Injecting Ancient Philosophy Into Modern Medical Education - Dr. Charles Lockwood, Executive Vice President of USF Health in Tampa

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today I'm delighted to welcome Dr. Charles Lockwood to Raise the Line. Dr. Lockwood is the Executive Vice President of USF Health in Tampa, where he's also the Dean of the Morsani College of Medicine. As Executive Vice President, he oversees the Taneja College of Pharmacy and the Colleges of Nursing and Public Health, as well as the School of Physical Therapy and Rehabilitation Sciences, the Graduate Biomedical Sciences Program and the USF Health Faculty Practice, which has more than 1,000 providers. 

Prior to his current position, Dr. Lockwood held leadership roles at some of the nation's top academic medical institutions, including NYU, Yale, and the Ohio State University. During his distinguished career, Dr. Lockwood has delivered more than 5,000 babies, authored over 300 scientific articles and multiple books, and co-edited seven major textbooks. He's also a past president of the American Gynecological and Obstetrical Society and the Society for Reproductive Investigation, and a member of the prestigious National Academy of Medicine. 

Dr. Lockwood has garnered over two decades of funding from federal, state, and private foundations. He led the research team that discovered the first biochemical predictor of prematurity -- fetal fibronectin -- and the basic molecular mechanisms underlying the menstrual cycle and preterm delivery, among other contributions to medicine. 

I'm looking forward to learning more about his work at USF and getting his insights on medical education and how it's evolved. So, Dr. Lockwood, thanks for taking the time to be with us today.

Dr. Charles Lockwood: Well, thank you.

Shiv Gaglani: So, you have quite an impressive background, and since so many of our audience are current or future health care professionals, I'd like to start with learning more about you, what got you interested in medicine, and then particularly in women's health.

Dr. Lockwood: Well, it's a little bit of a random walk story, as opposed to a well-thought-out plan. When I was in college, my major was actually developmental biology -- embryology -- so that kind of may explain the obstetrical part. But I think what got me particularly interested in getting an MD, as opposed to a PhD, was a summer research rotation at what was then called Sydney Farber Cancer, now Dana Farber, where I was able to work on a rat model for the treatment of acute myelogenous leukemia using bone marrow transplants. I came into contact with some really outstanding physicians, including Dr. William Moloney, who ran the lab and was a prominent medical oncologist/hematologist, and was able to go on rounds and to really be exposed for the first time to high-level academic medicine, and it kind of had me at “hello.” And so I applied late to medical school my senior year and was lucky enough to get into the University of Pennsylvania. Then I think my natural interests in embryology and development led me to obstetrics, and then to high-risk obstetrics.

Shiv Gaglani: Yeah, it's quite an amazing and interesting field. Actually, when you were at Dana Farber, did you overlap at all with Edward Benz? Do you know Ed Benz?

Dr. Lockwood: Well, I know of him, but we didn't directly overlap.

Shiv Gaglani: He was the keynote speaker of a conference I arranged in undergrad for undergraduate researchers. I remember being impressed with him and Dana Farber. And then the other connection -- just given how impressive your background is and what you've accomplished in OBGYN as well -- is Alan DeCherney. I'm sure you know him.

Dr. Lockwood: A dear friend and mentor and just a wonderful human being.

Shiv Gaglani:  Yes, so we have worked with two of his sons, Peter and Alex. Alex was a recruiter for Osmosis for a little while, and Peter is at Penn, as you know, your alma mater, and was on this podcast, too, and a really impressive person. 

Actually, before we get into your role in academic medicine -- you may not know this about me -- but I did two years of med school at Johns Hopkins, took time off to start Osmosis and grew this company. Elsevier acquired us a year and a half ago and now I'm going back to medical school. I'm actually here in Baltimore at Hopkins, starting my third year. My first clerkship is OBGYN. So, do you have advice for me as I begin my OBGYN clerkship next month?

Dr. Lockwood: Well, of course, it's the best clerkship! You're going to have the most fun. And there’s some great docs at Hopkins. I think it's always good to read and prepare for the rotation. In general, students either love it or hate it. If you can tap into the great joy of being present during the birth of a child and kind of get into the excitement that labor and delivery generates, you're going to really enjoy it. I think great obstetricians are adrenaline jockeys. We love the highs, but we also like the crises, and of course, high-risk obstetrics has plenty of those.

Shiv Gaglani: Yeah, certainly. So, I may pick your brain along the way as I go through it. But I'm excited. I have this recurring nightmare-slash-dream where I'm in a mall or something and some pregnant lady’s water breaks and she says, “Is there a doctor nearby?” And I'm like, “Well, I'm a medical student.” I need to know how to address that if that ever happens.

Dr. Lockwood: Yeah, I get that occasionally on planes and have delivered some babies in cabs.

Shiv Gaglani: That's amazing.

Dr. Lockwood: I got yelled at by a cabbie when I was a resident because the woman ruptured membranes, and he said, “Well, who's going to clean up my cab?” I said, “Well, not me and not her.”

Shiv Gaglani: (laughs) And not her either, yeah. Well, OK, so we're going to go more into OB-GYN. But let's go into your role in academic medicine and leadership roles, which is quite impressive. What got you interested in that part of medicine?

Dr. Lockwood: You know, I'm not sure there was anything that got me interested. I think it was one of these kind of accidents of being at the right place at the right time. I had gone to New York to work at Mount Sinai and really to do a postdoctoral fellowship in the laboratory of another great American hematologist, Yale Nemerson, and was very interested in clotting and coagulation, which is obviously a big, big issue in obstetrics and in gynecology. During that process, I also helped lead a team that discovered a marker for premature birth called fetal fibronectin -- which is actually still used by people every day around the world as a predictor of preterm birth -- and kind of got a little bit of fame locally in New York City, so I was approached by NYU to see if I'd be interested in being the chair of the department there. 

I was very young and very inexperienced, and I'm not sure why they ever approached me, but I am an adrenaline junkie, as I mentioned. So, with the opportunity to kind of rebuild a department and take on these administrative responsibilities - and, of course, also delivering a lot of babies and continuing my lab -- I jumped at the opportunity and really enjoyed it, and hopefully, it was reasonably successful for the university and for the department. That kind of got me off on that tangent of my career.

Shiv Gaglani:  Well, yeah, it's been quite a career, as I mentioned. So, let's turn to what you've been doing at USF. It's been very busy. Florida, and Tampa in particular, have had a lot of net migration, a lot of excitement in the air, it seems. I actually grew up in Cape Canaveral, so I'm very familiar with that area.

Tell us a bit about USF Health and what its strengths are, and what are some of the things you're proud of as you've taken on this role?

Dr. Lockwood:  Well, of course, I love Tampa.  I love the warm water. I sail and play tennis and golf, so all those things are fantastic here. I think I saw the opportunity to really take a strong community-based medical school and convert it to a research-intensive school and that was kind of the goal of President Genshaftwho recruited me. I saw there were a lot of assets that could be leveraged: a fantastic teaching hospital in Tampa General Hospital; Moffitt Cancer Center; and a really world-class Veterans Administration Hospital. 

There was certainly the opportunity to, de novo, build a strong research program in areas that I was interested in and we had the great advantage of a rapidly growing population. So, I think all those things were draws to the job. Also just a great culture...people really interested in building something substantial, both clinically and academically, and I would say I was able to recruit a great team and they deserve 99% of the credit.

Shiv Gaglani: Well, yeah, I've been following some of the innovations. We mentioned before the podcast started that I met your Dean of Pharmacy, Kevin Sneed, at a conference called FutureMed. He was probably the only dean of any health professional program I'd ever met at that particular conference where I met people like Peter Diamandis and Daniel Kraft and Eric Topol, among others. So, I was pretty impressed back then that USF had administrators who were thinking maybe three steps ahead. 

Can you tell us a bit about some of the innovations in educational methods that you've been focused on? I know we read about simulation, another thing you've been interested in, and what medical students can learn from ancient Greece. So, tell us a bit more about some of these initiatives.

Dr. Lockwood: Yeah, I can talk about the extremes. I think within a week of when I arrived, I was given the opportunity to build a new medical school thanks to the owner of the NHL franchise, The Lightning who had, with his partner, bought a substantial portion of property on the waterfront channel side. Jeff Vinik is just a wonderful guy, a great philanthropist and visionary. We leapt at that opportunity and we were able to get support from the state and from foundations and donors and other sources to build both the new medical school and a heart institute near our world-class simulation center, which we call CAMELS -- Center for Advanced Medical Simulation and Learning -- as well as Tampa General Hospital. 

So, it was an ideal opportunity, and as we confronted the physical architecture of building that building, I challenged everybody with the frightening concept that when that building was topped off, in 2020, medical knowledge was going to be doubling every seventy-three days -- that was the estimate. It’s probably about every thirty days now. It really, I think, fundamentally altered the way we thought about the building. So, we accelerated the process of curricular reform that we had started by dramatically reducing the amount of lectures, reducing the length of lectures, introducing a lot more active learning, a lot more problem-based learning, simulations, standardized patients, bringing in more clinical content into the first two years. At the same time, introducing a lot more assessments -- 40% of learning is assessment -- and we'd kind of gotten away from both formative and summative assessments. So, we introduced quite a bit more of that. It's hugely labor-intensive, but I think the end result was dramatic improvements in our board scores and where our folks matched. 

At the same time, we really focused on the research component. We said, look, in this era where medical knowledge is doubling far faster than our simple brains can possibly process that information, you have to be able to access information, make sure it's accurate, make sure that it's relevant to your patient, and apply it at kind of the point of care and point in time needed. To be able to do that, you’ve got to be a good researcher. You’ve got to understand what good quality clinical studies are and what poor quality studies are, and so in my time there, we've gone from about 20% of the students doing research thesis to well over 95%, and many of the students have four or five publications.

It's become far more research focused than when I arrived. We still have great clinical training since both Tampa General and Moffitt have gotten even busier, as has the VA. So they're getting great training, but I think they also are overlaying all that education and training on a much more solid research foundation. I think that combination has been very helpful. 

Now, at the same time, what we've tried to do is to stress -- talking about state-of-the-art current AI -- we've also tried to stress the need for grit and for embracing kind of the classic stoic teaching about taking on obstacles and challenges as wonderful opportunities to grow and to innovate and to mature and also to become more resilient and develop a better mental equipoise. There's nothing better than having a little bit of grit to face these challenges. We like to think of that as kind of an anti-coddling, anti-safetyism mindset and I think it's working because our students tend to use mental health counselors far less than the average medical school and obviously they're performing at a high level and they seem pretty happy and cheerful and seem to embrace the educational environment we're giving them.

Shiv Gaglani: I love that. There are so many threads I'd like to pull on, including the physician scientists...teaching them how to think and be critical. But are you yourself a fan of stoicism? Do you read a bunch of books in stoicism? 

Dr. Lockwood: My other major in college was political science, and believe it or not, I went to Brown for my undergraduate education and our political science department had a pretty conservative bent -- I mean, considering where the school is now -- and so one of the things we were required to do is to read a lot of political philosophy and a lot of philosophy. That was my introduction to stoicism and to the mindset which I embraced at that time and continue to embrace with great enthusiasm.

Shiv Gaglani: That's wonderful. Yeah, same for me. I mean, I love all the Ryan Holiday books, The Obstacle is the Way being his most famous, as well as William Irvine. You may have seen his...

Dr. Lockwood: I just asked everybody to read that, The Obstacle is the Way, and I think it's a good way to introduce them to Marcus Aurelius and to put it in a very modern kind of cool way.

Shiv Gaglani: Totally, and it helps shift people from maybe a victim mindset into an underdog mindset or a growth mindset. In fact, I just shared publicly that I'm going back to med school earlier this week, and there's a slide where I talk about one of the main reasons I've gone back to med school after this ten-year journey is to turn two negative emotions -- the “two Fs” I call them -- into positive emotions. So, fear into growth, right? If you confront fear...it's what Eleanor Roosevelt said, do something that scares you every day because that's how you grow. And the other “F” is frustration. I'm sure you know this better than I do -- having practiced so much and researched -- there's so much to be frustrated about in the healthcare system and education system. But you can turn that frustration -- instead of complaining about it -- into an opportunity to improve it. 

Like, I was very frustrated with the Hopkins lecture model a decade ago and so we turned that into an opportunity which became Osmosis. It's really great to hear that. You don't hear many deans talk about stoicism on this podcast.

Dr. Lockwood: Right. Well, in a way it's driven many of my career choices, you know, facing completely new and novel challenges whether it's research, clinical or particularly administrative. I remember being called in to see the dean at NYU after I'd taken the chair there. I'd been there for about five years. It was a new dean and he asked me if I would be the interim director of the cancer center and I looked at him probably pretty oddly and I said, well, “You know, I'm an obstetrician. I deliver babies. I really truly know nothing about cancer centers.” He said, “You seem pretty good at organizing and who knows, someday you may want to be a dean.” And I said, “Well, I'll never want to be a dean.”  

I took on the job for about eighteen months and hopefully did a pretty good job. But, you know, I think it's propelled me in ways that probably I never would have taken on without that mindset. And in my personal life, I’m not particularly a big fan of swimming and I probably have a little bit of claustrophobia and fear of drowning. So, I said, “Well, what's the best way to get around that? It's to get certified in scuba.” I think taking on those challenges in a controlled way, not in a reckless way, is a way of really fully embracing life and using your talents. Overcoming challenges is the best way to grow.

Shiv Gaglani: I love that. How specifically have you incorporated it into the curriculum at USF or into the practices?

Dr. Lockwood: Well, we have basically gone back to a lot of the traditional modes...to grades and to taking on big challenges and taking on a fair amount of extra academic loads. At the same time, I think we’re making sure the students realize they we’re here together, that they’re here to enter a solemn profession but one that can be a lot of fun and exciting and interesting. They also see the example of the faculty that are working really hard, and we're really busy. I mean, my Lord, Tampa General Hospital is one of the busiest hospitals in the country and has one of the highest acuity levels in the country. But seeing the clinicians really love what they do, I think, has helped set up lots of stoic role models for them.

Shiv Gaglani: That's awesome. Wow. You may also be a fan of Taleb. Do you know Nassim Nicholas Taleb? 

Dr. Lockwood: No.

Shiv Gaglani: Oh, you'd love him. He has a quote where he says, “stoicism is Buddhism with an attitude” (laughs)

Dr. Lockwood: (laughs) 

Shiv Gaglani: ...and he's written several really good books. He's most famous probably for The Black Swan.

Dr. Lockwood: Oh, of course, yes, yes.

Shiv Gaglani: But a really good book -- I don't know if you've read it -- is Antifragile. Do you know this concept?

Dr. Lockwood: It sounds right up my alley.

Shiv Gaglani: So, the whole concept is that there are some things that when you drop them -- like a clay vase -- they break; there are other things that when you hit them or drop them, they don't break, they're resilient; then there are still other things that when they get hit, they get stronger, right? So that's what antifragile is. So, when COVID comes to your doorstep, we become a better health system or a better educational system. Obviously, it's painful, but you want to build organizations and individuals who are anti-fragile, it feels like.

Dr. Lockwood: Well, it goes along with the Coddling of the American Mind, which is very much the same idea. 

Shiv Gaglani: Oh, neat. 

Dr. Lockwood: They’re arguing that the current mindset is, ‘what doesn't kill you makes you weaker,’ and that's totally wrong. So, that's another book that I really required all the administrators and the medical educators to read and I talk a lot about it in my writing, because it's such a great book. It really picks apart so many social pathologies that we see today, starting with the impact on social media and alienation of youth, and the “safetyism” structure that has permeated universities and now elementary schools and higher ed. I think it’s spot on in a lot of its arguments. 

I think you're right about COVID. COVID was our test as an organization and I'd give us an A plus. I mean, we took care of the sickest patients in the state at Tampa General. We were able to implement a lot of innovative ideas, including surveillance screening, and we were able to very rapidly move all of our curriculum online and implement telehealth within a week. I think we've done something like 500,000 visits now with telehealth. So, a lot of things to be very proud of.

We helped lead the state, honestly, with our membership on different gubernatorial committees that dealt with the crisis, particularly in the early phases. We even developed a 3D swab in our radiology department because there was a shortage of viral collection swabs, and they developed that in about a week. They released the formula to the planet and according to the London School of Economics -- this was about six months ago -- over 150 million had been manufactured. So, a lot of really cool things to be proud of, including being first in the state for vaccines and the use of monoclonal antibodies. 

But it was a test of our resilience and our ability to take this challenge and innovate and do all the things that -- getting back to that stoic philosophy -- stoicism teaches us is the result of taking on a challenge like that. I think the most surprising thing was the relative lack of burnout at the end of it. We're moving on to new challenges, but it didn't leave us hollowed out. It's just the opposite. We were a lean, mean fighting machine by the end of COVID.

Shiv Gaglani: That's awesome. You preempted that question I had of how you guys have responded to the pandemic. I know there are studies that show that prolonged grief counseling can actually be detrimental to someone's ability to recover from grief because it sort of incepts this idea that you should be grieving forever and have long-term bereavement. There's a balance between not being totally hard on people -- you need to be compassionate and caring -- but you also don't want to be coddling, as you've said, which I 100% agree with. So, that's great. It's so refreshing to hear you talk about that because I feel like a lot of academic medicine and also other fields in higher education are going the opposite way. It's a troublesome trend.

Dr. Lockwood: That's exactly correct and it's a trend that we’ve got to stop. Otherwise, it's gonna cause great societal harm, especially to young people.

Shiv Gaglani: It has, yeah, it already has. So, we've talked a lot about some of the lessons learned over the past several years. As you look towards the next five, ten years, what are you most excited about? You mentioned AI, which is obviously what everyone's talking about. How do you see things changing in health education and delivery because of these tools?

Dr. Lockwood: Well, first of all, AI has the promise to improve safety, which is great for patients, and more importantly, I think it has the potential to reduce non-value-added work for docs. Some burnout is real, right? If you spend a lot of time entering data into your electronic health record at 11 o'clock at night, there are probably other things you'd want to be doing at that time. So, the more we can decant that busy work out of the doctor's schedule, I think the better we'll become and also the more we'll be able to embrace lifelong learning and all the other things that make for great physicians. So, I think the practice of medicine ought to be improved by that. 

But ultimately, AI is gonna be critical to be able to care for patients and incorporating that into medical education is going to be both the challenge, and I think the great opportunity, of the next decade. Because again, information is accelerating in every field at a pace far exceeding our neuroplasticity. There's just no way we can keep up with it. You know, I was talking to one of our medical oncologists the other day and saying it seems like every issue of the New England Journal of Medicine has a new cancer drug. How do you keep up with that? And he said, it's a challenge. It really is, and so I think having AI incorporated into our ability to make diagnoses, identify the appropriate treatment, but also to surveil a population so that we can identify and prevent disease by picking up early indicators of disease is gonna be very important. 

For example, at Tampa General Hospital, we have CareComm, which is this GE master system for monitoring everything that goes on in the hospital and they've developed a fantastic sepsis program that identifies and warns of very early signs of sepsis. It's already had a demonstrable effect on sepsis mortality and costs. So, all these things are gonna have to be incorporated into our medical curriculum so that students readily adopt AI in ways that hopefully make their life simpler, but make patient care safer and better.

Shiv Gaglani: 100%. I mean, there's Marty Makary here at Hopkins who published that paper in JAMA, I believe, about medical error being the third leading cause of death in the US. I think it’s the equivalent of one or two jumbo planes going down every day for a whole year. And so, yeah, I'm very excited about AI, and that's one reason we even have the podcast is to try getting medical students, nursing students, pharmacy students, not just training for -- as Wayne Gretzky said -- where the puck is, but where it's headed. It sounds like you guys are already incorporating some of that. 

My last two questions for you. The first -- and you've kind of already started alluding to this in the conversation -- what advice would you give to our audience about meeting the challenges of the present moment and approaching their careers in healthcare?

Dr. Lockwood: Yeah, well, it kind of gets back at another theme that I probably pound away at too much, and that is the Daniel Kahneman notion of how we use heuristics 90% of the time in making choices about everything from what to watch on TV to what drug to prescribe a patient. It's important to understand the potential dangers of that, particularly in medicine, because it can lead to just an assortment of biases -- confirmatory biases, anchoring biases, ascertainment biases. Taking time out to think slowly about things, to really analyze information and to kind of double and triple check yourself and to ask some fundamental questions about the sources of information...that's gonna be a critical part of this new medicine in being able to adapt to this bewildering increase in data that we're getting. 

Being able to understand where your potential shortcut is not appropriate is vital. And as with stoicism, this has application across society, right? If you're listening to something on cable news or reading something on social media that doesn't make sense, it probably doesn't make sense and you need to think carefully and think slowly about that and not jump to conclusions. 

So, I think that the tendency, given the rapidity with which information is accreting in society, is to rely more on heuristics, and in fact, it's a mistake. It's like having too much grief or grief counseling. You really need to stop and think and think slowly about what you're deciding upon. Otherwise you're gonna perpetuate error and do bad things.

Shiv Gaglani:  That's wonderful advice for sure and certainly something I think as one matures and reads more of these books, they realize that so much of what we do and why we do it is not actually at the core of the individual -- if you ask the five ‘whys’ -- it’s not really an individual's decision. It's sort of like decisions by other people, by society, and what makes them decide to do what they do. So, being deliberate and thinking slowly, as you said, is great advice. My last question...is there anything else you want to leave our audience with about you, about USF, about healthcare in general...whatever you'd like to share?

Dr. Lockwood: Well, you hit on all my favorite topics, whether intentional or accidentally. It really is important that as we embrace all this fantastic new technology and artificial intelligence, that we remember that we're the same human beings from a genetic perspective that fought the Peloponnesian War, right? I mean, so we haven't changed and we have to understand our own limitations -- both as physicians and individuals -- but as a society, so that we stop making the same mistakes over and over and over and over again.

Shiv Gaglani: Wow, that's awesome. I'll leave you one other quote based on what you just said there. I'm sure you know E.O. Wilson, the entomologist and researcher.

Dr. Lockwood: Of course, yes.

Shiv Gaglani:  One of my favorite quotes is, the real problem of humanity is the following, “We have paleolithic emotions, medieval institutions and godlike technology.” So, that combination is now accelerated. We're still the same humans, as you said, who fought the Peloponnesian War and came out of the caves, but we have institutions that just have not kept up, and this technology is just obscene in terms of what it can do in a good way and a bad way.

Dr. Lockwood: Yeah, I mean, Sapiens: A Brief History of Humankind is another great book. Yeah, of course. So, there are wonderful ways of understanding the challenges of where we are at this point in society and how to face technology.

Shiv Gaglani: Well, we'll have to do a book exchange one day, so I'll let you know if I'm ever in Tampa. It's a great place. Dr. Lockwood, thanks so much for taking the time to be with us today. 

Dr. Lockwood: You too, real pleasure. It was a lot of fun. 

Shiv Gaglani: Likewise, and with that, thanks to our audience for listening to today's show and remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.