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The new President of the Royal Society of Medicine, Sir Barry Jackson, took office in mid-July 2002. A consultant surgeon at St Thomas' Hospital for nearly thirty years, he is a longstanding Fellow of the Society—a member of the sections of Surgery, History of Medicine and Coloproctology (of which he became President) and serving on the Scientific and Executive Committee and the Council. Other presidencies have included the Association of Surgeons of Great Britain and Ireland and, most recently, the Royal College of Surgeons of England. He is an Honorary Consultant Surgeon to the Army and was formerly Surgeon to the Queen. He is interviewed here by Robin Fox.
RF Sir Barry, you presided over the Royal College of Surgeons at a difficult time. The profession had been weakened by a series of scandals, and the notion of professional self-regulation took some heavy blows. From all this, you emerged as a strong advocate of periodic appraisal and revalidation—at least in principle. Clearly, this baptism of fire will be of great relevance to your work at the RSM, with its mission to promote continuing professional development. So let's start by talking about CPD. For example, is revalidation yet another of those politically driven schemes, introduced wholesale without proper pilot studies, and doomed to failure?
BJ It's five or six years now since the surgical colleges began asking for formal recording of continuing medical education, but a large proportion of surgeons still don't send in their CME data for collation. Why should this be? I strongly suspect it's because they don't see CME, as assessed at present, as having much validity. They reckon they are doing it anyway, and are content that they are keeping abreast of what is going on. The crunch will come when revalidation kicks in and they fail to satisfy the appraisers that they have participated properly in CPD.
RF In this evidence-based era, it would be nice to know about the cost-effectiveness of CPD, and whether some approaches work better than others. There are four Royal Colleges of Surgeons (if we include Ireland): maybe they should offer different approaches and compare them scientifically?
BJ Certainly, mere attendance at a course or series of lectures means nothing. We have all seen people sleeping through the programmes, or even signing the attendance book and leaving after ten minutes. So I agree with your implication that, somehow, we need to measure what is achieved. Within a specialty, this might be feasible. But another important aim of CPD is to foster links with other disciplines and foster more general skills such as communication; even if the outcome was not measurable, one might at least be able to certify that doctors had gone through a satisfactory process. There is an argument, I agree, for having a variety of different approaches—perhaps in competition. At present, however, I see a more pressing need for dialogue between the bodies that purport to deliver CPD—the Royal Colleges, the RSM, and the specialist societies.
RF Those last words emphasize the fragmentation of our profession. How many Royal Colleges is it now? Yet the boundaries between specialties are getting ever less distinct. Is it time for the London Physicians and Surgeons to set a bold example and merge?
BJ I would not go so far as that; but I do think that in these islands we should work towards a single College of Surgeons (perhaps with English, Scottish, Irish campuses) and a single College of Physicians. The RCS was less than enthusiastic about the most recent Royal College—of Paediatrics and Child Health—not because there was no need for such a grouping but because the specialty seemed comfortably containable within the RCP. I certainly hope there are no more Royal Colleges in the pipeline.
RF So, let's turn to the RSM. The Society is noted as a venue for specialist groups, its fine library, its meetings under the heading CPD, and its comfortable armchairs. As President you will be seen in the first three at least, but I suspect that you will get most satisfaction from meetings that embrace the wider profession.
BJ Yes, I am excited by the much broader view the Society is now taking. Let me give you an example of an artificial boundary that can be broken down. For twenty-five years I did a joint clinic with a physician colleague for patients with Crohn's disease or ulcerative colitis, and I like to think I was as good as a physician as in my role as surgeon. At the RSM a meeting on this subject can include not only physicians and surgeons but also nurses and patients. If you look at the Society's Sections, there are some big gaps in the coverage—for example, no gastroenterology, no cardiology. This is a good way to fill these gaps and to mirror what is already happening in clinical practice. It's not just specialties that need to interact more. We have seen how nurse specialists, despite much initial scepticism, have proved strikingly competent and proficient in their work; and I think that some procedures might reasonably be done by suitably trained people who have not earned the label of either doctor or nurse. The big question is whether such practitioners are accountable to patients directly or via a doctor. There is also the geographic broadening of the RSM: my predecessors and the present Council have expanded the Society's activities throughout the UK, appointing regional deans and promoting local meetings (usually multispecialty). This is a development in which I shall take a close personal interest. It needs to be matched by a better system of communication, between Society officers and the Fellows. Before long, I hope, the Society will be able to communicate by e-mail with almost every Fellow.
RF How would you like people to remember your presidency? In the RSM News you expressed a determination to be accessible: does this mean you will be wandering round the building, looking into what is going on?
BJ I'm not planning to be a policeman. My greatest pleasure, three years down the line, would be to hear Fellows (and especially newly joined Fellows) saying the Society has come on a great deal—different and better.
RF Finally, let's choose a photograph to be printed with this interview.
BJ Let us have the one in shirtsleeves. I want to be seen as a working President.