Medical School Graduates Urged to Get Back to Basics

New physicians have two choices to consider—one path leads to conformity while another is the more difficult road to innovation. 

"You will face this choice over and over again in your career and most think it is an easy path to be an innovator," said Robert Richardson Jr., chair of the board of trustees for the University of Cincinnati.

However, most of us have a false idea of what it means to be an innovator, added Richardson. It doesn't mean starting up a new high tech company and going out making a lot of money though that standard seems to be considered the norm for many.

"What I consider to be innovation is those who decide that they don't want to accept the status quo, truly rebelling against the status quo and not accepting things as they are," said Richardson. "It may seem easy, but the truth is people love the status quo. The status quo is what you know, but in reality the status quo is not acceptable if you really want to improve things and you want to see better health care and better results for patients."

Richardson offered remarks Saturday, May 28, at the College of Medicine Honors Day ceremony at Aronoff Center in downtown Cincinnati. During the ceremony, medical degrees were offered to 169 medical students, who were urged to ask questions even as young physicians to improve health outcomes for their patients.

Being an innovator means speaking up and advocating for patients when no else in the room might, said Richardson. "It puts you in an uncomfortable position. If you want to be an innovator you have to be comfortable making people uncomfortable," he explained.

Graduates along with their family members and friends also heard remarks from College of Medicine Dean William Ball, MD, and Zachary Gordon DeVore, a fourth-year medical student. The keynote address was given by Alvin Crawford, MD, professor emeritus in pediatrics and orthopaedic surgery at the UC College of Medicine.

"The practice of medicine will continue to undergo significant change," said Ball during his remarks to graduates. "It is now your responsibility to keep up with that change. We need you to become increasingly vested in the care and well-being of all people.  We need you to be activists for the health and well-being in the communities in which you have the privilege to serve. There is no sitting on the bench in medicine.  We all have to be on the playing field. You need to be healers, teachers and leaders."

Crawford, who served as director of orthopaedic surgery at Cincinnati Children's Hospital Medical Center for 29 years, was awarded endowed chairs in pediatric orthopaedics and spinal surgery, and the Spine Center at Cincinnati Children's was dedicated in his name. He has lectured or performed surgery in 41 countries and has trained 54 international fellows in pediatric orthopaedics and spine surgery.

Specializing in treating scoliosis, or curvature of the spine, Crawford is one of the nation's foremost authorities on video-assisted thoracoscopic surgery, which allows surgeons to insert rods through small incisions to straighten the spine. He is an expert on neurofibromatosis in children, a genetic disorder often associated with scoliosis. He has published more than 200 peer-reviewed articles, 63 book chapters and six books. A cum laude graduate of Tennessee State University in 1964 with degrees in chemistry and music, Crawford was the first African American to graduate from the University of Tennessee College of Medicine.

"Many challenges await you," said Crawford to graduates. "Personal debt, opioid addiction described by a former FDA head as one of the greatest mistakes of modern medicine, the Zika virus causing an imminent chronic disease epidemic threatening the Olympics, Affordable Care Act legislation, increased federal regulations and new payment methodologies (based on) patient satisfaction scores and pay for performance all usually resulting in decreased reimbursement."

Despite those challenges physicians now can benefit from technology that has led to improved laboratory testing and diagnostic body imaging accuracy along with advances in molecular genetics, pharmacogenomics and stem cell research, said Crawford. "The emergence of mobile health technologies is arming patients with more information and more control over their health. Smartphone apps and wirelessly connected medical devices are creating real-time data and enabling real-time interventions."

Crawford said technology will the differentiator in the marketplace.

"This is the best time ever to be a doctor because you can treat and or heal conditions that were untreatable even a few years ago," he said.  "The role that the physician plays has to transform from teach and preach to really thinking about how you create health information for the human that is with you for less than one percent of their life.  Equal efforts should be afforded to getting to know as much about the individual the disease attacks as the disease that attacks them, their happiness, their sorrows and how life is treating them.  All pain is not physical."

Crawford said he wanted this new crop of physicians to get back to the basics of medicine which include practicing good ethical behavior, using mentors, acknowledging medical errors, strengthening communication with patients, practicing culturally competent compassionate care and acknowledging the importance of cultural diversity in medicine.

"Always strive to provide treatment that is best supported by the evidence," said Crawford. "When equally efficacious treatments exist, provide the one with the least risk. If the outcomes and risks are equal, offer the treatment with the lowest costs. Some of you may have a tremendous debt and the call to unethical behaviors can be seductive."

Crawford said mentorship is a way to further growth and development and that seeking a mentor is not a sign of weakness. He also told graduates not to be angry at failure because often it is a stepping stone to success.  "We succeed by anticipating and obviating failure just as we do learning to walk, swim, roller-skate or ride a bike.  Every failure gives one the opportunity to begin again more intelligently."

Crawford said medical errors are considered the third leading cause of medical death in the United States. He said acknowledging those errors with transparency and offering recommendations for pursuing systemic corrections is paramount.

"One third of North Americans in medicine today have parents born elsewhere, including Asia, the Middle East, Africa, Europe and Latin America," said Crawford. "Look around you and the faces will reflect the changing colors of America. You are a rainbow of cultural, ethnic, educational and geographic diversity uniquely equipped to carry on the practice of our profession."

Members of the Class of 2016 will be entering residency programs in 29 states and the District of Columbia, with 39 percent of the class staying in Ohio for their primary hospital residencies. Of those, 20 students will complete all or a portion of their residency at University of Cincinnati Medical Center and eight will complete pediatric residency at Cincinnati Children's.

Crawford's speech was received by his audience, including by a former patient and new College of Medicine graduate, Kelsey Ann Kapolka.

"When I saw that (he was giving the keynote) I was thrilled, considering 12 years ago I came to him as a new patient and new to Cincinnati," said Kapolka. "He knew right from the beginning my interest in going to medical school and he was right there encouraging me and he actually put me in touch with a colleague of his who had a similar disability and had her meet with me and talk about the challenges."

Kapolka was a high school sophomore when she first saw Crawford, an orthopaedic surgeon, for spina bifida, a condition that affects the spine usually at birth. She hopes to be a pediatrician and will do her residency at Wright State University Affiliated Hospitals in Dayton.

"I think he was an amazing speaker and everything he said about patient care and treating the whole patient, he speaks from experience. You could tell that it was very genuine and he is that kind of physician. He was that kind of physician for me. Medicine is always something I wanted to do, especially pediatrics. Going in and out of the hospital, l knew I wanted to help kids in that capacity."

During Honors Day several awards were presented to students and faculty including the Leonard Tow Humanism in Medicine Award to George Smulian, MD, Ward E. Bullock Professor of Infectious Diseases and Director of the Division of Infectious Disease at the UC College of Medicine, and to fourth-year medical student Craig Hansen. The Tow award recognizes individuals who emphasize humanism in the delivery of care to patients and their families.

The 2016 Excellence in Public Health Award was presented to fourth-year medical student Sara Sadat-Hossieny. The award is given to a student who develops or implements programs that help educate patients about a specific disease or to promote healthy lifestyle choices.

Three College of Medicine faculty members also received awards for outstanding teaching and mentorship. David Fischer, MD, Department of Surgery, was presented the Golden Apple Award, while Robert Neel, MD, and John Quinlan, MD, both of the Department of Neurology and Rehabilitation Medicine, received Silver Apple Awards.

For more than four decades, medical students have upheld the tradition of giving "apples" to their favorite teachers at their commencement ceremony. The Gold and Silver Apple Awards Program was established in 1968 by the Pi Kappa Epsilon fraternity. The idea was to give the students the chance to recognize professors who had the most impact on their medical career—and life path—by serving as excellent instructors and mentors.