Good afternoon, my name is Sharon Anderson and I am the dean of the OHSU School of Medicine. It is truly my pleasure to welcome you to the Hooding Ceremony for the OHSU School of Medicine, M.D. Class of 2018.

Before I say a few words to our graduates, I want to say something to their family and friends.

Thank you.

I know that for many of you here today, the dream that your students are about to realize has been a shared dream, one for which you have put your own needs aside in order to make possible. Your steadfast belief in your students has been the wind in their sails. You helped them get through.

I also want to thank our teaching faculty, medical school leadership and staff.

I want to acknowledge that in the extremely demanding clinical world, it has become increasingly challenging for our faculty to carve out time to teach.

Your commitment to giving back and to keeping your own skills on the cutting edge by teaching the next generation is exemplary.

My gratitude extends to our many volunteer faculty, community providers and alumni who give their time to teach in the medical school.

And I want to add that for this class, like no other, the faculty and staff were not only our students' mentors, leaders, teachers and fan club, they were learning alongside our students as they ushered in the YOUR M.D. curriculum.

Now I have some words for our students.

Congratulations.

You did it.

Medical school is hard. It was when I went through, back in another lifetime, and it has only gotten more so.

Yet you have not only surmounted the everyday challenges of medical school; you have learned to do some very hard things well.

As part of the new curriculum, you have actually been tested on your ability to deliver bad news to patients and families.

You participated in a simulated encounter and had to show your compassion and clear communication skills in real time.

There is nothing more elemental in medicine than the moment that you have to acknowledge that there is nothing more you can do for your patient. 

Even harder still is recognizing that there is more you could do, but doing it is likely to create misery for the patient and not significantly lengthen life. 

I am a nephrologist who has treated kidney disease my whole career.

No one taught me that I could actually discuss with a patient, who had already been through a lot and is near the end of their life, that going on dialysis may not be worth it to them. But I learned to have those conversations because, ultimately, it is my responsibility to help my patients not only have a good life, but a good end of life.

You are starting your career in medicine knowing that being a compassionate communicator in the hardest of moments is a part of being an excellent physician. Your patients – and their loved ones – are counting on you and, because of your preparation, I know you will not let them down.

You are also doing other hard things well.

You and the classes following you have found your voices.

You've taken a stand for access to healthcare and against gun violence.

You have participated in Health Equity Week, providing free, basic medical care to people in Pioneer Courthouse Square.

You have gotten involved with the Bridges Collaborative Care Clinic, an entirely student run clinic that students across OHSU launched last fall to provide health screenings and primary care coordination for residents living in transitional housing.

And you are tackling some of the hardest topics.

You talk openly about institutional racism. About hardship and injustice for immigrants. About gender. About sexual abuse and harassment. And about your role as physicians in all of these things.

In doing so, you call out and hold to a higher standard all of us who came before you and were less equipped to do as you are doing.

But there is one really hard lesson that I am pretty certain you still need to learn:

You must learn to harness the incredible drive and passion that brought you to this moment of becoming a doctor. To truly succeed in taking care of others, you must also take care of yourself.

You must learn to recognize when you need a break and then you must take that break. I am the Dean of the School of Medicine. Consider my words your hall pass.

Because of the many hard things I have seen you do, I believe that you can do this too. You will help expand the national movement to reconnect with the joy in our work as physicians.

Use your passion as your beacon. Use it not only to care for your patients but also to go take a hike, get on your bike, listen to music, call up a friend.

In closing, on this day, I wish to offer you not only my congratulations but my gratitude. For the ways that you are, and the ways that you will, shape our profession and improve the care of all patients.

Before I return the microphone to Dr. Bumsted, I just want to repeat how proud I am of you and how pleased I am to be here to recognize your accomplishments and join your families and friends in celebrating this very special day. 

It is an enormous honor to be chosen by this class to speak. We came up together you and I – you are the first class that I have known all four years – and neither of us really had a clue as to what we were doing. And we embraced it.

For those who don't know me, I am the clinical thread director, meaning I teach the doctoring skills of history-taking, patient communication and physical examination. This thread runs through all of the blocks as the students spend their first 18 months learning the various organ systems, and this thread has bound us together.

I was never very involved in the pre-clinical curriculum before the transformation in 2014, and when Dean Bumsted called me to tell me I got the job I wasn't even sure I wanted it. I almost turned it down. I had a good life before all of this! I had work-life balance; I got to see patients, teach students and residents on the wards, keep up with the main journals, read non-medical books, rock climb, practice yoga, and go on long bike rides… life was good.

But there's an adage in academic medicine that you can do it all, but you can't do it all all of the time. A new curriculum is an unforgiving taskmaster, and for the past four years I haven't had time for most of those things and I have an extra 20 pounds to show for it. But having the privilege of working with you has been the single most rewarding experience I have had in a career that's exceeded all of my dreams, and all of my family's expectations. I'm not sure there is a person in this crowd not bound by blood or ring who is prouder of you and what you've become. And as my first class, like first love, you will always have a special place in my heart – third left intercostal space, by Erb's point.

You've come a long way in these four years – think back to your first clinical rotation, Step 1, your first OSCE, your first day of medical school, or all the way back to the youthful innocence of Frenchman's Bend – you have grown exponentially.

I was telling a student how difficult this speech will be, to say the right words to this class of amazing characters and personalities that I love and respect so much, and how it reminds me of being asked to speak at a wedding. She asked, "how many students are graduating?" 140 I think – to which she said, "No you're speaking at 140 weddings." Thanks Caroline Stephens, no pressure.

So how does one prepare for this?

I did what every commencement speaker has done in the past decade, I listened to David Foster Wallace's Kenyon address, This is Water, about a dozen times until I curled up into a fetal position because I can never come close to his brilliance.

I watched videos of the great orators – MLK, JFK, Emma Gonzales, and Naomi Waddler. I watched the speech that Dr. Alisha Moreland-Capuia gave last year, and it was brilliant and thoughtful and delivered with such heart. But I just can't channel Whitney Houston the way she can.

I asked my daughter, one of the wisest women I know, and she suggested I just talk about wolves, have everyone think I'm using them as a metaphor, waiting breathlessly to turn it back to your medical training but no, just stick with wolves.

Finally, I decided to use the formula of offering the advice I wished I had gotten when I was graduating, and sprinkling in a few quotes from Irish poets.

Let me start by describing for the family and friends the character of this class. They are the pioneers in this new curriculum. They are activists and dreamers, writers and jokers, singers and scientists, iconoclasts and comedians, mentors and survivors, a group so full of tenacity, heart and cool I'm humbled that they ever let me hang with them.

You were willing to be the first students in a new and unproven curriculum, the trailblazers. You helped guide this plane, drove changes to the curriculum, mentored the students who came after you, excelled in your clinical years, completed a four-year scholarly project and you have all landed as outstanding graduates, in excellent residency programs.

I wish I could take some credit for this, but you were born this way. Your future patients will be incredibly fortunate to have you on their sides.

And now, the real adventure begins. As with medical school, every year gets better and more challenging. Your life is a journey, and you are the hero of this epic poem.

Joseph Campbell described the hero's journey as occurring in 12 stages. At first, you were living an ordinary life, and then you were called to adventure. Perhaps you resisted the call, or like me, a dozen medical school admissions committees decided you weren't quite ready to go on this adventure the first year you applied. Maybe you met a mentor, and crossed the threshold into the special mythical world. You crossed one when you entered medical school, and now you're crossing another into residency.

Ahead you will face tests, you will approach the inner cave, face an ordeal, obtain your reward, journey home, undergo resurrection and finally return with an elixir, which at OHSU is usually Gleevec.

So what do I wish I knew when I started on my epic journey?

I really didn't know that being a physician would be so rewarding. We blend the best of science and humanism as we unravel the problems that have beset our patients and help them heal. We are so privileged. To call it a job or work is misleading. Cheapens it. You are in a profession where you are constantly stimulated – emotionally and intellectually – and you will learn new things about diseases and society and suffering and love and strength every day.

So what advice do I have for you?

Don't trust anyone. Your patients' lives are too valuable to rely upon hearsay and conjecture. You need to verify their history, do your own exam and follow up on all of their tests yourself.

Don't assume that others are right just because they have been around longer or are seen as experts. As Mark Twain said, "It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so." Except Mark Twain never actually wrote nor spoke those words, which proves his point.

Be humble. Arrogance is a fatal flaw in medicine – nobody talks about the healing power of arrogance because there isn't one, it's a poison. Remember when you enter a patient's room that it's not your stage anymore it's theirs, and that now you are a supporting cast member in their epic and they are the hero. Keep them as the center of your attention.

Be curious. Discoveries are made when we are curious, not just scientific discoveries, but insights into our patient's lives that can help them heal.

Use your words carefully because words have power. A patient being admitted to you isn't a hit, an IV drug user or a vasculopath, they are a son or daughter, mother or brother. People aren't defined by their diseases, so don't name them by their diseases. When you stop seeing your patients as people you lose your own humanity – I know because I've been there.

Read not in the casual way that you peruse People magazine, but read to master the material, because this is about real people. Read with the focus that you would for a big test, as you would an Anki card, because this is the biggest test, but this test isn't on pen and ink, or keyboard and monitor, or in a simulation lab, this is a test on flesh and blood, and heart and soul, and your preparedness may determine the difference between life and death.

No pressure.

So read, and observe, and find a good mentor who can coach you on your journey, and give you corrective feedback. I was fortunate to have many mentors, Faith Fitzgerald at UC Davis; Lynn Loriaux, Jack McAnulty and others here at OHSU.

Teach, not just because it is our duty as doctors, but because it will test whether you actually have mastery over a subject, and because it will feed your soul. The best teachers don't merely impart knowledge, they inspire. WB Yeats, another Irish poet said "Education is not the filling of a pail, but the lighting of a fire." Be that spark.

Master the art of listening, one of the most powerful therapeutic skills we have. You may think you don't have time, but if you just slow down, time slows down with you. Sometimes as little as five minutes of unhurried time with a patient can seem like an eternity, if you slow down and give them your complete, undivided attention, and I mean that in a good way.

Now, I want you to remember that this is a team sport. It takes everyone, not just the interns/residents/attendings, but also the nurses, therapists, aids, food servers and the janitorial staff.

One of the people with the most therapeutic bedside manners I've ever seen is Salim, a nearly seven-foot-tall, shaved-head food server from Kenya who spoke 18 languages and made everyone feel as though he was an old friend visiting from their own neighborhood, conversing on their front porch. This is what most patients want, connection with a real human. So get to know your team, and show them the respect they deserve; you might learn from them.

As a team sport, know that it doesn't all come down to you. Despite the best care, many of your patients will die or have complications – reflect on them and learn what you can to be better next time. Avoid assigning blame, to others and to yourselves, as blame is destructive, especially for those who care the most.

Your hours will be long, and you will be physically and emotionally challenged, and you need to take care of yourself. Follow the advice you would give to anyone one else, about sleep and exercise and diet and about being kind to yourself.

Sometimes the intensity and otherness of our experiences can be isolating, but remember this life was not meant to be lived alone.

Wolves are meant to live in packs, and the lone wolf can't survive in times of deprivation. Develop a community where you work, stay in touch with your classmates, and nurture the relationships that you have outside of work – don't drift away from your old friends, family and partners. When you say you're leaving now and will be home soon, be home soon. And when you do get home, save some of that life and charm for those who are waiting for and supporting you. Share your difficult experiences, with your colleagues, friends, family and when needed, a professional. I have been there, too.

So, in the end, what I want for you is what I want for my own child: that you will find happiness and fulfillment, more than to do well but to be well.

Remember when I said this isn't just a job? Well, maybe sometimes it is. I told you, don't trust anybody. Medicine isn't your whole life, you are more than this. Take care of yourself, and take care of each other. And this thing that we have? It doesn't end here. First love is eternal, and this thread that binds us is unbreakable.

I am truly honored to have the chance to speak with you all today – graduates and loved ones, staff and faculty. I had a phone call first thing this morning from both my sisters together, calling to tell me how proud they were of ME today and that they were thinking of me. My 82-year-old mother has been calling me for weeks wanting to know what I was going to say, gathering quotes and themes for me. So the first thing I really want to say to you all is, here's to our families! The ones we are born into and the ones we choose to gather around ourselves. Please join me in giving a giant shout out to all the loved ones who are with us here today – in person and in spirit!

My sisters this morning were sharing their stories about the day I first wore this robe. Each university has their own colors and designs for academic robes – this is Harvard's PhD robe, and they call this color "crimson," and as you can see I am joined by colleagues with all different degrees from all different universities. It also got me thinking about this symbolic ritual of hooding where your faculty will add these hoods to your robes so that people can see what kind of bird you are by your plumage. I want to congratulate each of you receiving degrees today – on behalf of staff and faculty, all of us – we are truly proud of your extraordinary and significant accomplishments!

It all takes me back 30 years to when I was sitting in your seats – I've been asking myself – what do I know today that I wish I'd known then?

The first thing I wish I'd known is that a career path isn't a straight line, it's more of a winding path. The first job I got out of graduate school was perfect for me on paper, it was exactly the type of job my notion of a straight-line career path said I should take. What I didn't anticipate is that I was terrible at it, and I hated it. I didn't connect with my students, I had nothing in common with my fellow faculty colleagues, I didn't care about the things I was being asked to teach there. It had looked as if it would be a great job from the outside, but it was pretty different how I felt inside, working in that job – it just wasn't me. I had followed the steps and it hadn't worked.

Which brings me to the second thing I know today that I wish I'd known then –

It turns out that career development actually benefits from a scientist mindset. Old-school career ideas use a more engineering mindset: "figure out where you're going, and then make a step-by-step plan on how you're going to get there."

What I know now is that for most of us, it's more useful to think like a scientist – testing out hypotheses, running process improvement "PDSA" cycles. It turns out that this is a helpful strategy in looking for a job, in looking to advance within your existing organization or line of work, if you're looking to change industries, or if you're looking to increase your leadership capability. Ask:

• What's your hypothesis of what you think you will enjoy and be good at?
• How could you design an exploratory experiment?
• What's your preliminary data, and how are you going to analyze it?
• Based on your preliminary results, what's the next experiment you want to run?

One of the reasons we don't think of our work lives as hypothesis-testing experiments has to do with what types of data we pay attention to.  For career experiments, there are external data points all around us:

• You apply for a job – do you get an interview?
• You apply for a grant – your proposal gets scored and funded/not funded.
• Your boss gives you a performance review.

These external assessments are potentially valuable, and yet they're not the whole picture, and sometimes we get unhelpfully focused on those external evaluations. I had a kind advisor Rivka Perlman tell me back in college that 80% of the feedback you get from other people is about them. 20% of it might be about you, but 80% of feedback is about the sender. And yet it's really human to get focused on those external evaluations.

Which brings me to my final "what do I know today that I wish I'd known then?" The main thing I've learned in these last 30 years is that there's really valuable data in here (gesture to my heart). It might be some of the most important data of all, if I'm trying to find a place where I can use my own unique gifts to make things better in some context that's important to me.

I've learned that I've got an internal compass built-in. It's not the kind of GPS where you type in the final address and it tells you the complete route. It's more like one of those old-fashioned pocket compasses, and the first thing I need to know is, what is True North for me? What are my values? What matters most to me? That's why it helps to have a clear vision of what difference I want to make, and a clear sense of why do I care? What's my "why" for the work I want to do?

I learned that my own internal compass needed some calibration. I needed to take seriously the data I was getting from inside myself, my own experience. My sister Michele's phrase for this is, "does this feel accurate for me?" It's her way of saying, is my compass pointing me to keep going straight ahead, or to turn left or right or even make a U-turn?

So a pivotal experiment for me came a few years in to my business school professor years when I had the chance to teach a new organizations course at an engineering school in Hillsboro as an adjunct faculty member. I developed a brand-new course for engineers who were learning how to be managers. I loved it, and much to my delight and amazement, so did they.

The students were all working professionals and the classes were these intense Friday/Saturday classes, every few weeks. And the content was on developing yourself as a leader, how to navigate complex organizational challenges in a high-integrity way. Quite a few of you here today have taken a version of this same exact class with me here at OHSU. I found my subject, I fell in love with the content of what I was teaching in a way that I never had with the content I was teaching at the business school.

I had found my True North – I wanted to make a difference in the lives of other people. I wanted to help them navigate their work lives more successfully. My first job wasn't meaningful for me – I didn't see a path to making a meaningful difference in the world, and I wasn't inspired. That all started to change when I worked with that first group of engineers, and it's really changed working with all of you here at OHSU.

Which brings me back to how delighted I am to be here with all of you right now. How much I enjoy connecting with each of you and how much I'm looking forward to witnessing where your paths take you next in your work and lives.

So what do I know today that I wish I'd known then?

1. It's not a straight line, it's a winding path.
2. A scientist mindset is useful in navigating our career paths – it's all our own individual series of hypothesis-testing experiments.
3. The most important data in these experiments comes from in here. What is there for me to learn from this experience? Does this work energize me or drain me? How can I take good care of myself, so that I can find a way to use my unique gifts to make a meaningful difference in the world around me?

In closing, my wish for each of you graduating today is that you find your flock. Looking out over all of us in these robes with these splashes of color here and there, it does really feel like we are a flock of birds with our colorful plumage.

Remember that we will always be part of your flock, your fellow students in the seats next to you and also the staff and faculty you've worked with over these years – we are all now your colleagues. Keep flying. Keep experimenting. Remember to use your own internal compass to guide you until you find your own flock in your professional life.

Thank you very much.