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Osler Centenary Papers: The Fellowship of Postgraduate Medicine and the spirit of Osler
  1. Donald Singer
  1. Fellowship of Postgraduate Medicine, London, UK
  1. Correspondence to Professor Donald Singer, Fellowship of Postgraduate Medicine, London, UK; fpm.chandos{at}gmail.com

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The centenary of the death of Sir William Osler1 provides a stimulus to considering ways in which his legacy lives on through the Fellowship of Postgraduate Medicine (FPM).

Osler was the founding president of the Postgraduate Medical Association (founded in 1911) and later of the Interallied Fellowship of Medicine2 (founded in late 1918). In view of their common aim of establishing permanent postgraduate medical education in the UK, the societies merged later in 1919, with Osler as president until his death at the end of that year. This joint organisation was initially called the Fellowship of Medicine and Post-Graduate Medical Association3 and continues to this day as the FPM.4

Osler was a lifelong promoter of postgraduate medical education. In the 1880s, in his role as a medical leader in North America,1 he pioneered hospital residency programmes for junior trainee doctors (see figures 1 and 2). As Regius Professor of Medicine in Oxford from 1905, Osler wished early postgraduate teaching in the UK, and in London, in particular, to include access to ‘the wealth of material at all the hospitals’.5 He also saw medical societies as important for providing reliable continuous medical development for senior doctors.

Figure 1

Osler with Johns Hopkins interns. Credit: Wellcome Images L0004895).

Figure 2

Young professors at McGill: William Osler, FJ Shepherd and George Ross.credit: Osler Library of the History of Medicine, McGill University. William Osler Photo Collection/NLM/NIH.

Under Osler’s leadership, the Fellowship of Medicine responded to demand for postgraduate civilian medical training after the First World War, supported by a general committee of 73 senior medical figures, with representatives from the British Army Medical Services, Medical Services of the dominions of the UK, of the USA and of the British colleges and major medical schools.3 Members included Sir Humphrey Rolleston,6 then president of the Royal Society of Medicine, and neurosurgeon Colonel Harvey Cushing, who went on to become Osler’s biographer.1 Some 50 general and specialist hospitals were initially affiliated with the Fellowship, which first arranged an emergency postgraduate course.1 3

As a result of interest from its many affiliated hospitals, the Fellowship rapidly went on to provide sustained support of postgraduate training well into the 1920s, published a weekly bulletin listing clinics, ward rounds, special lectures and organised training courses for men and women of all nationalities.7 In 1925, in response to expanding interest in postgraduate education, the Fellowship developed the bulletin into the Postgraduate Medical Journal (PMJ), which published clinical reports and review articles, and has continued as a monthly international publication since then.3

In the early years of the Fellowship, many of its fellows were also in influential positions, both in a wide range of other important medical societies as well as having roles as medical leaders in major medical institutions in the UK. Stimulated by discussions at the meetings of the FPM, through its fellows, the FPM was influential in encouraging London and regional teaching hospitals to develop and maintain postgraduate training courses. The FPM and its fellows were also important in supporting the creation of a purely postgraduate medical school, which was eventually founded at the Hammersmith Hospital in West London as the British Postgraduate Medical School, then Royal Postgraduate Medical School.3

At the end of the Second World War, there was a major development in provision of postgraduate medical education with the founding, in 1945, of the British Postgraduate Medical Federation (BPMF), which was supported by the government, the University Grants Committee and the universities, with Sir Francis Fraser, FRS, as its first director.3 This federated medical school of the University of London comprised 15 postgraduate medical institutions, including the British Postgraduate Medical School at the Hammersmith Hospital and 13 institutes attached to specialist postgraduate teaching hospitals.8 There was also a marked post-war increase in general provision of postgraduate training at individual hospitals and within the Medical Royal Colleges. Postgraduate centres were established at many hospitals. Nonetheless, the FPM continued some involvement in postgraduate courses until 1975.3 The BPMF later evolved into regional ‘deaneries’ across the whole of the UK. In 2013, the English deaneries were incorporated into Health Education England, the organisation currently responsible for managing specialty training nationwide.

Since 1975 the FPM has maintained a national and international role in postgraduate education through its journals, the PMJ9 and Health Policy and Technology (HPT)10 (founded in 2012), and by a series of affiliations with other organisations and institutes, including the European Association for Internal Medicine,3 the National Association of Clinical Tutors,3 11 the Medical Society of London,12 the European Medical Research Group11 and the Centre for Health Informatics and Multiprofessional Education at University College Medical School in London.3

Osler was an avid supporter of engagement between medicine and the humanities,13 chiding humanists for ignorance of modern science and fellow scientists for neglecting the humanities.13 The FPM has, over much of the past decade, supported this theme of Osler by being a major patron of the Hippocrates Prize for Poetry and Medicine.14 The Hippocrates Prize has achieved significant international interest, with around 10 000 entries from over 70 countries, and engagement with major international institutions, with previous annual awards conferences held in the UK and the USA (at Harvard and in Chicago), and planned for Oviedo, Spain, in 2020 and Sydney, Australia, in 2021. As an example, the FPM-supported 2018 Hippocrates awards were presented at international events in Chicago in partnership with the Northwestern University Feinberg School of Medicine, the USA Poetry Foundation and Harvard Medical School.15

Immediate past president of the Royal College of Physicians Professor Jane Dacre, DBE, was a judge of the 2019 Hippocrates Prize for Poetry and Medicine.16 Of poetry in the Hippocrates Prize she noted: ‘The words used, and the emotions expressed have helped my understanding of some of the more complex and difficult clinical areas. This heightened understanding came from the poems written for both health professional and open categories. Medicine is emotional and complex and poetry helps us all to come to terms with it’.16

The FPM also continues to run workshops and conferences, has introduced a new associate member category for the FPM and is launching new international awards for excellence in medical writing by doctors in social media.17

As recent examples of conferences, in 2017, in partnership with its HPT journal, the FPM and healthy heart charity, the Cardiovascular Research Trust, held a symposium in London on health policy for preventing heart disease, and in 2019, as a further collaboration with the HPT journal, the FPM co-organised a conference on European Cooperation on Healthcare,18 which was held at Erasmus University in Rotterdam, host institution of HPT Editor-in-Chief Professor Ken Redekop.

2018 was the centenary year for the founding of the FPM. In May 2018, the FPM supported a clinical updates session at the Hong Kong Medical Forum, as a joint venture with the PMJ and the University of Hong Kong, host institution of PMJ Editor-in-Chief Professor Bernard Cheung17. To mark its centenary, in December 2018, at the Royal College of Physicians in London, the FPM also organised a conference providing updates on excellence in clinical practice.17 The centenary of Osler’s death will be marked on 06 December 2019 by a further FPM conference on advances in medicine, with topics ranging from applying genomics to clinical practice to the impact of the fetal environment on disease in adult life, better management of heart failure and updates on palliative care.

Acknowledgments

The author is the president of the Fellowship of Postgraduate Medicine for which the Postgraduate Medical Journal and the Health Policy and Technology are official publications. He co-founded the Hippocrates Initiative for Poetry and Medicine with poet and academic Professor Michael Hulse.

References

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Footnotes

  • Twitter Donald Singer@HealthMed

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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