Personal beliefs, faith and Medical Practice – call for a universal code of tolerance

I am sure if there was a finishing school for public sector workers in leadership roles then rule #1 would be never talk about sex, politics or religion. It always gets you into trouble! I am certainly not looking for trouble or controversy but I do want to highlight to you a GMC document released over the weekend (Personal Beliefs) that is a “must read” – and one that I hope you will all find useful in reconciling what may be strong personal beliefs, patient beliefs and clinical practice. The bottom line is always put the patient first; his or her needs must super cede any individual beliefs, as the GMC’s guidance makes clear. The guidance talks of our personal beliefs including political, religious or moral beliefs and says: “While we do not impose unnecessary restrictions on doctors, we expect them to be prepared to set aside their personal beliefs where this is necessary in order to provide care in line with the principles in Good Medical Practice.”

We take great pride in Birmingham in welcoming Medical Students from a huge range of backgrounds and beliefs and as you will be aware Dr June Jones has helped co-ordinate this domain across the School for many years. The photograph “The Same Difference” which illustrates and celebrates the rich cultural diversity in our student body (on show on the ground floor near the Leonard Deacon Lecture theatre) is testament to this diversity. But we are also all too aware of the conflicts that may arise from personal religious beliefs and practicing Medicine in the UK. The GMC guidance highlights some areas where conflicts may arise relating to patients’ faiths – Jehovah’s witnesses and blood transfusion, male circumcision, termination, but also areas where our own beliefs might impair patient care. The guidance indicates that for some patients a face veil worn by a doctor may present an obstacle to effective communication and the development of trust, which is part of why we do not permit students to wear a veil and I would add to that example the importance of shaking a patient’s hand if offered. Equally, you may have firm religious beliefs on termination but these cannot impair your overriding duty of care to the patient. The advice is equally relevant to the individuals who have no religious faith, in optimally managing patients you must take their beliefs into consideration, however puzzling or baffling it may be for you to reconcile.

There will be many occasions in your careers where this issue arises. The guidance is extremely helpful but you must also all find your own ways of negotiating these scenarios based on your own backgrounds and beliefs. For what it is worth, I find my “universal church of tolerance” a good starter for ten, that in many ways merely extends one’s inbuilt core values to medical practice: 1) the understanding that all of us can believe what we wish, 2) that I respect other individual’s views irrespective of whether I believe it or not and 3) not to impose my personal beliefs on others, and importantly 4) my beliefs and perceptions must never detract from my overriding duty to provide care for patients who are in need of medical treatment.

I hope I have passed the “finishing school test” – but this is important and I know that you will all find the guidance helpful.

PM Stewart


A Time for Change

This may not be my last blog but it will be my most difficult to write. After 24 years here in Birmingham and 3 years as your Dean I have decided to move “up north” to take on the role of Dean of the School of Medicine at the University of Leeds, but with a wider remit to develop Medicine and particularly Biomedical research across the University (http://www.leeds.ac.uk/forstaff/news/article/3788/professor_paul_stewart) Whatever you chose to do in life, it is always a good exercise every once in a while to stand back and analyse where you feel you can make the greatest difference, and for a variety of reasons now is a good time for a new challenge.
We have been through a lot together in the last 3 years with new curricula, our NHS Trust teaching academies, GMC visit, change to admissions processes, intercalation expansion, anatomy reform, new estates infrastructure, MedSoc successes and dare I say it the dreaded SJT to name a few, but above all I have thoroughly enjoyed my interaction with you – our students and customers – best of all. As a group you continue to amaze me in terms of your academic abilities but also the numerous additional interests and skill sets that you seem to acquire as easy as I acquire airmiles! For me this is inspiring and professionally extremely rewarding and for this reason alone I can’t see my career moving too far away from Medical School leadership and student engagement in the forthcoming years.
I am very keen to see through this academic year and will not be leaving until all of your end of year exam boards are signed sealed and delivered and the next cohort of tomorrow’s doctors are graduated!! Hopefully this will leave ample opportunity to say goodbyes along the way. Please do me a big favour and all keep your noses clean so I have no awkward misconduct issues to handle in the interim!
Finally, one of the great joys of being a Dean is sitting around committees with other Deans of Medical Schools (ok so maybe “joys” is an over stretch!). But seriously you all need to know that having done so, and with no bias whatsoever, this is a terrific Medical School. The Dean is merely the “conductor of the orchestra” – a leader of an outstanding team, in this case Professors Gammage, Thomas, Kumar and Dr Coleman aided by Janet Crook and her staff in the School Office, all of whom have a clear and common vision of the way forward. Mahatma Gandhi famously said “the future depends on what you do today” – the Medical School has a very bright future to look forward to, and I am sure that all of you, like me will warmly welcome the new Dean when an appointment is made in the months to come……

PM Stewart
13 th March


The Francis Report – why it matters for The Medical School and for you as students ….

The final report of the Mid-Staffs Public Inquiry (known as “The Francis Report”) was published on Feb 6th 2013 (http://www.midstaffspublicinquiry.com/report).  The report was instigated by the Secretary of State for Health in an attempt to explore the reasons behind an excessive number of deaths – estimated to be somewhere between 400 and1200 – that arose from a failing NHS Hospital Trust in the mid 2000’s. The report is extremely detailed being over 2000 pages long; the executive summary alone is over 120 pages and has as its heart 290 specific recommendations designed to prevent a recurrence of this appalling failure of patient care. Patient suffering on an unprecedented scale is blamed primarily on failures of the NHS Hospital Trust board and its managerial and leadership abilities. However, wider flaws in “institutional culture” that placed finance and NHS targets ahead of the needs of patients and wider issues of poor communication with external agencies and watch-dog organisations are also highlighted by the investigation. It is a report that all of us who are involved in the clinical care of patients must take to heart and should provoke an inward look at each of our own professional values, and allow us to reflect on what structures should underpin state-of-the-art patient care. An important part of the report is levelled at the medical/ healthcare professional staff and the specific challenges of ensuring that the correct culture is in place across medical teams. It will act as a reminder to everyone of the importance of putting patients first.

This phrase, much used in the media in recent days, is at the heart of the report.  Of course we would all agree, but what does this actually mean for you and your training as a medical student? 

As you will be well aware, the Dean’s team has focussed for many years now on the importance of your own personal qualities and core values; indeed this process begins during welcome week at the Medical School. This is not only about communication skills, dedication, and team-working (attitudes and skills which we embellish throughout your training), but the core qualities of being a caring individual including empathy and inner resilience. Post Francis there are now additional responsibilities that we will be emphasising.  One of the Recommendations is that the GMC should require “providers” to “actively seek feedback from students and tutors” on whether hospital placements meet minimum standards of patient safety and quality of care.  Another Recommendation talks of the need for “Proactive steps….to be taken to encourage openness on the part of trainees” (i.e. doctors in training). 

We all have a responsibility to be aware of patient safety issues, and to make others aware of shortcomings if we see them.  “Openness” means that none of us, whether we are medical students, junior doctors, senior consultants or practicising Deans, tries to hush things up.  And it also means that there are no repercussions if we identify a problem.  The message of Francis is “openness, transparency and candour throughout the system”. As far as your tutors in the Teaching Academies and the Medical School are concerned, it’s our responsibility to make it as easy as possible for concerns to be aired.  We will therefore ensure that there are occasions when we ask directly if you have observed anything that worries you in clinical placements. 

As Francis makes clear, there are plenty of “systems” in place to monitor health care professionals and their workplaces.  But these systems can only function well if the culture of the workplace is right.  We all have a part to play here too, as students, doctors or tutors.  We need to promote a culture in which everything we do or say is for the benefit of patients.  This doesn’t just mean prescribing the right drug.  It means being alert to what is going on around us, not accepting poor standards in ourselves or others, and raising concerns where we need to. Putting the patient first must be at the bedrock of everything we do in our clinical life and accepting a personal responsibility to ensure that this is the case will go a long way to preventing another Mid-Staffs catastrophe.

John Skelton
Paul M Stewart
20th Feb 2013


Festive wishes from the Medical School Dean’s Office

Festive wishes from the Medical School Dean’s Office

Wishing you all a very Happy Christmas and every success in 2013


Jamie  Coleman
Michael Gammage
Prem Kumar
Kate Thomas
Paul Stewart


Basic Life Support at the University of Birmingham

One of the most pleasant (and I have to say most surprising) experiences as Dean is to witness first-hand the great things Students get up to outside “working hours”. Two weeks ago it was my own 30-year reunion back at Edinburgh Medical School and with it the opportunity to meet up with old friends. We had a great time for sure but I cant ever recall our year being so actively involved in extracurricular activities. Perhaps the most inspiring of these in Birmingham, is the Birmingham Life Support Scheme (BLS).

About a year ago I went to my first BLS meeting – on a rainy Monday evening in the Medical School – and was quite frankly overwhelmed with what I saw. Peer-led teaching of the highest quality (overseen by Professor Julian Bion and Dr Jonathan Hulme), organised brilliantly, that was delivering essential life support training for College Students. I was so proud of what I had witnessed – and wearing my hat as a British Heart Foundation trustee – that we began the process of endorsing BLS activity by the British Heart Foundation (BHF). BHF had invested in an advertising campaign led by Vinnie Jones highlighting the merits of hands only CPR.(http://www.bhf.org.uk/heart-health/life-saving-skills/hands-only-cpr.aspx#&panel1-1) and their enthusiastic support – with financial backing – for BLS as part of a wider community outreach programme has been most welcome.

All of this then became a reality in late August when Professor Kate Thomas called me urgently about one of our 4th year Medical Students who had sustained a cardiac arrest…

‘Out of hospital cardiac arrest’ describes a condition of sudden collapse and loss of effective cardiac output when outside of a hospital environment, and requires immediate intervention to prevent loss of life. It is a medical emergency affecting 37.72 out of every 100 000 people each year.1

This condition has been in the public spotlight over recent months following thousands witnessing the sudden collapse of Mr Fabrice Muamba, the Bolton midfielder, whilst playing in an FA cup quarter final match on a seemingly normal Monday evening.2 Immediate advanced medical care including cardiopulmonary resuscitation (CPR), rapid defibrillation, and expert treatment at the London Chest Hospital resulted not only in his survival, but his discharge from hospital just 30 days later following an ‘incredible recovery.’3

Whilst a remarkable story for many of us, for a group of healthcare students here at the Medical School this emergency situation recently also became a startling reality. Earlier this year Rajan Chaudhry, a fourth year medical student, suffered an out of hospital cardiac arrest whilst in the company of his friends. Thanks to their rapid intervention through provision of Basic Life Support his life was saved, and he has kindly allowed us to share with you his incredible story:

“On 14th of August this year, I was participating in a Bhangra dance class which I was frequently involved in. Like any other day, I felt completely normal and seemed it to everyone else. From what I have been told, I collapsed unexpectedly halfway through the dance routine. At this point, I was lucky to have friends trained in BLS present as fellow dancers. They promptly began BLS, and the ambulance arrived within 3-4 minutes. I had gone into ventricular fibrillation and subsequently had a cardiac arrest. I was defibrillated by the ambulance crew and taken to City Hospital, where I remained sedated on the Critical Care Unit for 5 days. After a couple of further weeks of tests and transfer to the QEHB, all investigations into the reason behind my event came back clear, and it was decided that an implantable cardioverter-defibrillator (ICD) should be fitted. Now I am recovering, having taken a year out from the medical course.

Given the situation, I cannot say what it was like to witness what my friends described as, “the worst experience of their lives.” However, the ambulance crew told them that the BLS which they performed and the decisive action which they took, bought me the valuable minutes I needed to survive. I cannot commend my friends enough for their quick-thinking and composure and there are obviously no words to describe how important their actions that day were to me. I was told my chances of surviving were less than 10% in my situation, and I owe them in a way I can never repay. Having been through this experience, I now truly count BLS as one of the most important things I have ever learnt, as it is the reason I am still here and able to write about what happened to me.”

The result of the actions that Rajan’s friends took cannot be overstated. Evidence shows us that chances of survival can be more than doubled in cardiac arrest victims who receive prompt, effective bystander CPR whilst awaiting the arrival of an ambulance.4, 5 Unfortunately survival rates for cardiac arrest victims still remain low, partly because too few people are adequately trained in life support techniques such as CPR and therefore unable to help those like Rajan when they are most in need of skilled intervention.

Given this, many organisations are attempting to reduce mortality following cardiac arrest through education. The British Heart Foundation’s HeartStart training scheme has, for instance, trained 2.6 million people to date in how to respond to a cardiac arrest and other potentially life threatening conditions.6

As the healthcare professionals of the future, we should all have a role in leading the drive to increase survival following cardiac arrest. Here at Birmingham we recognise the importance of training students at an early stage to deliver basic life support (BLS) so that – whether in a hospital environment or out with your friends – you can act proficiently in emergency situations.

This is why if you are a first year medical, dental or physiotherapy student at Birmingham, you will take part in the College’s innovative and widely acclaimed BLS course over the coming academic year. This unique course, started 17 years ago by a group of third year medical students, is the only in the country which is completely peer led, assessed and tutored, and is the largest of its kind in Europe. This means that you will not only be taught by your senior student colleagues, but that you will also be examined by them. Each year almost 700 students are taught in this manner, over a 4 week programme leading to a European Resuscitation Council (ERC) accredited BLS/AED qualification. You will be taught how to deliver CPR, how to defibrillate patients using an automated external defibrillator, and how you should treat other life threatening conditions such as bleeding, choking and shock to develop the same key skills that Rajan’s friends were taught only a few years ago on the same course, and which they depended upon in extreme circumstances this last summer. We will also provide you with teaching on the very latest automated feedback manikins, so that we can ensure you leave us with an unrivalled early ability to save lives and care for ill members of the public.

Those who are interested may then join us for further training so that they can return in their second year of study as qualified ERC instructors to instruct the new first year cohort. A number of these students will subsequently be invited to return as examiners, whilst others may be provided with the opportunity to help in the running of this course as committee members and to conduct research on BLS guidance, teaching and techniques. This provides opportunity for these students to publish their novel findings in high ranking journals, and to travel to present these – we have for instance recently presented findings from six research projects at the Resuscitation Congress in Vienna, have previously presented in Porto, Portugal and will soon present a summary of our course at a major conference here in Birmingham.

We are proud at Birmingham of the world-class BLS training that we deliver. We believe that we provide the opportunity not only for students to become proficient BLS providers, but to grow and progress as teachers, assessors, leaders and researchers in a course designed so that it can better itself, update itself and be of the best use to the students that it teaches. We hope that if you are a first year here you will enjoy your time on the course, and that it will equip you with skills that will not only benefit you throughout your career, but that may benefit you tomorrow.

We look forward to seeing you on the course, and we hope that you enjoy learning these vital skills from our excellent team of student teachers. We hope too that this time next year you will be joining us to conduct research that shapes and alters resuscitation guidelines that are utilized across Europe.

The Basic Life Support Committee
Resuscitation for Medical Disciplines
College of Medical & Dental Sciences
University of Birmingham

Congratulations to all involved and living proof that everyone’s efforts around BLS makes a tangible difference. It really does save lives!

- Paul Stewart

(Particular thanks goes to to Rajan Chaudhry for sharing his experiences, and I know you will all join me in wishing him every success in the future)

The faculty, committee, examiners and instructors of the RMD Birmingham Basic Life Support course 2012-13.


1Atwood C et al. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005; 67; 1; 75-80

2BBC News. Bolton’s Fabrice Muamba collapses on pitch [online]. Accessed 2/8/2012. Available from URL: http://www.bbc.co.uk/news/uk-17418794

3BBC Sport. Fabrice Muamba: Bolton midfielder discharged from hospital [online]. Accessed 6/8/2012. Available from URL: http://www.bbc.co.uk/sport/0/football/17733022

4Ritter G et al. The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims. Am Heart J 1985; 110; 5; 932-7

5Gallagher EJ et al. Effectiveness of Bystander Cardiopulmonary Resuscitation and Survival Following Out-of-Hospital cardiac arrest. JAMA 1995; 274; 24; 1922-5

6BHF. Heartstart training [online]. Accessed 6/8/2012. Available from URL: http://www.bhf.org.uk/heart-health/how-we-help/training/heartstart.aspx


The Olympic and Paralympic Legacy – Inspirational and Medicinal

It seems an age ago that Daniel Craig pushed HRH Queen Elizabeth from a helicopter hovering over London E20 into the Olympic park (that will now take her name), and thereby officially open the XXX Olympiad. And what an amazing two weeks it was! I like many of you I suspect, have shed a tear or two on witnessing the outstanding performances of all the athletes, but particularly those of Team GB. We will all have our favourite moments – be it Mo Farah, “Queen V” Pendleton, Chris Hoy or Jessica Ennis. The emotion from medallists who had succeeded despite losing much loved family members – notably Gemma Gibbons in the Judo and Tom Daley on the 10m diving board – was particularly tear jerking.  I had the good fortune to see some of the coverage from down-under in Brisbane and what a pleasure it was to savour our success whilst the Aussie press were lambasting their own failures.  One bitter statistic they were struggling to come to terms with was the concept that that my own great “nation” – Yorkshire – had outperformed Australia. In the end I think it was a tie, but the “Yorkshire grit” shown by Nicola Adams boxing her way into the history books was most heart warming.

Just as the blues were descending post Olympics, along came the Paralympics, and in many ways the performances here were even more amazing. Last year I spent time in Charlottesville in Virginia, USA as a Visiting Professor and saw firsthand how a close colleague coped on a day to day basis with disability. This talented Professor had broken his neck many years earlier when a tree fell on him in a severe storm rendering him paraplegic and wheelchair bound. His academic ability and innovation remain world leading, but I was also in awe of his daily routine in terms of the personal discipline required to cope with simple tasks that we all take for granted – hygiene, driving, work access, shopping to name a few.

To then consider the logistics alone, not least the immense physical efforts that individuals such as David Weir and Hannah Cockcroft must have gone through to become world beaters in wheelchair athletics, is simply mind boggling. Other individual performances – Ellie Simmonds in the pool, Sophie Christiansen and her horse and Jonnie Peacock’s amazing 10.9sec 100m run will, for me, remain treasured examples of outstanding personal achievement.

And now the blues have descended once more, what can we take from this mesmerising experience that in some small way might enhance our own future life paths? Firstly, it must be inspiration – we all have some in-built talent and capability, but the drive, dedication and execution to harness such skills and achieve a great deal more is surely within us in our every walk of life, not just Olympians? Secondly, success in the face of adversity. All of us in some phases of our lives have, or will, experience tough times – be it illness, physical or mental stress or permanent disability. For me the experience of watching others achieve way beyond anyone’s expectation despite huge adversity gives an inner strength in coping with similar (although arguably less severe) setbacks in my own life. As I look particularly to the new cohort of MB ChB students, these two personal qualities – dedication and resilience – will undoubtedly serve you all well in becoming a doctor.

There is also a wider health legacy for individuals and populations at large. Exercise must become a cornerstone of future health/social policy if we are to have a meaningful impact on tomorrow’s health priorities such as obesity and ageing. Birmingham is a young city with more of its population under the age of 16 than most – but it is also the obesity capital of the UK with up to 50% of its children either overweight or clinically obese.

At a time when our daily caloric intake is not dramatically different from 30 years ago, there is good reason to believe that this new “tsunami” of obesity is explained by sedentary behaviour – we don’t walk to school or do competitive sport anymore and restrict exercise to both thumbs operating the playstation! Similarly, there is a body of evidence to support the notion that healthy lifespan requires regular exercise in advancing years. Part of the issue here is “changing personal behaviour” – something that is notoriously difficult as we have seen from smoking and alcohol examples. Our own Sports & Exercise research programme here in Birmingham aligns obesity researchers with psychologists and sports physiologists to evaluate these areas (http://www.birmingham.ac.uk/research/activity/mds/centres/obesity/index.aspx).  We can make headway and hopefully the Olympic and Paralympic legacy will involve personal life style alterations as well as measures to induce population change. As future doctors you will all be well placed to champion such concepts.

Ok, I’m logging off now to go swimming – all too worried in the face of an ever younger new cohort of medical students that healthy ageing needs to be high on my own personal agenda!


The Journey Home

The Medical School finds itself holding a collection of human skulls and bone fragments from many places around the world. The records relating to how the collection was formed are either not available or incomplete, so little is known about the origin of the items.  Our collection is not on display, and is not used for teaching or research.  In my time as Dean, I have received many requests from cultures across the World claiming the materials might belong to their origins. What to do about them?

There are a variety of opinions about repatriation. Museums are often keen to keep collections intact to allow education and further research to take place. This informs our understanding of how early cultures developed and functioned. From a native perspective, it is often vital to have ancestral remains repatriated to allow the ancestors to rest in peace and the tribe to flourish again. Knowing that ancestors are kept as museum items is deeply traumatic and in their eyes a mark of disrespect. Believing that repatriation was the only ethical response to our discovery, a decision was made to attempt repatriation of any of the remains which had good provenance. The first part of the collection to be repatriated was the Californian collection. Each item had a label attached stating that is had originated from a grave in the San Luis Obispo area of California.  Dr June Jones was asked to contact tribes in that area to investigate whether there was any interest in repatriation. The Salinan tribe from the San Luis Obispo area responded enthusiastically.  What follows is a fascinating diary from Dr Jones of her recent visit to Califoirnia – the culmination of several months of negotiation with US Embassy in London and US Customs Officials. http://www.latimes.com/news/local/la-me-adv-skulls-20120520,0,421863.story

Tuesday 8 May

“Sealing the box, I feel a mixture of anxiety, relief and a huge sense of responsibility for what is about to happen. I am travelling down to London Heathrow to begin the journey of taking 7 skulls and 4 bone fragments back to their place of origin- the San Luis Obispo area of Central California. We found the human remains, fully labelled with their place of excavation, in our Medical School anatomy collection just over 14 months ago. This repatriation is the culmination of many months of collaborative effort between myself and tribal elder, John Burch. The San Luis Obispo area is home to the Tribe of Salinan Native Americans, and has been their ancestral land since prehistoric times. I know that when I arrive in Los Angeles I will be met by a very excited Tribal Elder. The first task is to get the box containing the skulls into my car- no mean feat considering the box is large and my car is not. Having accomplished that with the help of a colleague, I set off for the journey of a life-time.”

Wednesday 9 May

“Arriving at London Heathrow, my first task is to check the box in as part of my luggage. The process goes smoother than I had thought. United Airlines staff are really helpful once they know what is in the box! They surround the outside of the box with ‘fragile’ stickers and take me round to the area for large items, reassuring me that there would be no problems getting the box onto the flight. Arriving at Los Angeles, I am so relieved to see the box come along the conveyor belt, right next to my suit case. I then begin the process of clearing the box through US Customs. I have been in discussions for several months with the US Embassy in London and their specialist Customs team in Atlanta Georgia, so I have all the required paperwork and contact details at the ready, in case of any problems. Not for the first time on this journey, I am greeted with the opening question ‘what’s in the box, lady?’ I produce all the paperwork and tell my story. Again, I am met with nothing but interest and a genuine desire to help the process go as smoothly as possible. The Customs Official jokes that his family will never believe what he has dealt with today. We both laugh about the shock the staff x-raying the box in airport security must have had!

As I come through into the arrivals lounge, John and Chris are here to meet me. Our shared relief is palpable. They had driven 3 hours down from the San Luis Obispo area to meet me. We stop for long hugs and photographs then begin our journey north along the Coastal Highway, taking in some of the most beautiful scenery California has to offer. Our first stop is at the Sheriff’s office, to meet the County Coroner who will take possession of the skulls until the reburial. First, they have to be inspected by expert archaeologists to confirm that the remains are Native American. Apparently confirmation is gained by examining the molar teeth, which are ‘shovel’ shaped from years of grit in the diet. The experts are ready to begin the process of identification when we arrived. Each skull is carefully examined and confirmed as Native American, so reburial arrangements can proceed. We leave the skulls with the coroner and travel 30 minutes to John’s home, where I am staying. We talk late into the night about our work so far and our hopes for the reburial. There are already some legal issues that the tribe will have to overcome to be allowed to proceed with reburial quickly. If a tribe is Federally recognised, the process is fairly straight forward, but the Salinan tribe are awaiting Federal recognition, so the situation is complex. We go to bed wondering what the next few days would bring.”

Thursday 10 May

“Rather than wait by the phone for news of the reburial process, John decides to take me on a tour of important Salinan sites. He is the Spiritual Elder of the Salinan tribe, so he knows the land in a special way. We travel to Mission San Antonio, where Salinan Indians were rounded up and converted to Catholic Christianity. There is a plaque here recording the first marriage to be conducted at the Mission in 1773, between John’s many times removed grandparents. We then travel to ‘the Indians’, an area of sacred rock formations in the San Lucia Memorial park, and then to the Ventana Wilderness Trail. Being in these sacred landscapes with John is so special. Tourists would be impressed by the awesome splendour of the mountains, but John explains their sacred nature first hand, which brings a unique perspective to such a memorable day. Unfortunately we can’t stay as long as we wanted (which would have been about 3 months!) because we have an appointment at Mission San Miguel with the local news channel, who are covering the story on their 10pm news that evening. The Mission contains a Chapel with original wall frescos painted by the Salinan Indians in the 1770s. The contrast between the sacred sites we had visited in the morning and the Chapel we are now sitting in couldn’t have been starker.

We are interviewed by KCOY TV, who are really interested in the story. It becomes apparent that although around 700 Salinan Indians still live in the San Luis Obsipo area, little is known about them outside of their own community. There is also great interest in a UK University making the initial contact to begin and pay for repatriation. US repatriation efforts are usually initiated by Native American groups under Federal Law, which requires US Museums and Universities to return Native objects and remains. The process is often long, costly to the tribe and contentious, so our story had several unique features. To view the TV interview, please follow the link:


Friday 11 May

“The phone rings early this morning and we receive the best news of all- the Native American Heritage Commission have given permission for the reburial to take place today! We travel quickly to receive the remains from the Sheriff and Coroner, in front of TV cameras.  It is a very moving and symbolic moment to see the Elders formally receive their ancestors for reburial from the Sheriff. We then travel to the site of reburial, which is kept secret to avoid people coming to the grave site to dig up the ancestors again- yes, that actually still happens today! There are about 25 people present, mainly tribal members and people who support the tribe. The Sheriff and Coroner have come too, which is a very meaningful gesture away from the cameras. There are no photographs or recordings allowed of the reburial, and everyone is respectful of this. Tribal songs of welcome are sung to the ancestors, and their remains are laid to rest in a communal grave, side by side for the first time in over 100 years. It is a very emotional ceremony, with lots of tears shed and mixed emotions. The overwhelming theme I hear throughout the day, from State Officials and Tribal members, is how grateful everyone is to the University of Birmingham for repatriating the ancestors. There is regret over what happened during excavation and shipping the remains abroad, but that is completely overshadowed by the joy of homecoming. As one Tribal leader said to us as we gathered around the grave ‘tonight our ancestors will sit around the fire together in their own land for the first time in many years’. “

Saturday 12 May

“Today John takes me to another sacred site, Morro Rock on Morro bay. The rock is protected now as there are breeding pairs of peregrine falcons nesting on top of it, so no one is allowed to climb it. There are exceptions, however. At the winter and summer solstice John is allowed to take a few tribal members to the top to perform ancient tribal rituals. The rock is on the Pacific Ocean, so we have a great view of it whilst paddling.

After lunch we travel to the annual tribal BBQ. I am so privileged that my visit coincides with this annual event, where I get to meet around 150 tribal members. Listening to their tribal legends and stories I get a sense of a people still very much in touch with their cultural heritage, despite having completely assimilated into the American way of life. Older members reflect back on their lives, and the lives of their grandparents, discussing how much and how little has changed for them. The BBQ is truly the best I have ever had. BBQ’d oysters, local beef and chicken, lots of salads and dressings, and amazing cakes.

We spend our last evening together sitting round the fire at home, reflecting on the visit and the work yet to be done to bring ancestors and their tribal items back from many locations across America and Europe. The work ahead will be very hard, financially, practically and emotionally, but the tribe is prepared to go through it all in order to respect their ancestors. Having experienced the cooperation of our University, they only hope others will be equally receptive to their need for repatriation.”

Sunday 13 May

“I leave today for London Heathrow. I am sad to be leaving these wonderful people, but I know that I will return again. We have forged strong bonds in our joint desire to honour the ancestors, and we are grateful to the Dean of Medicine, Professor Paul Stewart, for making all this possible.”

The reputation of the Medical School is not just based on our ability to train outstanding doctors. June Jones has demonstrated outstanding professionalism in her handling of this humanitarian and ethical issue, for which we are all grateful. The repatriation of other remains continues…

PM Stewart


You want to study Medicine? Let The Voice decide!

It is a miserable weekend and I am on call (no wine!). What else to do on a Saturday night but cosy up in front of the fire and sample terrestrial television. And I am pleasantly surprised ….. isn’t the Voice brilliant? Expecting the usual trashy reality TV shows and related pre Match-Of-The-Day garbage, The Voice is refreshingly energetic, oozing with talent from all walks of life and judged by four “coaches” (Sir Tom Jones, Danny O’Donoghue, Jessie J and Will.i.am) each with the aim of attracting the best voice to their team and then nurturing and coaching them to greater things (http://www.bbc.co.uk/programmes/p00k96j4). As Saturday’s episode came to a close, two things came to mind as I was frantically texting my votes for Jaz Ellington (what a talent that guy is!). Firstly, how cool is will.i.am? I have always been a closet fan every since his days with the Black Eyed Peas, but his career seems to have taken off in so many diverse directions since. In addition to his music (almost 90 million singles and albums sold worldwide), he is creative director for Intel Corp and now runs his own successful fashion design company. (If any of you are considering birthday or Xmas gifts, I would love the fingerless gloves but not sure they would pass infection control). He also seems genuinely committed to putting something back to the community. Raised in a deprived part of Los Angeles his latest venture (iamauto) seeks to re-build “luxury” cars in ghettos in LA and re-cycle these for use in the local community. Add to that his love of cars and his driving skills (see http://www.youtube.com/watch?v=WBWabWHlIPs), and he is for sure an iconic figure.

The second thought process relates to an issue that is topical at present across the Dean’s team here in Birmingham and more broadly across the UK – how do we optimally select students for Medical School? The simple answer is that we haven’t a clue. Historically we have relied heavily (too heavily in my view) on academic performance at School. On the one hand this has some merit – Medicine is a taxing degree course and the data available do show that performance in GCSE’s and A level is a predictor of success, but this has now escalated to such a level that for the 2011 intake most candidates required on average 8.5 A* GCSE’s to gain entry. Having a reputation as one of the hardest Medical Schools to get into is one thing, but trying to reconcile this with much needed widening participation into Medicine from all corners of society and the current public/ professional driven demand for a greater scrutiny of the qualities required to do Medicine, means that our own processes do need to evolve.  The Vice Chancellor continues to remind me that in our era, many students were accepted into Medicine with B’s and C’s at A level and we are certainly not universally dissatisfied with the current medical workforce. Academic performance is one factor, but the not the whole story.

The UK clinical aptitude test is used by many Medical Schools; a publication just last week (http://www.bmj.com/content/344/bmj.e1805) suggests that it may increase intake into Medicine from under-represented socio-economic groups, but many of us remain sceptical of its ability to assess the necessary professional qualities required to do Medicine, notably caring individuals who can communicate. Further outcome data are required.

Although there is limited evidence base, one development we are actively considering is the Multiple Mini Interview (MMI), largely inherited from Canadian Medical Schools and now in use across several Medical Schools in the UK. I can’t help feeling that alongside academic credibility, we must have the opportunity to meet as many of our 3000 applicants as possible for a face-to-face exploration of why students wish to be doctors and a peer group assessment of whether they have the qualities to succeed. I accept this aspiration is over simplistic; even accepting the workload involved in seeing all our applicants, can anyone in a 5 minute interview of a 17-18 year old really assess whether someone will make a good doctor? Maybe not but it must be better than simply looking at one’s ability to store information?  The MMI process involves an interaction between the applicant and many interviewers (including existing students) across several stations each asking a specific issue that may focus on an ethical dilemma, a problem solving exercise, a team scenario in addition to the usual “why do you want to do Medicine” and “interests outside Medicine” type questions. Time will tell whether this will be an improvement on existing practice – but early reports from Dundee and St George’s Medical Schools are encouraging (http://www.ncbi.nlm.nih.gov/pubmed/22455698, http://www.ncbi.nlm.nih.gov/pubmed/21355692). Dr Austen Spruce is in the process of taking over as Head of Medical School admissions from Professor Lote as is charged with developing a strategy across the School – watch this space. Your collective help in any new process will be most welcome.

So finally here is my suggestion to Dr Spruce as he gets his thoughts in order – let The Voice decide! Imagine the scene – 32 Deans of UK Medical School sitting in the Leonard Deacon in comfy black and red leather chairs, Tom Jones hair-cuts and open neck T-shirts with their backs to a student wishing to do Medicine. Each with his/her hand (mine of course to be gloved!) poised over buzzers, waiting to assess the 5 minute vocal plea from the student expounding his/her merits to be a doctor. Irrespective of gender, race, socioeconomic background, I am totally impressed by the first candidate – plunge down on the buzzer and am whizzed around at high speed to come face to face with a student who I hope will now join my team ……  Hmmm dream on dean.i.am …..

PM Stewart


Speed, prostitution and the media – a dangerous triad!

It was Easter 1993 and I was feeling pretty pleased with myself. I had just secured a prestigious MRC Senior Clinical Fellowship and with it my Consultant contract. Life was looking good! You can probably see the smile on my face as we head south on the M5, kids in the back of the car, for a well deserved Easter break in Cornwall. It was 6.10am when we slowed to negotiate the start of a 10 mile stretch of road works with the inner lane coned off.

No one was in sight and the only other car on the road turned out to be an unmarked Police car sitting in the inner lane. I saw a policeman point something at me through his windscreen and was met with an official letter on my return from holiday a week later informing me that I had been doing 74 mph in a 50mph coned limit. The bad news was that I was to be the victim of a means tested process and was required to complete a form giving full details of my salary and personal circumstances. The recent change in contract had seen an increase in my salary and, to cut to the chase, I was faced with a maximum £580 fine. My smile had vanished, but to make matters worse, that same week a High Court Judge (John Prosser if I recall correctly) had admonished a 15 year old boy found guilty of committing rape with a £500 fine that he suggested be given to his victim towards a “good holiday”. I was incensed not only because I believed I had been driving responsibly in the first place, but also at receiving a punishment, which in eyes of some, equated to a charge of rape. I took great pleasure in arguing my cause at Stroud Crown court several weeks later; it made no difference – a sympathetic Judge but “his hands were tied” and the £580 fine became £700 with added court costs.  But my day was to get worse. Clearly not much happened in Court that day because I was greeted by a journalist after my hearing who claimed he was writing a piece on means tested fines and wanted to hear my story (incidentally means testing was abolished shortly afterwards). Nothing could have been further from the truth – the following day I was front page of the Birmingham Post “New Consultant in reckless driving offence” followed by entire section as to how I had potentially put my own patient’s lives at risk by driving at excessive speed. Anonymous hate mail followed from the public at large to my University/hospital address. It was an unpleasant experience to say the least. I did learn several lessons however; firstly, watch your speed and secondly, beware of the media. Having had a few run-ins since on professional rather than personal matters, I rushed off to be “media trained” and am hopefully now better equipped to use media positively and to spot where trouble may lie.

Almost 20 years later and Andrew Lansley, Secretary of State for Health is visiting Birmingham to announce a £12.8 million award from the government to support our pioneering Wellcome Trust Clinical Research Facility embedded within the Queen Elizabeth and Birmingham Children’s Hospitals. It is great news for us – officially recognising Birmingham as having the biggest and best such facility across the UK. The Media pack is alerted but sadly both BBC and ITN seem hell bent on picking holes in his plans for NHS reforms rather than celebrating the good news surrounding more research funding. Very clearly Lansley has been media trained as well!!

With Lansley en route back home, I have an urgent message to call Ben Hill in the University Press office. At last, I think, perhaps a sensible reporter wanting an in depth interview on the great innovations and discoveries across the Medical School that will impact on Human life! Alas, I am told to expect an uneasy few days as a story breaks on Medical Students and Prostitution ….. and Birmingham Medical School is the source!

And that is how I met Jodi Dixon – one of our very talented final year medical students. After discussion Jodi agreed to help me write this blog and this is her unedited contribution.

Last week I somehow managed  to make the world think that 1 in 10 medical students were sidelining in prostitution. To those who felt their reputation was called into disrepute or felt offended by what they read in the newspapers I am truly sorry this was never my intention. For those of you who found it funny, I’m glad someone got a laugh out of it and for those of you who have not got a clue what I am talking about here’s the truth about what happened- maybe you can learn from my mistakes!On the 14th December 2011 the BBC published an article with the headline ‘NUS: Students turning to prostitution to fund studies.’ This article reported the result of a 2010 study that showed   the number of students who knew a student who worked in the sex industry had increased. The Student BMJ then asked me to write an article looking into how acceptable it would be for medical students to work as prostitutes. Having always found medical ethics interesting I wrote the article, getting my information from studies already widely available through a Google search and a few e-mails to relevant people. I produced what I thought was a balanced article, it neither sought to condemn or encourage prostitution, merely spark debate by looking at what would happen in the hypothetical situation that a medical student was a prostitute.And so I was totally shocked when I realised this story had made headlines around the world, I had phone calls from across the globe, even radio stations and TV channels showed an interest in running features based on my article.

But what many seemed to report was not true. Obviously, 1 in 10 medical students are not prostitutes, in fact, apart from one medical student the Student BMJ interviewed anonymously, there is not a scrap of evidence that any medical student is a prostitute, I don’t know about anyone reading this but I certainly don’t know anyone. My article used data from a study that showed that 1 in 10 students in general knew a student who had worked as a prostitute (the same study the papers had already reported data from in December). And so the press took one paragraph of my article and sensationalised it into craziness!

Having written this article I have had my professional behaviour called into question. I never intended for the world to think that myself and my colleagues were prostitutes but in my naivety I did just that.

As I hopefully soon embark on my career as a doctor, I feel it an appropriate opportunity to think about what professional behaviour as a doctor entails and how we as the future of the medical profession must behave in a manner that meets the expectations placed on us.

So what exactly does professional behaviour mean?  Some aspects of professional behaviour are obvious. Obviously medical students cannot behave in a way that may harm patients, not attend university or placement, or cheat in exams and coursework; it is easy to see why such behaviour is unprofessional.  But, Medical students: professional values and fitness to practice published by the GMC states: ‘Students must be aware that their behaviour outside the clinical environment, including in their personal lives, may have an impact on their fitness to practice. Their behaviour at all times must justify the trust the public places in the medical profession.’ It is this point where what you do in your personal life may impact up on your professional life where what is right and what is wrong become shades of grey. The public expect certain behaviour by doctors. A 2002 article in the BMJ stated that: ‘in the United Kingdom doctors top the polls as the most trustworthy and hardworking of all professionals.’

The BMA conducted a poll in 2011 and found that 88% of adults trusted doctors. Since the poll began in 1983 doctors have topped the list of most trusted professionals every year. So I guess the problems arise when what you do in your private life conflict with what is expected of your profession in the eyes of the public. We can’t all be perfect, very few of us do nothing wrong so finally I’d just like to draw your attention to another point from the GMC guidance: ‘Reflect, learn and teach others.’
I have reflected on last week’s events, I have definitely learned from them and I hope I can teach you all to think about how what you do outside of your clinical practice might effect how others view you and your profession.”

Jodi Dixon

What Jodi doesn’t tell you is that she intercalated in Medical Journalism and has also written several other articles – notably an extremely incisive piece on Student participation in Clinical Research. Following this incident I have taken up the matter with Fiona Godlee, Editor in Chief of the BMJ who also raised surprise at the press interest in this story and has promised to do more to help authors faced with similar situations in the future. Thanks to lobbying from some upset parents of local students, the Birmingham papers have apologised for printing an incorrect interpretation of Jodi’s article.

We all make errors of judgement and will continue to do so. At times external forces – in this case the media – exaggerate the significance of these errors, but this must not make us fearful of new ventures. The secret is that we learn from these life events and thereby enhance our Professional standing.

Paul M Stewart


Role Models and Mentors …. A Fundamental Aspect of Medicine

Mentor 2OK, so what do David and Victoria Beckham, Frank Lampard, Keira Knightley (of Pirates of the Caribbean fame) and David Tennant (formerly Dr Who) have in common? According to a recent survey of teachers these were the leading individuals who British schoolchildren rated as their most popular role models. Closer to home the issue was emphasised to me at one of the recent inaugural lectures (parenthetically, why don’t students attend these lectures? The criteria to be awarded a Professorship at the University of Birmingham are tough; they are world leaders in their field be it research, education or a combination of both – a great opportunity for our students to experience first-hand some new advances in Medicine and to hear what makes some of our Faculty tick, students would be very welcome and the lectures are always entertaining and understandable …) enough digression and back to the thrust … where it was very clear how Professor X’s career had been heavily influenced by two or three individuals – clinical scientists who served as inspiring role models.

We will all have our role models. I think back to my own career and my strong desire to be a “doc” since the age of 7. I was unwell thanks to Hepatitis A and anaemia and largely confined to home where I had exclusive use of a toilet (we were fortunate in having two!) and personalised knife, fork, spoon, cup, plate and bowl and somewhat ironically forced to eat liver in copious amounts. But it was the total dedication of our family GP that truly inspired me to one day emulate his behaviour.  Role models evolve as we mature – my school Biology teacher who brought science to life and key individuals in my undergraduate career who endorsed my enthusiasm for Medicine. Finally the reason I am an Endocrinologist and not a Cardiologist (perish the thought!) was largely driven by an influential Professor at a key stage in my junior training. For sure much of this is serendipity but in research based on medical students, social theory tells us that we do compare ourselves with reference groups of people who occupy the social role to which we aspire.

MentorSometimes your role models will develop with you and take on the role of a mentor. Mentor was a character in Greek mythology – as a friend of Odysseus he was asked to take on the task of looking after his son Telemachus. The term “mentor” has now been adopted as someone who imparts wisdom and expertise to someone of lesser experience; continuing the theme above Bobby Charlton has been a well publicised mentor for David Beckham. Mentorship is a crucial part of Medicine and confiding and trusting in a colleague who you know will first and foremost have your interests at heart is a defining part of the role. Several post-graduate mentorship programmes have grown supported by medical bodies, such as the Royal Colleges, Academy of Medical Sciences and leading Charities and is strongly supported by the General Medical Council.

As an undergraduate, whilst I would hope that the Medical School can provide you with lots of role models, and does provide you with a Personal Mentor for your support and guidance, it is virtually impossible, based on 400 students/ year, to provide each and every one of you with a “life-long” mentor, who is exactly the person you would hope to emulate.  Seeking out such individuals for yourselves is essential to provide you with much needed support and wisdom at key stages in your future careers. In turn the tables will turn full circle as you yourselves become the role models for future Medical Students and graduates and take on the mentorship of the next generation of doctors, something we already see in the number of our recent graduates who become Personal Mentors to give something back to the system…

Paul M Stewart

February 2012

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