History of the Northern Clinical School

In the years after St Vincents became the third teaching hospital of the University of Sydney in 1924, Royal North Shore Hospital made approaches on a number of occasions seeking to become the fourth. In 1940 Sir Norman Nock, a prominent businessman who had been Lord Mayor of Sydney, became Chairman of a new Board of Directors of the Hospital. He became a leading influence in the post-war development of teaching hospitals generally and a strong force in restructuring RNSH to achieve that status.

Following a depletion of medical graduates consequent upon the War years, the University had record intakes of students and was faced with problems arranging instruction in clinical medicine and surgery. At a meeting of the Senate of the University on October 14, 1946 it was decided to ask the Hospital to agree to "being recognised as a clinical school for the teaching of medical under-graduates." In November the Board agreed to the request and on December 23, 1946 the Hospitals Commission concurred and gave approval for planning to be undertaken during 1947.

15th March 1948

Shortly afterwards, Dr W Wilson Ingram, then the Senior Honorary Physician and Director of the Kolling Institute of Medical Research, was designated Co-ordinator for Clinical Studies with a Committee appointed in March 1947 to plan for the advent of the Clinical School. At the time the only "educational" facility possessed by the Hospital was an old cottage once used as an infectious diseases ward for children and converted to a Preliminary Training School for Nurses in 1935. Despite assurances of financial assistance from the Hospitals Commission, the records indicate minimal help, given begrudgingly and belatedly, with the Hospital having to fight the bureaucracy to get anything that had been promised.

First students told to rough it

So to start the Clinical School, the entire facility for students was provided in part of Ward C1, later the neurosurgical "cranie bay" and now the Rheumatology Conference Room. This was locker room, common room and lecture room for the initial 36 students who commenced on March 15, 1948. On that day a formal inauguration of the RNSH Clinical School was conducted by the Chancellor of the University, Sir Charles Bickerton Blackburn, in the presence of a distinguished audience. This included the Minister for Health, who told the students they would have to rough it for a while. He might also have told them that this was because his Department had done nothing but delay progress for 18 months.

The first two years: Students

The first two years: Students' temporary room

Additionally the fifth- and sixth-year students were required to spend two months in residence for Clinical Medicine and Surgery and a further six weeks for Obstetrics. Two cottages, in a row of six "workman's cottages", fronting Herbert Street, which had been old when acquired in the 1920s, were renovated for this purpose. It was to be another two years, when the full complement of 128 students was on campus before the first "new" facility was provided. This comprised a single large lecture room over the then main theatre block, capable of holding all students. But it was also their common room, tea room, conference room and meeting room for medical staff and various other groups, because the Hospital had nothing else.

It was formally opened by the Dean, Professor Harold Dew on April 27, 1950. It was not until the advent of Australian Universities Commission (AUC) funding that the students alone were able to occupy these facilities, after the Clinical Teaching Block was built in 1963. Subsequently another old cottage on the corner of Herbert Street, (now the Diabetes Education Centre) and for many years the offices of the North Shore Brick and Tile Company, was made into a Students' Common Room and amenities until these were provided through AUC funding in 1971. It was the fifth triennium of AUC funding before all promised facilities were completed.

The basis for clinical instruction

The University's conditions for recognition as a Clinical School included that "A Board of Medical Studies be appointed from those engaged in teaching at the Hospital, and one of the Executive Officers be appointed as Student Supervisor and to act as Secretary to the board".

The first board, appointed in 1947, comprised Professor Dew (Professor of Surgery and Dean); Professor Lambie (Professor of Medicine); Mr Eric Goulston and Mr Hunter JWoodon (Surgery); Drs Innes Brodziak and Cotter Harvey (Medicine); Dr Angus Murray (Obstetrics & Gynaecology); Dr W.W. Ingram and Dr Wallace Freeborn (RNSH) and Dr R.G. Epps (Secretary). The Chairman was always the Dean of the Faculty or his nominee. Through the years various university clinical professors, heads of academic units and senior lecturers were included. Also representatives of the medical staff, the tutors and the students at RNSH and representatives of the Mater Hospital were added. In consequence, by the 1980s the membership of the Board numbered more than 35, and in effect became a forum for the Dean and the Warden to present reports. Thus it no longer served its intended purpose and in recent years ceased to function.

An integral part of planning for the Clinical School was the preparation and organisation of clinical lecturers and tutors for the student groups. In the reorganisation of the Hospital after the War, and in preparation for the advent of a Clinical School, all Visiting Medical Officer positions had been declared vacant and the concept of classified specialist medical staff began in August 1946. A majority of those then appointed were pre-war graduates who had served in the Armed Forces and had obtained higher qualifications. Some had been on the staff before the War while others were in the process of post-graduate training in the UK. These were the early days of our Royal Colleges and planned post-graduate training.

The teaching pioneers

The senior among these new appointees were the first clinical lecturers and tutors: Innes Brodziak, Stuart Allen, Frank Lawes (Medicine); Eric Goulston, Louis Loewenthal, Charles Lawes, Tommy Rose, Eric Langley, Kevin Fagan (Surgery); James McCulloch, Clive Paton, J.R. Radcliff (Anaesthesia); A.S.B. (Tom) Studdy (Gynaecology); F.H. Hales Wilson (Therapeutics); and the following year Douglas Anderson, R.D. (Bob) Puflett (Medicine); Angus Murray, Arthur Moon (Obstetrics); Roddie Macdonald (Gynaecology); and Clair Isbister (Diseases of the Newborn).

Equally important were those, mainly from full-time staff, appointed to organise the student groups, their schedules and clinical material. They came from the first teaching hospital registrars, all with post-graduate qualifications and each also filling the role of Tutor. Dr Reg Epps, the first Medical Registrar was also appointed the first Student Supervisor in 1948, and additionally first Secretary of the Board of Medical Studies. He was followed in 1950 in both positions, by Dr James Isbister, (whose father had been the first Australian medical graduate appointed to the North Shore Hospital in 1901).

Assistant Clinical Supervisors were also appointed: V.H. (Harry) Cumberland (Surgery) and Geoff Jasper (Obstetrics and Gynaecology). Others to play important roles in teaching in the early years were John Deakin and Doug Stuckey (Tutors in Medicine); Bruce Geddes, the first Registrar in Thoracic Medicine; Doug Tracy, Surgical Registrar (1950 - 1955) and Douglas Piper, Medical Registrar (1952 - 1954). The latter returned in 1956, after further post-graduate training in the UK, to the position of Deputy Medical Superintendent. He also took over from James Isbister as Student Supervisor, a position he filled with dedication and distinction until 1967 when the first administrative restructuring of the Clinical School began, with the creation of the post of Warden, supported by two clinical supervisors.

Clinical school numbers

The initial intake of students to the fourth year was 36, which included only four women, but this increased in the post-War years. In 1951 and 1952 the total at North Shore peaked to 140, a massive number given the inadequate facilities. A few years later this settled to an intake of 30 to 35 a year, producing a total of 90 to 100 students based at the Clinical School.

During the 1960s the intake had risen again to about 40 students a year, which considered in the context that RNSH was still only a 550-bed Hospital, placed constant pressure on the School's ability to provide adequate teaching. This finally resulted in a realisation of the wish expressed by the Mater Misericordiae to become an affiliated teaching hospital. It entered into a (then) unique agreement with Sydney University to undertake a co-ordinated teaching role administered through the RNSH Clinical School and having representation on its Board of Medical Studies. The plan was accepted by the University Senate in August 1968, so that each year from 1969, the Mater took two groups, initially of seven students each, in medicine and surgery. Thus, all students spent at least one term at the Mater.

With this teaching support from the Mater the intake immediately increased to round 60 a year, giving a regular total of more than 165 students until the all time high of 276 in 1976. This resulted from the introduction of the five-year curriculum in 1974, which meant that when the third year of the new course came into the school there were still three full years of the old course, resulting in four clinical years at the one time. In 1978 there were 118 graduates from the Hospital in one year. In retrospect one has to admire those who coped with such extraordinary demands.

The association with the Mater regrettably ended with its demise as a public hospital in 1982 - 1983. It had been a successful and harmonious relationship which was used as the model for other Hospitals in the Northern Sydney Area to become affiliated for teaching purposes. Despite this loss it was possible to sustain the teaching load of some 200 students because RNSH, with the new ward block in full use, had reached 900 beds. In 1984 the number again peaked at a record 214 students for three clinical years. However the five-year curriculum was already on the way out and February 1988 saw the first intake for a new six-year curriculum to include four clinical years. This intake continued at around 60 a year, with a total in excess of 200.

A welcome new approach to funding

As a result of post-War expansion in teaching hospital numbers and facilities and the base for clinical training moving from university to hospital campus, the universities became more involved with their clinical schools during the 1960s. If for no other reason this became necessary following the Menzies Government decision to embark on a triennial funding programme through the Australian Universities Commission (AUC). Those who had fought so hard to obtain even reasonable teaching facilities would say that during its 15 years, this programme, although administered in a bureaucratic and somewhat rigid style, provided for hospitals such as RNSH the only worthwhile teaching facilities they have received in the last 50 years.

he Norman Nock Department of Clinical Teaching and Lecture Theatre opened in September 1963

The Norman Nock Department of Clinical Teaching and Lecture Theatre opened in September 1963

The first specific purpose teaching facility of any sort built at RNSH was the Clinical Teaching Block in 1963 in the first triennium of this programme. It included the Hospital's first lecture theatre (later named to honour Sir Norman Nock); a proper library, three times larger than the area in the Kolling Institute being used for this purpose; a pathology museum; accommodation for the Professorial Sub-Units; and tutorial rooms. The second triennium provided funding for a Students Residence, opened in February 1968, an annex to the Clinical Teaching Block for clinical photography and a laboratory in the Pathology Museum.

Academic chairs

In February 1966 the University advised that it was advertising a second Chair of Surgery and that it would be moving to establish full professorial facilities within the teaching hospitals. Although RNSH did seek to have to have this Chair, it was eventually located at Sydney Hospital. However the University did move to strengthen the existing academic units by adding senior lecturers.

In April 1967, the University again advised that a Chair in Cardiology was to be established within the Department of Medicine and sought the Hospital's interest in providing necessary clinical facilities. The Hospital decided it could provide the required infrastructure and submitted a proposal accordingly. However, in July 1967, the University announced that the Chair would be based at Royal Prince Alfred and RNSH was to wait 30 years for such a development, despite its outstanding cardiac units, including surgical and other cardiology and services.

At about that time the Hospital was also asked to indicate its willingness to provide facilities for a proposed Chair in Orthopaedics. This resulted from a generous private donation, support from the Australian Orthopaedic Association and the promise of financial support from the Hospitals Commission. RNSH was favoured due to the recent establishment of a purpose-built Accident and Emergency Unit in Stage 1 of the new hospital. There were objections and demands from others, but in the event on February 5, 1968, the University Senate resolved to establish the first Chair in Orthopaedics and Traumatic Surgery to be located at RNSH and the Royal Alexandra Hospital for Children (RAHC).

The first professors at RNSH

On June 14, 1969 the appointment was announced of Dr T.K.F. Taylor, Associate Professor in Orthopaedics at the University of Seattle, USA, to the first full Professorial Chair associated with RNSH. This was a unique event because it changed all previous concepts of how Academic Chairs might be funded. It was a combination of private donations to both university and hospital, the contribution of a staff specialists salary and capital expenditure by the Hospitals Commissions. The latter provided office and consulting room accommodation for the Professor and his staff and construction of ward facilities for the necessary in-patient beds.

The Hospital continued to push for the upgrading of Medicine and Surgery, but the response was always that "the financial situation did not allow any new academic appointments". In March 1972, the University advised that the Senate had agreed to proceed to "full Chairs in Medicine and Surgery tenable at Royal North Shore". The following year Douglas Piper became the first Professor of Medicine and in 1974, Tom Reeve the first Professor of Surgery.

Although it was 10 years before another full chair was approved for RNSH, the period was used to expand and strengthen the existing units. In 1974 three senior lecturers were appointed: Ákos Györy (Medicine); Syd Nade (Orthopaedics); and Ralph Schureck (Psychiatry). Schureck, Nade and Györy were all promoted to Associate Professors in 1977. In the next three years Dr Michael Appleberg was added to Surgery as Senior Lecturer in Vascular Surgery, Dr Gedis Grudzinskas in Obstetrics and Gynaecology and Dr Gillian Shenfield established a Clinical Pharmacology Unit. She was subsequently appointed Associate Professor.

AUC funding for a professorial block

The third triennium (1967-1969) of AUC funding saw approval of what had become the hospital's major requirement after the original clinical teaching block. In the early planning of the new multi-story Hospital, Dr Wallace Freeborn had the vision to argue for a "Clinical Sciences Block" to house the University and research units which he correctly foresaw as part of the teaching hospital campus. While sketch plans were prepared for such a building the funding priorities for teaching and research always came last. The ultimate compromise, reduced in size and scope to satisfy AUC planning, became known as the "Professorial Block" and was named in recognition of the great contribution Dr. Freeborn had made in developing the Clinical School and the Teaching Hospital as its first Chief Executive.

In 1968, construction of a four-level building was agreed in principle, but it was to be built in two stages, with the first stage to accommodate the Departments of Medicine and Surgery. While this was the good news, the bad news was that the plans had these two departments occupying the second and third levels. This was because the project included a much-needed second lecture theatre, a laboratory and a workshop for which building regulations required they be located with an exit at ground level. It could be re-designed, but there would be extra costs and delays, so the hospital argued the benefits of building the ground floor first.

The Hospital

The Hospital's first lecture theatre (the Norman Nock Lecture Theatre)
was opened on the 13th September 1963

Support from the private sector

In December 1969, advice was received that the second stage, to include the ground floor as originally designed, and with provision for Obstetrics and Gynaecology and Psychiatry would be approved for the fourth Triennium (1970-1972). This appeared to resolve the problem, but the fun was just beginning because the Canberra bureaucracy ruled that the two stages be built in the order in which funding had been approved, i.e. with the middle two floors first. More delay ensued while the Hospital now argued its apparently unreasonable hypothesis that it would be cheaper to build the block as a single project starting with the ground floor. However these delays had an unexpectedly positive side.

The preliminary planning in 1966-1967 had allowed for six levels although this was before the decision to establish the Chair in Orthopaedics at RNSH. It now became apparent that it would be logical to provide research facilities for Orthopaedics in this block. The possibility was realised through the generosity of the Raymond Purves Foundation, which undertook to contribute to the building costs for an extra floor, and to fund laboratories and equipment. Although approval had finally been received to proceed as a single project, such an addition through private funding was not covered in the "rules" and obtaining approval for such a concept proved even more difficult. The delays added more than two years and the anticipated savings were lost. The project finally got underway in February 1971 and was opened in April 1973. In retrospect one can only lament that the first proposal for six levels was not implemented - but then we might still be waiting!

The final AUC projects

During the third and fourth Triennia, there were other lesser projects agreed. A common room was added to the students' residence; a tutorial room to the Obstetrics block and two levels of tutorial rooms to the Thoracic block (now Block 3). During the fifth, and what proved to be the final Triennium, an additional two-level block completed the students' facilities and amenities (1976). A substantial contribution was also made to the construction of the new Hospital block to provide post-mortem room facilities, a tutorial room on each level, a larger cafeteria, and what was to be 12th and final AUC funded project, completion of the third level of the original Clinical Teaching Block.

Appropriately, this final project, providing extensions for the Library, was officially opened by the man who started the medical library nearly 50 years before, and who had begun the detailed planning for the Clinical School in March 1947. Dr. Wilson Ingram, accompanied by Sir Norman Nock unveiled a suitably descriptive plaque on December 6,1978, which was his 90th birthday and was to be his final involvement in a Hospital function.

During the 15 years of the AUC funding programme, 12 projects were completed between 1963 and 1978, with Government grants exceeding $1.1 million, plus a quarter of a million dollars from private and donated funds, representing far more in today's figures. It must also be remembered that the programme established the concept for recurrent funding for teaching hospitals. It would be too frightening to contemplate where we would have been without it, given the almost total lack of Government support received during this School's first 15 years.

These projects provided the Professorial Block; the Clinical Teaching Block and Annex; the Norman Nock Lecture Theatre; the students residence, common room and other facilities; tutorial rooms in obstetrics and the main block and the library. In total a substantial achievement.

Increasing academic presence

It was not until 1982 that negotiations were finalised with the University for the next (fourth) Chair to be located at RNSH. It was to be the first Chair in Rheumatology in Australia, made possible by a generous bequest to the University from Mrs Florance, who requested that it be based at RNSH. Peter Brooks, from Flinders University took up the appointment as Florance and Cope Professor in 1983.

There had been an interval of 10 years since the last approval had been given for the Chairs in Medicine and Surgery. Whilst that period had seen a general consolidation in the five original academic units, the next 10 years was to see this number double, with a broadening in scope and strengthening of the original units. Chris Tennant was appointed Associate Professor and Head of the Department of Psychiatry in 1985 and to the new Chair in 1987. Obstetrics and Gynaecology was made a full Professorial Unit in 1988 with Doug Saunders appointed Professor.

Other specialties in which the Hospital had long had high clinical standards and great strength in teaching and research were recognised. Thoracic Medicine was first with the appointment of Associate Professor Norbert Berend in February 1985. He was to become Professor in 1994. In Endocrinology, Associate Professor Sol Posen who had transferred from Sydney Hospital in 1982, was honoured with a personal Chair.

Anaesthetics, the first area of specialisation designated by the Hospital in 1905, received overdue recognition with the appointment in 1990 of Michael Cousins as Professor of Anaesthesia and Pain Management, a title recognising his international status and achievements. Associated with this appointment was the creation of the first research Chair at RNSH, with the appointment of Laurence Mather as Professor of Anaesthesia and Analgaesia Research. In 1992, Bruce Robinson, was appointed the first Professor in Endocrinology. After five years of negotiation, 1992 also saw the acceptance by the University of a proposal for funding from a Statutory Authority, to establish the MAA (Motor Accident Authority) Chair in Rehabilitation Medicine, based at an Affiliated Teaching Hospital, with the appointment of Professor Dennis Smith. In 1993, the University agreed to the Hospital's long-standing submission for the Director of the Kolling Institute to have Professorial Status. Professor Robert Baxter commenced in this position the following year.

Recognising the considerable advances in medical teaching of the previous decade, the University determined in 1990 that academic titles should be available to eminent clinical specialists in teaching hospitals who had contributed significantly to teaching and research. Those at RNSH whose services have been recognised by the designation 'Clinical Professor' are: Malcolm Fisher (1991); Gordon Stokes and Eileen Gallery (1992); Bruce Benjamin, Gillian Shenfield and Lloyd Ibels (1993); and John Levi (1994). In another constructive initiative Professor John Chalmers, Professor of Medicine at Flinders University was appointed Research Professor and Chairman of the Northern Medical Research Foundation in 1996.

Inaugural Associate Dean: Professor K Goulston AO

Professor K Goulston AO

Professor Goulston has had a distinguished career as a leading gastroenterologist and educator of international renown being associated with the University of Sydney since 1978 and having been Associate Dean at the Northern Clinical School from 1993 through 2001.

Professor Goulston graduated MBBS in 1959 from the University of Sydney. He was awarded Fellowship of the Royal Australasian College of Physicians in 1971 and an MD from the University of Sydney in May 1967.

Professor Goulston trained initially at Royal Prince Alfred Hospital and subsequently undertook Fellowship training with Dr Franz Ingelfinger at the Boston City Hospital and University Hospital, Boston from 1964 to 1966. He returned initially to Sydney but subsequently held positions at Canberra Hospital, Concord Hospital and subsequently as the first Associate Dean of the Northern Clinical School at Royal North Shore Hospital.

During his career at the University of Sydney he was regarded as an outstanding teacher and was made Clinical Professor of Medicine in 1991. He has maintained a very high profile nationally within the gastroenterology community and has also undertaken research in many areas of Medicine. His achievements as the Associate Dean of the Northern Clinical School were outstanding.

Professor Goulston was appointed to the Associate Dean role at the Northern Clinical School in 1993. Under his leadership there was enormous growth in the number of academic teaching staff and a cultural change in attitudes towards research and teaching at the Northern Clinical School campus. He expanded the range of educational opportunities to medical students to include the district hospitals, local private hospitals, consulting rooms and also embraced educational opportunities at Port Macquarie Base Hospital, Lismore Base Hospital and Tweed Heads District Hospital. He introduced a programme of evaluation of all teaching at the Northern Clinical School and worked tirelessly to help establish the Northern Medical Research Foundation and numerous other fund raising ventures. He facilitated the development of the Clinical Skills Laboratory, teaching in communication skills and also helped forge a link with the Balmoral Naval Hospital as an additional teaching institution of the University of Sydney.

Professor Goulston is widely credited with the emergence of the Northern Clinical School as a favoured site for undergraduate and postgraduate medicaltraining. This was largely due to his focus on the recruitment of individuals of excellence to the clinical and academic staff. Under his leadership the clinical school academic teaching staff grew exponentially to include Chairs in 27 different disciplines.

Professor Goulston has served on the Sydney Medical School Management Committee, the Medical School Advisory Committee, on the Working Party of the Undergraduate Clinical Skills Committee and also on the Postgraduate Committee in Medicine.

Professor Goulston has had a leading role in gastroenterology in this country. He has trained 15 gastroenterologists who have all gone on to assume substantial positions within Australia or overseas. He has been a past President of the Gastroenterological Society of Australia and was Vice President and Member of the Executive Committee of the 9'h World Congress of Gastroenterology in Sydney in 1990. In addition he has served on the State Committee of the Royal Australasian College of Physicians and as Chairman of the Australian Gastroenterology Institute. Recently he was Go-Chair of the Greater Metropolitan Services Implementation Group of the New South Wales Health Department and was also appointed a Member of the New South Wales Health Council. Both of these latter appointments were at a Ministerial level.

He was made an Officer of the Order of Australia in 2000 for services to gastroenterology, Veterans, Colorectal Cancer Diagnosis and Clinical Teaching. His other substantial awards include the distinguished service medal of the Gastroenterological Society of Australia and the Geoff Marel Memorial Medal of the Confederation of Postgraduate Medical Councils of Australia and New Zealand.

There are many other bodies through which Professor Goulston has provided outstanding service to his profession. These are too numerous to list but demonstrate the breadth of his influence in gastroenterology and medical education over a most distinguished career. His energy and enthusiasm for medicine and medical education in particular has been applied at every institution at which he has been associated both within Australia and overseas.

2008: A new headquarters for the School

2008 marked a major change in the physical environment of the Northern Clinical School. After a five year program of planning, design and construction, the Clinical School headquarters moved into an outstanding new building on the RNSH site, where the Hospital’s education and laboratory research programs are now located in excellent facilities.

The $99M Kolling Building takes its name from Charles and Eva Kolling, the initial benefactors of the Kolling Institute of Medical Research, which is now housed in the upper floors of this fourteen level structure. The Douglas Piper Library, together with state-of-the-art educational facilities and administrative offices, are housed in the lower floors.

The building is a joint capital and operational project of NSW Health and the University of Sydney, and reflects the positive and constructive relationship which exists between the Sydney Medical School and the Northern Sydney Central Coast Area Health Service and the Hospital itself.

In December 2008 the Northern Clinical School published its 15 Year Report which celebrates both the 15 year anniversary of the successful operation of the Northern Clinical School, as well as the move of the School’s headquarters at RNSH into this outstanding new structure for teaching and research.