Academic programs are built on four main pillars: clinical excellence, research, education, and administration. These apply whether you build and design an u/s program or division, a simulation program, a toxicology or pre-hospital program and even an academic department. You never forget when your childhood dog dies. And I will never forget how all four of my childhood dogs died. These 4 tragic, dramatic, and traumatic experiences provided fantastic lessons on how an academic program can fail.