2021 Commencement

You may be seated. Good morning and welcome to all of our faculty, staff, students, and guests whether joining us in person or watching the live stream. We gather today in this beautiful historic venue which has become our tradition to celebrate the commencement ceremony of our eighth graduating class the class of 2021 from the Virginia Tech Carilion School of Medicine.

A medical student does not make it to this day alone. There are many others supporting, encouraging, and guiding them in this journey. I imagine many of those supporters are watching the ceremony today from spouses and partners to children, parents, grandparents, siblings, extended family, and friends. Fellow students, alumni, and many others each contributing to this journey in unique ways. Many attending virtually today are faculty physicians, educators, scientists, other health care professionals and patients. All of them have contributed to the education of our students. Through your efforts, each student is now poised to continue their training and to become the practicing physician you would choose for yourself or your family, the kind you would want to call my doctor.

And finally, to the guests of our graduates who are here with us in person today. Each of you has affected the life of one of these students in a way that has shaped their development into thoughtful, curious, and humanistic physicians so students, before we continue with our program I  would ask you to join me in thanking everyone here who has made this day possible for you. Thank you.

Every graduating class from our school is special but you, our eighth class, have been particularly high achievers. You were chosen from more than 4,403 applicants, more than 100 applicants per position, and triple the number from the inaugural class. Each of you came with strong academic and research credentials. It is you, our students, who are continuing to build the reputation that is consistent with the vision of the Virginia Tech Carilion School of Medicine. As a research intensive school, your class achieved exemplary scores on the USMLE exam. Your recent success in the 2021 match has set the bar very high for future classes.

During your time at VTC School of Medicine, you have helped our school grow stronger in its reputation for excellence and you have been key contributors in building the culture and community both within the walls of our buildings and within the greater community that defines our school of medicine. Class of 2021 you have indeed met and exceeded our expectations and we are very proud of you. Now it's your turn to give the audience a student perspective of the class. Two students have been selected by their classmates for this honor, Mr. Mehdi Elmouchtari will speak first followed by Mr. Giovanni Malaty. 

Hello everyone. So, I'm honored and humbled to be standing before you all as we congratulate the class of 2021 on this momentous day. Before you sit 38 of the most driven, accomplished, and talented people I've ever had the pleasure of knowing. Parker Hambright is also here today. You can wave to the nice people, Parker. As a student in the class of 2021, I've had some trouble deciding what exactly I want to convey to this audience. I could attempt words of wisdom but I'm just as clueless as the rest of you. I have no idea what's coming my way so that's out of the question. Instead I'd like to direct this speech to those who have gathered here in celebration of these freshly minted doctors.

What should you expect from this next stage? Well I think we need to be on the same page about the challenges facing us over the next three to seven or more years. Residency is hard. At its best, it's an incredibly rigorous training program that tests the limits of our endurance and intellect. At its worst, it's the systematic exploitation of a captive labor force. The pandemic has made that all too clear.

Graduating today are some of the highest achieving people in their extended families. These are the people who we don't need to worry about. They always land on their feet but residency will be unlike anything we've ever experienced before. And your job as the loved ones of these young doctors will be to check in once in a while. A phone call or even a text can go a long way especially on a difficult rotation.

And for my classmates. I've seen you in the trenches handling the rigors and sometimes the disappointments of medical school, the Herculean study sessions, smuggling emergency department trail mix to meet your daily caloric needs - that one's just me I've never seen anyone else do that. Wiping the sleep from your eyes in a futile attempt to keep up with Dr. Skolnik at morning report. Hi Dr. Skolnik! But I've also seen how much else you have to offer.

In this class I've met poets, painters, sculptors, humorists, musicians, teachers, missionaries, athletes, explorers, survivalists. So many of you have met and married the loves of your lives over these past four years and while you will undoubtedly find high quality mentorship in your training programs, your employer is the hospital system and they won't go out of the their way to preserve those sides of you. That's not their job, that's your job to defend and cherish that which gives life meaning and do it fiercely and without hesitation.

To close, this class does not just contain a group of highly qualified and impressive individuals. You represent tens of thousands of future patients who will be served by your intellect and knowledge as well as your humanity. Before I hand the stage to the brilliant and handsome almost Dr. Giovanni Malaty, I'd like to thank the family, friends, the faculty, the residents, and the patients who have contributed so much to get us to this point. Congratulations to the class of 2021.

So now I'd like to introduce Giovanni Malaty who's not just a close friend and our class president but a good friend of mine and the best super mario 64 speedrunner I've ever lived with. Thank you. 

Families, loved ones, esteemed faculty members, and class of 2021. My dear friends, I could not imagine an honor more humbling than being able to address you all one final time at graduation. Like many of my emails, I promise to make this speech unnecessarily long and boring.

Over the past four years, I have often been asked the question, how would you describe the class of 2021? Philosophical questions pondered by the likes of Plato, Aristotle, and Descartes surely pale in comparison to this question. Labeling this class with any one unifying quality or description is categorically impossible. These 38 people just don't fit in any singular box.

Dr Harrington once described our class as having lots of character. In writing the speech I decided to circle back to this proclamation, so I grabbed a McAllister's club sandwich and a dictionary. There I found three distinct definitions of character.

• Definition one: referring to a person's good and unsullied reputation. Yeah definitely not what he was talking about. 
• Definition two: a description of sound mental and moral attributes that give an individual high status. Not that either. 
• The third and final definition I came across I was convinced was the definition that he was referring to and the perfect term to describe the class of 2021. Character, noun: a quality of being individual in an interesting or unusual way. I'll give you three interesting and unusual ways that the class of 2021 is interesting.

This class is utterly brilliant. These 38 are, without a doubt, the highest functioning, most intelligently refined individuals I've ever come to know. With great ease they are able to absorb tens of thousands of pieces of information, much of that information bearing life and death implications, and recite it with precision at a moment's notice. There are estimates that the average medical student learns approximately 15 to 20,000 new terms during medical school but these are not simple terms, dictionary one-liner terms. These are terms like oligodendroglioma and hemophagocytic lymphohistiocytosis. Each of these terms with dozens of their own branches and offshoots of pertinent pathophysiologic, diagnostic, and therapeutic information that opens the door to hundreds of additional terms with their own definitions and so on. I can already see some of my classmates leaning over to explain those two words that I said to their families. See that's exactly what I'm talking about! This class is immensely brilliant.

Number two. This class is resilient. Over the past year, as did the rest of the world, the class of 2021 stared down the barrel of a worldwide pandemic the likes of which our country has not seen for over a century. Their first reflexive instinct was to step up and serve, volunteering to provide shelter, food, resources, transportation, and to administer vaccinations. Though their formal clinical years were truncated, their opportunities to attend away rotations were stopped, their expectations were constantly changing at a moment's notice, and their in-person residency interview opportunities all but vanquished, their instinct was to bear it all with a smile and go on being useful. The great 21st century philosopher Wayne Sotile once said, when in doubt do what your heroes do. And time and time and again, the class of 2021 saw burning building after burning building and without a shred of reluctance made the choice to run straight into the fire and help.

Last point: this class is deeply compassionate. They have consciously and without hesitation made the monumental decision to delay financial growth, socialization, world travel, relationships, and the formation of countless memories with their loved ones, all in the pursuit of this noble and formidable vocation. They have taken upon themselves a mantle of such high stakes that over their careers the very lives of thousands of complete and utter strangers will be tenderly held in their hands. On perhaps the bleakest days of their lives these strangers whose futures seem tumultuous and uncertain will approach these 38 individuals and contentedly allow their walls to simply fall away They'll make themselves utterly vulnerable as they reveal their darkest secrets and their unfiltered anguish, these 38 that sit among you will look at these very strangers and in the midst of the whirling storms of their lives we'll take them by the hands and urge them not to be afraid.

Character, noun, quality of being individual in an interesting or unusual way. From this day forward the class of 2021 will have attained one more quality of being individual and interesting in an unusual way. It will be as doctors of medicine. It is now my distinct pleasure to welcome for you, the class of 2021 graduation ceremony faculty speaker, as chosen by our class, chair of the department of obstetrics and gynecology and someone I consider to be a great mentor and friend Dr. Fidel Valea. Thank you. 

Thank you Dr. Malaty for your kind introduction. Good morning, Dean Learman, faculty, class of 2021, family members, and distinguished guests. What I really wanted to say and start off with was: friends, Roanokers, countrymen lend me your ears! But I was told to be a little bit more formal than that.

It is indeed an honor to address you today as we gather, some virtually, to celebrate the medical school graduation of the class of 2021. You know the origins of the word commencement date back to the late 13th century. It's derived from an old french verb comancier, a beginning or act of coming into existence today. After 20 plus years of education, you will come into existence as a doctor, a physician. And for the rest of your life whether you like it or not you will be first and foremost a doctor. It will become part of your identity and, for many of you, it will define you.

Let me tell you a story. You've all heard about the quintessential proud mother who loves to talk about her daughter or son the doctor. As a parent, I can certainly understand the pride one has in their children's accomplishments but it really goes beyond that. Even your friends will feel the same. They will introduce you at a party as, "this is my friend Fidel, you know, he's a doctor." I would say, why do you do that? You don't introduce John a friend of mine as an accountant or Danny as a lawyer. I would ask them not to introduce me like that but they just could not help themselves. After all these years my friends and family will still introduce me that way even today so get used to it.

The profession you chose is unique. It's a profession like no other. It affords you great respect but also great responsibilities. You will be called by your patients and colleagues, by your friends, your friends' friends, for advice at all hours of the day and night. You will be stopped while shopping, while on vacation with your family, and every now and then, you may even be asked to examine a sick pet.

I have two stories to illustrate this thought. I was once asked by a plaintiff's attorney for advice about his mother with ovarian cancer and this was after three hours of a deposition. I just couldn't believe that he would ask me. Several years ago, I was called by the North Carolina Zoo to care for Donna, a gorilla with endometrial cancer. I can tell you that that was one of the highlights of my professional career.

The point is that people will respect your opinion and want to hear what you think. It's important that you take this responsibility seriously. You will have a very powerful voice. One that can do a lot of good but could also do a lot of harm if not used responsibly. You will be held to a standard well above everybody else. You will always be on even though you think you're off.

I was on a flight a few years ago from Puerto Rico to Miami when a passenger on the plane stopped breathing. Flight attendants get on, they ask is there a doctor on board? My wife the social worker raises her hand for me. I couldn't believe she did that even though I knew deep down inside that it was the right thing to do. Although I was shaking on the inside, I was trained, as were you, to think clearly in crisis mode. The passenger survived and guess what? My wife did it again a few years later in a mall when a woman passed out. The moral of the story is that you must always be ready to serve if called upon in an emergency. No matter where you are or what you're doing and, it doesn't matter whether you're on call or not. It's sort of your obligation to society.

Hippocrates once said wherever the art of medicine is loved, there is also love of humanity. If you think about it, your choice of a career in medicine wasn't an accident. It was more like a deliberate decision rooted in the Virginia Tech motto, Ut Prosim, latin for, That I May Serve. You chose this profession because you wanted to help. You want to make a difference and you care about humanity.

In just a short time you will take the Hippocratic Oath. This oath has four basic tenets: beneficence, non-maleficence, justice, and respect for patient autonomy. I'd like to discuss these further.

• Beneficence. To do good for your patient and always have the patient's best interest in mind. When treating a patient, you should always choose the plan of action that is best for your patient even if it's not the one that's best for you or your patient's family. Remember your obligation is always to your patient first and foremost.
• Non-maleficence. I was able to say that. All the versions of the Hippocratic Oath would frequently start with a statement first, do no harm. As a physician, we are all bound by the Hippocratic Oath to prevent harm to our patients. This means avoiding things that directly or indirectly bring harm to them including the avoidance of neglect as neglect can also lead to harm. The challenge is to minimize harm. Sometimes in order to help a patient, you may have to cause some degree of discomfort. For example, starting an IV, that hurts. Setting a fracture, that really hurts. Or giving chemotherapy. These procedures bring discomfort but are necessary to help the patient. Your job is not to avoid them completely but to do what you can to limit the pain and suffering that they bring.
• Justice. In other words, do what's right. This may sound easy, but when you're tired and behind on your work, this tenant will challenge you. You may be tempted to cut a corner and try and catch up when no one's watching. You know they say that integrity is doing what's right when no one is looking. That's what I'm talking about. That is how you honor the Hippocratic Oath. Take the high road. Always do what's right, even when those around you don't.
• The final tenet, Respect for patient autonomy. This tenant has two corollaries: patient privacy and veracity. In other words telling the truth. Respecting patient autonomy starts with gaining their trust. You have an obligation to honor that trust and never disclose their private information or mislead your patient in any way. You must also respect the patient's right to choose even if their choice is not what you would like them to do or what you think is best. That is patient autonomy.

Remember the words of Maya Angelou, an American poet and civil rights activist who recently passed in North Carolina. “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Make sure your patients feel loved.

Finally in every version of the Hippocratic Oath, there is a statement on our obligation to advance the science and pay it forward to the next generation. Read, look things up that you don't understand, and never stop learning.  Teaching is a great way to learn and actually pay it forward at the same time, for one must first understand in order to teach.

Class of 2021, I am so proud of your accomplishments. You work hard, you play hard, even in the face of adversity such as the COVID 19 pandemic. Mahatma Gandhi said it best, “live as you were to die tomorrow, learn as if you were to live forever.” What you missed in clinical experience, you made up for with teamwork, perseverance, diversity, and acceptance of others. Remember your voice is strong. Use it to do good.

In closing the maven soccer player Pele once said, success is no accident. It's hard work, perseverance, learning, studying, sacrifice, and most of all, and I want to expand upon this, most of all love of what you are doing. I sincerely hope that you love the career you chose as much as I do. Thank you very much. 

Thank you Dr. Valea. We have a tradition of inviting one of our alumni to speak during the commencement. We're proud of our alumni and having one speak to these newly graduating physicians will give each a perspective on what their next few years will be like. In July, only two months away, these graduates will begin their journey as residents to prepare for the specialty they chose over the course of the next three to seven years.

We have selected Dr. Silpa Thaivalappil, a graduate of the class of 2017 for this honor. Silpa grew up in suburban DC, attended Georgetown University, and then earned a master of public health from the University of Michigan. She came to VTCSOM where she made a name for herself by her care and compassion for her classmates and her community. She was an inductee into the Gold Humanism Honor Society and was the class of 2017 recipient of the Arnold P. Gold Foundation Humanism in Medicine Award.

Silpa completed her pediatric residency at the University of Virginia and is getting ready to start her allergy and immunology fellowship in Tampa, just as you start your residencies. One of the true joys of my job is the privilege of keeping up with our graduates. Silpa and I have spoken on multiple occasions since graduation. That's a hint by the way. So I am thrilled to welcome back Dr. Silpa Thaivalappil. 

Thank you so much for the kind introduction, Dr. Knight, and thank you for the opportunity to speak before you today class of 2021. It is truly an honor to be able to come back to Roanoke for this and represent the alumni. I often get teased for having Roanoke goggles as I find myself reminiscing frequently about my time here. I miss the mountain views, Rita making coffee in the library during exams, casually running into Dr. Gilbert at Sweet Donkey, and Jellie and Dr. Knight being the ever come super duo that always seemed to have the answer. I miss how the whole community comes together for events like Docs for Morgan and the MLK day of service and how the school embraces new traditions and new ideas in order to create such traditions. I even miss how no matter how a night of going out begins, everyone inevitably ends up at Corned Beef.

I remember what it was like to be on the stage four years ago, feeling goosebumps as I recited the Hippocratic Oath with my classmates realizing that finally I was a real doctor. 

First things first, you are ready. VTC has more than prepared you to face the challenges of residency. Whether it's fostering your curiosity through our PBL and research curricula or giving a chalk talk to medical students on the fly after countless hours of presentations. Residency will challenge you in all kinds of ways but I have no doubt that you are equipped to handle these challenges, especially the resiliency that you have shown during these unprecedented times. Your third year clerkships are appended, you're interviewed for residency programs virtually, and yet you persevered and matched impressively well.

When Dr. Knight asked me to speak at your graduation, I struggled with what to say. But with graduation being the day before Mother's Day, I thought about my own mother Kala [name] Thaivalappil. My mother was the one who first led me to consider medicine as a profession and her strength, support, and wisdom helped me get through medical school. Four years ago, she sat up in that balcony box beaming down at me as I became the first physician in my family. But life had a cruel twist. Two years later my mother was diagnosed with multiple myeloma and ultimately succumbed to complications of her treatment.

Losing my mother during residency turned my world completely upside down and I struggle with the limitations of medicine. There are many days when I thought about quitting completely but I'd remember the pride my mother felt and I'd keep going in her honor. Eventually I did regain my faith in medicine as a profession but only after a lot of reflection on what it meant to be on the other side. Today I'd like to share with you the three ideas that helped me come back to medicine and what my mother would want me to convey to you as you start your own journey as physicians.

• Number one: remember your roots. Regardless of how crazy your schedule is, invest in your relationships, your family and your friends. When my mother first got diagnosed I was so fortunate to be in a residency where my program director reminded me that residency will come and go but I only have one mother. Take the time to call home to be there for milestones in your loved ones lives. Staying connected will mean the world to them and keep you sane too. Before your first day in residency write down why you went into medicine and the experiences here that reaffirmed it. There will be days you'll find yourself questioning your choice, and on those days, take a look at what you wrote down and when you have more experiences in residency that reaffirm your choice, and i hope you will have many, write those down too. It's these relationships and the reminders of why you went into medicine. These are the roots that will keep you grounded.
• Number two, be present. As the author Eckhart Tolle put it, “wherever you are be there totally.” As if it wasn't hard enough with all the demands of EMR to have a real face-to-face conversation with a patient, we now also have to navigate communicating with most of our face hidden behind masks. Being present is more important than ever. When much of what you have to go on now is only someone's tone and their eyes, we are often quick to deem a patient or their family as being difficult when they have a lot of questions or disagree with their proposed treatment plans. But seeing my mother go through multiple care teams with conflicting messages, have frequent interruptions in her hospital room at all hours of the day and night, and lose any semblance of control has helped me realize that there are always layers of fear, confusion, and frustration behind a patient who gets a reputation of being difficult. Our patients struggle more than we know and sometimes just taking a few minutes to sit down and understand where they're coming from can lead to cooperation, trust, and even save a few hours in the future for you. For many patients you're communicating with them at crucial points in their lives. Sure, you might have seen worse, but for them this is all that they know and as much as you will see the successes and miracles of medicine you will also certainly see its limitations. It's tempting to disappear when you think there is nothing more you can do for your patient but you can always provide a comforting hand, a hug, or even sit with a family. Even amongst all the shock and grief I experienced during my mother's final hours, I still remember the critical care fellow who stood by her bedside with my family. Just like Dr. Valea said, patients and families may not always remember exactly what you said but they will always remember how you made them feel. Be present with every patient encounter. It matters.
• Last but not least, know where your power lies. There's an old Jewish saying often paraphrased by one of my role models Dr. Arnold P. Gold, "it is not your responsibility to finish the work of perfecting the world but you are not free to desist from it either." In a few minutes you will officially be doctors, a privilege so few can attain but your power and influence go far beyond that of healing. You'll be seen as role models in your institutions and leaders in your communities. Of course you can't control everything and change is never quick but know where your power lies and speak up when you can. Be part of root cause analyses, GME and hospital-based committees, get involved in community health events, write editorials,  participate in local advocacy days. Every action does not need to be big and flashy. On most days my own advocacy involves empowering individual patients and their families to take charge of their own health and to not be afraid to ask questions. Educate those who are willing to listen and seek to find common ground with those who won't.

So, remember your roots. Be present. And know where your power lies. Leverage these ideals as the physician thought leaders you were trained to be. It is your enthusiasm that will open new frontiers in medicine. Your work ethic that will transform communities and most importantly your humanity that will leave a lasting impression for each and every one of your patients. Enjoy your day and remember to celebrate your mothers this Mother's Day weekend. I know I will. I am so proud to welcome you into the fold as VTC alumni and wish you great success. Congratulations again to the class of 2021. 

Well thank you so much Silpa. I used to wonder why graduations including medical school graduations are on Mother's Day weekends, seems like sort of like a conflict but obviously such pride can we take in children who achieve the things that children do in graduating from universities and from medical schools. It also gives us a wonderful opportunity to pay tribute to our mothers and grandmothers those that are here today as well as those that have passed or that couldn't be with us today. There's no question that Silpa's mom is smiling down upon her this morning, so thank you so much for those comments Silpa.

It's now my great honor to introduce our keynote speaker Dr. Richard Wardrop. Dr. Wardrop is a double Hokie. He graduated from tech in 1994 with a bachelor's degree in biology summa cum laude and returned 13 years later as faculty just in time to help launch our new medical school. After college he completed the MD PhD program at Ohio State where his graduate research focused on immunology and autoimmune disease. After completing a residency internal medicine and pediatrics, a chief resident year at UNC in Chapel Hill as well.

Dr. Wardrop settled here in Roanoke in 2007. He spent the next six years helping build the VTC School of Medicine. He was a founding assistant professor of internal medicine, pediatrics, and basic science. He served on the research domain curriculum planning team and was very involved in research and faculty development at Carilion. Dr. Wardrop was recruited back to Chapel Hill in 2013 as associate professor. He served as program director of UNC's internal medicine peds training program. Under his leadership the program became among the best in the country. He became a member of UNC's Academy of Medical Educators, ultimately serving as its president.

A year before the pandemic Dr. Wardrop was recruited to the University of Mississippi School of Medicine as professor of medicine and pediatrics and vice chair for education and faculty development in the department of medicine. He hit the ground running directing several faculty development and leadership programs as well as completing further training himself to become a diversity champion and change leader. 

Until the pandemic disrupted all such initiatives. He served as director of outcomes evaluation for an American Medical Association reimagining residency grant. The grant focused on collaboration across academic health systems to better align graduate medical education with learner patient and societal needs. Dr. Wardrop is a national leader in academic internal medicine. In 2020 he was elected to serve on the American Board of Internal Medicine and in the same year was named the Alpha Omega Alpha Distinguished Professor at the University of Mississippi.

An advocate for high value care in practice and education, critical thinking, and evidence-based medicine, physician well-being, humanism, and work-life integration, Dr. Wardrop has a deep well of interests and perspectives to share with our students on this most special day. Please give a warm welcome to Dr. Richard Wardrop. 

Thank you for that warm welcome. It is with sincere gratitude that I'm here today. Thank you very much Dr. Learman and Knight and the faculty and staff and of course the students for the opportunity to be here.

The honor to be invited to any, or to as the commitment commencement speaker at any medical school is an unforeseen in my case unimaginable aspiration. But to be invited at this graduation, on this day, and this time, at this school with something akin to academic and professional nirvana. As a former founding faculty here at the school and career medical educator. Literally since leaving Blacksburg in 1994 to start in the MD PhD program at Ohio State, there is no greater honor than I can imagine. Add to this the fact that I'm an alumni of Virginia Tech along with my wife graduating in the mid 90s having what I had, what I considered to be the greatest college of experience of all time.

The words Ut Prosim are not simply words to me. It has been my own way of life since the 1990s. In the dark of night however and in those more vulnerable moments, the weight of such a task can seem overwhelming, undeserved, and beyond your imagination. What on earth could I possibly have to share with these shiny new medical school graduates. Match day only a few months ago, you as graduates are gaining relevance, credibility, and acclaim at a daily rate. I can remember the adoration of others and the sheer and unprecedented joy at finishing medical school. And at that time in my life I matched at UNC. I was happily married with one child and plans for more. I was 30 and the world was before me. Apart from feeling incredibly blessed I felt a kind of gratitude that I had not experienced before. I was grateful to be entering the greatest profession. I was grateful for health and the unconditional love and support of my wife Sarah, my daughter Mary, my parents Dick and Jeanette, and my in-laws Paul and Laura.

Regardless of your station in life and state of mind at this time, I am sure much of that feeling has been realized by many of you and I certainly hope that this time is filled with shades of that kind of joy and gratitude by you all. For me however after the haze and euphoria of Match Day wore off and we began to move, plan our move to North Carolina, I was finishing my final rotation of medical school in April 2002. A second surgical sub-internship this time in plastic surgery, I was scrubbing into a case with one of the pediatric plastic surgeons and one of the urologists walked in who I knew and came in and started washing his hands and the amount of time it takes to do that, he started asking me about the match and I told him my good news. Impressed he said, fantastic congratulations! Now your education will really begin. Incredulous and before I could ask a clarifying question he winked at me and was gone. He said good luck. I never saw him again.

All these years later, having spent much of my professional life as a clinician educator, I completely understand the long and sometimes convoluted journey from medical doctor to physician is not always apparent. And so it seems to me that along the way inspiration and some grounding principles may be helpful. So in asking myself what I could pass along to all of you today including the graduates, significant others, faculty, extended families, children, and pets I made myself a promise that I would not simply reflect on my own experiences but do my best to summon the collective consciousness of others in order to be helpful in sending you off on this commencement day.

As physicians we aspire towards the spiritual and scientific simultaneously, but I wondered where could a keynote commencement speaker derive such inspiration. I fantasized about a dinner party with those that have inspired me over the years or a seance or commune with the spirits in the same way.

In the end, names that made the invite list may surprise you, some may not, but past and present great minds like Albert Einstein, Maya Angelou, Sir William Osler, Marcus Aurelius, and others, and of course, Jesus of Nazareth to me are no brainers. Then there are others that surprise me. Ronald Reagan, Michael Jordan, Bill Belichick, and Nikki Giovanni with the voice. Some of the voices and other mentors and guides throughout my career.

All of these people and more get credit for any wisdom or inspiration I have to deliver today and I didn't have to have a seance or summon these ideas. I found them that with some mindful introspection that they are inside of me every day and they're inside of my experiences but also inside of the lure of medical literature and our shared professional lives. So having doled out the credit ahead of time it is time for the main attraction. Allow me the latitude of giving you three good things. Think of it as your own professional triple aim.

Thing one. Do the work before you with excellence and expertise.

Ignore distractions whenever possible and minimize catastrophic worry and exaggerated regret about the past. Always be mindful of your position as a physician and be humble and aware of new knowledge. It was Bill Belichick, possibly the greatest coach in pro football history, who told his team amid an undefeated season, ignore the noise. In another quote, he said, do your job. I love this sentiment. It's harder to do this than it sounds and, from a leader, it insinuates that if you as a teammate know your role and responsibilities, execute accordingly and reliably, but are able to filter out unnecessary background noise and distractions, the team will be successful again. Much easier said than done.

As far as striving for excellence in your daily professional life, I give you Michael Jordan the unquestioned goat. During his prolonged peak is the best player on the planet in any sport. Fringe teams would count on him to fill their seats as and he would deliver. As teammate Steve Kerr would say in a paraphrase, Michael always brought his A-game. In a game on Tuesday night in Toronto in February, he'd go off for 39 points, double digit assist, several blocks and steals in a meaningless win. For Jordan, there was no lack of meaning in doing your best always and he is a great example for professional constancy of effort.

No one preached his students and colleagues better than Sir William Osler. While he was simultaneously inventing bedside teaching graduate medical education and founding Johns Hopkins Medical School, Osler was also pushing a renewed interest in stoic philosophy in his own graduation speech, A Way of Life, given to the graduating class at Yale in 1913. Osler implores new graduates of medical school to live life in day type compartments, resisting regret about the past, avoiding catastrophic worry about the future. In essence he invented one day at a time well before those in AAA and other 12-step programs. I encourage you all to read Sir William Osler. It would be worth your time. Osler himself was one of the first in our profession to truly espouse the benefits of applying new evidence and growing our knowledge over the, over your career having preached this innumerable times in many quotes and speeches. If ever there was an unintentional saint of evidence but evidence-based medicine, it was Maya Angelou who simply can be quoted as, do the best you can until you know better, then when you know better, do better. Indeed.

If ever there was an inspirational challenge specifically for the graduating medical students at VTC, I present to you another goat. This time Albert Einstein who said this: We cannot solve our problems with the same thinking that we used when we created them. You all have been given great access to mentors, research, materials, other cognitive resources, and projects, new ways of thinking, and new ways of doing things in order to help our patients. Our health care system and our society are literally at your beck and call. I urge you all, as emerging thought leaders, to always challenge and grow the collective thinking throughout your career. Again, do the work before you with excellence and expertise.

Thing two. Lead from where you stand.

Everyone is a leader in their own right. Patients, colleagues, peers, and supervisors look to you for strength, transparency, and equanimity. Try to deliver whenever possible. This is a favorite sentiment of mine and I'm not really sure where i heard it first but once I said it at a leadership retreat at UNC Chapel Hill. Those in attendance wrote it down. Repeated it. Many heads nodded. I'll take it. I have always tried to do this at every level as a kindergartner in Sunday school trying to get my peers to behave, to my role on the American Board of Internal Medicine maintaining credentialing standards for the largest medical board in the world. Leaders lead and I feel physicians are leaders in many respects, should view themselves as such, and develop these skills over a lifetime.

I'm old enough to remember some pretty difficult moments in the life of our nation. Certainly 9/11, the Challenger explosion, Oklahoma City bombings, and COVID are memorable but I grew up in the heart of the cold war in some pretty dicey times. To me, Ronald Reagan was a genuine presidential leader in, politics aside, his view of leadership is worth considering. When he stated the greatest leader is not necessarily the one who does the greatest things, he is the one that gets the people to do the greatest things. Well said. Be a leader. Osler was known for promoting and admiring those with equanimity. In his famous speech to the students graduating at Penn entitled [title] Osler urged these graduates to live their professional and personal lives aspiring towards equanimity whenever possible which in his eyes was always. To him and to me it is part of our professional ethos. And finally another Osler-ism. Sir William again urged us, to physicians and leaders, we are here to add what we can., to not to get what we can from life. So I encourage you all, as you move on, be members of and leaders in your community. Participate in the lives of your children in schools, your churches. Join the symphony, support the arts, donate to your medical school alma mater for instance, seek justice, support science and truth whenever possible. Again, lead from where you stand.

Thing three. Finally and I think the most important and, to me, the most uplifting to you in your future endeavors.

Thing three. Have charity always.

In dealing with patients, colleagues, family, and yourself, families and yourself, always be kind, show empathy, express gratitude, and exude grace. A famous theme again throughout Osler charges everyone who cares for patients to have charity always. In another essay Osler mandates to serve the art of medicine as it should be served. One must love his fellow man. Love it seems is a necessary ingredient in all that we do and aspire towards. Osler goes on to summon us to charity not just to patients but our colleagues, our mentors and advisors, our hospitals, and even our bosses. I would urge you to resist the gossip and cancel culture, and resist being, and resist being those who are very quick to judge the motives of others in medicine. May you now take heed that to truly be a citizen in medicine you must try to find a way to have charity to the shortcomings of your colleagues and yourselves whenever possible.

Physician and Holocaust survivor Dr. Victor Frankl was a great, had a great deal to say this about love. In his classic man's search for meaning when he unequivocally states, love is the only way to grasp another human being in the innermost core of their personality. No one can become fully aware of the very essence of another human being unless they love him. By this love they are unable to see the essential traits and features in the beloved person and even more, they see that which is potential in them which is not yet actualized but yet ought to be actualized. It's an amazing concept, love begetting love and self-actualization.

Without intending to make this talk religious, I will bring in one man who's had this to say about love and that's Jesus of Nazareth, who can be quoted as written in the Gospel of Matthew when he said, when he was asked what was the greatest of all commandments. He simply stated, love the Lord your God with all your heart, and with all your soul, with all your mind. This is the first and greatest commandment and the second is like it. Love your neighbor as yourself. For me as a physician and a human, I can think of no better guide for our professional approach. Love yourself, love one another, love a higher power.  I'll offer you all that to ponder. So after 49 years on this planet, I know that from love comes many things: patience, humility, gratitude, kindness, temperance, and many more of life's intended blessings. So again, have charity always. 

So in summary, these are the three good things for your graduation to ponder in the days and years that follow.

• Number one: do the work before you with excellence and expertise. 
• Number two: lead from where you stand. 
• Number three: have charity always.

In closing, I will recall my own medical school graduation. With the chaos of residency having literally already started I flew back to Columbus from Chapel Hill for my hooding. Apart from the ceremony and the awards I won, in the actual hooding, I remember the graduation speaker very clearly at the end. He summoned some really emotive statements about remembering and celebrated where you came from, your unique upbringing, your educational background, while celebrating our diversity as a class of 235 graduates. He also summoned a unifying theme by simply saying, you are all buckeyes today and every day. It means a great deal to be a graduate of the Ohio State University and you will always carry that with you in your hearts if you choose. It was stirring and brought unexpected tears to my eyes.

Likewise for your benefit, I remember another stirring call for unification amongst a diverse group from the mouth of one of the greatest artists of our time. Sometimes art and life collide with more power than can be anticipated and sometimes the product is beautiful even in dark times. Imagine a world-class poet standing next to a legendary football coach and you get the imagery I therefore will finish by quoting the great Nikki Giovanni when she unexpectedly uplift united an ailing university and national community in the wake of the Virginia Tech shootings in 2007. In case you ever misremember the spirit of Ut Prosim or the love within the Hokie nation, as you move forward into your own dark times or good times or unsure times remember this. We are Virginia Tech. The Hokie nation embraces our own and reaches out with open heart and hand to those who offer their hearts and minds. We are strong and brave and innocent and unafraid. We are better than we think and not quite what we want to be. We are alive to the imagination and the possibility. We will continue to invent the future through our blood and tears. Through all this sadness, and today all the joys of graduation, we are the Hokies. We will prevail. We will prevail. We are Virginia Tech.

Congratulations to the Virginia Tech Carilion School of Medicine class of 2021. God speed and God's blessings to you and in all that you will do. Welcome to the greatest profession. 

Thank you, Dr. Wardrop. I think, as I think back to my all the conversations I've had with Dr. Wardrop whether whether hearing him formally as you just did or or emails or telephone calls Wardrop, I'm always inspired and challenged and once again that happened. Thank you so much.

So we've heard from the representatives of the student body, the faculty, the alumni, and finally our esteemed keynote speaker. Today is about celebrating the completion of a four-year journey for our students so on to what we came here to witness.

Will the class of 2021 please rise?

Dean Learman, I have the high honor and great privilege of presenting to you the candidates for degree of doctor of medicine from the Virginia Tech Carilion School of Medicine. 

And there you are. Upon the recommendation of the faculty of the Virginia Tech Carilion School of Medicine and by the virtue of the authority vested in me, I hereby confer upon each of you the degree of doctor of medicine, with all rights, powers, and privileges pertaining there unto. 

Will the doctors make their way back backstage? And those who aren't going back, you may have your seats.

We call these ceremonies commencement for a reason, for graduation marks the end of one thing and the beginning of another. The 38 people are now set, these 38 people are now set to begin their journey as physicians. In the graduation program you will take note of the specialty as well as the residency program where our graduates will be training beginning less than two months from now. As we send them off, we want to introduce them to you.

As each name is called, the members of the class will proceed to the front of the stage where they will be hooded by several of the deans. The exterior of the hood is green velvet, the traditional color of medicine, the interior of the hood is blue and maroon representing the colors of Carilion Clinic and Virginia Tech, which taken together, are the official colors of VTCSOM.

After the hooding each student will proceed to Dean Learman who will present them with their diploma. You may take photographs of the hooding but we ask that you not impede the view of our official photographer who will be taking pictures of the graduates receiving their diplomas.

Ladies and gentlemen and Dean Learman, I present to you, members of the class of 2021, recipients of the degree doctor of medicine from the Virginia Tech Carilion School of Medicine.

• Dr. Adenike Temitayo Adenikinju 
• Dr. Sarah Anderson 
• Dr. Manavi Manoj Bhagwat 
• Dr. Dakota Buhrman Peterson 
• Dr. Lauren Elizabeth Cashman 
• Dr. Aaditya Chandrasekar 
• Dr. Mehdi Elmouchtari 
• Next is Dr. Miranda Elaine Gerrard who could not be with us today. 
• Dr. Kerilyn Nicole Godbe 
• Dr. Hailey Louise Gosnell 
• Dr. Parker Louin Hambright 
• Dr. Ayesha Kar 
• Dr. Varun Sriteja Kavuru 
• Dr. Dixon Scott Lee 
• Dr. Grace Mee-Jeung Lee 
• Dr. Miranda Creasey Lee 
• Dr. Giovanni Roy Malaty 
• Dr. Tien Ngoc Nguyen 
• Dr. David W. O’Neil 
• Dr. Ryan Seth Perry 
• Dr. Quan Anh Phan 
• Dr. Amit S. Piple 
• Dr. Samuel Mark Plant 
• Dr. Meeta Bharati Prakash 
• Next is Dr. Faith Robinson who also couldn't be with us today. 
• Dr. Ishaan Sachdeva 
• Dr. Davit Shahmanyan 
• Dr. Michael James Shlossman 
• Dr. Anna Shvygin couldn't be with us today. 
• Dr. Christian Taylor Smith 
• Dr. Vaishnavi Sridhar 
• Dr. Steven Anthony Svoboda 
• Dr. Meyha Natasha Swaroop 
• Dr. Kian Tehranchi 
• Dr. Peter James Weber could not be with us this morning. 
• Dr. Alyssa Nicole Wenzel 
• Dr. Cameron Penland Worden and 
• Dr. Kermit Sheng Zhang.

Will the class of 2021 please rise and be recognized?

Thanks everyone. I now invite Dr. Tarin Schmidt-Dalton, our associate dean for clinical science years one and two, to come and join us and lead all the physicians gathered today as well as our new graduates in reciting the Hippocratic Oath.
Dr. Schmidt-Dalton? 

Would all physicians in attendance including our newest physicians stand and recite the oath which can be found on the last page of your program.

• I swear to fulfill to the best of my ability and judgment and with the support and encouragement of others this covenant.
• I will respect the hard-won scientific gains of those in whose steps I walk and gladly share such knowledge as is mine with those who are to follow.
• I will apply for the benefit of my patients all measures appropriate avoiding those twin traps of over treatment and under treatment.
• I will practice the art of medicine as well as science, remembering that warmth, sympathy, and understanding may outweigh the use of scalpel or drug.
• I will not be ashamed to say I know not, nor will I fail to call in my colleagues when the skills of another are needed.
• I will remember that I do not care for a patient alone, rather I am part of an interprofessional team all of whom offer their skills to assist with patient care and caring.
• I will respect the privacy of my patients for their problems are not disclosed to me that the world may know.
• Most especially must I tread with care in matters of life and death, recognizing this awesome responsibility must be faced with great humility and awareness of my own frailty.
• I will remember that I do not treat data or disease but a sick human being whose illnesses may affect family and economic stability.
• My responsibility includes these related issues if I am to care adequately for my patient.
• I will prevent disease whenever I can, where prevention is preferable to cure.
• I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
• If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.
• May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of serving those who seek my help.

You may be seated. 

On behalf of all of the physicians here today, I'm very proud to formally welcome the Virginia Tech Carilion School of Medicine's class of 2021 into our profession.

Will the class please stand one last time to be recognized?

And please be seated. Thanks again to all of our guests for coming this morning. It's now time for the ceremonial party and graduates to please stand with me for the recessional. Thank you.