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We're continuing from with the regional position, yes, so John Bell had established this actually excellent and specialist clinic,

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which was superb for managing difficult lupus, scleroderma, peggies to see the best heart patients in Boston living and involved in that, John Lennon.

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And by that stage would have retired. But he did. He started it was his clinic.

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Yeah, that's what I was thinking. So I knew him. Peggy, pigheaded lupus work.

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That's right. I used to work in his clinic as well. That's quite right.

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So did he have a sort of skin clinic? Well, it was lupus patients.

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Yes. Right. OK, but but I used to once I started officially there, John Berman set it up as an official multidisciplinary clinic.

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Then I would bring across the lupus patients from the dermatology part.

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The difficult ones would go to that clinic.

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So while I was in St. Mandaville, I was still doing that clinic that the lupus visual system basically systemic,

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the destroyed ones with systemic problems, the simple, straightforward descriptions one would leave in the dermatology.

12
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Yes, but these patients do it on a systemic disease.

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Yes. Right. Because that had been your experience. They said, yes, I tried.

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I sort of forgot my career. Oh, yes. So that had continued all the way through.

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And I was John Ballerini who got that guy officially. So that was a great length to continue when I was in state Mandela.

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So when I came back to Oxford, that clinic obviously continued and I was doing a set up.

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I'd set up a big tumour clinic in Stoke Mandeville where I,

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I divided up the clinic so that instead of seeing a mix of patients, all the tumour patients were coming through on one day.

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It was a much more efficient way of running it. So you could see with I had a registrar between us, we'd see three patients every 15 minutes.

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So you would Ratliff's through screening and deciding who needed surgery, who didn't need surgery.

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So when I came back to Oxford, I ensured that we had a tumour service established in Oxford for screening patients.

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But it just does mean that your general clinics, you don't have any life relief.

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You have patients who need a lot more time. So I was then dividing my service more and more into medical and tumour.

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And so I set up a psoriasis clinic in Oxford.

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Yes. Which I think was really important because you don't need a lot of time with chronic disease needs.

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A lot of times these sorts of patients that are coming through to a hospital to secondary care are usually complex,

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is and has raised has really changed hugely.

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It's amazing. So what do you do for you given biologics, you switch to biologics?

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Well, TANF and yes, yes, it's fantastic.

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And that new ones coming out all the time. So people who have taken over from me have got more drugs than I had when I retired from the government.

31
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And they were going to really work well, they do really well, but psoriasis finds a way around it.

32
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So they will work for a time. They work in rheumatoid arthritis as well.

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But I think the arthritis patients, they don't seem to get the breakthrough. Sorry. I'm sorry.

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I first to help. Yes. So the management has changed enormously.

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And what's very interesting is the way the patients cope.

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So you may have somebody who's had chronic psoriasis,

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plaque psoriasis for years and sort of coped and we've got quality of life indexes and you get them to fit it in.

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And to your surprise, they say, well, you know, I'm alright, I'm coming.

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I've got used to it. And yes, I get on with it. Then you can have psoriasis.

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And if it starts to come back even a small bit, they can't cope at all.

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It's so sudden I discovered what life's like without it. Yes. So yes, it's fantastic.

42
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If you think back to what I was doing with Tarrant's when I started in dermatology, we were giving patients time to use it.

43
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Yeah, it's hardly surprising people didn't use this stuff as often different from vitamin D.

44
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Yes, yes. Yes. In what way? Well, well, the ultraviolet light that well it's Chess's where the T cells.

45
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So I mean a local immunosuppressant has big effects on the skin.

46
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Yes. And it does that separate from generating vitamin D in the skin.

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Yes. Yes. They have many different effects as psoriasis, a terrible disease.

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I was used to what we used to bring people in and we used to tell them they had to stay in until the psoriasis was cleared.

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And if they didn't, it was their fault if it came back. But I never, you know, said that that was what they were told if they wanted to go higher.

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And they were strongly discouraged when I started in dermatology, that's yes.

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It's your responsibility to come in and stay and three weeks or more.

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What was the success rate that was. That was different.

53
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All right, sunlight and what is it?

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Did you hear them? I did, cos they could people come in now for three or four weeks, my bad.

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Well, they used to come into the sleigh. This is wonderful because. Tell me about that.

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I mean, how many birds were there? Must've been I suppose it must've been about ten, something like that.

57
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Was that in the dermatology invasion? Yes, yes. Yes.

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And we had specialist nurses. We had ultraviolet light there and we had lovely grounds.

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And that's, of course, where she was based. So we'd come and do our outpatient clinics in the John Atlas.

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And I go back to the slide, you know, when the slide started.

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But the end I wanted to finish Terenzio to be able to tell.

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Yes, I said yes. So what is it finished in your time?

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And yes, the new unit was built and opened when I was at State Medical.

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Yes. Yes. Because the new parents are wonderful. Yes. Terence and Rodney raised fine and I raised the money for that.

65
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And then I sat in the hospital, put in some money as well. But a lot of that was raised by that very personal unit.

66
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Very, very good. So when did you get into structured teaching, as it were?

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I mean, you've had this experience to do and then you said when you were teaching was.

68
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Yes, I always loved teaching. That was one of the tools to get me back to also because I really miss not getting medical students instead of actually.

69
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Yes. So I came back to Oxford and got thoroughly involved in medical student teaching.

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Did you have the brief to do that or did you just get involved?

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No, it's just something we all talked about this because I was particularly keen on teaching and I must have done well.

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I don't think I have done any courses or anything. And then the interesting thing about coming back to Oxford was that I was no longer my own boss.

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I had three other colleagues and something colleagues say, you can't say you're going to do this.

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You've got to negotiate everything, which is fine. We all got on, but it's just not as quite as quickly.

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It was a big hospital. You can't change things quickly. So I came back, for example.

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It was nice. I know. Disease index. I've got a set up instatement.

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Well, I've got my own disease index, so I could actually sort out what I was seeing every year, how many patients I've seen.

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I could pull information. There was nothing in Oxford University and a computer that yes, there was no nothing.

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Chris Bunch had set up something and each department I think was doing their own thing and there was no coherent possible policy.

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And and I found it. If you knew you couldn't actually evaluate what you were doing, extraordinary things.

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I found it extremely frustrating, but that's the way it was.

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And then sometime into the second year, I suppose it must have been this letter came round to everybody.

83
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They were looking for a new director of clinical studies. And that's when things.

84
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So you volunteered? Yes. Yes. Well, I volunteered.

85
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Yes. I wrote say I was interested to a position that wasn't in the competition.

86
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I think they interviewed a number of people. The interview was extremely informal.

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I have no idea how it was really working. It was all Davit. Well, yes.

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And a cup of coffee. And how much would it cost him before I hadn't come across him as a student because he arrived.

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Yeah. After I left and I knew him,

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um I better when I've been doing my research because there was a time I looked at while I had applied for a welcome fellowship and didn't get it.

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So David was involved with that. I didn't know because I was running.

92
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It was John Bell. Right. There were those David is there's probably a pair of them because John was very much involved, I suspect.

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And tell me about the indirect evidence that as well,

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I hadn't realised quite what a challenge it is going to be because the quality assurance, secure assurance,

95
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certainty were coming in to look at Oxford and Oxford really hadn't engaged with

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what the other medical schools had done is that had Salford and Cambridge.

97
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I think to some extent I thought that they would probably not participate in this process at all

98
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and then realised I probably had to participate in it and this was going to be a big mistake.

99
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So I only had eighteen months to get the place turned around, fit for purpose place as viewed by an outsider who is doing the quality assessment.

100
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The James, you know, know the GFC had come in separately,

101
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the Q&A where the great and the good from other medical schools basically come the correlates with, you know, positive health.

102
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I mean, who is running the key? I don't know who runs the cure.

103
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It is I suppose it's I don't know if you can look at it, but the people on the teams are.

104
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Individuals from other medical schools were trained up as inspectors and they all dermatologists, so none of this is medical schools.

105
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This is this is the whole. So you would have a team of eight people coming in, inspecting the school and staying for five days.

106
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And there was a room. In fact, it's the committee room only the first on the academic corridor that was filled with files of information.

107
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And they needed to look at the curriculum. They need to look at how things were taught, how things were assessed,

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how we support students, what resources we propose, but nothing, even a curriculum.

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The good stuff. So that was the problem and I had no idea, I said I'd become director to see what it was.

110
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Nineteen ninety something. Well, look it up. Yeah, I think it was 1998.

111
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I started in 1999 and the QCA were coming in in May 2002.

112
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Yorkhill consultant Cordy's heads together. I did.

113
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I told them I'd put them on the bus going on and on the ringroad while the inspection team was here.

114
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They wouldn't play. We could bring about change because actually the inspection team were coming in.

115
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So yes, people realised that actually they were going to have to do something. And was that beneficial?

116
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I think it was, yes. I think Oxford it was a very good medical school, but it had drifted a bit.

117
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And there were there was feedback, I think, from the medical students who were less than happy with the quality of teaching they were getting.

118
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And David, I think, recognised that there were there were problems and things needed changing.

119
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The GMC had been in and Oxford wasn't actually measuring up to what they expected,

120
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although there was a tension between what the GMC wanted and the type of education Oxford provides.

121
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And I think the GMC had moved moved away from the views I had then,

122
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because the GMC at that stage were very much pushing integration and clinical clinical being introduced early.

123
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Yes. Separation between the two parties, special study modules so that students would have opportunities to pursue humanities,

124
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do other things like Oxford had not moved at all.

125
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And so there was quite a lot of moving needed. But we still retained what we believed was the best in Oxford and were able to justify what we did.

126
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And we don't have anything to do with the surgeons. Or was it just the research?

127
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No, no, no, no. Saho Medicare for those of us. Yes, it was that because the physicians are good, as we all know, that was challenging.

128
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I was challenging. I have some interesting discussions with the surgeons.

129
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Yes, but but I've learnt, you know, the right things to do because it was hugely difficult.

130
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It's hugely difficult. I actually had to ring Peter Morris in Australia because stuff wasn't being delivered.

131
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He was at a conference in Australia and I explained that the tape was coming in and whatever it was a month or two months,

132
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and I still hadn't had the information back from the surgeons. And please, could you do something about it?

133
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Which he did. And then the hands appeared.

134
00:13:04,670 --> 00:13:15,380
The stuff that Quicknet, which is a good thing, she's she's very good, but has his clinical lecturer at that stage wasn't delivering anything.

135
00:13:15,380 --> 00:13:20,220
Right. So there were challenges, but we got there and people pulled together.

136
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It was amazing. And we got a curriculum. There was a curriculum committee, you know, which have been running for years under Graham Evans.

137
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Oh, yes, there were all these papers and they had not made any decisions about anything.

138
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And in fact, the feeling was that if things were written down, the medical students wouldn't learn anything else.

139
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I mean, I'm sure I would want to know unless they just kept me away from it.

140
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But I'm not sure that ever had anything to do with agreement.

141
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When this committee wanted to have the way I was pulled out, these other papers, what I was trying to sort out what this committee had achieved.

142
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Well, that's another story. But there was a strong feeling that nothing should be prescribed.

143
00:14:00,550 --> 00:14:06,870
The medical student should find that way and they will be OK if they were pretty much I.

144
00:14:06,870 --> 00:14:11,310
It's OK. And that's another thing. I misremembered then.

145
00:14:11,310 --> 00:14:19,890
But their assessments were not a huge problem. The exams are completely idiosyncratic.

146
00:14:19,890 --> 00:14:27,240
The exams in year five, which is when they're doing that, various specialities, like everybody was doing slightly different things on the fire exams.

147
00:14:27,240 --> 00:14:29,070
If you pull them off, it's dysphonia medicine.

148
00:14:29,070 --> 00:14:39,120
Saiva exams, heavy emphasis on tropical medicine, predictable questions challenge your space of the curriculum, not exam at all.

149
00:14:39,120 --> 00:14:43,320
There was no blueprint of questions, nothing else.

150
00:14:43,320 --> 00:14:48,060
The amazing discourse emerged within the exams to the finals.

151
00:14:48,060 --> 00:14:53,700
You know, it wasn't just that, but the people who were sat in exams were not necessarily teaching.

152
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That was the other thing. So, you know, they were just examining the things that they thought were important to the.