Marc Chagall – Fables exhibition – London


Cannot believe that I was standing looking at Marc Chagall’s paintings in the flesh earlier.

I can see why he appeals to many of us who don’t have an artistic career with the tenderness of gestures in vivid colour, contrasted with some much sharper images in late 1930s-50s.

A friend who joined me mentioned some stained glass windows he has created in Kent too

Why “a good war” won’t “sort things out” – one off geopolitical post on Turkey, Russia & European relations

I write these blogs for personal reflection as well as an online writing space that is not necessarily discoverable. To clarify, I don’t support fascism or the ideologists that try and practice it in any country. I’m not going to say what I think Russia should or shouldn’t do, just explain it as I see it this week in 2016.

A well intentioned & very mild mannered chemist said to me recently that he believed that a good war will sort things out. Well history has told us about well intentioned chemists that become rich by making bombs or other lethal weapons.

He grew up after WW2 so how could he know? I don’t know of anyone who still lives to talk about wars, has fought in wars, has supported wars, has studied wars – who says they’re a good thing. So:

With it’s unique size & location has more complex relationships with its neighbours and history of how Russians have lived and worked in and out of these countries. Much has been made of Vladimir Putin’s statement about Gorbachev’s policies in the 1980s and 1990s but as far as I’m aware that has not ever been clarified in independent English language media. Vladimir Putin’s statement/interview (in English) following G20 this summer mentions that Russia does not trade territories, that discussion of territories in Europe with WW2 agreements is a Pandora’s box and that Russia has enough land.

The history of Russia and its relationships with its nearer and slightly nearer neighbours is continuously evolving and this is why I find some of the foreign policy statements that the Russian government more sensible – Russia is not an EU in itself but it is a federation with not completely dissimilar internal relationships from what I’ve understood so far.

From what I’ve read about the Russian President including some critics, there is an ultranationalistic far-right in Russia but he is not described in that category. However there is increasing evidence that he and/or advisors maintain relationships which benefit the European far right.

It is natural for citizens in the UK who have never lived abroad to view things that have a perspective that is similar with the views of US presidents and US corporations as that is what they are contiuously exposed to and vice versa in Russia. We are also aware that there have been throughout history, views held and supported by those with power in the US, UK and EU countries who maintain relationships that benefit the European far right. The UK and the US have not been invaded or occupied in the 20th century and that may be part of the reason why this ambivalence towards fascist ideas is again taking root – as well as Conservative (political party members) trading relationships with countries that produced these.

These relationships maintained by any country rightly bring into question the motivations behind other geopolitical intentions as the interests of the European far right have increased with large scale unemployment, inability to live with citizens who look different to them and fantasies about Hitler, Nazis or others who support/are fascists. A large geopolitical war won’t sort these out, the reality is not just far right but across all sections of political society, numerous smaller complex conflicts across the whole of Europe, Russia’s Eurasian neighbours and Russia which either escalate to military actions or don’t.

This is why I believe NATO needs reviewing but alongside European security and defence policy. I don’t think it is helpful to have an organisation in 21st century for which all military actions are steered by a US commanding officer, it is at odds with how the EU has evolved, attempted to evolve. Russia has a relationship with NATO and it’s not that there should be a gigantic geopolitical shift where suddenly instead of a US command or increased Russian interest being represented – that other countries become dependent on a Russian commander for example.

I don’t support economic sanctions either but that is not because I think Russia should be given freedom to use its size to score better deals for itself abroad, it is time to find useful agreements Russia, US, EU , China etc that recognise peoples’ countries’ rights to exist, agreements that don’t bankrupt their future and those of their citizens or the planet’s future. I don’t believe that agreement can’t be found, an agreement can be found that does not disadvantage a group of people territorially, economically, culturally.

There is evidence from Latvia, Lithuania and Estonia that Russian communities in those countries who have connections with families / friends / colleagues in what was the USSR are not given the same rights as others who live there. That is understandable considering the last few centuries where they have tried to define their identity, however that does not make everything ok.

Turkey for example. Recep Erdogan has changed significantly since the early 2000s where he was originally featured in Turkish media – visiting poorer people instead of taking holidays for relaxation and now in 2016, thinks it’s natural to a) want a 1000 room house, b) rights taken away from Turkish government and  given to him, whilst c) giving positions of power to relatives / friends. c) is not unique to him and happens in every country that I can think of.

I find some similarities between Russia’s relationships with its near neighbours and Turkey’s relationships with Turkmen in northern Iraq. When the second Gulf war broke out and the Kurdish conflict spread into areas where Turkmen were living and working, there was a huge response from Turkish citizens if military action was needed. There have been accounts of Kurdish people burning down offices and paperwork that shows the residential /  territorial rights of the Turkmen people. These actions are not acceptable but it doesn’t have to produce a military response if a diplomatic one can produce more long term stability.

There is also the issue of an English global language as highlighted by Andrew Monaghan in The Politics of New Russia where an agreement (trading, territorial or otherwise) is not necessarily the same thing for either parties. I know this at a very small level when I worked for PwC with my European colleagues – after sitting for several hours in a meeting, with even translators available, that doesn’t mean that the outcomes were what each party involved understood them to be or how they will be delivered.

A war won’t fix these, infinite patience might. And as a UK military commander said in a Remembrance Day service I was in yesterday in London, practice compassion daily – regardless of your situation.

Discoveries on your doorstep @university of Surrey

The university is delivering a 3 part showcase of research projects on delivering global wellbeing through science.

There were great posters including research on meditation, ehealth and lung cancer, autism & wellbeing and short talks including

Cardiology and ECG research from Dr Kamalan Jeevaratnam who discussed how reliance on QT for regulatory purposes causes challenges with pharma research and why regulatory guideline needs to change

Dr Sharkardokht Jafari, dosimeyry specialist and inventor of Trueinvivo – a new, exciting way to measure radiotherapy using glass beads.She gas kindly agreed to being featured as a case study in the People’s Uni module, which will be available shortly but she has also featured on international media. I spoke with her briefly, an incredible passionate lady dedicated to making treatment affordable back in Afghanistan.

Dr Milton Mermikides creating and producing amazing musical projects from often medical data including his own personal blood data during treatment for leukaemia

Taryn Smith studying vitamin D especially in teenagers, the differences in defining appropriate intake and use of fortified foods including eggs and mushrooms. I didn’t know that mushrooms process vitamin D from sun in very similar way to humans.

Life outside of the US election

I went for a walk around a local vineyard with friend & dog on Sunday. She is a more experienced and senior martial artist and we will be planning inclusive coaching sessions together over the next few months as 4 of us, 2 new black belts do our coaching courses together.

She has decided to learn Arabic so that she can continue to look at projects with refugees so we are both in the new language learning nursery uttering our first sounds.

Everyone I’ve spoken to since I last posted about Russia has been really positive and interested. Several people have said that whilst ‘big politics’ is what it is, it is good for Europe and the world to have more Russian balance in it. 

Cancer pain article by international pain experts at Royal Marsden

I asked our medical education director (who is also a senior consultant anaesthetist) and he said the following are international pain experts

  • Paul Farquhar-Smith
  • Matthew Brown
  • John E Williams

Paul Farquhar-Smith and Matthew Brown have just published the special update on persistent cancer pain which includes all the latest updates on different types of cancer pain and treatments pcu-24-4_web


I will continue to put articles as I find them on the cancerpainres twitterfeed for now

Shinseidokan dojo: Toughen up!


We are often told if we have injuries it’s because we’re moving the wrong way which is also frustrating and true. I don’t agree with the classic taller, big, muscles fighter etc – small people like me can build up muscle and get injured at the same time. Which does obviously boil down to practice and moving correctly etc

Course content 1-4 draft 0.1

coursecontent (pdf)

A lot still to do ! If anyone is interested in contributed all of the pages, documents and videos are in the back end site development of People’s Uni, please contact me for a login.

Once upon a time..

Have been thinking about liability scenario as a way of tying up first three sections. This is not going to be it, but if it was a game – it may be along these lines (disclaimer I was once a primary teacher)

You wake up one morning covered in blue spots. You go to your local pharmacist in the village

You: Hey

Pharmacist: Hey

You: You sold me those pills yesterday and now I’ve got blue spots. You didn’t tell me I could get blue spots.

Do you?

a) I’m going to sue your pharmacist ass right off, I have 3 lawyers on speed dial

b) Buy something else to get rid of the blue spots

c) walk away

You choose c) for now because you are in a village and have no idea what speed dial is or where you can find a lawyer. Feeling a little blue, you take yourself off for a nice walk in the countryside. You sit down on the edge of field by some woods and decide you’re hungry. You see a bunch of mushrooms. Do you?

a) Eat one because you think they’re the same ones you saw Matt Baker cook with on Countryfile tv programme last week

b) Don’t eat

c) Eat after checking your field guide to mushrooms pocketbook which of course you have with you at all times.

You choose a) and suddenly after an hour or so you notice most of your blue spots have disappeared. You get up and wander over to your uncle’s house across the field. Your aunt is in and you tell her all about your magical appearing & disappearing blue spots. She says you’re kidding and shows you her blue spots. You both wander back over to the wood and she eats a mushroom. Sure enough her blue spots disappear.

Word starts to spread around the village by evening and before long the mushrooms are all gone, before the pharmacist can get anywhere near them and start grinding them into powder. Nobody seems to mind about the large orange dinosaurs that everyone has seen arriving next to the woods snice they ate the mushrooms.

The next day you find another bunch of mushrooms have grown so you decide to take them to the next village’s market and sell them. Getting a little carried away, you make a big sign saying – mushrooms cure cancer and the next thing you know a stranger has bought the whole bunch and walked away.


Pharma course content sections 1 and 2, first draft

Some links won’t work as they have document or other module links in the course attached to them, but will provide later:


This draft has not been contributed to / reviewed by anyone else yet and as a first draft may be unncessarily boring, but a way of getting ‘words on paper’ which gives others something to work with. I have often noticed in most eLearning development projects I’ve been involved with that even experts in their area are not used to writing content so it’s not until someone writes something that they start to input.

Hope to upload drafts for 3 and 4 by end of tomorrow.


Randomised control trial background briefing paper

Can’t publish the full thing but the cost reduction/reallocations based on previous baseline I created at MHRA a few years ago and use occasionally when needed.

pdf version & below

Consultants Mandatory Training replaced by online learning

We are proposing to replace the face to face training sessions with a full online learning programme, following feedback from consultants during the next 2/3 months. Consultants Mandatory Training is currently delivered as a series of face to face training sessions during a day. The costs for the Trust include the consultant clinical time away from patient care and trainer time for preparation and delivery. The Trust has recently implemented a new learning management system – the Learning Hub which allows greater ease of access to a wider range of online learning including mandatory training modules.

The Learning & Development team have been working with subject matter experts overseen by the PGME Director to develop online learning content suitable for consultants. This means that they can complete the modules during their own time and location because the hub is hosted securely on the internet with a design that allows mobile and computer access.

As humans, consultants face increased information overload and retention issues. Face to face training may address an organisational need at the time but it takes them away from patient care and is not known how they need to use or apply any new knowledge or behaviours back in their work environment. Sometimes there may be a delay in needing to apply any new knowledge or behaviours which mean that retention from the face-face training session will continue to decrease.
The availability of online packages and resources on the hub helps address information retention and accessibility of information as needed including use of a mobile device. It is hoped this evaluation exercise will provide evidence about the effectiveness of learning interventions to meet organisational risks or needs as well as at a personal level.

Feedback indicates that consultants do not wish to spend time in classroom training for mandatory subjects. This analysis identifies areas where time and cost can be saved or reallocated by using eLearning. A consultant will spend approximately ½ day of clinical time attending mandatory training. Completing eLearning packages and/or refresher activities online can be done either outside of clinical time if preferred or approximately ¼ day continuously using the hub.

Baseline Cost Reductions / Reallocations:
Approximate Trainer & Training hours for Consultants Total days
2016 Total Days spent in Mandatory Training (total attendee hrs) x days (x hrs)
2016 Total Days Trainer & Support x days (x hrs)
2016 total days consultation, design, evaluation, admin x days
2016 total days delivery x days
2016 Hours spent in L&D admin support x days
2016 Total attendee, trainer & admin days x days
2016 Days spent in Consultant MT x days
2016 Days Trainer & Support for Consultants MT x days
Avg total trainer & admin Cost £x
Avg total attendee Cost £x
Avg Total Locum Cover Cost £x
Avg Total Cost £x

Evaluation Design
Whilst there is a suggested cost baseline, we do not have a baseline for what is an effective learning intervention as opposed to other interventions to meet the needs of mandatory compliance.

The Trust currently use feedback questionnaires similar to level 1 of the Kirkpatrick model which attempt to gauge effectiveness based on a reaction / satisfaction after the learning intervention1. Additional levels are learning – the extent to which participants change attitudes, improve knowledge or increase skills, behaviour where the new knowledge, skills or attitudes transfer into their job (e.g. through an assessment) or a further course and finally organisational results from the change in learners.2

Critiques of the model suggest that it removes the focus away from instructional design (a core component of online learning packages development), it does not accurately measure whether learners remember anything or whether they are motivated to apply what they’ve learned. This could be true in an online or face-face context.

Other critiques are that it falsely correlates feedback questionnaires with learning results3, or causal links between positive reactions and additional levels assuming that each level of evaluation provides data that is more informative than the last 4, insufficient evidence about how evaluation can inform whether good or bad behaviours which could then affect organisational risks can occur.

So evaluation of mandatory training for consultants could inaccurately identify whether this learning intervention has helped – such as a reduction in HAIs where consultants sit in a face-face session or online learning package to see examples of how to wash hands. You could also bring in clinical case studies where consultants could evaluate the evidence of hand washing in different clinical scenarios but this is also not possible to evaluate whether a more interesting learning intervention in a face-face session or online is effective in meeting a reduction in HAIs.

Effective learning evaluations should help organisations and individuals apply the principle of beneficence – an ethical duty where “actions must be taken when the opportunity arises to actively contribute to the health and welfare of clients and stakeholders”5

There are risks that a Kirkpatrick model will not be able to convey accurate information about whether risks have been addressed to stop future harm or loss6
Applying the principle of beneficence, as learning professionals we are ethically obligated to provide evidence of whether evaluation of a learning intervention is effective. That should extend beyond the organisation so that this exercise can be evaluated by a wider audience.

Alternative evaluation models suggest that a mix of accumulation of evidence over time and qualitative studies would be useful. Whilst is is not possible to have a group of consultants with a placebo (no mandatory training) currently, it is hoped this exercise could inform discussion to see if this is possible for future learning interventions. If we don’t then we are failing in our ethical duty.
A group of consultants who have registered to attend upcoming mandatory training sessions will be randomly selected to complete the training using online learning through the hub. An additional consultant will act as observer during the face to face training sessions.
Qualitative data will be gathered through short interviews and anecdotal snippets provided by..

1. Kirkpatrick, D. L. (2001). Evaluating Training Programs: The Four Levels ,2 ed. San Francisco, CA: Berrett-Koehler
2. Owston, R (2007), Models and Methods for Evaluation, Journal for the Theory of Social Behaviour 1(1):75 – 93 DOI: 10.1111/j.1468-5914.1971.tb00166.x
3. Thalheimer W(2015) Kirkpatrick Model Good or Bad,,
4. Bates R, (2004), A critical analysis of evaluation practice: the Kirkpatrick model
and the principle of beneficence, Evaluation and Program Planning 27 , 341-7
5. Bates R, (2004), A critical analysis of evaluation practice: the Kirkpatrick model
and the principle of beneficence, Evaluation and Program Planning 27 , 341-7
6. Bates R, (2004), A critical analysis of evaluation practice: the Kirkpatrick model
and the principle of beneficence, Evaluation and Program Planning 27 , 341-7
7. Owston, R (2007), Models and Methods for Evaluation, Journal for the Theory of Social Behaviour 1(1):75 – 93 DOI: 10.1111/j.1468-5914.1971.tb00166.x

Randomised control trial attempt – eLearning vs f2f

This won’t be a paper but in summary – groups of consultants attending mandatory / compliance f2f training were randomised with the Postgraduate Medical Education Director selecting anonymised bookings with only the word Chelsea or Sutton visible.

Different training occurs each month depending on need. If an elearning package was available then this was offered to the randomised group for that month.

We have received limited feedback but the feedback received so far has been a strong preference for elearnung so that it fits with clinic scheduling. I wrote a cost benefit analysis to include consultant time and locum cover when required to attend f2f training.

Approval was not granted as yet for a separate placebo group to receive neither f2f or elearning (instead to make their own learning arrangements) but hope this will continue to be in discussion further along. One of the reasons being unable to produce an evaluation that doesn’t disrupt patient care.

It has been a useful exercise.

Blood app link