Full spectrum exams are fascinating. Yeah, well, I was completely naive.
I had no training in medical education, so I have no idea what was required.
Not really. Did you go to other medical schools? Yes. Well, one of the people who helped me a huge amount was Chris Bulstrode.
Right now, I know Chris is an eccentric. He's a great man.
He's a great man. And he had very clear views about education and what was needed.
Was he a consultant to the NSA? And he must have been on the air.
And he I think yes, he was.
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.
And that was one of the first occasions I actually realised that you could learn how to teach.
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.
I actually called on Chris and Vicky Hunt, who's now his wife ran the education courses with him.
Was she a doctor? She's an educationalist, yes.
So I pull them in and said, look, I really don't know what we're going to do here.
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.
But this is everything. When did the business.
The preclinical school. Yes. Yes. This was the whole school inspection of the.
How did you relate to the problems? Well, I worked very closely with Stephen Goss.
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,
but in fact, you know, silos. So I was it was marvellous.
It really was good. The business of doing a consultancy there,
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.
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,
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.
So people had to start thinking about what the aim of the lecture was, had their learning objectives.
People said, what is allowed to say?
Yes, it was it was a very interesting ten months.
And with the learning that have to fit into the curriculum, yes, I'd have to be achievable as well.
And it had to be measurable. Right.
So how do you know that your student has actually achieved whatever it is and how much formal student feedback was when you started?
There was there was some negative feedback, which I think. But I mean, people were filling in forms or just talking.
Well, I think there was not not it wasn't collected particularly rigorous manner.
So that all changed as well. Yes. You were talking about that at the end of a recession or so.
It's at the end of their attached. Yes. There's a very good way of collecting the feedback now.
Yes. So it's all hugely change. And Tim Lancaster, my successor, has been fantastic because he's got good medical education background.
Now, when you say your success, I mean, you did three years, but then you were sort of your belt.
That's right. And I continued with a hat on curriculum hat.
I did three years and I could have done two more. And it was three year renewable for two.
And they offered me another two. But actually I was only doing because of the queue.
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.
Yes, I had to stop my dermatology actually completely. This was almost a full time appointment.
The director of clinical studies, not it's not as many sessions.
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.
But we were able to use it to get another consultant. I taught quite well.
And so did Peggy follow you?
Is he wasn't director of clinical studies? No. I brought Peggy in when I was appointed.
I needed somebody to help with the pastoral side. Yes.
And so because my predecessor was John Sayer and Joan trial used to do the pastoral side with him.
So I recognised that Peggy, who I'd known since I was a student,
had huge strengths and that it would be really great to have her help with the pastoral side.
So I brought Peggy in as an assistant or associate director of clinical studies.
So this is all after living in its first session?
Yes. Yes, I was after John said. That's right.
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,
who is a medical educationalist who was also tremendous.
Where did you bring her from?
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.
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.
She was just coming in to do a bit of advising for the Kuai side of things that we needed.
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?
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.
And when did you start? So you can say something when I can say that Tim Lancaster took over from me.
So that's the way it went. And Peggy stayed on as an associate, still doing pastoral work.
Right. And then when did you get into sort of national dermatology then?
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.
I realised that there were lots of dermatologists who needed help with teaching.
So I wrote about teaching in dermatology and set up some courses on education.
How you teach dermatology for this was dermatologists consult. You had a natural course for teachers.
Yes. You're not in Oxford? I worked for five years, I think.
And would you run that in the church? Because there going to college? Yes.
Yes. College based. It was residential and it was. Yes.
And if you picked up links with some bands. No, not really.
I sometimes we're very good to me. And they gave me accommodation.
But I, I when you when I stopped for that first year.
Yes. But I actually used as a house I didn't understand colleges. I'm not because I had not been a preclinical student.
And that was a challenge when I became director of clinical studies because I had absolutely no idea.
But the clinical students by and large, don't use the computer. They do not.
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.
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.
And so those college links have improved a little bit, having to do once a week, once a month.
It depends how we used to get junior doctors will be appointed by our colleges and associate,
tutor or support they give them and to do sort of school.
Yes. Well, the colleges were beginning to do it and the students had produced a website showing which colleges
were which weren't which were influencing where the students were going and the colleges.
The competition isn't. That is student Hopkins. Yes, he was he was doing things.
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.
So I think most colleges do something. It was something that I picked up on.
They were very concerned about inequality of provision. Yes. Yes.
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.
And when you began going to London to the British British Association of Tautologies.
Um, well, I actually we are very democratic in dermatology.
So people apply send in applications to be president.
Right. And you get voted for nationally. Right. So it's affecting business.
Go. Yes. So, I mean, when you're viso coming, going to be the president, you have to run a conference, is that right?
You should do you should do. It was in Manchester, but you had already been voted for.
But of course it was the year I was president. Yes. Right.
Not voting for. No, I don't think it was the year when I was president.
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.
The beheading is now streaming professional organisation. So you have to set a programme.
You go to the offices. And I looked at the programme, decided, but I wanted a strong medical dermatology theme for that conference.
And what would that be then? Medical dermatology? No, I mean, you said that.
What would the theme be? Oh, well, I meant for the for the actual workshops, the lectures.
I wanted to make sure that dermatology. There's lots of surgery.
Yes. Cosmetic dermatology is sort of creeping in.
They're not great enthusiast. There's paediatric dermatology, there's contact dermatitis, allergy immunology and the medical side of dermatology.
By that I mean sick patients. The contact with patients with systemic disease patients with psoriasis on system.
Biologics. I wanted to be sure that the theme for the conference encompassed something that
covered that aspect of dermatology is medical paederasts filariasis rouzier.
Well, yes, that's well the disease is it is it is a disease.
But yes. So sick patients and lupus and I mean, you know, rivertown criminological skin diseases.
So I mean, it's dermatology, medical dermatology, I suppose.
But I really wanted I was thinking more about the links with our physician colleagues.
Right. So we had Carryback Black, who was president of the Royal College of Physicians, came and gave a lecture, for example.
I mean, she did systemic sclerosis you talked about. Yes, I think yes.
So legacies, of course, there's a big overlap with I can't remember if we had a diet anthologist talking,
but we had a day that was devoted or a morning that was certainly devoted to aspects of medical dermatology,
and that has continued to be an annual meeting.
Now, that is a very strong thing, but you founded a difference to you if you follow the richest society in medical dermatology.
We did. Well,
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.
And we needed a voice. There were people who said dermatologists where all physicians were all medical dermatologists.
What is this? Actually, it's turned out to be a very successful society.
So the consultant dermatologists in the country, I mean, what percentage would be in the medical dermatology, medical dermatology society?
Oh, well, I don't know. I suppose we've got a couple of hundred is a good number to go to.
It's a good, strong society now. It's doing very well right now.
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.
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.
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.
Yes, it's doing really well and doing the numbers.
It's one concern is the way the medical schools expanded. We're up to a hundred and sixty or.
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.
Here's Tim, a general practitioner, the first GP.
He's been director who actually cut a week or general practise experience from the curriculum because of the pressures in general practise.
Do they still start with some general practise early on? Yes, they like that.
Yes, they do. Yes, I do. Yeah.
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.
Foundation doctors are all going out and doing community now. So there's quite a lot of tension.
There is good people used to say with the general. But yesterday I remember going away out to mourn in the marsh.
I think I think Paul was ill. Would that happen or not?
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,
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.
It's quite difficult,
actually pushing your own interests when you are supposed to be looking after everybody and sometimes your own interests to be subsumed by this.
But yes, we've now got an integrated assessment with primary care. So they get to Olasky, they have a proper dermatology station.
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.
So you might have the mother with a baby who's got bad eczema and they'll have to come
to the mother about how to treat the child using topical steroids and the moisturiser.
Or they might have a an actor who's just had a malignant melanoma removed.
And they have to talk to that individual about what steps they should be taken to reduce the likelihood of recurrence.
So they don't know the subject before that. They know well, they may have a broad idea of what the sessions could be.
It doesn't make any difference what they know. All the studies show they can just do just as badly.
They may be dealing with somebody with hand over tinnitus. That's the really important area.
Yes. And they may have to meet somebody with a leg ulcer and talk about how you're
going to deal with this business also and get him to move and lose weight.
And so those stations, yes, we write those stations and pass them on to general practise and then the GP picks a station.
So they do an integrated assessment. They have orthopaedics as well.
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.
So that's quite a big assessment of dermatology is thoroughly embedded into it.
Yes. How long would you be at each station? Well, as I said, you know, I think it's probably about 15 minutes.
Yes. And would you do two or three of you?
I think there's any I think Texas managed. I think we possibly getting a second dermatology station that's off with just one.
And then there will be a written paper as well with multiple choice questions or study matching questions, which would also encompass dermatology.
So that's at the end of the placement. Do it. And that's in year five.
Yes, we do have finals dermatology because dermatology in medicine panels, which we're supposed to Kolja,
the just you just used to call it the medicine and surgery or a staged assessment nopales,
but we all do quarterfinalist so they could have dermatology as relates to general medicine.
So they may well have psoriasis in that one actually was the luckiest comes up.
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.
So what he used to say is, you know, oh, I stopped when I retired.
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,
I'm still Peter Sullivan still appointed me as not I trust training programme
director because the Oxford Hospital Trust with responsibility for teaching.
So I'm responsible for the induction of the new foundation doctors arriving shortly to organise their induction and shadowing programme.
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.
And then I hit the wards and I have a half day and skills that we've set up so
that because eighty percent of our foundation doctors are not Oxford know.
So that's a big challenge. They're all coming new to Oxford and every hospital seems to.
A slightly different way of doing things, different equipment, different connectors,
so we have to introduce them to the equipment so they have Hafter Skills Lab and the rest of
the time they're working on the walls with the person whose job they're going to take over.
So they've got three days on the wards, something like that.
It's a week a to when they come on a Wednesday.
And I think this officially start work on the following Wednesday. Something like that.
Yes. That's a huge change. Yes.
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.
But the administrative department is brilliant in the Post Graduate Education Centre.
So I know I come up with the ideas, but they did.
And that's and bolts of contact. So you want to do that after you've graduated?
Yes. This is the first two years. And how much do you look after the ones that they've talked with them because.
Oh, you're talking about the people of October. So wherever they come from, yes.
There's something in the old days you knew what the weaknesses of the people trained in your medical school did,
but now you don't know what the to people be are.
Consultants in Oxford are very frustrated that they spent all this time educating our medical students to a supposedly high standard.
They really are taught and taught, not dogs. Not all the studies show that Oxford art forms everybody else and they lose them all.
And what determines whether they go for the first second terms? Well,
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.
Day used to be a year they HUSSAN So now it's two years.
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,
but they need a bit of time away. So I think it's probably a very healthy thing to go somewhere else.
So they want to go to London.
So they applied for jobs elsewhere because, you know, the American system, you know, that matches the hospital with the students.
Is that what happens in this country? Well, they they do.
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.
They all said the same exam. So they are right on that performance in that exam.
They haven't done that in this country. And we are supposed to put our students into quartiles.
And that assumes that our top quartile are the same as everybody else is top quality,
even though we never quite say and I hate to have to say it, but actually they're not the same, of course.
And we need to, I think, fight for a knowledge based assessment or assessment.
OK, well do locally,
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.
So quite a few of the Oxford people won't get what they pay for his first try to correct it when they should,
including the ones who maybe apply for hair, which is really frustrating.
Yes, it's a huge change, isn't it? Yes.
Well, I haven't asked you the rest of it. Yeah, I think I think you've covered everything.
I suppose one of the issues is women and working part time. Yes, but tell me about that.
Well, I think I was very fortunate, um,
because because of Rosemary route and being full time in Bristol for pathology trainee was interesting with a small baby.
You did have a benefit. Yes. Jamesburg arrived somewhat unexpectedly at the end of near the end of my house jobs.
So I went back to work when he was three months old.
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.
Can you believe we were cross matching Derek full cross match as I believe it is.
Goodness, I do that now. Anyway, when I did the on calls, Peter would bring James for me to breastfeed him at the weekends.
So he was weaned when he was about four months old.
So that didn't last long. And then fortunately when we came back here, I was able to to do part time training.
So I think for women now it is probably it's probably more difficult to arrange job shares.
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.
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.
And you and your girlfriend, five and three. How did you manage that?
Yes, there was a wonderful pre-school that James went to Duke University preschools and any afterschool activity I could find,
all mothers were know this. They all get put into after school activities, our children.
And then he really went to the Durham Nursery School Association.
Which was open from 7:00 in the morning until 6:00 at night, and you paid.
It was a brilliant organisation. The fees were graded according to your income.
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.
But it meant that Danny, at 33, was mixing with a whole mixture of interesting children of different backgrounds.
She had a wonderfully and was so good. Yes. So we managed.
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.
But when you back in this country with the children going to school the next day school.
Yes. And then he went to Headington and James went was driving.
And we had various people who picked up. But I was still part time for a lot.
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.
And now we were here because this is the right side of Oxford that people would drive,
you know, but then I had two borders with keyboardists or full of water jugs, Whitsuntide 10.
I was in my management. Sure. I said, well, yes, right.
And what's sort of worst thing that happened to when you look back and actually say supportive husband is key.
Absolutely key, I can believe. Yes. What's the worst thing is you think your medical life, you.
Well, I think it's people that are always the challenge and it's not caring for patients,
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.
So I suppose the worst struggles I had were probably in Stoke Mandeville trying to get things changed.
And the difficulty is there was a particularly tricky outpatient system.
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.
So I find that quite difficult. And is this what led to interest in difficult conversations, conflict resolution?
I'm not sure I have a particular interest in this.
There's a course as I was doing. Yeah, I know. We all have to do these courses, Derek.
When you say you have to do this with them, you know, all consultants have to go on these things.
But who is running the course? Nostromo Me postgraduate education in Oxford and right now will be run all over the country.
People will need to go to these things.
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.
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.
I mean, they're not keeping a big record of what people have done and make sure they're trained.
And did you find, for instance, the difficult conversation because a good one?
Yes, I think I only did that one very recently and I was probably a bit late.
The you know, the medical students are much better trained.
The communication skills training they have is superb and they really value it has been a complete change in culture.
People used to think you didn't need this stuff, but they were empathetic.
Yes, they are much more and they're technically as good.
Technically, they're better. Yes. Technically, they've got proper supervised clinical skills training.
Right. So like that memorable urologist in Swindon is it taught me properly how to do a catheter,
not they go up to a skills lab, they practise on mannequins.
They really are much, much better.
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.
And but now they would do it on a mannequin. Yes.
And if they do it on a mannequin, not as good as they on the person when they come to, do they?
It's not the same as are, but they know how to put the bits together.
So that side of things that has been sorted and then they will be supervised when they're doing it on the person.
But you won't get the situation where they haven't a clue how the various things assemble them.
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
do a procedure and then when and then did it by so quiet and you can read the book or yes,
they may well read the book,
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.
Well, I think being director of clinical studies was the best thing that for me was
game changing because I had an opportunity to do something completely different.
I met colleagues from so many areas. You know,
you talk about the science and I want to get an opportunity to interact with the surgeons or
the paediatricians or the psychiatrist or the people down the road in the preclinical school.
Yes. Oh, well, if I knew the policy, they were the least of our problems.
I know that that was a wonderful story. Yes, it was really made an enormous difference.
And I think that gave me a springboard then to go on and do the work in dermatology that I was able to do.
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,
were you just appointed, didn't you know, reappointed because this was like this?
Yes. They realised they needed somebody who was going to bring about change.
David, whether was supposed to do doing all this well, are you better on talk today?
Well, yes, he did appoint me.
I don't know who else was around or who else was interviewed. I think you would be thinking of other things.
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.
So, yes, it was it was for me, it was a great opportunity.
Well, that's great. Is that. That's absolutely. Well, thank you very much for the super you.