Squeeze the orange
Dr Adam Boggon (BSc (Hons) 2012) is a current Fulbright scholar at Harvard. Here he describes the importance of ‘squeezing the orange’ – a principle he first learned at St Andrews and has applied ever since.
I’m glad I read the prospectus. My mum and I were driving through Cupar on the way to my interview in St Andrews when she asked if I’d read the School of Medicine page of the brochure thoroughly. I hadn’t.
I rifled through it on the way into town, so when the obvious first question came – Why St Andrews? – instead of giving the real reasons – St Andrews is small and I’m a villager; I would have two different medical school experiences; it’s meant to be good – I was able to talk about the spiral curriculum.
In a spiral curriculum, topics are revisited multiple times at increasing levels of complexity. New learning is linked to prior material and competence accrues over time. Concepts are reinforced, refined, integrated and applied. This suits those who learn gradually (almost everyone) and especially those who may through absentmindedness have missed important points the first time round (me). The School of Medicine curriculum works like a spiral.
This was a useful starting point, because I passed the remainder of the time disagreeing with the interviewers about the history of utilitarianism (I was wrong). By the time we finished, the other candidates had left and Lower Parliament Hall was empty save for the portraits, my two interviewers and me.
Anyway, they let me in.
At the end of my first week, our class shuffled into rows beneath the high ceiling of Younger Hall and listened to a man talking about oranges. My recollection is somewhat vague. He was a tall patrician figure in formal robes. I cannot recall his name, role, or discipline. But I remember his message: This place is an orange – it’s up to you to squeeze it.
That was 2009. Since then I’ve moved fifteen times and worked in eleven hospitals. Clinical years in Aberdeen, Foundation Programme in Edinburgh then several years of roving SHO posts in Inverness, Orkney and the MRC-Unit in The Gambia. I did the London School of Hygiene & Tropical Medicine DTM&H in Tanzania and Uganda and moved to London for a lecturer post at University College London and the Royal Free Hospital in 2020.
In St Andrews I felt a sense of belonging born of the small medical school community and the liveliness of the student body (young people only move to a windy corner of north east Fife if they’re prepared to make their own fun). I spent a vast amount of time of time debating, playing sport, submitting gonzo reportage to student newspapers, attending lectures in other departments, running up Drumcarrow, earwigging in Taste and reading books stockpiled from Barnardo’s which made no reference to pharmacology or the alimentary tract. I was at best a middling medical student.
Strangely though, when the wheels began to come off during the pandemic it was this time at St Andrews that I drew on to help set up an early COVID vaccination centre and figure out how to redeploy three hundred doctors and medical students without getting my head bitten off or forgetting something essential. That meant nobbling people in corridors, arm-twisting, forming robust plans and making them persuasive and plain, and seeing things through.
As a result, I won an eccentric compliment from the clinical director of medicine at the Royal Free hospital – ‘If this was the First World War, you’d be a brigadier by now’ – and a Fulbright scholarship to Harvard.
For the Master of Public Health in Health Management, I take courses in biostatistics and epidemiology; health policy; finance; strategy and organisational behaviour as well as elective classes from across the university. My intention is to study health system organisation and delivery in detail to understand how to improve and sustain the systems through which the NHS provides care.
Teaching at Harvard draws heavily on the case method. Students read a twenty-page briefing paper outlining a given situation and arrive at class prepared for a discussion facilitated by the professor.
In my first term I worked through dozens of cases including an Indian manufacturer of prosthetic limbs; a struggling district hospital in Egypt; a cruise company determining its COVID policy; a merger of healthcare providers in San Francisco; a Japanese vaccine manufacturer; the lumpy roll-out of the Obamacare website; a Riesling winery in California and NASA’s space shuttle program.
Outside class I’ve gone to a St Andrews friend’s bachelor party in Western Massachusetts and a Red Sox game; hiked a section of the Appalachian Trail; shadowed campaigning prior to the midterm elections; attended Thanksgiving dinner at a local TV station; sang ‘The Braes O’ Killiecrankie’ at a concert hosted by the local Fulbright Association; tailgated at the Harvard–Yale match and joined a cross-university climate group where my peers include former White House staffers, UN delegates, architects, activists, firefighters and urban planners.
I’ve found the atmosphere stimulating, encouraging, invigorating and hopeful. Each day I meet remarkable people and draw on experience from patients I’ve cared for, from colleagues in Uganda and London, health services in Orkney and The Gambia, innovations in Inverness and Rwanda, and from friends, teachers, and books encountered from childhood. The spiral continues to wind.
I’m reminded how learning comes more from the spirit we bring to bear on experience, and the way that spirit is protected and encouraged by those who raise us, teach us, and for whom we work, than from any specific institution.
I’m reminded further of two principles I learned first and best at St Andrews:
Read the briefing paper.
But most of all, squeeze the orange.
–––––––––––––––––––––––––––––––––––
For more about the Fulbright Program including how to apply visit: https://www.fulbright.org.uk
For more writing by Adam visit: https://adamboggon.co.uk/
What a wonderful post! - a fellow St Andrews -> Harvard-Fulbrighter