Getting Started
August 20, 2001
It is a delight for
me to welcome all of you to campus today. As the newest students of the
Medical University, you join an institution that traces its origins back
to 1824. Of course, a great deal has happened over the past 175 years,
both in the health sciences and at the Medical University. In fact, sitting
here today, we may find it difficult to appreciate the distance traveled
in that time. Let me try to put some perspective on the early years.
For those hoping to
avoid ever sitting through another history lesson, let me remind you that
you are now in Charleston. History is crumbling all around us here. Those
of you living downtown no doubt will experience the pleasures of ancient
plumbing. Moreover, the electrical wiring in some residences likely was
installed by one of Thomas Edison's contemporaries. If we ever feel
removed from the history of this place, the fresh aroma of horse droppings
from the never-ending parade of carriage tours will bring us back to our
senses. With that fragrant thought on our minds, let's travel back
to the dawn of the Medical University.
When the first classes
were offered here, Florence Nightingale was a four-year old girl in England.
Another 30 years would pass before she would lead a team of nurses in
their groundbreaking work of caring for wounded soldiers in the Crimean
War. When the Medical University was founded in Charleston, Louis Pasteur
was a two-year old toddler in France. Another 40 years would pass before
he would develop the technique of heat killing microorganisms that would
later bear his name.
A little closer to
home, when medical education was initiated in Charleston, a nine-year
old boy was growing up in a small rural town in northeastern Georgia.
In 1842, at the age of 27, he would become the first person to administer
ether as an anesthetic for surgery. This doctor's name was Crawford
Long, and in that pre-managed care era of medicine, his fee was a grand
total of $2.
Florence Nightingale,
Louis Pasteur, and Crawford Long all grew up while medical education in
South Carolina also was in its infancy. It is perhaps no coincidence that
this institution was born at a time that would see great advances in the
science and practice of medicine. Now is not the time for me to deliver
a lengthy treatise on the history of this institution. On the other hand,
as you are now joining the Medical University family, it seems appropriate
for you to know about those who preceded you here.
A medical school was
created in Charleston by the Medical Society of South Carolina, a group
of private medical practitioners, who named it the Medical College of
South Carolina. This first medical school in the South was only the fourteenth
in the United States.
The initial faculty
totaled seven individuals and 23 students enrolled in the newly created
school. From the outset, the financing of the school was tenuous. The
initial budget was cobbled together from a variety of sources. The state
contributed $10,000 to help establish the school. The City of Charleston
anted up $15,000 to compensate the faculty for providing medical care
in the local hospitals. The remaining $11,000 was contributed by the faculty
members themselves. If the support of the faculty seems surprising, consider
the fact that today the faculty and staff members contribute over $200,000
per year to the University. Some things just do not change!
After six years of
operation, the school was $7,000 in debt. Again, this sounds painfully
familiar, as the University has struggled through some difficult times
financially in recent years. The state legislature covered this debt,
but did not provide any on-going subsidy to the school.
Finances were not
the only challenge for the young school. Within a decade, the faculty
wanted to become more independent of the Medical Society that continued
to govern it. When the Medical Society resisted this change, the faculty
went out on their own and created a separate school. Although the Medical
Society attempted to reconstitute its school with a new faculty, ultimately
they failed as competitors. Within a few years, the two schools merged,
with governance separated from the Medical Society. Interestingly enough,
to this day physicians in private practice and faculty physicians have
a competitive spirit.
I could talk a great
deal more on this topic, but I have digressed from my historical account.
Let's return briefly to the history of the Medical University. There
are certain events about which you should be aware, if not in the actual
dates of occurrence, at least in their temporal sequence. Pharmacy was
the second college added to this institution, beginning operation in 1882.
A year later, the Nursing School opened.
The institution as
a whole was in a pretty sorry state of affairs at the turn of the twentieth
century. This condition was well documented by Abraham Flexner on behalf
of the Carnegie Foundation in a famous study of medical education. Flexner
visited all of the 167 medical schools then operating in the United States
and Canada, reviewing each of them. He concluded that not only did too
many schools exist, but more importantly, the quality of most of the schools
was deemed substandard. Unfortunately, our school was no exception. In
his report, Flexner noted that we had "very meager" equipment,
no library "except for antiquated publications" and no full-time
faculty members. Flexner's assessment was substantiated by the "C"
rating assigned to us in the first survey of medical schools for accreditation
in 1910.
The silver lining
in the clouds of these critical reports was the attention focused on the
need to improve medical education in this state. These enhancements required
resources beyond those that could be raised through student tuition. The
State of South Carolina assumed responsibility for the school in 1913
and almost immediately the accreditation rating was moved up a notch.
The following year, the school moved to its present campus location. The
façade of the first building on this site is the front of the Hollings
Cancer Center, just around the corner from here.
Jumping forward in
our time travel, the creation of a dental school was approved by the General
Assembly in 1953, although the first class was not admitted until 1967.
The College of Graduate Studies was founded officially in 1965. The following
year, the Allied Health School, today known as the College of Health Professions,
was created.
Fortunately, the long
history of this university is not defined entirely by feuds between doctors,
financial woes and accreditation problems. While we are well served to
know the weak limbs on our collective family tree, we also should be aware
of the strong branches. One of the early deans, James Moultrie, was a
founding member of the American Medical Association in 1847. Three years
later he became its President. Interestingly enough, a few months ago,
a graduate of this institution, Dr. Randolph Smoak, completed his term
as the 155th president of the AMA. As mentioned earlier, some things just
do not change.
Returning to the 19th
century, this institution was shut down between 1861 and 1865 because
of the Civil War or as it is politely referred to in Charleston, "The
Recent Unpleasantness." In dealing with the casualties of that conflict,
the faculty made important medical contributions. Surgeon Julian John
Chisholm invented the chloroform inhaler for anesthesia. When the Union
government declared medical and surgical supplies as contraband of war,
these materials came into short supply in the South. Faculty member Dr.
Frances Peyre Porcher published a treatise in 1863 on local botanicals
that could be used as substitutes for traditional medicines. Surgeon and
Dean Robert Kinloch was the first to perform successful intra-abdominal
surgery for a gunshot wound to the intestine.
A few decades later
surgeon and Dean Francis Parker was the first to suture a severed nerve
and restore function. In 1936, Dean Kenneth Lynch along with colleague
William Smith linked asbestosis with cancer. In 1947, surgeon Horace Smithy
conducted pioneering work on heart valve surgery. Albert Sabin, the developer
of the oral vaccine against poliomyelitis, served on this faculty between
1974 and 1982.
So, as we can see,
a fair amount has happened on this campus before either you or I set foot
on it. From the historical perspective of this university, it is easy
to conclude that your presence here as a student is little more than a
footnote. If it makes you feel any better, sometimes I feel that way about
my own contributions as president. Before you settle into easy anonymity,
however, let me assure you that no event in this long history is more
important than your arrival today.
Now, it may seem presumptuous
for me to make such a grandiose statement about your matriculation. You
may even think that my remark is a pathetic attempt to pander to your
vanity. Please be assured, however, that I am not here to stroke your
collective egos. Rather, my goal is to help you appreciate the expectations
that will be placed upon you.
Admittedly, it may
seem premature to speak of such expectations. After all, you have just
arrived on campus, and in all likelihood, you are feeling a bit overwhelmed
at the moment. You may not even know yet where your classes are meeting
or what your schedule will be for the coming semester. No doubt, it seems
all too soon to be talking about courses; instead we may need to focus
on the basics of survival.
I can fully appreciate
these feelings. Twenty-five years ago almost to the day, I arrived at
medical school feeling equally overwhelmed. Although a quarter of a century
may sound to you like a very long time ago, for me, it has passed all
too quickly. Indeed, it is a sobering reality to me that most of you were
not alive when I matriculated into medical school. Rarely do I feel like
an old-timer, but today may be an exception to that rule. Hopefully, you
will forgive me if the shadows of nostalgia fall too heavily upon the
following observations.
The focus of my attention
as president is on the present and the future. That is why I attach so
much significance to your arrival today. After all, you are the future
of the health professions in South Carolina and beyond. Our task at the
Medical University is to prepare you not only for your immediate role
as a student, but also for your ultimate role as a caregiver, a researcher,
or an educator. While we orient you today as a learner, simultaneously
we are beginning the process of assimilating you into your new profession.
In so doing, the best
place to begin is to reflect upon the health of the population that we
serve. A popular belief exists that American health care is the best in
the world. In a certain sense, that is probably true. No other country
in recent history has had as profound an impact as has the United States
on biomedical science or clinical progress. Whether one measures that
impact through publications, patents, medications, devices, facilities,
or any similar indicator, Americans have been the leaders in discovery,
innovation and invention. In this country, we go to extraordinary means
to save a life, as demonstrated by such heroic efforts as organ transplantation.
It may surprise you,
therefore, that the United States does not lead the world in indicators
of the health of its people. For example, the World Health Organization
ranks the United States 24th in life expectancy, a category in which we
trail Malta, and barely outperform such powerhouses as Cyprus and Dominica.
Similarly, despite all of the progress in managing high risk pregnancies
and the intensive care of newborns, the United States ranks 15th in infant
mortality. If for some reason you think that the death in the first year
of life is not a representative measure, consider the probability of death
for adults between the ages of 15 and 59. In this category, the United
States ranks a disappointing 30th.
Another sad fact is
that despite spending more per person on health care than any other country
in the world, and despite leadership in medical innovation, the United
States is far from the healthiest country in the world.
Should you think that
South Carolina is somehow an exception to this rule, unfortunately, that
is not the case. This state has the 5th highest death rate in the U. S.
from heart disease, the most common cause of death. We have the highest
death rate from stroke, the third most common cause of death. For many
forms of cancer, such as malignancies of the prostate, pancreas, esophagus,
oral cavity and cervix, we rank among the highest five rates of death.
As these statistics
clearly demonstrate, the challenges facing the health care system are
great. Those of you who are preparing for a career in the delivery of
health services will be on the front lines of many of these concerns.
Others of you will pursue careers in research, teaching or administration
- a step removed from the clinical arena. Regardless of your professional
pursuits, however, each of you will have something to contribute toward
addressing these health challenges. In a real sense, that process begins
today.
Surely, nobody could
fault you if your current thoughts are much more focused on merely surviving
the next few days than on the challenges that you will face years down
the road. As the saying goes, "first things first." The rigors
of your academic program soon will be upon you. In short order, you will
find yourself confronted with more information than you or quite frankly
any other human being, can possibly assimilate. Under these circumstances,
for perhaps the first time in your life, you are likely to feel inadequate
to the task.
Such feelings are
quite normal – virtually everybody who has preceded you, myself included,
has experienced them. By our very natures, those of us who enter into
health professional schools are competitive people. We are accustomed
to being at the top of the class and we will not be pleased with anything
less.
As you well know,
the pathway to academic success begins with intellectual ability. Everyone
in this room has been blessed with a keen intellect. Talent alone has
not gotten you here, however. You have demonstrated through your hard
work that you can apply your abilities with enthusiasm and with purpose.
Your achievements to date have convinced us that you are capable of success
in this environment as well.
Still, in all likelihood
a time will come when you question our judgment, or your own abilities,
or the depth of your commitment, or all three. When that day arrives,
and for some of you it may be soon, I hope that you will remember the
following advice. A big difference exists between feeling inadequate and
actually being inadequate. Feelings of inadequacy arise when our performance
falls short of our own expectations, or what we presume to be the expectations
of others.
The emotions of such
situations often prevent us from rationally examining the assumptions
under which we operate. My caution to you, therefore, is to try to evaluate
if your expectations are reasonable. The assumptions that served you well
in your previous academic pursuits may not be valid here. In college courses,
for example, you may have been able to commit virtually all of the assigned
material to memory. Except for those of you with photographic memories,
it will be virtually impossible to recall all of the material to which
you will be exposed here.
Even if you could
cram your cerebral cortex full of all that information, stuffing your
gray matter is not the goal to which you should aspire. Effective health
care professionals are not necessarily those who can retain the largest
number of bytes of data. While random access memory may be critical in
the world of computers, it does not have the same intrinsic value for
human beings.
Instead, we hope that
you will develop the skills to locate the relevant information, evaluate
it, integrate it, and apply it. These are the ingredients of effective
problem solving, and they are far more important than any particular set
of facts. As new discoveries are made, what you are taught today as factual
information is likely to evolve anyway. Believe it or not, when I attended
medical school, just a quarter century ago, the human immunodeficiency
virus had not been discovered. I was taught that diet and stress caused
peptic ulcers, but today we know that most of these ulcers result from
infection with a bacterium, Helicobacter pylori. When I trained in pediatrics,
the leading cause of bacterial meningitis in children under age 5 years
of age was Haemophilus influenzae - a bacterium that is now virtually
eliminated among American children through the introduction of an effective
vaccine.
I could go on at length
about the advances in medical diagnosis and treatment that have occurred
since I graduated. Again, perhaps I am dating myself here as some sort
of relic. My point, however, is that the knowledge base that I acquired
in school, although current at the time, rapidly became outdated. If anything,
the pace of scientific discovery has accelerated since then. As a result,
the shelf life of facts that we present to you over the next few years
will be even shorter than that for the facts that I was taught. This is
not an excuse to avoid learning the facts, just a caution not to worship
them with undue reverence.
Far more important
is your ability to reason through complex problems. Our goal is to help
provide you with the skills necessary to solve these problems. In order
to do so, you will need to be able to characterize the problems, collect
relevant information, interpret the information that you have collected,
and then act accordingly. Whether your ultimate career pathway takes you
into clinical care, teaching, research, administrative work, or some combination
thereof, you will need to call upon problem-solving skills.
It is worth taking
just a moment to reflect upon why you would be interested in these skills
in the first place. Undeniably, each of you has personal reasons for wanting
to enter the health professions. For some, you may be continuing a family
legacy. For others, the imperative of serving your fellow citizens is
the motivation. For still others, the thrill of helping to advance knowledge,
either through teaching or research drives you. I suspect some of you
even found your way here in the pursuit of financial rewards. Regardless
of the reasons behind your original decision, my task is to assure that
your education here begins with the proper motivation.
It is tempting to
think that you are here for yourself. After all, it is only through years
of study and commitment that you have met the standards of admission into
this University. At times, being a student here may seem like a lonely
pursuit. Whether studying by yourself in the library or working alone
in a laboratory, you may find greater focus in solitude. As you pursue
these efforts, however, you should not lose sight of the fact that you
are part of a much larger enterprise. I am not just referring here to
the rest of the students in your class. I am not even limiting my reference
to the students in your school, or even to all of the students on this
campus. As of today, you are now part of the Medical University of South
Carolina. You join almost 2,500 students, over 500 residents, more than
1,200 faculty members, and over 7,000 support staff. We value team effort
and we applaud efforts that draw upon the knowledge and skills of all
of our team members.
No doubt, an institution
this large feels impersonal at times. One cannot possibly know everybody
who studies and works here on a first-name basis. You may be tempted to
assume, therefore, that you are just another face in the crowd. Let me
assure you that you were hand-selected to join us. We feel privileged
to have you here and we will do everything that we can to promote your
success. For it is through your success that we will achieve our ultimate
purpose, which is "to preserve and optimize human life in South Carolina
and beyond."
As we strive to improve
the health and well being of the citizens of our State, you are the agents
of change. You will advance medical knowledge, educate the public, deliver
care, and develop policy. Through your efforts, access to basic care will
be made universal, regardless of financial means. You will work to remove
disparities in health, along racial, ethnic and geographic boundaries.
You will advocate for the needs of our citizens and become the voice for
those who cannot be heard themselves. You will work to make our communities
healthier and safer. You will translate new knowledge into clinical application
for the benefit of our fellow citizens. You will lead the biotechnology
revolution of our state and lay the groundwork for the industry of the
21st century. You will lead us into the future of the health professions.
As you can see, we
have high expectations of you - let's get started. |
