Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

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GEORGE J. BAYLIN, M.D. RADIOLOGY Be critical, but understanding, be skeptical, but receptive to change and innovation, be provocative, but not punitiveg strive always to excite your col- leagues, never to incite them. Distinguish critically between growth and development and understand the basic differences between bigness and greatness. Graduation heralds for each of you a porten- tous change. You shift from medical student status to that of student of medicine. No longer is the storage of facts, the cramming for exami- nations, the attainment of grades, and the fear of superiors the way of life. Now you must make decisions, assume great responsibilities, shape the destinies of others, and acquire not only knowledge but wisdom. The challenges are great and will tax your ability and in- genuity severely. lt will require intense ef- fort and dedication to meet them successfully, but you are being launched with a sound back- ground buttressed by a magnificent Duke med- ical tradition. Lest you not be conversant with that tradi- tion, I will wax nostalgic and detail brieiiy some of the pillars on which it is founded. Graduation from the Duke Medical School endows you with stature and prestige even beyond that which accrues to you by virtue of your newly acquired distinguished degree. Why? Your school was founded on a bold new pro- gram of medical education that immediately caught the imagination of all involved. More- over, it soon commanded the attention and respect of physicians, scientists and educators throughout the country, indeed, throughout the World! Its basic discipline was hinged on a teacher- student interchange that featured mutual un- derstanding and respect. The prime emphasis was on hard earnest effort featured by a phi- losophy that learning, though infinitely diffi- cult, is nevertheless exciting and enjoyable. Student knew teacher-teacher knew student, not merely through the written regurgitation of facts, but via daily personal exchange. The interplay was based on intimacy. Each chal- lenged the other to greater effort and achieve- ment. Another major attribute that characterized the young new school was the inherent disdain for intellectual complacency manifested by its members. Everyone was constantly engaged in determining how best to improve all the phases of school activities. Fortunately, the young, in- dustrious, and energetic staff members pos- sessed magnificent maturity, particularly with respect to their own errors. Even the student was permitted the privilege of being wrong- given the chance to try once again to collect his thoughts, to regroup his ideas so as to re- cover from the inevitable false starts which beset us all. Also, infinite wisdom prevailed with regard to the recognition of those important differ- ences in individual ability, thus permitting each student to be directed in a meaningful fashion toward the attainment of his goals. The zest and dedication of purpose was con- tagious. The result was almost electrifying. Cln a few brief years Duke Medical School had acquired more than a reputation-it had ac- quired character that was destined to be ap- preciated in all cultural and scientific regions.J Graduates from such a program were obviously destined to carry forth a message that would soon be heard and understood. twenty-seven

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Immediately, I was quite pleased, and a little flattered, to be asked to write for the 1965 edi- tion of the AESCULAPIAN. When the request to submit a short essay of your philosophy of medical education and practice was more thoughtfully considered, however, it became apparent that an immediate rendering of such a philosophy was difficult, either because of complete lack of it or because of inadequate introspection concerning it. Once the invita- tion to write had been accepted the challenge had to be met. It is easier to write of medical education than of medical practice, because more of my time has been spent in working with medical students than with patients. To a considerable degree, however, Work with the two groups is similar. Each student and each patient is an individual with certain specific needs in addi- tion to, or in spite of, certain non-specific or generalized qualities. These specific needs call for specific handling rather than routine pro- cedures. ln addition to specific treatments though, there is a common ground of care in a medical education, as there is in medical practice. In my concept of medical education one is always a student. He is an adult all along and is to be treated as such. He should be indepen- dent to a degree, but will need guidance and cooperation as well as challenge. The last, how- TALMAGE PEELE, M.D. ANATOMY, NEUROLOGY, PEDIATRICS The concept of the patient's being an ordinary human in need of specific help should be upper- most in the student's mind. ever, should be administered as pleasantly as possible and still be meaningful. A family-like spirit should be engendered by the faculty, not one similar to boot camp. And there should be ample opportunity for social exchange not only at student-sponsored events, but in faculty homes. A student should learn that it is just as valu- able to know where to find more useful facts as it is to have them immediately available. The pursuit of more facts may lead him spon- taneously to a research program. Toward this he should be encouraged, but not driven. Not every medical student is emotionally or intel- lectually suited for research in the basic sci- ences or even in the clinical field. Neither is every enrollee in a medical school suited for administeringito and caring for patients. Varia- tion in curriculum appears necessary therefore. The medical student should have fun in his studies of biologic systems, and he should not lose sight of systems that are not biologic. The Arts have a place in medical education. While he should learn to classify and categorize for reasons of simplification, he should avoid dogma and learn that nothing in medicine is absolute. The concept of the patient's being an ordi- nary human in need of specific help should be uppermost in the studentis mind. The patient should not be a number merely subject to a set routine of tests. A need for each study should be apparent, and a so-called shot gun survey should be avoided. Many times per- sonal inconvenience to thepatient and undue expense to him or his sponsoring agency can be avoided by the careful exploitation of the old fashioned techniques of palpation, percus- sion, and auscultation. The medical curriculum should permit the student to have ample con- tact with those practitioners of clinical medi- cine who are masters of these simple tools. It is my impression that the more practical aspects of medicine can be learned at the bed- side, rather than in a laboratory. Once these are acquired, the student who desires to, may move into the laboratory, temporarily or per- manently. The other student will continue to learn at the bedside. ffl twenty-six

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That is the background responsible for the Duke character and fame. And how gratifying it is periodically to exchange with the grad- uates Hung far and wide those pleasant memo- ries of medical days. These exchanges have essentially become a trade-mark, one incident- ly, that is often the envy of medical colleagues who studied elsewhere. Take this heritage with you and carry it to greater heights. Use your Duke background as the fulcrum for sound progress. Be critical, but understanding, be skeptical, but receptive to change and innovation, be provocative, but not punitive, strive always to excite your col- leagues, never to incite them. Distinguish critically between growth and development and understand the basic differences between big- ness and greatness. Those who choose the role of practitioner of medicine accept the greatest challenge of all. It is diiiicult to administer to the sick, to help the infirm, to comfort the bereaved and to guide the confused. For those who do it well, there is the reward of personal satisfaction A major point of self-orientation toward medical education is the realization that the process of learning never ends. The true stu- dent of medicine sees the satisfaction of self- education from the enjoyment of learning new facts and evaluating these in regard to their potential practical application. The student and material success. The teacher-investigator- academician also plays a complex role that car- ries with it grave responsibilities. Truthfully, there is no choice between the various disci- plines of teaching, service and research. It is to no avail to disparage one or the other. There is but one choice-excellence in all. Bring the disciplines into balance so that each may flourish, and there can be no doubt about a great future. It is for you to accept the challenge, meet it without fear, and turn the turbulence now about us into a meaningful, productive, order- ly discipline of progress and change. Good luck! 1 If X I fly MADISON S. SPACH, M.D. PEDIATRICS The true student of medicine sees the satisfac- tion of self-education from the enjoyment of learn- ing new facts and evaluating these in regard to their potential practical application. who develops habits of self-education which are not dependent upon outside stimuli and pressures is indeed fortunate, as this will in- sure continued interest and work at learning long after medical school has been completed. There can be no substitute for hard work, for only through this can the individual achieve his potential contribution in such a demanding field. Thetmajor satisfaction achieved by striv- ing to be a better student and a better practi- tioner of the art of medicine is derived pri- marily from the fun of the work involved, rather than from recognition by others of the individual's contribution. In medicine, a job well done is truly its own reward. MW twenty-eight