Changing times. Annual oration: Royal Victoria Hospital, Belfast, October 2001.

The great majority of these Orations have been delivered by men, but since 1995 the medical staff have to some extent redressed the balance albeit belatedly, and Professor, now Dame Ingrid Allen gave the Oration in 1995. Last ear Professor Jennifer Adgey gave the Millennium Oration. It gives me great pleasure to follow her as Orator and when I look down the list of previous Orators it makes me proud to join that distinguished company. At this moment it also makes me nervous. Heraclitus was an ancient Greek; he was indeed a very ancient Greek. He lived in Ephesus around 500 BC but he was a man ahead of his time, and he is reputed to have said "there is nothing permanent but change". I have chosen the theme of "Changing Times" for this Oration and would like to discuss some aspects of changes which have taken place in recent times in this profession and in my own specialty. The first of these is the effect of recent changes on Academic Medicine. I fear these have not been entirely beneficial. The late Gary Love, former Professor of Medicine in this Medical School, gave this Oration in 1988. It was entitled "Serving Two Masters". By that he meant serving two employers, the University and the National Health Service. As everyone knows it is difficult to serve two masters and recently these difficulties have been compounded. This is largely due to divergence which has arisen between the priorities and objectives of the University and those of the National Health Service. As Gary Love said, the cardinal aspects of academic medicine are patient care, teaching and research. All medical staff, academic or otherwise are well acquainted with changes in patient care. The increasing complexity of modern medicine, the necessity for continuous updating and revalidation coupled with increasing expectation by the general public, is something which we are all learning to live with, not only in the medical profession but in nursing and professions allied thereto. Similarly teaching is not the prerogative of academic medicine. A great deal of undergraduate medical teaching is carried out by NHS staff. This hospital has a long and proud tradition of teaching which I will return to later. Nonetheless with the introduction of the new medical curriculum by the GMC three years ago, there was a switch away from formal lectures to problem-based learning and small group teaching. …