Dr Marie Elsya Speechly-Dick joined University CollegeLondon Hospitals (UCLH) in 1990 when she was
appointed to a registrar’s post ahead of more than 8 maleapplicants. She was the first woman ever to be appointedabove the grade of senior house officer at the hospital’scardiology unit.
Since then, the gender balance at UCLH LondonHospitals has changed markedly, and the Heart Hospitalprobably has more women cardiologists than any othercardiac centre in the United Kingdom. There are 7 femaleconsultants in cardiology, with a wide range of subspeciali-ties in intervenional cardiology, cardiomyopathy, and grownup congenital heart disease, and some hold academic posts.
Dr Speechly-Dick suggests that women have been attractedto cardiology at UCLH because other women are alreadyworking there successfully. “After 1 or 2 female appointments,you start getting a critical mass,” she says. “Maybe womenare attracted to the fact that it isn’t an all-male workingenvironment; maybe it is that the attitude of the men heresuggests that it is okay to have female colleagues. It is prob-ably a bit of both. I personally found senior coleagues atUCLH very supportive when I was a trainee.”
But other cardiac centres within the United Kingdomdo not show such a positive situation. A 2002 census by
the Royal College of Physicians1 found that althoughwomen entering UK medical schools outnumber men,women remain underrepresented in cardiology, making uponly 16.8% of trainees and 7.4% of consultants—all thisdespite cardiology’s status as one of the most popular spe-ciality preferences for women medical students, withwomen accounting for 28% of those who envision a careerin cardiology.2
These figures prompted the British Cardiac Society, nowrenamed the British Cardiovascular Society (BCS), to estab-lish a working group (which included Dr Speechly-Dick) toexamine the underrepresentation of women consultants andto question whether a continuing male predominance incardiology represents a cause for concern. It discovered thatmany women found themselves “turned off” from the spe-ciality early in their medical careers because they did notconsider it flexible or family friendly.3
From her working group experience, Dr Speechly-Dicksays she found that many women change their minds aboutcardiology by the time they reach senior house officer level.“It seems to be that women perceive cardiology as not familyfriendly in terms of working practices and hours, and thatother specialities, such as anaesthetics, appear more familyfriendly in terms of a professional working environment
Dr Marie Elsya Speechly-Dick, one of the first women to train part-timein cardiology in the United Kingdom, now practises as a part-time consultant cardiologist at University College London Hospitals, London,England. She talks to Ingrid Torjesen, BSc, about her work and why thespeciality remains predominantly male.
European Perspectives in CardiologyEuropean Perspectives in Cardiology
Postgraduate Cardiology Training in TurkeyOktay Ergene, MD, FESC, who sat on the European Societyof Cardiology Education Committee between 2004 and 2006,has been involved in Turkish government efforts to standardise postgraduate cardiology training in his country. Page f123
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Viewpoint: Marie Elsya Speechly-Dick, MD, MRCP
Spotlight: Gary McVeigh, MD, PhD, FRCP, FRCPIDr Gary McVeigh, professor of cardiovascular medicine in the Department of Therapeutics and Pharmacology atQueen’s University, Belfast, Northern Ireland, talks abouthis difficult early years and the development of his career.Page f125
What Prospects Do Women in Cardiology Have in the UnitedKingdom?
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The working group found noevidence of gender discrimina-tion at selection for cardiologytraining programmes. Its reportconcluded that “a substantialproportion of the talent pool isbeing lost to other specialities”and that “if [the failure of cardi-ology to attract women] is notcorrected it will prove increas-ingly difficult to maintain highstandards of cardiological prac-tice and research.”4
Dr Speechly-Dick says theBCS working group tried todevelop initiatives to encour-age women to enter cardiology.“We concluded that we neededto raise the profile of women incardiology and needed to makeit clear that flexible trainingwas an option. I don’t remembergetting any information on that as a junior. I had to find outabout it myself.”
She explains, “It was obvious at that time that very fewpoeple knew about how to apply for flexible training. I amstill grateful for the help, encouragement and mentoring Ireceived from Ilfra Goldberg, MRCP, who was postgrad-uate dean for flexible training at the time.”
Dr Speechly-Dick, who has 3 children, ages 11, 9, and 6,had her first child just after completing her MD thesis, soshe trained part-time and has worked part-time ever since.“When I was training part-time, for most of this period I wasthe only part-time female trainee in the country,” she says,“which gives you an idea of the lack of women in cardiologythen. There are more now, but there still aren’t very many.”
At that time, part-time trainees had to train proportionallyfor exactly the same time as a full-time trainee, making theprocess much longer. But, Dr Speechly-Dick explains, “Therules aren’t quite so punitive now. The regulations are grad-ually changing towards competency-based assessment, so,for example, you don’t have to train for exactly twice as longif you are half-time.”
The BCS working group also wanted to make a career incardiology more attractive by encouraging trusts to createpart-time consultants posts where possible, and to offer jobshares. But, Dr Speechly-Dick says, “This is not going to berealistic until there are a sufficient number of women in thespeciality to share jobs, or other part-timers who can jobshare. A lot of this isn’t going to happen until we get morewomen coming through the trainee grades.”
She does not consider it possible to increase the numberof women entering cardiology without a change of attitudein the profession as a whole, and an acceptance of moreflexible training and working practices for both men and
women. “We should also aim for a system that allows doctorsto move betwen full and part-time working as their commit-ments outside of work change with time.
The 2002 Royal College of Physicians census found that9.2% of all consultants work part-time, almost half themwomen.1 Thirty-eight of the 451 consultant cardiologists forwhom data were available worked part-time, but only 4 werewomen. Dr Speechly-Dick estimates that around 8 womennow work as part-time cardiology consultants.
Change will come as “a very slow process, a trickle downin terms of attitude,” she admits.” Female role models willhasten this change by encouraging more young women topursue cardiology, she argues, and as more women gainconsultant’s posts and some work part-time, this will impacton the perceptions of their peers. The appointment of DrJane Flint, BSc, MD, FRCP, as a female representative on thecouncil of the BCS, and the establishment of a nationalmentoring scheme for female cardiologists, as recommen-ded by the working group, all represent steps towardachieving this.
Dr Speechly-Dick enjoys teaching, so she has taken onmore and more such responsibilities because she feels it ishugely important and because she enjoys it. She currentlyhas the responsibility of teaching first-year clinical studentsin cardiology at the Heart Hospital in Bloomsbury (SeeFigure). In 2005, she was officially selected as an academicrole model by the British Medical Association’s HealthPolicy and Economic Research Unit for being an inspira-tional teacher and role model.
“One reason I do the teaching is so that the students havea female role model. They can see that there is a femalecardiologist with a family and children who is able to workpart-time at a teaching hospital,” she says. “I think it is
Figure. The Heart Hospital, London, where Dr Speechly-Dick has responsibility for teaching first-yearclinical students cardiology, a part of her work she regards as important and enjoyable.
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good for some of the female students to see that, and thismay help to change their attitudes in the future.”
In her current job, she divides her time equally betweenteaching and clinical work. She runs a rapid-access chestpain clinic, so her clinical work is not interventional, and, tosome extent, it is sessional, with no on-call requirements. “Ihave been lucky to be able to design my job to fit in with myinterests, my strengths, and my desire to work part-timebecause of my needs outside of work,” she admits. “I havequite a good work/life balance.”
Dr Speechly-Dick chose cardiology because she wanted tobe a hospital doctor and it seemed an interesting speciality. “Iliked the idea of an interventional speciality: the excite-ment, new techniques, and being able to do things on thespot. And there is the sense of community that comes fromworking in a hospital—the colleagues, the camaraderie, andthe multidisciplinary atmosphere.”
She continues, “I always recommend trainees to choosewhat they are going to be most enthusiastic about, because it
is best that they are interested in their work. Cardiology ischallenging and very competitive, and you need to beenthusiastic to succeed.”
If she was ever given the choice, Dr Speechly-Dick wouldchoose cardiology again. “Cardiology is a very rewardingspeciality,” she says.
In Turkey, entrance to a faculty of medicine depends on asingle selective examination administered by the
National Selection and Placement Centre. Students receiveassignments to universities according to their results, andmany of them hope to gain admittance to the faculty ofmedicine, which has an annual acceptance of 5000 students,40% of them female.1
Undergraduates study in medical school for 6 years andcan then qualify for admission to specialty training via thetwice-yearly Postgraduate Medical Education EntranceExamination, which tests medical knowledge and foreignlanguage ability. Around 3000 candidates pass this exami-nation, but the country only has about 160 to 200 places forcardiology residency training.
According to Dr Ergene, until 1990 cardiology trainingin Turkey came within internal medicine training, almost asa discipline within a discipline. Since 1990, however, thecountry’s medical establishment has accepted cardiology asa separate branch in medicine; it now consists of a 4-yearresidency at a state or a university hospital endorsed by theTurkish Ministry of Health.2 “Trainees prepare a thesis dur-ing the residency period, and at the end of this period, they
undergo oral and written examinations and an assessmentof their thesis,” says Dr Ergene. “If they complete thesesuccessfully, the Turkish Ministry of Health approves thetrainees as cardiology specialists. Most then can beemployed in state hospitals.”
As part of an ongoing effort to improve the healthservice in Turkey and bring it into line with EuropeanUnion (EU) requirements, postgraduate medical traininghas been undergoing a radical review to establish a nationalstandard and a core curriculum and to achieve properstaffing ratios in accordance with health policy and needs.
Dr Ergene believes training requires tailoring to takeinto account the geographical distribution of Turkey’s pop-ulation of 70 million. He says, “We have 1400 cardiologists,which means a ratio of 2 doctors per 100 000 people, andmost of them are concentrated in the big cities. But in geo-graphic terms, our population is unevenly spread, and insome areas, such as the Black Sea region, there may be nomore than 5 cardiologists for a population of 400 000. Andalthough faculties giving postgraduate cardiology trainingare increasing, this increase needs to keep pace with agrowing population.”
Postgraduate Cardiology Training in Turkey
Postgraduate Cardiology Training Is Undergoing a RadicalReview to Bring It Into Line With European Union Requirements
Oktay Ergene, MD, FESC, is a professor of cardiology based at a state hospital inIzmir, on Turkey’s Aegean Coast. He sat on the European Society of CardiologyEducation Committee between 2004 and 2006, and he has been involved in Turkishgovernment efforts to standardise postgraduate cardiology training. He talks to Judy Ozkan, BSc, about the reforms.
1. Census of Consultant Physicians in the UK, 2002. The Federation ofthe Royal Colleges of Physicians of the United Kingdom, 2002. Web site.Available at www.rcplondon.ac.uk/ college/mwu/mwu_02_home.htm.Accessed October 8, 2007.
2. Lambert T, Goldacre M, Parkhouse J. Career preferences and theirvariation by medical school among newly qualified doctors. HealthTrends. 1996;28:135–144.
3. Timmis AD, English KM. Women in cardiology: a UK perspective.Heart. 2005;91:273–274.
4. Timmis AD, Baker C, Banerjee S, Calver AL, Dornhorst A, EnglishKM, Flint J, Speechly-Dick ME, Turner D. Women in UK cardiology:report of a working group of the British Cardiac Society. Heart.2005;91:283–289.
ReferencesIngrid Torjesen is a freelance medical journalist.
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Further key developmental needsinclude educating trainers in terms ofdelivering the core curriculum.Currently, institutions set their ownstandards, creating considerable varia-tion across the system. To standardisethe training process, the TurkishMedical Association3 established aconsultancy board and, between 1994and 2004, carried out a review of thesystem. A regular congress of post-graduate training meets to work on acompetency training syllabus and reg-ulation of cardiology training. In 2002,the Turkish Society of Cardiologyaccepted the consultancy board regula-tions and developed a competency-based postgraduate examination and atraining programme called theCardiology Syllabus. The board is cur-rently working on the development ofa logbook for use across the countryfor trainee accreditation.
The Turkish Medical Association is one of the bodiesworking with the Ministry of Health on regulations to stan-dardise postgraduate medical training generally. Lack ofagreement between the bodies involved in the standard-isation process is making it difficult to implement thechanges. Although the Ministry of Health passed a law thatall agencies involved in the process have accepted in prin-ciple, the ministry has not yet implemented the law.
Dr Ergene says, “This is the main barrier to developingcardiology training, because the established regulationscover many essential topics. We need agreement betweenthe agencies involved in the training on working togetherand on which agency is going to be the main authority.”
The length of training is another aspect under review.The duration of residency training in Turkey was 4 yearsuntil 2002. Although 6 years is normal in EU countries, 5years is currently considered appropriate for Turkey. DrErgene considers this the right decision for Turkey, and hesuggests not reviewing this issue for at least 10 years.“Postgraduate cardiology training should be 5 years,including 1 year of rotation in internal medicine,” he says.“Increasing training duration to 6 years will lead to a short-age of cardiologists. At current rates, we need 10 to 12years to make sure that the current ratio of 6 cardiologistsper 100 000 people is achieved. While 5 years may stillseem to be short for postgraduate training, in the nearfuture there will be the addition of a further 2 years of sub-speciality training.”
Dr Ergene would like to see the EU clarify the issue ofsubspeciality training, because he currently perceives somedisparity: “Cardiology is a high-tech branch of medicinethat has grown naturally into subspecialities. Invasivecardiology, cardiac imaging, and electrophysiology sub-specialities should have priority in the subspeciality
training program.” However, when the Turkish Societyof Cardiology4 applied to the Ministry of Health to havesubspeciality training recognised, the ministry refused.“This was because the EU does not accept any subspecial-ity training policy,” explains Dr Ergene. “However, inHolland, postgraduates of cardiology will soon be able toselect a subspeciality among invasive cardiology, electro-physiology, cardiac imaging, and general cardiology, andother countries look destined to follow suit. In Turkey, ourfeeling is that at least invasive cardiology and arrhythmia/electrophysiology should only be performed after a sub-specialty training program to address any skills gap.Currently, some cardiologists are practicing with no realexperience in these fields, and this does nothing to enhancethe service we deliver.”
Dr Ergene concludes, “Since cardiology traininggained a speciality status, hospital departments providingtraining have increased in number, and most of themnow have cardiac haemodynamic and invasive electro-physiology labs, and they are very close to EU standardsin terms of facilities and equipment. Our greatest challengenow is to implement the standardisation of the post-graduate training model. I hope this will be complete in 5to 10 years’ time.”
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Figure. Dr Ergene with some of his staff and trainees. The Turkish Medical Association isworking towards the introduction of regulations that will standardise medical training.
Judy Ozkan is a freelance medical writer.References
1. Sayek I, Kiper N, Odabasi O. Turkish Medical AssociationUndergraduate Medical Education Report 2006. Ankara, Turkey:Turkish Medical Association; 2006.
2. Republic of Turkey Ministry of Health Web site. Available at:www.saglik.gov.tr/EN/Default.aspx?17A16AE30572D313AAF6AA849816B2EF4376734BED947CDE#. Accessed October 15, 2007.
3. Turkish Medical Association Web site. Available at: www.ttb.org.tr.Accessed October 15, 2007.
4. Turkish Society of Cardiology Web site. Available at: www.tkd.org.tr.Accessed October 15, 2007.
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Education provided a turning point in the life of Dr GaryMcVeigh, and with his career firmly established, he
now devotes a large amount of his time to aspiring doctors.He grew up in Lurgan, just outside Belfast, Ireland, andwhen he was in secondary school, from 1968 and 1975,“the Troubles” were at their worst in Northern Ireland’shistory. This period of severe civil unrest in the countrylasted from 1963 until 1985, with a cycle of violencefomented mainly by 2 rival outlawed paramilitary organi-sations, the Catholic Irish Republican Army and theProtestant Ulster Volunteer Force. Rioting and disorderwere commonplace (Figure 1), and shootings and terroristbombings were frequent. It was a difficult time and a harshenvironment in which to grow up.
Dr McVeigh was the first person in his family to go touniversity. “I came from a deprived estate in the middle ofthe Troubles in the 1970s, and I just wanted to get out,” hesays. “I grew up in a staunchly working class Republicanestate. I saw education as an escape route from theTroubles.” And get out he did, by studying medicine atQueen’s University Belfast. He says, “For a working classkid at the time, it seemed terribly exotic to study medicine.”
Medical rotations through the Belfast hospitals camenext, followed by passing the examinations for member-ship of the Royal College of Physicians. He then enrolledfor an MD by thesis, also at Queen’s University. Hisresearch, in the field of hypertension, investigated the casefor low-dose diuretics as a treatment option. He obtained
his MD in 1987 and had his research published in theBritish Medical Journal.1 “It was pretty topical at thetime,” he says. “That piqued my interest in research.”
Dennis Johnston, MD, the Whitla Professor of ClinicalPharmacology at Queen’s, served as Dr McVeigh’s firstmentor. “He introduced me to the research environmentand the field of hypertension.” Having decided he wantedto do more research, Dr McVeigh enrolled for his PhD atQueen’s. He won a Senior Fulbright Scholarship, a British-American Research Fellowship, and a Wellcome TravellingFellowship that enabled him to spend the year 1988 at theUniversity of Minnesota, Minneapolis, Minn, working incardiology under the mentorship of Jay Cohn, MD, head ofthe cardiology division at the university. Dr Cohn introducedDr McVeigh to the study of the structure and function ofarterial blood vessels.
“That initial work was also in the field of hypertension,” hesays. “But it was really viewing hypertension as a vasculardisease assessed through the study of the structural and func-tional properties of arterial blood vessels using waveformanalysis.” After this year in the United States, he returned toBelfast to complete his PhD and his medical training.
Dr McVeigh eventually returned to the United Statesand worked there for 6 more years as an associate profes-sor of medicine at the University of Minnesota. He says, “Icontinued to pursue my research work with Jay Cohn, andduring that time I helped validate a noninvasive device forrecording arterial pressure waveforms.” During his 6-year
tenure in Minnesota, he also partici-pated actively in clinical work in boththe inpatient and outpatient settingswhilst pursuing his research interests.“I really wanted to understand howrisk factors alter the properties of arte-rial blood vessels to accelerate diseasedevelopment and the early occurrenceof cardiovascular events.”
But Belfast would become his homeagain. He took up a consultant post—a joint appointment between Queen’sUniversity and the United Kingdom’sNational Health Service—and becameprofessor of cardiovascular medicine in
Spotlight: Gary McVeigh, MD, PhD, FRCP, FRCPIA Journey From a Deprived Area of a Troubled Northern Irelandto the Heights of Cardiovascular Research and Clinical PracticeDr Gary McVeigh is professor of cardiovascular medicine in the Department of Therapeutics and Pharmacology at Queen’s University, Belfast, NorthernIreland, and a consultant physician at the Belfast Health and Social Care Trust. He talks to Jennifer Taylor, BSc, about his difficult early years and the development of his career.
Figure 1. Rioting and disorder were commonplace in Belfast during the Troubles, and this madeit a harsh environment in which to grow up. Dr McVeigh found education was a way to escape.
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Editor: Thomas F. Lüscher, MD, FRCP, FACCManaging Editor: Keith Barnard, MB, BS, MRCS, LRCPWe welcome your comments. E-mail the managing editor [email protected]
The opinions expressed in Circulation: EuropeanPerspectives in Cardiology are not necessarily those of theeditors or of the American Heart Association.
2004. “My time is spent 50/50 between the National HealthService and the university,” he says. His clinical work in thehospital involves care of the acute medical admissions andoutpatient work specialising in diabetes mellitus, hyperten-sion, hypercholesterolaemia, and heart failure. His universitywork involves research in these areas, along with under-graduate teaching of medical students.
Dr McVeigh enjoys the teaching aspects of his role, andhe serves as the regional adviser for Ireland for the RoyalCollege of Physicians of Edinburgh. He represents not onlyNorthern Ireland (part of the United Kingdom) but also theinterests of the college’s member physicians in theRepublic of Ireland. The work for this professional bodyentails education, setting standards, and organising exami-nations. “In the present challenging environment, main-taining standards must remain a high priority for theprofession,” he says.
Committee work represents a big part of Dr McVeigh’scareer. He sits on the executive committee of the BritishHypertension Society, and he has received recognition as aclinical expert in hypertension by the European Society ofHypertension. He currently serves as president of the UlsterMedical Society, which fosters interdisciplinary educationfor specialists and generalists in all fields of medicine. DrMcVeigh serves on an appraisal panel for the UnitedKingdom’s National Institute for Health and ClinicalExcellence. This work involves monthly meetings inLondon to examine the clinical and cost-effectiveness ofvarious technologies. “I view it as a kind of continuing med-ical education,” he says. “Reading the volumes of materialon different technologies certainly keeps you up to date.”
Dr McVeigh’s research is going strong. He has approx-imately 100 peer-reviewed publications relating to hisspecialist area. Since 2000, he has supervised 11 MD studentsand 4 PhD students, and he has secured £2.5 million in grantfunding. He is particularly proud of the United KingdomMedical Futures Innovation Award he won this year, in thecardiovascular section (Figure 1). “Medical Futures inviteapplications from the United Kingdom for novel technolo-gies, with commercial potential, designed to improvepatient care,” he says. His ultrasound-based cardiovascular
disease predictor, which facilitates the study of arterialblood vessel structure and function (Figure 2), won the bestdiagnostic award in the cardiovascular category. “Themajority of my research is clinically based,” he says. “Ournew approach has a direct clinical application, and we arecurrently studying patients from our cardiovascular riskclinics. In particular, we are focusing on damage to particu-lar target organs like the eye and kidney.” He explains, “Iam continuing to automate the technique so it can be rolledout across Northern Ireland, with the aim of removing oper-ator dependency so that any healthcare worker could use it.With our software development, clinicians will be able to useexisting machines to make the physiological recordings.”
“The roll-out involves getting the agreement of clini-cians,” he says. They would pool the data they collected, toform 1 large study. “If it works in a few pilot centres, thereis no reason why we could not collaborate to collect UnitedKingdom–wide data,” he adds. He believes the informationcould enable them to stratify cardiovascular risk for anindividual much more precisely than current methodsallow.
Figure 1. Dr McVeigh (2nd from right) was proud to receive theUnited Kingdom Medical Futures Innovation Award this year.
Figure 2. The novel part of this generic ultrasound machine is thesoftware Dr McVeigh and colleages developed to enable cliniciansto use existing machines to make physiological recordings.
Jennifer Taylor is a freelance medical writer.Reference
1. McVeigh G, Galloway D, Johnston D. The case for low dose diureticsin hypertension: comparison of low and conventional doses ofcyclopenthiazide. BMJ. 1988;297:95–98.
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