Student Clinician Keynote Address
Keynote Address: Celebrate This Day!
The following essay is an extract from the Keynote Address delivered by Dr. Mark Nunnally earlier this summer at the Student Clinician Ceremony, as part of the Orientation to the Clinical Biennium for the rising class of third-year students.
Members of the incoming Pritzker clinical class:
Celebrate this day! Remember with pride the accomplishment that comes with completing pre-clinical studies. You have accomplished a lot in preparing yourselves for the clinical curriculum. From here forward your lives will never be the same.
Mark Nunnally, MD
Assistant Professor of Anesthesia and Critical Care
Prepare for the unexpected. This is the best advice I can give to you. When, someday, you reflect on the memories of medical school, you should not so much ponder what you planned for as you should explore the significance of what you did not see coming.
Uncertainty can bring great things. There are many celebrated discoveries where observant clinicians happened upon something innovative even though they weren’t seeking it. Alexander Fleming noticed that bacteria didn’t grow around a mold contaminate on a culture plate. Horace Wells observed a man, intoxicated by nitrous oxide gas during a traveling medicine show, injure his leg and not notice the pain. Should chance discoverers really deserve credit for stumbling into something important? Absolutely. They had the presence of mind to recognize and seize opportunity.
The word for unintended discoveries is serendipity. Interpreted liberally, serendipity implies that there are opportunities for discovery everywhere. Serendipity can impact your training through achievement and through perspective. Achievement results from using chance opportunities to make something good. Perspective changes as one becomes aware of the possibility of possibility, leading to opportunities, and altering how you think about what you see.
Opportunity. Achievement. Perspective. Think about these during this time of transition, and how they might shape your future experiences. Prepare for the unexpected.
Preparation can significantly impact your clinical achievement. “In the field of observation, chance favors only the prepared mind,” said Louis Pasteur. As you begin your training in the wards, be prepared. The time you spent in the classroom mastering the basic sciences left you with the tools to make the most of what you will experience, be it by plan or by chance. Make the most of your preparation by adding to and refreshing your knowledge. Even five minutes with an anatomy book before a surgery can be valuable time.
Think about perspective. Each patient is potentially the one who will stick in your mind forever as an example of a great save or a tragic loss. Some will teach you more in a few days than you learned in a semester, if you look for the opportunity. Reinforce that learning. Keep notes. Maximize the chances to learn.
As you develop your clinical skills, use serendipity to become a better clinician. Find perspective on how to practice; don’t settle only for simple right and wrong approaches. Recognize how much is complex and unpredictable. You might find yourselves developing instincts. Cultivate these, as they are signs. They show that you are beginning to connect what you have learned to a clinical situation.
How does one best take advantage of chance opportunity?
First, keep your eyes open. Yogi Berra said, “You can see a lot by watching.” Look for the chance opportunities, the subtle clues, the things you would not expect. This requires an open mind and an attention to detail.
Second, seek insight. Ask questions of your teachers and of yourself. You might question the value of something, but also try to understand the reason things are the way they are. Questioning authority can be good if it leads to understanding, but be cautious about walking away from guidance. By becoming independent while still unprepared, one is less ready for discovery.
Finally, with perspective, make the most of an opportunity. Just because things don’t go as planned doesn’t mean there isn’t a positive side. Of course there will be bad developments and sad, sometimes tragic, news. The bad doesn’t go away with this outlook, but sometimes the good comes into clearer focus.
Some of you know, or think you know, what you will be doing after medical school. Some of you are unsure. Remember that you never know what you might find. Be ready to have your perspectives change with experience and be open to the possibility that the thing you dislike today might be the thing you love tomorrow.
In the years to come, there will be many memories. Your first delivery. Your first surgery. The first time you have a patient you care for die. When you remember the moments, also remember what you learned that you did not expect.
Prepare for the unexpected. And celebrate!
