Lives of the fellows

George Algernon (Sir) Smart

b.16 December 1913 d.2 November 2003
Kt(1978) MB BS Durham(1937) BSc MD(1939) MRCP(1940) FRCP(1952)

Not all professors of medicine have transformed the academic aspirations of the institutions to which they were appointed. George Smart did. Such opposition as he encountered from conservative-minded colleagues he usually overcame by a genial persuasiveness, combined with boundless enthusiasm and a streak of determination. Many of the innovations that he pioneered in the field of education, although seldom traced to their originator, are enshrined in today's approach to the training of doctors.

The greater part of Smart's professional life was centred on the Newcastle Medical School, which he had attended as an undergraduate after school days at Uppingham. He combined a BSc with his MB BS course in which he graduated with honours in 1937. He stayed in Newcastle for his junior hospital posts then joined the Royal Air Force in 1941 as a graded medical specialist, having already obtained his MD and his MRCP diploma. Initially he served on an operational station and then transferred to the RAF nutrition team with responsibility for the conduct of nutritional surveys of personnel at home and overseas. This experience was to influence his future career. It brought him in contact with Sir Austin Bradford Hill [Munk's Roll, Vol.IX, p.235], who in the coming years was to bring statistical enlightenment to medical experimentation.

He learned from Bradford Hill about the design and analysis of experiments and about population sampling in his nutritional surveys. He also worked with T F Macrae, later research director at Glaxo Ltd, on laboratory-based studies of metabolism. With R A McCance [Munk's Roll, Vol.IX, p.327] he investigated malnutrition in post-war Germany.

Following demobilisation, Smart was appointed to a lectureship at the University of Bristol, whence he was granted leave to take up a Commonwealth Fund fellowship (now the Harkness fellowship). This too kindled his interest in the scientific approach to clinical medicine. As a Harvard research fellow he worked at the Massachusetts General Hospital and also in the chemistry department at the Massachusetts Institute of Technology. His main topic of research was adreno-cortical function in diabetes mellitus. MIT introduced him to the chemistry of radioactive isotopes and their applications in endocrine and metabolic medicine. During the three months travel built into the fellowship programme he visited many of the major medical centres in North America, observing their research activities and, in particular, their teaching methods.

Against this early background, it is easy to envisage the challenge that he saw confronting him when in 1951 he returned as reader in medicine to his old medical school in Newcastle, then still part of the University of Durham. He had already been elected to the Fellowship of the College and, at an unusually early stage in his career, to membership of the Association of Physicians. Six years later, he was appointed to the chair of medicine.

In the 1950s the notion of a properly founded clinical academic department was not widespread. He inherited no decent laboratory space or research equipment. Although he managed to continue with a certain amount of personal research in metabolism, his output was limited and he was never a prolific author. His real effort was directed towards building up the department, procuring laboratory space and equipment, attracting young research workers and engendering a scientific approach to medicine in both staff and students. Above all, he wanted to reform the undergraduate curriculum which had remained unchanged for decades.

Fortunately there were a few like-minded heads of academic departments in the school who saw the need for change and shared his interest in some of the educational ideas being generated in schools in the US, particularly Western Reserve in Ohio. From regular evening meetings in each other's homes emerged the blueprint for a new curriculum which was eventually introduced in 1962. It was based on the systems of the body rather than the departmental disciplines and it brought together basic science and clinical teachers in integrated courses. New methods of assessment and new teaching aids incorporating up-to-date technology were developed. To stimulate enquiring minds, students were encouraged to undertake research projects and overseas elective attachments and a new bachelor of medical science degree was introduced.

The move to systems-based teaching and examining inevitably resulted in some loss of departmental autonomy. Although this was initially resented, it represented a first step towards faculty reorganisation. Over the years the 1962 Newcastle curriculum has undergone progressive modification, but it did provide a prototype for developments in other schools and many of the ideas generated by George Smart are now enshrined in the canon of medical education. With his friend Sir John Ellis [Munk's Roll, Vol.XI, web] he played a major part in founding the Association for the Study of Medical Education, of which he was later to become president.

An opportunity to realise further ambitions came when he was appointed dean of medicine in Newcastle in 1968. A major building programme to replace the existing medical and dental schools and to provide a new hospital ward block had been in prospect for several years. Momentum gathered as he took office and he had a leading role in the planning process. He managed to negotiate remarkably generous library and laboratory space with the University Grants Committee and the DHSS, who were jointly funding the project, and he ensured that there was proper provision for all the clinical, as well as the basic science departments.

After three years as dean, George Smart was invited to take over the directorship of the British Postgraduate Medical Federation (BPMF) in London, in succession to Sir John McMicheal [Munk's Roll, Vol.IX, p.341]. He engaged with the specialist institutes, whose administration and funding allocations came under the BPMF, but his principal interest was in working with postgraduate deans and developing their role, which was becoming increasingly important with the advent of structured training programmes and continuing medical education. He retired from the BPMF in 1978 and in the same year received his knighthood.

George Smart was a good servant of the College. He was an examiner for many years and served on council and on the board of censors. He was senior vice-president from1972 to 1973 and in 1974 he gave the Lumleian lecture. Under the title 'monitoring in medicine', he made a prophetic plea for greater accountability on the part of the profession. He foresaw the development of 'league tables' and predicted their unpopularity. But he argued that the profession need have nothing to fear from them, provided it took responsibility for establishing the ground rules and making the system work.

He also stated, and this 30 years ago, that "...we should welcome the development of means whereby patients' reactions to their care can be assessed, for, even if this did not particularly correlate with the actual objectively assessed outcome, to know the things which are important to patients would be invaluable in the professional training of doctors, as well as in improving efficiency by making available and effective services more acceptable." He ended with a short passage from Genesis and the comment that "If God could take the troubled to check on his work and see that it was good, surely doctors should."

The enthusiasm and commitment which George Smart brought to medical education were evidenced in his recreational pursuits. He was a keen sailor and gave valuable service to the Royal National Lifeboat Institution over many years, advising it on medical training and survival procedures. He was made a vice-president in 1988. His other main diversion was photography, in which he was expert and which gave him the opportunity to indulge his delight in gadgetry.

In his retirement in West Sussex, Sir George, although handicapped by deafness, maintained his interest in local and national affairs. He was a generous, loyal and friendly man and was proud of the success of many young colleagues whose careers he helped to launch. He could look back on a long and happy life with his wife Monica, who survives him with their daughter and two sons. He could also reflect on the great changes in medical education which he had seen in his lifetime and to which he had contributed in such large measure.

David Shaw

[, 328,2004,170; The Independent 2 Dec 2003; The Times 3 Dec 2003]

(Volume XI, page 527)

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