Welcome Address-Class of 1997
Critical Ingredients

by C. McCollister Evarts, MD
Chief Executive Officer, Milton S. Hershey Medical Center,
Senior Vice President for Health Affairs and Dean
Pennsylvania State University College of Medicine

Thank you Ken. I'm grateful for your generous introduction; but, perhaps more grateful that you got my ruptured Tendo Achilles to heal a second time after behaving badly as your patient following the initial rupture--and much more importantly, that you persisted in becoming a superb orthopaedist, arthroscopist, sports medicine guru, and leader of orthopaedics.

This is a stage littered with dignitaries which prohibits my recognition of each of them. So, I shall direct my attention to the class of 1997. In preparing these comments, I thought some of discussing the revolution that health care delivery is undergoing, but I thought better of this recognizing that such a discussion is best held another place--another time. I've attempted to return to basics.

As one embarks upon a professional career, what are the essentials that contribute to success? You have all begun your professional career, have experienced some of the vicissitudes of assuming the responsibility for a patient and are relying upon your background to guide you as an orthopaedist. What can you add to the mix to carry you forward?

What are some of the critical ingredients? First, and foremost, an obvious critical ingredient for all of you is knowledge. Your current knowledge base is an accumulation of many, many years of education, beginning as a child and following a course throughout the educational process culminating in an orthopaedic residency. This lengthy process has provided you with a large amount of theoretical and practical knowledge. You have sharpened your ability to solve problems; to approach diagnostic dilemmas; to function under difficult circumstances. During this period of time, there has been a gradual evolution towards professionalization. Part of the professionalization process has been the necessity to develop both intellectual and emotional discipline which allows one to effectively practice orthopaedics in a competent manner. Your knowledge accumulation has become discipline specific. You are beginning to tune in to outcome measures and evidence-based medical practice.

An obvious corollary of the critical ingredient--knowledge--is that of a commitment to continuing your quest for knowledge. Osler stated: "Education is a life long process in which the student can only make a beginning during his college course." You must have a life-long commitment to maintaining and increasing your knowledge and skills. These will subsequently be translated into ever improving patient care.

The American Academy of Orthopaedic Surgeons provides significant opportunities to learn in the form of continuing medical education, home study, a comprehensive review journal, and access to an orthopaedic learning center. Therefore we find ourselves with the absolute necessity of continuing to upgrade one's knowledge base.

On a personal note, reflecting upon a career as an orthopaedist which extended over 30 years, perhaps, the most important component was the relentless pursuit of increasing my knowledge base--late nights, early mornings. Remember Winston Churchill's words, "Only the mediocre are always at their best."

A second critical ingredient is that of skill--defined as the ability coming from one's knowledge, practice, aptitude to do something well. Skill involves dexterity and expertness. What are some of the necessary skills? It's obvious that you have learned the skill of data collection; namely, listening to your patient; performing physical examination, using the laboratory, X-ray and imaging techniques to arrive at the appropriate diagnosis--continue to refine and hone these skills.

Procedurally, it is critical to develop certain motor skills, as they are the cornerstones for attaining proficiency in surgery. It is necessary to practice, and practice, and practice to improve your motor skills--use all available materials including cadavers,

To interject a point, the future may well hold the opportunity to develop motor and procedural skills in a virtual operating room setting. This is under development at Penn State's College of Medicine.

Another skill includes the ability to manage huge amounts of information--to embrace the digital age. The diagnostic and technologic tools now available to you as an orthopaedist are nothing short of remarkable. New surgical procedures have been introduced; treatments are different; change is everywhere and you must keep up! The technological revolution has lead us to know how to do things perhaps more than knowing why. One must always guard against doing what is possible medically rather than what is reasonable. It is clear that in the current health care environment you will need to ration the use of diagnostic procedures, to be on the outlook for the inappropriate use of therapeutic procedures, and guard against creating an environment where patients have heightened, unrealistic societal and/or personal expectations--feeling that science has progressed to the point of being able to cure all diseases, or conditions, especially theirs.

To the critical ingredients, knowledge and ,skill must be added that of values/attitudes. Essential to one's success is a commitment to excellence and to the public we serve. It is important to carry the theme into practice that most of you began medical school with, namely, service to others and the recognition of the centrist position of the patient. One must be compassionate as well as knowledgeable. Compassion should not be achieved at the expense of downgrading science or technology. One does not wish to be cared for or operated upon by a compassionate ignoramus.

It is crystal clear that one's integrity has to be maintained throughout their professional life. Losing that results in an erosion of public confidence and a breakdown of the patient/physician relationship. In addition to attention to detail, it is critical to be able to function within a health care team in a collaborative manner. The era of the "geheinrat" physician leader is over.

In order to develop one's knowledge, skills and some of the values and attitudes viewed as critical ingredients, perseverance takes rank. A favorite Welsh proverb of mine is: "Talent without perseverance is barren."

Medicine is both exciting and demanding. It remains a profession in which one can make a difference,. We have talked about some of the qualities of a humanist, including compassion, integrity, service to others. These in conjunction with the essential ingredients of knowledge and skill lead to an orthopaedist who really can make a difference. Never lose sight of Francis Peabody's exhortation: "The secret of the care of the patient is in caring for the patient."

Obviously, there are many more critical ingredients. There are personal characteristics that must be considered. Many of these have been already developed in each and everyone of you--stamina, the ability to work hard, and perseverance have been part of your life. The stage has been set for you to embark upon a challenging and rewarding career in orthopaedics never failing to use the critical ingredients--knowledge, skill, values, and attitudes.

But before concluding let me add the overarching--the mother of all critical ingredients--the central link--the very core--the factor that is germane to all learning -- it is the "parachute factor".

"The parachute factor" is the true philosopher's stone which transmutes all the base metal of humanity into gold. It will make the bright person brilliant, the brilliant steady. To the youth it brings hope; to the middle-aged, confidence; to the aged, repose. It has been the very core of advances in science, medicine, arts, and the humanities during the past many centuries. Hippocrates made it the basis of observation. It underlies scientific discovery through the ages as humans have attempted to discover the relationship of the heavens to the planet, the elusive and mysterious dimensions of time, the vast and colorful arrangement of plants and animals, the intricate workings of one's own body, the surprising variety of human societies past and present. Not only has the parachute factor been the touchstone of progress, it becomes the measure of success in every day life. It has been responsible for your early successes. You may have guessed the answer.

What is the parachute factor? It is an open mind! Why the parachute factor?--because "minds, like parachutes, only function when open." I repeat--minds, like parachutes, only function when open.

So to conclude--given these critical ingredients, you will be able to shape your own performance; to make a difference with your patient; to influence your community as well as your profession as we enter the next millennium.

Finally, to the class of 1997, were I possessed of Fortunatus' lucky amulet to generate flights of fancy, I would wish for each one of you, preservation of the sparkling ferment of the springtime of life throughout your career; a spirit of sustained perseverance at your tasks; and an enduring fidelity to the critical ingredients so necessary for the practice of medicine.

Welcome to the American Academy of Orthopaedic Surgeons.

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Last modified 20/February/1997