Southampton medical school, the first 50 years by University of Southampton

SOUTHAMPTON MEDICAL SCHOOL: THE FIRST 50 YEARS

CONTENTS Foreword

4 Our alumni

A new medical school at Southampton

6 Consolidating success

The foundations of medicine at Southampton 8 Continuing research success

The changing needs of medical education

9 Enterprise

The Royal Commission on Medical Education 10 Further developments in education

Supporting careers in academia

Setting up the new school

Designing the curriculum Organising the new faculty

24 The medical school today â&#x20AC;&#x201C; and into the future 33

Embedding the course

The medical schoolâ&#x20AC;&#x2122;s leadership

Building excellence in research and education

Developing research strengths

Educational developments

Recognition of quality

References

100

Acknowledgements

102

FOREWORD The Royal Commission on Medical Education, chaired by chemist and Nobel Laureate Lord Todd, began its work in September 1965. It was tasked with a review of medical education in Great Britain, including consideration of the nature and number of institutions providing medical training. By 1966 it had identified an alarming shortfall in the medical workforce; an additional 11,000 doctors were needed within the coming decade to meet future needs. In an urgent memorandum to the government it recommended a substantial increase in the number of medical graduates without delay. 4

The Commission subsequently recommended the establishment of a new medical school at Southampton. Fifty years on Southampton boasts one of the country’s leading medical schools, with a reputation built on a track record of innovations in medical education and an approach to research driven by strong basic discovery and early clinical translation to improve patient care. Some of these achievements are captured in this history, which was motivated by Jack Howell, the school’s first Professor of Medicine and its second Dean. Jack wrote a detailed, first-hand account of the early days of the school, inspiring this record of the medical school’s development from its creation to the present day. Looking back at those early years in the 1960s and 1970s, while there have been major changes, there are also some remarkable similarities. The Todd Commission was responding to a predicted shortfall in the medical workforce, a requirement to deliver more care in the community and a need for an innovative approach to medical education with a focus on clinical skills, mental health and the link between health and social care. In the early years of the 21st century, these challenges remain a priority. Indeed, they are exacerbated by the need to provide for a growing population of older people, many of whom are living with one or more long-term conditions, and by severe funding pressures on health and social care systems. Despite far-reaching changes in the external environment, Southampton has remained true to the principles of innovative medical education. We continue to instil the necessary understanding of the medical and behavioural sciences to underpin a sound grounding in clinical skills and

an awareness of social and preventive medicine. These principles have been widely adopted and form the basis of best practice in medical education globally. In addition, these principles have informed Southampton’s approach to innovations in scientific training, including the individual research project for medical students, the four-year PhD programme and the establishment of a Postdoctoral Association to nurture research careers in the biomedical and life sciences. We hope that you enjoy finding out more about the first 50 years of this great medical school. Of course, Southampton is a great medical school because of its students and staff, collaborators and friends. While it’s not possible to mention all of those who have been involved in its development in this broad-brush account, we thank everyone who has helped to build the foundation for the next 50 years. We also thank Caroline Graty for her expert help with writing the text and colleagues who have been involved in the narrative. Finally, we dedicate this work to our fellow heads of the medical school, Donald Acheson, Barbara Clayton and Colin Normand, for the huge part they played – and especially to Jack Howell, without whose first manuscript this story would still be untold. Charles George Eric Thomas Michael Arthur Chris Thompson Iain Cameron Heads of the medical school, University of Southampton April 2017

A NEW MEDICAL SCHOOL AT SOUTHAMPTON

In 1971, 40 young men and women arrived at the University of Southamptonâ&#x20AC;&#x2122;s new medical school to begin a brand-new degree course. Their arrival was the culmination of several years of planning, preparation and hard work by a team of pioneering academics and clinicians whose innovations would eventually change the landscape of UK medical education.

Left: Donald Acheson, first Dean of the Faculty of Medicine. Above: Jack Howell (left), Professor of Medicine and the medical school’s second Dean, on his retirement in 1991, with Sheila Mooney, Professor Colin Normand and Heather Howell.

The foundations of medicine at Southampton The evolution of the medical school can be traced back to the 1950s and the arrival of two academics. Kenneth Munday, a young biology graduate, was appointed Lecturer in Comparative Physiology in the University’s zoology department in 1952. He had studied at the University of Manchester and his first post was as a lecturer at the University of Aberdeen, where he was involved in the teaching of medical students. His academic interests were in physiology and biochemistry and he continued to develop these interests at Southampton. Another lecturer, Gerald Kerkut, was appointed two years later. His special interest was neurophysiology. Together, Munday and Kerkut created a sub-department of physiology and biochemistry. There were eight undergraduates in its first year, but numbers expanded rapidly and the group became a separate department in 1958. Munday became its first professor in 1962 and Kerkut was awarded a personal chair a few years later. By 1969, they had about 50 students in each of the three

years of their physiology and biochemistry honours degree, plus about 50 PhD students. Within 10 years the department had become one of the largest in the University. This ambitious new department established strong research and educational links with clinical groups in the region and contributed to the postgraduate teaching of young doctors preparing for the examinations for higher diplomas of the Royal Colleges. When in 1959 the health authority structure changed, creating the Wessex Regional Hospital Board, the University and Regional Board made their first joint application for a medical school. This attempt to bring undergraduate medical training to Southampton was unsuccessful, probably for two reasons. One was a lack of support within the University – there were some who did not welcome the prospect of a large, new, expensive and influential faculty of medicine, believing that it would consume a disproportionate amount of the University’s resources. Indeed, the Vice-Chancellor at the time, Dr Gwilym James, was not enthusiastic.

The second reason for the rejection of this early application was a perceived lack of need – the number of medical students graduating each year appeared more than sufficient. This view was held because in 1956, partly due to pressure from the British Medical Association, the Department of Health set up an inquiry under the chairmanship of a previous Minister of Health, Henry Willink, to consider the future numbers of medical practitioners and the appropriate intake of medical students. It reported in 1957 and advised “a reduced intake by about a tenth from as early a date as is practicable” to avoid a surplus of doctors. In 1944, the Goodenough Committee had estimated that a total intake of 2,500 students a year would be required to meet future needs, but following the implementation of the Willink Committee recommendations the numbers of British medical students fell rapidly – in 1964, for example, only 1,500 graduated.

The changing needs of medical education By 1965, national events were taking place that would enhance Southampton’s prospects of establishing a medical school. It was increasingly obvious that, contrary to the Willink Committee findings, a shortage of doctors already existed. Further, there was concern in many quarters that the education of doctors was not equipping them adequately to meet the needs of the National Health Service (NHS), with teaching in community medicine and sociology particularly lacking. Within the profession there was also recognition that medical curricula were in need of revision and many medical schools were attempting, largely unsuccessfully, to do so. A growing demand for doctors A rapid advancement in medical knowledge during the century and the formation of the NHS were transforming both medical practice itself and the demand for qualified healthcare staff.

As Professor Jack Howell, the medical school’s Foundation Chair of Medicine, wrote: “When I was a clinical student at the Middlesex Hospital Medical School in London in the late 1940s, I had little conception of what lay ahead. The doctors’ world was about to change in a fundamental way, because in 1948 the post-war Labour government introduced the NHS. This had profound consequences for patients and doctors.” The last major change in the organisation of healthcare had taken place 37 years earlier, when Lloyd George introduced national insurance for all workers, giving them free access to a GP and, if needed, to hospital where they would be charged for their treatment according to their ability to pay. This was a tremendous social change, but while it provided medical care for workers, it did not include their families. GPs ran subscription schemes for families but insecurity was widespread. This unsatisfactory situation was swept away by the introduction of the NHS. The government anticipated that after an initial flurry of activity to clear the backlog of untreated patients, the demand for healthcare and therefore the cost of the NHS would decrease. But it was soon apparent that the work of the NHS was not going to diminish; on the contrary, it progressively increased, as did the demand for qualified medical staff. There was concern that the NHS relied too heavily on doctors from overseas, while around a quarter of UK-trained doctors were leaving to work abroad, fuelled by a worldwide demand for medical personnel. Medical advances and an overstretched curriculum The formation of the NHS took place in the context of a rapid advancement in medical knowledge, particularly around the time of the two World Wars. Penicillin was discovered in the 1920s and began to be widely used during the 1940s. The needs of aviation and submarine medicine stimulated high-quality basic research that led to greater understanding of human physiology and the application of new technologies to clinical care.

For the first time there were reasonable working ‘models’ of the body, which began to provide a rational basis for many aspects of medical practice. By the late 1940s, biochemistry had evolved to take its place alongside physiology and pharmacology in the ‘scientific’ education of doctors. Clinical biochemistry began to play a major role in clinical medicine. As new techniques and new drugs became available, doctors were able to influence the natural history of major diseases to an unprecedented degree. There was also an increased understanding of mental illness. As Howell explained: “This area, which had little time devoted to it when I was a student, became a major speciality with increased understanding of the nature [of mental illnesses] and of the use of drugs and other approaches which could now do much more in their treatment. It became increasingly recognised that social, psychological and occupational factors were important in both causation and treatment of many illnesses; and that doctors had been inadequately prepared in these subjects.” As observation and research led to greater understanding of how the healthy body works and how it can be affected by disease, this new knowledge was added to the medical curriculum. Over time it became clear that the curriculum was overloaded and that radical revision would soon be imperative.

The Commission (widely known as the Todd Commission) was tasked with a fundamental review of the whole structure of medical education, its organisation, content and resource requirements. Its terms of reference included reviewing undergraduate and postgraduate medical education in Great Britain, advising on what principles future developments should be based, and considering what changes may be needed in the pattern, nature, number or location of the institutions providing medical education. Making the case for a new medical school The University of Southampton was quick to take up the opportunity offered by the Todd Commission. In July 1965 it convened the first (and as far as records show, only) meeting of the Medical School Committee to discuss its response. The committee was chaired by John Raymont, Professor of Oceanography. He explained that a letter had been received from Sir John Wolfenden, Chairman of the UGC, enquiring about the University’s plans for a medical school and that the Vice-Chancellor had said that he hoped to be in a position to reply by mid-August (1965). From the timing of the letter, it seems likely that the UGC was already aware of the University’s interest in gaining a new medical school. Membership of the Medical School Committee

−− −− −− It was in response to such concerns that the University Grants Committee (UGC), the body that advised government −− −− on the development and funding of the university sector, −− recommended the establishment of a Royal Commission on Medical Education. The government agreed and the −− Commission began its work in September 1965 under the −− chairmanship of esteemed organic chemist and Nobel Laureate Lord Todd.

The Royal Commission on Medical Education

Professor John Raymont, Oceanography Professor Leslie Brent, Zoology Professor Richard Cookson, Chemistry Professor Kenneth Munday, Physiology and Biochemistry Professor John Smith, Sociology Professor Gordon Trasler, Psychology Robert NM Robertson, Secretary and Registrar Derek Schofield, Academic Registrar

The Medical and Biological Sciences Building on the University’s Boldrewood Campus opened in 1973. Designed by renowned modernist architect Sir Basil Spence, it provided cutting-edge lecture and laboratory space for Southampton’s new medical school. However, by the 2000s its facilities had become out of date and high maintenance costs led to the decision to redevelop the campus. The Boldrewood building was demolished in 2011 and teaching now takes place at University Hospital Southampton and the University’s main campus.

The committee discussed what might be contained in this reply and identified a number of points: first, that the University was “most anxious to establish medical teaching; second, that the Wessex Regional Hospital Board is the only regional hospital board without a medical school and third, that the University already participates in postgraduate medical teaching to a considerable extent and that there would be a very good supply of clinical material for a medical school”.

pattern, based on a school of human biology providing for a BSc degree after three years, followed by further clinical study for a medical qualification. Actually most medical schools in the UK did not offer a BSc degree in the pre-clinical subjects as part of the standard course, Oxford, Cambridge and Edinburgh being among the exceptions. In most medical schools, a small number of students were able to take a one-year intercalated BSc degree, usually in physiology or biochemistry.

The committee went on to consider the building requirements of a new medical school, discussing in detail how students might be accommodated and possible timescales, depending on the levels of funding available.

Recognising that partnership between the University and the Regional Board was crucial for future discussions, the committee recommended the immediate establishment of a joint advisory committee, consisting of representatives from both institutions as well as a number of independent advisers. The joint advisory committee would report to both the University and to the Regional Board.

This outline of requirements was based on the assumption that pre-clinical instruction would be given at the University and clinical instruction within the hospitals. It also assumed that the course would be a modified form of the traditional

Joint Committee deliberations The first meeting of the Joint Committee for the Development of a Medical School took place on 14 December 1965. The University’s representatives included the recently appointed Vice-Chancellor, Professor Kenneth Mather, who, unlike his predecessor, supported the plans for a medical school. It was agreed that the terms of reference should be “to consider and report on matters connected with the proposed medical school including curricular facilities and organisation”. Membership of the Joint Committee University representatives: −− −− −− −− −− −−

Professor Kenneth Mather, Vice-Chancellor Professor Leslie Brent, Zoology Professor Richard Cookson, Chemistry Professor Kenneth Munday, Physiology and Biochemistry Professor John Smith, Sociology Professor Gordon Trasler, Psychology

Wessex Regional Hospital Board representatives: −− −− −− −− −− −−

Mr Christie-Miller, Chairman Dr Michael Darmady, Consultant Pathologist HH Langston, Board member Professor NH Martin, Board member Professor John Raymont, Board member Dr Patrick Shackleton, Regional Postgraduate Dean

Joint secretaries: −− Robert NM Robertson, University Secretary and Registrar −− Dr John Revans, Senior Administrative Medical Officer of the Wessex Regional Hospital Board

At the first Joint Committee meeting, Mather reported that he had submitted a statement on the proposal to establish a medical school at Southampton and had discussed it with the Chairman of the UGC, Sir John Wolfenden. Sir John had apparently been completely non-committal in his reaction but had asked to be kept informed of the work of the Joint Committee. He had also suggested that the Joint Committee might wish at some stage to discuss its proposals with the UGC’s Medical Sub-committee. It was accepted that in making the case for, and in the planning of, a medical school, the existence of good postgraduate medical facilities in the region’s hospitals and in the University should be stressed, particularly as an increasing number of general practitioners might be expected to seek a postgraduate qualification in the future. It was thought, however, that the main emphasis should be given to the undergraduate course and the need to produce doctors with a new approach to their calling – as the minutes put it, doctors “who will practise and serve medicine as scientists, whether as general practitioners, specialists or research workers in medicine or in ancillary fields”. The committee’s discussions give a flavour of the progressive ideas that were being considered in relation to the curriculum. It agreed that: “In the undergraduate course any rigid or formal division between pre-clinical and clinical teaching should be avoided, that students should be introduced into the hospital wards at a very early stage in the course, and that students in the last years of their undergraduate career should continue to return to the University for some laboratory work and other studies not specifically related to instruction which could be given only in a hospital.” This indicated a greater degree of integration of pre-clinical and clinical teaching than was proposed at the Medical School Committee meeting, perhaps because of the presence of clinical practitioners on the Joint Committee.

A proposal to build a new teaching hospital on Southampton Common having proved not to be feasible, the committee recognised that a degree of physical separation of preclinical and clinical facilities was inevitable. Pre-clinical work would, broadly speaking, be carried out in buildings to be erected on the Boldrewood site already owned by the University, while the major part of the clinical course would be taught at Southampton General Hospital (which was recently renamed University Hospital Southampton). A number of existing University departments would be involved in pre-clinical work, and would be re-housed on the Boldrewood site. In addition, new departments would have to be created. The existing plans for rebuilding the hospital would also have to be extensively revised to meet the needs of a teaching hospital. The committee accepted the practical implications of running the course on two different sites and discussed the need for two separate working parties at this stage, one to look at pre-clinical and the other at clinical aspects of the proposed school. The two working parties would have some members in common and report regularly to the Joint Committee to ensure an integrated approach to curriculum planning. Finally, it was reported that both the Wessex Regional Hospital Board and the University had been asked to submit evidence to the Todd Commission. Everyone agreed that the University’s evidence should complement that of the Regional Board and the two submissions should be prepared in conjunction. It would be important for the Regional Board to emphasise the high-quality postgraduate facilities for medical education that were already in existence and also the good liaison with the University. The University would draw attention to its investment in the biological sciences department, which could provide the basis of pre-clinical teaching.

Preparing Southampton’s submission The Joint Committee met frequently over the next few months with the aim of preparing a submission. It appointed two external advisers who subsequently worked closely with the committee; William (Bill) Cranston, Professor of Medicine at St Thomas’ Hospital, London, and Robert Milnes Walker, Professor of Surgery at the University of Bristol. Milnes Walker had recently completed a Rock Carling Fellowship of the Nuffield Provincial Hospitals Trust during which he had reviewed medical education in Britain. He also had experience of commissioning new academic buildings. To ensure that the submission would embrace current thinking, the Joint Committee invited two experts (in addition to the two external advisers) to contribute their views. These were Dr John Ellis, Dean of the London Hospital Medical School and a member of the Royal Commission, and Melville Arnott, Professor of Medicine at the University of Birmingham and a member of the UGC’s Medical Sub-committee. The Joint Committee submitted its document to the Todd Commission at the end of March 1966. In June the UGC Medical Sub-committee visited the Southampton hospitals, the Boldrewood site and the University, and met the Joint Committee members. At around the same time, the Commission issued an interim memorandum that would have favourable implications for Southampton’s bid for a medical school.

“At the time, I was a third-year PhD student in the Department of Physiology and Biochemistry. On the appointed day of the site visit, we all had to appear wearing a clean white lab coat and to be doing something ‘medically relevant’. Lord Todd peered at my angiotensin bioassay preparation and grunted before moving on. I have always believed the grunt was significant to the future of the school!” Dr Alan Noble Former Senior Lecturer in Physiology, describing a visit from the Todd Commission in 1967

The Commission’s interim memorandum While its original terms of reference didn’t specifically mention student numbers, it wasn’t long before the Todd Commission identified an impending medical staffing crisis. On 15 June 1966 it wrote an urgent interim memorandum to the Secretary of State for Education and Science. The memorandum suggested that, based on the current output, by 1975 there would be a shortfall of 11,000 practising doctors. It also stated that its initial enquiries “have led to a firm conviction that a substantial increase in output is required without delay; although long-term action must await full consideration of major policy issues, some interim action is possible and is urgently recommended”. The Commission made three recommendations: to expand existing medical schools; in the short term, to consider the use of additional institutions temporarily to augment the resources of medical education; and to define the most promising proposals for the establishment of new permanent medical schools. The government responded rapidly. Early in 1967, it decided to bring forward the redevelopment of the medical school and main teaching hospital at Leeds, and it was hoped that buildings for a new medical school already planned at Nottingham would start before the end of 1968. The government also asked the Commission to advise on the relative merits of its proposals for increasing medical school capacity. The Commission responded: “We recommended strongly that one of these, the establishment of a new medical school at Southampton, should be put in hand as quickly as possible.” It added that: “The case for establishing a new medical school in Southampton is thus so strong that we advise the government to authorise this development without waiting for our final recommendations.”

Outlining its reasons for selecting Southampton, the Commission also said: “Of those cities and towns without medical schools already, Southampton undoubtedly offers the most adequate facilities. The University has already a total of 4,000 students and has staff and departments, including a well-established Department of Physiology and Biochemistry, which can constitute a strong nucleus for a medical school. There are strong links between the University and the Wessex Regional Hospital Board, which serves a growing population already amounting to two million (half of whom are concentrated in Southampton, Portsmouth and Bournemouth and the surrounding areas). The Board is rebuilding the main Southampton hospitals on lines which are readily adaptable to meet the needs of undergraduate clinical teaching.” The government accepted the Commission’s recommendation and in November 1967 it announced that a new medical school had been awarded to Southampton, with an anticipated annual intake of 200 students. There can be no doubt of the influence of the Joint Committee’s submission on the Todd Commission’s recommendations. The drive and determination of Dr John Revans, the Wessex Board’s Senior Administrative Medical Officer, and the wholehearted support of the ViceChancellor, also contributed to the University’s success. While applications for new medical schools had been received from many universities, including Bath, Brighton, Durham, Exeter, Lancaster and Swansea, only Southampton, Nottingham and Leicester were successful. The University now had the opportunity to create a new curriculum designed to educate and train young doctors to meet the needs of medicine for the rest of the century and beyond.

SETTING UP THE NEW SCHOOL While the award of a new medical school was something to celebrate, there was much to be done before the first cohort of students could begin their training. The University quickly set up an Interim Board of Medicine to plan and direct the burgeoning affairs of the fledgling faculty.

“Thanks to the recruitment of an inspired team of colleagues, and improvisation on a grand scale, we were not only able to reach our target class size of 130 students by 1976, but also to achieve a formidable series of educational innovations.”

The Interim Board’s first meeting took place on 22 November 1967 and was chaired by the Vice-Chancellor, Professor Kenneth Mather. The University members included Professors Munday, Brent and Raymont, and Dr Patrick Shackleton, who had been closely involved in preparing the case for the school. The Interim Board agreed that it would meet monthly to “deal with courses, curricula, appointments and other matters which would normally be the concern of a Faculty Board”.

Sir Donald Acheson Foundation Dean

−− −− −− −− −− −− −− −−

Membership of the Interim Board of Medicine Professor Kenneth Mather, Vice-Chancellor Professor Leslie Brent, Zoology Professor Richard Cookson, Chemistry Professor Gerald Kerkut, Neurophysiology Professor Kenneth Munday, Physiology and Biochemistry Professor John Smith, Sociology Professor Gordon Trasler, Psychology Professors Bill Cranston and Robert Milnes Walker, external clinical advisers −− Dr Michael Darmady, regional adviser on pathology services to the Wessex Regional Hospital Board (WRHB) −− Dr Patrick Shackleton, Regional Postgraduate Dean −− Dr George Swift, Chairman of the Council of General Practitioners and part-time adviser to the WRHB −− Dr John Revans, Senior Administrative Medical Officer, WRHB The dean and future professors of pre-clinical and clinical sciences would join as they were appointed. In the months preceding the appointment of a new dean, the Interim Board considered a number of issues. The day before its first meeting there had been a visit by representatives of the Medical Sub-committee of the UGC, led by Professor R B Hunter, Vice-Chancellor of the University of Birmingham. The subjects raised at this meeting illustrate the range of topics requiring discussion and decision. The UGC visitors

were aware that a draft curriculum had been prepared by the Joint Committee working party and discussed the provision of accommodation in the proposed new pre-clinical medical sciences building already planned for the Boldrewood site. It was clear that to accommodate the needs of the medical school, the original plans to teach science students in this building would have to take lower priority. The visitors were also concerned that the proposals for the fourth-year research project (see page 30) would require extra accommodation that might not be available, but the University was confident that many students would choose a clinical topic for study at Southampton General Hospital. Munday also assured the visitors that he had discussed the proposal of this novel year with Lord Cohen, President of the General Medical Council (GMC), whose personal reaction had been favourable. However, the Medical Sub-committee visitors made it clear that they were more concerned with the needs of the curriculum for buildings and other facilities than with its precise content. Members of the UGC sub-committee also visited the Southampton General Hospital site and were joined by representatives of the Wessex Regional Board and the Ministry of Health. The Wessex Board outlined the proposals for rebuilding the hospital as a teaching hospital, in which all the major clinical teaching facilities would be located. There would be minor facilities, such as a few seminar rooms and cloakrooms, at the nearby Royal South Hants Hospital. Of the £20m needed for the rebuilding of these hospitals, some £3m would be directly attributable to the medical school. The two representatives of the Ministry of Health disappointed their colleagues when they appeared to be reluctant to commit themselves to specific points and left the general impression that they had “completely failed to appreciate the need for urgency in dealing with the planning development of the teaching hospitals”. Administrative arrangements for the management of the University hospital were mentioned but were largely left for discussion at a future meeting.

In the months that followed, the Interim Board considered a range of issues including academic accommodation at Southampton General Hospital and the Royal South Hants Hospital; transfer of the contract of the Regional Postgraduate Dean, which had previously been held by the University of London, to the University of Southampton; the implications of an eventual intake of 200 students per annum; academic staff requirements for 1968/69; library arrangements for the medical school given the physical separation of the pre-clinical and clinical sciences; the effect of a University department of general practice on other general practices in the area; the organisation of community medicine; and the draft undergraduate curriculum. The content of these meetings also shed light on the complexity of the planning necessary to agree and provide the resources for the medical school, which required cooperation between the University, the Wessex Regional Board, the local medical community, the UGC and the GMC. Arrangements for joint working between the University and the NHS Another area for discussion was the structure within which University and NHS staff would work together. The Interim Board was concerned that relationships between the incoming academic clinicians and their NHS colleagues in the Southampton Health District might be affected by the newly introduced ‘cogwheel’ management structure for clinical services in NHS hospitals (the name of which was derived from the illustration on the cover of the introductory booklet, which showed interconnecting cogwheels to represent integrated management). Under the cogwheel structure, a new committee, the Medical Executive Committee (MEC), would be a key committee of consultants and GPs that would advise the District Management Team (DMT). Clinical services were grouped into divisions, for example of medicine, surgery, radiology, psychiatry, pathology, etc, each with a divisional chairman elected by the members of the division. Each division was accountable

through its chairman to the MEC, which was made up largely of the chairmen of individual divisions, with chief officers of the Southampton Health District in attendance. The chairman of the MEC was ex-officio a member of the DMT. Paradoxically, despite its name, the MEC had no direct executive authority but was advisory to the DMT. Nevertheless, the MEC and its chairman were de facto very influential. No doubt for this reason, Dr John Revans recommended that the chairman of the MEC be an ex-officio member of the Interim Board but the University’s Standing Committee of Senate disagreed; it considered it an unwise policy to appoint non-University members ex-officio to a University committee. The Interim Board agreed to postpone the matter until the autumn term because the appointment of the Dean was imminent. This issue, if badly handled, had the potential for souring relationships with the NHS. In the event, the University was reassured and later, with the support of the Dean, the chairman of the Southampton MEC was invited to become an ex-officio member. The Interim Board was also concerned that the cogwheel arrangements might make the position of clinical professors difficult unless academics were well represented on the MEC. They learned that the cogwheel structure had been introduced apparently without problems at the Manchester Royal Infirmary. A visit to Manchester was arranged, during which the Southampton team learned that no problems had arisen; the system was working well and a number of NHS divisions were actually chaired by clinical professors. However, circumstances in Southampton were different to those at the Manchester Royal Infirmary, which had had its own board of governors since 1948, under which NHS and academic staff had worked together for 20 years before the introduction of the cogwheel system. It remained to be seen how it would work at Southampton, where the future teaching hospital would not have direct control over its

resources, and would be one of many hospitals accountable to the Wessex Board. In the event it worked well and was an effective committee. The first chairman of the MEC was the senior surgeon at Southampton General Hospital, Mr Tom Rowntree, who, while primarily and properly mindful of the interests of the clinical services and NHS staff, gave invaluable support to the new Dean and the medical school during the critically important first years. As plans evolved, the Vice-Chancellor became aware that relationships with local consultants were not as good as he had hoped, largely it seemed because of poor communication. To remedy this he organised small, informal dinner parties to keep them informed and involved, which did much to improve confidence in their relationships. Appointing the Foundation Dean Among the many issues that required the Interim Board’s consideration, none had greater priority than the appointment of a dean to lead the planning of the new school. An advertisement was approved in March and Professor (later Sir) E Donald Acheson was appointed in September 1968. Donald Acheson was a particularly appropriate choice. He was 42 years old and a distinguished physician, holding the post of May Reader in Medicine at Oxford. He had graduated from the University of Oxford and the Middlesex Hospital Medical School, London. There, like Dr John Revans some 15 years earlier, he had won the School’s premier clinical prize, the First Broderip Scholarship. As a postgraduate at Oxford, and during a period in the United States, he developed a special interest in the emerging discipline of clinical epidemiology, to which he made many important contributions.

The new Dean was critical of current medical curricula because of their lack of emphasis on the role of social, psychological and environmental factors in the community in the cause and perpetuation of ill health. He also wished to develop the potential contributions of general medical practice and general practitioners, which had largely been neglected in undergraduate teaching. Most importantly for someone in this challenging new role, he had the essential personal ingredients of self-conviction and leadership, qualities that, together with tact and good judgement, were critical for success. Acheson had already shown that he was not afraid to confront authority. While at Oxford in the early 1960s he was tutor to a young South African doctor preparing for the examination for Membership of the Royal College of Physicians (MRCP). At this time, the success rate for this crucially important examination was very low. During the examination, candidates were eliminated progressively up to a final viva voce and the overall final pass rate was around 10 per cent. When the outstanding young South African doctor failed the MRCP examination, Acheson was incensed and wrote a letter to The Lancet protesting at the situation. The President of the Royal College of Physicians, Sir Robert Platt, chose to reply personally in defence of the College and an acrimonious correspondence in The Lancet followed. Acheson’s public criticism of the College was not without risk because election to the Fellowship was in the gift of the College. This danger was recognised by the Vice-Chancellor of the University of Newcastle, the distinguished neurologist and ‘wag’ Sir Henry Miller, who sent a brief note to Acheson with congratulations ‘on your life Membership’. The young doctor who had sparked the debate was Ralph Wright, who later became Southampton’s second Professor of Medicine.

Sir Donald Acheson (1926–2010) Foundation Dean of the Faculty of Medicine, 1968–1978 Donald Acheson trained and practised at Middlesex Hospital and later worked at the University of Oxford where he was Director of the Oxford Record Linkage Study and May Reader in Medicine. In 1968 he became the first Dean of the new medical school at Southampton, where his progressive ideas earned him the nickname ‘the Red Dean’. Following a sabbatical at McMaster University in Canada, in 1979 he set up a new Medical Research Council Environmental Epidemiology Unit at Southampton, and in the early 1980s he became Chairman of Southampton and South-West Hampshire Health Authority. He left the University in 1983 to become the government’s Chief Medical Officer. He is widely recognised as the key policymaker of the UK’s successful AIDS prevention strategy. Later he completed projects for the World Health Organization in war-torn Bosnia and chaired an influential independent inquiry on health inequalities, which reported in 1998.

The Dean’s vision for the new school Acheson had the daunting task of establishing a school that was expected to make a radical change in the way doctors were prepared for a lifetime’s career in the NHS. No new medical school had been created in the 20th century and there was no one to turn to for advice. However, there was considerable interest locally and nationally in Acheson’s plans. Early on, he was invited to present his vision of the new school to the medical staff of the Royal Postgraduate Medical School at Hammersmith Hospital, London, the premier postgraduate and clinical research hospital in the UK. Jack Howell recounted: “At a crowded meeting [Acheson] outlined how the school would be based predominantly on the healthcare resources of the whole Wessex region rather than simply on a teaching hospital at Southampton. There would be an appropriate emphasis on medicine in the community in addition to that seen in the hospital. He stressed a more important teaching role for general practitioners, not only to provide more balanced experience of illness, but also to encourage more graduates to enter general practice for which there was much need. No doubt he thought a requirement for high-quality research went without saying and did not need to be stressed. However, a senior member of the Hammersmith staff later told me that the talk was greeted with dismay. They had hoped he would seize the opportunity to create a high-powered research institution, a sort of Mayo Clinic on the south coast. Instead he appeared to be promoting a medical school devoted to producing general practitioners! They had missed the point completely.” Getting on with business Acheson took up his post almost immediately after appointment and was welcomed to the Interim Board at its meeting on 15 October 1968; he assumed the chair thereafter.

The business it covered over the next year was wide ranging and reflected the enormity of the task faced by the new team, including discussion of important topics such as the Wessex Medical Library; entry requirements for the undergraduate course; the position of mature age students; salary scales and tenure of academic staff; NHS arrangements for the first three clinical professors, who would hold honorary consultant contracts with the Wessex Regional Hospital Board; the administrative structure of the new faculty; the progress of the plans for new buildings; and the arrangements for joint appointments between the Wessex Regional Board and the University. Building the founding team While the early medical school team included a number of existing staff, finding the right people for the foundation chair posts was crucial. Acheson urgently needed the support of clinical academic colleagues, not only to help develop the new curriculum but to forge relationships with the NHS throughout the region and to establish their own clinical services at Southampton. An earmarked UGC grant facilitated the appointment of new staff, allowing decisions on new posts to be made and implemented rapidly without having to compete for funding with other faculties. It was from this nucleus of staff that the new faculty developed. Existing University staff Many of the non-medical staff who would contribute to undergraduate teaching were already in post in Physiology and Biochemistry and in Zoology (Faculty of Science), and in Sociology and Psychology (Faculty of Social Sciences). Both faculties had already played a major role on the Joint Committee via Professors Richard Cookson, John Raymont, Leslie Brent, Kenneth Munday, John Smith and Gordon Trasler.

Biology Leslie Brent, Professor of Zoology and a distinguished immunologist, moved to the Chair of Immunology at St Mary’s Hospital Medical School, London a few months after the announcement of the new medical school at Southampton. He was succeeded by Professor Bernard John, who played an important role in the preparation of the new curriculum and in its early teaching. Unfortunately for Southampton, in 1972 John accepted an invitation to the prestigious Chair of Biological Diversity at the National University of Australia at Canberra; subsequently it was Professor Crowdy (Biology) who became most involved in the new school. Physiology and biochemistry The so-called pre-clinical disciplines of physiology, pharmacology and biochemistry were strongly represented by Professors Kenneth Munday and Gerald Kerkut and the staff of the Department of Physiology and Biochemistry, which was already a large department with about 150 undergraduate and 50 postgraduate students. A considerable increase in academic staff would be required to meet its significant additional role in teaching medical students. This raised organisational and administrative challenges for the University because it was clearly desirable for the expanded department to remain a single group, even though its responsibilities would now be shared between science and medicine. The resolution of these issues became clearer when the broad structure of the curriculum had been decided. At this early stage, only one new chair was planned – a Chair of Pharmacology within the Department of Physiology and Biochemistry. Social sciences – sociology and psychology Rather than try to establish new, necessarily small sociology and psychology groups within the new medical school, it was agreed to make appointments to the existing departments in

the Faculty of Social Sciences, in return for the departments’ involvement in the teaching of medical students. Two appointments were made – Mrs Ida Topliss, Lecturer in Social Science and Dr Donald Marcer, Lecturer in Psychology. Appointment of new staff Assistant Dean After the new Dean was appointed, the next role to be filled was Assistant Dean. The successful candidate was Dr Stuart Roath, formerly consultant haematologist at the University of Leeds. He had long been interested in medical education, but like his new colleagues he had no experience of developing a medical school. In this role he would require drive and organisational skills, at least sufficient to keep pace with the dynamism of Acheson. This was an almost impossible hope, and although they worked reasonably harmoniously, their relationship in administrative matters appeared never really to ‘gel’. Roath continued to contribute to the teaching strategies of the school but spent most of his time as a clinical academic haematologist. Foundation Chair of Human Morphology The appointment of a senior academic to plan the teaching of topographical anatomy and histology in the new curriculum was urgently needed. Dr David Bulmer, Reader in Anatomy at the University of Manchester, was appointed in June 1969. He was unable to take up his post until January 1970, but contributed to curriculum planning meetings in the interim. Foundation Chairs of Clinical Science The first clinical chairs were advertised in April 1969 as Foundation Chairs of Clinical Science in Medicine, Surgery and Human Reproduction. In June 1969, Sir James Fraser, Professor David Millar and Professor John (Jack) Howell were appointed to the Chairs of Clinical Science in Surgery, Human Reproduction, and Medicine respectively. They took up their posts the following October.

These posts were called chairs of clinical science on the advice of one of the external advisers, Professor Robert Milnes Walker. Having studied medical education in depth, he promoted the view that clinical medical students should be taught in systems-based, multidisciplinary clinical units in which physicians and surgeons would work together in caring for patients. He envisaged professors of both medicine and surgery being attached to these units, and proposed that their title should be professor of clinical science. Unfortunately, these titles gave the impression that the new Southampton professors were scientists rather than clinicians, which did not help in establishing their credibility as clinical professors. Rather than formally negotiating a change of title, the new professors merely adopted conventional titles without confronting the issue.

Once in place, the founding team could begin tackling the colossal challenge of developing a new medical school. Everyone was conscious that the first students would arrive in October 1971. Time was short and there was much to be done. The Boldrewood building was behind schedule. A new curriculum had to be devised. A faculty structure had to be agreed and organised, to be housed in buildings that were yet to be designed and built. Academic and clinical services by academic staff had to be developed. Firm practical relationships between the University and the NHS needed to be forged both locally and throughout the Wessex region. Selection procedures for students needed to be agreed.

Acheson wrote of the new staff team: “We asked a great deal of these young men and women... Not only had they to establish their personal clinical skills at at least the standard of the local specialists… but they had to undertake research, Millar was a superb practising obstetrician and be inspiring teachers, help in the creation of a radical new gynaecologist. He was also a competent computer programmer, and his contributions at Southampton included approach to medical education, be diplomatic, and above all – to sustain year on year the creative energy to innovate.” laying the foundations for a sound policy for the development of medical computing in the Wessex region. Tragically, however, he died in 1971. A memorial prize was Designing the curriculum founded and a bust of Millar by Cecile Epstein was placed One of the greatest achievements of the founding team was outside the lecture theatre in the South Academic Block at the development of a new approach to medical training. Southampton General Hospital. A new Chair of Human Unlike their counterparts in established schools, they had a Reproduction, Professor John Dennis, was appointed in 1972. golden opportunity to start from scratch, unencumbered by the need to change entrenched and defensive attitudes or Senior Assistant Academic Registrar overcome the logistical difficulties of simultaneously running A key appointment in June 1969 was that of Miss Sheila an old and new course. Broadhurst (later to become Mrs Sheila Mooney) as Senior Assistant Academic Registrar. She was an Oxford graduate Radical at the time, their approach has become best with a degree in English who had been Assistant Academic practice and has been widely adopted elsewhere. Today’s Registrar at the University of Bristol. She was responsible for Southampton medical training still has the principles the administration of the medical school, accountable to agreed by the founding academics at its core. the Academic Registrar, Mr Derek Schofield. She was also responsible for continuing the impeccable recording of the The need for innovation minutes of the Faculty Board and main committees of The determination of the Southampton academics to find a the school, formerly the task of the Academic Registrar. new approach was driven by a profound dissatisfaction with

aspects of their own medical training; the shortcomings of the traditional curriculum were widely recognised. While the context in which healthcare was delivered had changed rapidly in the first half of the 20th century, there was little change in the education of doctors. New ‘facts’ were added to the curriculum at an ever-increasing rate, but its structure remained largely the same. It was becoming increasingly clear that it was no longer satisfactory simply to keep adding new knowledge as it became available. Until the 1960s, UK medical curricula were heavily influenced by the requirements of the professional examinations for entry into medicine. The overall structure of the traditional curriculum had been influenced by the 1906 Flexner report, which recommended that the teaching of the pre-clinical sciences such as anatomy, physiology and pharmacology be separated from the clinical teaching of medicine, surgery, obstetrics and gynaecology and so on. Thereafter medical students were taught in two separate phases: an initial pre-clinical phase lasting around two years, followed by a clinical phase of three years with a large apprenticeship component. The idea was to educate students in the biological sciences first, to provide them with a scientific base from which to learn about diseases and the skills of clinical practice. However, for many students keen to become doctors, this was demotivating as it meant they had no contact with patients during this time. The GMC had long criticised medical curricula for their excessive factual content; in its recommendations on medical education published in 1957 and 1967 it took the view that the memorising and reproduction of factual data should not be allowed to interfere with the primary need for fostering the critical study of principles and the development of independent thought.

Similarly, the Todd Commission had recognised the need for a greater focus on the development of trainee doctors’ critical faculties. As stated in its final report, published in 1968, it “could not emphasise too strongly that the undergraduate course in medicine should be primarily educational. Its object is to produce not a fully qualified doctor, but an educated man who will become fully qualified by postgraduate training”. It went on to state that the aim of a medical education should be to produce a graduate “with two essential qualifications. He should have, first, a knowledge of the medical and behavioural sciences sufficient for him to understand the scientific basis of his profession and permit him to go forward with medicine as it develops further; and, secondly, a general introduction to clinical method and patient care in the main branches of medicine and surgery, together with an introduction to social and preventive medicine. We hope that he will be taught throughout in such a way as to inculcate in him a desire to continue learning not only during the postgraduate training which we hope he will undertake ... but throughout his professional life”. (The use of the masculine pronoun is an interesting reflection of the times – the medical profession was still very much a male-dominated world in the late 1960s.) This mention of behavioural sciences reflects the importance the Commission placed on this strand of medicine. Its final report also recognised a lack of teaching in subjects such as ‘community medicine’, at the time a relatively new term that encompassed public health, preventive medicine, social medicine, and environmental medicine. However, the desire to include new subject areas raised a challenge: how could space for these subjects be found in an already overloaded curriculum? In its 1967 report Recommendations as to Basic Medical Education, the GMC

acknowledged explicitly for the first time that it was not possible for an undergraduate course alone to produce a safe and competent general practitioner – a point originally made by the Goodenough Committee back in 1944. It was widely accepted that further professional training was required by all doctors, be they specialists practising in hospital or general practitioners working in the community. Given appropriate legislation, this would permit some clinical subjects currently in the undergraduate curriculum to be postponed until the postgraduate phase of training. The way students were taught, as well as what they were taught, was also up for review. The Todd Commission report criticised teaching methods because they did not enthuse students to learn, although it did not prescribe solutions.

Professor Jack Howell, Medicine Professor Bernard John, Zoology Professor Gerald Kerkut, Neurophysiology Professor John Martin, Sociology Professor David Millar, Human Reproduction Professor Robert Milnes Walker, external clinical adviser Professor Kenneth Munday, Physiology and Biochemistry Professor John Smith, Zoology Professor Gordon Trasler, Psychology Professor Geoffrey Taylor, Nutrition Dr Patrick Shackleton, Regional Postgraduate Dean Dr George Swift, Chairman of the Council of General Practitioners and part-time adviser to the WRHB

There were some attempts to change the status quo and in the 1960s many medical schools set up curriculum review committees, but the University of Newcastle’s medical school was probably the only one to make headway. Under the leadership of Professor George Smart it achieved substantial improvements, but these were mostly brought about by changes in the way subjects were taught rather than in the design of the course itself.

Its members were conscious that they had just under two years in which to prepare for the first student intake. They were also well aware that the results of their deliberations would eventually have to pass the scrutiny of the GMC before the curriculum could be confirmed. However, they did have the benefit of the groundwork laid by the Joint Committee’s curriculum working party, which had prepared a draft curriculum for the University’s submission to the Todd Commission four years earlier.

The Curriculum Sub-committee

This far-sighted early draft anticipated several features identified in the Commission’s final report. It stressed the intention to blur the boundaries between pre-clinical and clinical teaching; to place more emphasis on teaching in community medicine, including general practice; and to give greater weight to the behavioural sciences of sociology and psychology. Its two most original proposals were that selected hospitals in the Wessex region should be used for clinical teaching in the final year, and that one academic year, probably the fourth, should be devoted to an honoursstandard course “based upon the concept of scientific study in depth”.

The challenge of designing the new curriculum was taken up by a sub-committee, established by the Interim Board, which met for the first time on 30 October 1969. Membership of the Curriculum Sub-committee −− −− −− −− −−

Professor Donald Acheson, Dean Professor Kenneth Mather, Vice-Chancellor Dr Stuart Roath, Assistant Dean Professor David Bulmer, Human Morphology Dr Michael Darmady, regional adviser on pathology services to the Wessex Regional Hospital Board (WRHB) −− Professor Sir James Fraser, Surgery

−− −− −− −− −− −− −− −− −− −− −− −−

The Curriculum Sub-committee members supported the general approach of this early draft and began the work of fleshing it out. Because its content could be divided broadly into two types – biological and behavioural – two working parties were set up: the Biological Sciences Working Party (under the chairmanship of James Fraser) and the Behavioural Sciences Working Party (under the chairmanship of David Millar). The underlying strategy and content of the new curriculum rapidly emerged; the next step was to translate these into a more detailed programme of teaching and learning. To this end, the Dean arranged for the Curriculum Sub-committee to spend a weekend retreat at a hotel in Bournemouth, where the group would be incarcerated until the task was done. “This certainly focused our minds,” wrote Jack Howell. “We arrived at the hotel in Bournemouth late one Friday afternoon and held our first session before dinner. Donald Acheson presented for discussion a draft timetable for the whole five years of the course that he had prepared over the previous several days, taking into account what had already been discussed at Curriculum Sub-committee meetings.”

“The creation of a new curriculum designed to meet the needs of medical practice for the rest of the century and beyond was perhaps our greatest challenge and our greatest opportunity... It was clear that tinkering with existing timetables would not make sufficient change: something more fundamental was needed.” Professor Jack Howell

When it came to pinning down the detail, Howell explained: “We began to work our way through the draft, starting with his proposals for the final year. This might seem an odd way to begin, but it is essential to know from the outset what you wish the finished product to be. What will the knowledge and skills of the new graduate need to be in order to benefit from the postgraduate opportunities that he/she will encounter? If we were clear about this, the way in which each of the preceding years would contribute would also be clear. “The speed with which the Dean’s draft timetable was agreed was breathtaking, so much so that we completed our task that first evening. Sheila Broadhurst negotiated our early departure with the hotel manager. We had dinner and went home to some very surprised spouses!

“This session was a key event because we could now get on with the essential details of the structure, content and timetabling of individual courses, and the identification of course coordinators and the members of the course teams.” A pioneering new curriculum The result of these deliberations was a truly innovative curriculum that successfully overcame some of the flaws of traditional medical training. As Acheson put it, the underlying philosophy was to welcome new students as partners in their own education, to foster their enthusiasm, to help equip them for a lifetime’s learning and development and “above all, to avoid stuffing them with facts”. Early contact with patients

with the GP back at the medical centre. The visits were organised by the Department of Primary Care based at the academic health centre at Aldermoor in Southampton. The establishment of this centre was a key achievement of Professor John Forbes, the school’s first Professor of Primary Medical Care, and the course received much support from local GPs largely thanks to Forbes’ energy and drive. In the second type of early medical contact, students would be introduced to a healthy woman in early pregnancy during antenatal visits. Where possible, students would follow the progress of a pregnancy and, by visiting the home, see the effect of the arrival of a new baby on the mother and her family.

Professor Michael Arthur embarked on his medical training at Southampton in 1972 (and later in his career became the school’s Professor of Medicine and Dean). He talks about his own experience of this element of the curriculum. “Traditionally you wouldn’t be let loose on patients until you’d done at least three years of scientific training and you The Southampton pioneers were determined to capitalise on understood everything in detail. I’ve always been much more students’ enthusiasm and promote their understanding and of a problem-based learner; seeing patients from the start of confidence by introducing patient contact from year one. the course not only reminded you why you were studying This idea was supported in particular by David Millar, who medicine, but allowed you to see the clinical relevance of had seen early clinical contact in action during a visiting what you were learning immediately. It also helped to build fellowship at the Case Western Reserve Medical School, confidence in talking to patients.” Detroit, in the early 1960s. Systems courses The Early Medical Contact course consisted of two parts In existing curricula the pre-clinical subjects, including and aimed to show students the effect of health problems physiology, pharmacology and biochemistry, were taught, on people’s lives but also the influence of sociological and largely didactically, as separate subjects by members of the environmental factors on individuals, their families and relevant departments. However, often the teaching of these the community. subjects was not synchronised. For example, the functioning of the cardiovascular system might be taught by Supervised by a GP, students would visit a patient with a chronic disabling illness at home. This helped them to see the physiologists early in the first year, but students might not effect of illness on individuals and families, and to appreciate learn about the action of cardiovascular drugs until they took a pharmacology course later in the second year. Relevant the part played by a doctor and other support services in alleviating their problems. Each session ended with a debrief biochemistry was also taught in a separate course with little One criticism of the traditional medical curriculum was that the course structure tended to demotivate students; they wanted to become doctors but were denied the opportunity to see patients for the first two or three years of their studies.

or no reference to the other courses. It was left to the student to integrate the content of each course into a comprehensive model of the system and the whole body. The new Southampton degree aimed to remove this fragmentation by adopting a systems-based approach, which integrated the teaching of the physiology, pharmacology, biochemistry, special pathology and mechanisms of disease relevant to each of the major systems of the body. A series of courses was designed for each of the major systems – human reproduction, cardiovascular, respiratory, gastrointestinal, renal, endocrine, nervous and musculoskeletal – in which the normal and the abnormal would be considered together, illustrated by the demonstration of clinical examples. Howell, a strong supporter of this approach, wrote: “I was influenced by having been Lecturer in Physiological Medicine at the Middlesex Hospital Medical School in Professor Samson Wright’s Department of Physiology between 1954 and 1957, where one of my responsibilities was to present ‘clinical demonstrations’ as part of the physiology course. I saw at first hand what an effective, stimulating and feasible approach it was to combine the presentation of basic physiological sciences with clinical medicine, especially when illustrated by the demonstration of an actual patient.” Writing in the British Medical Journal, Howell also noted: “Introducing students to the mechanisms of disease and including clinical teachers from the outset also eases the transition from pre-clinical studies to clinical medicine which can seem very abrupt for some students.” The McMaster approach The Southampton academics had also been influenced by a visit to McMaster University Medical School in Ontario, Canada. There a radical approach had been introduced, primarily to avoid didactic teaching and to increase the involvement of students and engage their interest. Within this approach, called problem-based learning, the underlying basic science and clinical aspects of illnesses were studied in

the context of clinical case histories, but without any systematic didactic teaching. The approach was also being considered at new medical schools in Maastricht, Holland and Newcastle, Australia. At McMaster, problem-based learning replaced lectures in physiology, pathology and pharmacology. Instead, under the guidance of a tutor, six or seven students discussed a prepared case history and identified areas to be studied in more depth through their own research. In this way, students learned in the context of trying to understand the clinical problem, and hopefully, progressively built working models of increasing complexity. In the early stages, a coherent model of the illness might be difficult to construct because of limited knowledge and lack of the ‘big picture’, but as more case histories were analysed and researched, information should become ‘joined up’ and an overall picture of the whole body emerge. Given adequate resources, skilled, well-motivated, relatively mature students, plus well-selected, well-presented problems, this should be a robust approach. By its nature, the problem-solving approach reversed the learning sequence and used lack of knowledge as the stimulus to learn. Further, by being linked to particular clinical situations, information should be more firmly embedded in the memory. Students should also have the presumed motivational advantage of being educated from the outset in medicine rather than first in the individual biological sciences and only later in clinical aspects. While the circumstances at Southampton and McMaster were different in terms of the resources available and the student body (the McMaster students were graduates or mature students), the visitors could see the considerable merits of the approach. Planning the new systems courses Working parties were set up to design each of the systems courses, and physiology lecturer Dr Alan Noble found himself

heavily involved in the process. “On each working party there were three or four senior clinicians, an anatomist and a couple of physiologists. Unfortunately the Professor of Physiology became ill and was absent for a year so there were very few of us physiologists on the ground,” Noble says. “My colleague Dr Brian Chapman and I covered eight courses – mine were the cardiovascular, respiratory, renal, endocrine and reproductive systems, some of which I had only a basic understanding of. I spent an awful lot of evenings and weekends trying to learn enough to get through the next working party meeting. I was still 25 at this time and had only recently finished my PhD, so it was a big learning curve. But we got it all done and the systems courses have worked extremely well.” Introductory courses One concern about the systems approach was whether students would have sufficient background knowledge of the underlying sciences to tackle them successfully. For example, could students be expected to understand the mechanism and effects of a heart attack following coronary artery thrombosis without first having knowledge of the process of atherosclerosis? Many academics were convinced that it was necessary to provide introductory courses in the different basic sciences in advance of the systems courses to help students to understand them adequately. The curriculum committee therefore agreed to include an introductory course in physiology and courses in general pathology, anatomy and biochemistry in the first year, which students would take before embarking on the systems courses. The fourth-year study in depth One of the most strikingly progressive ideas in the new curriculum was the fourth-year research project or ‘study in depth’.

In many medical schools, the opportunity already existed for a limited number of the more academically successful students to spend an additional (intercalated) year studying a relevant science, such as physiology, biochemistry or genetics, leading to an honours degree. By contrast, Southampton required every student to undertake this type of study as part of the standard course. Each fourth-year student would conduct a research project on a topic of their choosing, with supervision from an academic. This would be written up and presented to the year group at a special conference at the end of the year. As the 1972 course brochure describes: “…it will be possible to combine clinical and non-clinical aspects of the topics chosen and to follow up in the laboratory or the community or by epidemiological research the problems encountered in clinical work… it is intended that students will be given the widest possible choice of areas in which to work including the various clinical fields, anatomy, biochemistry, physiology, pathology, and all the various social sciences, or, more commonly, a combination of these.” The idea had been debated by the Curriculum Subcommittee, which recognised that the breadth of the conventional medical curriculum left little time to deal with any matters in depth. Was in-depth study an essential part of undergraduate education when there would be ample time later in a doctor’s career for more in-depth study? Some clinicians considered it more important to cover as wide a range of clinical experience as possible in the undergraduate period to avoid some disciplines being disadvantaged later on. For example, those in the so-called ‘specials’, such as ear, nose and throat, ophthalmology, orthopaedics and sexually transmitted diseases, were likely to be allotted only limited time to introduce their subjects and, understandably, were pressing for more.

The fourth-year study in depth encouraged students to develop the analytical and critical skills they would need throughout their medical careers.

But there was general agreement among committee members with the Todd Commission’s view that the aim of the undergraduate course was not to produce a ‘finished’ doctor but a broadly educated graduate who could become a doctor by further training. It was generally felt that a period of ‘study in depth’ was a good way – and perhaps the only practical way – to meet this aim.

The study in depth provided practical experience of research methods and the handling of data. As well as sharpening students’ critical faculties, it later became apparent that the project was also important in developing the independence that students would need to succeed in their final year, when they would be working on their own as apprentices in clinical units throughout the Wessex region.

As well as emphasising that all medical knowledge is science-based, the study in depth was intended to counter the necessarily broad and somewhat shallow content of the rest of the curriculum. As Acheson wrote in his autobiography: “…students should not only discover that most medical knowledge is based on science but far more important that it is often uncertain and indeed hypothetical and in clinical practice at all times requires critical evaluation. We felt that the sheer volume of the facts which medical students have to absorb leads to these often being presented as oversimplified half-truths. In other words, the uncertainty surrounding much accepted knowledge remains concealed.”

Michael Arthur talks about how conducting an independent study enriched his medical training and influenced his career. “I was interested in the complications of diabetes and why they occurred, so I explored the metabolic abnormalities of people with different stages of diabetic complications. This involved doing full 12-hour profiles on those patients, taking their bloods, looking at their metabolic rhythms against their food intake and so on, as well as running all of the laboratory experiments and putting the data together. I came up with a small but significant finding that led to much more careful prescribing of a diabetes drug called metformin for patients with diabetes and renal disease.

“I remember that wonderful feeling of knowing something that was new and unique; it was encouraging and quite addictive. Also, doing the research itself really brought you into the department and I was inspired by the people there. I came away thinking that I’d like to be involved in creating that wonderful life experience for other people.” The organisation of the fourth year As well as spending 22 weeks on the study in depth, fourthyear students would spend time on attachments to the ‘specials’, including ear, nose and throat, ophthalmology and orthopaedics. These clinical specialities were timetabled for one half-day each week, during which students would receive a mixture of didactic introductory teaching and clinical experience through attendance at outpatient clinics. Clinical training In traditional curricula, subjects such as child health and psychiatry were taught as short part-time attachments during the second or final clinical year of training. To reflect the importance they attached to these subjects, the Southampton curriculum planners scheduled these as full-time attachments during the first clinical year – in this case the third year of the course. Because students had received an introduction to the clinical skills of history taking and physical examination in the second year, these attachments could occur at any time during the third year; they did not have to be preceded by attachments in medicine and surgery, where these skills were traditionally developed. Third-year clinical attachments were therefore planned in general medicine and general surgery of 10 weeks each, with five weeks each of child health, psychiatry, human reproduction, and a mixed attachment in geriatrics and medicine. Fifth-year clinical ‘apprenticeships’ The fifth year of the Southampton course was entirely clinical. Here again the curriculum designers broke with

tradition in order to provide the best possible learning experience for their undergraduates. In established medical schools based on a large teaching hospital, the usual practice was to have a group of between six and eight students attached to a consultant ‘firm’. The number of students, and the fact that there would be groups from different years of the course on the ward at the same time, made it difficult to offer close supervision and hands-on experience to the trainee doctors. In order to optimise students’ learning experience, the Southampton approach was to have just one or at most two students per consultant firm. There would be no lectures; instead students would learn clinical medicine for themselves from a variety of sources, including books, journals, ward rounds, seminars and tutorials conducted by the clinical staff, and attendance at autopsies. They would be stimulated by the need to understand the presentations of the patients they were seeing. Students would be jointly assessed at the end of their attachments by the consultant of the firm and a visiting academic clinician, with the results contributing to their final degree. This system of assessment would reassure the GMC that the use of ‘non-teaching’ hospitals and non-academic staff would not compromise the standard required of the students. The challenge of finding the required number of placements for students was overcome by taking advantage of units beyond Southampton, in the wider Wessex region. It was hoped that as well as dramatically increasing the number of available ‘apprenticeships’, this would foster relationships between the regional district and University hospitals and raise standards of patient care and clinical research, as well as teaching, throughout the region. All acute general hospitals in the Wessex region were invited to take some students as apprentices, initially one per firm.

By 1976, attachments were being offered at hospitals in Basingstoke, Portsmouth, Winchester, Bournemouth, Poole and Salisbury, as well as in Southampton, covering medicine, surgery, obstetrics and gynaecology, child health, psychiatry and general practice. Each student could also take an elective attachment. Howell explained: “We stressed... [that] there would be no requirement for the consultants or other staff to give formal lectures… We expected the student to be closely supervised and guided in how to learn from the patients and to be instructed in how to perform certain common procedures such as intravenous infusion, electrocardiography and lumbar puncture. It was important that the students should not become a burden to an already busy firm; but equally they must have the opportunity and encouragement to develop their clinical skills and have the time to read as extensively as possible, especially about those patients whose records they were keeping.” Social and behavioural sciences The increased emphasis on behavioural sciences, which were mentioned in the Todd report as an essential part of undergraduate medical education, was reflected in Southampton’s new curriculum.

GMC approval Having designed a bold new curriculum, the medical school needed to gain the approval of the GMC for its adoption. A meeting with GMC representatives took place in April 1971 at which the Southampton academics addressed concerns about how teaching standards would be maintained at regional hospitals and the amount of time allocated to the fourth-year research project. The GMC gave the curriculum its support, paving the way for a revolution in medical education in the UK.

Organising the new faculty A non-departmental faculty Alongside curriculum planning, the new Southampton team was considering another important topic – how best to structure the new faculty. The Vice-Chancellor, Professor Kenneth Mather, was clear that he would prefer a non-departmental structure, as he felt that departments tended to be regarded as ‘territory’ to be defended and this often acted as a barrier to change.

It was therefore decided that the faculty’s basic structural units should continue to be small professorial groups, each based on a clinical specialty and each of roughly equivalent A first-year course entitled Man, Medicine and Society size and authority. Normally, the minimum size of a group introduced students to epidemiology and the social sciences, would be a professor, supported by a senior lecturer, lecturer, showing their relevance to medicine and the importance of technician and secretary. The professor would usually populations and groups as units of study in medicine. The represent the group on the Faculty Board where power course also attempted to put into perspective some of the would ultimately reside. The teaching responsibilities of each many factors that influence health, including occupational, group would be prescribed by the faculty but coordinated by environmental and genetic factors. An integral part of the a senior professor. course was a guided walk in two areas of Southampton with Initially there were four groups, based on the specialisms of contrasting socioeconomic conditions. Having taken this the Dean and foundation professors. James Fraser would be introductory module, students would then study head of the surgery group; David Millar would be head of epidemiology, psychology and sociology in more focused obstetrics and gynaecology and related aspects of human courses during the first and second years.

reproduction; and Jack Howell would be head of the medicine group. The Dean, a clinical epidemiologist, would head up the community medicine group.

the number of staff in each group, ensuring that any changes the faculty wished to make to the curriculum or the teaching responsibilities of a group would not affect its basic funding.

In the school’s early days there were insufficient resources to create professorial groups in each discipline, so some compromise was necessary. It was agreed to create additional senior lecturer posts in some disciplines, for example respiratory medicine and clinical pharmacology posts within general medicine. These would be established within a professorial group but without their own supporting staff. It was anticipated that when resources became available, successful senior lecturers would be considered for promotion to personal chairs to head their own professorial groups.

Rejection of ‘student load’

Some groups, such as medicine, were initially relatively large because while there was only one professor of medicine, the group had to include a range of specialties. For example, within the medicine group, three full-time senior lecturers representing respiratory medicine, gastroenterology and clinical pharmacology, and four part-time senior lecturers representing cardiology, neurology, dermatology and venereology, were appointed. When a professorial appointment was made in a specialty, a separate professorial group was formed. Howell wrote: “The professorial group structure gave us what we wanted – in effect one large ‘department’, the faculty, within which no single group or even combination of groups dominated.” It is likely that the structure worked well for medicine because unlike most disciplines, medicine is essentially a ‘single’ department rather than one that encompasses a number of distinct specialties.

Traditionally, the annual grant to departments was heavily influenced by their ‘student load’, which is estimated by multiplying the number of students being taught by the number of hours of teaching. For example, the Department of Physiology and Biochemistry (P&B) was already well established within the Faculty of Science at the time the new medical school was created. It had a large student load because it ran a popular and successful three-year honours science degree course for about 150 undergraduate students; in addition it had approximately 50 PhD students. Students were mostly taught by staff within the department, but if it was necessary for part of their course to be taught by a different department or faculty, the student load and the associated resources would be transferred. Although student load was the basis of departmental funding, the costs of teaching did not rise in proportion to the number of students taught. A department with a high student load was therefore usually better resourced to pursue other activities, especially research. In turn, heads of departments were under pressure to preserve or increase student load and to resist changes that would reduce it.

With the advent of the medical school, and the need for considerable teaching in physiology, pharmacology and biochemistry, the P&B student load increased considerably. It would have been a simple matter to calculate the additional student load if P&B had undertaken all of the physiology and biochemistry teaching. This would have increased the department’s allocation considerably for the employment of additional academic and support staff. But as the structure Faculty finances and dynamics of the curriculum evolved, especially the While the new organisational structure avoided large nature of the systems courses, it became clear that departments, a decision needed to be made about how individual groups would be funded. Essentially, a way to fund integrated teaching by science and clinical staff would teaching programmes was needed that was based broadly on be needed. A basis for funding other than student load was required.

Whatever system was to be adopted, it would have to meet a number of needs. It must recognise the absence of a departmental structure in the faculty. It must not create resistance to changes in the curriculum or faculty structure. It must ensure that the costs of implementing the curriculum could be afforded, and that the costs of individual parts of the teaching programme could be measured so that their cost-effectiveness could be assessed. It must also not be a financial barrier to cooperation between individuals in different groups, which was vital for the nurturing of a thriving research environment. It was eventually agreed to adopt an approach that separated the costs of teaching from the costs of running each group so that changes in student load would cause no direct benefit or loss. This would mean substantially less money going directly to P&B (although, being primarily a Faculty of Science department, it retained the conventional financial arrangements for its science students) and it is to their credit that, after some discussion, P&B academics accepted this radical approach. Monitoring course costs Around 40 individual components of the curriculum were identified and each was made the responsibility of a named grant-holder, almost always a senior academic. The medical schoolâ&#x20AC;&#x2122;s Finance Committee agreed a provisional budget for each component and a code was allocated so that all expenditure could be attributed to a code and monitored centrally. Course expenditure was routinely monitored and reviewed by the finance sub-committees, for whom it was a simple matter to identify each component of expenditure on each part of the course.

of the NHS, each medical school was required to appoint a professor of medicine and a professor of surgery to develop academic departments that would be responsible for the organisation of teaching and conduct research. These professorial units became academic enclaves within NHS teaching hospitals; the bulk of clinical services and the management of the hospital remaining dominated by the part-time clinical consultants. Some NHS consultants chose to have full-time contracts with the NHS but most had seven to eight sessions (out of 11) per week. Junior NHS doctors in training were attached to either type of unit, but junior academics were mostly attached to the professorial units where facilities and supervision for research were more readily available. The creation of the new medical school at Southampton brought with it the opportunity to reconsider these arrangements. Basically, the decision was whether to establish academic communities within the NHS hospitals comprising the teaching hospital group (Southampton General Hospital, Royal South Hants Hospital and the Western Hospital), or to integrate the academic and NHS staff working within the same specialty. In this model, there would be two consultants â&#x20AC;&#x201C; one NHS and the other University â&#x20AC;&#x201C; sharing responsibilities within a clinical firm. The NHS consultant would be responsible for the clinical services and the professor (or senior lecturer) would be responsible for the organisation of both undergraduate and postgraduate teaching, and for research and postgraduate studies.

Each system had its merits. The advantages of an NHS and an academic specialist working together seemed self-evident; this would provide a broader clinical base for each plus a senior colleague in the same specialty. The potential disadvantage was that the academic could be relatively Organisation of clinical academic groups isolated from other academic colleagues and the critical Most medical schools in England did not have clinical academic mass of a single multi-specialty university academic departments headed by professors until 1948, the department would make academic development more Regius chairs of medicine at the universities of Oxford and difficult. Despite this risk, it was agreed that the integrated Cambridge being notable exceptions. With the establishment approach was most suited to providing a university hospital

capable of the highest standards of clinical care as well as teaching and research. Consequently, the first senior lecturer appointed in medicine was Dr Graham Sterling, whose special interest was respiratory medicine. Following the model described above, Sterling would join Dr William (Bill) Macleod at the chest unit at the Western Hospital and they would work together in a common unit; this was done and ran very successfully for several years until Macleod’s retirement in 1987. Similarly, Dr Duncan Colin-Jones was appointed Senior Lecturer in Gastroenterology, and Dr John Bamforth, Consultant General Physician with a special interest in gastroenterology, generously agreed to share the beds of his unit with him. The appointment in 1973 of Dr Charles George (later to become Professor and faculty Dean) as Senior Lecturer in Clinical Pharmacology gave Jack Howell a colleague with whom to share firm responsibilities. Consolidating the team The second Professor of Medicine As the faculty expanded and the workload of individual professors increased, it was apparent that some groups were overloaded. For example, it became obvious that another professor (and therefore professorial group) was needed in a medical discipline. A proposal to this effect was approved by the Finance Committee and resources were allocated for the appointment. The interests of the new professor were to be chosen from clinical immunology, rheumatology and clinical pharmacology. The successful candidate, appointed in 1971, was Dr Ralph Wright, who had an international reputation for his discovery of the relationship between the Australia antigen (hepatitis B virus) and chronic liver disease and cirrhosis during his earlier career at Yale University in the United States. His interests were in the expanding discipline of clinical immunology, with a particular focus on liver and bowel disease.

Howell explained how the new appointment led to the creation of a second professorial group in medicine. “My group became known as Medicine I. Medicine I was larger because it included three full-time senior lecturers – in respiratory medicine, gastroenterology and clinical pharmacology. But when Wright was appointed, his resources included the standard minimum package of new appointments – senior lecturer, lecturer, technician and secretary – and this group then became known as Medicine II with its own accommodation and equipment. (It initially shared beds with David Barker and Donald Acheson at the Royal South Hants Hospital, moving to Southampton General Hospital in 1981.) This was consistent with our decision not to create departments – that is, we didn’t combine to form a department of medicine. “As Foundation Professor, I remained the representative on the main faculty and University committees, but could have been asked at any time to relinquish any of these roles by the faculty. Wright had fewer administrative responsibilities and was freer to develop his academic interests.” Wright and Medicine II gave the medical school significant additional research strength, as was intended. Their studies of the immunopathogenesis of coeliac disease, inflammatory bowel disease, and autoimmune chronic active hepatitis were groundbreaking. Working with pathologist Dr Harry Millward-Sadler, Wright described chronic active hepatitis and cirrhosis in patients with alpha-1-antitrypsin deficiency, and this partnership also co-edited the globally acclaimed textbook Liver and Biliary Disease: Pathophysiology, Diagnosis and Management. Wright sadly died after a tragic accident in his home in 1990, but over his 19 years at Southampton he inspired the next generation of Southampton graduates to pursue a career in liver research and hepatology, most notably Professors Michael Arthur and John Iredale. Together they continued his work on the cellular and molecular basis of liver injury and

chronic liver disease, including paradigm-shifting studies of the mechanisms that lie behind the reversibility of liver fibrosis and cirrhosis. Psychiatry The appointment of a professor of mental health (psychiatry) was an urgent need and resources for this were prioritised. The chair was advertised in 1970 and attracted a large field of candidates. Dr James Gibbon was considered to be academically head and shoulders above the other applicants. He was Reader in Psychiatry at Newcastle and had spent some time at Johns Hopkins Hospital. There he became a colleague of Professor Paul McHugh and shared his interests in research in chemical and biochemical aspects of the brain.

and key staff would not be available for a few years. In response to an approach by the Dean, the Bonhomie Foundation generously agreed to provide £3,000 per year for five years to enable the appointment of a foundation professor to be brought forward. This was insufficient to provide for all of the appointments needed, but an additional major grant was made by the Fund Action for Crippled Children. It offered to provide £5,000 per year for five years, enabling the University to advertise the chair in the summer of 1970.

Colin Normand was appointed Foundation Professor of Child Health in October 1970 and took up the new post in the following February. He knew Southampton and the Wessex region well, having been a student at Winchester College in the late 1940s, where he was head boy. He was a graduate of Oxford and St Mary’s Hospital Medical School, London. As a Gibbon was joined by Dr Brian Barraclough, who had reader in the department of Professor Leonard Strang at previously been a Medical Research Council (MRC) senior lecturer in the suicide research unit at Graylingwell Hospital. University College Hospital Medical School, he had developed a special interest in neonatal and paediatric He was to bring great expertise in this field to the medical respiratory physiology, and especially in the recently school and continued publishing some of the most highly cited scientific papers in psychiatry through to the late 1990s. discovered role of surfactant in preventing lung collapse in newborn babies. These interests convinced him that Community medicine/primary care neonatal physiology and pathophysiology were the basis of clinical paediatrics and he was keen to influence the medical John Forbes was appointed as a senior lecturer in the curriculum accordingly. Subsequently, Dr Judith Darmady community medicine group in 1968, and later became was appointed Senior Lecturer and Dr Martin Radford Professor of Primary Medical Care when primary care became a group in its own right. Forbes’ brief was to develop Lecturer in Paediatrics. general practice education and research including a model practice. By 1973 the first practice team was in place – Forbes Orthopaedics was joined by George Freeman, David Skelton, Chris Metcalfe Jim Ellis was the school’s first Professor of Orthopaedics. He had a longstanding connection with the region; in 1950 he and Pat Hertnon. was appointed as a consultant surgeon to the Winchester Child health and Southampton group of hospitals and in 1968 he began to work part time for the Wessex Regional Board, first as Because of the importance of child health in a modern Director of Postgraduate Studies and later also chairing the medical curriculum, the school was anxious to establish a Board’s medical advisory committee. He also played a role professorship in child health at the earliest opportunity. nationally in his field, for example as a member of the editorial However, it became apparent that funding for the professor

board of the Journal of Bone and Joint Surgery and President of the orthopaedic section of the Royal Society of Medicine (1970–1971). Ellis retired in 1976 and was succeeded by Professor JR Shearer. Shearer had previously been Senior Orthopaedic Registrar to the Grampian Area Health Board and Clinical Lecturer in Orthopaedic Surgery at the University of Aberdeen. Before joining the new team at Southampton he was seconded as Lecturer in Orthopaedic Surgery to the Nuffield Orthopaedic Centre at Oxford. Geriatrics It was widely acknowledged that increasing longevity would mean ever-increasing demands on medical services. Alongside a growing need to care for sick elderly people there was recognition of the importance of the new specialty of geriatrics in the NHS, led by a new breed of specialists, geriatricians. Medical and surgical services for older patients with acute physical and mental illnesses were increasingly required, as well as social services to help support them in their homes. It was clear that much more had to be understood about the needs of older people, the causes of those needs, how health problems could be prevented or delayed, and the most effective way to deliver care. This was a situation that was crying out for academic study and for undergraduate teaching. It was therefore agreed to create an academic unit in geriatrics as soon as possible. There were already a small number of units of gerontology for the study of the ageing processes, mainly in the USA, but at the time academic units for the study of geriatric medicine did not exist in the UK. However, with pressure to develop more traditional units such as child health and psychiatry, there were limited resources at Southampton for this field. Fortunately, Dr John Revans and the Wessex Regional Board also saw the development of an academic unit of geriatrics as a high priority and agreed to provide the funds to appoint a

professor and to support the post for five years, freeing up University funds. The fact that there were already geriatric services in Southampton, pioneered by Dr Tom Rudd, was also encouraging. These services were closely integrated with social services and were already gaining recognition nationally as models of good practice. Rudd was highly supportive of the medical school’s wish to develop a new unit and was closely involved in its planning. The chair was the first of its kind to be advertised in the UK, shortly before a similar post was advertised by the University of Manchester. Southampton appointed Professor Michael Hall and Manchester appointed Professor John Brocklehurst; the two departments subsequently had the warmest of relations. Indeed, when Brocklehurst retired in the 1980s, the chair at Manchester was filled by Dr Bill MacLennan, a former senior lecturer at Southampton. Early professorial and senior lecturer appointments −− Professors Kenneth Munday (Physiology and Biochemistry), Gerald Kerkut (Neurophysiology) and Akhtar (Biochemistry) – already in post −− Human Morphology: David Bulmer and Donald Mayor −− Pharmacology: Humphrey Rang and David Colquohoun −− Nutrition: Geoffrey Taylor −− Clinical Epidemiology: Donald Acheson and David Barker −− Surgery: Sir James Fraser and Bert Wilkin −− Human Reproduction: David Millar, then John Dennis, and Max Elstein −− Medicine I: Jack Howell, Graham Sterling, Duncan Colin-Jones, Charles George and Lindsay McLellan −− Medicine II: Ralph Wright and Colin Smith −− Child Health: Colin Normand and Martin Radford −− Mental Health: James Gibbons and Brian Barraclough −− Microbiology: William Brumfitt, then Peter Watt −− Pathology: Dennis Wright and Harry Millward-Sadler −− Clinical Biochemistry: George Alberti, then Barbara Clayton −− Orthopaedics: Jim Ellis and Stephen Wood

−− −− −− −−

Europe Chair of Rehabilitation: Hugh Glanville Anaesthetics: John Norman Renal Medicine (Portsmouth): Dolf Polak and Harry Lee Medical Statistics (MRC Environmental Epidemiology Unit): Martin Gardner −− Geriatrics: Michael Hall and Bill MacLennan −− Medical Information Science: Michael Alderson −− Community Medicine: John Forbes and Estlin Waters Academics in other departments, closely involved with the new medical school: −− Sociology: John Smith and Ida Topliss −− Psychology: Gordon Trasler and Don Marcer Student selection Curriculum design was not the only area in which the medical school broke new ground – it also agreed a progressive admissions policy. The school’s founding academics were well aware that the quality of a school’s output depends on the calibre of its students, and that student selection was therefore crucially important to success. In agreeing a selection policy, they needed to consider the qualities they should be seeking in applicants, and how to identify those qualities. This was no easy task given the breadth of roles within the medical profession, and at the time there was little available evidence about the effectiveness of other schools’ selection procedures. Most schools interviewed applicants and some later introduced more complex structured assessments, but it was not clear whether these raised the quality of the student intake.

after, publicly financed medical education at Southampton, we were conscious of our responsibility to be fair to applicants from a wide range of backgrounds, and of course to the public. We therefore adopted an approach that we considered fair and defensible.” The agreed approach was to select students on the basis of A level results; interviews were only required if more information was needed to support their application, or for mature students. There was unanimous support for a proposal by the Dean that 15 per cent of places should be reserved for mature students. In addition, the prevalent policy of providing only a small quota of places for female students was rejected, and Southampton became one of the first UK medical schools to admit women and men on equal terms. Another break with tradition was Acheson’s proposal that no preference should be given to applicants with parents or other relatives in medicine. His team supported this idea but it caused considerable upset among some colleagues in Southampton and the Wessex region. However, Acheson’s view was that a medical school hoping to break new educational ground could expect opposition from traditionalists in the profession. If there were significant numbers of students within the school from medical families, the task of introducing necessary change could be made more difficult.

While a selection process based on exam results would enable the school to attract academic high-flyers, some concern was raised about whether students would have the range of non-academic qualities and abilities that would Howell wrote: “In 1970, in preparation for the selection of the usually be recognised at interview. However, within a few first entry of students in 1971, these considerations exercised years Southampton medical students were clearly us greatly. In our discussions, most of us agreed that demonstrating their diverse interests and capabilities, interviewing school leavers would be unlikely to be more than enthusiastically arranging and taking part in a range of marginally helpful, might introduce unwanted bias and activities including sports, music, performances and almost certainly would not be cost-effective in time and social events. effort… In deciding whom to accept into the much sought

Embedding the course There was no shortage of applications from prospective students, and in October 1971 the first intake of 40 men and women arrived at Southampton to begin their studies. The school was officially opened by Sir Keith Joseph, Secretary of State for Health and Social Services, and was featured in a special supplement about the University published by The Times. A further 65 students were selected for admission in 1972. Making do Delayed building works meant that the facilities on offer to the first student cohorts were far from ideal. Sheila Mooney, Senior Assistant Registrar, remembered: “When the first intake arrived, the South Academic Block at the General Hospital was still under construction and Boldrewood was nearing completion. The Dean’s office was in a house in University Road and some professorial units were accommodated temporarily in Matron’s Bungalow, the Medical Hut and various houses near the Royal South Hants Hospital.

Dr Alan Noble was doing a PhD in physiology at the time of the school’s inception; when he graduated he was invited to become part of the founding team. Noble recalls: “The head of my department called me in and said, ‘We’ve got this new medical school coming, you can have a lectureship. You’ve got 48 hours to think about it.’ It was a tough decision because I had been planning to do a postdoctoral fellowship in America. But I thought being involved in setting up a new medical school might be interesting, and I would do it for three years. I retired from Southampton 40 years later!” The early days proved exciting but challenging. Noble says: “I found myself teaching all sorts of things, simply because there was no one else to do it. At the same time I was also heavily involved in commissioning parts of the Boldrewood building, particularly the Biomedical Sciences Unit.” Noble went on to become one of the school’s most popular lecturers and taught every Southampton medical student until his retirement in 2008 – almost 3,500 of today’s doctors. Rolling out the new curriculum

“On the main campus, the Department of Physiology and Biochemistry was still in its old buildings, awaiting the move to Boldrewood. The students, who had been forewarned, were thus welcomed as pioneers (or possibly guinea pigs) to a physically non-existent medical school.”

Despite these early makeshift arrangements, the programme of teaching continued as planned; a new brand of medical training was underway. The founding academics could see how their proposals worked in practice and were able to review and refine them as the programme progressed.

Students were taught in borrowed classrooms and lecture halls until the main block of the Medical and Biological Sciences Building at Boldrewood became ready in July 1973. Work at Southampton General Hospital was delayed by a builders’ strike and a fire in the East Ward Block, but the South Academic Block had been completed, creating a hub for the medical school within the hospital that included lecture theatres, a library and a postgraduate centre. The East Ward Block was eventually completed in 1974, with new laboratory and pathology blocks ready for 1976.

For example, in 1974 the first intake of students started their fourth-year study in depth, having been advised the previous summer to start thinking about a possible topic or discipline in which they were interested. The small size of the group made it relatively easy to match students, projects and supervisors but it did not limit the range of topics studied. For instance, Jack Howell supervised two students investigating the way in which the control of breathing is affected by reduced oxygen levels in the blood (hypoxaemia), using apparatus to take measurements in healthy adult

volunteers and those with lung disease. Another student, supervised by James Fraser, was prompted by her experience in the outpatient clinic to investigate inconsistencies in the speed in which patients presenting with a breast lump were seen. This involved collecting data from an appropriately large group of women, including clinical, sociological and psychological factors. It also touched on the availability of clinical services. While identifying project topics was rarely problematic, as the cohort expanded it became more challenging for students to find skilled supervisors to guide them. Sometimes supervisors were insufficiently experienced in research and didn’t recognise that while the question being asked by the student might be a good one, it may not lend itself to this type of study, or that resources may be too limited to tackle the topic effectively. It was evident early on that closer management of the study in depth was needed and a system of scrutiny was introduced that required supervisors to submit an outline of the project to a group of senior, experienced academics for approval or comment.

having passed their final examinations. The first Southampton-trained doctors were to become part of the medical workforce. Donald Acheson commented: “…although they sometimes complained of having been experimented on like guinea pigs, [these students] had been partners in an extraordinary adventure in which they had played a crucial and constructive role.” Recognition of the new course

During their training these students had been only too aware that the new curriculum was yet to be approved by the GMC. The detailed programme and its timetabling had been discussed with the GMC in April 1971, and while the GMC had supported the proposals, this only allowed the school to implement the curriculum – it did not mean the degree would be recognised when the first graduates wished to register with the GMC as medical practitioners. This would depend on the outcome of two further visits by GMC representatives at the end of years three and five. In the event, students’ anxieties were unfounded; the course was approved and the GMC noted the very high standard of teaching, the high level Another area for early review was the teaching of behavioural of scientific discipline and the enthusiasm of the students. sciences – medical sociology and medical psychology – which Indeed, the GMC visitors’ final report stated: “We should like to express our pleasure at having the opportunity to originally took the form of weekly lectures given during the first five terms. Because these subjects were relatively new to watch the development of this new medical school and we congratulate the Dean and all his colleagues on a medical curricula and would occupy only a small part of the course, there was some concern that they would struggle to magnificent achievement.” make the same impact on students as the more traditional Further endorsement of the course came in 1978 from Sir subjects central to the practice of a doctor. This turned out George Pickering, Regius Professor of Medicine at Oxford to be the case. Attendance at lectures was optional and and an esteemed figure in the medical world, who had visited students were ‘voting with their feet’. Having attempted to Southampton while conducting a survey of medical make the lectures more effective, the two departments education in the UK. He commented: “The boldest and in eventually introduced projects in sociology and psychology many ways the most successful new curriculum is that of the instead of lectures – an approach that students found more University of Southampton.” Of the fourth-year project, he appealing and was therefore more successful. wrote: “I would like to hazard the opinion that this venture of Southampton’s is the most important experiment in medical By 1976 the student intake had increased to 130. The same education in my lifetime. It should provide the young year saw the graduation of the initial cohort, all but one

graduate with the discipline and habits of mind of the scholar, and thus fit him for the opportunity of self-education which he will enjoy… for the rest of his life.” In addition, the curriculum was attracting considerable outside interest. In 1979, for example, the Association for the Study of Medical Education met at the University and devoted the first day of its programme to the Southampton approach. Reviewing teaching methods and the curriculum Despite these accolades, there was no question of the academics resting on their laurels. In 1976, in the spirit of continuous improvement, Acheson established a working party to review the school’s teaching methods, with the aim of improving their effectiveness and cost-effectiveness. The working party was chaired by Jack Howell, and members included Dennis Wright, Professor of Pathology, whose subject regularly received praise from students for the way in which it was taught; Colin Coles, Lecturer in Medical Education; Stuart Roath, Assistant Dean; and Ted Cantrell, Lecturer in Rehabilitation, who had an abiding interest in education. Sheila Mooney provided administrative support and the monthly meetings were a forum in which to explore the complex issues surrounding the evaluation and improvement of teaching methods. While feedback was routinely sought from students about different aspects of the course, the working party wanted to find a way to gain more in-depth insights into the student experience. It took a radical, immersive approach by recruiting a qualified educationalist to join a particular course and then report to the teaching team and the curriculum committee on their perception of the course, its delivery and results. Brenda Mountford was appointed as a research assistant and started by attending one of the systems courses. At the end of the course, she wrote a report for the curriculum committee and the Dean, which contained a number of recommendations that were largely implemented.

Further enhancement of the students’ learning came about in a more impromptu way, following a request by consultant physician Dr Rodney Dathan for some additional basic science support for the third-year students on his firm. Alan Noble and Brian Chapman offered some extra evening tuition for a group of four students once a fortnight, at which a student would present a patient history and the group would discuss the relevance of the accompanying lab results and physiological data. Students found these sessions incredibly useful, and Noble says: “Word spread and students started coming from different firms, so the group grew to 12, then 35, and eventually over 100 students would regularly attend.” These sessions ran for 28 years in this format and aspects became incorporated into the main curriculum. Introduction of new degree courses The school’s founders were aware that requiring A level chemistry as an absolute entry requirement would discourage students with an arts background from entering medicine, to the potential disadvantage of the profession. To address this, a pre-medical foundation course was introduced in 1976. The course provided an opportunity for 15 students from any background who could demonstrate an ability to achieve, including school leavers or mature students, to study a foundation science year. If they were successful they would then progress to the five-year medical degree. The foundation year was tailor made and covered relevant aspects of chemistry, physics and biology. It ran for six years and enabled some very able people to become doctors. Its success was in large part due to the enthusiasm of its academic lead, Professor Trevor Shelley. However, many prospective students were unable to afford the costs of a six-year course, having already received a grant for a first degree in another subject. The course therefore did not always have enough good applicants to ensure its viability and, reluctantly, the school discontinued it in 1985 on financial grounds.

Other educational developments included the approval of a nursing degree in 1976/77, although it was five years until the course commenced. Within that time the nursing curriculum was agreed and Lyn Martin was appointed as the senior lecturer. By 1986 10 nurses had graduated, and by 2000 the intake had increased to between 40 and 50. Another successful venture was a postgraduate course in rehabilitation studies, which was launched in 1978/79. Early academic traditions As the degree course bedded in, so did a sense of community among academics and students. In this flourishing educational environment a calendar of academic events developed, some of which remain today. The John Wade Foundation Lecture was established by the Wade Foundation and was originally held every two years. The aim of this public lecture was to provide a forum to bring developments in medical science to a wide audience. In May 1972 Professor Sir Charles Stuart-Harris presented the first lecture, entitled ‘Medicine Today and the Role of Science in Medical Education’. The Wade Lecture is now an annual tradition; the 2016 lecture, marking the 40th anniversary of the graduation of the first cohort of Southampton medical students, was given by Professor Michael Arthur, who was by then President and Provost of University College London. Fourth Year Day

Acheson. “It became a custom that the medical school hired a Solent ferry boat complete with bar, restaurant and dance floor and all of us, students and staff alike, set out on a trip to the Isle of Wight and back with a break on the island for refreshments. To begin with all went well at these maritime parties, but as the years went by and the student numbers increased what had started as a more or less intimate affair become more and more uproarious. “In 1977 with about 100 students ready to ‘let off steam’ and half as many staff on board, the ‘shuffle’ finally came to grief. As the boat neared the Isle of Wight, various people dived overboard, swam ashore and invaded the local pubs. The climax came when the boat was about to leave on the return trip. Some of the students succeeded in purloining a barrel of beer from one of the pubs. The police were called and I found myself in the island’s only police station bailing them out. We all got home safely but that was the end of the River Boat Shuffle.” Student life As the River Boat Shuffle showed, there was plenty of fun to be had for Southampton’s medical students alongside the hard work. “One advantage in 1971/72 was that there were more staff than students. There was great enthusiasm on both sides and the staff-student parties run by the faculty office laid the foundations for the social events which are now an essential part of the student calendar,” recalled Sheila Mooney. “The Christmas Revue began as an entertainment during one of these parties and clearly demonstrated the ready ability of senior medical staff to revert to and enjoy student humour!”

At the end of the fourth year, students presented the results of their research projects to fellow students and staff in a series of 10-minute presentations and answered questions from the audience. In the early years, the Fourth Year Day was followed by a nautical celebration that came to be known as The student-staff camaraderie extended to sporting the ‘River Boat Shuffle’. activities, and to the rugby pitch in particular. Alan Noble remembers: “We had to wait until the third intake of students “After all, students who had borne several months of arrived in order to get a rugby team going. I played for the increasing pressure in preparing their first piece of original team for nine years and we had some terrific times.” Michael research, and had then plucked up the courage to deliver the Arthur was one of the early student recruits, playing results to a large audience, felt the need of a party,” wrote alongside academics including Noble and Dr Stuart Roath.

Rugby club 40th anniversary In 2015 more than 150 people attended the Southampton medics rugby club 40th anniversary reunion. Former players are now doctors working in a range of roles, from brain surgery to NHS leadership. The Southampton team has won the national medical school championship three times in recent years – including beating their nemesis, Cardiff, in the 2016 final.

Much student-led activity was orchestrated by the Southampton University Medical Society (later known as MedSoc), which was established by the first intake of students in 1971. The 1976 course brochure gives a flavour of its activities, which included “lectures, theatre visits, film shows and various social events such as the Annual DinnerDance”. At that time, annual membership cost £1 and was open to staff and students alike. By 1982 students were planning an Association of Alumni, the May Ball had become an annual celebration and a group calling itself BOSOMS (Best of Southampton Old Medical Shows) was rehearsing a revue entitled Beyond the Syringe, which it would perform at the Edinburgh Fringe. Student representation Mechanisms were put in place to realise the Dean’s vision of a school that delivers education in partnership with its students. As well as asking for feedback at each stage of the course, students were represented on a Faculty StaffStudent Liaison Committee, made up of equal numbers of staff and students and chaired by the Dean. The student representatives were from each year of the course and were elected by their peers. The committee provided an opportunity to discuss topics of interest or concern at twice-yearly meetings, with direct access to the Faculty Board. Changes in leadership In 1981 the school celebrated its 10th anniversary, and by July 1982, 597 students had graduated. There had also been a change in leadership; Donald Acheson had stepped down as Dean and was succeeded by Jack Howell in 1978. While the establishment of a thriving educational environment continued under Howell’s direction, the late 1970s and 1980s proved financially challenging for the medical school. Like the rest of the University it was affected by government funding cuts, and from 1977/78 its UGC grant was no longer earmarked. Initially it was able to use reserves

to plug the gap, but there were harder times ahead. In 1981 the UGC outlined further grant cuts that would contribute to a forecast University deficit of £3.6m by 1983/84. To avert this, the University was forced to make dramatic cuts across all faculties, including a 10 per cent cut to the medical school’s budget. The school’s dependence on clinical lecturers on short-term contracts meant that the subsequent recruitment freeze was particularly problematic – so much so that the University had to make exceptions. Professor (later Dame) Barbara Clayton became Dean in 1983. She had arrived at Southampton in 1979 having been appointed Professor of Chemical Pathology and Human Metabolism – the first woman in the UK to hold this post and the medical school’s first female professor. Clayton’s term of office spanned another financially challenging period; however, she successfully achieved budgetary balance by 1986/87. In addition, she initiated the first UK chair specifically dedicated to nutrition, to which Professor Alan Jackson was appointed in 1985. He had a specific brief to address the teaching of nutrition to medical students, and to foster and sustain excellence in nutrition research. Jackson went on to make a major national and international contribution to education and research in nutrition and in 2005 was awarded a CBE for services to public health and nutrition.

Curriculum review Clayton retired in 1986, although she remained at Southampton as Emeritus Professor, funded by a Leverhulme fellowship. She was succeeded by Professor (later Sir) Charles George. Towards the end of George’s deanship the faculty carried out a major review of the curriculum, undertaken by a committee chaired by Dr Alan Thomas. The review endorsed most of the curriculum’s innovative features and incorporated some of the first-year introductory courses into the systems courses. This remedied a concern that had troubled the curriculum designers, as the introductory courses had made the first year much more didactic than they had intended. Before leaving the University to become President of the British Medical Association, Howell had the experience of teaching the new respiratory systems course to first-year students while teaching the original course to second-years; he found that the “difference in the enthusiasm of the students was striking”.

A clinical scientist with a formidable track record, Clayton was also known for being a determined but diplomatic leader and an approachable figure who was concerned for the welfare of students. Keen to continue the ethos of academicstudent partnership, she increased student representation on the Faculty Board. She was also aware of the importance to the University of external and internal partnerships. She was an active member of the 84 Club, a Southampton ‘town and gown’ network that brought leaders from academia and industry together, and she established an annual professorial dinner between medicine and engineering.

Professor Jack Howell CBE (1926–2015) Dean of the Faculty of Medicine, 1978–1983 Jack Howell became the medical school’s Foundation Professor of Medicine in 1969. He qualified in medicine at the Middlesex Hospital in 1950, and while working there won a Medical Research Council research fellowship at Johns Hopkins Medical School in Baltimore, USA. As well as being instrumental in the design and implementation of Southampton’s pioneering medical curriculum, he established a world-leading respiratory research group that continues to thrive today. A prize for undergraduate research was named in his honour in recognition of his major contribution to respiratory research at Southampton. Affectionately referred to as ‘Whispering Jack’ by students and colleagues because of his husky voice, he was an enabler who allowed people to explore new ideas in research and education. Howell’s later roles included Chairman of Southampton District Health Authority, President of the British Medical Association, and President of the British Thoracic Society.

Dame Barbara Clayton (1922–2011) Dean of the Faculty of Medicine, 1983–1986 Barbara Clayton joined the medical school as Professor of Chemical Pathology and Human Metabolism in 1979. She studied medicine at the University of Edinburgh and completed a PhD in clinical endocrinology, later working at St Thomas’ Hospital and Great Ormond Street Hospital before taking up her role at Southampton. She made many contributions to public health, including the development of a new method for detecting the genetic metabolic condition phenylketonuria, and the establishment of a link between exposure to lead and impaired intellectual development in childhood. Her research led to the eventual removal of lead from paint, plumbing and petrol. As the medical school’s first female professor and the first woman to become President of the Royal College of Pathologists, she did much to further the role of women in medicine. Clayton was a recipient of the British Medical Association Gold Medal and was made a Dame in 1988 in recognition of her outstanding contribution to the understanding of the importance of diet and nutrition in chemical pathology.

Sir Charles George Dean of the Faculty of Medicine, 1986–1990 Dean of the Faculty of Medicine/Dean of the Faculty of Medicine, Health and Biological Sciences, 1993–1998 Charles George trained at the University of Birmingham and worked in hospitals in the West Midlands and at Hammersmith Hospital before joining the medical school at Southampton. He was appointed as a senior lecturer in 1973, later becoming Professor of Clinical Pharmacology. He also served as Chairman of the Education Committee of the General Medical Council for five years until 1999. He left the University of Southampton in 1999 to become Medical Director of the British Heart Foundation, driving forward the charity’s work on heart disease prevention. He left this role in 2004 to concentrate on his work as President of the British Medical Association (BMA). He has held numerous honorary and advisory roles; he chaired the BMA’s Board of Science and Education, was a member of the government’s Task Force for Coronary Heart Disease, and was on the Scientific Advisory Committee of the Association of Medical Research Charities. He was knighted for services to medicine and medical education in 1998 and received a BMA Gold Medal in 2010.

THE MEDICAL SCHOOL’S LEADERSHIP Deans of Faculty

1978– 1983

1986– 1990

Jack Howell Dean of the Faculty of Medicine

1968– 1978

Donald Acheson Dean of the Faculty of Medicine

Charles George Dean of the Faculty of Medicine

1983– 1986

Barbara Clayton Dean of the Faculty of Medicine

1990– 1993

Colin Normand Dean of the Faculty of Medicine

1993– 1998

Charles George Dean of the Faculty of Medicine/Dean of the Faculty of Medicine, Health and Biological Sciences

1998– 2000

Eric Thomas Dean of the Faculty of Medicine, Health and Biological Sciences

2003– 2004

Michael Arthur Dean of the Faculty of Medicine, Health and Life Sciences

Iain Cameron Dean of the Faculty of Medicine

2000– 2004– 2003 2010 Roger Briggs Dean of the Faculty of Medicine, Health and Biological Sciences

1995– 1998

2010– present

Eric Thomas Head of the School of Medicine

David Williams Dean of the Faculty of Medicine, Health and Life Sciences

Heads of School

2001– 2004

Chris Thompson Head of the School of Medicine

1998– 2001

Michael Arthur Head of the School of Medicine

2004– 2010

Iain Cameron Head of the School of Medicine

BUILDING EXCELLENCE IN RESEARCH AND EDUCATION Establishing a centre of excellence in research had always been an ambition for the new medical school and by its 10th anniversary studies were being undertaken in 23 areas.

The Duke and Duchess of York visit Southampton General Hospital, 1987.

Left: Young participants in the medical school’s asthma research trials with Professor Jack Howell (back left). Above: Professor David Barker, who broke new ground with his theories on the developmental origins of adult disease.

The range of research being carried out within the medical school included studies into the role of diet in thrombosis and arterial disease, the contributing factors to unexpected infant deaths, the development of cyclosporine for preventing the rejection of transplanted kidneys, the impact of schizophrenia on families, and the use of lasers in cancer surgery.

academics to the school and enabling existing staff to rise through the ranks.

These young academics quickly found themselves in senior roles. Professor (later Sir) Eric Thomas says: “Essentially the faculty skipped a generation. In 1995 I found myself in charge of a medical school, at the age of 42, with Michael Arthur as my deputy with research responsibilities. Everybody in the A number of factors came into play in the late 1980s and early faculty was young and very research oriented, and they 1990s to invigorate the school’s research agenda. By this time weren’t shackled by any preconceived ideas.” the new curriculum was well established and the school was back on a sound economic footing thanks to the stewardship This time of renewal coincided with the appointment of a young and visionary Vice-Chancellor, Professor Howard of Barbara Clayton and Charles George – indeed research Newby, who empowered Thomas and his senior colleagues income had already started to grow during George’s first to make their own decisions and run the school as they felt deanship. By 1991/92 research grants, contracts and best. In addition, the NHS trust’s Chief Executive at the time, consultancies were contributing £6.7m to the school’s David Moss, was cognisant of the needs of the medical school finances. and of the value of the school to the trust. There was also a renewal of the academic team. Many of the founding academics reached retirement at around the same With a solid research foundation to build on, an empowering environment free from the constraints of tradition or time, bringing a new generation of research-active

hierarchy, and strong partnerships with clinical colleagues, this talented, ambitious team was ready to take the medical school to the next level. Administrative support Smooth operational running is vital to the success of any organisation, and the medical school was no exception. During this period the academic team was supported by dedicated and skilled administrators, including Senior Assistant Registrar Sheila Mooney and her successor, Janine Morris. Brian Moody, the faculty accountant, also became a crucial member of the team.

Developing research strengths When Colin Normand became Dean in 1990, one of his first actions was to establish a strategy committee to advise on the school’s research direction and priorities. Initially chaired by David Barker, Professor of Clinical Epidemiology, and later by Eric Thomas, it took the approach of investing in the school’s strengths, focusing on fields with an existing national or international standing.

The new generation of senior academics The senior academic team in the early 1990s included Professors Chris Thompson (psychiatry), Roger Briggs (geriatric medicine), John Warner (paediatrics), Michael Arthur (medicine), Ann Louise Kinmonth (primary care), John Primrose (surgery) and Eric Thomas (obstetrics and gynaecology). John Warner and Ann Louise Kinmonth went on to take up senior academic posts at Imperial College London and at the University of Cambridge respectively. John Primrose joined Southampton in 1994 and continues to lead an academic group that undertakes translational laboratory oncology and large-scale randomised trials. His clinical interest is in cancer, particularly hepatobiliary (HPB) cancer. Under his leadership Southampton has become a renowned tertiary referral centre for HPB cancer and one of the country’s foremost centres for training current and future clinical academic surgeons.

Michael Arthur, who was the school’s research coordinator from 1995 to 1998, explains: “We realised we couldn’t be fantastic at everything, so we decided that we were going to be world-class in a few things. Eventually, we reorganised our research groupings into multidisciplinary divisions rather than clinical disciplines to boost the profile of the research, particularly for the Research Assessment Exercise, while making sure this didn’t have an adverse effect on our excellent medical education.” The strategy resulted in a focus on areas of excellence including the fetal origins of adult disease, immunopharmacology (particularly relating to the lungs and liver), cancer research, nutrition and public health. Many of these areas evolved from the school’s earliest days and are fields for which Southampton has a global reputation today.

Epidemiology and the developmental origins of adult disease The 1990s saw groundbreaking research into the link between adult health problems and experiences in the earliest stages of life, led by Professor David Barker of the MRC Environmental Epidemiology Unit.

lymphoma around the nuclear processing plant at Sellafield. By the late 1980s these studies, led by Gardner, had shown a link between paternal exposure to radiation and a higher risk of developing these diseases.

When Acheson left the MRC Unit in 1983 to become Chief Medical Officer the work on occupational health hazards was continued by teams led by Gardner and Professor David The Unit itself was founded in 1979, when the MRC invited Donald Acheson to set up a new environmental epidemiology Coggon. For some time the main focus continued to be industry-related carcinogens, with studies conducted on unit to investigate “any subject you care to choose and in workers exposed to various substances including association with any university within the United Kingdom formaldehyde, man-made mineral fibres, phenoxyl acid you consider appropriate”. This extraordinary invitation herbicides, styrene, ethylene oxide and mineral acid mists. In was an acknowledgement not only of Acheson’s track many cases the results were pooled with findings from similar record of research into occupational medicine, but of his studies in other countries, coordinated by the International great talent for making things happen and bringing the Agency for Research on Cancer, allowing more robust right people together. conclusions to be drawn. For Acheson, the decision about where to locate the Unit was In the early 1990s, the Unit was contracted to carry out a new obvious – an outstanding team was already in place at national analysis of occupational mortality for the Health and Southampton and he knew the University and the region Safety Executive and the Office of Population Censuses and would welcome the MRC’s presence. The focus of the work Surveys. Such analyses are performed approximately every was also clear. The Unit would continue the areas of 10 years, and findings from earlier periods had suggested investigation in which Acheson and his colleague David unusually high death rates from pneumonia in welders. The Barker were already engaged – occupational health hazards new investigation not only confirmed this, but also showed and the geographical pattern of diseases such as coronary that the high risks extended to other occupations involving heart disease and diabetes. exposure to metal fumes, such as foundry work. The findings pointed strongly to a short-term, reversible increase in Health hazards in the workplace susceptibility to pneumonic infection, providing a basis for Acheson had already made an impact in his field; at the later research to understand the biological processes that University of Oxford he was the first to establish the hazard of sinonasal cancer in furniture makers (hardwood dust) and underlie the hazard. in boot and shoe manufacturers (dust from vegetabletanned leather). His work at the MRC Unit included important epidemiological research on known and suspected occupational causes of cancer, and his work with medical statistician Professor Martin Gardner on the health risks of asbestos led to the introduction of new safety standards and a ban on the import of blue and brown asbestos. The Unit also investigated incidences of childhood leukaemia and

Early origins of disease The second stream of research at the MRC Unit was led by David Barker. A clinical epidemiologist, Barker came to the medical school in 1972 as a physician in Acheson’s team at the Royal South Hants Hospital and went on to become a Fellow of the Royal Society (FRS) and one of the most influential epidemiologists of his time.

Professor Colin Normand (1928–2011) Dean of the Faculty of Medicine, 1990–1993 Appointed in 1970, Colin Normand was the medical school’s first Professor of Child Health. He won a scholarship to study physiology at the University of Oxford and qualified at St Mary’s Hospital in 1952, working at University College Hospital before joining the team at Southampton. There he built a well-respected, stimulating and harmonious paediatrics department. He was heavily involved in designing the new curriculum, particularly as part of the team developing the fourth-year study in depth, and he promoted the use of regional centres for clinical teaching in paediatrics. Over the years he became active in many aspects of university administration and his facilitatory style meant his skills as a chairman were sought after. Normand also made a substantial contribution to respiratory physiology research. During a year’s fellowship at Johns Hopkins Hospital in Baltimore he worked on lung surfactant, an area of research he continued at Southampton.

Celebrating 25 years In 1996 the medical school celebrated its 25th anniversary. It hosted a series of events including keynote lectures by eminent figures from public life, health and science, such as Baroness Jay, Anthony Clare and Lewis Wolpert. Students and alumni enjoyed an anniversary ball and even a staff and student bed race. In the same year another eminent speaker came to Southampton. The Fourth Year Day, during which students presented their research projects to their peers and academics, had become an annual tradition, and it had become customary for the students to invite an external speaker to give a lunchtime address. In their choice of invitee that year, the school’s students showed they were just as capable of ambitious thinking as the academics. Eric Thomas recalls: “The students wrote to James Watson, Nobel Laureate and discoverer of the molecular structure of DNA, and he wrote back to say yes, he happened to be in the UK and would come along. Suddenly they had the most famous scientist on the planet coming to campus! It demonstrates the type of students that we were attracting because of the nature of our course.”

School or faculty? Originally known as the Faculty of Medicine, in 1995 a University restructure saw the medical school become the School of Medicine, part of an integrated Faculty of Medicine, Health and Biological Sciences (known from 2003/04 as the Faculty of Medicine, Health and Life Sciences). In 2010 it became the Faculty of Medicine once again, when the University reverted to a flatter organisational structure.

Barker joined the MRC Unit as Professor of Clinical Epidemiology and became its Director in 1984, a year after the opening of purpose-built premises on the Southampton General Hospital site. Barker’s interest was in the geography of disease, in particular non-communicable disorders such as heart disease, high blood pressure, diabetes and stroke. The Unit had undertaken detailed mapping of mortality in England and Wales, and Barker noticed strong geographical correlations between contemporary incidences of chronic disease and infant mortality in 1910.

older age. He worked closely on these studies, and throughout his career, with Professor Clive Osmond, who joined the Unit in 1981 and is now MRC Senior Scientist and Professor of Biostatistics. The work spanned disciplines, with Barker teaming up with Professor Alan Jackson of the Institute of Human Nutrition and with specialists in child health and obstetrics to explore the connection between early life experiences and disease in older age. The scope of the Unit’s research broadened when Professor Cyrus Cooper came on board in 1992 as consultant and senior lecturer. Cooper had been a research fellow at the Unit in the early 1980s, when he completed a dissertation on hip fractures in older people. When he returned in 1992 he was recognised as an authority in the epidemiology of osteoporosis, and his interest in musculoskeletal ageing complemented Barker’s expertise in cardiovascular and metabolic disease.

This observation led to the development of what became known as the ‘Barker hypothesis’ – the idea that health problems in adulthood are ‘programmed’ during fetal development and early infancy, with the implication that this could be prevented through improved maternal wellbeing, health and nutrition. Controversial at the time, it was a paradigm shift in thinking about the causes of diabetes, cardiovascular disease and cancer, challenging the notion that they could be explained by a combination of genetics and Having studied the patterns and frequency of fractures, risk factors and the effectiveness of prevention strategies, at the unhealthy adult lifestyles. MRC Unit Cooper turned his attention to the early origins of osteoporosis. Over the next decade he demonstrated that This hypothesis opened up a new field of research, now widely referred to as the developmental origins of health and there was a developmental contribution to osteoporosis, that low birth weight was a risk factor for poorer skeletal disease (DOHaD), and provided a focus for the MRC Unit’s health in later life, and that a mother’s diet, physical build and work that continues today. the amount of exercise she took influenced the growth of her To test his theory, Barker was able to take advantage of the baby’s skeleton. scrupulous record keeping of midwives and health visitors The establishment of key study cohorts during the 1980s and earlier in the century. In a seminal study, published in The Lancet in 1989, he used the birth and early infancy records of 1990s was central to the Unit’s work. These included the Hertfordshire cohort mentioned above, which was set up in 5,654 men from Hertfordshire, born between 1911 and 1930, the mid 1980s, and the Southampton Women’s Survey – the to demonstrate that those with the lowest weight at birth only study in Europe of women and their children for which and at the age of one year had the highest death rates from information about the mothers was obtained before they coronary heart disease decades later. conceived. Between 1998 and 2002 the survey team would Over the next 10 years, with colleagues in Cambridge, interview over 12,500 Southampton women aged between Helsinki, India and Amsterdam, he found more evidence that 20 and 34; those who became pregnant would be monitored linked birth and infant weight with conditions such as during pregnancy, with further data about the child collected cardiovascular disease, high blood pressure and diabetes in at birth and at regular intervals during their early life.

Developing strengths in cancer research Cancer immunology research was another important field to emerge during the early days of the medical school. This was largely due to the pioneering work of Professors Freda and George Stevenson. Their work was supported by cancer charity Tenovus, which, at a time when resources were scarce, funded a laboratory at Southampton General Hospital. The new lab was officially opened by Princess Margaret in 1971.

Feinstein on immunoglobulin M antibodies, before returning to Southampton in 1983 to take up a ‘new blood’ lectureship in cancer immunotherapy. By the mid 1990s, technological advances were enabling researchers to overcome some of the challenges inherent in this branch of research. New techniques enabled scientists to make monoclonal antibodies in limitless amounts, and, through protein engineering, it became possible to make antibodies that had the specificity required to recognise cancer and that would not be rejected by the human body.

George Stevenson came to Southampton from Oxford, where he had worked with Nobel prize-winning immunologist Rodney Porter. George’s wife Freda, also a talented researcher, joined him. The Stevensons’ work was based on the theory that it should be possible to attack cancer cells using the immune system’s antibodies, if the right target could be identified. They discovered that malignant B-cells (cancer cells) display a unique ‘marker’ protein called an idiotype. Because this marker is only present on cancer cells and not normal cells, it offered a precise location to be targeted by antibodies produced by the body’s natural immune system. This discovery was key to opening up the field of cancer immunotherapy.

The Southampton team continued to study how antibodies worked, why they were able to attack cancer cells, and how to harness that ability. Glennie says: “A big breakthrough came when we were able to show that certain antibody specificities, which we’d thought were reacting with cancer cells, were in fact activating the immune system. By this stage the immune system was known to have a role in recognising cancer as it developed. We found that certain antibodies reacted with cells in the immune system and could stimulate those cells to overreact to, and destroy, the cancer.”

Martin Glennie, who is now Professor of Immunochemistry and Head of the Antibody and Vaccine Group, embarked on a PhD with the Stevensons in the late 1970s, having completed a BSc at Southampton. His research investigated a problem in the therapeutic use of antibodies – that when they bind to a cancer cell they are internalised and broken up by the cell. In 1980 he moved to Cambridge to work with Professor Arnold

Freda Stevenson was also carrying out research that would make a significant contribution to the understanding and treatment of chronic lymphocytic leukaemia (CLL). By looking at the genetics of the immunoglobulin molecule on the CLL cell surface, she discovered two subsets of the disease – one in which the genes were mutated, and another

During this time, Freda Stevenson explored the possibility of inducing immunity against cancer cells. She designed Despite the limitations of the technology available at that ‘genetic vaccines’ which could be delivered to muscle cells time, their work yielded clinical results. Building on the and then immunise patients against the cancer. One Stevensons’ findings, researchers at Stanford Medical School important additive was a harmless piece of tetanus toxin that in the United States successfully treated a lymphoma patient overcame the immune tolerance against the co-delivered using monoclonal antibodies. George Stevenson was cancer antigen. These concepts have now been applied to a awarded a prestigious Armand Hammer Prize in 1982 in range of cancers by Professor Christian Ottensmeier and Dr recognition of this pioneering contribution. Natalia Savelyeva.

with unmutated genes. This observation was important because one subtype developed very slowly while the other was more aggressive. It led to a new ‘watch and wait’ approach to treatment, with many patients avoiding unnecessary treatments and their side effects. Another important figure in the school’s cancer research team, appointed in 1972, was Dennis Wright, Professor of Pathology. He had a special interest in lymphoma and, soon after his arrival at Southampton, received a major international award for his work in Uganda on Burkett’s lymphoma. The school was also investigating the potential of chemotherapy – then a relatively recent advance in cancer treatment. The medical oncology department was established by Professor Michael Whitehouse with funding from the Cancer Research Campaign (now Cancer Research UK) – the beginning of a longstanding partnership between the medical school and the charity. Respiratory research The school’s longstanding reputation for excellence in respiratory research has its origins in the work of Jack Howell. He was not only a pioneering educator but an influential figure in respiratory research, noted in particular for his work in the late 1960s on the asthma drug sodium cromoglycate. He took this interest forward at Southampton and built a strong research team, appointing Dr Richard Godfrey, Professor Anne Tattersfield and Professor Stephen Holgate to the University. Attracted by the research possibilities a new medical school might offer, Stephen Holgate came to Southampton in 1975 having trained in London at Charing Cross Hospital. After completing his general medical training as registrar on rotation at Salisbury and Southampton hospitals, he became a lecturer, helping to roll out the new respiratory systems course. Alongside this he worked on postgraduate research under Anne Tattersfield’s supervision.

“During the early to mid 1970s there was a rise in asthma deaths in England, Australia and New Zealand, which turned out to be due to the overuse of bronchodilator inhalers,” says Holgate. “My research related to trying to understand the mechanisms behind this, and I published papers showing that patients developed resistance to the drugs if they took them at a high dose. That helped to change the thinking on asthma, and the mechanisms of the condition became the focus for my work for the next 40 years.” Following a period of research at Harvard, Holgate returned to Southampton as a senior lecturer. He was encouraged by Barbara Clayton, who was Dean at that time, to apply for one of the MRC’s highly competitive clinical professorships, which would enable him to focus solely on research – this was successful and the MRC continued to fund his post throughout his career. Charles George, who at this time was Professor of Clinical Pharmacology, facilitated joint work between Holgate and Martin Church, a senior pharmacology lecturer who was interested in the drug actions related to allergy. They formed a fruitful partnership and started to build up a team of young researchers, including Peter Howarth, who is now Professor of Allergy and Respiratory Medicine at Southampton. “At the time most asthma research used animal model systems, because that’s how drugs were developed in those days,” Holgate explains. “We started working with people using ‘allergen challenges’ – the introduction of low concentrations of allergens to trigger patients’ asthma – to find out more about what was happening in their bodies.” The 1990s saw a number of important findings and the development of innovative research techniques, building the team’s reputation in the field. In the early 1990s, Holgate and clinical research fellow Dr Sebastian Johnson worked with Dr David Tyrell of the MRC Common Cold Unit in Salisbury to develop the first comprehensive gene-based test to detect respiratory viruses in secretions. Using this test, they went on

to show that viral infections – especially rhinoviruses – are a major cause of asthma attacks, stimulating a wave of research into new approaches for treating such exacerbations. The work was funded by the British Lung Foundation, and the charity’s patron, Princess Diana, visited the University to launch the study and meet schoolchildren who had been enrolled into the cohort. The team also developed a method for putting a bronchoscope into an asthmatic patient’s lungs to biopsy the airway, enabling the researchers to demonstrate for the first time that even mild cases of asthma caused considerable inflammation and tissue damage. This led to a further stream of studies looking at inflammation and asthma. “We were the first to explain how drugs like inhaled steroids worked in asthma by supressing this inflammation. The mechanisms that drove asthma in these susceptible patients were beginning to make sense,” says Holgate. The interdisciplinary asthma and allergy research team pioneered the first use of a monoclonal antibody treatment of severe allergic asthma that blocked the allergic trigger, immunoglobulin E, and subsequently led to the introduction of the first biologic for this disease, omalizumab. More breakthroughs followed; the team was the first to show that diesel pollution caused damage in the lungs, following this with work on other air pollutants such as ozone and nitrogen dioxide. This work, and the discovery of the first novel asthma susceptibility gene ADAM33, involved the modelling and remodelling of the airways in childhood and adult asthma, respectively. Much of this was made possible by an emerging culture of experimental medicine that was rapidly developing in the medical school at Southampton to promote carefully controlled studies on humans with common diseases. Holgate comments: “There was a tremendous facilitatory atmosphere in the new medical school; the pervading atmosphere was one of encouragement and excitement.

I was able to recruit bright young researchers from the UK and all over the world; like me they had been trained in a rather rigid system but at Southampton they were given the freedom to follow their interests, and innovation happened as a result.” Understanding genetics In the late 1980s two internationally renowned genetics researchers (and another husband and wife team) arrived at Southampton and laid the foundations for the medical school’s outstanding research in this field today. Professor Newton Morton, an American scientist recognised as one of the founders of genetic epidemiology, had developed LOD (logarithm of the odds) scores for gene linkage analysis, providing the basis for thousands of studies that have identified human disease genes. He established a genetic epidemiology group at Southampton, now led by Professor Andrew Collins, that continues to conduct breakthrough research in this field. Professor Patricia Jacobs OBE, widely known as ‘the mother of cytogenetics’, made one of the first observations of a human chromosome abnormality in 1959 – the additional X chromosome in Klinefelter’s syndrome. She came to Southampton via the University of Hawaii and Cornell University, becoming Director of the Wessex Regional Genetics Laboratory and Honorary Professor of Human Genetics. “Her reputation as a pioneer in this area of research, combined with her dynamic and inspirational leadership, enabled Jacobs to draw together a talented group of scientists and clinicians that has made significant contributions to our understanding of the genome today,” says Karen Temple, Professor of Medical Genetics. Jacobs has been elected a Fellow of the Royal Society and received numerous awards in recognition of her work.

Above: Renowned geneticists Professor Patricia Jacobs and Professor Newton Morton. Left: Professor Stephen Holgate (right) receives an award from Johnson & Johnson for his team’s pioneering use of a fibre optic bronchoscope to study the airways of asthmatic patients. With Peter Howarth, now Professor of Allergy and Respiratory Medicine at Southampton (centre), and Dr Michael Emmanuel (left).

Primary care An early flagship research project in primary care, led by Professor John Forbes, was a major scheme to deliver ‘age-specific’ primary care. This explored the idea that, as medicine became more complex, primary care should be delivered by specialist paediatricians, geriatricians and ‘mediatricians’. By 1976 this study was well underway, supported by an innovative computerised clinical record system at the Aldermoor practice. Unfortunately Forbes had to retire early due to ill health, and staffing issues hampered the group’s development from the mid 1970s. However, the appointment of Professor John Bain in 1980, and subsequent academic appointments including Ann Louise Kinmonth, Roger Jones and Ian Gregg, led to a renewed research agenda focusing on common and chronic conditions including diabetes, cardiovascular disease and gastrointestinal disorders. Another significant figure in Southampton’s primary care research, Paul Little (currently Professor of Primary Care

Research), became the first GP to be awarded a Wellcome Health Services Research Training Fellowship (1993–1997, for health promotion research) and the first to be awarded an MRC Clinician Scientist Fellowship (1998–2003, for research on common self-limiting illness).

Educational developments As well as establishing a thriving research environment, the medical school continued to review, improve and expand its educational offering. In 1990 the go-ahead was given for an integrated degree for physiotherapists and occupational therapists; the first cohort began in 1993. Also in 1990, an intercalated BSc course was agreed in principle, which would enable students to take a year out of their medical training to study a subject in greater depth. Following a decision to broaden health professional training as part of the University’s expansion, in 1995 the Faculty of Medicine became part of the Faculty of Medicine, Health and Biological Sciences. The new faculty encompassed the

schools of medicine, nursing, occupational therapy and physiotherapy, and biological sciences. The move reflected increased recognition of the multidisciplinary nature of health teams. Employing 800 staff, the faculty became the University’s largest budgetary group. Charles George, who began his second term as Dean in 1993, says: “Part of my role during this period related to getting this big new faculty into being and working harmoniously across the four schools. We had brought the former NHS school of nursing and midwifery into the faculty, with a single intake every year rather than the NHS’s traditional two. And the school of occupational therapy and physiotherapy was maturing but being scrutinised by the various regulatory bodies.” By 1999 the annual intake for the medical degree course was 157; the following year this would increase by 24 and further expansion would follow.

Sir Eric Thomas Head of the School of Medicine, 1995–1998 Dean of the Faculty of Medicine, Health and Biological Sciences, 1998–2000 Eric Thomas completed his medical degree at Newcastle University in 1976 and trained as an obstetrician and gynaecologist, going on to work at the universities of Sheffield and Newcastle. He joined the Southampton team in 1991 as Professor of Obstetrics and Gynaecology and went on to various leadership roles within the medical school. Thomas left Southampton to take up the role of Vice-Chancellor of the University of Bristol, where he remained until 2015. His many other responsibilities have included Chair of the Worldwide Universities Network, President of Universities UK and Chair of the board of CASE Europe. He was knighted in 2013 for services to higher education.

Recognition of quality Several significant achievements during the 1990s and early 2000s confirmed Southampton’s position among the country’s top medical schools. Its curriculum had made the transition from radical experiment to exemplar, supported by teaching and research of the highest standard. Tomorrow’s Doctors In the early 1990s, the GMC established a working party to review its guidance on medical education. This was an opportunity to resolve some of the problems with the traditional curriculum that the Southampton founders had already grappled with. One of the working party members was Charles George, and another curriculum innovator, Professor David Shaw of the University of Newcastle, chaired the group.

Between them, George and Shaw successfully convinced the rest of the group of the merit of their universities’ approaches and the new guidance, Tomorrow’s Doctors, published in 1993, represented a major change in the culture and content of medical education. It put attitudes and behaviours on an equal footing with knowledge and skills, reduced the burden of factual learning and endorsed early clinical contact and an integrated systems approach. It also placed emphasis on small-group learning and reflective practice, and suggested that courses should include an opportunity for in-depth research. Another development was the introduction of visits to medical schools to ensure that these new approaches were incorporated into curricula countrywide. Succeeding Shaw as Chair of the GMC Education Committee in 1995, George became responsible for ensuring the adoption of the Tomorrow’s Doctors principles. When a new medical school was established in Brighton in 1997, it was invited by the GMC to base its new curriculum on Southampton’s. The Southampton model had become a benchmark of best practice in medical education.

London medical schools, nor those at Oxford or Cambridge, received a top score. The result was testament to the vision of the school’s founders and their innovative curriculum design, the ongoing commitment of the academics who followed and the scientific rigour that underpinned the Southampton course. Soon after the announcement, Dr Gavin Millar, the school’s education lead, wrote in the school’s Medical Education Newsletter: “This result reflects not just the efforts of a few key people, but the overall excellence and commitment of a huge number over a sustained period. “What does it mean? It doesn’t mean more money. It doesn’t mean more students. It does mean recognition of quality within UK medical schools, and also within our own University. It certainly reinforces the excellent results of the last Research Assessment Exercise in projecting the school as right at the forefront of medical schools in this country, and that means high on the global scale. That will not be lost on top-class teachers and researchers developing a career in academic medicine or medical sciences, nor on potential students with ambitions to graduate from the best possible institution.”

Quality Assurance Agency assessment In 1999, the school’s teaching was reviewed by the Quality Assurance Agency (QAA), an independent national body charged with monitoring standards and quality in higher education. Michael Arthur remembers: “The review was a huge exercise that took over a week, involving 150 box files of evidence and a thorough interrogation of the course. Scores were given in six areas of the curriculum, covering the approach, the facilities and so on. Our goal was to get the maximum score of 24 – four out of four in all six areas.”

Research bid success

Evidence of the effectiveness of the school’s research strategy came in 1999 when Southampton was awarded a £5m Wellcome Trust Millennial Clinical Research Facility award – one of just five successful applicants from a field of 31. The funds would pay for a building at Southampton General Hospital including space for 12 inpatients, eight outpatients and a fully equipped clinical investigation area. The award demonstrated the strength of the partnership between the University and the local health service (by then The medical school achieved full marks in every category, known as the Southampton University Hospitals NHS Trust). one of only four in the country to do so. “It was very dramatic, It also vastly enhanced the ability of researchers to translate because the QAA panel revealed the score in front of a laboratory findings into medical practice for real-world packed lecture theatre,” says Arthur. “The place erupted!” benefit – an aspect of medicine in which Southampton had The success was sweetened by the fact that none of the taken a lead.

The medical schoolâ&#x20AC;&#x2122;s reputation for research excellence grew during the 1990s, enabling it to attract funding from a range of partners.

Located in the heart of University Hospital Southampton is the dedicated NIHR Wellcome Trust Clinical Research Facility which provides a superb clinical environment, cutting-edge equipment and specialist early phase trial expertise.

The bid had been put together by Michael Arthur and Eric Thomas, the ground having been prepared by earlier discussions between Charles George and NHS colleagues about a possible pharma-funded clinical research unit. With Peter Lees, the hospital trust’s medical director, Arthur and Thomas had visited clinical research facilities in Manhattan to inform their application. Thomas recalls: “When we returned, we got the team together and said, ‘We can do this.’ Perhaps 10 years earlier there would have been an acceptance that a grant like this was bound to go to Oxford or Cambridge or London. But since then there had been a change of attitude, and, without the burden of hierarchy and history, we felt we could achieve anything.” “The Wellcome Trust grant made us realise we were in the ‘big time’,” adds Arthur. “Getting recognition at a national level, and knowing that we had been successful when other very prestigious universities hadn’t, really built our confidence.”

A new hub for cancer research Another significant success came in 1999, when the school was awarded funding for the Somers Cancer Research Centre – the first new building in the medical school for around 20 years. The grant was made, following a national competitive process, by the Wellcome Trust and Higher Education Funding Council for England Joint Infrastructure Fund. The project received additional support from the Cancer Research Campaign and a philanthropic donation from Mrs (later Dame) Phyllis Somers, after whom the building is named. The new Centre transformed the breadth and quality of cancer research at Southampton, laying the foundations of the school’s subsequent successes in this field and beginning the process of changing the front of the Southampton General Hospital campus into an important concentration of new research facilities.

Research Assessment Exercise 2001 Further endorsement of the school’s research came in 2001 when it was highly rated in the Research Assessment Exercise, particularly for clinical laboratory sciences, hospital-based clinical subjects and biological sciences. Arthur comments: “The senior team had contributed to creating a medical school that now had a reputation for being excellent in both teaching and research, which fuelled our recruitment of excellent academics and students. So those were very big moments and things I’m incredibly proud of.”

Professor Michael Arthur Head of the School of Medicine, 1998–2001 Dean of the Faculty of Medicine, Health and Life Sciences, 2003–2004 A Southampton alumnus, Michael Arthur was among the second intake of students to complete the new medical degree and graduated in 1977. (He also met his wife in the second year when they were assigned to the same clinical group.) Following postgraduate studies, also at Southampton, he joined the academic team, progressing to the role of Professor of Medicine by 1992. Arthur’s research interests in the field of hepatology were developed during a Fogarty fellowship at the University of California (1986–1988) and later at Mount Sinai School of Medicine in New York, where he was a Fulbright Distinguished Scholar (2002–2003). He was awarded the Linacre medal of the Royal College of Physicians in 1994 and became a Fellow of the Academy of Medical Sciences in 1998. In 2004 Arthur became Vice-Chancellor of the University of Leeds, and in 2013 joined University College London as President and Provost, the first clinical academic to hold this position in the University’s history. He has also been Chair of both the Worldwide Universities Network and the Russell Group.

OUR ALUMNI

Since welcoming its first cohort of 40 students in 1971, the medical school has trained thousands of doctors who have gone on to make a huge impact on medicine and healthcare around the world.

1979

1980

Dr Chaitanya (Chai) Patel Chairman, HC-One

Professor Sir Peng Tee Khaw Director, NIHR Moorfields Biomedical Research Centre; Professor of Glaucoma Studies and Wound Healing, University College London

Entering his fourth decade in health and business, Dr Chai Patel is one of the UK’s most prolific serial entrepreneurs, investors and philanthropists. In 2011, with the UK’s largest care home provider, Southern Cross Healthcare, on the brink of collapse, he formed HC-One to rescue a third of the Southern Cross homes. The move saved the homes of over 10,000 residents, as well as the jobs of 14,000 Southern Cross employees. Since this time, he has led the HC-One team to invest millions in a mission to drive up standards across homes. His co-owned private equity business, Elysian Capital, recently closed its second major fundraising round – a £250m fund aiming to invest in a range of British businesses. Alongside his work in health and social care, Patel was Chairman of the ‘Enemy Within Appeal’, which raised £33m for the veterans’ mental health charity Combat Stress. He has also directly donated over £4.6m to good causes around the world through The Bright Future Trust, his family charity, and contributed significantly to numerous other charities.

Professor Sir Peng Tee Khaw is one of the UK’s leading eye specialists and has developed surgical techniques for glaucoma that have been adopted worldwide. He has raised more than £100m for research and buildings including funding for the world’s largest children’s eye hospital and translational research clinical centre.

1985 Dr Ros Tolcher Chief Executive, Harrogate and District NHS Foundation Trust Dr Ros Tolcher undertook the first part of a GP training rotation before a spell living overseas. On returning to the UK in 1991 she started working in community services, later becoming a consultant in sexual health, Clinical Director of Sexual Health Services in Southampton and Medical Director of Southampton City Primary Care Trust. She led the creation of Solent NHS Trust, becoming its first Chief Executive when it was legally established in 2011. In 2014 she became Chief Executive at Harrogate and District NHS Foundation Trust.

1985

1988

Professor John Iredale Pro Vice-Chancellor Health, University of Bristol

Professor Margaret Ip Department of Microbiology, Chinese University of Hong Kong

Professor John Iredale took up the role of Pro Vice-Chancellor Health at Bristol in 2016, having been Regius Professor of Medical Science and Professor of Medicine, Dean of the medical school and Vice-Principal (Health Services) at the University of Edinburgh. A recognised leader in the area of inflammation research, he was formerly Director of Edinburgh’s MRC Centre for Inflammation Research. He has been elected to Fellowship of the Academy of Medical Sciences and is a Fellow of the Royal Society of Edinburgh.

Professor Margaret Ip is a clinical microbiologist with research interests in the epidemiology and antimicrobial resistance of pathogens such as Streptococcus pneumoniae, MRSA and Group B streptococcus. She is an Honorary Consultant in Microbiology at the Prince of Wales Hospital, Hong Kong. She contributes to key scientific committees locally and internationally, publishes widely, and is associate editor of a number of international peer-reviewed journals.

“I have to say I relished my time at medical school. The Southampton course suited me perfectly. While I probably should have spent more time studying and less on the medics revue and other social activities (I learnt after graduation from the then Dean that we had a reputation as a very active year socially), I wouldn’t have had it any other way.”

1989

1991

Professor Jane Lucas Professor of Paediatric Medicine, University of Southampton

Professor Karen Walker-Bone Professor of Occupational Rheumatology, University of Southampton; Director, Arthritis Research UK-MRC Centre for Musculoskeletal Health and Work

A specialist in paediatric respiratory medicine, Professor Jane Lucas established, and runs, the national primary ciliary dyskinesia (PCD) diagnostic laboratories and clinics in Southampton. She started her career in clinical paediatrics before undertaking specialist training in paediatric allergy and chest medicine. She returned to Southampton in 2002 to conduct further research in this area, graduating with a PhD in 2006. In 2012 she obtained major funding for a service to look after children with the disease. Her research focuses on improving the diagnosis and treatment of PCD. She chairs the PCD European Taskforce and BEAT-PCD, a global network of over 200 PCD researchers and clinicians.

Professor Karen Walker-Bone is a rheumatology specialist whose work has received national and international recognition. Before taking up her role at Southampton she was Clinical Academic Sub-Dean at the newly established Brighton and Sussex Medical School (which adopted a curriculum based closely on the Southampton model). She sub-specialises in occupational rheumatology and rheumatic manifestations of people infected with HIV.

Dr Mickey Chopra Global Solutions Lead for Service Delivery, World Bank Dr Mickey Chopra is responsible for taking forward the World Bank’s work on optimising service delivery and models of care for efficient and equitable outcomes. Before joining the World Bank he was Chief of Health and Associate Director of Programmes at UNICEF, leading the agency’s work in maternal, newborn and child health, immunisation, and paediatric HIV/AIDS. “I was lucky to be one of the first to take advantage of doing an intercalated degree in the Faculty of Social Sciences. It really changed my perspective. Also nice to get away from Boldrewood for a year!”

1992

1998

Mr Paul Grundy Lead Neuro-oncology Clinician, Wessex Neurological Centre, University Hospital Southampton

Dr Guy Fordham Army Medical Corps

Mr Paul Grundy leads the surgical neurooncology practice at University Hospital Southampton (UHS). He introduced day-case neurosurgery for brain tumours to the UK and performs high volumes of neuro-oncology surgery, including large numbers of awake operations (for tumours in vital regions of the brain). He also leads and manages regional and specialised services at UHS in his role as Divisional Clinical Director. He was awarded the Health Service Journal’s prestigious Clinical Leader of the Year award in 2012 and in 2013 was named one of the UK’s top 100 most influential medical leaders. He has also been the national lead for brain and central nervous system tumours for NHS England’s Clinical Reference Group (CRG) since 2013 and continues to work in both the cancer surgery CRG and the neurosciences CRG. In 2016 he became secretary of the British Neuro-Oncology Society.

An international hockey player, Dr Guy Fordham amassed a total of 87 England caps and 84 GB caps during his sporting career. He competed in the 2000 and 2004 Olympics in Sydney and Athens, and won a bronze medal in the 1998 Commonwealth Games in Kuala Lumpur. Having completed general practice training he is now in the Army Medical Corps, where he continues to play and coach. “The academic format of the course at Southampton allowed me to thrive and has stood me in great stead throughout my medical career. In addition, the Faculty of Medicine was hugely supportive towards me as an international hockey player while still an undergraduate. Overall, I owe the Faculty a huge debt of thanks.”

“I was inspired into a career in neurosurgery by the exceptional teaching during the nervous system course at the beginning of the second year at Southampton, and have never looked back.”

CONSOLIDATING SUCCESS The early 2000s saw a new chapter in the medical schoolâ&#x20AC;&#x2122;s leadership. Eric Thomas stepped down as Dean in 2000 and became Vice-Chancellor of the University of Bristol. Michael Arthur, who became Dean in 2003, also went on to prestigious new roles, first as Vice-Chancellor of the University of Leeds, and then as President and Provost of University College London.

In 2008 funding was awarded for two National Institute for Health Research Biomedical Research Units, enhancing the schoolâ&#x20AC;&#x2122;s capacity for translational medicine. The unit dedicated to respiratory medicine is headed by Professor Ratko Djukanovic (pictured).

Professor Chris Thompson Head of the School of Medicine, 2001–2004 Chris Thompson studied medicine and psychology at University College London, then trained as a psychiatrist at the Institute of Psychiatry (now part of King’s College London) where he held a Wellcome Trust Research Fellowship. He published many papers on biological abnormalities in severe depression and won the Gold Medal of the Royal College of Psychiatrists in 1983. From 1984 he undertook pioneering research into seasonal affective disorder while he was a senior lecturer at Charing Cross Hospital Medical School, joining the Southampton team as Professor of Psychiatry in 1988. He built an internationally respected education and research centre, with particular strengths in interdisciplinary collaboration, especially with primary care, in which he led studies designed to improve the treatment of depression. He also served as Registrar and Vice-President of the Royal College of Psychiatrists and was Founding President of the International Society for Affective Disorders. He was awarded an honorary fellowship by the Royal College of Physicians and an honorary membership by the Royal College of General Practitioners. In 2004 he left the University to join the board of Priory Group as Chief Medical Officer. The company was the largest independent sector provider of mental health, learning disability and special needs education services in the UK, providing services largely to the public sector. He spent 10 years in this role before founding a healthcare management consultancy and retiring in 2016.

Taking up the baton as Head of the School of Medicine was Professor Chris Thompson, followed by Professor Iain Cameron, who became head of the medical school in 2004. Cameron was later appointed Dean when medicine once again became a faculty in its own right, following a University reorganisation in 2010. There had been further renewal of the clinical team from the late 1990s. By 2010 the academic leads of the original clinical specialties included Professors Robert Peveler, then David Baldwin (psychiatry), Avan Aihie Sayer, who went on to lead the Newcastle National Institute for Health Research Biomedical Research Centre (elderly care), Howard Clark (child health), John Iredale then Ratko Djukanovic (medicine), Tony Kendrick, then Mike Thomas and Michael Moore (general practice), John Primrose (surgery) and Nick Macklon (obstetrics and gynaecology). Cameron had joined the school in 1999 as Professor of Obstetrics and Gynaecology. “I joined Southampton to work with David Barker’s group looking at the developmental origins of adult disease – that was a real draw for me,” he says. “Having trained and worked in more traditional universities, including Edinburgh, Cambridge and Glasgow, I was also attracted by the ‘can-do’ attitude at Southampton. There was a sense that, rather than living on past reputation, the school was forging ahead and creating its own reputation. The sense of collegiality appealed to me too. People were – and still are – keen to work together to achieve their aims.” Cameron’s aim was to build on the successes of his predecessors. “Together, Michael Arthur and Eric Thomas created a step change in the way we were perceived in terms of our education and our research. I wanted to maintain that momentum and build on it,” he says. He set out to strengthen the school’s medical training and its fields of research excellence, and to ensure discoveries generated impact through translational medicine and partnerships with the NHS and industry.

In line with the wider University strategy, he also placed increased emphasis on cross-disciplinary research, creating an environment in which academics from medicine could team up with colleagues in other disciplines to tackle key health challenges. One successful example was collaborative work on bone and cartilage tissue engineering to promote healing in complex bone fractures, conducted by medical and engineering researchers at the University. Another area of collaboration was with Health Sciences, which became a faculty in its own right following the 2010 University reorganisation. “The delivery of healthcare is by its nature multidisciplinary, with different professions bringing different skills and knowledge that are all vital to the team,” explains Cameron. “Our researchers and educators work closely with those in Health Sciences, taking advantage of the fact that we’re one of a few Russell Group universities with leading programmes in medicine, nursing and the allied health professions.”

Continuing research success Epidemiology through the lifecourse While the identity of the MRC Environmental Epidemiology Unit changed during the 2000s – it became the MRC Epidemiology Resource Centre in 2003 and is now the MRC Lifecourse Epidemiology University Unit – it remained at the forefront of research related to the developmental origins of adult diseases and health conditions. David Barker had revolutionised thinking about the origins of good health and continued to inspire debate and innovation among the global research community. The World Congress on Developmental Origins of Health and Disease became an annual event, meeting in countries including India, Australia and South Africa, and Barker’s work was acknowledged with numerous awards and honours.

Barker retired in 2003, although he continued to work with the Unit and expound his theories; he spoke about his work at an event to celebrate the MRC’s 100th anniversary just weeks before his death in 2013. He had published more than 500 research papers and 10 books, as well as working with the BBC Horizon team on a documentary, broadcast in 2011, to bring the developmental origins concept to a wider audience. Cyrus Cooper was appointed as Director following Barker’s retirement, and the Unit’s work continues to expand and flourish under his leadership. Its work now falls into two major themes – musculoskeletal ageing, including research into osteoporosis and sarcopenia (age-related muscle loss), and metabolic ageing, which includes studies looking at cardiovascular disease, type 2 diabetes and obesity. Cohort studies Researchers continued to gather data from the Southampton Women’s Survey cohort, the pivotal study established in 1998. Over 3,000 women from the cohort became pregnant and were monitored during pregnancy. Their children were followed up at birth, at six months, and then at regular intervals during their childhood; the team of research nurses is now conducting visits to 12- and 13-yearold children. The result is a bank of information about the children’s development, including their bone density and fat and muscle mass, grip strength, lung function and cardiovascular structure. The survey data have helped to define areas for further study, such as the Maternal Vitamin D Osteoporosis Study (MAVIDOS), one of the first human clinical trials to test the early life origins hypothesis. In 2008 MAVIDOS recruited 1,000 women in early pregnancy to find out whether the children of those who took vitamin D supplements in pregnancy had higher bone mass at birth than those who didn’t. The results, published in 2016 in The Lancet, showed that babies born in winter to mothers who had taken the supplement showed a marked improvement in bone density.

Established in 2008, LifeLab aims to help young people understand the science behind health issues and to encourage them to make healthier life choices.

“Our current research is looking at the mechanism of that relationship,” says Cooper. “We’re looking at the epigenetic (DNA methylation) changes that alter the vitamin D axis according to the vitamin D status of the mum during critical periods of development. Further down the line this could enable the development of targeted interventions for those at greater genetic risk of poor bone health.”

Again, this study will generate a rich ‘biobank’ of biological samples that will be collected throughout the trial to answer important questions about how to provide babies with the best start in life. Influencing attitudes to health

As well as providing a focus for clinical interventions, the Unit’s findings informed the development of interventions Another study investigating maternal nutrition began in 2015. that aim to encourage women and young people to improve NiPPeR (Nutritional Intervention Preconception and during their own health – and in turn the health of future Pregnancy to maintain healthy glucosE levels and offspRing generations. The Southampton Initiative for Health was one health) is looking into the effects of a specially formulated such study, run in collaboration with Southampton City nutritional supplement, taken before and during pregnancy, Council and Southampton Primary Care Trust and delivered on the health of both mother and baby. The study is being led through Sure Start centres in Hampshire. It showed that by the EpiGen Global Research Consortium, of which the training Sure Start staff using a specially designed ‘healthy MRC Unit is a member, enabling participants to be recruited conversations skills’ programme gave them confidence to in Southampton, Singapore and Auckland in New Zealand. It have more productive conversations with parents about diet will look at how the supplements help to maintain healthy and lifestyle choices. levels of blood sugar, vitamins and minerals in the mother, and how diet may influence changes in the baby’s genes that A health literacy initiative, LifeLab, was established in 2008 could impact on their future health. and continues to thrive today. It was designed to teach young

people about the link between lifestyle and health through a hands-on educational package, demonstrating the impact of their choices on their own health and on the health of their future children. To date more than 1,000 school children aged around 14 years from across the Hampshire region have taken part in classroom activities and visited the LifeLab laboratory on campus. Renowned fertility scientist, author and television presenter Professor Lord Robert Winston visited LifeLab in 2011 and was impressed by the experiments he saw, which involved young volunteers using the latest ultrasound, body fat and muscle strength testing equipment and learning about how their diet can affect their DNA. The initiative has been evaluated to monitor its impact, with feedback showing that participants were more aware of the need for healthy eating than counterparts who didn’t take part. It also boosted participants’ interest in considering a future career in medicine, health or science. Further breakthroughs in cancer immunology The medical school built on its reputation for cancer immunology research, continuing to study the structure and function of antibodies, develop new therapeutic treatments and translate them into clinical practice. Work at Southampton, and similar studies in the United States and other research centres worldwide, led to the identification of a group of antibodies called checkpoint blockers. Martin Glennie explains: “We know now that as cancers grow they may be recognised by the immune system and destroyed, or they may find they can supress the immune system. As the cancer grows, the immune system becomes exhausted and loses its effectiveness. These checkpoint blockers essentially switch the immune system back on.” This discovery led to further work to find out more about how those types of antibodies work and how they could be improved, and a successful antibody production programme

“What drew me to Southampton in the late 1990s was the discovery science work that Freda Stevenson and Martin Glennie were doing in immunology. I knew that if I came here we would be able to put together exciting programmes to turn that science into developments in the clinic. Southampton has been a fantastic environment for doing that because it’s a very collaborative medical school, where people enjoy working together to do the difficult work of taking discovery science into clinical application. It has a unique atmosphere of collaborative endeavour.” Peter Johnson Professor of Medical Oncology

“The fantastic thing about Southampton is that you can come up with an idea or observation, develop it in the lab, and then translate it into patients, all on the same site.” Martin Glennie Professor of Immunochemistry

Genomics began to play an increasingly important role within the school’s cancer immunology research, following the discovery that certain mutated tumours seemed to be more responsive to immunotherapy. The Wessex Investigational Sciences Hub laboratory (WISH lab), established in 2014, As well as receiving initial support from the cancer charity continues to support this research by enhancing the Tenovus, this work went on to be funded by a range of University’s genetic sequencing and bioinformatics capacity organisations including Leukaemia and Lymphoma Research and developing immunological assays to industry standards (which became Bloodwise) and the European Union. Support for early phase clinical trials. from the Cancer Research Campaign, which merged with the Imperial Cancer Research Fund in the early 2000s to become Another developing area of cancer research focused on the tumour microenvironment. Diana Eccles, Professor of Cancer Research UK (CRUK), continued and the medical Cancer Genetics, explains: “When a cancer develops, there school became a Cancer Research UK Centre. The charity is a lot of ‘discussion’ between the cancer cells and the funds a range of research at Southampton, particularly surrounding structural and immune cells in the body. We focusing on oesophageal, bowel, breast and head and neck think this discussion is an important factor in how aggressive cancers, as well as immunotherapy, genetics and nutrition. a tumour is, how effectively the body can contain it and how Peter Johnson, Professor of Medical Oncology, says: “As part likely it is to spread to other parts of the body. This is a of the Cancer Research UK Centre network we built strong relatively new focus for research – until recently studies links with a number of other institutions with complementary concentrated solely on cancer cells without looking at the or similar research interests. One is The Francis Crick surrounding cells.” Institute in London, a joint venture between CRUK, the MRC, Freda Stevenson’s group continued to work on B-cell the Wellcome Trust, and three London universities, which malignancies, with studies investigating the genetics of the conducts discovery science in the field of immunology. In disease and potential targets for therapy. This led to the addition we have close links with immunology researchers development of drugs that target immunoglobulin signalling at the University of Oxford, alongside many other national pathways and are effective in inducing remission in a wide collaborations.” As well as leading numerous studies at range of patients. Another area of research paved the Southampton, with a particular focus on the treatment of way for the development of genetic vaccines for chronic lymphoma, in 2008 Johnson became Chief Clinician for lymphocytic leukaemia (CLL), later applied to other cancers. CRUK, with responsibility for the strategic oversight of all the CRUK research taking place in clinics around the UK. In 2014 Freda Stevenson received the Jean Bernard Lifetime Achievement Award from the European Haematology The school’s immunology research attracted interest from Association for her work in this field, and in 2015 was awarded industry partners. In 2008, for example, the American the Rai-Binet medal by the International Workshop on CLL. biotech company Celldex Therapeutics entered into a George Stevenson’s contribution to cancer immunology was licensing agreement with Southampton to develop an recognised by the University in 2016 with the award of an antibody targeting a protein known as CD27. Swedish honorary doctorate. company BioInvent expanded its collaboration with Southampton in 2015, and funds laboratory posts investigating antibodies of interest. developed at Southampton. One of the many promising antibody treatments, known as ChiLob, went into early clinical trials in 2012 and later progressed to wider clinical testing.

Left: Professor Diana Eccles leads a national cohort study that has recruited over 3,000 women with breast cancer to investigate the role of inherited genetic mutation in breast cancer risk and prognosis. Above: Professor Karen Temple, co-lead of the Wessex NHS Genomic Medicine Centre.

The genetics of asthma The medical school’s world-leading respiratory research continued throughout the 2000s. Researchers had made new discoveries about the mechanisms of asthma; they now wanted to tackle the question of why some people developed asthma and others didn’t. The arrival of genetic epidemiologist Professor Newton Morton at the University in the 1980s gave Stephen Holgate and his team the opportunity to investigate the genetics of asthma. The researchers teamed up with a group at Harvard, with a large investment from two American companies (the Genome Therapeutics Corporation and the pharmaceutical company Schering-Plough). The result was the groundbreaking discovery of an asthma susceptibility gene, named ADAM33, in 2002. Holgate says: “The discovery provided us with the first opportunity to understand people’s individual risk factors for asthma, as well as identifying a potential target for novel treatments. It led to the establishment of a specialist genetics unit at

Southampton and drove a stream of further research to unravel the mechanisms of the gene, which continues today.” In 2014 the Southampton Allergy Centre was recognised as a World Allergy Organization Center of Excellence for allergy research, clinical service and education – one of only three centres worldwide to hold this status. Contributing to national genomics research In 2014, the University and hospital trust became part of a transformational national genome project through the establishment of the Wessex NHS Genomic Medicine Centre. It is one of 13 centres in the UK selected to take part in the 100,000 Genomes Project, an ambitious government initiative that aims to collect and decode 100,000 people’s genes to provide new insights into rare genetic diseases and cancer. Professor Karen Temple, the Centre’s co-lead with Professor Tony Williams, says: “Being named as a Genomic Medicine

Centre demonstrates our position as a major player in modern genomics – an area of research excellence that has its roots in Professor Patricia Jacobs’ arrival in Southampton in the late 1980s. By contributing to the 100,000 Genomes Project, the Centre will improve the prediction and prevention of disease, enable new and more precise diagnostic tests and allow personalisation of drugs and other treatments to specific genetic variants.” Influencing primary care practice Building on studies carried out in the 1990s, several streams of the school’s primary care research made an impact on doctors’ practice during the 2000s. These included studies investigating the management of depression, led in the mid 1990s by Ann Louise Kinmonth and psychiatrist Chris Thompson, and followed up by Tony Kendrick (who became Professor of Primary Care in 1998) and Professor Michael Moore. These studies, which informed national treatment guidelines, showed that inclusion of GP performance indicators for the assessment of severity of depression at diagnosis and follow-up was associated with improved targeting of treatments and referrals. Another strand of research on the management of respiratory tract infections, taken forward by Professor Paul Little, Professor Michael Moore, Dr Ian Williamson, and Dr Hazel Everitt, played a role in the reduction of antibiotic prescribing. Its findings influenced a number of important national clinical guidelines and the implementation of prescribing strategies to discourage unnecessary antibiotic use that are now part of GPs’ everyday practice. Other research strengths that developed during this period included work on complementary medicines (led by Professor George Lewith) and the management of asthma (led by Professor Mike Thomas).

A boost for translational medicine In 2008 the National Institute for Health Research (NIHR) made two £3.75m Biomedical Research Unit awards to the University and the hospital trust, to fund one unit dedicated to respiratory medicine and another dedicated to nutrition, diet and lifestyle. This significant investment recognised the medical school’s research expertise in these areas, its track record for translating basic research into novel treatments, and its robust relationship with its NHS partner. Five years later, when the NIHR funding rounds reopened, the nutrition unit achieved Biomedical Research Centre status – an even more prestigious award. Additional funds from the Department of Health and further investment from the hospital trust and the University enabled the creation of the Southampton Centre for Biomedical Research, comprising 4,000 square metres of clinical and laboratory space dedicated to multidisciplinary translational research activities. The Centre was officially opened in March 2011 by the Secretary of State for Health, Andrew Lansley, and Professor Dame Sally Davies in her first public engagement as Chief Medical Officer. This consolidated the University’s translational clinical research infrastructure, co-locating the NIHR Biomedical Research Centre in Nutrition, the NIHR Respiratory Biomedical Research Unit, the NIHR Wellcome Trust Clinical Research Facility and the NIHR Cancer Research UK Experimental Cancer Medicine Centre. Bringing people, facilities and technology together across several subject areas facilitated collaboration and has secured Southampton’s place as one of the UK’s leading centres for translational research.

Enterprise From the medical school’s earliest days, partnerships with pharmaceutical companies and other organisations were vital, attracting funding and enabling the development of new discoveries for the benefit of patients. As well as fostering partnerships with existing companies, the school

Dr Jill Warner (right), who established the MSc Allergy programme at Southampton in 2000, with a young asthma patient.

developed its own enterprise agenda. This was flourishing by the mid 2000s, when a number of spin-out companies were established to realise the commercial and therapeutic potential of its researchers’ discoveries.

Building on another area of the medical school’s research expertise, Karus Therapeutics was formed in 2005 to develop innovative patient-friendly drugs for a wide range of immune and inflammatory disorders and cancers. The new company evolved from a six-year collaboration with Cancer Research UK; the cross-disciplinary founding team included cancer scientist Professor Graham Packham and heart biologist Professor Paul Townsend from medicine, and chemist Professor A Ganesan. Its second funding round in 2013 attracted investment of £4.7m, and in 2016 it announced its first clinical trials of a targeted immunotherapy treatment for lymphoma.

One such discovery arose from Stephen Holgate’s work on the link between viral infections and increased risk of asthma attacks. His team found that an antiviral protein was under-produced in the lungs of people with asthma, which led to clinical tests of a drug, interferon , that could activate the airway antiviral pathways. To capitalise on the discovery and create avenues for its development, Holgate, with colleagues Professor Donna Davies and Professor Ratko Djukanovic, formed the spin-out company Synairgen in 2003. Drug discovery company Capsant was spun out of the University in 2003, in response to growing demand from By October 2004 Synairgen was valued at over £28m on the pharmaceutical companies to test potential new drugs. It has London Stock Exchange’s Alternative Investment Market. In since developed drug discovery screens for epilepsy, trauma 2014 it licensed the drug interferon , which prevents and stroke and is working on more advanced techniques to exacerbations of asthma linked to the common cold, to support neurological research. Another successful spin-out, AstraZeneca in a deal worth up to $232m. vaccine development company iQur, evolved from

hepatology research led by Professor William Rosenberg, while joint research with chemists at Southampton led to the formation of Primerdesign, which specialises in DNA synthesis and detection products for lab use. Recent Primerdesign products include detection kits for the Zika virus.

Further developments in education

Gavin Millar, who had overseen the development of the school’s medical education since the early 1990s, including the successful Quality Assurance Agency and GMC reviews, retired in 2000. His successor was Professor Chris Stephens, who became Director of Education and later Associate Dean, Education and Student Experience. As well as being involved Other enterprise activities evolved during this period, in curriculum development and working with staff to develop including the licensing of antibodies developed at Southampton to pharma companies for use in research. Two their teaching roles, he led student expansion from an intake successful enterprise units also developed within the medical of 150 students in 1998 to 246 in 2004. He also helped to develop the school’s innovative widening access school. One is the Wessex Institute, which supports the programmes. national research agenda by managing programmes on behalf of public bodies such as NIHR, the National Institute The founding principles of the curriculum, including early for Health and Care Excellence (NICE) and the Department clinical contact, the emphasis on research-driven learning of Health. The Wessex Institute hosts NIHR’s Evaluation, and the systems approach, continued to underpin Trials and Studies Co-ordinating Centre (NETSCC) and Southampton’s medical training. However, its content and Dissemination Centre, and in 2016 was awarded a four-year delivery were regularly reviewed to ensure it responded contract to deliver the Department of Health’s public to changes in healthcare and in patient expectations. involvement in research programme, INVOLVE. With NIHR contracts worth £100m over 10 years, the Institute makes a This led, for example, to a greater emphasis on patientsignificant financial contribution to the University while centred care and professional values and behaviours. Karen supporting high-quality research. Morrison, Professor of Neurology and the current Associate The medical school’s second enterprise unit is EDGE, a research management system that was designed in response to the needs of cancer researchers at Southampton. Officially launched in 2008, EDGE is now used in all but one of England’s health regions and has also been adopted in Canada, supporting frontline clinicians in their research activities and promoting best practice in clinical research processes. Salim Khakoo, Professor of Hepatology and Associate Dean, Enterprise, explains: “Our enterprise activity is driven by our need to deliver our research into the community and ensure it has the greatest possible impact. Through enterprise we are also contributing to the delivery of the country’s research agenda.”

Dean, Education and Student Experience, says: “Feedback and reflective practice have become an important part of medical training; we want our students to be able to recognise feedback, accept it and work on it to continually improve their practice throughout their career. We are also embedding professionalism in terms of values and behaviours – the things that make someone a good doctor – from the very start of the course.” The curriculum also responded to changes brought about by new discoveries and approaches. Practice was changing in hospitals, with a much shorter average length of stay for patients, for example, and greater use of outpatient clinics. Incidences of fatal heart attacks were decreasing, but more people were living with chronic diseases. It was essential to keep pace with such trends to ensure Southampton’s medical training remained at the cutting edge.

Widening access to medical training As well as updates to the curriculum, the 2000s saw the launch of new undergraduate programmes to broaden access to medical training. These courses aimed to encourage people from a range of backgrounds into medicine and address under-representation of lower socioeconomic groups in the medical profession. In 2002 the medical school selected 18 young people for a pioneering new programme designed to give students without the standard entry requirements for the five-year programme (the BM5) an opportunity to train as doctors. Known as the BM6, this new six-year course welcomed applications from young people from disadvantaged backgrounds who hadn’t achieved the required A level results for the BM5 but could demonstrate their potential by meeting a number of other criteria. Students would undertake a ‘year zero’ programme, delivered at nearby New College, to strengthen their knowledge and their academic skills, before continuing their studies alongside first-year BM5 students. Extra academic and pastoral support would be made available throughout their training.

“I believe the BM6 scheme is essential in encouraging those into medicine who would otherwise not have had the opportunity or believed they had the ability. It has helped my confidence and belief in myself that I can do it and it’s great to see my other friends from the BM6 grow in the same way.” Karen Carter BM6, 2006

At an event in July 2003 to celebrate the first cohort passing the foundation year, guests were visibly moved by presentations given by four of the students, one of whom described it as “an opportunity I just can’t believe I’ve been given”. The course has since received national acclaim. It was featured as a case study in two Universities UK reports on widening participation in 2002 and 2005, and in the Department of Health’s report, Medical Schools: delivering the doctors of the future in 2004. An analysis of widening access programmes by Jonathan Mathers et al, published in the British Medical Journal in 2011, concluded that “efforts of the three schools offering foundation programmes [of which Southampton is one] seem to have been far more successful in diversifying the future medical profession than the more

widespread graduate entry initiative”. Medical schools across the country have followed Southampton’s lead and many now offer similar widening access programmes. Graduate entry course Another course that broadened the medical school’s intake was introduced in 2004/05. The new BM4 degree gave graduates with first-class or upper second-class honours in any subject the opportunity to enter a career in medicine. Successful applicants would study a specially designed course for two years, then join years three and five of the BM5 course. The first intake comprised 40 students, selected from over 1,100 applicants. About two thirds had degrees in biological sciences; the rest had graduated in a range of arts, humanities and physical sciences disciplines. When the course celebrated its 10th anniversary in 2014, its recent graduates included those with first degrees in French, Latin, English and war studies as well as neuroscience, anatomy and veterinary medicine. Karen Morrison says: “The BM4 continues to provide a pathway for people who have decided to come into medicine from a career or education in another field. The range of life experience and the diversity they bring are a real bonus, both to their fellow students on the course and for the staff delivering it.” Delivering medical training in partnership with Europe More recently, a groundbreaking programme has seen the Southampton approach to medical training being implemented in Europe. In 2009 the school was approached by German healthcare provider Gesundheit Nordhessen Holdings to explore the possibility of setting up a joint medical undergraduate degree programme. This led to the development of the BM(EU), the first programme of its kind in the European Union. It enables German students to study alongside BM5 students in Southampton for the first two years of their course before returning to Kassel in Germany for the majority of their clinical training.

The first 19 BM(EU) students arrived at Southampton in 2013. Student involvement was key to the design of the programme and the first cohort in particular helped to shape the course. “The BM(EU) enables German students to gain a UK medical degree and experience the excellent Southampton curriculum,” says Morrison. “Our curriculum is at the forefront in terms of encouraging reflective practice and feedback, something that’s not currently highlighted in standard German medical schools. In addition, the course is delivered in English, so it gives students an advantage if they want to go on to work in an English-speaking setting.” BM(EU) student Johanna Althaus said of her two years in Southampton: “I have to say it was great! The English and the Germans were together in one year group and many friendships were built. After two academic years in Southampton we arrived in Kassel and already miss the rest of our year group.” Advances in teaching and learning As the range of the school’s programmes grew, educational and technological advances also led to developments in the way its students learned. For example, the courses became less lecture-based with more small-group teaching, and anatomy teaching began to be delivered in a new state-ofthe-art prosectorium, rather than through individual dissection work. Increasingly high-tech simulated patients were introduced for clinical teaching, while the growing emphasis on patient-centred medicine was reflected by the use of expert patients, who brought the patient voice directly into the educational arena. The introduction of additional settings for clinical teaching enabled students to gain an even wider experience of medical roles, with placement opportunities in district general hospitals, GP practices and secondary and tertiary referral centres around the region.

The school’s education initiatives continued to influence best practice beyond Southampton. The National Undergraduate Neuroanatomy Competition is one example. Developed by students, academics and clinicians, its aim is to provide medical students throughout the UK with the opportunity to further their interests in the neurosciences and develop their portfolios, and acts as an educational tool for their own learning. The first competition took place in 2013; in its first three years 182 students from 29 of the UK’s 33 medical schools took part. Student support and involvement A GMC review in 2008 praised the medical school for innovation and good practice in a number of areas, including staff development and the use of e-learning. Another area singled out for comment was its pastoral support for students. The school had embedded an effective system to ensure students could access help and support if they had problems, academic or otherwise. This is now influencing practice across the whole University. True to Donald Acheson’s early vision, students continued to be partners in their educational experience. Fourthyear medical student Fiona Vincent describes how she was involved in representing student views: “As the Faculty Officer I was the lead representative for all students studying medicine. I led the team of course representatives from each year group, chaired staff-student liaison meetings and represented the medical school at the Medical Schools Council Conference. This role involved working closely with faculty staff to help improve and shape the course for the future.” The strength of student involvement in curriculum design and teaching was recognised in 2014 when the medical school was presented with the ASPIRE Award of Excellence in Student Engagement – the first UK medical school to receive this prestigious award. ASPIRE’s peer reviewers commented: “Aspects of the Faculty of Medicine’s engagement with

students that were particularly impressive were numerous, including the consistent involvement of students, with full voting privileges, on various curriculum management and student assessment committees… All reviewers simply loved the ‘you said…we did’ annual report back to students that helped them see the power of their feedback and thus Southampton has much higher response rates even in the later stages of the students’ experience with the school.” Postgraduate courses Back in the 1960s, a factor in Southampton’s successful application for a medical school was its excellence in postgraduate education; this continued with a flourishing doctoral research community and taught MSc programmes reflecting the school’s research expertise. The MSc Allergy programme, for example, was established in 2000. It was designed for doctors, nurse specialists, dieticians and other health professionals, and offers education and training in the mechanisms, diagnosis, treatment and management of allergic disease. It continues to have a unique focus on directly helping patients by encouraging practitioners to take their learning back to their services and clinics, share best practice with their colleagues and implement improvements. Similarly, the MSc Diabetes Best Practice was introduced in 2015 to equip healthcare professionals with the latest knowledge and practice to benefit those affected by this increasingly common condition. A thriving masters degree in public health, established in 2013, also developed, offering specialist pathways in global health and nutrition. A cross-faculty programme, it brings together expertise from medicine, social and human sciences, law and health sciences. The school’s doctoral research programme was enhanced in 2006 with the introduction of a four-year Integrated PhD in Biomedical Sciences. Conceived and implemented by Professor Tim Elliott and Dr Jane Collins, the new

A new MSc Diabetes Best Practice programme, led by Dr Nicola Englyst, was launched in 2015 to meet the growing demand for specialist care.

programme integrated a one-year taught programme â&#x20AC;&#x201C; initially in cell biology and immunology of cancer â&#x20AC;&#x201C; with a three-year research degree. Funding from the MRC and Biotechnology and Biological Sciences Research Council (BBSRC) enabled further pathways to be added over the next few years, in specialist areas including stem cells and regenerative medicine, and infection and immunity. Following a successful bid in 2015 for an MRC Doctoral Training Partnership with Queen Mary University of London, a new pathway in translational immunology was established. It has a strong interdisciplinary focus, in particular with mathematics, drawing on the Universityâ&#x20AC;&#x2122;s expertise in big data manipulation and data modelling for a new module on quantitative biology, and facilitation of novel studies requiring critical bioinformatic analyses.

Supporting careers in academia The success of any organisation is dependent on its people; in recognition of this the medical school continued to invest in initiatives to nurture and develop its researchers and academics.

Postdoctoral Association The Postdoctoral Association was formed in 2004 to support postdoctoral researchers through a mentoring scheme, seminars, workshops and an annual conference. These activities, which continue today, are designed to help those at the beginning of a research career to understand how they can progress, learn more about their options for the future and identify training and development opportunities to help them achieve their goals. Athena SWAN The medical school was also keen to play its part in addressing the sector-wide issue of gender equality within higher education. The University of Southampton was a founding signatory of Athena SWAN, a nationwide programme that encourages universities to identify and remove barriers that may be preventing women from attaining senior academic roles. Through the Athena SWAN scheme, the medical school developed its own action plan and began to implement changes to enable and support the career progression of its female academics. These included

developing its mentoring scheme, providing unconscious bias training for members of recruitment and promotion panels and introducing more flexible working arrangements. Places were also made available on the Springboard programme, which helps women to identify practical steps they can take to achieve their career goals and build the confidence to take these steps. As a result of these initiatives, the school received a bronze Athena SWAN award in 2013 and achieved silver in 2015. Dr Nicola Englyst, Associate Professor, leads the medical school’s longstanding mentoring scheme. She was also part of the first job share at lectureship level in the school, which enabled her and a colleague to further their careers while managing family commitments. “When I was a postdoctoral researcher there were very few female role models, so as a woman it was difficult to see how you could progress,” says Englyst. “That has really changed over the last few years. Women have more confidence to go for promotion – they’re not being promoted ahead of men, but are better equipped for the process.”

The medical school turns 40 In 2012 the medical school celebrated its 40th anniversary. Over 180 alumni, students and staff attended a series of lectures and interactive tours at the University’s new Life Sciences Building, and a three-course banquet dinner and dance was held at St Mary’s Stadium, home of Southampton Football Club. Over £38,000 was gifted by alumni to support the Medicine Anniversary Fund, which would be used to enhance student experience.

This shift is reflected in the school’s promotion data. The number of female academics applying for promotion in the medical school rose from four in 2010/11 to 18 in 2014/15, with success rates increasing from 50 per cent to 78 per cent in the same period.

THE MEDICAL SCHOOL TODAY – AND INTO THE FUTURE The last 45 years have seen the transformation of Southampton’s medical school from a radical experiment involving “improvisation on a grand scale” (as Foundation Dean Donald Acheson put it) to one of the UK’s leading centres for medical education and research. 88

“Over the years an environment has been created that encourages students and staff to realise their potential; to identify their strengths and develop skills that can be applied in a range of contexts. This has enabled many of our alumni and academics to take on key leadership roles nationally and internationally.” Professor Iain Cameron Dean of the Faculty of Medicine

Today the curriculum is firmly established as an example of best practice and similar models are used across UK medical schools. While its approach is no longer unique, Southampton remains one of the best places in the country to study medicine, ranking ninth in the UK in The Guardian university league table for 2017. Its academics remain engaged in pioneering research that is helping to revolutionise healthcare and the school has become a major player in the global medical research arena. In the 2014 Research Excellence Framework, 75 per cent of its research was rated as either internationally recognised or world class. A score of 94 per cent for international research impact demonstrated the continuing emphasis on basic research that translates into real-world benefits for patients. With around 1,000 staff members, research income of £35m and an annual turnover of approximately £100m, the medical school accounts for around a fifth of the University’s staff, a fifth of its turnover and nearly a third of its research income. Its enterprise activities continue to generate significant revenue, with several spin-outs in the pipeline. In 2016, 255 new students started their medical training at Southampton; 185 first-year students on the BM5 degree and 40 on the BM4. Another 30 students, nearly 10 per cent of the year’s intake, began the BM6 widening access course. International students made up around 7.5 per cent of the year’s intake. While the curriculum they will study has undergone a major reorganisation in recent years, the principles on which it was based, such as early clinical contact and a systems-based approach, remain at its core. Karen Morrison says: “The focus on research-embedded learning also remains. The idea of being able to critically appraise the literature on a topic and then make a judgement about what’s best for patients is a big theme throughout the undergraduate programme. The course still provides dedicated space for student-focused research projects – now undertaken by all students in a term

in the third year rather than the fourth. Between 20 and 30 students each year also undertake an additional intercalated Masters in Medical Science degree here in Southampton, with a similar number taking intercalated medical science courses in other universities.” Student Fiona Vincent talks about the benefits of the course’s practical approach. “The new curriculum offers hands-on training opportunities from the very start of the course, however, after the research project in the third year the training is almost entirely clinically based at GP surgeries and hospitals. This offers us an opportunity to learn alongside the multidisciplinary team. By learning in this environment, being exposed to the day-to-day running of a hospital or GP surgery, you gain a real insight into the work of a doctor and as you develop the skills you are encouraged to get involved with the care and management of patients.” The latest curriculum developments reflect advances in medical practice. There is an increasing emphasis on personalised medicine, for example, in which preventative measures or treatments are based on an individual’s genetic makeup. Most of the school’s 2016 intake will graduate in 2021, the school’s 50th year. Aware that rapid medical and technological change is inevitable, the medical school continues to ‘futureproof’ the education of tomorrow’s doctors. Iain Cameron explains: “Our aim is to equip students with the flexibility to work in the current context but also to adapt to changes in the profession and the delivery of healthcare in the future. The key is to select the right people with the right values to be good doctors, and develop students so that they are able to communicate well and find and evaluate information when they need it.”

Professor Iain Cameron Head of the School of Medicine, 2004–2010 Dean of the Faculty of Medicine, 2010–present After graduating in medicine at the University of Edinburgh, Iain Cameron undertook postgraduate clinical and research training in obstetrics and gynaecology, and reproductive medicine, in Edinburgh, Melbourne and Cambridge. He joined the medical school at Southampton in 1999 as Professor of Obstetrics and Gynaecology, having previously been Regius Professor of Obstetrics and Gynaecology at the University of Glasgow. His main clinical and research interests are reproductive medicine and investigation of the impact of the maternal environment on early pregnancy. As Head of School and Dean he has led a focus on the lifecourse, early clinical translation and links between medicine and the physical sciences, including computing, engineering and mathematics. Continuing the close collaboration with University Hospital Southampton NHS Foundation Trust, he has overseen the creation of world-class clinical research facilities to translate basic discoveries to improve patient care. He has been a non-executive Director of the University Hospital Southampton NHS Foundation Trust Board since 2011, and in 2013 was elected Chair of the Medical Schools Council, the national body representing the UK’s medical schools.

Far left: Established in 2014, the Wessex Investigational Sciences Hub laboratory plays a key role in the school’s genomics research. Left: The Southampton Centre for Biomedical Research. Above: Jahangir Alom, founder of the Widening Access to Medicine Society (WAMsoc), a student-run group that encourages pupils from underachieving schools to consider a career in medicine.

“We’re mindful that we want to give students a really well-rounded curriculum so they get exposure to lots of areas of medicine,” adds Morrison. “But it’s also important to make sure we don’t overload the curriculum, so that students have time within their placements to observe doctors and develop their own professional values. So for the curriculum to remain fit for purpose into the future, we can’t be afraid of cutting areas that were once thought crucial.” Educational developments are continuing at postgraduate level. As well as the new MSc Diabetes Best Practice, an MSc in genomic medicine has been launched. Commissioned by Health Education England and delivered through a network of centres, the course will prepare scientists and health professionals from medicine, nursing, public health and other backgrounds to understand and respond to this burgeoning field of medicine. In addition, the school’s thriving postgraduate research community continues to contribute to its world-leading

research. Professor John Holloway, Associate Dean, Research, who with Karen Morrison is jointly responsible for the school’s postgraduate research programmes, says: “The medical school at Southampton has always been a place that has been founded on research, and postgraduate research students undertaking study for higher degrees, PhDs and MDs, are a crucial part of the team. The school’s annual research conference is always a highlight of the academic year due to the energy of the postgraduate students as they present their research findings. “I was an overseas visiting PhD student in the medical school in the early 1990s and the exciting nature of the research taking place in the department and the quality of the training I received were key to my academic career. Today’s students likewise receive excellent training, designed to produce the next generation of leaders in research. This is delivered through our three-year MPhil/PhD or MD/PhD programmes, and the school’s innovative integrated four-year PhD programmes in biomedical sciences.”

The school’s PhD programmes have launched many eminent research careers. A recent success story is Dr Yifang Gao, a student on the very first four-year PhD programme (on cell biology and immunology of cancer), who went on to a distinguished postdoctoral training period in the Wessex Investigational Sciences Hub (WISH) laboratory. She recently won a highly prestigious repatriation award from the Chinese government’s Young Talent Programme, and will be returning to Sun Yat-Sen University, one of the top five institutions in China, to set up a research lab in transplantation immunology. Another graduate of the integrated four-year PhD programme is Dr Matt Loxham, who studied the infection and immunology pathway. He was recently awarded a BBSRC Future Leaders Fellowship for studies into the health effects of urban air pollution related to shipping activities. This interdisciplinary study involves the Faculty of Medicine and the National Oceanography Centre Southampton. It links with Southampton Marine and Maritime Institute and Lloyd’s Register and is of interest to national environmental and local policy makers. Loxham says: “Southampton is the largest cruise ship terminal in Europe and one of the largest cargo ports in the UK, handling over 40 million tonnes of goods per year. My work will involve studying the chemistry of emissions from ships and dockside activities, and then relating this to its effects on the airways, initially in cell cultures but aiming to progress to look at real-life exposures too. The idea is to better understand what types of air pollution sources might be in operation at the docks, and which of these might be the most relevant for understanding how the health of people in port cities might be affected by these emissions.” Today’s student community The medical school’s 1,400 students are as active as ever, with MedSoc providing plentiful opportunities for learning, fundraising, sports and socialising. Fiona Vincent says:

“MedSoc is great fun. There are a wide range of societies to get involved with, from sport, to wilderness medicine, to music, as well as plenty of academic societies such as students4students, which enables near-peer teaching. MedSoc hosts many events every year, from the family champagne reception to the scrubs crawl. Everyone gets involved.” One recently formed society, the Widening Access to Medicine Society (WAMsoc), has developed an outreach programme to raise the aspirations of potential medical school applicants from underachieving schools. Working alongside IntoUniversity Southampton, this year it provided an insight into university life for 26 secondary school students. A traditional fixture in the student calendar, the Medics Revue is still going strong. The 2016 performance, The Fungal Book, played to sell-out audiences and raised funds for Solent Mind and Hampshire and Isle of Wight Air Ambulance. Valuing diversity Building on its work to support women in academic roles, the school continues to develop its policies and culture to address diversity and equality issues. Cameron says: “We’ve done a huge amount of work to understand the causes of gender imbalance across the faculty and introduced changes to make things better. When I became head of the school we had no female clinical professors and a small number of female non-clinical professors. But over the past 10 years that’s changed and the balance has shifted with a number of women now in leadership roles.” Professor Diana Eccles, Head of Cancer Sciences, has seen a gradual change since first coming to the University in the early 1990s. “Awareness of equality issues is much higher now, and while there are no quick fixes, the conversation is happening and people feel more comfortable talking about it.”

“I have made some wonderful friends. I have developed my leadership and teaching skills. I have been very fortunate to meet some fantastic mentors who have shared their wisdom and guidance with me and continue to support me on my journey as a medical student and future doctor.” Fiona Vincent BM5, fourth year

One development that will benefit both women and men at PhD and postdoctoral level is the early career researcher (ECR) ‘roadmap’. “The roadmap will help ECRs to understand the requirements for progressing along the academic pathway, such as the timing of fellowship applications, as well as providing information about alternative career paths,” explains Eccles. “Based on an MRC initiative, the roadmap has been tailored for use in the medical school and the wider University by staff and members of the Postdoctoral Association.” The school is set to continue broadening the reach of its equality and diversity initiatives. Adrian Reyes-Hughes, Head of Faculty Operations, says: “Athena SWAN has opened up the discussion about inclusion, and we now have a dedicated equality and diversity champion who is looking at wider issues including age and disability.” Research today – and looking ahead Today the school’s medical research portfolio encompasses its traditional areas of strength as well as making inroads into emerging fields. While some of the early pioneers are still making key contributions – a group led by Professor Freda Stevenson was recently awarded a new grant from Cancer Research UK, for example – they have also ensured their work will continue into the future by developing a cohort of highly trained scientists at Southampton. Work to understand the developmental origins of adult disease continues, combining the University’s expertise in epidemiology, nutrition, bone and joint disease and non-communicable diseases. Today the MRC Lifecourse Epidemiology Unit has around 100 members of staff and receives £3m in funding from the MRC, supplemented by a further £2m annually from funders such the Wellcome Trust, MRC, NIHR, British Heart Foundation, Arthritis Research UK and the International Osteoporosis Foundation.

Translational medicine has been strengthened with a recent award of £15m to researchers and clinicians at the University and the University Hospital Southampton NHS Foundation Trust. The grant will create a new NIHR Biomedical Research Centre, bringing together respiratory and nutrition research as well as expertise in data, microbial and behavioural science. The Centre will focus on taking discoveries from the laboratory to the clinic to help tackle obesity, poor nutrition, asthma, allergies and infections. The award reflects the robust partnership between the medical school and its NHS counterparts that has been a feature since the school’s earliest days. In the primary care field, there is a focus on research into interactive digital interventions to support patients to manage their own conditions. “This type of technology will become increasingly important as an ageing population places greater demand on primary care resources,” explains Professor Tony Kendrick. “Our researchers have worked closely with Professor Lucy Yardley in Psychology to investigate primary care applications for the interactive LifeGuide software that she developed at Southampton. A six-year programme is currently looking at the part LifeGuide can play in supporting people who are coming off unnecessary long-term antidepressant prescriptions. Other projects have explored the use of online tools to help eczema patients manage their condition and to support emotionally distressed patients.” A new centre for research into cancer immunology In September 2017, researchers will move into the UK’s first dedicated centre for research into cancer immunology. Based at University Hospital Southampton, the new centre is the result of a University-wide £25m fundraising campaign. Connected to leading institutions worldwide, the Centre for Cancer Immunology will provide a state-of-the-art research environment in which the medical school’s interdisciplinary teams can expand clinical trials, explore new areas and develop lifesaving drugs.

Martin Glennie gives his view on how research in this area will progress in the coming years. “We will continue to develop new drugs but we’ll also be looking at how to combine them to get the right synergy to boost their impact and make them more effective. “Another area that’s very exciting, and in which I hope Southampton will play a major role, is discovering more about the genetic alterations in individuals’ cancer cells, known as the mutanome. We know cancers carry hundreds of mutations, which accumulate over a long period. Over time the mutations allow the cancer to adapt so that it can escape from the immune system and become independent of the normal regulators of cell growth. “Now, with the latest technology, we can map the genetics of individuals’ mutanomes to make a personalised vaccine that steers the immune system in the right direction, probably used in combination with checkpoint blockers. “Over the years, each development in cancer treatment, such as chemotherapy and radiotherapy, has made another group of cancers curable. I think that immunotherapy will do the same for some of the really aggressive cancers, such as certain types of skin cancer, lung cancer, bladder cancer, and head and neck cancer.” Researchers are also beginning to explore how patients’ intrinsic genetic characteristics influence their risk of getting cancer and their survival after a diagnosis. One such study, being undertaken with the Biomedical Research Centre and a national group of collaborators, is looking at how nutrition in its broadest sense is connected to treatment and outcomes for women with breast cancer. “Research is exploring the cancer cell, the cancer microenvironment, and now the macroenvironment, all of which seem to be important for cancer risk, treatment and outcomes. We’re moving to a more holistic view,” says Diana Eccles.

“We are very proud of the truly excellent academic partnership we have achieved with the University of Southampton’s Faculty of Medicine. Our collaborative work has created fantastic results which are positively influencing how we manage patient health, from bench to bedside, in the UK.” Fiona Dalton Chief Executive, University Hospital Southampton NHS Foundation Trust

Opening in 2017, the new Centre for Cancer Immunology will bring together Southampton’s world-leading experts to work on the next generation of cancer treatments.

Its partnership with University Hospital Southampton NHS Foundation Trust will enable the medical school to continue to translate research from the lab for the benefit of patients.

Working across the disciplines

Always a feature of the school’s research, multidisciplinary initiatives continue to thrive.

help society. Because of the good relationships that have been developing here Southampton is well set up for that kind of team science.”

Eccles says: “We’re working increasingly with other disciplines, including biological sciences, engineering and mathematics. For example, in the Cancer Genetics group we have gained Cancer Research UK funding to work with scientists at the Institute for Life Sciences to image the cancer microenvironment using advanced new technologies. By finding out more about the molecular structure we might, for example, be able to find patterns that tell us about a person’s prognosis, or find ways to manipulate the microenvironment to make the cancer more ‘visible’ to the immune response.”

Holgate also sees the biology of chronic disease as a key area for future research. “Understanding what causes chronicity is a big challenge, as chronic diseases are having a huge impact on today’s society. What is it that causes the resilience of the human body to break down and enable disease to take hold? It’s all about the biology of chronicity, which is linked to the biology of ageing, as well as susceptibility and environmental factors such as lifestyle or pollution. That’s true for my area of respiratory research, but also applies across a whole range of diseases such as liver disease, inflammatory bowel disease, dementia and arthritis.”

Stephen Holgate sees interdisciplinary work becoming more and more important. “We need experts from different disciplines to come together if we’re going to answer the complex questions that we have set ourselves in order to

As well as building on existing strengths, the school’s researchers will continue to scan the horizon in order to stay at the leading edge of new developments. “We need to be aware of emerging fields so that our research remains

relevant,” says Cameron. “One such field is data science, where we are forming new partnerships with Southampton’s world-leading computer and data scientists to explore ways to bring this to healthcare.” Much has changed since the medical school’s first intake of students arrived in 1971, but its ambitions for the future are similar to those of the school’s founders. “We will continue to deliver education of the highest standard so that our graduates, be they medical students, postgraduate taught students or PhD students, are well equipped for the future,” says Cameron. “And we will continue to conduct cuttingedge research and develop our discoveries for the benefit of patients in years to come.”

“Although we are still a relatively young and small medical school, there are some research areas in which we are becoming strikingly successful. It’s exciting to imagine how that will develop and grow over the next 50 years, and how we can keep building on the critical mass of expertise we have at Southampton.” Peter Johnson Professor of Medical Oncology

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University of Southampton, Faculty of Medicine. (2012) Medinews: 40 Years of Discovery. University of Southampton, Faculty of Medicine. (2015) BM(EU) goes home. In Facilitator. Medical Education News, issue 45. University of Southampton, Faculty of Medicine. (2016) 40 Years of Changing Lives: Medicine at Southampton. University of Southampton, Medical Education Development Unit. BM6. Available at: www.southampton.ac.uk/medu/ curriculum_design_and_delivery/bm6.page [accessed 20 June 2016].

Waters, W.E., Marcer, D. and Topliss, E. (1976) Epidemiology, psychology, sociology. British Medical Journal. 2: 95–97. Wikepedia. Donald Acheson. Available at: https://en. wikipedia.org/wiki/Donald_Acheson [accessed 22 November 2016]. Plus numerous University of Southampton and Faculty of Medicine publications and web pages, including: University of Southampton, Faculty of Medicine. (1972) Faculty of Medicine. University of Southampton, Faculty of Medicine. (1976) Handbook of Information, Faculty of Medicine. University of Southampton, Faculty of Medicine. (2000) Simply the Best: QAE 24/24. In Medical Education Newsletter 14.

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Acknowledgements Our thanks to the following contributors and interviewees: −− −− −− −− −− −− −− −− −− −− −− −− −− −− −− −− −− −− −−

Professor Michael Arthur Professor Iain Cameron Dr Jane Collins Professor Cyrus Cooper Professor Diana Eccles Professor Tim Elliott Sir Charles George Professor Martin Glennie Professor Stephen Holgate Professor John Holloway Professor Peter Johnson Professor Tony Kendrick Professor Salim Khakoo Professor Karen Morrison Dr Alan Noble Professor Karen Temple Sir Eric Thomas Professor Chris Thompson Fiona Vincent

Thank you to Peter Howell for sharing the manuscripts written by his father, Jack Howell, upon which the early chapters of this book are based. We are grateful to the University of Southampton Library for permission to reproduce the cover image and photographs on pages 8, 11, 51, 52 (left), 60 (left), 63 and 81.

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