This is David Patterson, Professor David Patterson being interviewed by Derek Hockaday 8th of January 2009.
David, what really made you come from Western Australia to Oxford?
Well, I was fortunate to get a scholarship from Australia not being Australian, but they were kind enough to give me a scholarship to do fill.
And I came to new college to. You must have applied for the scholarship.
I mean, you wanted to come to England. Well, that's right. I actually visited Oxford a year or so before in the early 80s and met Dan
Cunningham and Evie Peterson because I was in Sydney and the control of breathing.
And at that stage, Oxford was the Mecca home for the control of breathing.
And I came to Oxford and fell in love with the place and was tossing up about going to UCLA or coming to Oxford.
So I applied for a scholarship and was fortunate to get it.
And the scholarship could take me anywhere I wanted to go in the world.
And I was minded to go to America. But the Americans never wrote back, whereas Oxford did.
And the rest is history. So I understood. So you came to work with Dan Cunningham?
Yeah, I came to work and Dan had, in fact, had just retired and so I didn't see much of him.
And then I worked with Abbey Peterson at New College and he sadly died of cancer during my time.
And then I was shunted to Bob Torrance because I was in chemo reception.
So I kind of flipped between room three Bob Torrance repairs.
And I was and at that stage, Peter Robbins has been appointed and had taken Dan's post.
So I kind of worked across the human and the cat lounge. When did you switch from breathing to the heart of, let's say,
breathing to the heart is interesting because I was working on the regulation of potassium and potassium effects,
physiological systems, and we had seen in humans during exercise.
And this was worked on with James Conway and Cardiology with Peter Slide.
They put catheters in our subjects and these subjects got very hyperkalemia during exercise.
And of course, all the physicians at the Radcliffe said, well,
this is impossible because clearly you've got Hamel's blood and and no one has a potassium of eight millimoles.
Right. Without not having serious cardiac events. And and then that got me into into the heart because I, I said, well, look, here's an observation.
The hyperkalemia, why are they going to asystole? Why were they dropping dead?
And so I work that got me into cardiac electrophysiology and I post-box with Dennis Noble and Hilary Brown learnt to patch,
clamp and worked and that area of the heart.
So it was a sort of a tortuous route, but that's how I got there after spending some time in America as opposed to this fundamental.
I want to ask you how things have changed during your contract with Oxford.
How do you see teaching have changed because he would have come as a tutor?
Yeah, yes, I was at my first appointment was a tutorial fellow back in the early 90s,
and it was quite a scene before the visualisations had taken place.
It was the old faculty board of Physiological Sciences and Clinical Medicine.
And in those days, you know, the tutors, the tutorial fellows, you know, had a big influence in the system.
You know, in terms of what went on, you know,
the most of the research took place in South Park's road and on the old Radcliffe Infirmary with some taking place, John Radcliffe.
But this is long before the Old Road campus was built and the Wetherall Institute was just being conceived of and being built at that time.
So the teaching has changed a lot.
Um, the curriculum has evolved, and I think it's more focussed because before the Oxford students were very good,
as David Whitchurch would say, and journalistic style writing, but for content might be seen to be wanting in some areas.
But having said that. John Ledingham would always say it doesn't really matter what you chaps teach them,
just get them excited and we'll fill the gaps when they come up to see us in terms of content.
So we tend to pretty much in my early days as a tutor, we would not work in curriculum.
We would tend to work around areas that interested us and hopefully interested our pupils and not be too textbook driven.
And I would have thought there was even more choice. Is that right?
Yeah. There's way more choice. Yeah. Yeah.
Because, you know, the curriculum was small and, you know, 30 years ago and we didn't have all that post genomic information.
And, you know, genetics plays a big part now in medicine, whereas 30 years ago it was a very small part of it.
So, you know, something has got to shift to accommodate that.
And these days. You know, I think these days the students have much more pro forma experience compared to students 30.
I think it's more precooked in the system, get more precooked, whereas I think before it was a little bit Darwinian, I guess, you know,
like Oxford is a funny place, as you know, because you've been a student here that, you know, you'll either make it or you don't make it.
And I think that's how it used to be, I think. And now, you know, it's it's more integrated.
It's you know, you've got to be pretty bad not to get through the system here,
whereas I think many, many decades ago, you know, you're kind of left to your own devices a bit.
And that suited some people very well. And other people and some of your contemporaries might have been like but struggled in that environment.
Now, I don't know what happened when you came, but in the old days of pharmacology and pathology and back would separate themselves.
But now pathology has come into the mainstream, is that right?
Yeah, yeah. Pathology is the dance school has always been a bit of a powerhouse sitting there
in South Park's road and they make up a certain amount of the medical curriculum.
Not you're not a huge amount of physiological sciences. Physiology makes up the most.
More than fifty five per cent of the preclinical teaching is done through physiology.
But physiology is deep as deep. Yeah, yeah.
So that's an amalgamation of the old university laboratory physiology with the Department of Human Anatomy
and Genetics and Genetics obviously came along is when Kay Davies was appointed Dr Leaves Professor.
Yeah. And administration. You mentioned about the divisions.
How does that changed and has it affected them? Well, I think it's definitely affected how the university runs.
And I think in earlier on it was a slightly devolved system with the general board and heads of department would have to make the case for
various events to do with their department to visualisations has provided more co-ordination in the university and like minded subjects.
So in medical sciences, it has facilitated the preclinical and clinical campuses and many aspects of that have been very good.
In other aspects, you could debate about the issue being just the word itself.
Division, you know, imposes a certain description.
And, you know, often we don't want to see that as an impediment to do other things across other divisions, mainly many for interdisciplinarity.
I think that's very important, especially with the physical sciences. Yeah, physics and chemistry and different.
Yeah, because I think if you look at how Oxford has developed as a university, as a science university,
it really only took off for modern science in the eighteen hundreds and in the old Parks Road,
South Park's road area and the preclinical schools departments were embedded in amongst the physical sciences.
You know, most unusual, you wouldn't build a medical school like that these days, you know,
having physiology, pharmacology, pathology next to chemistry, physics, mathematics.
So that is historical. But that's also given great strength, the basic science in preclinical arena.
And then, of course, when the Radcliffe Infirmary moved to the John Radcliffe and then the Oldroyd campus,
then there was a new suite in science that has taken place.
Certainly the results have been way back. There was a little interaction between the clinicians and the great nations.
Do you feel there's much more now? Yes and no. I think in the old days there was probably much more because, you know,
the the the physicians and surgeons were placed at the Radcliffe Infirmary and say many of them,
especially on the academic side, they all had college appointments. So just geographically they would go to the college for lunch.
And one was in much closer geographical proximity to the old university.
Then in the 70s, when the John Radcliffe Hospital was built, most of that activity went up the hill.
The old Radcliffe Infirmary just kept some of the sub specialisations and then eventually that has evolved.
So in answer to your question, it's different.
I think people are more mobile now, just electronically with communication.
So that has helped. And there's still a lot of movement, you know, across the different aspects of the city with.
With science, but it probably is not as close as it used to be, in my opinion, just given the geography and,
you know, you get medical societies, bring the two groups together, which you and I are both members of.
So that's always been a vehicle to facilitate that interaction.
I imagine that you and clinicians might easily put in a joint fund application because that wouldn't have happened in there very much.
No, not at all. Also, you know, that's been facilitated by new funding models at the university, which have been very good.
And, you know, because of some specialisation, you know, if you take cardiovascular or if you take urology or rheumatology,
then, you know, you can bring in many aspects of science to underpin new medical discoveries here.
That is just not attacking it from a clinical point of view.
It's attacking it from a basic science point of view.
And so often, if you're getting chemists by chemists, physiologists and all involved geneticists,
engineers, you know, I think there's much more interdisciplinarity now than there ever used to be.
Tell me how the whole business of funding is changed,
because nowadays you're never paid for your bench or your flooring and now you have to pay that out.
I know. Well, I think, as was a former vice chancellor once said that came to this university,
one thing Oxford's very good at, it's losing money and everything it does, which is probably true.
Um, yeah. We never costed anything properly. And these days, you know, there was a cost model.
It's still a cost to properly you know, we still lose money on virtually everything we do apart from industrial research.
And that's fine. But basic research, the research councils and the charities, you know, the jewel support system is very fragile.
And for every pound, you get many people to see this.
But as a head of department, I see this, you know, cost money to run money.
And so, you know, you can have the direct cost to do your experiment,
but you've still got to pay for the heating, the lighting and the infrastructure for that work to take place.
And there's a cost with that. So there is real pressure. This is not unique to Oxford.
This is true of British science. And just currently how much you get from Europe?
Well, we get quite a lot of money from you. In fact, we take more out of Europe than we put in direct costs, fantastic indirect costs,
not so good because we lose money on the EU grants because they're not directly costed correctly.
So, again, as a head of department, I hate them because they cost me money to run.
But if you get one, if you get one as a scientist, you like it obviously.
But they're a bit like NIH grants. They've lost loses.
Really? Yeah. Not many people realise that in the.
Yeah. And then have things sort of changed in the in the subjects that are being taught.
Do you see much change in that. Well the type of subject has been.
Yeah. Sort of information. No. Well anatomy is moderately static because anatomy is what it is.
You're learning a new language and that language probably hasn't changed for centuries or tissues of the body.
You know, the great Clarke's book was a revelation. Yeah, but you may say it's not anatomy, but I know it is.
It is. And I think, you know, with imaging and technology and physics, medical physics, imaging,
spatial resolution has has changed out of all recognition and teaching, as well as doing stand to morbid anatomy.
You know, we're now starting to move into more situations of virtual reality.
Three dimensions. I don't holo lens ultrasound.
Yeah. Yeah. As we reconstruct images and students put on their holo lens goggles and they can see an organ in front of them and space is rotating it.
And of course, if you're going to be a surgeon, then the surgical planning, this type of technology is critically important.
And, you know, I think some areas of medicine have hugely improved as a consequence of this.
You know, especially precision surgery, like neurosurgery has really taken off because of new technology.
And the medical students now are getting exposed to this new technology and really clinically,
clinically, clinically, because they're all very tech savvy.
And I think as as this moves into the clinical arena. Especially in surgery, then this is going to be hugely influential, so that part of teaching,
we're doing a smarter the basic principles of physiology haven't changed that much,
but our understanding of the cellular and molecular processes are now that much better.
And, of course, that's important for targeted therapy. So the students understand much more now about how drugs work, where to target the drug.
And it's just not seen as a black box where you give something and wait for a response.
Our teaching at Oxford, you know, is pretty academic in terms of what we try to get across to the student about how processes work.
So the people who write essays, you know, people still write essays once a week, once a week, I'm not sure all colleges.
But as a college they do. We don't tend to like what I don't get the students to type them.
I like them to handwrite them, because at the end of the day, that's what they're going to have to do in the exams.
So why shouldn't they take that? Exactly.
And also, they're not used to writing, you know, because they get fatigued and they're busy, used to tapping on their phones and their computers.
And I think there is a certain rhythm of thinking that handwriting brings out.
Ah, that is your brain is moving at the right place for transfer of information.
So traditionally, we still give the students the essay to write, to bring back, to discuss.
And, um, and it's just not one essay.
We're preparing them over many, many terms to sit these exams.
And so, you know, we like to think we're not running content.
We're running process in terms of trying to teach them how to think, because what I'm really interested in is not their problems for IBM.
You know, it's the final on a school year.
When the real work starts, though, we're preparing them over several years to really become young scholars.
And they've got to learn a new language because they don't do this language at school called medicine.
So as a professor and head of a department used to tutor, I do every turn.
Every time. Yeah. I don't have a full load. I must reduce.
But yeah, I yeah, I'm one of the few heads of department that still tutors.
I think I like it because I think it's important for the head of department professor to, you know,
turn up and give the lectures and teach undergraduates as well as to research how many at a time do you have?
Ah, in my first year I do them in threes for finals pairs.
Yes. Yeah. And say they'd come and one of them would read his essay and I mean it's a waste of time.
I never really I've never taken down my ride.
My, my line is, you know, their essays will get inked up and we'll discuss them.
It's not a recapitulation of the lecture. It is more detailed, it's a different focus, it's a different angle.
And we may go off paced and talk about other things.
We tend to in parallel, we tend to run a close to the lecture series.
So it's not completely uncoupled. But, you know, having just written a textbook,
I've got a real appreciation of admiration for people that have done this previously because I didn't realise the amount of work involved.
But trying to explain complex cardiovascular.
Yeah, complex matters to a medical student is, um, you know, it's often difficult.
You know, we take a lot of this for granted. But, you know, since, you know, William Harvey and Starling and these people,
well, the the field has grown enormously just given the technology in the system.
So, yeah, I think teaching is very important.
Um, as an academic, uh, for the next generation, is funding a problem of undergraduate and graduate students?
Uh, it's funding a problem. Well, we can always fill the place up with people.
That's not a problem. Whether they can afford to pay for it. It's another question then,
I guess because we're a state funded university and you pay the same at Oxford as you pay Birmingham or Newcastle or Manchester, I think.
We give something different from those universities were very expensive to run, given our style of teaching.
So nine thousand two hundred and fifty pounds a year, no way reflects the true cost of that experience.
You know, roughly, it's been calculated that it's about eighteen thousand pounds.
So clearly there's a cross subsidy that takes place in the system.
And the question is, how long can that be sustained for undergraduates to have this Rolls-Royce experience and many tutors?
We don't want to dumb it down. We want to be able to continue to give a high end experience.
But that comes at a cost and a financial cost. Postgraduates much better because students are better funded now in the system.
Arguably, one could say, are we training?
Too many are for the jobs that are out there because there's been a huge explosion in postgraduate education in the last 20 years.
But the number of faculty positions has not increased proportionately. So a lot of these students graduate.
So they have to move on to other areas of work.
And maybe that's not everyone has to be an academic. I think that's also important.
You know, some go into clinical medicine, the pharmaceutical industry, publishing or the city of London.
Do you get a lot from abroad now? Relatively? Yeah, a lot.
A lot from abroad. When I first came to Oxford and physiology, there are only eight graduate students in the department.
And that was you know, there was the you know, the foreign scholars like myself, Commonwealth scholars, Rhodes Scholar.
Then you had your MRC students and that was it.
Know there was no one was privately funded to come.
And of course, that's all changed. Now, that is there's a high percentage of privately funded students.
By that, you mean welcome by their parents?
Well, I think their parents, yeah, all their tight loans come with a lot of privately funded people in the system.
What has helped us? A lot of the research charities, because they have been terrific in creating these doctoral training programmes, you know,
especially the Welcome Trust and the British Heart Foundation, who have given Oxford a huge amount of support for doctoral training in the system.
I'm sure you are very involved in the admissions of people, as it were.
How important do you think that is and how critical is it to people's careers to get accepted or not accepted?
Well, I think coming to Oxford is a badge of honour if you can get into the place.
So, you know, it's the admissions are very important here.
You know, it's hard to get out. You this is you know, this is arguably one of the top medical schools in the world.
You know, if you believe the metrics, I'm not sure we do.
But but let's take it. Um, it's very competitive, like medical admissions we've just done now.
We had one thousand seven hundred applicants for one hundred and fifty places.
So you can't interview all those people. You know, you can shortlist for 50 and interview for 50.
And most of these candidates are highly competitive for places at medical school.
But we can't take everybody. And, you know, Oxford is a boutique medical school.
And if you look at the best medical schools in the world, which are mainly in the United States, you know, there are about the same size as us.
So I wouldn't personally like to see us get two big name as a medical school,
because otherwise I think it'll take away some of the training aspects and personalisation that we have with the pupils.
Do you think it's ever possible to aim for life or social background?
Educational background? Yeah, yeah. I'm a deprived and no and no question and we do that like we we do factor that and people always ask,
you know, is Oxford just not occupied by the elite public schools?
And, you know, aspects of it are in some subjects.
But I like to think in medicine and I can only talk about this college because I've been doing it for a long time here now.
But my life has always been that you can't blame the child to the school their parents decided to send them to.
So, you know, I've taken Etonians and one year, along with kids from Scunthorpe and John Leggat College, which,
you know, more deprived area of the United Kingdom, and these kids would not normally meet one another.
And life and to be honest, it's good for both of us is to make one.
And so my life has always been I'm. Interested in, you know, potential, I'm interested in rough diamonds, I don't like the polished product because I,
I think if you're seeing that at 17, then there's not much more I can do to them if they're coming into polished.
But I like to see the potential. And I realise that some pupils come from different baselines because they've had different experiences.
And, you know, we're interested in their rate of rise as the incline that I'm interested in.
And even if their baseline is low, you know, I think if we can see the potential of them, then we will give them the opportunity.
And, you know, we've had some terrific pupils who have gone on to have stellar careers.
And, you know, we're not I'm not starting from the position of choosing GPS.
No, I'm not. You know, a lot of them may become cheap, and that's fine because it's important to have brought GP's out there.
But, you know, I'm looking for the next generation of leaders in medicine and surgery who want to do to tertiary academic work.
And and, you know, most of our our pupils, you know, they've all gone on to become consultants and are now becoming professors of medicine or surgery.
And that that's that's fulfilling seeing that.
But, you know, I think it's harder admissions are harder now than they were 30 years ago.
And the reason I say that is because 30 years ago, if you were predicted three A's at every level,
then you were pretty darn smart and you come in and do the Oxford entrance test and that would usually affirm it.
These days you look at the UCAS forms and they've all got 12 ace stars at GCSE.
They're all predicted three or four ace stars at a high level.
Um, and they're all super brilliant on their forms.
And for the poor old shooter, as pretty high as pretty and they're on the ball, got grade eight, whatever.
And you know, I've represented the county or country and speak three languages and like,
there's no way we would ever get into Oxford as anybody ever looked at the outcome of people turned out no show.
Yeah, no, that's probably that's probably something like we make mistakes, of course.
And good. And I always like to say to the students when they come, look, I'm sure you're well suited for medicine,
you know, and, you know, we'll do our best to get the best slot.
If you don't make it this time around, then, you know,
you get into a good medical school and you may be able to come back to Oxford as a clinical student or do a house job here.
Are you involved at all in the decision between where as to where they do their clinical now?
I so we've changed our policy now at Oxford two years ago and of course before after the first B.M., when they applied to do the second year,
they'd have to apply again to the clinical school and they would most of them would get it, but not all of them.
And we would transfer students to London and then we would backfill them with students from Cambridge.
Two years ago, the policy was changed, that seamless entry.
So as long as you pass your prelims, then you're guaranteed a place at the John Radcliffe.
Now now we we don't handcuff the students to John Radcliffe.
We would say to them at the end of finals, final score school in the third year, if you wanted to go to another clinical school, then you can.
And of course, London schools like our students,
despite what they say about despite what they say about our lack of innocence, they still like our students.
And, you know,
I've always argued that was quite a good system because it gave the student an opportunity to have a break from Oxford if they wanted it.
And also for the students that were ranked down the list, you know,
like the students that were ranked one hundred and forty five to one hundred and fifty five on exam performance,
you know, if they're dragging themselves at that end of the class. Now, those students all pretty bright.
Yeah.
But those students typically we would send to London and they would actually then appear on the top part of the class list, UCL or Imperial College.
Right. And I've always said to the students, look, it's a bit like running the final of the 100 metres at the Olympic Games.
Someone's got to get last right now. Someone's got to get lost.
But that doesn't mean you're slow. You're right. That doesn't mean you're slow.
You're still fast, but you got lost. And I think that's a little bit like medicine at Oxford.
Student number one five five Houssein, seen at the bottom of the class, are still pretty darn good at Oxford.
Now, you've done a lot, as it were, outside Oxford, the editing Journal of Physiology or writing books.
And so how do you fit that in with great difficulty in education?
So what I did when I was editor in chief of the Journal of Physiology, I used to about two hours every day.
So I would I would tend to do that in the evening and at lunchtime.
And with electronic media these days, because of the immediacy thing, you can push information around the world quite quickly.
And I had a fantastic editorial staff in London. So, you know, I was just really triaging and making, you know, strategic decisions.
Yeah, it was a fantastic job. Yeah.
Being editor in chief of JP, because I saw a lot of science travelled the world and met a lot of very interesting people.
So I you know, I enjoyed that part. Academic publishing.
I enjoyed that part of the job, you know,
just like I enjoy still teaching undergraduates because they will always ask you the silly question that no one will ask you.
But often it's one of the most poignant questions, and especially if you're trying to explain it to them.
And, you know, when I was doing the textbook with Neil Haring, who was one of my former pupils, who's now a consultant, John Radcliffe in cardiology,
I would use different chapters to rehearse on the students to see how they and tutorials to see how they reacted to the concept of explaining it.
And if they couldn't understand it and they're all much brighter than I am, then then I think, well, I haven't written that properly.
Yeah. You know, I have an Oxford medical student doesn't understand this then, you know, how could anyone else understand it?
So I found that quite useful. And did you do the same?
I say you're welcome. Oh, yeah, I was I've been on my sort of standard stint on BHF committees and for my sins,
I did the Iraqi National Committee in 2008, then the committee in 2014.
I decided to P45 myself from that experience ever again.
Someone has to do it. But I think I've done my tour of duty as far as that's concerned.
And I didn't know the beginning, but well, I did move from a target to Western Australia.
Oh. So I was when I left a targo, I was sort of travelling trying to figure out what I was wanting to do.
And I always, you know, I got physiology quite late at medical school at a targo has been exposed to anatomy and physiology.
And I always liked physiology kind of lefter bit and then rediscovered it again when I went to Australia.
And Wolf, Simmons' was professor of Physiology, a University of Western Australia,
and he was a Rhodes Scholar at Oxford and knew George Gordon, right?
Yeah. He was that era and had done his day film in physiology.
And so just indirectly, Oxford got planted in my mind.
Um, and then my very good friend, John Koop, who sadly passed away last year.
He was Bowmen Professor of physiology at Birmingham.
And I met him in the Himalayas because I was very tense and climbing and and I met him in the early eighties.
And I was trying to decide, do I go to L.A. or do I go to Oxford?
And John had just been my chair of physiology at Birmingham and said to me in a bar in Katmandu in the early 80s,
oh, well, why don't you come to Birmingham?
Because, you know, and I think you should go to Oxford because that's where all those great respiratory physiologists are.
So that's why I came.
Eventually I came to see John and then then had met Dan Cunningham, Bob Torrence and every Peterson, and then I was sold to come here.
But, you know, for me, I've drifted. So, you know, there's a lot of serendipity.
There really are. No, there always is, to be honest.
Like, this was not preplanned because, you know, I was the first in my family to go to university.
Like, you know, I come from a farming heritage and, you know, everyone left school very early.
So, you know, for me, Oxford was a long way away, which hadn't asked you that I should have.
You've asked me here. No, no, no, no. It's been most interesting.
Well, you've been at Oxford a long time, much longer than I have,
and you would have seen it change tremendously during your time as an undergraduate, just the evolution of the clinical school.
Like, you know, that that's been on my mind. That's been the biggest change in the last 20 years like that.
You know, they've done a terrific job on, you know, the last two Regius professors.
Oh, yeah, yeah, yeah.
You know, it's been phenomenal what David Wetherall and John Bell have done and building, you know, modern medicine in medical sciences.
You yeah, it's been terrific.
And I think the challenge is to make sure that that, you know, that momentum doesn't get uncoupled from the preclinical schools.
You know, the preclinical schools just don't become some sort of teaching rump or of the medical school that, you know.
Yes, there is indeed that. And that it's important that, you know, the preclinical department are not translational motivated departments.
You know, they're they're USPI is different. You know, they're USPI is to educate, you know, which are claiming the clinical school is, too.
But, you know, they're involved in basic fundamental discovery science, which may have Transito.
Absolutely. And it's important to have some of your portfolio there.
Right. As well as being mission driven, because, you know, a lot of the you know, the new exciting science on the old road cambers,
you know, it's very mission driven to, you know, solve and treat certain diseases.
And that's terrific. You know, we need to do that. But at the same time, you need to discover new principles to base translational.
And if you look at all the big Nobel prises that you know, that have really influenced medical science,
you know, these have come from these basic science departments.
If you look at their history, fluorescent proteins at Patch, clamp it.
Yeah, right. Yeah. And you can you can trace back the technology.
I think you'll see the same thing with opto genetics. I think you see the same thing with CRISPR, with gene editing.
Right. These have come from basic science departments as the tools have been made like imaging for example.
OK, so in clinical medicine we use where end users of those tools to help solve problems.
But Oxford is unique. I think that it's got this good mix of basic science, clinical science embedded amongst physical sciences,
like there's no medical school in the world that looks like that.
You know that because medical schools tend to be entities to themselves and Cambridge or Cambridge.
Yeah, but I think when they when they tend to have moved away from the tennis court roadside to Adam Brooks,
you know, they've still kept a little bit of that in their life science programme.
You know, Cambridge is super successful science like fantastic with no you know, the Olympians, the there's no question about that.
But I think Oxford is going it's in a transitional period at the moment.
And, you know, it's important that, you know, we can be even better, you know,
if we get a lot more integration across the sites, you know, and be a little bit more imaginative.
And the way we make appointments in terms of adjunct appointments across the different departments.
Um, but, you know, I think on the whole, I've spent my life sitting on committees and allegedly trying to think about strategy.
And at the end of the day, you know, probably the best strategy is not to have a strategy and and and just,
you know, like my life and just leave people alone whether or not to have a community.
No, not well, exactly.
And the thing is, you know, the our job is to hire the best people and let them get on with it and provide a good environment for them.
And not having too many committees, I think, because otherwise you can be death by committee and you never actually get anything done.
So but also it's in great shape. Yeah.
Do any of the American medical schools have a tutorial system or anything like that?
It's very interesting because Hamilton I think started trying something a bit like that.
Maybe, I'm sure in Canada. Yeah, no, they know that because medicine on the whole outside of the UK is gradually entry is so they've got a four year,
four year medical degree based on another degree going in,
whereas where direct entry from school, you know, we're both models, but many were direct entry from school and the very problem based.
But I would argue that, you know, we're problem based, too, and we invent a problem based learning, you know, we call it a tutorial.
So we do the traditional lecture based stuff, which you will have as a medical student,
but then you come to your tutor and that's where you get your PBO.
Mm hmm. Right now, the tutors know a little bit about something, but on the whole, we don't know much about anything.
And, you know, as a little bit of the blind leading the blind, but that's what PBL is to an extent.
It's about facilitation. So it's taking them down areas that they may not normally have gone.
But I think the nice thing about Oxford and Cambridge, too, is that our foundations are very strong scientifically to base the tutorials on.
I think it would be different if you didn't if you just had the tutorials and nothing else.
I think that would be a completely Darwinian surance show.
But I think the combination of the college and the lectures and the labs is still pretty good.
As for training students and you know, we get criticised as being old fashioned.
But having said that, you know, the proof is in the product.
You know, our kids, you know, if you look at national examinations, membership examinations for physicians and surgeons, we're not doing too bad.
They sure are here. And I think having that direct involvement with the college and the tutor, yeah,
I still think is very important because it depends when you ask the question.
You know, if you ask the question to a fifth or sixth year medical student about the importance of it,
or you ask them 15 years later or 20 years later, you get a different answer when they look back about the experience.
So I think it depends when you ask the question, because we do it all the time.
You know, as we get older, when we see our pupils, you know, climbing, climbing the medical ladder, anything else you might say?
Well, thank you very much, Superlative. You really know my.
My pleasure.