Guest Columnist Roy Sessions, M.D. – Protecting the Educational Process

Protecting The Educational Process: Capitalizing on the Gene Pool

“He plants trees to benefit another generation”
—Caecilius Statius, quoted by Cicero

My goal today – somewhat of a change of pace – is to express some of my thoughts on education; and while this piece is slanted to medical education, it could well be directed to other venues, because it involves selection, mentorship, and the basis of leadership. In recent blogs, we have discussed some pretty sober topics – suicide, failure of cancer treatment, and others – and I’ll get back to that type of subject matter in due course. Starting out the new year, however, in an upbeat and futuristic way seems like a good idea – at a minimum, I asked your indulgence for this change of course.

The integrity of any profession is largely dependent on selecting the right applicants—in my life experiences, physicians generally and oncologists specifically— and then building on character and values. During the ten years when I was chairman of a surgical department at Georgetown University Medical School, in Washington, D.C., I directed a residency training program, the corps of which consisted of eighteen young doctors (three per year, in a six-year curriculum), all of whom had been carefully selected during a very competitive process from a large pool of highly qualified medical students. Most of the applicants were extraordinary, having excelled in academics, in sports, community service, and so on. Had we relied on these accomplishments alone, the selection could have been accomplished by drawing lots. Essentially, they were all smart and multidimensional people; so the three were chosen each year largely by relying on qualities of character and a value system that included morality, ethical behavior, family values, integrity, willingness to subordinate the interest of the individual to that of the group, absolute academic honesty as well as a willingness to adhere to an honor code, a commitment to excellence, a desire to be of service to humankind, a love of the profession, and God forbid, even patriotism. I don’t claim that we were always correct in our judgment of the candidates, but our batting average was quite good. What translates into good surgeons is a little different from more cerebral endeavors, but you get the picture.

I fervently believe that the perpetuation of high ethical and moral standards by means of careful recruitment is the single most important responsibility of my profession’s leadership; and the opportunity for success in this endeavor is present because the talent pool from which to choose is replete with young men and women already imbued with these qualities and values. Educators should commit to the notion that with the correct selection process for advanced training, and then by the imposition of the highest expectations and standards on those selected, the high ideals that we seek are achievable in the next generation of leaders, and this especially applies to doctors.

Allow me to expand on that, because it’s what I know best. That said, I’m confident that many of the non-medical readership will interpolate this to their own sphere. In molding young physicians, and particularly future oncologists, it’s essential to select those who respond in a positive way to the emphasis on character and values. This is no simple task, because in attempting to be modern—dare I admit it, politically correct—whether by exclusion or otherwise, we have deemphasized these basic principles in our guidance of young people through the minefields of today’s world; and I believe that, in the process, they have suffered from an insidious intellectual and moral debilitation that results from lowered expectations. I have never been reluctant to discuss important professional and even personal values in meetings with my residents; and it has always gratified me how well this generation responds to these “old-fashioned ideas.” We should be careful to not underrate the youngsters of today –  they are different then we were. That said, several things are notable: not only did We create and enable them, but times truly are different. It is my idealistic hope that a values-based upbringing will stand the test of the times. The truth is, while these values can be applied to many endeavors in life, they are especially relevant to the medical profession, and in fact, should form its very foundation. To carry this notion even further, I believe it’s especially important in the world of cancer medicine, where so much relates to interpersonal chemistry between the physician and patient in a very high stakes process.

I owe much to the residents that I have selected and helped to train. Their expectations of me have provided a behavioral compass throughout my professional life, and our interaction is embedded in the infrastructure of my clinical and personal philosophy. Importantly, this generation of young physicians has given me a sense of optimism for the future of medicine as well as a reason to sustain enthusiasm for teaching.

Considering the array of issues that influence the practice of medicine— political turmoil, socioeconomic uncertainty, changing value systems of people in general, and so on—it’s not surprising that in this country there is an atmosphere of concern for the dynamic target that we euphemistically refer to as the Health Care System. In fact, it’s an understatement to say that major uncertainty and insecurity exist in all of society about the future of American medicine. While I also have concerns for the system, I do have steady confidence in the intelligence, the goodness, and the quality of the next generations of physicians. They truly are the cream of the crop in our culture, and an important goal of the leadership of the government, the profession, and the insurance industry should be to create a consumer-friendly and functional health care system that does not squelch the optimism and idealism of the future keepers of the public’s health. A thoughtful analysis of this statement is particularly relevant to the future, because of the emotional burden of taking care of cancer patients.  When that burden is added to the cumbersome daily chores that physicians face today, we should all be concerned. To paraphrase Thomas Smith, the professor and chair of Hematology, Oncology, and Palliative Care at Virginia Commonwealth University, oncology is already very hard work, and with increasing resistance to higher reimbursements for cancer care, it is no wonder that the United States faces a looming 40 percent shortage of oncologists. There are a variety of reasons why so many outstanding young people have historically been willing to undergo the long, grueling, and very expensive period of training required to become a physician. That the academic elite of our young people will continue to have this affinity for the profession cannot be taken for granted, however. We should not ignore the benefits that have hitherto served to offset their very demanding education and lifestyle. When the negatives start to outweigh the positives, many will seek other avenues for their idealism and ingenuity. Happy New Year.

Roy B. Sessions, MD, FACS
Seabrook Island, SC