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Full spectrum exams are fascinating. Yeah, well, I was completely naive.

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I had no training in medical education, so I have no idea what was required.

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Not really. Did you go to other medical schools? Yes. Well, one of the people who helped me a huge amount was Chris Bulstrode.

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Right now, I know Chris is an eccentric. He's a great man.

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He's a great man. And he had very clear views about education and what was needed.

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Was he a consultant to the NSA? And he must have been on the air.

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And he I think yes, he was.

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But he is, in fact, come to think of it, I did go on a course that Chris ran for educating consultants, teaching consultants how to teach.

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And that was one of the first occasions I actually realised that you could learn how to teach.

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That's right. Inspirational. So when I took on this role, I realised we had the KIYA coming and I was going to need help.

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I actually called on Chris and Vicky Hunt, who's now his wife ran the education courses with him.

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Was she a doctor? She's an educationalist, yes.

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So I pull them in and said, look, I really don't know what we're going to do here.

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We've got the Kuai coming. And I think this we've got a problem. And I said yes, and it's going to help Vanessa as well.

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But this is everything. When did the business.

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The preclinical school. Yes. Yes. This was the whole school inspection of the.

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How did you relate to the problems? Well, I worked very closely with Stephen Goss.

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Yes, very closely. And it was a real opportunity for better communication across the two halves because we had to present ourselves as one school,

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but in fact, you know, silos. So I was it was marvellous.

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It really was good. The business of doing a consultancy there,

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giving lectures or talking come in because I gather the people with video and then it was played back to them and they could see it with you.

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Not specifically with me, but we did do we did it quite a lot of training teachers and we explained to them what because the Q&A,

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we're going to come just choose random things to come and sit in. We didn't know what they were going to watch, but they could come to anything.

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So people had to start thinking about what the aim of the lecture was, had their learning objectives.

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People said, what is allowed to say?

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Yes, it was it was a very interesting ten months.

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And with the learning that have to fit into the curriculum, yes, I'd have to be achievable as well.

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And it had to be measurable. Right.

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So how do you know that your student has actually achieved whatever it is and how much formal student feedback was when you started?

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There was there was some negative feedback, which I think. But I mean, people were filling in forms or just talking.

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Well, I think there was not not it wasn't collected particularly rigorous manner.

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So that all changed as well. Yes. You were talking about that at the end of a recession or so.

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It's at the end of their attached. Yes. There's a very good way of collecting the feedback now.

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Yes. So it's all hugely change. And Tim Lancaster, my successor, has been fantastic because he's got good medical education background.

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Now, when you say your success, I mean, you did three years, but then you were sort of your belt.

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That's right. And I continued with a hat on curriculum hat.

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I did three years and I could have done two more. And it was three year renewable for two.

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And they offered me another two. But actually I was only doing because of the queue.

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I was only managing to do a half day to the day at the time. And I was wondering about really how we loved him.

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Yes, I had to stop my dermatology actually completely. This was almost a full time appointment.

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The director of clinical studies, not it's not as many sessions.

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And I actually looked at it and I knew that I I was losing my skills and I felt that actually three years was enough, I think, to my colleagues.

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But we were able to use it to get another consultant. I taught quite well.

44
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And so did Peggy follow you?

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Is he wasn't director of clinical studies? No. I brought Peggy in when I was appointed.

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I needed somebody to help with the pastoral side. Yes.

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And so because my predecessor was John Sayer and Joan trial used to do the pastoral side with him.

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So I recognised that Peggy, who I'd known since I was a student,

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had huge strengths and that it would be really great to have her help with the pastoral side.

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So I brought Peggy in as an assistant or associate director of clinical studies.

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So this is all after living in its first session?

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Yes. Yes, I was after John said. That's right.

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And let him do some of to, you know. So I did it for three years with Peggy and I brought in the other person I brought in was Helena McNally,

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who is a medical educationalist who was also tremendous.

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Where did you bring her from?

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Well, you know, it's all chat this, too, because Peter said his his colleague, Martha McNulty, had a wife who was a medical educationalist.

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And so I said because I knew that well, I knew Nikki Hunt obviously didn't want an appointment for an appointment in the medical school.

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She was just coming in to do a bit of advising for the Kuai side of things that we needed.

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A medical education was embedded in the medical school. And I talked to her and said, well, I think, you know, please, would you like to come?

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And I talked to somebody else, David Brown. I said, have you got any money? I left for a couple of sessions and she not many more sessions.

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And when did you start? So you can say something when I can say that Tim Lancaster took over from me.

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So that's the way it went. And Peggy stayed on as an associate, still doing pastoral work.

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Right. And then when did you get into sort of national dermatology then?

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Well, that's when I went back to dermatology. Yes. So I developed teaching courses because I had not had the medical immersion in medical education.

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I realised that there were lots of dermatologists who needed help with teaching.

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So I wrote about teaching in dermatology and set up some courses on education.

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How you teach dermatology for this was dermatologists consult. You had a natural course for teachers.

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Yes. You're not in Oxford? I worked for five years, I think.

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And would you run that in the church? Because there going to college? Yes.

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Yes. College based. It was residential and it was. Yes.

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And if you picked up links with some bands. No, not really.

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I sometimes we're very good to me. And they gave me accommodation.

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But I, I when you when I stopped for that first year.

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Yes. But I actually used as a house I didn't understand colleges. I'm not because I had not been a preclinical student.

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And that was a challenge when I became director of clinical studies because I had absolutely no idea.

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But the clinical students by and large, don't use the computer. They do not.

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It's changed. We've got this this is one of the things we did was we strengthened the support that colleges gave to students.

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So they now most of them will be getting clinical tutorials from somebody who's linked to the college to supplement to the medical school.

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And so those college links have improved a little bit, having to do once a week, once a month.

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It depends how we used to get junior doctors will be appointed by our colleges and associate,

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tutor or support they give them and to do sort of school.

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Yes. Well, the colleges were beginning to do it and the students had produced a website showing which colleges

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were which weren't which were influencing where the students were going and the colleges.

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The competition isn't. That is student Hopkins. Yes, he was he was doing things.

85
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He was very good. And that's really about. That's right. So that has gradually strengthened and not until his continued strength in that.

86
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So I think most colleges do something. It was something that I picked up on.

87
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They were very concerned about inequality of provision. Yes. Yes.

88
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And we had to do something to try and encourage the colleges to give a little bit more support, sort of in, you know, teaching people nationally.

89
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And when you began going to London to the British British Association of Tautologies.

90
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Um, well, I actually we are very democratic in dermatology.

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So people apply send in applications to be president.

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Right. And you get voted for nationally. Right. So it's affecting business.

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Go. Yes. So, I mean, when you're viso coming, going to be the president, you have to run a conference, is that right?

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You should do you should do. It was in Manchester, but you had already been voted for.

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But of course it was the year I was president. Yes. Right.

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Not voting for. No, I don't think it was the year when I was president.

97
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So how did you run the conference in Manchester? Brilliant. Manchester is a wonderful city for a conference and we have a very good conference team.

98
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The beheading is now streaming professional organisation. So you have to set a programme.

99
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You go to the offices. And I looked at the programme, decided, but I wanted a strong medical dermatology theme for that conference.

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And what would that be then? Medical dermatology? No, I mean, you said that.

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What would the theme be? Oh, well, I meant for the for the actual workshops, the lectures.

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I wanted to make sure that dermatology. There's lots of surgery.

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Yes. Cosmetic dermatology is sort of creeping in.

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They're not great enthusiast. There's paediatric dermatology, there's contact dermatitis, allergy immunology and the medical side of dermatology.

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By that I mean sick patients. The contact with patients with systemic disease patients with psoriasis on system.

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Biologics. I wanted to be sure that the theme for the conference encompassed something that

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covered that aspect of dermatology is medical paederasts filariasis rouzier.

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Well, yes, that's well the disease is it is it is a disease.

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But yes. So sick patients and lupus and I mean, you know, rivertown criminological skin diseases.

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So I mean, it's dermatology, medical dermatology, I suppose.

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But I really wanted I was thinking more about the links with our physician colleagues.

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Right. So we had Carryback Black, who was president of the Royal College of Physicians, came and gave a lecture, for example.

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I mean, she did systemic sclerosis you talked about. Yes, I think yes.

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So legacies, of course, there's a big overlap with I can't remember if we had a diet anthologist talking,

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but we had a day that was devoted or a morning that was certainly devoted to aspects of medical dermatology,

116
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and that has continued to be an annual meeting.

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Now, that is a very strong thing, but you founded a difference to you if you follow the richest society in medical dermatology.

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We did. Well,

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there are a number of us who felt that surgery was becoming so strong that people were forgetting our links with medicine on that side of things.

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And we needed a voice. There were people who said dermatologists where all physicians were all medical dermatologists.

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What is this? Actually, it's turned out to be a very successful society.

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So the consultant dermatologists in the country, I mean, what percentage would be in the medical dermatology, medical dermatology society?

123
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Oh, well, I don't know. I suppose we've got a couple of hundred is a good number to go to.

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It's a good, strong society now. It's doing very well right now.

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They are in Oxford. Once you've been director of clinical studies and you give it up, you must look over and wonder how things are going.

126
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I know you said your name is just very good, but I still do other things that you would like to see happen that didn't.

127
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I don't know. No, I don't think there are, because I think Tim has actually taken all the things we were doing and pushed them forward.

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Yes, it's doing really well and doing the numbers.

129
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It's one concern is the way the medical schools expanded. We're up to a hundred and sixty or.

130
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We all have difficulties with placements. I think it's interesting that Tim has had to pull back on the amount of general practise I did.

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Here's Tim, a general practitioner, the first GP.

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He's been director who actually cut a week or general practise experience from the curriculum because of the pressures in general practise.

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Do they still start with some general practise early on? Yes, they like that.

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Yes, they do. Yes, I do. Yeah.

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So he's just they get into the other stages, but he's had to because general practise is under pressure for finding space for people later on.

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Foundation doctors are all going out and doing community now. So there's quite a lot of tension.

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There is good people used to say with the general. But yesterday I remember going away out to mourn in the marsh.

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I think I think Paul was ill. Would that happen or not?

139
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Yes, it does. Yes. And so just thinking in terms of, you know, when you assess them at the end of the three month attachment,

140
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of course, they never used to get an assessment at all, though. Correct. So that was one of the things we had to change when I started to exercise.

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It's quite difficult,

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actually pushing your own interests when you are supposed to be looking after everybody and sometimes your own interests to be subsumed by this.

143
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But yes, we've now got an integrated assessment with primary care. So they get to Olasky, they have a proper dermatology station.

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Right. And they've got to talk about something. They could be dealing with a mother of a child to be actors in these situations.

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So you might have the mother with a baby who's got bad eczema and they'll have to come

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to the mother about how to treat the child using topical steroids and the moisturiser.

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Or they might have a an actor who's just had a malignant melanoma removed.

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And they have to talk to that individual about what steps they should be taken to reduce the likelihood of recurrence.

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So they don't know the subject before that. They know well, they may have a broad idea of what the sessions could be.

150
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It doesn't make any difference what they know. All the studies show they can just do just as badly.

151
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They may be dealing with somebody with hand over tinnitus. That's the really important area.

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Yes. And they may have to meet somebody with a leg ulcer and talk about how you're

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going to deal with this business also and get him to move and lose weight.

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And so those stations, yes, we write those stations and pass them on to general practise and then the GP picks a station.

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So they do an integrated assessment. They have orthopaedics as well.

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I think in that assessment now and then have primary care care in the community, I think and I think there's a bit of geriatrics.

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So that's quite a big assessment of dermatology is thoroughly embedded into it.

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Yes. How long would you be at each station? Well, as I said, you know, I think it's probably about 15 minutes.

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Yes. And would you do two or three of you?

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I think there's any I think Texas managed. I think we possibly getting a second dermatology station that's off with just one.

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And then there will be a written paper as well with multiple choice questions or study matching questions, which would also encompass dermatology.

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So that's at the end of the placement. Do it. And that's in year five.

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Yes, we do have finals dermatology because dermatology in medicine panels, which we're supposed to Kolja,

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the just you just used to call it the medicine and surgery or a staged assessment nopales,

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but we all do quarterfinalist so they could have dermatology as relates to general medicine.

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So they may well have psoriasis in that one actually was the luckiest comes up.

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And what they have medical ophthalmology or medical. Yes, because they then have the eyes will come into the exam is in the last stage.

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So what he used to say is, you know, oh, I stopped when I retired.

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So I do I'm a foundation or was a foundation training programme director when I stopped and I did that for three years or four years,

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I'm still Peter Sullivan still appointed me as not I trust training programme

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director because the Oxford Hospital Trust with responsibility for teaching.

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So I'm responsible for the induction of the new foundation doctors arriving shortly to organise their induction and shadowing programme.

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How long does that last? They arrive on a Wednesday. We give them a bit of time, one and a half days and the lecture theatre.

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And then I hit the wards and I have a half day and skills that we've set up so

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that because eighty percent of our foundation doctors are not Oxford know.

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So that's a big challenge. They're all coming new to Oxford and every hospital seems to.

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A slightly different way of doing things, different equipment, different connectors,

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so we have to introduce them to the equipment so they have Hafter Skills Lab and the rest of

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the time they're working on the walls with the person whose job they're going to take over.

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So they've got three days on the wards, something like that.

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It's a week a to when they come on a Wednesday.

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And I think this officially start work on the following Wednesday. Something like that.

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Yes. That's a huge change. Yes.

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And and that's and then the rest of the year, I'm organising the mandatory teaching programmes for Fundación year one and year two.

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But the administrative department is brilliant in the Post Graduate Education Centre.

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So I know I come up with the ideas, but they did.

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And that's and bolts of contact. So you want to do that after you've graduated?

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Yes. This is the first two years. And how much do you look after the ones that they've talked with them because.

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Oh, you're talking about the people of October. So wherever they come from, yes.

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There's something in the old days you knew what the weaknesses of the people trained in your medical school did,

191
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but now you don't know what the to people be are.

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Consultants in Oxford are very frustrated that they spent all this time educating our medical students to a supposedly high standard.

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They really are taught and taught, not dogs. Not all the studies show that Oxford art forms everybody else and they lose them all.

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And what determines whether they go for the first second terms? Well,

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I think one of the reasons they're moving is they've had six years in Oxford and they know not a foundation programme is two more years in order.

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Day used to be a year they HUSSAN So now it's two years.

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So they don't want two more years in Oxford and a lot of them want to come back for their core medical training or their specialist training,

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but they need a bit of time away. So I think it's probably a very healthy thing to go somewhere else.

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So they want to go to London.

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So they applied for jobs elsewhere because, you know, the American system, you know, that matches the hospital with the students.

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Is that what happens in this country? Well, they they do.

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They rank the hospitals and the hospitals for that. But the big problem, I think, is that there is no national exam now in America.

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They all said the same exam. So they are right on that performance in that exam.

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They haven't done that in this country. And we are supposed to put our students into quartiles.

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And that assumes that our top quartile are the same as everybody else is top quality,

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even though we never quite say and I hate to have to say it, but actually they're not the same, of course.

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And we need to, I think, fight for a knowledge based assessment or assessment.

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OK, well do locally,

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but I think the knowledge side of things should be tested nationally so that our students are fairly ranked because that come out right at the top.

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So quite a few of the Oxford people won't get what they pay for his first try to correct it when they should,

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including the ones who maybe apply for hair, which is really frustrating.

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Yes, it's a huge change, isn't it? Yes.

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Well, I haven't asked you the rest of it. Yeah, I think I think you've covered everything.

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I suppose one of the issues is women and working part time. Yes, but tell me about that.

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Well, I think I was very fortunate, um,

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because because of Rosemary route and being full time in Bristol for pathology trainee was interesting with a small baby.

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You did have a benefit. Yes. Jamesburg arrived somewhat unexpectedly at the end of near the end of my house jobs.

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So I went back to work when he was three months old.

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Is. Yes. And what did you have, a nanny? Oh, yes. We had a lovely lady who came in and and I remember when I was because I did on calls for pathology.

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Can you believe we were cross matching Derek full cross match as I believe it is.

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Goodness, I do that now. Anyway, when I did the on calls, Peter would bring James for me to breastfeed him at the weekends.

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So he was weaned when he was about four months old.

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So that didn't last long. And then fortunately when we came back here, I was able to to do part time training.

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So I think for women now it is probably it's probably more difficult to arrange job shares.

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But the scheme I had, it was we were very fortunate. And I came back from America for the interview for the senior registrar job in dermatology.

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I had to fly home from Duke to be interviewed on the national scheme to get upgraded his my expense situation and Hope and the children.

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And you and your girlfriend, five and three. How did you manage that?

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Yes, there was a wonderful pre-school that James went to Duke University preschools and any afterschool activity I could find,

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all mothers were know this. They all get put into after school activities, our children.

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And then he really went to the Durham Nursery School Association.

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Which was open from 7:00 in the morning until 6:00 at night, and you paid.

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It was a brilliant organisation. The fees were graded according to your income.

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So you there was no part time. You paid the full whack and I ended up paying the full whack because we were well, we were doctors.

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But it meant that Danny, at 33, was mixing with a whole mixture of interesting children of different backgrounds.

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She had a wonderfully and was so good. Yes. So we managed.

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Yes. But it is always a balancing act. Yes. And I think a lot of mothers feel they never do anything well, because they're constantly stretched.

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But when you back in this country with the children going to school the next day school.

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Yes. And then he went to Headington and James went was driving.

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And we had various people who picked up. But I was still part time for a lot.

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And when I went full time to statement about and he started as a week keyboarder and then heading to the north where we were living, there he is born.

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And now we were here because this is the right side of Oxford that people would drive,

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you know, but then I had two borders with keyboardists or full of water jugs, Whitsuntide 10.

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I was in my management. Sure. I said, well, yes, right.

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And what's sort of worst thing that happened to when you look back and actually say supportive husband is key.

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Absolutely key, I can believe. Yes. What's the worst thing is you think your medical life, you.

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Well, I think it's people that are always the challenge and it's not caring for patients,

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it's it's getting on with people and making sure that you because if you upset somebody, you're never going to put it right again.

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So I suppose the worst struggles I had were probably in Stoke Mandeville trying to get things changed.

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And the difficulty is there was a particularly tricky outpatient system.

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I used to come home with indigestion patients telling me to keep going or John Wilkinson would reassure me and tell me to keep going.

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So I find that quite difficult. And is this what led to interest in difficult conversations, conflict resolution?

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I'm not sure I have a particular interest in this.

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There's a course as I was doing. Yeah, I know. We all have to do these courses, Derek.

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When you say you have to do this with them, you know, all consultants have to go on these things.

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But who is running the course? Nostromo Me postgraduate education in Oxford and right now will be run all over the country.

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People will need to go to these things.

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If you're an education supervisor, if you're in management, you will be expected to develop your skills in exactly how many I mean, to you.

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We have to keep yourself up to date. You're supposed to go to your education, supervision, training, just like every other year or something.

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I mean, they're not keeping a big record of what people have done and make sure they're trained.

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And did you find, for instance, the difficult conversation because a good one?

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Yes, I think I only did that one very recently and I was probably a bit late.

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The you know, the medical students are much better trained.

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The communication skills training they have is superb and they really value it has been a complete change in culture.

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People used to think you didn't need this stuff, but they were empathetic.

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Yes, they are much more and they're technically as good.

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Technically, they're better. Yes. Technically, they've got proper supervised clinical skills training.

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Right. So like that memorable urologist in Swindon is it taught me properly how to do a catheter,

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not they go up to a skills lab, they practise on mannequins.

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They really are much, much better.

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You see, in the old days when there were four students on the first the most to do practical procedures because there were so few of them.

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And but now they would do it on a mannequin. Yes.

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And if they do it on a mannequin, not as good as they on the person when they come to, do they?

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It's not the same as are, but they know how to put the bits together.

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So that side of things that has been sorted and then they will be supervised when they're doing it on the person.

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But you won't get the situation where they haven't a clue how the various things assemble them.

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They will be able to do it in the right order. And when you say they're supervised because they nowadays when I read a book about how to

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do a procedure and then when and then did it by so quiet and you can read the book or yes,

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they may well read the book,

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but they will they will have a really good practical session and the skills that it's the best thing that happened to the best that.

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Well, I think being director of clinical studies was the best thing that for me was

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game changing because I had an opportunity to do something completely different.

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I met colleagues from so many areas. You know,

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you talk about the science and I want to get an opportunity to interact with the surgeons or

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the paediatricians or the psychiatrist or the people down the road in the preclinical school.

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Yes. Oh, well, if I knew the policy, they were the least of our problems.

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I know that that was a wonderful story. Yes, it was really made an enormous difference.

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And I think that gave me a springboard then to go on and do the work in dermatology that I was able to do.

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In a sense, it was coming kind of at the end because you were appointed with this head that we were appointed in light of that,

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were you just appointed, didn't you know, reappointed because this was like this?

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Yes. They realised they needed somebody who was going to bring about change.

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David, whether was supposed to do doing all this well, are you better on talk today?

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Well, yes, he did appoint me.

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I don't know who else was around or who else was interviewed. I think you would be thinking of other things.

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Yes, but he he they knew they knew something had to happen and they had to have somebody who was going to bring people along with them.

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So, yes, it was it was for me, it was a great opportunity.

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Well, that's great. Is that. That's absolutely. Well, thank you very much for the super you.