Ceremony 5
Academic Oration
Friday 23 November 2012 at 1630hrs
JESUITS’ CHURCH – VALLETTA
Prof. Josanne Vassallo
M.D.,M.Sc.,Ph.D.,F.R.C.P.(UK),F.A.C.P.,F.A.C.E.
Faculty of Medicine and Surgery
We have gathered to honour the new graduands of the Faculty of Medicine and Surgery
and the Faculty of Dental Surgery. This four hundred year old baroque church, on the
site of the original Collegium Melitense, provides a fitting backdrop, lending dignity and
gravitas to this very special celebration. On this day, we pay tribute to the graduands’
hard work and achievements. A sense of pride prevails, as well as excitement at the
thought of what their future might hold.
In order to pursue their chosen profession, these young people have effectively
committed themselves to a lifelong quest for knowledge. This quest is common to, and
indeed, unites both scientists and clinicians, as they work to enhance medical knowledge
and to develop new diagnostic and therapeutic modalities based on an understanding of
the aetiology and pathogenesis of disease and of disease progression. Furthermore, the
knowledge base that arises as a result of research is essential to the practice of evidencebased medicine and dentistry and to the provision of
patient-centred quality care.
Therefore, for those who will not embark on a research career but opt for clinical
practice, it is still vital to have a working understanding of research methodologies, in
order to critically appraise medical literature, practise evidence-based medicine, and
undertake clinical audit of their own care delivery. It is this ethos that has led the
European Union to fund a network of excellence, MEDINE, whose remit has been to
consider the competences and skills essential for medical graduates including research as
an integral part of both under- and postgraduate medical curricula. Science is analytical
by virtue of what it aims to define and develop whilst the practice of medicine has been
dubbed a science and an art. As a researcher, a clinician accumulates data to support or
refute a hypothesis; as a practitioner, a clinician decides to what extent the accumulated
facts in a given study population are applicable to the individual. The latter may well
differ genetically, ethnically and culturally from the original population. His or her
country of residence, access to health services and financial means may mandate
deviation from the advocated research-derived “practice norm”. At this stage, expert
opinion, as opposed to hard evidence, is what determines the best course of action.
The building of a knowledge base is what forms the basis of education at all levels but
the ultimate goal of any educational program is a formative one that enables students to
develop their individual skills both within and outwith the boundaries imposed by the
drive to impart and assess knowledge. One of the greatest challenges in education is,
therefore, to foster an individual’s potential and creativity whilst maintaining and
achieving uniform educational standards. Information technology has made it possible to
provide education to underserved populations, to enable more equitable cross-border
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access to academia, to educate larger student cohorts, to share research resources and data
as, for example, has recently been demonstrated in the Human Genome project. We must
acknowledge, however, that it is difficult to impart certain skills without the provision of
a period of apprenticeship. This is particularly true of skills that involve dealing with
humanity, with disease and suffering in individuals. In order to correctly assess and treat
an individual patient, a physician must acquire expertise, must develop what is best
described as his or her clinical acumen. This can only be acquired at the bedside due to
patient-related variables that cannot be mimicked by scenarios or by simulation in a
computer laboratory. Clinical acumen encompasses a broad spectrum of knowledge, the
ability to take a pertinent history and examination as well as the appropriate choice of
investigations. Once a diagnosis is made, a management plan which takes all variables
into consideration, can then be formulated targeting that particular patient’s needs. The
hard earned acquisition and application of this attribute is ultimately what determines a
clinician’s worth. Regrettably the rise in student numbers, limitation of resources,
pressures of work, the need to meet targets, deadlines and management-related issues can
potentially impinge negatively on this crucial aspect of education and training. Discipline
and effective time management are therefore essential pre-requisites for health care
students and professionals alike.
Medicine and dentistry are noble professions which aim to prevent harm, to alleviate
suffering and to heal. On such occasions as today, I am invariably humbled by the
wisdom and relevance of the Hippocratic Oath to ethical, safe, humane and effective
medical practice, a relevance that has survived centuries of evolving medical practices.
Those amongst you who today graduate as Doctors of Medicine and Surgery will take
this same Oath and I sincerely trust that it will provide you too, with the same inspiration
and guiding principles essential to the fulfilment of your obligations to your patients,
your professional raison d’être. Those who will pursue a career in Science, I hope that
likewise, you too, will adhere to the highest ethical principles and codes of practice, both
in your dealings with colleagues and partners in Science, as well as at your place of work.
Regrettably, in both Science and Medicine, there are instances when individuals seek to
advance themselves through dishonest and unethical practices, or by exercising unfair
advantage at the expense of their colleagues, their institutions, their patients and at times,
their very families and friends. The price ultimately paid in such instances surely negates
the material benefit derived from the ensuing meteoritic rise in careers and fortunes.
Navigating troubled and oft tempestuous seas in the pursuit of excellence, without
compromising one’s principles and values, requires courage and perseverance but there is
a huge and abiding sense of satisfaction when one finally triumphs against the odds. The
ensuing serenity is a state of being well worth seeking.
Equitable health care provision remains elusive and thus the focus of ongoing research
and endeavours. Globally, organisations, such as the World Health Organisation,
facilitate networking and provide the infrastructure and resources necessary to establish
and achieve targets in healthcare. The European Union is committed to developing the
European Research Area and a number of initiatives to foster networking, the
establishment of centres of excellence, and the formation of multinational research
groups are now beginning to bear fruit. On a national and regional level, however, the
goals and targets set must be realistic, keeping in mind the local context and available
resources. Healthcare and scientific institutions must factor these variables in when
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planning services, staff development and advancement. Our graduands have embarked on
demanding careers. They can only be empowered to achieve their full potential if
institutions, organizations and governments work to ensure an appropriate framework
within which these excellent young people can continue to grow and develop. Frustration
at lack of training opportunities, or overly slow career progression, can transform
individuals into disgruntled, apathetic persons. Acknowledgement of these issues and a
commitment to resolving them is essential to maintaining standards and improving
medical care.
Nurturing of precious human resources is also crucial to combat the global surge in
communicable and non-communicable diseases, which tax human and financial resources
to the limit, at both a national and international level. Healthcare provision is expensive
and at times there is a temptation to cut corners in an attempt to make ends meet. Such
cost-cutting measures can impinge on healthcare delivery and may place professionals in
an untenable situation where they may not be able to maximize patient safety and quality
care. The resulting stressful environment can have a negative impact on both physical and
mental health and we are not exempt from these. In 1889, Sir William Osler, the father of
Modern Medicine, in his treatise titled Aequanimitas, advocated “coolness and presence
of mind under all circumstances, calmness amid storm, clearness of judgment in moments
of grave peril” attributes that “may make or mar your lives—which may contribute to
your success, or help you in the days of failure”. This exhortation to clinicians remains
highly pertinent, possibly even more so, given the challenges we face today in the daily
pursuit of our profession.
On a positive note, since my return to Malta in 1995, I have seen our university hospital
and medical school move to a new state of the art facility, a facility that is gradually
being honed into a centre of excellence. There has been recognition of the need for
research and development and funds have been committed to help academic members of
staff to establish research programs. Graduates have been given the choice of training in
an increasing number of different clinical specialities, as well as of following formal
Masters and Doctoral programs. Professional mobility for training and employment
purposes has burgeoned in the last decade. Attracting graduands back to our shores once
they have completed postgraduate training is essential to maintain access to state of the
art quality healthcare.
In the words of Anais Nin who believed that dreams are essential to life: “Dreams pass
into the reality of action. From the actions stems the dream again; and this
interdependence produces the highest form of living.” May each of you have the
opportunity to pursue your dreams, supported by those dearest to you. In turn, respect,
support and empower those around you as they tread their chosen path. May you achieve
fulfilment through the practice of your professions and in your personal lives whilst
contributing to the establishment of an enriched, thriving, humane and truly enlightened
society.
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