Did you know that National Public Radio maintains a list of the best 350 commencement speeches of all time (https://apps.npr.org/commencement)? The list includes links to speeches by presidents, poets, and celebrities. I found it intimidating, until I realized that I could only identify one physician on the list, Atul Gawande. The following words are adapted from a speech I gave at the University of Maryland School of Medicine’s commencement on 16 May 2019. I used the occasion to share my thoughts on the changes that have occurred in society and medical practice, education and research over the nearly four decades since I graduated from Stanford University School of Medicine. My reflections were through the lens of someone who has trained in pediatrics, neonatal intensive care, and medical genetics, which was not even a board-certified specialty when I graduated from medical school.

In my speech I highlighted three major advances in technology that have profoundly affected our lives as well as medical practice, starting with the personal computer. It is hard to imagine medicine, or even life, without the personal computer. Many of the students were even tweeting through their mobile devices as I spoke. I started receiving my first emails in 1995, around the time that many of the graduating students were born. They are a generation that has grown up with the Internet and social media as a constant companion and source of news, both individual and global. The impact of personal computers on medical care, however, was not really felt until 2009, when the federal economic stimulus package gave a financial incentive to hospitals and health-care systems to use electronic health records.

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