Medical School Hotline

On May 15th, I had the distinct honor of addressing the graduating class of 2011 as well as their family, friends, and loved ones. In my five years as president of the Association of American Medical Colleges (AAMC), I relish few invitations as much as those to speak at graduation ceremonies. And in my 13 years as a medical school dean, commencement always stood out for me as one of the most significant and important milestones in the life of a physician. Such wonderful feelings are bound up in commencement—pride in accomplishments, anticipation of what comes next, and a shared sense of joy and celebration. It is for these reasons that I felt so privileged to have shared in this special day at the John A. Burns School of Medicine.

Since returning from the beautiful JABSOM oceanfront campus, I have had time to reflect on my first visit to Hawai‘i's only medical school, what makes it unique, and the hopes I have for the class of 2011 and all future physicians.

What Makes the John A. Burns School of Medicine Unique

For me, the most striking characteristic of JABSOM is its incredibly diverse student body. In fact, I learned that JABSOM is the most culturally and ethnically diverse medical school in the United States, if not the world! The student population truly reflects the composition of the people of Hawai‘i, the Pacific region, and beyond—an admirable feat that medical schools around the nation are working hard to achieve, and one that the AAMC supports through efforts such as our holistic admissions initiative.

The primary mission of JABSOM is to train physicians for practice in Hawai‘i and the Pacific, and the school is succeeding on this front. Ninety percent of JABSOM students are state residents, and approximately 50 percent of the practicing physicians in Hawai‘i have graduated from JABSOM or the Hawai‘i Residency Program. These facts demonstrate the school's commitment to the people of Hawai‘i, a state with a higher than average prevalence of chronic diseases such as asthma and diabetes and a greater percentage of the population living in poverty than the United States average.¹

JABSOM's commitment to the Hawaiian people is also reflected in the career choices of its students. Half of JABSOM graduates enter residencies in the primary care specialties of internal medicine, family medicine, and pediatrics, or related fields like obstetrics/gynecology.² These specialties are integral to the creation of medical homes—places where patients can receive comprehensive care coordinated by a physician with whom they have a long-standing relationship. True reform of the nation's fragmented health care system cannot occur until we have the right numbers of primary care physicians in place, and JABSOM graduates will be well positioned to lead the change our health care system requires.

Lasting Impressions of a Celebration of Culture

Even before I left Washington, D.C. I knew that this graduation exercise would be different. Imagine my surprise and delight when I was told not to pack traditional graduation regalia, but an aloha shirt! (I couldn't help but wonder whether the debate in Washington would be more civil if legislators took their sartorial cues from island culture.) As the ceremony got underway, I couldn't take my eyes off the incredible amount of local color, from the delicate haku leis to the homemade Kihei garments. But what the absence of stiff formal wear lacked in familiarity, it overwhelmed me with comfort and a sense of ease.

As I settled into my seat and waited for the ceremony to begin, the first notes of the opening Oli chant, performed in the native Hawaiian language, signaled to me another beautiful expression of culture. The chant was every bit as much a call to ceremony as the traditional Pomp and Circumstance, but conveyed a unique sense of place. This element of the ceremony made it obvious to me why JABSOM excels at training professionals to care for the people of the Pacific—it recognizes that context, culture, and community mean so much.

Finally, I was touched by the ceremony's Maile lei-draping ritual. When I learned that the graduates received their Maile lei from a special person in their lives, I could only smile as those special people—loving sisters and brothers, proud mentors, and ecstatic grandparents—honored the graduates in this uniquely Hawaiian manner. In fact, there were tears of joy visible in more than one pair of eyes, especially for those for whom these graduates represented the first family member to complete college, let alone medical school. For all of these reasons, the JABSOM graduation ceremony will stand out in my mind as unique and among the most culturally diverse medical school commencements in which I have taken part.

Remembering Our Ethical Foundation

As new physicians, it is my hope that the class of 2011 never forgets the ethical foundation upon which medicine is built. The four ethical principles of clinical medicine to which physicians commit are wonderfully simple. The first is beneficence, an obligation to always seek the good in caring for patients. The second is non-maleficence, the rule of “above all, do no harm.” The third is autonomy, respect for patients as people, for their privacy, and for their decisions. The fourth principle of clinical ethics is justice, a physician's obligation to make certain that all patients are treated fairly and that resources are used wisely. Unfortunately, our nation has created a health care system that in too many cases is marked by injustice. There are patients receiving the best care, even receiving too much care, while other patients receive no care at all until they are so ill they are wheeled into the emergency room. When one examines the ethical principle of justice, it is evident that many aspects of the health system are falling short.

My Charge to the Class of 2011

I have great faith in the class of 2011 and all future physicians. These bright minds could not have taken on the challenge of medical school if they were not deeply committed to helping others and deeply motivated by core ideals and ethics. Whether volunteering at the Waimanalo Health Center or running free clinics for the homeless through the Hawai‘i Homeless Outreach and Medical Education Project, the class of 2011 worked hard to support Hawai‘i's most vulnerable populations. By reaching out beyond the campus to serve and educate others, each student learned that part of working in health care is a commitment to social justice.

I hope the JABSOM graduates will take time to remember the professional legacy they have inherited, and the ethical obligations that come with it. While these students are likely to forget that I addressed them on their commencement day, I hope they do three very important things:

1. Cherish the precious memories and enduring relationships formed in their years at JABSOM.

2. Adhere to the fundamental values of compassion, integrity, and service that lie at the heart of the Hippocratic tradition.

3. Find the courage to bring more justice to our health care system and make sure we never lose the sense of doing good and creating a better society. After all, that is what brought each of us to medicine in the first place.

I would like to thank Dean Hedges and the class of 2011 for allowing me to share this special day with JABSOM. I again extend my congratulations to our nation's newest physicians.