Month: December 2018
Service Before Self: The Legacy of George H.W. Bush
I’ve always liked George Herbert Walker Bush.
I realize, as I write those words, that it’s somewhat inappropriate and maybe even a little pretentious to use the term “liked” in reference to a former President of the United States who I never met or knew personally. It implies a familiarity I certainly can’t claim. Words like “respected” or “admired” might be more suitable, and are certainly applicable. But, in truth, “liked” is what comes immediately to mind. So, why is that? I think it’s because what has resonated with me as I’ve watched and read the various tributes since his passing a couple of weeks ago, and what probably resonates with most Canadians, are the fundamental human qualities- honesty and vulnerability-he maintained through his life. A few quotations provide insight into the character of the man.
In describing his neurologic symptoms that confined him to a wheelchair during his later years:
“It just affects the legs. It’s not painful. You tell your legs to move and they don’t move. It’s strange, but if you have some bad-sounding disease, this is a good one to get.”
While he was president, he famously indulged a life-long food preference by banning broccoli on Air Force One:
“I do not like broccoli. I’m president of the United States, and I’m not going to eat any more broccoli.”
In ending a contentious discussion with his Secretary of State James Baker:
“If you’re so smart, Baker, why am I president and you’re not?”
How can you not like someone so genuine?
Despite being what we might term a person of privilege, he seemed and acted like a regular, decent, fair and unfailingly respectful person caught up in powerful roles and great events. In terms of attitude and character he was, one might respectfully conjecture, an American that many Canadians can identify with and feel a certain kinship.
But none of that should detract from what he did or accomplished through his life. He was, arguably, the most qualified and best prepared person ever to assume the presidency, having previously served his country as a World War II combat pilot, two terms in congress, Ambassador to the United Nations, Special Envoy to China, Director of the CIA and two terms as Vice-President.
He advanced environmental concerns and worked to reduce trade barriers in North America. He led the US at a time when it was the only significant superpower in the world and could therefore have exerted unilateral authority. But he chose not to. Instead, he responded to the Iraqi invasion of Kuwait by firstly seeking the advice of the Canadian Prime Minister of the time, Brian Mulroney, and then working through the United Nations to form a multi-national coalition to engage the threat. When the former Soviet Union collapsed, he cautioned against gloating and maintained a respectful attitude. In a recent statement current Russian President Vladimir Putin provided the following tribute:
“George Bush Sr. was well aware of the importance of a constructive dialogue between the two major nuclear powers and took great efforts to strengthen Russian-American relations and cooperation in international security,”
He never wrote an autobiography, but wrote thousands of personal letters, casually composed but highly articulate and poignant, cherished by those who received them.
What is perhaps most remarkable about him is that, despite being what we might consider a “person of privilege” who could easily have chosen a life of quiet and private comfort, he made deliberate choices to engage public service, beginning with his decision to drop out of school and voluntarily enlist in the Navy at the age of 18 against family advice. He became a naval aviator undertaking 58 combat missions, during one of which he was shot down and had to be rescued at sea. That would have been enough for most people. Returning home after the war, he could easily and understandably have entered a comfortable private life as a successful businessman, but instead chose public service leading to the numerous positions and culminating in the presidency in 1988.
His family members, who have themselves taken up positions of social and political responsibility, remember his exhortation of “Service before Self”.
Perhaps the most revealing GHW Bush quotation are the words of a note he left in the Oval Office for his successor, Bill Clinton, who defeated him in the 1992 presidential election:
The last five sentences are perhaps the most telling of all and speak volumes about the author
You will be our President when you read this note. I wish you well. I wish your family well. Your success is now our country’s success. I am rooting hard for you.
Truly a life of Service before Self. A legacy and example for his nation. Indeed, for us all.
A holiday reading list on leadership and change
In his keynote address at the UGME fall faculty retreat on December 10, Dr. Gary Tithecott addressed the topic of Leading change for success in medical education during challenging times. Dr. Tithecott is Associate Dean, Undergraduate Medical Education at Schulich School of Medicine and Dentistry, Western University.
During his presentation, Dr. Tithecott cited a few books and mentioned others as worth delving into. As I like to do here, I’ve created a “Top 5” list from those he mentioned (OK, it’s actually six books, as he recommended two from a single author). These books are practical and accessible reads with clear advice, he said.
There’s still time to add some or all of these to your holiday wish list.
Mindset: The New Psychology of Success by Carol S. Dweck
The traditional attitude – Fixed Mindset – dictated that your fate is determined by skill you have genetically and that you demonstrate, Dr. Tithecott explained. With a Growth Mindset , by contrast, asserts that with dedication, encouragement and effort you can learn from and with others to increase your ceiling.
Since one key responsibility for a leader is to develop other people, a Growth Mindset is essential, he said. Citing an article from Forbes magazine, he noted a Growth Mindset allows leaders to
- Be open-minded
- Be comfortable with ambiguity & uncertainty
- Have strong situational awareness
- have a greater sense of preparedness
- have clarity on what others expect
- Take ownership
- Grow with people
- Eliminate mediocrity and complacency
- Break down silos
Grit: The Power of Passion and Perseverance by Angela Duckworth
One key to success in leadership, Tithecott said, is in the power of working hard and sticking to it. For a leader it’s supporting someone to go outside of their box. He quoted Duckworth:
Grit, in a word, is stamina. But it’s not just stamina in your effort. It’s also stamina in your direction, stamina in your interests. If you are working on different things but all of them very hard, you’re not really going to get anywhere. You’ll never become an expert.
Leading Change and XLR8 by John P. Kotter
OK, this is actually TWO books, not one. Noting that no talk on change and change leadership is complete without including Kotter, Dr. Tithecott recommended both Leading Change and the more recent XLR8.
He reviewed Kotter’s list of why change fails:
- Not Establishing a Great Enough Sense of Urgency
- Not Creating a Powerful Enough Guiding Coalition
- Lacking a Vision
- Under communicating the Vision by a Factor of Ten
- Not Removing Obstacles to the New Vision
- Not Systematically Planning for, and Creating, Short-Term Wins
- Declaring Victory Too Soon
- Not Anchoring Changes in the Corporation’s Culture
Leaders Eat Last: Why Some Teams Pull Together and Others Don’t by Simon Sinek
The symbolism of leaders eating last – exemplified by the US Marine Corp chow line, described by Sinek – points to leaders who put their team first. This in turn, leads to more acceptance of the challenges of change, Tithecott said.
The Leader Who Had No Title by Robin Sharma
Leadership can be found in different places and doesn’t necessarily mean the person “at the top”. Where and how leadership for change can be developed can vary, Tithecott said, recommending Sharma’s book.
The Essential Elements of Medical Education Transcend Politics and Culture
How do you judge a medical school? Specifically, how do you know if it’s providing an effective educational experience for its students? There’s no shortage of perspectives on that question. Everyone involved in medical education, from first year students to Deans, will happily weigh in. Theories and opinions abound, ranging from the rigorous application of systematic Program Evaluation involving the collection, processing and consideration of multiple pre-determined sources of data, to the “I know it when I see it” approach. Our accrediting agencies certainly favour a data driven approach, now requiring the analysis of twelve standards which break down to 95 elements requiring the collection and reporting of literally hundreds of individual points of information.
I was recently faced with this question, with the added complexity that the medical school was situated in a country with very different political and social structures than our own, and very different challenges to the delivery of health care. The school was in a large (very large) city in China, and I was part of a small team asked to provide perspectives on a recently developed English language program.
The obvious and perhaps easiest approach is to measure it against our established, North American accreditation standards. However, I found many of the standards, particularly those relating to issues such as diversity, admission procedures, faculty appointments and governance, simply did not translate to that cultural context. So, I decided to concentrate instead on the essentials – those elements that are foundational to any medical education process and should retain relevance regardless of social or political context. With that in mind, I concentrated on four “essential ingredients” of medical education.
The first, and most obvious, is students. Medical education is fundamentally about student learning and their personal development as physicians. They therefore need to be capable of learning and, probably more importantly, motivated by a true commitment of service to their future patients and communities. The students I encountered certainly had those attributes. They were very well-qualified academically, highly-motivated, ambitious and adaptable. They also seemed to have high levels of social responsibility and commitment to utilizing their medical training in the interests of their society. They are also all only children which, I came to learn, puts them under considerable pressure to succeed.
Students need to encounter teaching faculty, basic scientists and clinicians committed to the process of passing along their accumulated knowledge, experience and wisdom to the next generation of physicians. Their commitment must be based not simply on conditions of employment or obligations, but an almost instinctive impulse to teach that they see as part of their professional role and personal mission.
In China, I met numerous clinical faculty and curricular leaders during the visit who were uniformly committed to providing education both through formal teaching and in conjunction with their clinical responsibilities. They saw this as an embedded component of their appointments, and felt supported in their roles through provision of faculty development. When pressed, they admit that educational responsibilities are provided “over and above” their clinical or academic roles.
Together, students and teachers must encounter patients. Those patients must be accessible, representative of the conditions and circumstances students will eventually encounter, and be willing to participate in the educational process. In the Chinese school I reviewed, there was virtually unlimited and unfettered access to patients of all types. This is the result of the sheer volume of patients and pathology in a city whose population approaches that of all Canada. Whereas many Canadian schools struggle to ensure students are exposed to all clinical problems, clinical instructors in China are able to select patients for students to see and work with based on their educational needs. The Internal Medicine clerkship director pointed out how she is able to first identify what clinical problems any particular student needs to encounter, then select among multiple appropriate patients.
The fourth essential element is resources. These include space for teaching, facilities for basic science instruction and the equipment and technology necessary to provide contemporary medical care. This requires a commitment on the part of school and medical leadership to ensure resource stewardship, and mechanisms to ensure they have the means to ensure updating and refreshing into the future.
And so, in the end, the similarities were much more significant than the differences. It comes down to students, teachers and patients coming together in an environment providing adequate resources to allow the educational process to flourish. When they do, it seems education just happens, almost spontaneously. Without any of the first three fully in place, it’s not possible, even with outstanding resources.
The purpose of a medical school and its leadership is to ensure the essential elements are in place and well-supported. Once they are, education happens. The urge to learn and to teach, it would seem, transcend geography, culture and politics.