Faculty Spotlight: Donald Knowlan, M.D.

When you enter the lobby of GUMC’s Medical-Dental building, the first thing you see is a portrait of Donald Knowlan, MD. The painting was commissioned on the occasion of Knowlan’s so-called retirement—he is an emeritus professor of medicine but remains irrepressibly active on the medical campus, teaching classes and holding court in his favorite chair just outside Dean for Medical Education Stephen Ray Mitchell’s office. Knowlan balked at being featured at first, but allowed the painting to proceed under the condition that it be an action picture, rather than a more traditional, formal portrait with the subject posed in full academic regalia. “There has to be a patient and students, and it has to be at the bedside,” Knowlan requested.

“The portrait has become symbolic,” says Mitchell. “Students will ask me, ‘What’s the strength of Georgetown?’ I will point to that portrait and say, it’s the triangle. The triangle connecting the patient, the student, and the teacher.” In the painting, Knowlan guides the student’s hand and watches her as she interacts with the patient.

Knowlan has taught at Georgetown since 1961. After receiving his MD from St. Louis University School of Medicine, he trained in Internal Medicine at GUMC. Subsequently, he completed a fellowship in Clinical Cardiology at Georgetown and another in Biochemistry and Nutrition at the University of Pittsburgh, then assumed the directorship of Medical Education at Georgetown University/Virginia Hospital Center, Arlington Hospital Affiliated Program in the Department of Medicine. He became a full professor at GUMC in 1991, a Professor Emeritus in 2000, and a member of Georgetown’s esteemed MAGIS Society of Master Teachers in 2003.

Knowlan, who has seen a lot of medical students arrive and graduate, has plenty of perspective to share about the journey they take to become doctors. “When they first come, I think they initially feel they don’t belong here,” he says. “They had a goal, and that was to get to medical school, and they’ve moved out of the support system that allowed them to do it. Now they’re here, and they say, wow, I’m not sure I want to do this. They start adding up the years. Let’s see, there’s 4 years of med school, then 4 years of residency—some of the residencies are 7 or 8 years…”

His advice: Don’t think too far ahead—take it a day at a time.

“The first year is very agonizing for them,” he says. “All of a sudden, they look around, and they see the top kid from Notre Dame and the top kid from Georgetown—and they realize it’s not the same crowd they went to pre-med with. Now they’re running with some highly talented and skilled people, but what they don’t realize is that they are one of them.”

“Half the doctors in the United States graduated in the lower half of their class,” he laughs, pausing to let you get the joke, “I don’t think any of them can take it to this day. Back in high school, college, our med students were number 1, and they come here and find out they’re, maybe, number 120.”

Knowlan declares that he never saw a medical student who didn’t improve each year. He remembers “way back in the sixties” giving bad grades to some junior medical students, watching them improve in their senior year, then going on to excel as interns. “They were just delayed,” he says. “I learned from that to be a little more patient with their development.”

There are lots of reasons Georgetown turns out great medical students, Knowlan will tell you. “The first is today I think the students are smarter. All of us from my generation think we couldn’t have gotten into medical school today, competing with these people—they are really dynamite. And they’re good. They’re highly motivated, good kids.”

Another reason—more women in the class. Knowlan is convinced women bring additional balance, maturity, and competitiveness to the group. “The women are focused,” he says. “The medical students today, when they come in, they’re ready, and they take off.”

The fact that Georgetown receives no state support is an advantage when it comes to selecting top students from all over the country, Knowlan maintains, because the university is not bound by state regulations that mandate a certain percentage be allocated to in-state admissions. He says this creates a great dynamic which he refers to as “the blend.”

“We get a lot of different students, and one group I really like are the kids from the military. We get students from the Navy, Air Force, and Military Academy. They blend in here really well. I love it when I go on the ward and I have a military student in the group, and I’ll say, ‘Hey, I want somebody to present a case next Friday at 10:30’, and one of the students will say, ‘Well, I don’t know that I’m going to get one of these and I’m not so sure…’ And I’ll say, ‘Anyone here from West Point?’ And the guy says, ‘Yeah, me.’ And I say, ’Can you get me a case?’ And he says, ‘Done!’”

“So that’s the good thing about the blend, because when the other kids see that, pretty soon they’re all saying, ‘Done!’”

Finally, Knowlan credits GUMC’s long tradition of great educators, going back to Harold Jeghers, MD, who had a singular focus on education and recruited young doctors such as Proctor Harvey, MD, to come to Georgetown and teach. “My feeling is Georgetown attracts great kids. Everybody’s patting the school on the back—and O.K., they got part of it—but it’s the quality of the students we get that does it.”

“When they leave Georgetown, they’re really well-prepared and oriented for clinical work. I can’t tell you how many times a head of a residency program that I know says great things about our graduates.”

On Sunday, May 17, 2009, 190 medical students will graduate. About 44 percent of them matched with the nation’s top 25 residency programs, and 13 percent with the top 10 programs, as ranked by U.S. News and World Report. Approximately 40 percent will have residencies in primary care, up from last year in spite of the challenge posed by soaring student debt. Spirits will be high as students move beyond the Hilltop to the next phase of their education. They will have become doctors. As Dean Mitchell likes to tell them on Match Day, “I have good news. You all have jobs.”

Knowlan looks ahead to what awaits them. “You know, these residency programs, they’re looking for certain kinds of schools. And they start saying, ‘We get these graduates from Georgetown, they come in here, they know the job, they do the job, they focus and get it done—we don’t even remember their names, they go right through the program—that’s the kind of resident we want.’”

By Frank Reider, GUMC Communications