Gratitude and Connections: Reflections on My Osteopathic Journey

I hope everyone had a very enjoyable holiday season and the new year has started smoothly and positively. I know I took time to unplug, rest and be present with family and friends … that always renews my spirit. It also gave me time to reflect on the previous year and how I've enjoyed writing the recent commentaries that have become a part of “my corner.”

It took me a while to realize that I have a platform to share ideas and thoughts about osteopathic medical education (OME) and osteopathic medicine. Of course, that platform does not exist without you—the OME community. This message, however, is a little different. As we move forward into a new, uncertain year, I want to talk about gratitude. How we are all impacted by others along the way and how, even unknowingly, we can positively influence colleagues, friends and strangers.

A Fortunate Encounter: Thanking the Physicians Who Opened the Door

Late last year, I became a Master Fellow of the American College of Osteopathic Internists (ACOI). Participating in the ceremony invoked several emotions that were the catalyst for what I’m sharing with you here.

As part of the new Master Fellows class, I was seated next to Carole Kirila, DO. Our conversation led to the discovery of a most interesting connection. You see, I owe who I am today to a group of physicians practicing during the early 1980s at Shenango Valley Osteopathic Hospital in Sharon, Pennsylvania. As it turns out, Dr. Kirila's father was a founder of Shenango Valley Hospital.

I was an EMT working/volunteering with a local ambulance company while attending Westminster College in New Wilmington, PA. We routinely took patients to Shenango Valley Hospital, and it was there that I was first exposed to the DO pathway. The short story is that the physicians I met there introduced me to osteopathic medicine and, through their passion and dedication to the degree, influenced me to choose osteopathic medicine for my future. My family questioned this decision, but I never looked back.

A number of the physicians I met there and at Youngstown Osteopathic (Cafaro) Hospital provided letters of recommendation for me to the Philadelphia College of Osteopathic Medicine, Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) and West Virginia School of Osteopathic Medicine. They were the first to open a door for me. For that I am grateful.

A Spark for Teaching: Forging Connections from OU-HCOM, Residency, Fellowship and Practice

During my four years in medical school numerous role models influenced me, but one stands out, Anthony Linz, DO, who practiced in Sandusky, Ohio. I entered osteopathic medical school with the goals of becoming a pediatrician and returning to my hometown to practice. But Dr. Linz changed that trajectory. He created my interest in teaching and, ultimately, pulmonary medicine. I never had the chance to thank him, but I am forever grateful.

During my internal medicine residency, my program director was Robert G. DeRue, DO, and the assistant program director was Mark P. Pace, DO. Dr. DeRue taught me to pay attention to the whole person and the space around them. Dr. Pace taught me to always begin at the beginning as a specialist and not to rely on the work of others (I later learned that helped to avoid anchoring bias and diagnosis momentum). Dr. DeRue passed away weeks after I completed my residency. To both, I am grateful.

My pulmonary fellowship program director was Donald G. Burns, DO. He was one of the first board-certified pulmonologists in the osteopathic community. While Dr. Linz sparked my interest in teaching, it was Dr. Burns who insisted I develop my skills. He opened the door for me to practice in Dayton, OH, at an osteopathic legacy hospital where I eventually became the Internal Medicine Program Director (IM PD) and Director of Medical Education (DME). Dr. Burns knew how grateful I was for his influence and support, but by sharing it here, so does anyone reading this message. He gave me a chance and encouraged me to find my voice.

Medical practice was a challenge for me, as I could see where medicine was headed but didn’t have the resources to successfully grow my ideas. I didn't want to do what others were doing, and that created bumps for me. I explored proactive health management (preventive pulmonary medicine) and tried to create a preventive healthcare delivery system called New Innovations in 1997. In the Dayton community I had two supporters from the home respiratory care community, Jerry O'Ryan, RT, and Gerald Carr, RT, MBA. Their unwavering encouragement kept me looking for ways to focus on keeping pulmonary patients healthy, not simply treating the symptoms and disease. Along the way, I met Ed Stiles, DO, who helped me to more effectively integrate osteopathic manipulative treatment into my specialty practice. I am grateful to them all.

From Mentorship to Leadership: Lessons in Gratitude and Growth

While growing as an educator, I was fortunate to meet D. Keith Watson, DO. Dr. Watson opened countless doors for me at all levels of the DO community, but most importantly, he helped prepare me to be his successor at the Ohio University College of Osteopathic Medicine (now Heritage COM) as the chief academic officer of the Centers for Osteopathic Research and Education, the Ohio Osteopathic Postdoctoral Training Institution. This perhaps more than any other role led to my having the amazing honor of serving as the president and CEO of AACOM. But these are not the only people to whom I am grateful.

There is Chris Tidwell, DO, an emergency medicine physician who may not realize that he “knocked me straight” one day. The fatigue of private practice and other stressors had left me burnt out and behaving in what I now recognize as unprofessional ways. He called me on it, noting that my talents were being lost in my attitude. I tried after that day to be different. If he had not spoken to me as he did, I wonder where I might be. To Chris I am grateful.

Recently, I received a handwritten note from a DO who interned at Brentwood Hospital when I was an internal medicine resident. Sandy Berglund wanted me to know how much I had affected her (30 years ago) during a particularly challenging moment while on call together one night. To her and every other student, intern, resident and fellow who has ever shared those experiences with me and helped me see where we make a difference without intending or knowing it, I am grateful.

At the recent ACOI conference I sat looking up at the board that I was until recently part of and realized how much I miss them. So many of them (current and past), along with ACOI leadership, have influenced me. The ACOI Council on Education and Evaluation and the Board of Trustees allowed me, in partnership with other members, to explore innovative ways to advance osteopathic internal medicine education. And for that I am grateful.

I could go on but will mention only one other. My wife who has stood by me and encouraged me for two decades. I never believed I could become the leader of AACOM, but she did. I questioned whether I should apply for the job after colleagues first approached me and suggested I should. She reminded me that, since we had met in 2003, I had often talked about wanting to make a difference in our broken healthcare system and that this role might be that chance. She believed in me when I didn't and for that I am grateful.

Professionally, I am surrounded by an amazingly dedicated team, a supportive board, a community of physicians and educators who are passionate about whole-person care and an ever-increasing number of medical students trained in the osteopathic tradition. I don't know what is ahead in 2025 or beyond, but I look forward to OME increasingly demonstrating that it is an important piece of the puzzle needed to improve the health of our nation.

Maybe, just maybe, we can make a difference. And to be part of that, I am grateful.

Robert A. Cain, DO
AACOM President and CEO