An old dog barks backward

A reflection on almost 50 years in academic medicine reminds me of my good fortune to have benefited from so many gifted mentors who helped shape not only my academic career, but also my own persona. After graduation, your choices of which personal direction to take are myriad. My strongest advice to you is to experience as many options as are available to you, and not to make a lifelong career decision too hastily or based on inadequate experience in your potential discipline. That is not to say that a subsequent mid-career change might not be necessary or desirable. A strong mentor can provide the wisdom that you may require at a critical signpost in your life. You will know your true ‘end game’ when you experience it. Dr Harvey J Guyda Paediatricians must have the ‘paediatric gene’ to be able to succeed in a world in which your patient frequently cannot communicate what is wrong, who may pee in your right ear as you examine him (you learn quickly that this should not be a repeatable occurrence), and who comes with a significant family construct that provides the historical and medical history that are so essential in working through a difficult differential diagnosis. Each patient is not just a case of a thyroid disorder, for example, but a complete package with important familial, socioeconomic and environmental aspects that must be paid attention to. In paediatrics, decision making is a shared responsibility that involves the parent or caregiver, and the medical professionals caring for the child. The parents of an ill child must have all of the information that they require to make an informed decision. Occasionally, they may make choices that they believe are in the best interest of their child, but these may be at variance with the care team’s recommendations. These situations require understanding and empathy with the parents, and may necessitate consultation with other colleagues for guidance in seeking a common resolution. Following my early days as a medical student, I left Winnipeg (Manitoba) for my three-year fellowship training program at Johns Hopkins Hospital (Baltimore, USA). I was following the advice of a mentor, Al Zipursky, that one should seek training from a different academic centre than your medical school to broaden one’s educational and life experiences. Do not fear RESEARCH. This term encompasses an enormous range of investigative studies that are usually characterized as ‘clinical’ or ‘basic’ research. The opportunity to ask valid scientific questions and to undertake any of these investigations, in a variety of combinations, can be enormously rewarding. That is not to say that research does not have its ups and downs, particularly with regard to being able to generate consistent output and being able to obtain stable long-term funding for your research program. Dedication and hard work will be the key to your ultimate success. Dealing with rejection (eg, your latest scientific paper, your research grant application) is not easy, but persistence, despite adversity, and appropriate mentorship will be essential. If you make a decision to undertake a formal research academic career, you must have formal training that prepares you for an independent career, and a faculty position that guarantees you the academic freedom and resources to establish your research program. Unfortunately, the rubric ‘publish or perish’ is all too relevant to the establishment and advancement of a successful academic career in an underfunded and highly competitive research environment. You need to have the best possible research environment to fulfill the expectations that may be placed upon you. If medical education is a significant component of your selected career, the advice that I would impart to you is to develop your teaching skills just as you would sharpen your medical practice techniques. Identify your strengths and weaknesses, seek new and innovative teaching techniques (the centres for medical education or simulation centres are great learning venues), and insist on receiving objective feedback on all of your teaching performances. My most successful teaching sessions have been in small interactive groups, with organized teaching materials such as slides, photographs, charts and questions delivered in the form of a structured quiz. As Chairman of the Department of Pediatrics at McGill University (Montreal, Quebec), I established weekly ‘Guyda Rounds’ that involved case discussions presented to me by trainees. Together, we worked out investigative paradigms. The diagnosis was not as important as the means by which we got there. As a former clinical laboratory director, I was particularly critical of the shotgun approach to investigation and stressed the need to develop sensitivity to health care economics that we all bear the burden for. I had the good fortune to join the Pediatric Endocrinology group at the Montreal Children’s Hospital, when Eleanor Colle (EC) was the Director. She epitomized someone who had her life balance issues well controlled. EC knitted and crocheted her way through our academic conferences as she raised four children, but she could quote a page number from any current journal article pertinent to any discussion. EC ingrained in me that a quiet, thoughtful and reasoned approach to any dilemma – clinical, academic or personal – wins out every time. Over time, I learned to appreciate that immediate angry reactions are never productive – far better to put that critically written letter aside in a drawer for a few days and then reread it before sending a markedly toned down version. Having someone who is removed from the situation read your difficult correspondence, before you send it, fosters true humility. As we advance in our careers, we all spend far too much time in ineffective meetings. I have used the instructional videos produced by comedian John Cleese to illustrate the essential elements of planning and executing a successful meeting: (1) Plan meetings in advance; (2) Prepare a detailed agenda; (3) Prenotify attendees; (4) Control the discussion; and (5) Summarize and record decisions taken. In my current administrative role, I have learned both the value and wisdom of ensuring point 5 is faithfully carried out: it is essential to record verbal commitments to avoid subsequent disagreements or misunderstandings. Throughout my many years and, especially as I transferred into a full-time career as the Executive Director of the Montreal Children’s Hospital, I have learned that leadership comes in many forms – not all of it praiseworthy or welcomed. My own beginnings in a leadership role were somewhat rocky and not always smooth, but time and the valued wisdom of many others have contributed to the development of my interpersonal capabilities. One must be open to constructive criticism and learn from it. The leadership attribute that I value the most is an open-door policy for students, trainees and colleagues alike, that provides a welcoming, understanding and equitable reception, with a high ethical imprint. Unfortunately, conflicts do occur in some of our teaching, clinical or academic pursuits that require resolution, and these are among the most difficult of challenges that one faces in a leadership role. It is most important to LISTEN: listen to what others are saying, and keep your own words and body language appropriate and respectful. You may have to agree to disagree, but at least you can move forward together. In closing, it is important to underline that one MUST take ‘time outs’ for physical exercise, personal reflection and having some fun. My lengthy academic career has opened the world to me, providing me with opportunities to travel the world and to take my family with me when possible. In whatever career choice you make, I hope that you will receive the unwavering understanding and support that I have received from my wife, Pat, and our two children Marley and Evan. It is from my family that I have learned to have both feet firmly planted on the ground, and to work in concert with others – to provide time and support for them as well, to achieve a greater whole for all. Dr Guyda is the Executive Director of the Montreal Children’s Hospital (MCH) (Montreal), the McGill University Health Centre (MUHC) (Montreal) and Dodds Professor Emeritus of McGill Universtiy. He is the former Chair of the Department of Pediatrics, McGill University and Pediatrician-in-Chief of the MUHC. He obtained his MD and BSc (Med) from the University of Manitoba (Winnipeg), completed his paediatric residency at the Winnipeg Children’s Hospital (Winnipeg), and continued his postgraduate education in paediatric endocrinology at Johns Hopkins Hospital. He is a member of the Board of Directors for the Canadian Association of Paediatric Health Centres, and is a founding member of the Steering Group for the Canadian Child and Youth Health Coalition; both have shown national leadership in the advocacy and support of significant programs that improve child and youth health in Canada. Dr Guyda volunteers as President of the Board of Directors for the Diabetic Children’s Foundation of Quebec. He was coeditor, with Robin Williams, on “Poor Kids! Canada’s Child Poverty Challenge” in Paediatrics & Child Health. Dr Guyda is a visiting professor at the University of Alberta (Edmonton, Alberta); Université Necker (Paris, France); University of Havana (Havan, Cuba); Hadassah University (Jerusalem, Isreal); University of Helsinki (Helsinki, Finland); University of Hong Kong (Hong Kong, China); and the Roy A Kroc Visiting Professor at the University of Ottawa (Ottawa, Ontario). Dr Guyda has been named to the American Men and Women of Science. He has been awarded the Juvenile Diabetes Foundation International Mary Jane Kugal Award; the Canadian Society of Endocrinology and Metabolism Distinguished Service Award; the Pfizer Award for Leadership from the Montreal Children’s Hospital Foundation; the Dr Noni MacDonald Award for important contribution to paediatric medicine published Pediatrics & Child Health; and the Alan Ross Award from the Canadian Paediatric Society. He has received the Robert H Vines Memorial Lectureship (Australian Endocrine Society); the John P Maclean Memorial lecturer (University of Manitoba); and is a Fellow of the Canadian Academy of Health Sciences. The MCH Foundation and McGill University have created the Harvey J Guyda Chair in Pediatrics that will be held by the Chair of the Department of Pediatrics at the MCH and McGill University.

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