 Good morning. I am Dr. Teresa Gonzalez, and it is my privilege to welcome you to the 2021 keynote lecture and fellows forum devoted to leadership and leader development. Leadership is a mission essential task for fellows of the American College of Dentist, and it's been part of our mission essential task list for more than a century. Leadership in the COVID era has presented unique challenges and over the past 20 plus months, we have learned that the only thing that has been certainty is the uncertainty that abounds. At best, leadership is a profoundly human endeavor, inevitably filled with challenges, triumphs, and occasional failures. Behind every leadership role is a person trying to do their best in an environment of changing expectations and prevailing uncertainty. In military parlance, we define this as a VUCA environment, and VUCA is an acronym that stands for Volatile, Uncertain, Complex, and Ambiguous Environment. We are at a profoundly pivotal moment in the history of leadership and leadership development, and you might ask why. Because we're in the middle of a radical transformation of the human experience at work, at home, in society, and in general. And much of this is fueled by technology and engagement platforms and an ever-increasing, robust slate of active participants. First and foremost, the pandemic has forced a shift of our usual routines, and as a result, leaders are struggling to connect with their teams more than ever, especially when there is a great deal of change, uncertainty, and the requisite emotional valence. This has affected leaders at every level of the leadership spectrum. National data suggests that one in three leaders feels that they are effective at handling the challenges associated with their leadership role, and only 40% of Fortune 500 executives feel that the leader development they have received is of sufficient quality, quantity, or relevant to their leader maturation. Additionally, 60% of front-line leaders say they have never received any training of preparation for leadership role, and sadly, more than two-thirds of front-line leaders fell totally unprepared for the roles they occupy. Finally, according to Harvard Business Review, 87% of first-time leaders feel frustrated, anxious, and uncertain about their role, and perhaps this is why at least 50% of executive transitions fail. No doubt leadership is a daunting task, and that might explain why there are more than 650 definitions of leadership. While multiple definitions of leadership exist, the different definitions generally converge in the theory that great leaders have the ability to make strategic and visionary decisions and convince others to follow those decisions. The consensus is leaders create a vision and successfully and willfully encourage others toward mission accomplishment. We believe that each of us has the potential to lead effectively, and the American College of Denses is so committed to leader development that has been an integral part of our mission for decades. Leadership, we believe, is our stock in trade, our mission to advance ethics, excellence, professionalism through leadership. Leadership is therefore an organizational mandate. For each of these reasons, and so very many more, the organizers of this annual meeting and convocation have prepared a series of three lectures on leadership, with a particular emphasis on leadership in times of uncertainty. The opening lecture will be presented by Dr. Carl Hayden, author of the Nine Virtues of Exceptional Leaders, and the founder and CEO of the IDEA Leadership Institute. The second lecture in this series will center on the courage to lead in times of uncertainty using the lessons learned from the Lewis and Clark voyage of discovery. And the final lecture in this series will be presented by Dr. Lawrence Larry Goretto, Professor Emeritus from Indiana University, and a nationally recognized thought leader in ethics and values-based leadership. Now, for just a couple of administrative notes, at the end of the presentation, the speaker's panel will reconvene and reassemble to take your questions. We would like you to utilize the Q&A section of this delivery platform to post your comments and to posit your questions. Now, on behalf of the American College of Dentists, please sit back, relax, and enjoy these sessions created especially for you. Thank you, Dr. Gonzalez. Well, I am honored that the college would have me back a second year speak at the annual meeting and convocation. As Dr. Gonzalez has said, and she's talked about in terms of what leaders have faced over the last 20 months or so, it has been really difficult in so many ways. And I know we all wish we were together. Let's hope that next year we'll be together in Houston. So we hear virtually, ironically, the etymology of virtual is right in line with what I want to talk about this morning. Its Latin root is virtues, which is translated as valor or courage in battle. Now, I am not sure how that translates into online learning, but nevertheless, I assume there's some connection to my comments in that word this morning. Maybe we've all done battle with online platforms since this pandemic began. I suspect we have. Last year, I suggested that dentistry needs more heroes, more moral exemplars, role models who through their words and their deeds serve as beacons to illuminate the future of dentistry. And I suggested that a collection of biographies might be in the college's future. Soon after I made these comments, Dr. Gonzalez sent me this book. Now I'm going to hold it up. I hope you can see it if you pay particular attention to the cover. I'm going to have a slide with this cover and the book on it later. But the title of the book is A.C.D. Our First Century, the narrative history of the American College of Dentists. This volume was edited by one of those beacons of light, Dr. Patricia Patt-Blatton. So I asked Dr. Blatton about the meaning of the symbol on the cover, and she told me that the symbol is for marksmanship, and it was chosen as a metaphor for the college's first century. She said we literally hit the mark. She also explained to me that there are three levels of this badge for marksmanship. They're marksmen, sharpshooter, and expert. And so there's room for improvement as a symbol of leadership. And finally, she said, this designation isn't permanent. You have to continually practice and calibrate to meet this skill, just as leaders do. So I appreciate the cover of that book, and I especially appreciate that we have these models of leadership and role models that we can follow nicely displayed, nicely discussed in this narrative. So thinking of what leaders do, I've entitled this talk Profiles in Leadership, the ACD as a Moral Community. Knowing that I'm going to fail to recognize a lot of people deserving of attention, I will still mention a few current leaders this morning as role models and examples. I don't have a lot of slides so that you'll know where I'm headed over the next roughly 40 to 45 minutes. Let me just give you a brief outline. So I have a few more introductory remarks, and then I'll pick up where I left off last September. I want to explore with you the virtues or character strengths and how they relate to leadership. We're going to go to the Vatican to do a quick refresher. You'll see that on my slide. Secondly, I'm going to turn to a specific virtue or character strength, the virtue of courage. And I hope to lead us in an understanding of courage by looking at remarkable examples of courage. And then I'll weave courage throughout the remaining comments that I have. Thirdly, we're going to compare what I call the ethos of the covenant to the ethos of the free market. And in doing so, we'll do an exploration of the dangers of ethical fading to the dental profession. And then fourthly, we're going to travel back in time. We're going to go to Ancient Greece to learn about historical antecedents for the concept of a moral community. And then lastly, I'll just conclude with some comments about the ACD as a moral community. As I was preparing for this session, just a few more introductory remarks. You can look at this slide. The history of the ACD is written in the lives of its members. And in a real sense, the ACD, the narrative of the ACD is their narrative and it's expressed in their commitments, their responsibilities that they have taken both within and without the profession. I found particularly interesting in this narrative, chapter six, remembering the past presidents of the college, written by Dr. Gonzalez. She carefully selected leaders who have advanced the profession under the light of a triune flame of ethics, professionalism, and ethic and excellence. So as I read their biographies and I learned about what was on their minds when they served as president, I was struck by a more or less recurring theme or recurring themes. And you'll see these themes on the slide here. In 1934, Dr. Bezel Palmer made the comment you read in the top left corner. It's fitting that I'm not in this book, but the phrase at the bottom right comes from my remarks at last year's annual meeting. So I read these things, and I read these like recurring themes. So what's behind this lyric? What's behind this? And it occurred to me that calling attention to unprecedented challenges year after year, it's good rhetoric. I mean, after all, what true leader isn't motivated by an unmatched challenge? But it's much more than that. It's true. It's true. I believe that we could reasonably conclude that the founders of this college because they founded this college because they encountered unprecedented challenges. And if the history of dentistry is any indication, every ACD president for the next century can state unequivocally year after year that dentistry faces new extraordinary challenges. The difficulties may differ in kind and degree, but with the rising sun, new problems and opportunities are illuminated for those with eyes to see. So I'd like to paraphrase a comment by the physician philosopher Carl Yaspers. He makes his comment about philosophy. I'm going to make it in terms of leadership. The essence of leadership isn't the possession of the answers, but the search for the answers to lead means to be on the way. Questions are more essential than answers, and every answer becomes a new question. So the point is, we are always on the way, and being on the way means that we encounter new challenges, new questions at every turn. So to ask the right questions requires wisdom. That's a virtue, and it leads to wisdom. In the face of uncertainty, a person has to combine wisdom with hope. Great leaders do that. To address the challenges that face the profession requires courage. And with this, I'm going to turn back to the theme that I introduced to you last year, the theme of character, and by implication character-based or what I would call, and others call virtuous leadership. So I said I'd take you to the Vatican. Some of you have probably seen this fresco. It was painted by Raphael in 1511 for Pope Julius II. In one of the reception rooms in the Vatican's Apostolic Palace. Now in this fresco, Raphael shows us three of the four cardinal virtues and three spiritual virtues. So just by way of refresher, take a look at the fresco. So prominently seated right in the center is prudence or wisdom. And you'll see on her breastplate there's an effigy of a weaned gorgon. Now that gorgon is to ward off deceit and fraud. And if you look carefully at the face, I think this is really neat what he did. This is Janus-like face. Her head, their two faces shown in profile. So the youthful feminine face looks forward into her mirror. And this is an allegory for wisdom and knowledge of the present. And the backward-looking visage is of an old man as he is peering into the past. Peering into the past for sound judgment predicated on experience. His view is enhanced by the flaming torch of a puddle depicting hope. Then temperance is on the right. She holds the bridle of her string. She's accompanied by a puddle of portraying faith that points upward to heaven with his right hand. And then courage. Courage again is going to be one of my themes. It will be one of Dr. Gonzalez's themes. Courage or fortitude is on the left. You see that she's armor clad. She caresses a lion with her left hand while she's grasping a sapling black oak with her right. The oak tree symbolizes strength and alludes to the family to which Pope Julius II belonged. And next to her is a puddle representing charity. And he's harvesting acorns from an oak tree. The fourth virtue, cardinal virtue, justice isn't included in this scene. Instead, she is depicted holding scales in a sword and a tanto in a ceiling directly above this particular fresco. So with that bit of art history and as a reminder from last year, virtues are character strengths. They're habits such as prudence or wisdom, justice, courage, hope, and charity. And these are habits that contribute to a person's well-being and the well-being of others. These habits, as they're referred to in positive psychology, character strengths help us live good lives, treat others well, and contribute to human flourishing in the communities and societies in which we live. Now, one of the unique features of virtue ethics is its concern with the whole life, not simply when making a decision about something moral as it stay. So virtue ethics focuses not on principles, not on rules or processes for solving more problems, but on the choices that become habits that lead to a good life or, in the case of bad habits, revises away from a good life. I want to give you another perspective on the virtues. And I'm going to do that by looking at a concept that is central in the mission of this college, the concept of excellence. So this will give you a little different perspective. The same Greek term for virtue, that Greek term is arite, is also translated as excellence. And I'm going to ask you to think about two different kinds of excellence. So the common understanding of excellence, I think, like we say Dr. Jones is an excellent dentist. I think what most people mean by that is Dr. Jones is a skill-component practitioner. So this type of excellence builds on science, on evidence, and it's translated into procedures, rules, protocols, to the skillful practice of dentistry. So I'll refer to this as the excellence of competence. But dental practice also involves another type of excellence that grows and is cultivated from a long historical tradition. In the West, this tradition dates all the way back to Hippocrates. And it's safeguarded and fostered and modeled by this college. I'm going to refer to this as excellence of character. And I'm going to link this to the ACD as a moral community. So if you'd like to see how this is codified, the American Dental Association does a very nice job in capturing these two senses of excellence in its preamble to the ADA principles of ethics and the code of professional conduct. So the association says that dentists should have not only knowledge skills in technical competence, read that as competence of excellence, but also those traits of character that foster adherence to ethical principles. So qualities of honesty, compassion, integrity, fairness, charity are part of the ethical education of a dentist and the practice of dentistry, and help them to find the true professional. Read that as excellence of character. These are these qualities that are in the ADA's code or what I call virtues or character strengths. I believe this twofold meaning of excellence is in keeping with the college's commitment to excellence, competency and character, competency and character. Excellence of character is the fountainhead of ethical practice of professionalism and leadership. So if you're following the outline I gave you, I'm now going to introduce the virtue of carriage and try to give you some examples to define this virtue. And Dr. Gonzalez is going to continue this exploration with you. So as we think about the meaning of carriage, this past spring, I don't know if any of you noticed this or caught the movie again, but this past spring Netflix included saving Private Ryan among its elections. Years ago, this was the last movie I saw with my father, who was a World War II veteran. And if you've seen the movie, especially on a big screen with surround sound, you recall, you recall on that big screen how the camera angle gave you the feeling that you were there in that amphibious troop transport when the when the gate dropped and the bullets started passing you. I mean, you could you could hear the bullets and too often you could hear them thump as they hit their mark. And I distinctly remember just sitting in a movie theater, sitting in my seat, I distinctly remember feeling fear and anxiety and thinking how do I get off this beach? Now I can't imagine I just cannot fathom what it was like to be on the beach Omaha Beach on June 6 1944. But that our minds so often go to the soldier when we think of courage tells us something about this virtue. Courage shines so bright in the darkness of battle, because so much is extinct. Courageous soldiers put their lives on the altar for the good of others and infirm devotion to an ideal. They do it by facing down fear. The soldier's carriage is isn't simply physical carriage. It's that but it's also psychological carriage that demands enormous self control of the presence of mind. The soldier who fights for a just cause is driven by moral courage, a commitment to an ideal or principle. As we think about courage, let me just come to what I would say is a more certainly more current scene, one that you'll recognize. In 2020, we found ourselves on a new battlefield, one that is also deadly. Often unheralded warriors strapped on a different kind of armor to fight an enemy that's killed over 700 Americans alone. According to the World Health Organization, there have been over 237 million confirmed cases of COVID-19 globally. I don't know what the count is now, I tried to find it, but last spring the Kaiser Family Foundation reported that over 3,600 healthcare workers in the US have died of complications from COVID-19 after they contracted it on the job. These people are models of courage. So, let me speak for a moment about the profession and carriage in the context of the last 20 months or so and then looking forward. I'll just take this as a sort of an aside comment that's relevant, I hope, to our current situation. So, if another pandemic comes, is dentistry going to be ready? According to a study published in the Journal of the American Dental Association, a data, dentistry around the world reported a lack of preparedness to confront COVID-19 early in the pandemic. So, when they were asked about their attitudes toward the delivery of care, 52% of respondents strongly agreed that they would prefer not to treat and would refer a known or suspected COVID-19 patient. So, if there is another pandemic, continuing to care for patients will require the application, not only the best scientific evidence for all concern, but it's also going to require courage. Some have argued that dentists were not mobilized appropriately in the war against the pandemic. And if there is a next time, and many people think there will be a next time, all health professionals may well find themselves on the front lines of testing, diagnosing, administering vaccines, and perhaps providing other care. And that's going to take courage. So, in 2020, we also found ourselves on another battleground, an all-too-familiar battleground. And this one did bring guns and violence, not harmed from an undiscriminating infection, but deliberate injury from fellow human beings. We were reminded in 2020 that the more disease or racism still sees below a veneer of civility, that racism and inequality still permeate a culture, a culture in which we say all people are created equal. And like those who have gone before, others join a march for social justice and equality. And to join this march takes courage. So, issues of social justice and equality should also concern the dental profession. You know, as I think about ACB leaders who are making a difference here, I immediately think of Dr. Carlos Smith. Dr. Smith is a member of the eJournal's editorial review board and a board member of the American Society of Dental Ethics. He's also an ACD scholar in this year's at the Leadership Institute. So, I asked Dr. Smith, what are some of the major issues in your mind confronting dentistry? And Dr. Smith told me diversity. He said he explained to me diversity in terms of ethics and inquiry. Ethics, because every action, every hire, every patient encounter should have at its core a dentistry social contract with the public. And he said inquiry, particularly inclusive inquiry. What kind of questions are we asking? Of whom, on behalf of whom, and to achieve what outcomes. So, I think you would agree with me that Dr. Smith has identified one of the major challenges facing the profession. And that is the inclusion of everyone. In addition to the challenges presented to the profession by the pandemic, by racism, there is another one that I think continues to grow and is exacerbated in the profession today. And that's making choices in the face of conflicting values. So, where are the conflicts? Well, they may exist in the context of different cultural values or a patient's philosophy of care and conflict with the dentist. They sometimes exist at the intersections of caring costs. They often involve incongruities among self-interest, which is in the best interest of the patient. And there are many interests that are represented by entities that create the context and the systems for health care. So, now more than ever, I think, dentists need moral carriage. And let me explain what I mean. There we go. So, dentists more than ever need moral carriage. So, I juxtapose on this slide what I call the ethos of the covenant and the ethos of the free market. By covenant, I mean the commitment that the dentist makes as a member of the profession to the patient and to the public. So, that commitment, the ethos of the covenant is based on trust. In contrast, the ethos of the free market is a system in which the costs are good sold and the services are regulated by buyers. And thank patient and sellers, thank dentist, negotiating in an open market. Now, the covenant says you can trust me to act in your best interest. The free market says caveat implore to use a contrast that was drawn by Dr. David Chambers in the college's ethics report and a paraphrase of that. The covenant is about relationships and the free market is about transactions. I'm going to transition to this slide and then I'm going to go back because I honestly don't like looking at this slide, but I thought it was a nice image for the challenge that the dental profession faces. This is an etching by the Belgian artist James Ensor, published in 1904. He created a series of these etchings entitled The Seven Deadly Sins. This one is avarice. Greed or avarice, whether it's in dentistry, the health professions, or anywhere else, seems to be a pervasive vice. Maybe it's in our origins. Maybe it includes our ancestors competing with one another for food and sustenance. I don't know. But while the problem of avarice has always existed, I think it probably differs now in degree in dentistry because the evolution of health care and dentistry along with it into big business. And I'd call this the commercialization of the covenant. And that commercialization comes with something that is often referred to as ethical fading. So last year, a friend and colleague gave me a book by the British American author, Simon Sinek. I'm sure many of you have read Sinek's book, probably seen his YouTube videos. I have a couple of his books. But one that I was given is The Infinite Game. Chapter eight of The Infinite Game is entitled Ethical Fading. And as I investigated this term, I discovered it was first introduced by Ann Tindrensall and David Messick in 2004. It was in an article entitled Ethical Fading, The Role of Self-Deception, The Role of Self-Deception and Ethical Behavior. So ethical fading takes place when the ethical factors of a decision disappear from consideration. It happens when people overemphasize or focus heavily on one aspect of a decision. For example, profitability. When ethical fading occurs, people tend to see what they're looking for. And if they aren't looking for an ethical issue, they may miss the issue entirely. So like moral disengagement, ethical fading allows one to restructure reality, to make actions seem less harmful and less unethical than they actually are. So to illustrate ethical fading, Sinek tells the story of Wells Fargo Bank. So from 2011 to 2016, employees opened over 3.5 million, 3.5 million fake bank accounts. Most of these were unnoticed because employees would routinely close them shortly after they were opened. So when this behavior became public, there were like 5,300 Wells Fargo employees that lost their jobs that were fired. John Stumpf, the CEO of Wells Fargo testified in front of Congress that these deceptive practices, he said, go against everything regarding our core principles, our ethics and our culture. But did they? Were these employees bad people without standards, morally corrupt? Well, as it turns out, employees in the sales department at Wells Fargo were under extreme pressure to produce, to sell more services to make their numbers. Employees were motivated by financial incentives, but they were also motivated by fear. They were pushed daily to sell from eight to 20 different products. And when they didn't, management berated them. One employee recounted her manager saying to her, if you don't meet your goals, if you don't meet your solutions, you are not a team player. And you're bringing the team down and you'll be fired and it will be on your permanent record. Now that's the banking industry. But it is not difficult for me to imagine dentists recommending unnecessary care motivated by either financial incentives or even fear. It's not difficult for me to imagine a contest for some non-monetary award, from recognition to an automobile, for aggressive treatment planning and prescribing care and devices that a patient doesn't need, but that increase profit. Even if the patient does require these things, the motivation is misguided and the ethics of the treatment decision fade from consideration under the shadow of the profit motive. Semic states that ethical fading is a condition of culture. And I might say it is a condition of a profession that allows people to act in unethical ways to advance their own interests, often at the expense of others. So financial or economic self-interest is a primary driver behind over-treatment, malpractice, fraud, and other business dealings with the intent to maximize profits at the expense of patients and the systems that support healthcare. This is nicely chronicled in the College's ethics report, where the observation is that the commercial focus has exacerbated the transition from practice models based on, as I said before, relationships to those based on transactions, where success is measured by the excess of reward over expense. And each person is there to maximize their own interest. So what does carriage have to do with ethical fading? Let's go back to carriage. First, I would say that when someone denies their self-interest on behalf of the patient's interest, that requires moral courage. It's the courage to honor the government. In 2019, 59% of the graduates who reported their entering private practice of that 59%, only 10% plan to be sole practitioners. And out of that, only 5% intended to open a new practice. So as we all know, the practice of dentistry, the structure of dentistry is changing dramatically. Many members of this college are educators. So as you think about your students entering the practice of dentistry, if they find that they've joined a practice that puts the ethos of the free market above the ethos of the covenant, it will require immense courage to take a stand in that culture. They could lose their jobs, their lives, their livelihood could be disrupted. And there is no guarantee that doing the right thing will pay off materially. So we should advise our students to choose their employer wisely and to have the moral courage to do the right thing for patients and society. And inevitably, and we want this, these students are going to take on leadership roles as business persons and corporate executives in dentistry. And we need to encourage them and develop them and role model for them how to be courageous and how to make decisions that place profit as a means and not an end. So I told you we were going to go back in time. And we're going to do that now to set sort of a, I'm going to call it a cultural context for the virtues. I apologize, my slides are a little slow advancing here. Not only slow advancing, they're not advancing. I will tell you if there is some technical support with the slides, you could, let me just see if I can go and actually press the slide. Now, if there's some technical support with the slide, we can go to the slide on Athens. You can't miss it. You'll see the Acropolis. Otherwise, I'm just going to keep going and I'll just ask you to picture the Acropolis in your mind. So we're going to return to this ancient past and think about the place of courage in the community. To do this, I want you to think about ancient Greece and heroic societies in ancient Greece. These were typified in Homer's Iliad where courage is the highest virtue. Courage in the heroic society grew out of fixed social walls. One's duties were clearly defined within the community through the structures of kinship and household. So as a head of the household, one had the obligation to protect it in battle and that required courage. The duties were inseparable from one's social roles. So the virtues, especially courage, were conditions for personal success in the heroic society. So in your mind, I want you to go forward a few hundred years to the Athens of Socrates, Plato, and Aristotle. That Athens knew other virtues. They were exposed to other cultures and other customs. And so the roots in Athens of the virtues shifted from the Homeric family to the city-state. Other virtues such as justice, wisdom, temperance were recognized, they were debated, they were practiced. Both Plato and Aristotle argued that the human well being and flourishing that we all desire was culture transcendent and that the possession of the virtues was a necessary condition to experience this well being. Yet they both observed that the realization of these virtues takes place within a social order. That is, the virtues are part of a tradition. How we understand them and how we practice them is rooted in what I would call the moral community. So why is this important? Why would I take you back to ancient Greece? Well, it's to illustrate and to make a point. So if you think about moral, modern moral debates, ethical debates about critical issues, for example, race, war, abortion, wealth distribution, these debates go on without end and with no side-winning. Valid arguments can be made on both sides of these debates. The disagreements arise from different starting premises of the arguments. So why can't people agree on moral starting points? The philosopher Alistair McIntyre argues that the reason is because we don't belong to any consistent shared moral tradition. Instead of a consistent tradition, we are inheritors fragments of different traditions. So we start our arguments. We start our debates in different places. So I'd like to suggest to you that medicine and by implication dentistry does share relatively consistent moral tradition. But in the last decades, this tradition is in the process and it seems to be increasing how quickly this is happening in the process of becoming fragmented. I said this last year that you think about the profession and across the profession. The values of professionalism are competing with those in the free market. The character of the profession is fragmented among those that comprise it. So like brickwork that's eroded and broken into pieces over time, the character of the profession is morally pluralistic. And each piece and each group in the profession is substantially setting its own ethical standards. Now it's time for me to share with you a new slide. Let's see if I can do that. Oh, there we go. We're moving again. Great. Well, that's where you've just been to Athens. And now I'm going to take you to just a medieval conversation with some doctors, some physicians back in medieval times. Again, thinking about the antecedents of the moral community. So there have been numerous attempts over the years of creating a moral tradition within medicine and again within dentistry as if you think of it as a part of that tradition. And I think you make a good argument for centuries, these efforts were somewhat successful, even if they were flawed, somewhat successful. Edmund Pellegrino and David Thomas Mock described these historical antecedents as an attempt at a moral community. So for example, in the opening sentences of the Hippocratic Oath, initiates are instructed to respect their teachers, to keep the art of medicine secret, and to teach it only to their sons and the sons of other physicians. So I actually might sound familiar until a few years ago, right? But this early attempt at a community is an example of a guild. It was secretive, it was sexist, it was paternalistic, it was elitist. But yet later in the oath, there is recognition that physicians have certain responsibilities that set them apart with an obligation to society. So there was something there. Now in the West, in the Middle Ages, we saw the moral community of physicians through the virtue of Christian charity. So medicine was a vocation and as a vocation, a calling through which a physician would work out personal salvation through caring for others. But this model lost its cohesiveness over the years as religion became more pluralistic and society more secular. In the 19th century, the physician was seen as a member of a community of gentlemen. In 1803, Thomas Percival, who is the author of the first official honor code in medicine, he wrote, the study of professional ethics will soften your manners, it will expand your affections, and form you to that propriety and dignity of conduct, which is essential to the character of a gentleman. I quoted Percival last year. So service to the patient and society was acknowledged, but the moral community as a gentleman's club just isn't adequate for today either. What would be adequate for today? You probably see some people here that you recognize and know. I'm moving now to the final part of my comments to you. The ACD is a moral community. So I'm going to follow Pellegrino's definition. A moral community is one whose members are bound to each other, bound to each other by a set of commonly held ethical commitments, and whose purpose is something other than mere self-interest. Now, I think we could certainly argue that the dental profession as a whole should be or ought to be a moral community. At the same time, I think we recognize that commonly held ethical commitments are growing less common in the commercialization of the covenant and the ethos of the free market. With that said, I believe that this college is a moral community. Its commitments are clear, and they're consistent throughout its narrative. What is critical, and I'll say more about this in a moment, is that the college must be an exemplar of the dental profession as the moral community. It has to be that social matrix in which the virtues associated with ethics, with excellence, with professionalism, with leadership are practiced. So the college's bylaws, its mission, and the many resources it provides to teach and foster the ethical practice of dentistry, codify what this college stands for. Quoting the bylaws, fellowship on individuals is awarded in recognition of Victoria's achievement and their potential for contributions in dental science, art, education, literature, human relations, and other areas that contribute to the human welfare and give encouragement to them to foster the objectives of the college. So as the college inducts new fellows this year, Dr. Blanton's narrative history reminds us that this community is founded on the commitment of each fellow on each one of us to safeguard and model the college's purpose. So I gave this talk, the title, the first part of the title, Profiles in Leadership. So let me tell you about a few more people that I think demonstrate by their lives their commitment to what this college stands for. Dr. Shirei Farmer-Dixon, you'll see her in this slide at the bottom left, is Dean at the Mahary Medical College School of Dentistry, and she's a fellow of this college. I met Dr. Farmer-Dixon about 20 years ago. Among her many attributes, Dr. Farmer-Dixon is a lifelong learner and she's a wise leader. Dr. Farmer-Dixon is very forthcoming about the importance of other people in her life that have mentored her and helped her learn to lead and become the leader that she is today. So as we think about role models, she is an example of someone who lives the past forward, the nurturing and the mentoring that others have given to her. She said as a leader, she said I value the opportunity to mentor and inspire others, whether I'm at work or at a meeting, at home, visiting a family, at church, attending a sporting event, volunteering at a community service. If there is an opportunity to serve and mentor, I'm excited to do so. And I can tell you, she means that. I've seen her do it. I took this quote from an autobiography of Dr. Farmer-Dixon in this book. I'm hoping you can see this book. It's just been published. The title of it is Undaunted Trailblazers, Minority Women Leaders for Oral Health. The editors of this book are Dr. Sheila Price, Dr. Gene Sinkford, and Dr. Marilyn Wolfrup, all fellows of this college. The college welcomed Dr. Sinkford in 1967 and 50 years later recognized her with a lifetime achievement. Dr. Price, Sinkford and Wolfrup, give us 31 different profiles of minority leaders, pioneers who have courageously overcome significant obstacles due to the prejudice associated with their race and their gender. They've overcome these things to make transformative contributions to oral health. The college should be proud that of these 31 leaders profiled 18 are fellows of the American College of Dentistry. So last year, I asked for a book of role models, a book of heroes of dentistry. And now we have two of them in the last year. I think that's fantastic. The second item in the college's bylaw state, one of its goals is taking an active role in dental education and research. And this commitment is exemplified in people like Aditya Thadunada. Dr. Thadunada is the Associate Dean for Graduate Research and Training at the University of Connecticut School of Dental Medicine. He is an ACD scholar in this year's Indian Leadership Institute. And I asked him, I asked him, part of his duty as a scholar in the institute, your scholar, for me to ask him questions like this, right? I asked him, I said, what's your purpose as a leader? How do you see yourself making a difference? And he said, I want to articulate the importance to our profession about educating the next generation of dentists. And he referenced the pandemic and he said, that's disrupted dental education, but it provided a pause button for us to reinvent. He said, I want to construct meaningful virtual experiences that are human run and technology driven to produce a higher level of learning and experience. So there you have another ACD fellow that's fulfilling another part of this college's mission of its purpose. So there is no moral community without fellowship and there's no fellowship without fellows who are committed to a common purpose beyond self-interest. So several months ago, I read a biography by James Glick. It's a biography of Isaac Newton. And Isaac Newton is perhaps the greatest scientist who ever lived. Historian see Newton as the culmination of a period that's often called the scientific revolution. Glick writes that when Newton observed the world, when he observed the universe, it was like he had an extra sense organ appearing into the frame or skeleton or wheels underneath the surface of things. He sensed the understructure. He was so important and recognized as so important even in his lifetime that Alexander Pope wrote for his epitaph, nature and nature's laws were hidden night. God said, let Newton be and all was light. For Newton, the inventor of the calculus, the laws of nature were written in mathematics. Moreover, mathematics, these mathematics that govern the motion of the universe were already there. Newton would say he didn't create mathematics as a way to explain the universe. He simply discovered what was there. Now I find this a fascinating proposal and a view that's still debated by physicists and philosophers. And I tell you that, I give you that sort of sort of analogy that I think some people believe that ethics and morality are somehow like this, somehow woven into the fabric of the universe. And if people will just look, they will discover it. So there's a moral structure that we can somehow intuit through an extra sense that shows how we ought to act, including how health professionals like dentists should relate to their patients and their society. Now I'm not going to deny conscience and that we have some sense of that. But I really do not believe this is the case. I believe, I just agree with Alistair McIntyre, that our moral debates go on without resolution because we lack consistent moral tradition. We lack this need of the social grounding, this social matrix that takes us back to ancient Greece and takes us back to what others have tried to do through history to create a tradition within medicine. So we miss that. We're lacking that. So I'm going to take you back. I promise to you I'd show you the cover of the narrative history on a slide. Here it is. And I want to say to you that I think that the ACD not only illuminates the way for the dental profession. I think it not only illuminates, I think it is the way for the dental profession. Certainly this college is cognizant of the traditions that have shaped the character and the duties of health professions and health professionals. But the college is also the creator and the sustainer of the virtues and the practices that define and preserve the ethos of the covenant in a profession that is increasingly fragmented. So I'm going to take some liberties with the cover of the narrative history. I'm going to tell you, and I hope Dr. Blanton will forgive me for this, but I also look at this and I think that this sort of symbolizes the place of the college in the dental profession. The college is at the moral center of dentistry. It reaches to the four corners. It reaches to dental practice, research, leadership development and advocacy on behalf of the patient and society. And this reach is indeed a monumental duty. It requires courage. So referencing the research of Cynthia Peary and Cooper Woodard, there are five necessary conditions for courage. The first one is intentionality. That means deliberate and purposeful, not an accidental occurrence. And I think we can say that this college is intentional. Secondly, courage is directed toward a worthy goal. And the college certainly checks that box. Thirdly, courage involves personal risk. And fourthly, where there's courage, there's fear. Courage is confronting and overcoming fear. Lastly, the outcomes are uncertain. So risk and uncertainty are inherent in the college's activities, but the experience of risk and uncertainty is a frequent occurrence for individual fellows and other practitioners as they set self-interest aside for the interest of the patient and society. A fellow who practices in a practice or organization where the culture is antithetical to the ethos of the covenant. Consider the college, the leaders in this college who advocate for change and innovation in dental education. That takes courage. Consider those who advocate on Capitol Hill and their states on behalf of patients and society. That takes courage. So my final comments. In her book, Collective Courage, Jessica Gordon Newhart chronicles African American corporate business ownership and its place in the movements for black civil rights and economic equality. And I'm going to use her concept of collective courage to close. So collective courage rises out of the moral community. That's the college. Collective courage finds strength in the company of others. Through collective courage, we're stronger together. We need each other in the college. We need each other. The profession needs the college. Through collective courage, this college as a moral community will continue to be the guiding light, the conscience of dentistry, and the moral center of the dental profession. Thank you. This is Dr. Teresa Gonzalez and I'd like to thank you for that extraordinary presentation. You never disappoint in any lecture that begins looking at the images from the Vatican and the cradle of civilization while you just have to appreciate in love and thank you for that. The importance of courage will continue now in this theme as I talk about undaunted courage. So we began this morning at the cradle of civilization and the ancient world talking about why it was important to establish a moral community. I'm going to fast forward you now to the 1800s in the nascent democracy that is the United States. And in the context of the discoveries of Lewis and Clark and their incredibly ambitious or an unquestionably ambitious journey to open up the American West. We'll have that discussion. You might wonder why we would take lessons in leadership for more than 200 years ago. We take lessons in leadership for more than 200 years ago because what was true in the 1800s is true today. And when I tell you a little bit about the history of this group and how it came together and how it was formed and what attributes that were necessary to allow for this to take place. I think you two will be equally impressed. The last thing I want to say is we enter undaunted courage is I'd like to say again thank you to Dr. Hayton who will rejoin us for the question and answer for a couple of reasons. My mother was a classics scholar and taught the classics in an Edith Hamilton sort of way all of my life. So anytime I get a chance it's almost like a visit from my mother. So thank you Carl for that. So let's talk a little bit about leadership. You know I naively believed most of my 31 year military career that people were just born to lead. I was even encouraged to think that that people had attributes as leaders that they were ordained to lead. And then when I got to know more and more leaders who were painfully honest with me they told me leadership is a art. It is a practice. It is an opportunity to be developed and not only should you lead you must lead. Leadership is a requirement for all those who have been given by virtue of education and talent and circumstance the opportunity to lead in our communities and our universities and our uniformed services and beyond. We say in the American College of Dentist that the true north is ethics the true north is ethics and as long as we true leadership to ethics then we should be in good stead for our second century of service to the profession and the public we are privileged to serve. I want to talk a little bit and those of you who know me and I know many of you do I know most of you. The interesting thing is there is nothing that doesn't have a historical precedent and so the best history is indeed the one we are planning for. But I want to talk a little bit about this unquestionably ambitious journey of Lewis and Clark. And then I'm going to tell you why I'm going to talk about it because I'm going to talk about it in the context of leadership. Two of the most unlikely people on the planet chosen to lead this army expedition. The question would be why? What did Jefferson know? What did Mary with a Lewis know? What did the conscripts know and how did it work? This journey as we will discover takes essentially eight it's going to be a journey of 8000 miles to and from it's going to take 863 days. Now would you put that in perspective for just a moment for just a moment and I want to think about the last time you got into your vehicle as a member of your family to go to a destination resort pre-pandemic and you were going to travel some amount of distance in the car and you had a mission plan and you had lodging and you made all the necessary arrangements and I want you to keep in the back of the mind how long did it take before there was descent in the ranks before the mission would have been better possibly left and whether or not you took casualties along the way. I mean this is what happens think about the enormity of it and I'm going to now read just a quote from Mary with a Lewis about this. He says we are now about to penetrate a country that is at least 2000 miles in width the good or evil it had in store for us was for experiment yet to determine. He has really no idea. These are uncharted areas that he will endeavor to explore along with the core of discovery and he will run out very quickly of distributed outpost for which there are provisions. It's an interesting tale of survival against every odd against every element against every deprivation and yet it remains one of the most important stories in our history of leadership. Let me give just a little history here about the Louisiana Purchase. There's a famous time in the history of our nation that takes place at a place called Fort Woods and at some point in this time there is a Spanish flag on the same day and at the same ceremony there is a Spanish flag that is lowered ceremonially. A French flag is then hoisted into the air. It furls and is unfurled and then it is brought down and within the hour after a salute there is the then American flag goes up. It must have seemed surreal for a young Mary with a Lewis a captain in the United States Army and a Lieutenant William Clark to see that it is nonetheless true. What is interesting about this discussion is what it meant in terms of the plan. Essentially the purchase of the Louisiana Purchase doubled the geography of the United States and for 15 million U.S. dollars or 80 million French fry to the time the size of the country was increased by 827,000 square miles. But Jefferson had ambitions far beyond the purchase of Louisiana. His ambition was to go into the territories and determine if there was as there was alleged to be an all water navigable route between the Missouri River connecting with the Columbia River to the Pacific Northwest. It had been reported historically and sailors and voyagers and intrepid adventurers of antiquity all believed it to be so no one had ever tried. Now let's go back and look at the United States in the time of Thomas Jefferson. In the time of Thomas Jefferson everything that you see in pink is the United States. Say it's essentially everything east of the Mississippi River in the geographically say Florida. Florida is still a Spanish possession at that time and it will be for another 20 years. Now there was already issues along the Mississippi River. The value of the Mississippi River to the United States economically and for commercial interest and development of that part of the world was always known. And as there had been some contentious and acrimony contentious events and acrimony that developed along the river Thomas Jefferson needed Louisiana wished to buy Louisiana this purchase for control of the Mississippi River. But he had far greater ambitions as I have mentioned if you think about that doubling the size of the nation is no small accomplishment. And this is sort of a spectacular example of 18th century diplomacy. You have James Monroe and Thomas Jefferson purchasing the Louisiana territory and what is known as the Louisiana purchase. But with their eyes on target as what is called at that time diplomatically manifest destiny they intend to and wish to extend the United States from border to border from Atlantic to Pacific. And things will happen in the context of the 18th century which allow for that but nonetheless that is the plan. So we're going to go back here to the early 1800s. We brokered this purchase and the expedition will take place between 1804 and 1806 when they returned to St. Louis. Now a lot of things are going to happen in the development of this nation but by 1845 the United States had annexed Texas and by 1849 and the beginning of the California Gold Rush it made manifest destiny more obvious for all involved. Now think about this again. I'm going to tell you who this core of discovery is. Who are these individuals? What is their mission? Well their mission is to find this navigable route. That's what their expressed goal is. So Thomas Jefferson has at his disposal all manner of individuals that he could entrust this mission to. And the first question you might ask is why would you choose Mary Wether Lewis? Now I'm going to remind you that this young Virginian Captain Mary Wether Lewis at this time serves as the personal secretary of Thomas Jefferson. That's important. That is the only direct commission that Jefferson made. He relied on the capability of Mary Wether Lewis to put together and assemble the expeditionary force. So this sort of broad strategic goal was to go West Young Man in the words of Horace Greeley to find this route to assemble an agile force and to report back and return with maps and examples of fauna and flora. That was sort of the plan at this time which I think is always intriguing. Well how big a force do you need? Well at the end of the day there's about a total of 50 people involved in this expeditionary group and what is interesting about the group is there will be two officers. Only two officers and they will be of course Captain Mary Wether Lewis and Lieutenant William Clark. There will be five non-commissioned officers and these gentlemen are extraordinarily valuable because they have seen military engagement and military combat in the French and Indian war. So they're going to be very, very important. They're going to be about 30 conscripts and we'll talk about how conscripts came about in the Corps of Discovery. There are going to be three permanent civilians in this expeditionary force and 12 temporary civilians who are essentially going to be chosen for their ability to navigate the Missouri River. That is going to be the complement that is going to travel this 8,000 miles and expend this time together over 863 days. Now I mentioned that Mary Wether Lewis and William Clark had both attended those cereal fly grazing in 1802 in this territory. They knew each other not well but when Lewis was tasked to find another leader to essentially co-lead if you will or his immediate executive officer in this command he made the conscious decision to choose someone unlike himself. The only thing they truly had in common was they both were born in Virginia and they both were military officers. Hard stop, that's what they had in common. They were very different in terms of their education and experience and they were very different in terms of their ability to lead and to engage with others and I think that's the fundamental tentative leadership we'll talk about. Generally, and think about this from promotion boards and acceptance boards and promotion and 10-year documents, there's a general and sad truth that likes chooses like but here in 1803 Mary Wether Lewis chooses someone uncharacteristically unlike himself and they are indeed polar opposites. Lewis is bookish, he's an intellectual, he has a great command of the English language, he's been educated in Virginia and he has had a lot of expert knowledge in his relationship with Thomas Jefferson as his personal secretary. William Clark is functionally literate, he can write and he is educated with compulsory education of the time. He will be born in Virginia and spend his formative years in Kentucky and then from the rest of that time in Louisiana territory. Very, very different gentleman, very, very different skill sets and I always think that's a good start. Along the way, and this is also very important, the core of discovery for which the expeditionary forces known, the core of discovery, are going to engage more than 50 different tribes of indigenous people, native Americans. From essentially the initiation up the Missouri River through the Dakotas to Astoria, Oregon, there are going to encounter 50 different tribes and no two of these tribes has a great deal in common. Some are warring factions, some are hunter-gatherers, there are many different tribes and this entire board of discovery which it's called is truly a voyage of discovery for a couple of reasons. It's just not because the craft is named discovery but they are discovering not only a great deal about themselves as leaders, they're discovering a great deal about the cultures in which they're engaging. And we'll talk at length about Sokotria because she's going to be extraordinarily important in the context of this expedition for many reasons, some of which are obvious and some of which are going to be less obvious. She is a Native American woman, she's a Shownie Indian wife of who will become an interpreter for the group to St. Charbonneau. Her story is compelling story of Native American women of that time as well. We'll come back to Sokotria and her relationship with the voyage as a function of time. Let's talk just a minute more about Lewis and the attributes he has as a leader. I've talked about his near prodigious intellect. He is actually quite brilliant. He is a bookish intellectual but he has given to what is called in the medical parlance of that time melancholy. He has some episodes of depression and it is well known by those who know him including Jefferson and he actually believes the expedition will be good for him as well. But he's a very very interesting man in his own right and some of the excerpts from his journal which he is the most prolific journal writer on the group and the most literate are extraordinary and I'll share a couple with you just in terms of leader and leader development. I want you to look at Mary Weather Lewis and William Clark as Eastern gentlemen of the time. They are technically veterans of military operations and they are they look very very east coast educated and they comport themselves this way and this is how it all begins in 1804. It will not take long before they become less east coast frontiersmen and more native as they approach this extraordinary journey. The State Department has a term about this it's called going native going native and it's one of the reasons in foreign service that we do not have unlimited tours of duty in different countries because the likelihood that you will become more like the individuals of the country you are for which you're representing America to than you are of your own people. But there they are learning the ways they are they are learning respect for cultures they are learning what they need to know and they're taking a lot of advice from indigenous people because they are living in these plains and this is extraordinarily important from their perspective and what they discover pretty quickly if they pay enough attention and if they understand that they are but strangers in this land they will be able to have more fidelity in being able to execute their mission. So this is entirely gratuitous respect they need the help of the indigenous people and they know they need it. So let's talk just for a moment about the best of the days. I mean a good day on this voyage of discovery we're going to use this flat bottomed keel boat which was particularly designed especially designed for this mission and when I say they're going to go up the Missouri River they are quite literally going up the Missouri River and tell what is they are going to push and pull and prod and on a good day they might get five miles upstream. This is not a an easy voyage by any circumstance and what is always struck me as extraordinary about the Lewis and Clark mission is that they truly have no idea what they're going to face. They have no knowledge of it. The last real map that exists of the continental United States at that time sort of runs out about Council Bluffs Iowa. So everything else beyond that point of contact is largely speculative photography. They have no idea. They're not even sure if it's possible. They do not know what deprivations they will face and they do not know if they shall succeed and I want you to think about that when you ever question your own leadership skills and your own leadership arrangement is we often self-load I think do we know enough to lead have we learned enough to lead and generally we have great knowledge when we enter at least background knowledge that is provided to us when we enter a new position. It's not universally so but for those of you who have the privilege to serve in the academy or military service you get a great deal of leader development not so much for this formation. This formation is largely expeditionary and I think that's part of what is the intrigue. Now I mentioned to you there are about 30 enlisted men so let me tell you about how they came to be members of the Corps of Discovery. Now as Lewis and Clark provisioned at a place called Fort Woods and prepared for this journey up the Missouri to the Columbia to the Pacific Northwest as they prepared and provisioned for it they were looking for conscripts looking for people to hire on this forage of discovery so they would often speak to military and territorial commanders in the area and they would say do you have any soldiers that you can provide for this mission are you aware of any. Now I want you to think about this from a leadership perspective there are two reasons I think for you to recommend someone is one they're very very they're extraordinary what they do and the second is you might think that the the expedition would be good for them right you might be inclined to let them go so this is really kind of a mishmash of what I would call a rag tag formation that somehow another Lewis and Clark have to assemble into a functional military unit and they are struggling with it there's going to need to be some discipline although discipline is a two-way sword quite literally there needs to be rules of engagement there needs to be attention to the mission and every member of the core of discovery must understand the mission now it doesn't take very long into the actual voyage of discovery before them to realize that there is much they do not know and the ability to acknowledge what you do not know is also a hallmark of leadership but there is so much that they do not know they do not know that they do not know but because they do not know and because they have the right degree of humility they are able to find out from those who do know and that is largely the indigenous folks of the area so they will begin to become more agile with as an expeditionary force and be able to traverse more efficiently in watercraft actually design for such travel now on two occasions they are going to winter over they're going to win over for a couple of reasons first of all how much further west are you going to go in the winter in north dakota so they're going to essentially winter over in what is western north dakota or fort mandan this is the mandan indian tribe live in this area now when i say winter over they're going to need to construct lodging they're going to need to build their shelter they're going to need to live off the land they are facing temperatures near daily temperatures of minus 40 degrees fahrenheit so this is going to be no small accomplishment and very early in the context of leadership louis and clark discover something that will help them a great deal later by the time they actually meet their mission objective and what they'll discover is is difficult as the expedition is the hardest thing to do is keeping the peace when everyone does not have the mission directed goal of moving forward but rather now we're wintering over they set upon a course of action which i think is great and that is they're going to reward scholarship so there's education going on at fort mandan they're repairing their equipment they are journaling and even those who are minimally literate are being educated to journal and write down their information related to the journal and some of the most colorful of the journal entries come from the enlisted soldiers as you might imagine and some of the most provocative as well come from this group in terms of how they're treated and what's going on so this is going to be a time for great reflection and self-study a time to figure out what you've got done correctly and what you've done what went horribly wrong and this is an opportunity then to share this not only with your co-leader in this case william clark but also with the troops the troops get to know each other very very well and this is going to be hugely important because in climates like this in the wilderness like this and in periods of time for which there's less action this is where the concept of cabin fever literally sets in and there were many voyages of early intrepid adventurers where it ended horribly because of conflicts that arose during times of essentially wintering over so we have learned those lessons well i want to mention a couple of times i have hiked most of the lewis and clark trail largely out of intrigue and i'm always amazed at how rugged it is still i cannot imagine what it would have been like there before the public health commission and the roosevelt era parks put in walkways but it was extraordinary difficult this is a very very treacherous terrain it still is but one of the things i always like to look as this is a glinda goodacre statue of succumb to and i think the one thing that we don't ever pay enough attention to although every time i see her with her son john batista little pomp i almost stop and salute not only does she traverse this terrain in moccasins with 46 males over a period of 863 days she is carrying little pomp the whole way and little pomp is an affectionate name he is anything but little he weighs about 34 pounds and he's being carried by succumb to we are his mother as they engage this expedition what happened so after that wintering over at the mondom area of the dakotas and at fort mondan is there is a leveling from a leadership perspective of the hierarchy within it clearly mario whether louis is still the captain he gives equivalent ranking although it is not a an official ranking to captain clark who is actually a lieutenant in the united states army the truth is that mario whether louis petitioned for a commission a higher commission of promotion for william clark but it was denied it was denied on the basis of promotion sequence he is he was not as educated he had not served as long and in that grade and therefore he was still a lieutenant but he was never referred to as lieutenant mario whether louis wanted him to have the same positional authority and one of the reasons he does is because of william clark's very unique skill sets william clark is among while functioning literate is among the most affable of human beings the troops love him he's an excellent hunter he's pretty good at math development he's good at repairing the weaponry that which they take with him and so this becomes important from that perspective now i want to go back to this concept of the leveling of the hierarchy so we have the captains and we have the conscripts right the core of discovery we have three civilians two saint charbonneau the interpreter a french canadian we have um cicada wea and we have now essentially little pomp this is everybody we have the other individual who is there is actually a slave he is william clark's slave his name is york and he's accompanied william clark um from virginia on but what you see in the context of ormondan is increasing respect respect for skill respect for special knowledge respect for um the mission uh everyone has demonstrated the courage to succeed so far now they have no idea exactly how much further they have to go but at this point this is working very very well for the group but what you really appreciate if you pay attention to it is the development in the journal notes about humility now i will say to you that all military groups and all mission statements are predicated on some number of values based um attributes for leadership and the united states army for which i spent over 30 years those attributes are loyalty duty respect selfless service honesty integrity and personal courage they sort of loosely spell an acronym because what where would be possibly be in the army without an acronym leadership that's what they spell but what is interesting is all military formations and all mission statements are undergirded by these sorts of attributes and what you're beginning to see represented in the journals of lewis and clark at this time are the constructs of respect integrity courage and humility humility this year was just added to the army's core values for leadership and in my opinion not one minute too late humility is it's going to be hugely important i'm going to read to you now a passage from mary weather lewis related to humility and i hope you'll forgive me from reading to you but i love the journal entries and so i have not committed them to memory but i do want to share it with you i have in all human probability let me stop there and say this is on the even on the occasion of mary weather lewis 31st birthday he's 31 years old which is essentially middle age at that time uh owing to the very truncated life expectancy of the 1800s now he is journaling on the evening of his birthday and this is what he tells us i have an all human probability now existed about half the period which i am to remain in the world i've reflected that i had as yet done but little very little indeed to further the happiness of the human race or to advance the information of the succeeding generations i viewed with regret the many hours i have spent in indolence and now sorely feel the want of that information which those hours would have given me had they been judiciously expending but since they are past and cannot be recalled i dashed from me the gloomy thought and unresolved in future to redouble my exertions and at least endeavor to promote those two primary objects of human existence by giving them the aid of that portion of talents at which nature and fortune have bestowed on me or in the future to live for mankind as i have here to for live for myself he is lamented the wasted youth or an indolent youth and i think what is so important in that construct is looking at mary weather louis as a reflective contemplative man he's gone beyond leadership for glory leadership for personal gain he is now looking at leadership for the greater good for humanity for the next generation and i think at this point we would say in military parlance he'd gone from being a leader of men to being a strategic visionary leader of humanity and that is hugely important it's a very good thing they had inculcated humility because times were going to get really tough now on this voyage of discovery now they had been told by the native americans that there were a series of falls about the area of modern-day montana and these series of falls were not navigable not navigable by native americans and certainly not by those who had less skill and even with more agile watercraft it simply was not possible to do this what they were going to have to do was they were going to have to do a portage they are going to have to literally carry the gear across the land and then rejoin the river when it is safe to do so and there's a series of falls there are levels one two and three falls that are extraordinary the native americans believe and have given counsel to mary weather louis and william clark that it should take about half a day to go overland it is actually going to take 18 days it is going to take 18 days or about a mile a day but when you think about how it's done it's extraordinary they have to fall the trees so the trees have to be they have to fall they have to generate the carts they have to load the equipment and then they have to make passable those impassable roads or terrain to move that equipment forward people are exhausted they're working 20-hour days i always say this is the military equivalent to an object going over the berm or an academic equivalent to a visit from a coda or in the hospital the joint commission we all have these berms we have to cross we all have to do a certain amount of portage and that's really what separate separates the pioneer from the settler this is a huge lift by all involved everyone is equivalent in this myth strong backs hard work long days hunger deprivation inclement weather everything you can imagine has befallen the group and yet they succeed everyone is doing a little bit of everything and so louis has decided on this day that he's going to cook he's gotten there ahead of the formation he's worked on his maps he is journaled and now he is going to cook and he says in his journal to myself i assigned the duty of cook i've collected the wood and the water and i've boiled a large quantity of dried and excellent buffalo meat and made each man a large sweet dumpling by way of a treat he's rewarding the troops now as much as a reward as louis believes this is for the troops the troops not so much and they rather hope that they never get to the point where mary whether louis cooks for them again but on that day he had taken that role now i want to mention something because it is a metaphor for decisions or a matrix right well when we do when the road divides it's a metaphor use it in your own life when you have a binary decision stay or go it's hugely important and what's going to happen on this day is significant um they're going to come to a fork in the Missouri river and this fork is going to be a significant decision whatever direction they go and has enormous consequences for the expeditionary force now the question is what to do about it what are we going to do about it well a couple of things happen first of all by this time in the voyage of discovery there is essentially no hierarchy that remains there is command and there is control and there is provisioning but generally speaking everyone feels pretty free to have the conversation the majority of the formation believe that the correct fork to take is the north fork that's important it's a binary mercifully louis and clark believe the correct fork is the south fork so for three days the mission stops and what happens is they ride out a little bit further every day they take measurements they measure the current they measure the width of the river each time trying to determine what is the correct route because it has huge consequences they do not want to endure another portage another portage may be one portage too many and so what they're trying to do here is they're trying to decide which direction they can go now almost to the person to the person uh the crew this motley crew believes the correct role is to go to the north fork that is their belief and they have reasons for that belief and they voice these rather freely with the command both married with a louis and william clark believe the correct route is the south fork and that's what they believe but they stall out here for three days each time trying to determine the way to go at some point no one ever changes their opinion right no whatever changes their mind the crew believe it's the north fork the leadership believes it's the south fork we've all been in that sort of dichotomy before but because there was so much trust in the leadership because there was so much respect for persons in the formation and because of the integrity that had been demonstrated again and again by mary with a louis and william clark that the crew said essentially that we believe it's the north fork but we have every reason to believe in your guidance and your wisdom and we trust you to do what is right this is that trust element that dr hayden talked about it is the bedrock of all real relationships so whether they be right or wrong uh mary whether louis and william clark chose the south fork and the crew went and as it turns out um they were correct now had they not been correct they would have still been trusted but they were correct and they were able to do that i think it says something about their culture it's hugely important that's a healthy team culture now i'm not suggesting that leadership can be done by committee that's certainly not uh entirely true but there are times for going it alone and there are times for collective ambition and collective culture i think getting that to that point and having the trust of those who uh you have the privilege to lead is hugely important now i'm jumping ahead to the demise of mary whether louis which many people believe and it is historically written was by his own hand um on a trip back through tennessee in a way to clear his reputation about another issue but um four years after mary whether louis's death thomas jefferson writes by way of eulogy a note about mary whether louis and i'm going to read it to you now it says of courage undaunted possessing of firmness and perseverance of purpose which nothing but impossibilities could divert from its direction on its disinterested liberal of sound understanding and a fidelity to truth so scrupulous that whatever he should report would be as certain as it's seen by ourselves with all these qualifications as if selected and implanted by nature in one body for this express purpose i could have no hesitation in inviting the entire enterprise to him i think that's extraordinary um we talked a little bit about the relationship of louis and clark and how subordinate and ranked technically william clark was but with regard to influence he was a great influencer in the words of contemporary scholar malcom gladwell when clark would have been the maven he was able to influence the opinions of others and an incredibly affable impersonal character very very important they had different spheres of influence they had different natures and i like to think it's a very strong argument for not choosing like not choosing other leaders like you but using leaders with different um capacities and different characteristics on your team now i want to mention and go back just a second to secondria because um she is her contributions have been overstated by other some and understudied by some the truth is they're probably right in the middle she's an extraordinary i think about her when i think about 8 000 miles carrying little pop and a pep who's across this terrain but she is an interesting woman in several regards um there are several times initially she is going to work sort of as a guide uh she's going to work sort of as an interpreter um i told you she was at the mandan fort mandan but she was not from the mandan tribe she's shoshone and she actually grew up in portions of the columbia river over toward the pacific north west she was kidnapped when she was age 12 she was bought by the mandan warriors to north dakota and she was sold as the wife of two saint charbonneau now all of that is true but one of the interesting things about her is um her role in the formation she has almost a diplomatic role really because and it wasn't planned this way it was planned because true saint charbonneau the interpreter wasn't going to come unless he could bring his wife so it wasn't really thought through other than that and of course she was with gild and so they couldn't come unless they came as a as a group um but the army has a long history of keeping families together and so it is true here but what is really interesting from the purpose is her symbolic role wasted at that time i think on many but not on sacaja wea um the presence of a woman had a very civilizing effect on the behavior of some of the men and that and that's true that's not new that's the opening of the american west the other issue that i think was important is she has sort of a diplomatic role because the native americans knew that she really uh her presence meant that they were not a warring party because no a native american uh no woman would be traveling with a warring party by convention of indigenous people and then secondly she is traveling with her family so it kind of reconciles as uh part will say the intent of the group and i think that's also important to know the other thing that i think is important about sacaja wea is that several times when they were navigating uh some very very um adverse terrain on the columbia river uh they came close to losing not only provisions but also maps and samples of flora and fauna that they're going to take back to washington uh you know mary witheluis was a bit of a naturalist as well and each time when that happened she did not preserve the provisions but rather the maps and the scientific and she sort of empowered the scientific endeavors by ensuring the protection of those uh satchels if you will from those watercraft hugely important but the time they get the last wintering over uh at fort clatsop in essentially modern day astoria argan by the time they get there they are one functional high functioning expeditionary force they like each other they respect each other they communicate with each other those who are minimally literate have become increasingly literate uh it is really really extraordinary and the relationship between the native americans now one last point about sacaja wea at some point when they cross the continental divide and go through the bitter wood wood bitter root mountains they have to abandon the watercraft themselves and they'll have to reconfigure watercraft they come upon them to have to buy horses from the shoshone often the nazpence actually uh native american tribe and um there was no real motivation for the indigenous people to sell horses uh to the explorers and they're not going to do it until the chieftain recognizes that with the warring party is his sister who had been abducted about age 12 by the mandan indians and his her relationship with khamiswayt her brother who was a chieftain then by virtue of bravery and action that he agrees to allow the horses so she has lots of roles um the some of which are actual and some of which are legendary and some of which are diplomatic but extraordinary story um and of course no there's no issue related to uh whether gender sort of differences made a difference in her uh contributions um it is important that um getting together and agreeing where to stay they had learned something in fort mandan which is another attribute of great leaders uh try not to make the same mistakes twice um i have a whole book of 31 years in military service and having commanded formations for years i have a whole book of mistakes i shall not make twice and i so did louis and clark and by the time they get to fort clatsop by the time they get to fort clatsop uh they decide that buy-in and wintering over is hugely difficult the mission is complete we're going to turn around and go back and so we need to get this right now along the way they're going to lose exactly one member of the crew the core of discovery and they are lost to natural causes what is believed to be a ruptured appendix and that was charles floyd uh that is the only loss the only casualty in this um this epic journal journey the last thing i want to say about uh this discussion here is that in fort clatsop they believe that perhaps just perhaps there would be a water route back in the sense that someone be coming in exploring the northwest territory and that they might even pick up a watercraft and sell around and return to the mississippi deltah now none of that is true they're going to go back essentially the same rate uh and the same route they left well on the return trip um the indian woman this is written by now william clark he is journaling and i love his because it takes a while to figure out what he's trying to say and mercifully when they were were reinstituted in the journals of louis and clark they're in their sort of original grammar and language but he says william clark says the woman the indian woman informed me that she'd been in this plane frequently again she was a child getting that from here and that we would soon discover a gap in the mountains in our direction so upon return from the pacific northwest and planting the american flag there uh william clark and cicada wea and others break on one route and of course the original route is recovered and retraced by mary weder louis a little bit later on the same journey um cicada wea says well she can recall another pass in the um essentially yellowstone river basin now this is such a significant finding that it allows william clark and cicada wea and company to get back before the other group going overland on the original route as a matter of fact this discovery was so as significant that it became the optimal route for the northern pacific railway to cause the continental divide again she is retracing the steps of her youth um and finally william clark tells us the indian woman confirmed those people of our friendly intentions as no woman ever accompanies a war party of indians in this quarter and the wife of shabbano our interpreter we find reconciles all the indians as to our friendly intentions as a woman with a party of men is a token of peace so all of that was true in terms of their intent and their missions although they did have uh faced hostilities several times there were no um it did not escalate um what we have learned and is written greatly by scholars a real true scholars of history and of william and clark i'm the correction of louis and clark's specifically and that is the kind of healthy team culture that team should have is a leadership think about your own team culture you've got to be competent we train you to competency professionally you need to be have competency as a leader you need confidence to make the decisions correct decisions when needed but you need wisdom you need wisdom to know when you need a collective deliberate process and when you need to go it alone and i think that is truly what separates the wheat from the chaff really in terms of leadership um in the alchemy or maybe in the calculus listed we've talked about calculus this morning with um einstein but in the calculus maybe we should have this discussion maybe in the percentage of attributes of humility versus hubris humility should always be in excess or in abundance and i think that if you have that part of humility about your leadership style and what we often call accountable servant leadership that i think what you will find is that you will be able to be a more deliberative and collaborative leader i think that's hugely important as well well i hope you've enjoyed our eight thousand mile journey from essentially st louis to to uh the pacific northwest and back we've taken only one casualty of natural causes and i may have taken a few in terms of my telling of the tale but i think it's one of the best examples of how leadership should be done we wouldn't be talking about leadership lessons of louis and clark or from louis and clark if we had not 200 years after it occurred if it had not been a successful expeditionary force what made it successful were the values that underwrote the effort of each member of the team what made it successful is the respect they show for each other what made it successful was their commitment to the mission and what made it successful for all involved at the end of the day was their buy-in on what was for the good of the order for any mission you undertake or task to undertake those uh circumstances must be met in abundance to succeed and if they're not go back and look at your decision-making process go back and look if see and see what kind of trust dividend you can reinvest in your formation so that you will have the opportunity to lead as an accountable servant leader again i'm dr teresa gonzalez i hope you enjoy the trip and uh i am will be followed by my esteemed colleague and dear friend dr lauren scaretta thank you good morning good afternoon everyone it's still morning out here on the west coast two wonderful talks i am i am pleased to be able to follow my two colleagues here and pick up on some of the themes that have been discussed already i i think one of my goals in trying to put my my particular contribution together was to be able to illustrate in my own way some of the academic side of things that we think about when we're teaching students but i'd like to pick up more than just that i think some of the things that we're going to talk about in this next segment again pick up on themes that have already been discussed but they're about inter-colleague relationships as well things that we have to pay attention to so i titled this the unsurprising ethics of leadership i don't think there are any surprises here i'm going to call attention to some things some things that i expect you know but some things that i expect we need to pay a little bit more attention to in our day-to-day interactions with with each other lots of different ways to define ethics we spent some time yesterday for those of you that were with us on the course about facilitation facilitating a discussion of ethical dilemmas we spent some time talking about ethics this is the definition that i have used for a number of years now came from a colleague at at IU health when i was a fellow in the clinical ethics program there and steve ivy refers to ethics as reflecting on right behavior it's a process it is an action it's not just thinking but it's also a discernment process in trying to make a decision about where to go and what to do uh my my colleague Dave chambers uses the term ethics is not a spectator sport and i think that's a wonderful way of thinking about this because if we only think about it nothing happens it's not just about watching we're thinking it's about doing and that's where i want to go with this because it's the whole rest of this ethics of leadership is about doing so here's a proposal might even be a premise ethics and professionalism is far more about what we do and what we promote than what we say i'm going to end with this topic as well with this concept as well i'm going to give you five words at the end of this that if you take nothing else away from what i say those five words are important so we can talk and we do about principles and values and responsibilities and in in training students in developing new professionals we still may not develop an ethical professional because it's not about what we just talk about the didactic preparation of our students is necessary um this is the speaks to that concept of can you teach ethics well i teach professional ethics i teach ethics to students who are becoming healthcare providers the responsibilities and obligations that they take on are not the same as what laypeople have so yes i think you can teach this i think you have to teach it for people to understand the new obligations they have in coming into this new identity as a healthcare professional but it's not sufficient visible actions and discussion about those actions are required at every level of the profession i'm going to spend a lot of time talking about what carl spoke about earlier the intentionality piece and i'm going to focus on the intentionality of role models so this concept of visible action and discussion that's a piece of role modeling here we actually talk about these things they're important to us in the leadership perspective because if they're important to us as leaders there will they will be important to followers as well this is a from um a quote from rich masala in an article that he published in uh journal dental dental education back in 2007 i highly recommend the article it's a very good article and and another piece from dave stern at from university of michigan dave's a medical educator who talks about teaching and measuring professionalism in medicine so masala said professionalism is not an incidental byproduct of medical dental education it doesn't just happened there's no switch that gets flicked when students graduate that says oh they're professional now that's just not how it works it's a skill that's developed in the same manner that clinical skills are developed and to fail to recognize that is to fail to develop people in the profession dave stern points out and this is always fascinating to me there are numerous examples of this in the literature that some aspects of medical dental education actually inhibit or regress professionalism development now i taught at a dental school i taught at indiana university for for 30 years um maybe it's only at indiana university that we had situations where our clinical colleagues who are overseeing the care of patients in the clinic would say to a student yeah i know that's what he said you're gonna do but we're gonna do something different he's an idiot i've heard those words let's just say that's an example of inhibiting or regressing professional development putting a student and a patient in the middle of a conflict between two colleagues how's that look for interprofessional collegiality we're teaching something there and it's not a good lesson so what really matters to you in your role as a role model and i make the point you are a role model so let's be intentional about this let's not just be passive not recognizing that role modeling is happening let's recognize that role model is happening at any point in time when you're interacting with colleagues especially in the presence and in the in the visibility of people that are developing professions those developing professionals are going to become like you for better or for worse so this role modeling again the intentionality of it has to be for the good carl mentioned the concept of habit earlier and a habit he was talking about relative to virtuous behavior doing doing well and making others well so the question that i ask is will followers your followers that you're leading will they be habituated to professional behavior are they seeing it from you are they recognizing it as normal and appropriate and are they doing it themselves that's how we develop professional behavior and professionals so again this follows on something that carl said earlier there are two directions for impacting those you lead here sadly we see this one in the news every day here if experience is one of distrust and threat then this defensive self-interest is going to be the stance towards professional life of those who follow you however if experience rewards cooperation collegiality and trust there's that word that trice has been talking about too then this is this comes to be accepted as attitudes that are normal and rational every day attitudes every day behaviors i use this i think it's always a very useful progression to think about it actually i i i know this exists in a lot of other fields i got it when i was doing some work for our police academy in indianapolis and it looks at the development of a skill and so i'm applying it to ethics and professionalism here and i'm i'm thinking about our own students that come to us out of college into a dental school environment and we have them for the four years that we have them they come to us as unconsciously incompetent they simply don't know what they can what they don't know how to do and what they um what what they don't know so unconsciously incompetent is a is a poor place to be as a clinician and so uh you know it's poor place to be in terms of skill development we work to get people out of that so as we develop these things as they go through their basic curriculum their lab work they go through their ethics and development ethics and professionalism training they become consciously incompetent now they begin to understand what they don't know or can't do and we continue to work with them over time with extra perfect practice right not just practice makes perfect but perfect practice makes perfect over time they become consciously competent when they think about something when they focus on it they can do it and do it well do it acceptably well and then over a long period of time this competence becomes unconscious you don't have to think about it anymore it's habituated at that point in time so it's interesting to think about where do we actually graduate our students and i will make the argument that we graduate our students at this consciously competent step they have not yet reached the point where this is habit and they don't have to focus on it it's just too new they haven't spent enough time doing it this unconscious competence is a lifetime's work Dave Stern in his book on medical professionalism has laid out a professionalism structure that i think is really useful to think about and it starts with a few things that are as you think about them they're really important it's actually a masterful depiction of professionalism at at the foundational level Dave lists clinical competence and by that he's talking about we we would turn term this knowledge and skill of dentistry Dave talks about it as knowledge of medicine but this is knowledge and skill in dentistry the the ability to understand basic mechanisms the ability to understand relationships between the biologic being that you're caring for and the clinical practice that you're doing the skill development that you have in in becoming competent to provide good care communication skills is also foundational block part of this foundation the ability to communicate with patients the ability to communicate with each other i will just as an aside say communication skills is not something that we teach in lecture we can teach about communication they learn to communicate in a role modeled practice environment ethical and legal understanding again we teach about these things we develop our profession our professionals are our new professionals to understand the the changes in the obligations that they have as a result of accepting the identity of a role model but again these are not things learning about them is not the same as doing them this is where the role modeling piece comes in and so the pillars the four pillars that David uses in supporting this concept of professionalism are one of them is exactly the same as the college excellence he uses humanism accountability and altruism as the as the pillars of support so i think it's a useful model i think we could very easily apply this to the principles of the college uses in thinking about these things but it is a basis for understanding the professional development of our students from from from a school perspective and the basis for understanding the continued development of practitioners in in practice life to me this is one of the epitomies of a college fellow you you have this very strongly developed professionalism that is maybe not so strongly developed in in others this is something that we got to work work at i want to spend some time talking about what professionalism is and maybe what it isn't a bit if we think about professionalism we're not talking about perfection because frankly we're imperfect beings if we were talking about professionalism and and perfection there would not be the failures of human frailty here but as pritchett said here competent dedicated professionals sometimes fail honest mistakes are made unexpected complications arise lapses happen i'd ask each of you to think back in your own lives about things that maybe you wouldn't do a second time that you thought about it's good that nobody saw those things and and it's certainly something that you wouldn't want to call attention to as a new fellow in the college here we all make these mistakes so the question is why do professionals fail in their ethical responsibility and this is again a fascinating area there's a literature on this in both medicine and law i think there's some good stuff in dentistry as well a little harder to find but if you look at the literature professionals fail for a number of reasons the first is that they fail to recognize that there's an ethical issue even present we we call this insensitivity the term sensitivity means the ability to recognize an ethical issue when one is present so this is an ethical insensitivity failure to recognize the ethical dimension that's present in the circumstance that's that that's being experienced i think this is probably the most common thing that happens the second reason that professionals fail is because of defective reasoning we spend a lot of time talking and teaching about a decision-making model using ethics as a basis in fact the in the course yesterday that we did on facilitation uses that model as a as a framework for facilitating discussions about ethical dilemmas once one recognizes that there is a model for doing this that involves seeing the issue thinking about options understanding the professional principles that are involved recognizing the other ethical issues that are present in the or other other issues that are present that can be that are part of the ethical dimension assessing the options and coming up with the one that does the most good and least harm and then implementing that option i'll come back to that one in a minute as well once one recognizes that there's a reasoning process possible then it's less likely that you have defective reasoning but again all of us make assumptions sometimes and sometimes that reasoning goes awry this is a big one here and and it's it's one that concerns me when we have a professional who has a lack of clarity about their professional obligation i think it's fixable but sometimes people simply fails it fails to take in some individuals takes a little extra work and there's a failure to recognize that your professional obligations as a member of a healthcare profession are different than your obligations as layperson you have abundant other obligations not the least of which is the nature of that human being that you're caring for and their needs that need to be put as a primary focus the term courage comes up here again this this term courage is i think it's been present in both of the two presentations before this the term courage here is about implementing resolving a problem addressing something having the courage having the fortitude to move forward and actually address something so so you can maybe separate out know how encourage just a little bit as i as i think about this after after listening to carland uh and uh teresa i might think about this a little bit differently but courage is an important point here and a lot of times things don't get resolved because people lack the courage to actually go and address it so those are the first four of these things and i think these are absolutely and eminently addressable issues with professionals that fail when i've been referred practitioners who have been in front of a state board and have been sanctioned many times i'm looking at good people who have screwed up and they've screwed up for one of these four reasons here and we were able to work through these things there are two others though and i'd like to highlight these last two because they're different the two others are a lack of commitment to professional ideals and deficiencies of character and competence we have to address these two and we address these two by either omitting people who have these characteristics from the profession or by removing them from the profession they don't belong in a professional environment where other human beings are at risk from their care and this is the challenge uh dick jones and his uh presidential address today talked about self-governance if this is not done by the profession um it's not going to be done and the trust back to that trust element the trust that the public places in a profession to provide care the the monopoly that the society gives the profession and dentistry to provide care oral health care um that trust is is diminished when when these sorts of individuals are allowed to continue so i've mentioned this already i'm gonna i'm gonna skip through it here again ethical insensitivity being more blindness a failure to recognize that an ethical dimension of care is present an ethical issue is present so how do professional failures and or lapses how are they addressed and how are they managed what are the skills that one needs to do this this is a reasoning process model it's a four step model similar to the six step model i mentioned earlier but it's the same thing a person that's attempting to address laps has to have sensitivity to the fact that there is an ethical issue present that's an awareness issue they have to be able to reason through have the judgment to be able to reason through the issue that's present and the potential options that are available to doing that and look at the pros and cons of those options and addressing the one that does the most good and least harm but they also have to have the motivation the character to actually want to do this okay they have to be willing to go through the steps and and address the issue when we're faced with someone who has lapsed who has where a failure a failure is present we can also choose to simply ignore it do nothing and i would i would argue that that is a lack of not just courage but character and then the last step of this process being implementing recognizing and implementing an intervention of some sort and i hasten to mention that we don't teach these skills in lecture this is a rolled modeled environment this is something that you have to do as a role model our students don't see these things we there's no way to teach this in any way shape or form except by doing it when professionals especially young professionals see us do nothing that becomes what they accept as an appropriate response it's not an appropriate response so please and so that brings me to this concept that's certainly in the academic literature of the hidden curriculum and the hidden curriculum is defined really simply is what we do what's visible as what we do now it can be a very what let me just say that differently it is a very powerful teaching tool and it can be a teaching tool that is concordant with what we say so in other words if what we do and what we say are concordant then we have a very powerful teach a very powerful teaching environment but it can also be discordant what we do is different from what we say i.e. what we teach in which case what we are actually teaching is what we do no matter what how strong the words have been no matter how often the birds have been repeated if the professional behavior is different than those words that's the learning that the students do so it's again we're back to this concept of intentionality as a role model of making certain that what we do is what we say we're going to do so this is if we think about this your role as an exemplar leader as an exemplar it's the underlying basis for the power of the hidden curriculum people who are in positions of authority acting concordant with how the profession believes they should be are teaching a very strong and very powerful message people who are a discordant from what the profession says people who are acting in ways opposed to that are also teaching but they're teaching something that we don't that we don't want to teach we shouldn't want to teach so how do we do that well it happens every day in our interaction with our colleagues it happens certainly with interactions with staff and interactions with patients and if we were doing this in a in a workshop format there are lots of very fun cases that you can do that show examples of interactions that are problematic and the message that are that's taken home by a learner or a young professional who is in a in a training program but the one that thinks most important is how we interact with each other if our interaction with each other is one of respect and one of of collegiality then that becomes the norm and and again this is a crucial learning component especially for those of you that are that are teaching for those of you that have young colleagues who are with you in practice for those of you that have staffs I think again is the is the collegiality within the office environment present because if it's not it's affecting patient care as well so leadership by this is a you know leadership and followership here a little bit leadership demonstrated by ethical actions has a strong impact on the ethical behavior of a group this is from work by you can see it at the bottom of the slide here a guy named Dan Rayleigh Dan's a a behavioralist he's a behavioral economist at Duke but he his background is behavioral sciences and if you get a chance google his TED talk called our buggy moral code it is a short talk I think it's about 15 minutes long absolutely transforming in terms of how you might think about leadership and followership and so again Dan's Dan's comment here leadership demonstrated by ethical action has a strong impact of the the ethical behavior by a group so think about the profession of dentistry leadership demonstrated by ethical action has a strong impact on the ethical behavior of the profession itself and even more so when we think about failures of leaders to respond to unethical actions or events it's a desensitizing process it desensitizes the professional community and the fact is is that it results in increased likelihood of unethical acts it doesn't just allow unethical acts to occur it increases the likelihood that they're going to occur it's really important to remember this and again if you watch that TED talk he's got some really interesting experimental evidence to show this fascinating so by your actions you as leaders you have the ability to influence and set a tone for your own professional communities and that tone also extends beyond the individual communities it extends to society it extends to co-professions it extends broadly and again watch watch the TED talk I I this this altered my thinking about things that strengthen some things about how I believed about this so I leave you with a couple of comments here the professional ethical expectations for healthcare provider can be taught I believe that firmly I can I think I can prove that but I hope you recognize they have to be modeled that teaching is more than just the words that we use in a practice environment especially with your again your your young colleagues your new associates and such you are modeling make sure you're modeling the things that you feel you should from a professional perspective let's make sure those are those those are on the on the right path I'll leave with two quotes here this is from Eleanor Roosevelt it's one of my favorites a good leader inspires people to have confidence in leader a great leader inspires people to have confidence in themselves that in essence is what we do when we train people when we train them to be young professionals we're trying to inspire them to have confidence in themselves but we're trying to inspire them to have confidence in a manner that supports the goals and mission of a professional life so I said I would leave you with five words that if you only remember these five words my job today is done what you permit you promote those are the five words and they're crucially important if you close your eyes to disrespectful unprofessional unethical behavior it doesn't just stay present it gets worse and there are numerous numerous examples of this so I'm going to I'm going to close this out we're a couple of minutes early today which leaves us a little bit more time for discussion and would ask that my colleagues Theresa and Carl join me back here video-wise and open your mics back up and let's have a bit of a discussion here I'm going to need them just a second to review a couple of the questions that have come in unless either of you have already looked at some of these and want to take a crack at any of them here thank you Larry I'll take a crack one came early by a 2021 candidate Dr. Monopoli he has several questions for the presentation but it talks a little bit about I think this is from Carl's discussion of the covenant between the provider and of course the healthcare covenant I think it's it was a beautiful discussion it was the first question to populate but he talks a little bit about the Medicare B discussion so I think I would offer this I have to tell you the truth I was privileged enough Michael in my whole career to be able to work in a healthcare environment as a uniformed military officer in the United States Army to provide care because everyone had access to care and I know what it's like when people have access to care and what that does to the health of a population so that's first second I do think we have to think about Medicare in this context it is alleged that by 2030 20 percent of the American population will be 65 or older defined as what is called in the language of Medicare mature seniors which means they would be eligible for a benefit now that's a lot of people the truth is there are more seniors alive today that have ever lived in the history of the world so that's first the idea of having a dental benefit as part of a health benefit is intriguing to me of course we want people to have optimal oral health we want them to have optimal dental health but the discussion is not whether or not we want them to have dental coverage as part b of a medical arrangement or Medicare arrangement the question is how we do that now there's been a lot of written about it there have been a lot of working groups assembled to have this discussion at all levels the ADA has put out some talking points at ADA.org the CDA has assembled a working group and Peter Duvall has spoken on this and others so I think most of the issues that are related to the deployment of it is how it will be deployed when it will be deployed what will it include and to me those are all administrative guardrails so that has to be discussed as a separate from the idea that we are for people to have access to health care as a population so I know what it looks like when it's done deliberately as a condition of employment and military service I have to believe what is good for the army is also good for the public writ large and so I'm a very big fan and I'd say stay tuned on this discussion there is much to be said and I'm encouraged there is movement however glacial in this direction that concludes my comment thank you. If I could just add to that I think this the question was asked in the in the context of the ethos of the covenant compared to the ethos of the free market and you know this is a this is a paradigm case isn't it so and it's very complicated that's why it's paradigm case that's why it's a bit of a dilemma and that's why it will take a lot of discussion to work through all this you know I don't have an informed opinion about where Medicare would fit in or whether there should be a separate benefit for dental I just don't have an informed opinion about that I do know as I think everybody who's listening and watching this I do know the public is looking at this carefully right and I don't think the public is looking at dentistry with with sympathetic eyes and it could and that could very well be because the the public isn't as informed as they should be about all the issues that are related to this I will I just noted somebody sent me something from a well-respected academic journal the Reader's Digest that dentistry was now is mentioned as one of the most trusted professions and you know I mentioned that out of out of the Reader's Digest because we all know about Reader's Digest expos a years ago you know I think as as tough as these conversations are to work through this you know I am sympathetic to what I think is the professions one of the one aspect of the professions position on this and that is if this is a good society and we claim that it is then then our government does have a responsibility to help pay for the care that's part of being that's part of living in a good society I suspect that in the end there's going to be a lot of compromise and yeah and and and if if and then it won't be it won't be perfect for anyone but if if there if there's imperfection I would hope that the imperfection is in favor of the patient and the public and and frankly it and not the profession. Larry here and Carl thanks for those words and I think you know again I go back to that that slide that you showed on the ethos of covenant and free market and I think your comments are very much related to that particular slide. The focus the focus from a profession's perspective has to be outwork for the good of patience and I think that's a crucial component here if the focus becomes perceived as being inward on the benefit of the profession I think we have a problem and that's my concern about this again I too I'm a patient here I'm not a practitioner my understanding of this my recognition of the various aspects of this are probably not as well developed as as they should be in order to think about it and I think in reality that's part of what needs to happen here I want to hear more discussion about this I want to hear thoughts about this from both directions but I certainly don't want to hear we don't want to do this I want to hear why we don't want to do this and I think these are these are a this is a crucial question and there's a leadership function here that I'm concerned about I want to make sure that that discussion is broadly broadly discussed across the leadership within the entire profession of dentistry and I will tell you that you know as much as as much as I have concerns about cost associated with expanding Medicare that's a different issue than having dentistry as being considered a part of health care that concerns me dentistry is a part of health care from my perspective it just seems like it's not when we think about Medicare and care of seniors again I'm sure there's lots of discussion here I'm looking through the questions that we've got I'd like I'd like I think everybody to comment one more time about Carl mentioned it I think Teresa you mentioned it as well this concept of courage with regard to role models again my own perspective is that people in a leadership in a leadership function whether they think so or not they're role models how does one kind of how do you stimulate that how do you how do you help students how do you help young professionals recognize that that is a that that is something that's just simply a fact Carl and then maybe Teresa after that I don't I don't know that I can say it any better than than you said it Dr. Greta I I think I referenced this article last year it made a big impression on me it's a article I read years ago in academic medicine and the title of it was vanquishing virtue and the and the two two medical I think of a two medical faculty they argued that students come in with with the values that we would associate with health professions so altruism taking you're taking care of the poor wanting to do the right thing and then over the period of four years of medical school that somehow gets taken away from them and the argument that the authors make is it's the hidden curriculum that does that so it's it's watching the way that other that other faculty members act and and behave toward patients and others so again you said this in so many words I think I think that students will will remember you long after they remember what you said so they are watching and being cognizant of that and having having conversations I think you know when it comes to courage having conversations about the challenges the one we just we just had this we just we just addressed in our answers to the question about the meta of Medicare I mean that these are not these are not these are tough problems and these unprecedented challenges are tough and we have we have to we have to work this out in dialogue and it's and it's and it's good for those we're we're mentoring and developing to see and understand how tough this is and how leaders really work through these these challenges thanks Carl Theresa you you have you have you are the product of a the product of a confluence of two professions the military profession and the profession of dentistry here thoughts about this thing this question about role modeling and courage I well thank you first of all the opportunity to comment and I'll just tell a brief aside story and it involved a deployment to Iraq in 2009 for which I was on what is called a torch all right at expeditionary forts and I was there with trusted lieutenants and young soldiers and a young male on the C 141 aircraft was moved to tears as we sort of did our combat landing at biop in Baghdad and he looked at me when I spoke to him he looked away for me he said ma'am I am afraid I said son if you are not afraid landing in a hostile terrain you should be afraid you should be very afraid because we're all afraid I said but we have to have the courage to pull together and we don't know what we are entering and we do not know how this will end but if you weren't afraid and you had you have the courage to say you're afraid that's the place to start because if you're not afraid you're suffering from a post-modern rationalization of what normal is you know I went on that young man did ultimately graduate from dental school and I gave the graduation speech at his program modeling the way does matter and it's okay to be afraid courage is not about getting it right or getting the answer right or even winning life it's I don't think life is a zero sum game courage is about going into the unknown with the the conviction that what you're doing is right and just you close very commonly Larry and our relationship together with the discussion when we teach together with Eleanor Roosevelt I agree with that I also agree with the concept that what you allow you unconsciously promote and I don't know anyone who's going to be canonized for sainthood but most of us can be better leaders and the way we do that is we model the way that we think that will inspire a next generation of leaders to bring the next generation forward this is an iterative business and just like qualifying militarily you've got to do it every year and you need to do it well over so I'm struck by a comment that you just made and thinking about it from the perspective of leading because followers want you to go in a particular direction versus leading because it's the it's the direction that you believe followers should go do you understand my distinction here and I'll I'll put it in poll terms here leading because the polls are pushing in a particular direction versus leading because it's the most appropriate direction to go how do we combat that how do we deal with those things I think it will be the challenge of our time fueled by both information and disinformation campaigns and there's certainly a statistic to suggest or support any theory no matter how unwise or unreasonable the reality is that'll be a challenge too but I think it will come down to at the end of the day trust um I do think trust is the one virtue that we do not pay enough attention to although many at least Carl Hayden has written greatly on this and but I think that's what it's got to come down to is what what is true what is trustful what allows you to move in the right direction and I think of those profiles in courage historically many of them annotated in John Fitzgerald Kennedy's profiles encourage are people who took on very unpopular discussions that are time for which there was no public will and yet succeeded so I know there is a way forward I know it is not easy and I know that it's Sisyphean and so each of us must really roll that rock every day so I think um it's not so much to you know to to lead in the direction that is right depends on who's doing the leading but I do think we as a moral community we generally know right I really do believe that and for those reasons anytime we move away from what is generally or societally right we know when we're doing that as well over Carl thoughts yeah I think part of the responsibility of leadership is to take direction sometimes when they're unpopular and then the polls go the other direction and um um and I think and I think that is uh we have so many members of the college that are in academic institutions I think that's very difficult in academic institutions where let's just say maybe it's more of a democracy than say in business okay so a CEO in a business can can move things maybe more quickly and regardless of of how others view the action um if he if he or she thinks that's the the direction to go um I I I do think um I'm going to go back to trust as well because it seems to me and the and the examples that we've just heard uh Dr. Gonzalez example about uh the trust and the and the expedition in which direction do you go um I I will tell you that when I when I work with teams uh leadership teams the the thing that is astounding to me is how how low the level of trust is among the people that that are on those teams and again this a lot of this is an academia and it's in the in the reasons for it I mean there there's reasons uh the reasons related to resources uh there's reasons because somebody feels like they've been betrayed at some point in the past but if there's low trust it's tough to get anything done stuff for a leader to get anything done it's almost impossible for a team to get something done um I one of the things that I would I would also say about the courage and trust is um it's also linked to vulnerability and I think about I think about Brené Brown's work on this that vulnerability is essentially the the the uh defining characteristic of courage if you keep you're not vulnerable you can't be you can't be courageous and uh good leaders are willing to be vulnerable they're willing to put themselves out there they're willing to say I made a mistake they're willing to say I don't know let's figure this out um so um and and going going back to your previous question I think people seeing leaders who are vulnerable and willing to be transparent and and willing to say when they know and when they don't know and when they need help and I think all that's very good for developing leadership in terms of role modeling you know important points I I love Teresa's comment about Sisyphian um it's in terms of you know pushing this thing uphill all day long if I have that if I remember that that reference correctly it's also Gordian in a lot of respects these are thorny thorny problems that are really tough to unravel and and again thanks Carl I think you know the point about uh requiring lots of communication and conversation about these is is imperative there's some there's some questions that have come in here I'm looking at the list of things um there's a question about uh and I'm reading this how can we test and or question applicants to dental school to filter out individuals who do not possess ethical awareness and or character um I'm I'd love to find such a test I'm not sure that one exists do do either again Carl from your work on leadership and Teresa from your work in the military any any thoughts about this particular question maybe Carl first I I do I do not know of such a test um I and of course it's much easier to um to assess ethical awareness than it is to assess character and when I say assess ethical awareness I mean you can ask people questions about ethics and you can just sort of see how they think about a problem you can do that like you're doing you're solving a mathematical proof okay that doesn't mean you're you've got the character that's behind the reasoning um and and I'm also I'm also speaking certainly outside of my area of of expertise in terms of admissions to dental school I've never done that but um you know I would I would be looking and I know this is tough because people people do do the right thing so that they at least appear to have the character that you want them to have but I still don't know how you do better than that I mean you you know look at you know look at that what people have done you know what have they done with their lives and have they done it over sustained period of time um in terms of of of giving back in terms of things that show strength of character um I really don't know how to do any better than yeah so the past behavior begets future future actions sort of thing right Teresa thoughts yeah and thank you for that I'm sitting there um thinking as Carl was answering which is always impolite so excuse me Carl you should be thinking not with the idea to answer but with the idea to listen but two things on that and it's very very difficult there've even been um not validated uh opportunities to look at what attributes that you could discern from a testing mechanism and I will tell you there's a reason they're not validated and that's because they're not valid the other issue is what are you looking for we know what we want we I do believe that healthcare is a calling I actually do believe it's a calling like many things and if healthcare is a calling you're starting from that perspective of the covenant um the the ethos right so but having set on promotion boards and admission committees for both medicine and dentistry I will tell you there's a couple of things we're really privileged with in the 21st century first of all there's about a one to 12 to one in 16 applicant to acceptance rate and dentistry at perhaps the highest it's been and it's certainly among the most academically prodigious group we've ever had at least by virtue of traditional measures so they're clever they're available they are interested and despite the economic burden of professional education they're interested so all of that is great now how to get the ones to the point how do we get them correct the correct compliment well I may be naive in this but I think it's true I find what works better is to have a compliment that reflects society that's first how they respond to questions is largely performance art in some cases and quite frankly as an interviewer of a little over 3 000 different candidates for a variety of positions in my career I will tell you that on 11 occasions I've had the inter I've interrupted the interview and said please go out and I want you to come in and answer not the questions you have do not give me your answer give answer the question I've asked this is not Henry Kissinger who famously reported here are my answers now what are your questions so I think authenticity is important letting them make mistakes letting them be afraid letting them ask the questions that they they have thought about having the interview be a just interview and not a got you interview I think how you comport yourself in that interview reflects how open and candid they are it certainly was true with my troop populations I believe it to be the same with my students and it's always ends this way you know the interviewers went well when they say ma'am just one more thing and generally in that last comment is something that they are conflicted about I hope there's never a an assessment that will look at that because I also do not know how you measure it and I think attempts to do so might create a my interject variance an error into a process that at least is humanistic at this point over thank you I'm struck by a couple of things here on this one is our behavior when faced with folks like this when we when we have a concern about someone who is behaving inappropriately unethically are we responding that that's the first question do we actually have a response do we do something in other words not just words but is there an action that happens and I think again back to Dana really's work I see a comment in the questions here about who who was that Ted talk again the Ted talk was our buggy moral code and the the person giving it is Dana really a behavioral economist from Duke Dan makes the point that the failure to act results in desensitization and that desensitization is one that affects the entire professional community but it affects again from his work it affects beyond the bounds of the community it affects other communities as well so you you think about society looking at us whether it be the profession of education the profession of dentistry the profession of medicine the military profession all all the all the true professions where altruism and the desire to put someone else's needs first are are you know the highest calling essentially if that if we're desensitized because we don't act we have situations where we don't act we end up with a situation where people simply acting doesn't become an obligation and and I I believe that acting when we're faced with these issues is an obligation it's not something that we can shirk looking I'm looking again looking at the question set there's a question here about where would you consider substance abuse where do you consider substance abuse lies in the list of wild of why professionals fail ethically certainly a nothing new but also something that has been very prevalent especially in this past year when when I worked and did some work for the state board for the vast majority of the cases that we dealt with were practitioners who had been something who had been sucked into this very sad life of abuse and the impact that it has is is dramatic so I'm not sure how to place it it's prevalent it's certainly something that's there it's a is it is it a I guess I mean you can make the argument that it's a failure to recognize the impact that an action has on on your own career and on others but it's also an addiction and so you know you've got a medical a medical situation going on where your ability to do your to do your work and to do it appropriately is impacted I I don't I don't know how to think about it other than that I wonder if either of the other others of you have have a thought about about substance abuse as a professional failing the impact of for it obviously it has an impact but what about it as a professional failing I'm waiting the eight second role Larry because yesterday I learned that you should wait eight seconds before you engage but you're waiting for the answer well that too that too we should start with it if we were to speak let's start with the truth Voltaire so two things on that and I want to do it from a substance so my in my other life I was oral facial pain manager as well so I have dealt with lots of addiction the physiologic aspects of addiction and people who are chemically coping for a variety of maladies not surprisingly that also occurs in the dental community and in the medical community writ large I think first thing you hit it right out of the park Larry is first of all let's separate the addiction from the reasons people chemically cope that would be the first place to start and not necessarily the ubiquity of the medication for which they're using to to chemically cope I think their reasons professionals fail I think one of the reasons I don't know this is a large player it's a large it's a human frailty it is an addiction it is a DSM 5 diagnosis or that is true and we have efficacious therapies but to your point though is to recognize the pattern before the pattern becomes meets the diagnostic criteria so how do we help each other well why do people chemically cope and I think included in that conversation is a long discussion about behavioral health which is largely stigmatized to the point in our culture that people don't seek help and they believe that chemical coping is a management strategy as well now we all know how that will end the physiology will escalate the dose and reduce and increase the tolerance and so this shall not end well but I think two things when I've seen young professionals get in trouble one is chemically coping with alcohol or recreational use of drugs and the other is of course avarice and letting of course what greed and avarice where you're kind of letting things take control of you and what you're allowing and what you did as an occasional situation became your habit they're all manifestations of the same sorts of issues I do think we ought to have a good way to talk to each other about these things and I'm not talking group therapy but this is where you confide in folks when you are on that slippery slope and headed toward to into the abyss there has to be a way to recognize to recognize it reconcile it and recover it over and Larry I really don't have anything else to add I appreciate both of those perspectives yeah I'm going to bring this back to courage here for a second because Teresa what you just said there would require a tremendous amount of courage from a person who is on that slope and and you know it's not just courage I mean it's awareness too the ability to be aware that that's happening and then the courage to say something about it maybe that's a way to tie this together with what you were talking about Carl I'm looking through the questions here again the the there is a question here about asking all three of us to speak about courage it relates as it relates to our three perspectives why is it that and this is an interesting question why is it that courage is such a theme right now what is it that's causing all three of us to kind of have zoomed in on that that that one's that one's easy for me and it's the last 20 months I think I think most of us some most of us I mean look sometimes it's taking courage for me to get out of bed in the last 20 months right this is this has been this has been a really disruptive thing that's happened to us this pandemic and so from a personal standpoint it's really easy because I think it's taking courage to make some of the decisions I have had to make with AL and things like that but the but the other piece is that that that's just obvious to me is the courage has been ubiquitous in the last 20 months so if I look at what I just mentioned it briefly but you know I just look at what what people have done in the health professions that physicians nurses clergy others who have who have taken care and and frankly given their the ultimate sacrifice they've lost their lives for caring for others to me that that's just an enormous amount of courage I can't you know defathom that if I look at social justice issues and what people have done in the last 20 20 months to to take a stand and to try to make a change in this country in terms of of social justice equality civil rights that takes enormous courage so it's been on it's been on my mind frankly because I have seen it so much exhibited by others uh and in the in the last 20 months Drissini thoughts on that well thank you Larry um yeah I think that Carl has hit that very close he's driven that point home in a couple of ways I mean the the courage it takes as an ICU nurse to go into that facility the courage it takes as a teacher to go in and try to educate students in all that has unfolded with regard to the pandemic and all of the uncertainty and all of the acrimony I think all of that is courage that's raw courage that's demonstrable courage and I think every time I see something like this that I consider a a random act of courage helping someone who you know who is truly truly struggling or suffering in addition to the normal burden of individuals who are struggling that's all courageous efforts um and I think that there are things that happen in life and in history and in each of our lives as leaders that force us to do sort of a moral inventory first and then that force us to do sort of a values based inventory of what are we going to do for the rest of our life we're privileged enough to be able to look at moving beyond the pandemic as a function of time I just need the rest of the time post pandemic I need that post pandemic haze when it clears to make have made me a better person a better leader and a better individual and I can only do that for me and model that way and I hope the other people when they do their personal inventories of what happened and what did we learn I think would be an enormous tragedy to leave the pandemic and go back to where we were uh pre-pandemic uh this period of time should have been a great time for reflection and for a reevaluation and a strategic reset and I think if we can commit to that it's never too late to do it you could still be an expert marksman uh if you just do the work and do the practice so that would be my comment over I think Carl's comments during his presentation about thinking ahead and looking for the next time something devastating and critical hits us is a it's it's not just a nice thing to do I think it's a you know obviously it's a necessary thing to do and I know that's happening um I'm also again I'm speaking in my role as a patient but I have this I have this ability because of spending so many years in teaching dental students to you know obviously I don't do what you guys do but I think I understand it reasonably well I saw an entire community of people incredibly skilled very very well trained individuals sidelined at the beginning of this pandemic in not participating in healthcare in any way shape or form and I'm not talking about participating in dental care obviously emergency patients happen and those things those folks need to be cared for but I'm talking about the testing and I'm talking about the assessment of patients and I'm talking about the other things that could have been done away from systemic treatment of patients that were so ill that would have allowed the physicians and the nurses who were staffing those clinics to go care for those patients so I I hope that is something that we look at going forward that we discuss going forward again whether it's appropriate or not is beyond my uh skillset but I hope it's something that we talk about as we move into the the potential planning for another devastating event I'm going to turn this back to Teresa here for final comments here we are we are right right at the right at the time here and I just wondered if you'd like to end things up here well thank you Larry um on behalf of the American College of Dentistry it is our expressed hope that you've enjoyed this discussion of leadership as a mission essential task for fellowship in the college you arrived as fellows and were nominated and will be celebrated this afternoon as fellows your leadership journey doesn't end today it just begins and for that we are committed to being the best versions of leaders that we can be and we're very interested in uh enlisting your willful cooperation as you teach us and lead us across the berm and our second century of service thank you for attending this we will see you at the convocation and congratulations to the class of 2021 our newest family members thank you kindly