December 10, 2021, by School of Medicine

50 at 50: Ian Hall: Reflections on 35 Years in Medicine

In 1985 I successfully applied for a medical registrar position in Nottingham.  I had decided respiratory medicine was going to be my chosen specialty, and Nottingham had a good reputation for its training programme.  I’d never been to the city before I was appointed, and intended to stay for a couple of years then move on, but apart from a year in Philadelphia for a MRC fellowship I’ve been in Nottingham ever since.

The first thing that struck me about Nottingham was that it was a ‘real’ place.  Having trained in the erudite but somewhat artificial atmosphere of Oxford, Nottingham seemed like a slice of normality.  It also seemed to me to sit on a boundary. Parts of the south of the city were a genteel extension of the Home Counties, yet 10 miles away one felt in the north with the legacy of the mining industry and the bitter days of the miner’s strike still very evident.  As a keen climber and outdoor person in general, being close to the Peak district was a big bonus.

Whilst initially I stayed on a standard clinical training route, I quickly realised that my niche was going to be as a clinical academic.  It was difficult to get an academic orientated post as a Senior Registrar in respiratory medicine in the late 1980’s, so I ended up as a Lecturer in Clinical Pharmacology which gave me the freedom to carry on with research, and then was fortunate to obtain fellowships which led to a substantive position.  I was also lucky to move into functional genetics research in respiratory medicine at a time when this wasn’t very developed, which has dictated the path of my research career ever since.  Later on, I took up various leadership roles, eventually resulting in a period as Executive Dean of the Faculty from 2009-2015.  This was a busy period for the faculty: the faculty was reorganised into 4 schools, the Vet school graduated its first student intake, and on the research side we invested in major new infrastructure for MR imaging and translational research.

So what are my reflections of the last 35 years?

First, the way we practice medicine has changed out of all recognition.  When I first undertook a medical ‘take’ in Nottingham, we looked after everyone admitted in a 24 hour period, and the same team of doctors continued to manage those patients until they were discharged, regardless of where they were in the hospital, and then the whole cycle would start again a few days later.  This meant that continuity of care was excellent, and that there was a genuine ‘team’ spirit which made work rewarding.  However, the resulting rotas were very antisocial, and the work load resulting from a busy ‘take’ probably compromised patient care at times, so it is not surprising that the system has completely changed to one centred on shift based working.  This has however bought major drawbacks in terms of training, job satisfaction, and (often overlooked) ownership of support for trainees.  I think the ‘team spirit’ element has largely disappeared at least in the acute specialties, to the detriment of support for patients and the workforce.  I would not advocate a return to the system of working we used in 1990, but I do believe some redesign is required to reverse the impact of the downside of shift based working.

Secondly, it is worth recalling that the medical school was established in Nottingham partly to address poor health care outcomes regionally.  Although there was some medical training based at the General Hospital in the early nineteenth century, the main reason a medical school was created in Nottingham was to train doctors who it was hoped would remain local and service the health care needs of the population.  Subsequently the medical school has also become a strong focus for clinical research, with internationally recognised clinical academics across a broad range of speciality areas. However, we still have work to do to drive up outcomes in the region: one only has to look at Public Health England data to realise Nottingham remains below the national average in many domains.  So I think the medical school can still do more to help address these issues, for example by working closely with the new Integrated Care system (ICS).

Thirdly, the infrastructure for clinical support is now much stronger than it was in the 1990’s, mainly because of the creation of the National Institute for Health Research (NIHR) and the ability to access funding through the many schemes NIHR operates.  I was delighted when in 2017 we obtained funding for a Biomedical Research Centre (BRC), which provides the focus for many of our programmes of early phase clinical translational research.  For example, I was always struck by the fact that Nottingham was internationally known for its role in the development of MR imaging, yet until fairly recently did not have a dedicated MR imaging research facility embedded in the hospital to support patient based studies.  We can now support this through the BRC to undertake state of the art MR imaging in a wide range of patient groups. This emphasises the need for the medical school taking full advantage of the excellent science base in the rest of the university to drive translation in clinical research.

Finally, a few thoughts on medical education.  One of the problems I found when I was Faculty Dean is that you spent much of your time dealing with the very small number of ‘difficult’ staff or students. It was very easy to forget what a wonderful group of staff exists in the faculty, many of whom have dedicated most of their working lives to making the medical school the success it is today.  Similarly, nearly all of our students are fantastically dedicated, with many taking on extra-curricular roles which benefit wider society.  The recent pandemic has I think highlighted the need for this sense of community to be fostered.

So congratulations to the medical school for the successes and achievements of the last 50 years!

By Professor Ian Hall, Director of the Nottingham Biomedical Research Centre and Professor of Molecular Medicine

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