Monday, December 15, 2014

A voyage round my study

My study used to be the reception area cum drug dispensary when my parents and their partner, Andrew Smith, were looking after 10,000 patients, all of whose medical records were kept in that room. The room was connected to the private hose and was the first room on the way to a two consulting room surgery. The first receptionist working in that room that I remember as a child was Miss Grey. Sylvia Ellerby and Joan Calvert followed and Sylvia lives in Fryston and is in her 80s. Joan became the practice manager for a neighbouring General Practice and we were so pleased to be invited to her retirement dinner. The room had a connecting door to the house as well as a door to the corridor of the surgery.


The present day study is the first one above. On the goblet on the window ledge one can just see  a photograph.  This is of my father (a GP)  making up some medicine in the same room. You can see that smoking a fag helps him concentrate.

My study is houses a collection of all sorts of objects, photographs, pictures, certificates etc. Each has a memory for me.

Below are photographs of items in my study taken in December 2014. They are in no particular order and each has a commentary.


The instrument shown is the Zero Gradient Aural Thermometer. Professor Bill Keatinge and I developed this in the 1970s and Muirhead Ltd manufactured it. It sold a few including one to NASA. It is featured in The Science Museum's online collections.


The card on the left is of Albert Durer's The Rhinoceros (1515). We saw the actual drawing in the Germany Exhibition in the British Museum in December 2014. The two on the right are from Barbara Hepworth's Hospital Drawings. They were created in the 1940s and were part of an exhibition in 2012 in the new Hepworth Gallery in Wakefield, 10 miles or so from us. The one on the left is of (Sir) Reginald Watson-Jones, who became othopaedic surgeon to The Queen. He taught us at The London Hospital. He had a maroon Rolls Royce car and his chauffeur wore a matching maroon uniform. There is a tiny battery driven lamp in front of these.



The box contains compact discs of the complete works of Mozart. There are about 160 discs and it would take over a week of continuous listening to hear the lot.


On the left is a photograph of our late good friend Geof Mair. I had the honour of being asked to write his obituary for the British Medical Journal. The photo is with a copy of that. He died in 2002 from a serious lung disease. He did have a heart/lung transplant which only helped him for a short while. The main body of this picture is of Kath and I having a meal with my second cousin Lorna and her husband Stuart. She started work as a GP in Allerton Bywater which is only 4 miles from us. Stuart is also a GP. Lorna has now retired. They own a lovely apartment near Pisa, Italy.



Next door to the surgery, there was a street called Park Dale which, despite having a lot of money spent on it in the 1980s, became dilapidated again. In 2011the houses were demolished and replaced with ann estate of eco houses. These have greatly improved the area. Wakefield and District Housing got approval to have a street named after our family - after Kath, me, my mother and father - all of whom worked in the surgery at one time or another. This calendar was skilfully made by my neice, Mary and given to us a s a present. There is a Sloan Street in Lisburn, Northern Ireland, called after my grandfather, the teacher.



On the right is a mug that Tony Nicholas had made for me and presented to me at my leaving lunch at the Wakefield NHS Primary Care Trust in 2010. I worked really closely with Tony on the education programme for General Practitioners. He went to the same school as I (Queen Elizabeth Grammar School, Wakefield) and is ace at his job. We were a great team.



This is my mother. I think it was taken in Berlin. I am not sure.


This was drawn many years by my niece, Carol, She did a degree in ceramics and has a lot of talent. However, she has not done much art work in recent years because of ill health.


This is 6 week old (in November 2014) Angel. Both I and Kath sponsor a guide dog for the blind. We get photos and news sent regularly until an owner is found.


This was given to me for my 50th birthday by my brother Frank. It is of our father and his siblings. My father is on the left. . From left to right - George, Winnie, Sam, Florrie, Howard, Angel. The last three are cousins.


This is an oil painting of my Irish grandfather Francis Sloan. It was presented to him by friends and past pupils on his retirement in 1935 as a headmaster of what is now called Sloan Street School in Lisburn, Northern Ireland. It was painted by Maurice Canning Wilks who is moderately famous. When she was a little girl, a relation, Joanna Smith, slept on a camp bed in the study. My grandfather looked very stern to her and she asked us to cover the painting with a sheet.




There are some photos on a glass cabinet and the central one is of Kath when she was a bridesmaid at our good friends, Kath and Alan's wedding. On the left is a photo of me getting my BSc in Anatomy. On the right is my German great grandmother, Alice, with my grandmother, Lilly, in her arms.


This is one of my very favourite photos taken on our wedding day on June 3rd 1978.



Showing off now!! On the left is my new best friend with a lovely smile as she is talking to me. The small broach can be worn in the lapel by anyone associated with The Most Excellent Order of the British Empire. Kath gave me it as a present when I got the MBE.


This is a drawing I bought frim an art gallery in York. The artist is Brian Lewis who lives in Pontefract. I know him pretty well. Kath and I were friends with his first wife, Jean, who was a fellow GP and who died at a tragic young age in her 50s.


Showing off again!! Every 4 years people with the MBE or any other Order of the British Empire award (OBE, CBE,  KBE etc) can apply for a seat at a service in St Paul's Cathedral. I was lucky to get one in 2012. The service was stunning. Prince Philip is the Grand Master of the Order and he and The Queen are wearing the colours of the Order. I have a DVD of the service. The bells rang out and the music and choir were fabulous. I shall apply again in 2016. The only problem is that I am not allowed to bring Kath.


This was the brass plate from Leckhampton Road Surgery, Cheltenham. I was a partner there for about 4 years in the 1970s. When I left the practice gave me this as a memento. 


This is a Fez I bought on a holiday in Morroco in the early 1980s. We met a couple from Liverpool. We have exchanged Christmas cars every year since then. He also bought a Fez. The rule is that the Christmas card has to have a red Fez  drawn in somewhere - on an angel or sheep's head for example.


These were poker chips owned by my German grandfather. He was a great gambler. The chips were made in Chicago. He liked poker and roulette. His favourite numbers on a roulette table were 8,11, 30 and 17. 


This is a painting given to me by Abdul Paliwalla. Abdul was at University College with me. He became a GP. He has Parkinson's disease and the 2014 Parkinson's Society Calendar  has one of his paintings.




You can hang this round your neck and if you blow into the yellow thing it makes the sound of a duck quacking. Once a year a gang of us who were training together at  The London Hospital  meet for a reunion. A few years ago we went to Philadelphia and went on a duck boat on the river. A duck boat can run both on land and water. The guide issued us with these instruments and played music that we all had to quack to. It was really corny but great fun. I have a photo of the Dean of Students quacking away.


This is Professor J Z Young - a cutting of his obituary He died at the age of 90. He was still working. Those at University College, London, studying Anatomy for a BSc with his went to Naples for 6 weeks. Wee undertook research with him on octopuses and squid. It was great fun and a fantastic experience. He is one of my heroes. Very eminent man. Look him up on youtube - dissecting a squid!!





 This is is my German grandmother's handbag. It is Italian and when opened has all sorts of compartments including small glass bottles with perfume. Looks pretty ragged just sitting there on a shelf.



It is difficult to capture this wooden box properly. It has a hidden inner compartment and can only be opened by sliding bits of the outside in unexpected directions. It is a real challenge to open it. Over 30 years ago I gave it to Jo Smith in Herbert Brace's house in Fryston. Jo took it down Fryston coal mine and a gang of miners spent a significant amount of time trying to open it. Not much coal obtained that day!

This is a voodoo doll bought in the deep south of the USA - perhaps in New Orleans. In the mid 1990s we appointed a new young partner for our medical practice. He seamed ideal but gave us back word. He did not want to work with us as he felt the partners were too familiar with the staff. We had had a party in our house for the partners and staff to welcome him. We were all very upset and angry. One morning I put the doll in the receptionists room with some pins and a note stating: "Think of someone you have recently met at a party and use the pins accordingly". I returned to that room after I had done my morning surgery to find that most of the pins were stuck in the doll's groin. Hazel, the senior receptionist, said to me: "you didn't even feel the slightest twinge?"



 This is the Hippocratic oath in French. It is an oath that Doctors swore in the old days. The first part is : "I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.
I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.
With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage". Source  - Wikipedia.
This French version was given to me by Bill Message, the partner, of Dr Jean Lewis, who were good friends. He gave it me after Jean's untimely death in her 50s in the early 1990s.

This is the Member of the British Empire medal. 


On the left is a photograph of my German grandmother, Lilly, and me in the garden of this house where we live and where i lived as a child. On the right is my Aunt Sania. She was Russian  married my mother's brother, Herbert. She walked out of Russia at the time of the revolution (she was a white Russian). She and Herbert had to get out of Germany with the onset of the second world war and they came to Britain. They were interned on the Isle of Man for 5 years. They returned to Germany after the war. She was a lawyer and got significant compensation from the German government for some members of my family.



This is the koala bear my uncle Ernst and aunt Erna sent me from Australia when I was a very small child. I used take him to bed with me.




This jack in the box releases a frightening and horrific puppet that makes me jump out of my skin.


The music box plays the theme tune to the film "The Godfather". I was asked to say something a few years ago at my Goddaughter, Samantha's 21st birthday. Despite being very nervous with all those young people there I ended up playing the tune to her on this musical box.

  Click here to see it being played.



I have a duster somewhere in the room. New Year's resolution for 2015 - get the study cleaned.


That is the end of this voyage. It is a very personal and somewhat self indulgent journey. It has given me a lot of pleasure researching and writing it.




























Monday, February 10, 2014

Foundation Wall at the Royal College of General Practitioners

In the Royal College of General Practitioners' new building in Euston, London, one can visit and see the foundation wall. For a generous contribution, members and fellows can have a name or names put on the wall. There is an IPad in front of the wall where one can search for names and linked to the names on the wall are some photographs and a few words.

There is a matching virtual foundation wall on the college's website.

This can be accessed on the internet via

 http://foundationwall.rcgp.org.uk

Enter "Sloan" and have a look.

Thursday, January 27, 2011

NHS Reforms
This is what I sent in as a response to the proposals for health reform by the coalition government:


"I retired as a GP just over 5 years ago after working in Castleford, West Yorkshire, since 1978 and before that in Cheltenham. I was a trainer, course organizer, GP Tutor and latterly Associate Director of Postgraduate General Practice Education at the Yorkshire deanery until I left to take up my PCT post.

I was employed part time by the PCT, until my retirement at the end of May this year, as GP Adviser, Protected Learning and Appraisal Lead. I ran the education programme for 250 GPs and locums and supported and developed 17 local GP appraisers. I was an appraiser myself and also a Quality Outcome Framework Medical Assessor. I have mentored many GPs in trouble. No one has ever doubted me when I say that I have talked face to face and at length to more GPs than anyone else working in the Wakefield District.

When fundholding was introduced I joined a group called “The Five Towns Family Doctors Forum” (I have left out the apostrophes on purpose!!) This was a group that was vehemently anti fundholding on ethical grounds We were forced to become fundholders - and I really mean forced - by the threat and actual withdrawal of staff by the then Health Authority. From 1994 to 1998 I was a board member and vice chairman of the Wakefield Multifund. The multifund was essentially a fundholding consortium of the anti fundholders. We had our own manager who did all the work. I got on with teaching and clinical work and was not the slightest bit interested in our fundholding status. We forfeited big money with this approach.

Some of the fundholders in this area made a serious financial killing. Any fundholding monies put into buildings owned by GPs would be a future personal financial gain.

I undertook mobility and attendance allowance examinations during the time of fundholding. I came across several patients of fundholding practices that I felt should have been referred to a consultant but had not been. There were patients I saw who had not had investigations undertaken. When the 1997 election was approaching I asked the then chief executive of Wakefield Health Authority whether he had any plans for fundholding being abolished by an incoming Labour government. He replied that they could not do that as it was well “set in”. The abolishing of fundholding was announced soon after the 1997 election results were declared. I was really happy with that.

As I mentioned above, I worked for the PCT part time for 6 years. The people I worked with were truly concerned about improving patient care. I have read the manifestos of both the Conservative party and the Lib Dems as well as the coalition document. There is no mention of abolishing PCTs. Rather there is a load of platitudes. What is the point of these documents with regards to helping one decide for whom to vote? They are a farce.

Andrew Lansley keeps repeating that the GPs he talks to don’t like the behaviour of the PCTs telling them what to do etc. Of course they don’t. It is normal for GPs to bellyache about management. (I gave a farewell presentation to the people I worked with at the PCT called “working for the enemy”!!)

What do I know about the GPs working in the NHS Wakefield District area?

There are about 250 GPs (and this includes locums) working in the Wakefield area. I have read each of their personal development plans for the past 6 years. I have also undertaken appraisals of over 40 different GPs over these years. I can count on the fingers of both hands the number of GPs interested in “management”. The vast vast majority are only interested in clinical care and improving their clinical knowledge and skills. The less than 10 GPs interested in financial stuff are the “old fundholding gang”. The majority of GPs in our area did not want to engage with the PCT in planning services despite being offered money for this work. Pockets will be lined again. GP Commissioning Groups will be mandatory and I imaging GPs handing over the responsibility for commissioning etc. to private companies. It will take 10 years for this change to be functional and cost billions. Fundholding, total purchasing, PCTs, PCTs merging, strategic health authorities and now this. I am glad I am retired.

One group of GPs in one practice has set up a company and it has bought practices in Leeds, practices further afield and out of hours centres.
Another GP, with a huge annual income, is also purchasing practices out of the area. I must say that all these activities are legal and have been allowed by the Labour government and the PCT. I know that the business activities of some GPs take them out from clinical activities and put a strain on the remaining clinicians in those practices. This will happen with working in consortia.

There are some reports that say that the Local Medical Committees (LMC) are mostly in favour of these proposals. That may be so. Our Wakefield LMC (of which I was a member as a GP educator for many years) does not truly represent GP’s views, in my opinion. It does not seek views. However, it certainly helps GPs in trouble and answers GP’s questions. Not one of my partners ever mentioned the LMC or its newsletter. I am sure they are typical.

The Labour government introduced targets for improving health care in the form of the Quality Improvement Framework (QOF). I was a PCT medical assessor for the past 6 years. I must have assessed over 30 different practices over the years. My job was to check that they had achieved the clinical targets they claimed they had achieved. The GPs did not complain about having to achieve targets. The main complaint of GPs was that “ticking the boxes” intruded into the consultation. If a patient goes along to the GP with a depression problem and has not had their weight, blood pressure etc measured according to the warnings put up by the QOF software these measurements are doe as they are linked to GP’s income – and it is a seriously huge amount of income. (It is interesting to note that being involved with the QOF is voluntary). However, I never came across a single GP who thought these targets were a bad thing as they were evidence based and led to seriously better outcomes. I personally think that the QOF was one of the best things the labour government did for patients and that this boosted GP’s incomes considerably was worth every penny.

There are some fantastic people working for the PCT and they truly have only one motive and that is to improve patient care. When fundholding was abolished, I think I can count on the fingers of one hand the number of primary care managers that lost their jobs. These were in practices that had used fundholding savings to pay for salaries. The abolishing of Primary Care Trusts will demotivate those working there in the transition period and result in huge unemployment. I have already been asked to give a reference for one of my ex PCT colleagues. Most GPs are unaware of the role of PCTs in improving patient care. Most GPs, for example, are unaware that there are 4 or 5 expert people managing the quality of care of the 100 plus nursing and residential homes and this includes looking at costs. I worked in the same open plan office as these people and they work extremely hard.


The proposals in this white paper if enacted will destroy the NHS.

18 members of my family have worked in the NHS as doctors

I know my comments will make not jot of difference to anything.
Here are the first and last lines of Ben Okri’s poem “Dancing with Change” 2007

"Change is good, but no change
Is better............

No change is good, but dancing
Gracefully with change is better”



Richard E G Sloan MB, BS, BSc, PhD, FRCGP
RSloan7798@aol.com"

Sunday, January 16, 2011

I was browsing the Youtube video website and came across two of my undergraduate teachers, J Z Young and Andrew Huxley.

John Zachary Young was the Professor of Anatomy and was seriously famous and is one of my heroes. I have mentioned him elsewhere in this blog. After I had completed my preclinical studies, I was fortunate to be selected to study for a further 18 months in his department of anatomy tfor a degree in that subject. A major attraction of the course was that for a six week period of the summer vacation six of us joined him in Naples, Italy, to assist him in the study of the nervous systems of octopuses and squid. 5 of us worked on octopuses and I was the squid man. What I had to do, twice a day, was to dissect out a giant squid axon, and measured the speed of nerve conduction using a stimulator and an oscilloscope. JZ, as he was known to everybody, showed me how to dissect out the nerve. Despite this, I did not get a single recordable result for about 2 ½ weeks. I was damaging the nerve. The dissection had to be undertaken using a microscope. He was trying to provide further evidence for the Hodgkin Huxley formula:

cv = sqrt(K a / 2 R_2 C_m) Hodgkin and Huxley 1952
cv : conduction velocity
K : 10470
a : radius of axis cylinder (238um)
R_2: specific resistance of axoplasm (35.4 Ohms)
C_m: capacity per unit of area of membrane (10^-6)

Click on the link below to see JZ demonstrating the anatomy of the giant squid axon.

http://www.youtube.com/watch?v=pw6_Si5jOpo


Andrew Huxley was the Professor of Physiology At University College London when I was an undergraduate there. He was my physiology tutor for a term. He knew the logarithm tables by heart and showed us this when he marked our practical calculations! He was quite a boring lecturer and we used to count how many times he said “er”. However, it was announced that he had been awarded the Nobel Prize for his work on discovering how nerves conducted electricity. This work could not have been undertaken without JZ Young’s discovery of the giant axon in the squid. A huge number of us crowded beneath his window and chanted his name until opened the window and waved. After that his lectures were packed with all sorts of students from different faculties other than medicine. He demonstrated the sound of nerves conducting by inserting electrodes into his own arm.

Click on the link below to hear Professor Huxley explaining his work for the Hodgkin.

http://www.youtube.com/watch?v=W4Lys3STeq0

Tuesday, December 16, 2008

Education Essay

Adult Developmental Learning and Change – an essay.
This essay is a narrative of my thoughts after reflecting on my learning and teaching experiences over the past 4 or 5 decades. It was written as an assignment for the Postgraduate Certificate of Primary Care Education in September 2001.

An essay is a composition and as such allows thoughts, theories and ideas to be described, reflected upon and developed. An essay is, therefore, different from a scientific paper, a review of evidence or a historical account of events.
I have been a learner, teacher and facilitator of education in varying degrees all my adult life. The people I have encountered throughout this time have had a great effect on my direction and development.
Gollanz (1923) pointed out, in his preface to Shakespeare’s ‘As You Like it’, that the division of life into 14,10 or 7 periods is found in Hebrew, Greek and Roman literature and that in the 15th century the seven ages became a common theme in literature and art (the mosaics on the pavement of the cathedral at Siena). Appendix 1 shows 3 versions of “ages of man”.
Levinson’s Developmental Periods described by Daloz (1986 p 55) is the structure I will use to organize my thoughts. Appendix 2 is a transcript of the figure from that page.
What is an adult and when did adult learning start for me? In law, an adult is one who has reached full legal age, the age of majority – 18 years in this country. It also means mature or grown up. Brookfield, 1986, outlined his 6 principals of adult learning and I feel these are stated in appendix 3.
I went to Queen Elizabeth Grammar School, Wakefield from the age of 6 to nearly 18. Assessment took place in the basic form of term reports. I can be described, on some of those early days, by one of Shakespeare’s seven ages of man from his comedy, As You Like it:
“ Then the whining schoolboy, with his satchel and shining morning face, creeping like snail unwillingly to school”.

Termly assessments were written throughout school and these were read by one’s parents. The assessments were both a threat and a motivator. They were both summative and formative.
School was in no way voluntary and the aims and objectives of the curriculum were teacher and exam driven. It is an axiom of American education that parents are partners in their children¹s education. The pupil can end up with parents acting as coaches or tutors. This role of parents may embrace some adult learning principals as the environment of the home may be freer than school.
As one progressed through the sixth form, there was a feeling of mutual respect between teacher and student. Praxis, collaboration and empowerment
were introduced. If one behaved as a child one was treated as a child and punished as a child despite attempts of the teachers to treat us as adults. Perh
The objectives of sixth form learning that were strongly shared by teachers, parents and me included passing A levels such that I got a place in a medical school.
Levinson described the stage of me about to enter Medical School as moving from pre- to early adulthood and he stated that this begins at about age 17 and is called the early adult transition.
On the 30th September 1963, not yet 18 years old, I attended my first lecture at University College, London. The lecture was by the Professor of Anatomy, J. Z. Young and I can remember the content of that lecture, as well as it’s objectives, well and clearly to this day. He was eminent, charismatic, a communicator and a “lecturer extraordinaire”. He delivered the Ferrier and Croonian lectures at the Royal Society in 1950 and 1965 respectively. He was a Fellow of the Royal Society. He used lectures, tutorials and written material as his main ways of communicating but also the radio. Indeed, he was the Reith Lecturer for the BBC in 1951 and he said in one of those broadcasts:
“Whether we like it or not, we can be sure that societies that use to the full the new techniques of communication, by better language and by better machines, will eventually replace those that do not”. (Young 1951 p 7).



The advantage of a lecture is that it lets an expert share his or her knowledge, attitudes and skills with a large number of people in a short time (Chambers and Wall 2000 p 79). The disadvantages are that there can be passive listening, the pace is the same for all, and attention is lost after a few minutes. A good lecturer, like J. Z. Young, on that first day for us at medical school, knew the level of expertise of the audience, had rehearsed and timed it, used appropriate visual aids in the form of colour slides and sparked the imagination of the audience, keeping their attention with his style and subject matter. He used better language and machines to communicate. He had the full text of his Reith Lectures published in a book so we could reflect on these in our own time. All these ways of improving a lecture are known today (Chambers and Wall 2000 pp 81-83), but often ignored.
The educational methods used at Pre-clinical medical school were mainly lectures and group tutorials on specific topics. There were also Physiology and Biochemistry practical classes with roaming supervisors. The dissection table encouraged teamwork and friendship as well as dealing with the morbid - all relevant for General Practice.
After pre-clinical I took 18 months out to undertake a B.Sc. in Anatomy and this is where I learned what adult learning was all about and how I appreciated it. The head of department was Professor J Z Young and he employed the Oxford Tutorial System as a teaching method.
“The foundation of undergraduate teaching at Oxford is the tutorial system. It is not a system of spoon-feeding. Undergraduates are expected to pursue a course of independent study under the guidance of their tutors, who set problems to solve or essays to write, and suggest books to read and university lectures to attend. Teaching is also sometimes carried out in classes of larger numbers. The tutor provides constructive comment on the undergraduate's written work and a discussion is opened up. The success of the tutorial system depends on the undergraduates; they must organise their time effectively, work steadily, and contribute fully to the dialogue.” (Merton College, Oxford University, Web Site, 2000).
We were encouraged to question, doubt, discuss ideas with our tutors as equals and socialise with them. I realised that interactions with both my teachers and fellow students were as important to me as knowledge and skills acquisition. I spent 6 weeks in the Stazione Zoologica in Naples researching the conduction velocities of the giant axons of squid as part of this course. While there we visited all the famous Roman sites as well as enjoying many meals in the company of visiting researchers. This trip gave me a life long-interest in Italy as well as science and I experienced the interaction of environment, art, history and social intercourse on learning – the visible and invisible words (see page 12 below).
In 1966, aged 21, I started my 3 years clinical studies at The London Hospital followed by a year of house jobs there after qualification. This was not a happy experience. I was not yet in Levinson’s adult world but still in early adult transition (Levinson 1978 p 57). Yet, on reflection, during the B.Sc. course, I had just experienced adult education at it’s very best and felt I needed serious adult learning experiences in order to progress with my medical education. However, I entered the world of the apprentice, with masters and pupils, paternalism and teaching by humiliation being commonplace. This way of teaching creates doctors with attitudes and behaviour disliked by their patients. Brookfield’s mutual respect was notable by its absence.
Smith complained that the apprenticeship system was still employed significantly in clinical training, especially in surgery (1996). Wass realised there was something wrong but stated, weakly,
“the time-honoured apprenticeship system of medical training should be improved by a more structured approach and better supervision.” (1996)
Paternalism was deeply ingrained in General Practitioners in the late 40’s and early 50’s (MacGregor 1997). Despite increasing openness throughout the 1990s, there now exists widespread dissatisfaction with the attitude of some doctors because of their paternalistic approach and poor communication skills (Irvine 1997). The President of the General Medical Council, commenting after the Ledward case said, “ some doctors still think they’re playing God (Irvine 2000). It is a view that the attitudinal problems of our profession were as a direct result of the educational methods used in clinical schools and postgraduate medical education in teaching hospitals. Despite many changes in medical school and postgraduate hospital based courses radical improvements are still required.
Clinical teaching delayed my entering the adult world of exploration of the possibilities of adult life (Levinson 1978 p 82) until the age of 25. I became a Lecturer in Physiology at The London Hospital Medical College and researched hypothermia to Ph.D. level. Appendix 5 is the preface of my thesis (Sloan 1976). I learned so much from all the people I worked with and one can see from this appendix that the learning involved a supervisor as well as critical reading and publishing work which was assessed by journal editors. The job also involved my lecturing, facilitating tutorials and running and supervising practical classes. For the latter aspect of the job I had no training and no opportunity to learn about educational theory and methods. This was the norm for both pre-clinical and clinical teaching. It was assumed all doctors could teach. I was persuaded that the lecture was the best method of teaching and concentrated my efforts on these rather than learning how to run groups or undertake educational needs assessments or evaluation.
For the research aspect, I chose my supervisor after 2 months in the department. I chose the area of work I wanted to research. The relationship I had with my supervisor was of guide and mentor rather than apprentice and master. Bill Keatinge had the attributes of a mentor described by Chambers and Wall - “an experienced, highly regarded, empathic person” who “guides an individual in the development and re-examination of their own ideas, learning and personal and professional development” (2000 p 146). The education I experienced embraced closely all 6 of Brookfield’s principals of adult education, just as I am experiencing now with this postgraduate certificate.
I entered General Practice as a Principal in 1974 without vocational or any other training. I could hardly remember how to treat a sore throat and had not dealt with patients for 3 years. The practice and I were happy with this situation! On reflection, my learning needs would have better been addressed by a period of training. I wrote up my Ph.D. over the next two years and this involved the reading and writing that I loved. I gave a few lectures in postgraduate centres. I went to a few courses and lectures at the local postgraduate centre. I was in the “Age thirty transition” (Levinson, 1978, p 58). General Practice was to be my career. Levinson points out that for some, this can be an “age 30 crisis” and indeed that period of 4 or 5 years in Cheltenham, London then Castleford, involved my moving house 5 times, getting divorced, leaving General Practice and resigning after one week as a lecturer in Physiology.
I went through what I call my educational dark age from 1977 to about 1983 – aged 32 to 38 – The Second life Structure: Settling Down (Levinson 19783 p 59). I remarried, bought a house in which we still live but was working as a single-handed practitioner with an increasing list. It was my dark age because of the nature of being single-handed. I attended a few courses and lunchtime lectures and read a bit and that was it. By the end of this period I decided to become a trainer and was taking on a full time partner.
In 1985, aged 40, I entered the mid-life transition, the beginning of middle adulthood, which is a period of advancement within a stable life structure (Levinson, 1979, p192&201). This was the start of my deep involvement with the Yorkshire Education Network. I became a trainer, then Continuing Medical Education (CME) Tutor for GP Principals and then a Course Organiser for the Vocational Training Scheme (VTS) for the Pontefract District.
To become a Trainer the Practice had to be set up as a learning environment of excellence according to National and Regional criteria. There is a course for prospective trainers called the “O Course” which allowed one to reflect on one’s potential training skills and feel what training is all about. This was facilitated by an educationalist with senior tutors from the Yorkshire Education Network. My assessment started there and reassessment for training is every one to three years. This involves an inspection of the surgery by a team of fellow and senior educationalists who also examine tutorial skills by assessing a video of these. Reassessment of CME Tutors and VTS Course Organisers involves an annual appraisal. Trainers have to attend workshops monthly and residential courses at least every 2 years. Tutors and course organisers attend residential seminars about three times a year. Here I have learned about running a group, course planning, time management, learning styles, learning needs assessment, facilitation, motivation and other elements important in postgraduate medical education.
Mentoring and being a member of a local Professional support Group that looks at under-performing and ill GPs and GP Registrars has been my “Age 50 Transition”. I nearly feel I am an expert in postgraduate medical education. Nearly!
This course, the people on it and running it, have got me back to the academic way of thinking, researching for evidence, writing referenced accounts, essays and praxis.
I am at the start of the ‘culmination of middle adulthood’.
“For men who are able to rejuvenate their selves and enrich their lives, the decade of the fifties can be a time of great fulfilment.” (Levinson 1978 p 62).
I realise that I have picked up the academic approach that I left behind after I had completed writing my Ph.D.
“The wheel is come full circle” (Shakespeare 1608 King Lear).
There have been such circles throughout my adult life and not only at the end of my educational development.
· I was a medical student and then a lecturer teaching medical students.
· I have been on the “O Course” and now I am a tutor for this course.
· I researched the literature for my Ph.D. and now again I am researching the literature.
· My first lecture was from a Reith lecturer and I have just met another Reith Lecturer in my role as a Trustee of our Pontefract-based Prince of Wales Hospice.
Many of the people I have had the good fortune to be associated with in my adult life have been versed in art, music, languages, ethics, philosophy, history and politics. These people have had a significant, albeit unquantifiable, effect on my knowledge, skills and attitudes. There is more to education than meets the eye.
“Surely, therefore, we need to look towards the creation of greater balance in the way we educate people so that the practical and intuitive wisdom of the past can be blended with the appropriate technology and knowledge of the present to produce the type of practitioner who is acutely aware of both the visible and invisible worlds that inform the entire cosmos.” (The Prince of Wales 2000.)

I look forward with relish to late adult transition and late adulthood in the company of my wife Kath who has taught me more than anyone else. I hope to have a similar enthusiasm in that age of my life as J Z Young did. He died aged 90 and was in the middle of writing a book on the cephalopods (Tucker 1997).
(2400 words)

REFERENCES.

BROOKFIELD S (1986) Understanding and facilitating adult education Milton Keynes: Open University Press.

CHAMBERS R and WALL D (2000) Teaching Made Easy – a manual for health professionals Radcliffe Medical Press Ltd Oxfordshire.

DALOZ L A (1986) Effective Teaching and Mentoring San Francisco: Jossey-Bass.

GOLLANZ I (1923) As You Like It Preface Shakespeare J M Dent and Sons Ltd London p xii.


Appendix 1.

Ages of man.

1. Shakespeare. As you like it. Act 2, sc. vii, lines 139 – 166.

Jaq. All the world’s a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurses arms.
Then the wining school-boy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honour, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sanse taste, sans every thing.


Appendix 2.



Figure 1. Levinson’s Developmental Periods.

Late Adulthood
65
LATE ADULT TRANSITION
60
Culmination of Middle Adulthood
55
Age 50 Transition. Middle adulthood
50 Entering Middle Age
45
MID-LIFE TRANSITION
40
Settling Down
33
Age 30 Transition
28 Early Adulthood
Entering the adult world
EARLY ADULT TRANSITION
(Childhood and Adolescence)

Appendix 3.


Brookfield’s Principals of Adult Education.

6 principals applying to teaching-learning encounters or to curriculum development. The six principals of effective practice in facilitating learning
1. Participation is voluntary
2. Respect among participants of each other’s self worth. Attention to increasing adult self worth underlies all facilitation attempts.
3. Facilitation is collaborative - setting objectives, curriculum development, and evaluation. Continual renegotiation of priorities.
4. Praxis is placed at the heart of effective facilitation
5. Facilitation aims to foster in adults the spirit of critical reflection. Adults will come to question many aspects of their professional, personal and political lives.
6. The aim of facilitation is the nurturing of self directed empowered adults.



IRVINE D (1997) The performance of doctors. i : professionalism and self regulation in a changing world Education and Debate British Medical Journal 314 p 1540.

IRVINE D (2000) Editorial The Sunday Times Newspaper 4th June.

LEVINSON D J (1978) The seasons of a man’s life Alfred A Knopf New York.

MACGREGOR S (1998) From paternalism to partnership British Medical Journal 317 p 221.

MERTON COLLEGE Web Site (2000) Oxford University
http://www.merton.ox.ac.uk/prospectus/tutorial-system.html.

PRINCE CHARLES The Prince of Wales (2000) We must go with grain of nature The BBC Reith Lecture The Times Newspaper 18th May Section 2 p 7.

SHAKESPEARE, W. (1599) As you like it ii, vii, lines 145 – 147.
SHAKESPEARE, W. (1608). King Lear. v, iii, line 174.

SLOAN R E (1976) The effect of age and sex on body cooling rates Ph.D. Thesis, University of London pp 9 – 10.

SMITH T (1996) Apprentice Surgeons Soundings British Medical Journal 312 p 1223.

TUCKER A (1997) John Zachary Young – Broad grasp of the Brain Obituaries The Guardian Newspaper July 14 1997.

WASS J (1996) The core curriculum for senior house officers Career Focus British Medical Journal 313 p 7054

YOUNG J Z (1951) Doubt and Certainty in Science. A biologist’s reflections on the brain Oxford University Press.

Tuesday, September 30, 2008

Advanced Motorist

A month or so ago, I passed my Institute of Advanced Motorists (IAM) Test at the second attempt. I had been working at it for about a year. It really is one of the better things I have done recently as I feel I am driving better, more safely and anticipating hazards.
At the beginning one is allocated an “observer”. Mine is called John Convery and is a senior nurse working in the accident and emergency department at Pinderfields hospital, Wakefield. The road traffic accidents he deals with are the motivators for him doing the observer work.
One arranges to drive your own car every couple of weeks or so for about an hour with John teaching and observing. I volunteered to make a commentary about what I was doing and seeing. This I found easy as I simply rambled on. There were books to study and these included the Highway Code, a book on road signs and the IAM handbook. I became a very sad person and was reading the Highway Code whilst eating my breakfast.
One has to stick to the speed limits. This means that one has to know what the speed limit is at any time and it took me a while to be able to do this. There can be a change of speed limit on a sign hidden behind the leaves of a tree. One should be able to tell what the limit is if one has missed the sign. Generally, if there are lamp posts it is 30 mph. There are repeater signs for 40, 50 and national speed limits on roads that have such limits and lamp posts. Isn’t this fascinating? One drives up to the limit if it is safe. In 30 limits I experienced serious road rage from tailgating vehicles and sometimes pulled over to let them overtake. I also had, in the early days, some heated discussions with Kath when I was dawdling along. I did a lot of practicing by myself. Having an observer talking about his job got me used to driving in an advanced manner with a passenger – a normalized situation.
I could write at length about what I learned about every aspect of driving. Suffice it to state that I feel I am a better and safer driver in Italy, which we visit a lot. There are some serious lunatic drivers there.
On the first Sunday each month one could go along to Halford’s car park in Pontefract and have a drive with a senior observer, usually retired police drivers. The first session I had was with Gerry (whom I knew as he was in our Italian language class. He got me into all this). He was excellent and it was early days for me. He got me reversing in to a parking space (I was hopeless) and doing a three point turn (I had forgotten how to do that properly). He taught me, as did John, to drive “with sparkle”.
I went with another senior observer, Graham, later in the year and had another drive with me before my test. He told me I was OK and did not need wishing luck. How wrong he was!!
The test is one and a half hours and my first examiner was Phil. He is a sergeant in the traffic division of Wakefield police. We met in Morrison’s car park in Wakefield. I got there well before him so he did not see me park. It was a cloudy day and he arrived wearing shades and reversed his car immaculately into a parking space. I thought there was going to be trouble here! Before we got into the car he said he presumed I had done a cockpit check before I left home and he proposed an external car check. He asked me what the minimum tred on tyres was. I had no idea. He asked me how to check that both brake lights were working and I gave a hopeless answer to that. We set off and he took me on some seriously narrow country roads on Emley Moor. I was driving with too much “sparkle” i.e. too fast and I completely mucked up a bend, committing the sin of having to brake whilst in the bend. I made an inappropriate merry quip about the police at one point. He got me reversing downhill round a bend first on one side of the road and then the other. I completely mucked it up. I had not practiced reversing apart from into a parking space. He talked a lot and I got the feeling I had done everything wrongly. When we got back to Morrison’s and parked up he told me he could not recommend me for membership of the IAM. I was shaken as I thought he might forgive a few errors. He advised me how to change gear differently and all sorts of other things.
We were going to London later that day. I seriously felt I had let my observer John down as he had taught me such a lot and spent so much of his free time with me (all unpaid). I texted him and he replied that he thought the examiner was a swine. It did not spoil the weekend but I talked about it with Kath a lot and that did me good. I have failed all sorts of tests and exams over the years. I failed my driving test the first time. As the time went on I realized Phil was absolutely right to fail me. I was determined to pass the next time. There are two examiners and I did not know which one I would get next. I decided to practice all the things Phil had told me about. I wrote an article on “failure” which is on one of my blogs. I went out and did as much of the test route as I could remember. Our garden has a curved flower bed one has to drive past to get out. I practice over and over again reversing first with the curve next to the driver’s side and then next to the offside. I tilted the mirrors down to see what I was doing.
I decided that I was OK at the advanced aspects of the test but had not revisited what one has to be able to do in the basic test. I bought yet another book that was very good. It talked about tyre tread, pressures. I read and learned about my car from it’s manual. I bought a tread meter and a gadget that measures the tyre pressures and is also a pump powered from the cigar lighter.
I applied to go in for the test again as soon as was feasible. I decided to take the test and not tell John Convery this time. One evening the phone rang and it was Phil!! Better the devil you know.
I was seriously nervous the morning of the test. Phil told me he had not slept beacuase of his irritable bowel. Like last time, he fixed his own reversing mirror on to the windscreen by means of a sucker. He got out his notepad and we set off. After 10 minutes he said “let’s get the reversing over with”. We did and it was OK. Not downhill this time. As I was “rambling on” I pointed out how I had taken on all the things he had told me and that I had bought a tread meter and tyre pump. I was very open and honest about my approach. We were only out for an hour and I had the strong feeling I had passed. I had. I thanked him and gave him a copy of my essay on failure on which I had hand written “thanks, Phil”.
So I phoned Kath and texted John. He replied “you slimy bastard” but was obviously pleased.
I arranged to meet him to thank him and took a card and a present. He is a very decent man with a great family who were very nice to me.
What conclusions have I come to? Wel, I am a qualified educationalist and I learned that you can never stop learning even about something you have been doing every day for decades.

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Sunday, July 27, 2008

Failure – a learning experience?



There are some people I have met who have never failed an examination or test in their lives - so far. I believe some of these have missed out on something. Failing at something or feeling a failure should be a learning experience. Passing every examination or test may lead to over-confidence. Some of the people who have passed everything may also have never failed at interview for a job. In my experience, the latter can result in an arrogant and ambitious approach to work as well as problems dealing with those responsible to them as employees.
There is sometimes a sense of failure when one questions what one is doing at work and the possible guilt feeling if one has not a “proper job” We have to move on from these feelings and progress our thoughts. We should not allow failure feelings to become set in or prolonged. We should look back on our experiences and relationships and be positive. Some failures take longer than others to put on the back burner.

This piece was going to be mainly autobiographical but that is too easy. I have written the autobiography of my failures in another essay. I will start by listing my perceived failures and then discuss failure in a more general sense.
I failed: to pass O level English Literature; to pass mock O level chemistry; to pass my driving test first time; to pass an exam called “conjoint” (a final examination in medicine and surgery that would have enabled me to practice as a doctor); to obtain a higher degree in my Anatomy B.Sc than a lower second; to, in my mother’s eyes, become a consultant; to get higher marks in a postgraduate certificate in primary care education completed in 2001; get re-elected as a metropolitan district councilor in 1983; to pass the Institute of Advanced motorists test, recently; to write any fiction.
Let me describe “rich pig’s worries”. After that you will understand that it is ridiculous for me to worry, at this stage of my life, about the above list of perceived failures. A number of years ago, I was working on postgraduate medical education based at Pontefract General

Infirmary. I was a General Practitioner and I worked closely with a consultant physician, Mick Peake, who was the hospital educationalist. One afternoon I was in the Postgraduate Center at the hospital and he came in looking flustered and worries. He told us that the forthcoming weekend was going to be a nightmare to him. He had to travel all the way to London to buy a new cover for their swimming pool. His partner is a consultant paediatrician. Need I write any more about “rich pig’s worries”?

So what about my list of failures? They are luxury failures. I did not fail to have a fabulously interesting and fulfilled career. I was very upset each time I failed but, in the fullness of time, regarded each failure as a learning experience. At the time of writing, I am learning how to reverse my car round a bend on a road going downhill and how not to go round corners on country roads too fast. I am looking forward to re-taking my advanced motoring test again. I realised that the guy who failed me was right to fail me. Again, failing the advanced motorist’s test is a luxury. I own a great car and have the time to indulge trying to drive better.

What do other sources say about failure? Can we learn anything from these?
Wikipedia (accessed 26th July 2008):
“The criteria for failure are heavily dependent on context of use, and may be relative to a particular observer or belief system. A situation considered to be a failure by one might be considered a success by another, particularly in cases of direct competition or a zero-sum game. As well, the degree of success or failure in a situation may be differently viewed by distinct observers or participants, such that a situation that one considers to be a failure, another might consider to be a success, a qualified success or a neutral situation.
It may also be difficult or impossible to ascertain whether a situation meets criteria for failure or success due to ambiguous or ill-defined definition of those criteria. Finding useful and effective criteria, or heuristics, to judge the success or failure of a situation may itself be a significant task.”

“It is possible to fail in many ways...while to succeed is possible only in one way.” Aristotle. (384 BC – 322 BC)

“You may be disappointed if you fail, but you are doomed if you don't try.” Beverly Sills. American Opera Singer. (1929 - )

“Don't be discouraged by a failure. It can be a positive experience. Failure is, in a sense, the highway to success, inasmuch as every discovery of what is false leads us to seek earnestly after what is true, and every fresh experience points out some form of error which we shall afterwards carefully avoid.” John Keats. Poet. (1795 – 1821)

“A minute's success pays the failure of years.” Robert Browning. Poet. (1812 – 1889)

“Success is the ability to go from one failure to another with no loss of enthusiasm.” Sir Winston Churchill. (1874 – 1965)

“I remember and reflect on my failures more than my successes. That reflection has made me a better person.” Richard Sloan. (1945- )

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