Dean's Newsletter

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Commencement, 2006: Keynote address

May 24, 2006

This year's Commencement exercises were held on the afternoon of May 19th, following our Final Class Exercises earlier that morning. The warm feelings all around, and the superb speeches by Steven Gabbe, MD (Keynote), Jeffrey Zampi, MD (student) and David Lambert, MD (faculty), made for a memorable afternoon. Even the weather cooperated: as the crowd spilled out onto the streets around the Eastman Theater immediately after Commencement, the clouds cleared and the sun appeared on cue. There were many smiles and photo-ops all around.

Memorable as the day may be, the well-chosen words of Commencement speakers tend to disappear into the rarified Eastman air, soon to be forgotten. Enter the Dean's Newsletter to preserve these thoughts. In this week's newsletter, I will publish the speech of Dr. Steven Gabbe, Dean of the Vanderbilt University School of Medicine, who received an honorary Doctor of Science. (The speeches of Drs. Zampi and Lambert will appear in next week's newsletter.)

Dr. Gabbe, who learned that he was diabetic during medical school, has devoted his career to advancing our understanding of diabetes in pregnancy and enhancing the health of women and with this condition, and their babies. His broader contributions to reproductive medicine as one of our nation's leading physician-scientists, and his longstanding and well-recognized commitment to medical education, made him a superb choice for Commencement speaker. Here is the text of his speech:

"Four Laps, Four Minutes, Four Years"
Commencement Speech, May 19, 2006
Steven G. Gabbe, MD
Dean, Vanderbilt University School of Medicine

Thank you so much for honoring me as your graduation speaker. This week, you complete an exciting journey, reaching a goal you have dreamed about for many years. Today, I want to spend a few minutes telling you about another medical student and the lessons we can learn from him. Just over fifty years ago, Roger Bannister, who was in medical school at St. Mary's Hospital in London, became one of the most famous medical students of all time when he was the first person to run a mile in less than four minutes. Runners had been seeking the four-minute mile the way Captain Ahab had pursued the great white whale. The record had remained 4 minutes 1.4 seconds for 9 years. But, Bannister broke the 4 minute barrier. Let me repeat--as a medical student, he made worldwide headlines.

When I decided to speak about Roger Bannister, I wrote to him and asked what message he would want me to convey. He directed me to a quote and to his training schedule. First, the quote, "however ordinary each of us may seem, we are all in some way special and can do things that are extraordinary, perhaps until then even thought impossible. When the broad sweep of life is viewed, sport, though instinctive, physical and ephemeral, illustrates a universal truth that most of us find effort and struggle deeply satisfying, harnessing almost primeval instincts to fight, to survive. It gives us all a challenge, a sense of purpose and freedom of choice. It is increasingly difficult to find this in our restricted twenty-first-century lives. The particular target we seek may not be important. But what is important is the profoundly satisfying effort in thought, feeling and hard work necessary to achieve this success." How applicable this quote is today. You all have met many challenges, you have struggled, and now you enjoy great satisfaction with the achievement of your medical degree.

Steven G. Gabbe, MD

Bannister's training schedule was kept on a piece of chart paper from his third year obstetrics rotation. Under the direction of his coach, Franz Stampfl, Bannister had increased the amount of speed work he was doing, but was still challenged by his responsibilities as a medical student. In the hospital, he worked under consultants following patients in a 40-bed ward. He rotated to a new clinical service every few months and had to get by with little sleep. Lunchtime was his only break during the day. He would hurry from the hospital, take the underground train two stops to the Warwick Road Station, and then walk to the Paddington Recreation track where he would train for about 30 minutes. Compare that to the support and training programs professional athletes enjoy today!

For some time, experts wondered whether it was humanly possible to run faster over a one-mile course. The public became focused on this event and the challenge of running the mile in less than four minutes. As Bannister himself noted, "I suppose the appeal (of the event) lies in its very simplicity, four laps in four minutes – it needs no money, no equipment, and in a world of increasingly complex technology that stands out as a naïve statement about our nature."

Bannister was a true amateur. After attending school in Bath, he was accepted to both Cambridge and Oxford and chose Oxford because a place was immediately available for him. He had had some success in school races and so decided to compete in track at Oxford. In his first race, he completed the mile in 4 minutes 53 seconds and placed second. Just a year later, he won the important Oxford-Cambridge Race by 20 yards in a time that was nearly 25 seconds faster. Bannister loved the competition of racing even while maintaining his excellence as a student. He noted, "it was the intensity of living, joy and struggle, freedom and toil, satisfaction at the mental and physical cost."

After graduating from Oxford, Bannister received a research scholarship and spent one year studying exercise physiology. He used a treadmill to examine the effects of speed and incline on running performance as related to body temperature and the composition of the air breathed by his study subjects. Bannister published two papers in 1953, "The Carbon Dioxide Stimulus to Breathing in Severe Exercise" and "The Effects on the Respiration and Performance during Exercise of Adding Oxygen to the Inspired Air." He learned some very important lessons about research and about his own endurance. Bannister noted, "Gradually I began to understand the infinite capacity for taking pains that is necessary before any scientific advance can be made. The discipline of research is exacting and grueling. Each experiment, even though it may only be one in a series of hundreds, must be considered of vital significance in itself. It may prove to be the experiment producing a variation which explodes one's preconceptions – even the most careful inductive scientist allows himself the luxury of some preliminary general speculation." He added, "Each race is an experiment. There are too many factors which cannot be completely controlled for two races to be the same, just as two similar scientific experiments seldom give exactly the same results." How many of you have learned important lessons about yourself as well as science through your research work?

As I mentioned earlier, Bannister attended St. Mary's Hospital Medical School in London. It was at St. Mary's that Alexander Fleming had discovered penicillin. The Dean at that time was Lord Moran. He was known for recruiting amateur athletes because he believed that sport built strong character and made for good doctors. In the middle of an interview with a prospective medical student, the Dean would retrieve a rugby ball below his desk and throw it at the candidate. If the interviewee caught the ball, it was said he would be admitted. If the candidate threw the ball back, he would receive a scholarship!

Bannister's first year at St. Mary's was 1951. At this time, he was also training for the 1952 Olympics. Bannister, like all of you, had to learn to manage his time carefully. Bannister noted, "I did not have time to train until evening, when it was dark. Often I was tired from standing in hospital wards, operating theatres, or tube trains. I needed an enormous effort to make myself change into my running clothes, but once I had taken the plunge the run always refreshed and invigorated me." This statement is a wonderful example of the importance of devoting time to extracurricular activities and their importance in renewing our energies. Please remember that despite the time pressures of residency training.

Bannister's performance in the 1500 meters at the 1952 Olympics in Helsinki was a great disappointment. He finished fourth. Bannister had assumed there would be only one time trial to qualify for the final race and then the medal race itself. However, he learned very late in his preparation that there would actually be a preliminary race, a semi-final, and then the final race, three races on three consecutive days. He was simply not prepared for this challenge.

Bannister returned to St. Mary's and resumed his medical studies. Somehow, he found the time to continue his training, although the total distance he covered, 15-35 miles each week, was quite limited by today's standards.

Bannister knew that 1954 would be his final year of competition. He could see that his medical training would not allow him to compete any longer. With his coach and two close friends, who would pace him, Chris Brasher and Chris Chataway, Bannister planned to assault the four-minute mile at the Iffley Road track in Oxford on May 6, 1954. The day was wet and windy, and it was not until moments before the race that Bannister decided to pursue his dream. The race was run before no more than a thousand spectators with one television camera and a handful of reporters. Bannister's parents surprised him by attending. Brasher took the lead for the first two laps and ran the half-mile in 1 minute 58 seconds, Chataway then took on the responsibility for pacing and finished ¾ miles in 3 minutes .7 seconds. Bannister describes the following lap, "it felt the moment of a lifetime had come. There was no pain, only a great unity of movement and aim. The world seemed to stand still or did not exist. The only reality was the next 200 yards of track under my feet. The tape meant finality-extinction perhaps." The track announcer proclaimed the time. When he said "three minutes", the ovation drowned out the "59.4 seconds". He had done it. He had broken the four-minute mile. In describing that moment, Bannister recalls, "I grabbed Brasher and Chataway, and together we scampered round the track in a burst of spontaneous joy. We had done it - the three of us!" He realized that he could not have met his goal without the help and support of his colleagues. Your moment of a lifetime has come. Think of all of those – family, friends, faculty - who have supported you, enabling you to reach this day.

Bannister's challenges were not over yet. When he returned to London, he had a series of three-hour essay exams in medicine, surgery, obstetrics, pharmacology, and several other fields and then a practical exam in which he was presented with a patient and had 45 minutes to take a history and do a full exam. At the end of what we would now call an Objective Structured Clinical Examination or OSCE, he had to give a diagnosis and develop a treatment plan. He knew that if he missed something serious, he would fail. But, he succeeded, just as he had in running the mile.

Amazingly, Bannister held the record for just 46 days, when on June 21, Australian John Landy ran the mile in 3 minutes, 58 seconds. Bannister had one last athletic challenge remaining, the Empire Games in August in Vancouver, British Columbia. Here he would face John Landy in head-to-head competition. He knew that Landy could outrun him for the first three laps and hoped that he could catch Landy with his kick on the final straight-a-way and, that's just what he did in a race that has been called "The Perfect Mile". As they accelerated to the finish, Landy looked over his left shoulder to locate Bannister. Bannister then sprinted past him on the right side winning the race in 3 minutes 58.8 seconds. Landy was nearly a second behind.

Bannister went on to a distinguished career in both sports and medicine. He led two major campaigns for the British Sports Council, one building recreational centers throughout the country and another to discourage athletes from using performance-enhancing drugs through random drug testing. He conducted neurological research, wrote scientific papers, and edited a textbook Brain and Bannister's Clinical Neurology. In 1975, Dr. Bannister was knighted for his contributions to medicine and athletics.

What can the remarkable accomplishments of Sir Roger Bannister and the lessons he learned teach you about your career in medicine? First, pacing is important. Think of your career as a marathon -- not a sprint. Pace yourself carefully. Prepare yourself thoughtfully for each challenge: residency, fellowship, practice, an academic career. Bannister felt that because of his preparation, he could run the mile in four minutes regardless of the conditions. Manage your time carefully and find the time to do those activities that bring joy to your life. For Bannister, it was his running. For you, it might be music or painting or cooking. Remember the importance of your coaches and of teamwork. As a house officer, your coaches will be the faculty, your fellow residents, nurses, your friends, family, and patients.

You come to the finish line of medical school prepared by your rigorous training. Your graduation day is here. In residency, there will be times when you will feel you are running as fast as you can, when you will find it hard to catch your breath. But, just as you have succeeded in completing the strenuous race of medical school, so will your run through this next phase of your training be a successful one.

Again, let me extend my best wishes to you and wish you good health and much happiness in the years ahead.

References
Bannister R. The Four-Minute Mile. 50th anniversary ed. Guilford (CT): The Lyons Press; 2004.
Bascomb N. The Perfect Mile. 1st ed. New York (NY): Houghton Mifflin; 2004.

Next week, we will present the speeches of Drs. Zampi and Lambert.

Meliora,

David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry