Editor's Note

Tone at the top

By Dana Cook Grossman

The tone of any organization comes from the top, and at a medical school that's the dean. Nineteen people have served as dean of Dartmouth Medical School—on a de facto, acting, or permanent basis—during its 213-year history.

Well, during a little over half that time; there actually was not a dean until the late 1800s. The nation's fourth-oldest medical school, DMS was founded in 1797 by a prescient 34-year-old named Nathan Smith. He led the institution for 16 years, leaving in 1813 to help found Yale Medical School. But despite his long and illustrious tenure at Dartmouth, he never held the title of dean.

For most of the 1800s, the secretary-treasurer of the faculty was as close as the School had to a leader, though the post's only official duties were keeping the minutes of faculty meetings and balancing the institution's books. Carlton Pennington Frost—the secretary-treasurer for 24 years, from 1872 to 1896—is considered to have been, on a de facto basis, DMS's first dean. When he stepped down in 1896, the faculty minutes show for the first time the election of someone to a position bearing the title of dean—William Thayer Smith.

After Frost, the record for longevity is held by John Bowler, who was dean for 18 years, from 1927 to 1945. The shortest tenure was by someone to whom, after Nathan Smith, DMS probably owes the greatest debt: Marsh Tenney. He held the deanship on a permanent basis only from 1960 to 1962 (though he later served two terms as acting dean), but he revitalized the School at a tenuous time in its history and so is considered its "refounder."

A hallway in the dean's wing is lined with photographs of all the deans—except for the newest incumbent in the position, who arrived just two months ago. I was walking past that row of photos recently when it hit me that I've at least met 13 of the 19 individuals who have held the deanship—everyone from Marsh Tenney on—and have gotten to know some of them fairly well (though I didn't know all 13 during their deanships; I've been around a while but not quite that long!).

I'm not sure where a medical school deanship ranks on the list of challenging jobs, but it's surely on the list. Everyone wants something from a dean—a better lab, a bigger office, more teaching time for X subject, fewer teaching demands for Y department, the dean's presence at some marquee event, the dean's ear to argue for this or that cause. Deans must lead and inspire the teaching and research that lie at the heart of a medical school's mission and conciliate those activities with academic medicine's clinical mission. They have to avoid getting bogged down in the minutiae of running a complex institution but still must balance the books (just as those 19th-century secretary-treasurers did!). They need to model the compassion and the intellectual curiosity that we all hope characterize the nation's future doctors and scientists.

Thankfully for that future, all the deans I've known have been driven by a sense of bigger purpose, not bigger perks. I don't have room here to say something about all of them, but I'll mention three whose names appear elsewhere in this issue:

I'm already moved by the kinds of things that Chip Souba, who became the 19th dean on October 1, is putting out as guiding principles. Click here ta to read about his aspirations for DMS. The words he uses—"connecting minds," "building better human beings," "well-grounded on the inside"—are resonant with a sense of purpose and, I'm confident, augur well for the School's next stage.

It was a particular pleasure to work with Bill Green, who was dean from January 2008 until Chip Souba's arrival—a period of considerable financial turmoil, as we all know. But his steady hand kept the ship on course. And, if you'll pardon the mixing of high seas and wild west metaphors, it was widely appreciated that he's a straight shooter. Happily, Bill hasn't left DMS, only the deanship.

But sadly, one of their predecessors has left us all—Bob McCollum, dean from 1982 to 1990, died in September (click here for an account of his career). He was dean when I took over as editor of this magazine in 1986. I recall two things about interviewing with him for the job: his warm demeanor and his tiny office, which, I learned, he'd chosen because he was canny enough to realize it would be hard for anyone else to petition him for a bigger office if the dean had such a little one.

I have to say, I think that kind of tone—purposeful, forthright, warm, canny—should be music to the ears of anyone who's concerned about the future of medicine and biomedical science.