Welcome, fellow students, to the 120th Annual Meeting of the American Laryngological Association. First, I offer my deep appreciation to the members of our distinguished Council and the Fellows of the Association for the honor and privilege of serving as your President for this past 12 months and, with the Program Committee and membership, of developing this year's program, which reflects the preeminent and international character of this Association.

It is indeed a privilege to have been elected President and to join the group of those outstanding otolaryngologists who have served as President of this esteemed organization during its long and illustrious history. I was fortunate in my personal life to have a family heritage that included a father who was an excellent role model - both professionally and personally and a mother who instilled a love of reading and a tradition of scholarship from an early age. My wife, Patsy, has helped me recognize the importance of my mother's contributions to my ethics, values, and traditional beliefs.

On April 24, 1976, I presented my first paper before this Association. My brother, Paul C. Holinger, MD, MPH, was a coauthor, and my father, Paul H. Holinger, MD, was the senior author. Standing here today, 3,000 miles away, 23 years to the day, from the Venetian Room at the Breakers in Palm Beach, Florida, I can still recall the thrill, the anxiety, and the hope that I would do justice to my family heritage in otolaryngology, to the long hours of reviewing medical records, and to the endless writing and rewriting of our manuscript. In this context, my congratulations to the essayists, whom I thank for submitting their work for consideration by the Association, and I offer best wishes for successful presentations during the Scientific Sessions. The scientific program represents an elite group of papers selected from an enthusiastic and overwhelming number of submissions. Head and neck oncology and basic science constitute the majority of the program this morning. Tomorrow, phonosurgery and neurolaryngology (including laryngeal transplantation) are the major themes.

The Baker Lecture, to be delivered by Robert Sataloff, MD, and the Address of the Guest of Honor, Byron J. Bailey, MD, and my brief remarks, examine various aspects of medical education. I will discuss the importance of the role model in laryngology.

Throughout our daily interactions with medical students and residents, each of us functions as a role model. Since role modeling is primarily a passive function - teaching by example - we may not be acutely aware of its importance.

In what respect is the concept of the role model important to laryngology? In addition to the function of specific training - teaching the trade - the literature on role modeling cites 2 major areas of significance: 1) influencing medical students' career choices, and 2) facilitating socialization into the world of medicine with the establishment of an appropriate professional identity.

Residents and students must see a standard of excellence to pursue, a model to copy. The ideal role model is a superior clinician who is dedicated to teaching. The key concept is dedication, taking teaching seriously, and therefore assuming a more active role both in teaching and learning. The ability of the role model to stimulate intellectual curiosity is another essential element of good role modeling,(1) as are the demonstration of the importance of scientific reasoning, skepticism of dogma, and continuing selfeducation that conveys the message that medicine is constantly evolving.(2)

The first function of role modeling - career choice - is particularly important to us as specialists in our relationships with medical students. Interestingly, most of the recent literature about role modeling has been written by and for educators working in the primary care specialties.(3) Many studies are designed to gather data for the purpose of recruiting medical students into primary care areas. In this regard, it is particularly important for medical students to be exposed to otolaryngologists who are excellent role models and the earlier, the better. Forty-eight percent of medical students change their career plans during their second year.(4)

Negative role models can have strong dissuasive effects on specialty choice. Attributes of these individuals include difficult personalities, lack of camaraderie, professional dissatisfaction, and disheartening interactions with patients. Overworked and dissatisfied physicians who demonstrate poor communication skills with patients and students may permanently close career options.(5)

The second function of role modeling is socialization into the medical profession and the establishment of a professional identity, including facilitating the acquisition of the values, attitudes, and behavior associated with professionalism, humanism, and ethical practice.(2)(3) This aspect of role modeling is particularly important to us in our obligations to our residents.

Given the importance of role models, it is important to identify specific attributes of excellent physician role models. Wright et al(3) recently published results of a multicenter study that identified the following as attributes of excellent role models: 1) spending more that 25% of one's time teaching, 2) spending 25 or more hours per week teaching and conducting rounds, 3) stressing the importance of the doctor-patient relationship, 4) teaching the psychosocial aspects of medicine, and 5) having served as chief resident or having participated in formal training in teaching.

In addition to these 5 attributes, the study made several other observations of interest to laryngologists. Generalists were more likely to be named as excellent role models than subspecialists. Excellent role models enjoyed teaching medical students and residents more than did controls and were more satisfied with medicine as a career. They also recognized students as individuals with private lives, who may have spouses and children, mortgage payments, and family emergencies.(6) Career achievements related to research - including total publications and time spent on research - were inversely associated with identification as an excellent role model.(3)

Characteristics of physician role models highlighted in other studies (7)(8) included personal qualities (such as compassion, sense of humor, and integrity), clinical skills, and teaching skills. Enthusiasm was the characteristic that role models felt to be most important in influencing students' attitudes.(9)

What are the implications of these data at a time when faculty members are under increasing pressure to generate more revenue and when major medical schools prioritize basic medical research in the face of decreasing peer-reviewed funding? It has been noted that medical education is no longer the major activity of American medical schools.(10) Addressing this problem involves refraining institutional goals, making education of students once again the highest priority. It requires a change in the basic culture of academic medical centers and restructuring financial resources. (11)

It is indeed fortunate that many of the attributes of excellent role models are skills that can be acquired or behavior that can be modified.(3) The costs of this faculty development, in time and money, need to be supported so as to help physicians acquire the skills required for effective positive role modeling.(3) Medical schools should reward good teaching and formally recognize faculty members and residents who are effective teachers and role models.(1) Attending physicians who are excellent role models need to be identified so that they can be encouraged and supported to spend more time with medical students and residents. I would argue that they should also be rewarded with career advancement (7) and support for sustaining career satisfaction and attaining economic goals.(3)

Plato observed that education is a life-long process. Our Association's own motto is Docendo Discimus: by teaching, we learn. I conclude with Tosteson's poignant observation that "the most important, indeed, the only, thing we have to offer our students is ourselves. Everything else they can read in a book."(12)(P693) May each fellow of this splendid organization continue its long and respected tradition of accomplishment in education.

REFERENCES

1. Ficklin FL, Browne VL, Powell RC, Carter JE. Faculty and house staff members as role models. J Med Educ 1988; 63 :392-6.

2. Barondess J. The GPEP report. III. Faculty involvement. Ann Intern Med 1985;103:454-5.

3. Wright SM, Kern DE, KolodnerK, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med 1998;339:1986-93.

4. Hunt DK, Badgett RG. Woodling AE, Pugh JA. Medical student career choice: do physical diagnosis preceptors influence decisions? Am J Med Sci 1995;310:19-23.

5. Mutha S, Takayama JI, O'Neil EH. Insights into medical students' career choices based on third- and fourth-year students' focus-group discussions. Acad Med 1997;72:635-40.

6. Dunnington GL. The art of mentoring. Am J Surg 1996; 171:604-7.

7. Wright S, Wong A, Newill C. The impact of role models on medical students. J Gen Intern Med 1997;12:53-6.

8. Wright SM. Examining what residents look for in their role models. Acad Med 1996;71:290-2.

9. Ambrozy DM, Irby DM, Bowen JL, Burack JH, Carline ID, Stritter FT. Role models' perceptions of themselves and their influence on students' specialty choices. Acad Med 1997; 72:1119-21.

10. Abrahamson S. The state of American medical education. Teach Learn Med 1990;2:120-5.

11. Reuler IB, Nardone DA. Role modeling in medical education. West J Med 1994;160:335-7.

12. Tosteson DC. Learning in medicine. N Engl J Med 1979; 301:690-4.