Leaders in Medical Education

Dr. Richard Larkins, Former Vice-Chancellor and University President of Monash University

Philip Xie
Dec 23, 2015

Professor Richard Larkins is an Emeritus Professor at the University of Melbourne, where he was the Dean and Head of the Melbourne Medical School; and at Monash University, where he was previously Vice-Chancellor and University President. Professor Larkins' award of Officer of the Order of Australia in 2002 was made for his service to medicine and health; as an advocate for increased investment in research, as a contributor to health policy reform, and as an initiator of innovative medical programs and the provision of training opportunities for medical officers in the Oceania region. In addition to his enormous contribution to medical and social policy development in Australia, Professor Larkins has made a profound impact through advising on medical training and health policy development throughout the World.

How did you first become interested in medicine?
My father was a doctor and obviously enjoyed it. He died when he was 37 and I was 16 – that probably inspired me to do medicine.

Can you share your background on how you got to where you are right now?
Initially, I thought that I would be like the role models I had been exposed to –i.e. private practice physician with some hospital sessions involving teaching. I became involved in research when I was endocrine registrar and then undertook a PhD in London. Although I returned to a hospital job, I wanted to have more time for teaching and research so decided to try to transfer to a university clinical academic appointment. This meant leaving a secure, prestigious and well remunerated position at the Royal Melbourne Hospital for a less well paid and less prestigious position at the Repatriation General Hospital in Heidelberg. This allowed me to undertake more research, to receive a prestigious research prize and I was appointed Professor of Medicine in the University of Melbourne back at the Royal Melbourne Hospital at the age of 40. After doing that for 14 years, I was appointed as Dean of the Faculty of Medicine, Dentistry and Health at the University of Melbourne. I had no ambition to be a university vice-chancellor, but unexpectedly an opportunity arose to become Vice-Chancellor of Monash University. I recognized that this would be an exciting challenge so I decided to take up the position. It was indeed a very rewarding position. In summary, my career was largely unplanned and opportunistic. In each position I held, I did my best and when new opportunities arose, I was able to take advantage of them.

Your decision to leave your dual clinical and academic senior post at the Royal Melbourne Hospital for an academic position at the Repatriation General Hospital was quite controversial at the time, what influenced this decision and how did you manage the transition?
I realized that I had a passion for research and education as well as clinical work and thought that a clinical academic appointment in a university department would suit me better than a hospital position. I had worked in London with the newly appointed professor at the RGH, Jack Martin, an Australian returning to Australia from Sheffield and knew that he was an outstanding researcher and I thought I could learn a lot from him.

Your earliest publications included research you conducted on the New Zealand Obese mouse as a model for diabetes in humans, and the regulation of vitamin D metabolism in the kidney. How much of an impact did these early research experiences have on the rest of your career? (e.g. nature and content of the work, overseas travel, opportunity to attend conferences)?
My early research was very important to my career. I was really hands-on and learnt a lot about the basic tools of research. Many things went wrong and I learnt a huge amount by sorting these out. The research itself was exciting as I was able to demonstrate a selective defect in insulin release in response to glucose as a critical component in the NZO mouse which was an excellent model for type 2 diabetes. My work in London on vitamin D metabolism was very interesting because it was a totally new regulatory pathway very important for bone and calcium metabolism. I attended many conferences, published papers in Nature and Lancet and in other leading journals and met many important leaders in the fields of diabetes and vitamin D and calcium. Later in my career it was difficult to directly undertake laboratory work myself as I was too busy, but my previous direct hands on experience was invaluable in guiding the work of PhD students and others.

Do you feel that a research component should be an integral part of a young/aspiring doctor’s career path? (Why/Why not?)
I think a research component is a very valuable experience for every young doctor. It leads to an understanding of the basis for our knowledge, evidence, statistics, critical reasoning, writing and problem solving. Everyone who undertakes research becomes more critical of dogma, more questioning and I think a better doctor, even if they do not end up continuing an active involvement in research.

You mentioned in your book New Tricks, that preclinical medical education in your time was very traditional and that minimal efforts were made to make the subjects relevant to medicine. What do you think have been the most positive advancements in medical education since then?
I think learning basic medical science in a clinical context has led to a much sharper appreciation of its relevance and a better retention of key aspects of basic science underpinning medical practice. It engages students more actively. I also think that greater emphasis on a range of aspects of medical practice that used to be largely ignored has beneficial –e.g. public health, epidemiology, general practice, international health, indigenous health, communication skills.

What are 2-3 changes you would like to see in the current Australian medical education system?
At least in some medical schools, the move to graduate entry with a requirement for biomedical science before entry to the course has led to a reversion to the separation of basic medical science from clinical medicine so it is important that this does not lead to a regression to the previous model. It also prolongs the time to get a basic degree to 7 years which I think is too long considering the time demands of subsequent medical training. It is great for graduates of other degrees to have an opportunity to enter medicine, but we must be careful that this does not become the only option and that the entry requirements become too rigid.

Major teaching hospitals are becoming less and less suitable for basic medical training so the recent trend to move more to regional and rural settings, private hospitals and teaching general practices must continue. This is difficult to organize but we must get better at doing this.

Medical students and professionals are constantly tested by stringent examinations, public pressure, and the physical and mental stress unique to the health profession, what advice can you give to future generations to help negotiate these challenges?
Have a balanced life – sport, music, drama, friends and family provide great relief from the pressures of medicine. Remember that you are only human – you will make mistakes and you won’t be able to satisfy everyone all the time. If you do your best, look after the rest of your interests and be philosophical when things do not turn out as you would have wished, you should be able to deal with the pressures and have a deeply rewarding and fulfilling time in this wonderful profession.

Do you have any final thoughts regarding the medical profession as a whole?
Whatever external regulations or pressures might apply, there is nothing that can come between the special relationship that a good doctor has with his or her patients. This is a privileged component of medical practice that makes this profession so rewarding.