Professor Sir George Smart

Reforming medical educationist
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The Independent Online

George Algernon Smart, physician and medical educator: born Alnwick, Northumberland 16 December 1913; Lecturer in Medicine, Bristol University 1946-50; Reader in Medicine, Durham University 1950-56, Professor of Medicine 1956-68; Professor of Medicine, Newcastle University 1968-71 (Emeritus), Dean of Med-icine 1968-71; Director, British Postgraduate Medical Federation 1971-78; Kt 1978; married 1939 Monica Carrick (two sons, one daughter); died Fishbourne, West Sussex 2 November 2003.

George Smart was not only a respected physician with particular interests in nutrition, metabolism and endocrinology, but was also one of the leading UK medical educationists of his time.

Born in Alnwick, Northumberland, in 1913, he was educated at Uppingham School. He had a lifelong interest in all things scientific and, after a brief flirtation with chemistry, he chose medicine as a career. He qualified from the Newcastle Medical School (then within Durham University) in 1937. During the Second World War years he served with the Royal Air Force and was a clinical member of a scientific team that was responsible for studying and maintaining the nutritional standards of RAF personnel.

After the war he worked for a time in Bristol and then spent a year in the United States as a Commonwealth Fund Fellow before returning to Newcastle in 1950 as Reader in Medicine. In 1956 he was appointed Professor and Head of the Department of Medicine. He initiated and supervised research and carried full clinical responsibilities, but it was for his achievements in medical education that he will be particularly remembered.

The undergraduate medical curriculum at that time was demoralising. Students came to medical school longing to see patients, but this was denied them for the first two years. Regional anatomy was a feat of memory, as was much of physiology, and this contributed little to intellectual development. Far from the scientific attitude being carried forward to the clinical years of the curriculum (and through professional life) it was the habit of unthinking learning by rote that was reinforced. The main criticisms of the "traditional" medical curriculum at that time were of its rigidity - it was too full and disjointed. Incentives to learn were either lacking or inappropriate and students had little clinical responsibility.

Recognising these shortcomings, George Smart was one of a small team of dedicated medical teachers responsible for the planning and implementation of the "New Curriculum" in Newcastle, based on the innovative undergraduate curriculum pioneered at Case Western Reserve University in Cleveland, Ohio. A number of key guidelines were defined, including the principle of integrated teaching based on body systems, the allowance of time for self-learning, limitation of the amount of factual knowledge that a student was required to assimilate, the desirability of involvement in clinical or experimental enquiry, and early clinical experience. From these guidelines curricular objectives evolved; Newcastle was the first medical school in the UK to produce explicit objectives.

This curriculum was introduced in 1962 and was a remarkable achievement; it paved the way for similar developments in other UK medical schools. One of the most important principles of this new philosophy was that the curriculum should never be allowed to stagnate as it had in the past; it should remain constantly under review. It should evolve and change as medical knowledge and practice advanced.

Smart's educational endeavours were not confined to the undergraduate field. In 1962 he was appointed Postgraduate Sub-Dean, working alongside Dr C. "Nat" Armstrong, the NHS Regional Director of postgraduate medical education. He was also one of the founders of the Association for the Study of Medical Education and later became one of its Vice-Presidents.

In 1968 he was appointed Dean of Medicine in Newcastle. Although he was Dean for only three years, Smart's contribution to the school was far-reaching. In addition to his innovative curricular work, he maintained his interest in all aspects of postgraduate medical education. With Professor Eric Blair, Professor of Physiology, he pioneered the establishment of the intercalated honours degree of Bachelor of Medical Science for medical students. His mind was always active and fertile and he was for ever seeking out new ideas, whether in medicine, biochemistry, education, electronics or computing. Above all, his ability to build a team and to provide a friendly and thriving environment for first-class work came second only to his energy and enthusiasm.

In 1971 he left Newcastle on his appointment as Director of the British Postgraduate Medical Federation in London. Here he was responsible for the medical institutes of London University and for overseeing the four Thames postgraduate deaneries. From 1965 to 1967 Smart had acted as a Censor of the Royal College of Physicians; in 1972 he was elected as Senior Censor and Senior Vice-President, offices he held for one year. From 1979 until 1983 he served as Chairman of the General Medical Council's Review Board for Overseas Qualified Practitioners.

What of the man outside medicine? George Smart had an enormous number of interests and pursued these with the same vigour he had shown in his professional life. He was an enthusiastic photographer and a knowledgeable bird watcher. Until latterly sailing was a passion, and generations of junior colleagues will remember crewing for him. He often combined all three interests by arranging trips to the Farne Islands off the Northumberland coast for his staff and for external examiners. A dedicated supporter of the RNLI, he served on the institution's management committee and its Medical and Survival Committee from 1979 until 1983.

John Anderson