, 2nd Edition, ed. Richard
L. Cruess, Sylvia R. Cruess, Yvonne Steinert. Cambridge University Press, 2016.
A few years later we looked back at what our departmental initiatives
produced and found positive impacts on the learning climate for medical
students. Our residents were recognized by the graduating class of the
medical school to receive one‐third of the GHHS awards given to residents.
There was also a positive impact on the workplace climate for faculty and
staff.
35Reflecting on What Worked
1. Start small and look for partners 7. Provide firm but compassionate
2. Take the time to established a shared feedback to colleagues who
mission, vision, and values demonstrate non‐humanistic
3. Use appreciative methods to envision the behaviors: Cup of Coffee conversation
future and develop strategies for change 8. Emphasize humanism as a core value
4. Follow‐through on work started at the in all recruitments
retreat you held for 2&3 9. Link agendas and group work to your
5. Communicate frequently, particularly mission, vision and values
when change is afoot 10. Never stop tending the garden ‐
6. Celebrate successes in every mission area water, fertilize, weed, and plant (wash,
rinse, repeat)
DiCorcia MJ, Learman LA. Changing the educational environment to better support professionalism and
professional identity formation (Chapter 18). Teaching Medical Professionalism, 2nd Edition, ed. Richard
L. Cruess, Sylvia R. Cruess, Yvonne Steinert. Cambridge University Press, 2016.
Our reflections on what worked are listed here. Numbers 8 and 10 are
perhaps the most important – just like our gardens at home, the garden of
humanism needs to be tended regularly.
The other reflections emphasize the importance of developing new habits: for
communication, appreciation and transparency.
36Optimal healthcare, education and research rely on
appreciative and humanistic work environments.
We all play a part in creating these environments.
As a chair supporting the multiple missions of an academic department I
learned that an appreciative and humanistic learning and working
environment is essential for everything we do: caring for patients and
communities, educating the next generation of health professionals, and
forming successful and productive teams of biomedical and clinical
researchers.
While leadership is important to get things moving, sustaining change
requires a co‐created process which includes everyone.
37Our Patients*
Remember Best How
We Make Them Feel
You are the first doctor who
truly listened to me and
understands what this has done
to my life, and that helps.
*and our partners/spouses, children, parents,
siblings, extended family, friends, students, peers,
team‐members, people in general
Before moving on from the topic of humanism, I’d like to share a couple of
additional considerations. First, is the idea of healing.
Although our trainees worry most about the development of their knowledge
and skills, our patients will best remember how we made them feel.
One of the most precious gifts we can give our patients, and each other, is the
gift of being understood, accepted and valued simply for being who they are.
Physicians from every specialty who are the best healers harness the skills of
humanism and keep them in their metaphorical white coats along side their
abundant knowledge and clinical skills.
Our patients know it when they see it, and they really know it when they feel
it. And so do we. This is who we are when we are at our best. It is who we
want our students and residents to become.
38What are we teaching them?
Second, is the importance of role models to the formation of professional
identity in our students and residents.
I grew up with an older print of this poem hanging on the wall in our house.
Although our students and residents are adults in their 20’s they are looking
for examples of what it means to act professional. No formal curriculum or
oath has as much power as our example to shape the norms our students
aspire to achieve.
To be at our best as role models we need to purge the pink behaviors from our
repertoire and show the blue.
But we are only human. Life happens, and sometimes it is hard to be at our
personal best. We need to develop self‐compassion while also doing a gut‐
check to understand whether we are in a good place for our patients, students
and residents.
If I can still feel empathy with the patient, and channel how I would feel in the
patient’s shoes, I am in a good place.
If can cannot get to empathy but can feel sympathy, seeing the patient’s
suffering and doing what I can to relieve it, I am still in a good place.
But, if I cannot feel empathy or sympathy, and the best I can do is use a script
to support the patient, it’s time for me to check‐in, go home, get some rest, or
seek help.
39Joseph Mamlin, MD
I mentioned Joe Mamlin earlier. He is one of the most remarkable physicians I have had
the pleasure to know. After serving as chief of medicine at a hospital for low‐income and
uninsured patients, instead of retiring Joe decided to help a new medical school in Kenya
build its research program in HIV/AIDS.
It took only a few months after he arrived in Kenya before Joe developed enormous
moral distress. The humanitarian crisis from HIV/AIDS was accelerating and patients
needed care, not research. So Joe shifted his effort to designing models of health care
and teaching Kenyan physicians and trainees how to implement those models in the
hospitals and special community health centers he lobbied the government of Kenya to
build. Many thousands of lives were saved, and with the advent of new antiretroviral
regimens HIV/AIDS became a chronic disease. As more patients survived they needed a
livelihood to put food on the table and pay a share of cost for their medications. So Joe
recruited water engineers to create arable land for his patients to farm.
Joe’s worked tirelessly in very complex and under‐resourced environments. His
humanitarian efforts brought him the respect and admiration of his colleagues at Moi
University, in the Kenyan MOH and MOE, and by funders at USAID who supported a lot of
this work. It also led to his nomination 3 times for a Nobel Prize. He His wife Sarah Ellen
lived with Joe in Kenya, developed programs for orphaned children whose mothers had
died of HIV/AIDS.
During my first trip to Kenya as OBGYN chair, I had a chance to shadow Joe for a day.
Filled with joy and purpose, Joe would take the time to bring toys to young children
recuperating in temporary housing near a rural community clinic. He would supervise
the care of medical officers he had trained to provide HIV care in the clinic. When his
patients told him they could not afford both medicine and food, he would reach into his
wallet and share what he had.
40Hillary Mabeya, MD
https://beyondfistula.org
I also had the pleasure of meeting Dr. Hillary Mabeya who served as the
academic chair and clinical chief of women’s health at Moi University.
Incredibly modest and soft‐spoken Dr. Mabeya had become an award‐winning
fistula surgeon. The kinds of fistulas he would repair were unlike the small
ones we encounter in middle and high‐income countries. These fistulas were
created by obstructed labors in which the uterus continued to contact even
after fetal demise because surgical obstetrical care was so inaccessible. Over
time the pressure necrosis in the lower pelvis created breakdown of the
connective tissues between the urinary tract, vagina and rectum, leaving
young women with large fistulas as well as incontinence of urine and stool.
They were often outcast from their communities, unable to learn a trade or
complete schooling.
Fistula repair might be possible in one complex operation, or might require
several. Dr. Mabeya set up fistula camps across the rural areas in Kenya to
help the many women with these fistulas. He noticed early on that repairing
them was only the beginning of what his patients needed.
Dr. Mabeya and his wife set up a not‐for‐profit organization to support the
cost of postoperative care for these women and a recovery program in which
they could learn a trade so they could more easily reintegrate into the villages
in which they grew up.
The Mabeyas were on a mission of great meaning and impact.
41Leaders inspire teams to appreciate each other, feel
connected to a greater purpose, and identify
strategies for maintaining and enhancing well‐being.
Team members inspire each other by appreciating
how their diverse efforts and perspectives co‐create
the successful work of the team.
Each of the heroes and inspiring role models I’ve introduced this morning
would be the first to tell you that if they accomplished something remarkable
in their lives, it happened only because of their teams.
Leaders inspire teams to achieve great things, to feel connected to a greater
purpose, to appreciate each other, and to keep themselves whole and well.
Team members inspire each other by appreciating how their diverse efforts
and perspectives co‐create the successful work of the team.
42“If you had but one lecture left to give,
what would you say?”
YOUR NAME
HERE
AN EVENING IN THE FUTURE
So, as we return to the challenge of giving a Last Lecture, here is a summary of
the most important lessons I learned from the leaders who most inspired me.
If I have had a successful career, it would be measured by how effectively I
used these insights to lead authentically and to inspire others.
43My Top 5
1. Early in one’s career it is okay to say “yes” to opportunities. Explore and
discover your deepest connection to purpose, and then start saying “no”.
2. Tune in to how where you are on the continuum of fixed mindset vs
growth mindset. A growth mindset creates its own purpose, as well as the
challenge of finding opportunities to stretch, grow and reinvent.
3. Identify the inspiring people in your life and let them know. Being inspired
by others can help you find your own, authentic inspiring self.
4. Optimal healthcare, education and research rely on appreciative and
humanistic work environments. We all play a part in creating these
environments.
5. Leaders inspire teams to appreciate each other, feel connected to a
greater purpose, and identify strategies for maintaining and enhancing
well‐being. Team members inspire each other by appreciating how their
diverse efforts and perspectives co‐create the successful work of the
team.
1. Early in one’s career it is okay to say “yes” to opportunities. Explore
and discover your deepest connection to purpose, and then start
saying “no”.
2. Tune in to where you are on the continuum of fixed mindset vs growth
mindset. A growth mindset creates its own purpose, as well as the
challenge of finding opportunities to stretch, grow and reinvent.
3. Identify the inspiring people in your life and let them know. Being
inspired by others can help you find your own, authentic inspiring self.
4. Optimal healthcare, education and research rely on appreciative and
humanistic work environments. We all play a part in creating these
environments.
5. Leaders inspire teams to appreciate each other, feel connected to a
greater purpose, and identify strategies for maintaining and enhancing
well‐being. Team members inspire each other by appreciating how
their diverse efforts and perspectives co‐create the successful work of
the team.
44A Farewell Message from ???
1. Value one another. You have
remarkable colleagues.
2. Value the mission. It is so important
to so many people who are looking
to us for hope and treatments.
3. Value the culture. It truly is unique,
and such cultures are fragile and Christopher P. Austin, M.D.
need constant renewing. Director
National Center for Advancing
4. Remember that innovation is an Translational Sciences
‐April 15, 2021: The work of
attitude that requires ongoing translational science has just
energy to maintain and keep the begun
entropy of the status quo at bay.
And never, ever stop being bold.
My perspectives are by no means unique. Here is a similar set of
recommendations in a farewell message. The key points here transcend time
and profession – they could be recent or from long ago. They could be
authored by a leader in any sector of society: education, research, industry,
government.
ANIMATE
Well, this farewell message comes from a medical school classmate of mine –
a research neuroscientist who just stepped down as the leader of one of the
NIH institutes called NCATS. All of the Clinical Translational Science Institutes
are funded by NCATS, including the one that VT and CC are part of called
iTHRIV.
Chris Austin and I did not talk to each other about my Last Lecture and his
farewell message, but you can see several noteworthy similarities.
Appreciative leadership, the importance of organizational culture, and clearly
a growth mindset to fuel innovation.
45We’re going to pay one final visit to that unhappy couple in hot water.
I was just 26 at the time: half‐way through medical school and graduate
school I was just beginning to understand myself and my future identity as a
physician, educator and researcher.
Now with 35 years more life experience, if I were to meet the same couple the
next time we visit Maui, I’d feel way more comfortable having something to
offer them over a Mai Tai or two.
Here are the questions I have asked myself from time to time, and that I offer
to this couple or to colleagues that have lost a sense of fulfillment.
46Hot Tub Conversation
Triggers: crisis (health, relationship, career) or your choice
1. What is your personal mission, and how does it help you understand
what you most value (your true north)?
2. How would (or does) finding a deep connection to purpose in your
work affect your health, happiness and life satisfaction?
3. How would (or does) having a work environment aligned with your
values affect your engagement, creativity, effort, satisfaction, and
success?
4. What habits and activities (inside work and outside work) give you the
energy, optimism and well‐being to your my best self?
1. What is your personal mission, and how does it help you understand
what you most value (your true north)?
2. How would (or does) finding a deep connection to purpose in your
work affect your health, happiness and life satisfaction?
3. How would (or does) having a work environment aligned with your
values affect your engagement, creativity, effort, satisfaction, and
success?
4. What habits and activities (inside work and outside work) give you the
energy, optimism and well‐being to be your best self?
47My Power Packs
We’ve talked a lot about the importance of finding purpose in one’s work as a
physician. Before closing I wanted to share with you the things outside of
work the keep me whole and give me strength, energy and purpose.
My family including my wife, our daughters and their partners, and our 3 furry
companions who have shared our home in 3 cities over the past 12 years.
Staying healthy, enjoying the outdoors.
Being able to share my joy of music by singing with the Roanoke Symphony
Orchestra Chorus.
48My Most Important Mentor
Sandra Learman
March 27, 1936 – June 5, 2014
Before closing I wanted to leave you with some images of my most inspiring
mentor – my mother. A high school graduate who raised her kids and helped
in our father’s business, Mom enjoyed being involved in social justice
movements and exploring different spiritual traditions.
Mom taught my brother and me the importance of caring and supporting
each other, setting high goals, and believing in ourselves. Although mom was
proud of our academic and professional successes, that would not meet her
expectations of a life well lived.
Mom wanted her children to use our talents to make the world a better place
by improving the lives of others and standing up for injustice. She involved us
in these efforts when my brother and I were in high school, and it made a big
impression.
She would be so happy to know that as Dean, I am inspired every day by the
wonderful colleagues I work with, by the students and residents we serve and
by the generous and gracious community of Roanoke.
Paul, THANK YOU again for inviting me to be with you to open this year’s
Symposium. I hope we have time to hear comments and questions from the
colleagues who are with us this morning. If any of you have found your way
back to joy after a challenging period in your careers, I invite you to please
share your experience. Thank you all so very much.
49You can also read
