Higher Specialist Training Research Articles

Research needs of higher specialist trainees in psychiatry in Ireland: mixed methods study.

Higher specialist trainees (HSTs) in psychiatry in Ireland were recruited to complete a 21-item online questionnaire anonymously. Questions were designed to establish the research experience of HSTs in various years of training, identify perceived barriers to participation and generate potential strategies to overcome these barriers. Of 165 HSTs surveyed, 50 (30%) responded. Most respondents (58%) were in the second or third year of HST. Most (72%) were training in general adult psychiatry. Themes that emerged from analysis of the qualitative data were 'collaborative research culture', 'guidance', 'choice' and 'access to resources'. Participants felt they needed more structured guidance and regular supervision, and expressed a desire for more networking and collaboration. The need for a supportive, collaborative research culture within psychiatry was predominant among responses. Structured research programmes and access to resources may facilitate a more positive research culture and should be considered as part of the training curriculum.

Retracted: Where are they now? Career Trajectories of Geriatricians after being awarded Certificate of Successful Completion of Training in Geriatric Medicine

Abstract Background A Certificate of Successful Completion of Specialist Training (CSCST) is awarded on completion of Higher Specialist Training (HST) in Geriatric Medicine. A yearly list of doctors completing training and being awarded CSCST is published by the Royal College of Physicians of Ireland since 2018. In this observational study we examined the current professional status of Geriatricians who recently completed the HST program in Geriatric Medicine and were awarded CSCST. Methods We reviewed the current status of Geriatricians awarded CSCST since 2018 and cross referenced with the medical council register to examine what proportion are currently working as Geriatricians in Ireland. We examined what was the primary university of graduation and time from graduation to being awarded CSCST. Results CSCST was awarded to 46 doctors from 2018 to 2023 inclusive. 67% (n = 31) were female. The median number of years from entry on the medical council to being awarded CSCST was 11 years (IQR 10 – 11, range 9-21). 96% (n = 44) of geriatricians completed their primary medical degree in Ireland. University College Cork was the University from which most Geriatricians had graduated (32% of Irish graduates). 87% (n = 40) of Geriatricians are currently on the specialist register for Geriatric medicine in Ireland. Of the six not currently on the specialist register, two are undertaking research in Ireland, two are completing international fellowships, one doctor is working as a consultant in Australia, and one doctor is on maternity leave. Conclusion There is a high rate of retention of graduates of the Geriatric medicine HST program. Most graduates of the program went to an Irish medical school with a median time of 11 years from primary degree qualification to CSCST. To build on this we plan to complete a wider study examining individual factors that influence job satisfaction and retention of Geriatricians.

Performance in Irish Selection and Future Performance in Surgical Training

Selection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity. To determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments. This retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program. Participants included all trainees recruited to dedicated postgraduate surgical training from 2016 to 2020. These data were analyzed from July 11, 2016, through July 10, 2022. Selection decisions were based on a composite score that was derived from technical aptitude assessments, undergraduate academic performance, and a 4-station multiple mini-interview. Assessment data, attrition rates, and rates of progression to HST were recorded for each trainee. CST performance was assessed using workplace-based and simulation-based technical and nontechnical skill assessments. Potential associations between selection and assessment measures were explored using Pearson correlation, logistic regression, and multiple linear-regression analyses. Data were available for 303 trainees. Composite scores were positively associated with progression to HST (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). There was a weak positive correlation, ranging from 0.23 to 0.34, between scores and performance across all CST assessments. Multivariable linear regression analysis showed technical aptitude scores at application were associated with future operative performance assessment scores, both in the workplace (β = 0.31; 95% CI, 0.14-0.48) and simulated environments (β = 0.57; 95% CI, 0.33-0.81). There was evidence that the interpersonal skills interview station was associated with future performance in simulated communication skill assessments (β = 0.55; 95% CI, 0.22-0.87). In this study, performance at the time of Irish national selection, measured across technical and nontechnical domains in a multimodal fashion, was associated with future performance in the workplace and in simulated environments. Future studies will be required to explore the consequential validity of selection, including potential unintended effects of selection and ranking on candidate performance.

Use of online educational resources before and during the COVID-19 era in oral and maxillofacial surgery

Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner.An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic.Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5–10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10–20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs.Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions.

An exploratory study of obstetrics trainees' experiences of breaking bad news.

Breaking bad news is one of the hardest tasks performed by doctors. The news can significantly impact on the patient's life; however, the process also generates stress for the doctor. The aim of this study was to explore the lived experiences of breaking bad news for obstetrics trainees in Ireland. A qualitative study using interpretative phenomenological analysis (IPA) was performed to capture the experience of breaking bad news for the trainees. Semi-structured interviews were conducted with trainees over Zoom. The transcripts were analysed in line with the IPA framework with the assistance of NVivo software. Seven trainees were interviewed, five at Basic Specialist Training (BST) level and two at Higher Specialist Training (HST) level. Four superordinate themes were identified from the analysis: "the reality of working in obstetrics," "the role of the doctor," "development of communication skills" and "the importance of the patient experience." The trainees described breaking bad news in a variety of clinical contexts. This task could be emotionally draining; however, only two trainees mentioned ways of coping with this. Their formal training was limited with the majority of learning occurring "on the job." This study provides an insight into factors that influence trainees experiences of breaking bad news. The results complemented existing literature and raised questions about how to better support trainees through increased training and psychological support.

SP11.17 The predictive paradigm: examining the validity of a national selection process in surgical training

Abstract Introduction Selection processes should conform to a ‘predictive paradigm’, identifying candidates who will become competent professionals. This study investigates the ability of a centralised, multi-modal national selection process to predict the future performance of surgical trainees. Methods A retrospective analysis of prospectively collected data from successful applicants to the Royal College of Surgeons in Ireland (RCSI) Core Surgical Training (CST) programme from 2016-2020 was conducted. Performance in subsequent assessments, attrition rates, and rates of progression to Higher Specialist Training (HST) were recorded. Selection decisions were based on a total score, composed of technical aptitude assessments, undergraduate academic performance, and a four-station multi-interview. CST performance was assessed using workplace-based and simulation-based assessments. Associations between selection and assessment measures were explored using Pearson correlation, binary logistic regression, and multiple linear regression analyses. Results Data was available for 303 trainees. Composite scores were positively associated with likelihood of progressing to HST (Exp(B) 1.09, 95% CI 1.05 – 1.13, p&amp;lt;0.001), and were significantly associated with performance across all CST assessments (r .23 - .34, P&amp;lt;0.001). On multivariate analysis, technical aptitude scores were the strongest predictor of future operative performance, both in the workplace (B 0.31, 95% CI .14 - .48, p&amp;lt;0.001) and simulated environments (B .57, 95% CI .33 - .81, p&amp;lt;0.001). The ‘interpersonal skills’ interview station was the strongest predictor of performance in simulated non-technical skill assessments (B .55, 95% CI .22 - .87, p&amp;lt;0.001). Conclusion Performance at the time of national selection, measured across technical and non-technical domains in a multi-modal fashion, is associated with future performance in the workplace and in simulation-based assessments.

The retention of training doctors in the Irish health system

BackgroundThere is limited quantitative evidence on the migration patterns of training doctors in Ireland. The aim of this study is to estimate the number of trainee doctors leaving the Irish health system and the numbers returning.MethodsThis study uses administrative data to track the migration patterns of Irish trained doctors at various career stages.ResultsEighty-four percent of interns who commenced intern training in 2015 subsequently commenced a basic specialist training (BST) or general practice (GP) training programme in subsequent years (2016–2021). Of those who completed BST training in 2017, 75% went on to higher specialist training (HST) in Ireland. In 2021, of the 2016 cohort of doctors awarded Certificates of Satisfactory Completion of Specialist Training (CSCST), 68% are employed in Ireland and 32% are abroad or unknown. Of the 2016 group that are abroad, the UK is the main country of practice. There are variations in the retention rate across disciplines; from the 2016 cohort, 52% of anaesthesiology CSCSTs were working in Ireland in 2021 compared to 88% of psychiatry CSCSTs.ConclusionPrevious research has highlighted Irish doctor’s intentions to migrate and intentions to return to Ireland. This study documents for the first time the extent to which Irish doctors are leaving and returning to the Irish health system from 2015 to 2021. The paper also gives a picture of variations across medical disciplines and the location of emigration of qualified specialists.

Evaluating workforce needs for higher specialist training for psychiatry of intellectual disability in Kent, Surrey and Sussex: a workforce scoping service evaluation

PurposeWhilst recruitment and retention of high-quality staff is vital to providing a good service, at the time of the evaluations, Kent, Surrey and Sussex (KSS) was the only area of the UK without a Higher Specialist Training (HST) scheme in intellectual disability (ID). The purpose of this project was to identify barriers to recruitment and support the need for change.Design/methodology/approachThis evaluation included conducting interviews with 16 practitioners in the region with links to ID to consider the gaps in training and find solutions.FindingsFour themes were identified, namely, good experiences are important to recruiting people into the ID field; bad experiences or lack of exposure to people with ID are likely to prevent engagement with this field; there is an ongoing need for specialist psychiatrists in ID services; and there is a developing need for specialists in neurodevelopmental disorders. Finally, the challenge means we need to think differently about developing a workforce. Seven recommendations to support workforce delivery in KSS were developed.Originality/valueThis paper highlights an important rationale for ongoing need for HST in ID work and also reasons to engage people in this field. This has not been undertaken in the ID field in this way previously.

137 VIRTUAL CONSULTATIONS IN GERIATRIC MEDICINE OUTPATIENT DEPARTMENTS; THE PERSPECTIVE OF GERIATRIC MEDICINE SPECIALIST TRAINEES

Abstract Background Covid-19 social distancing measures restricted access to outpatient services. “Virtual Clinics”(VCs) were introduced in Outpatients Departments (OPDs) to continue service provision. OPD experience is vital to geriatric medicine training. The geriatric medicine Higher Specialist Training (HST) curriculum requires annual OPD participation. This study sought to identify the impact of VCs on geriatric medicine training. Methods An online mixed-method questionnaire was developed and circulated among geriatric medicine specialist trainees. 20 closed-questions collected demographic information and considered opinion of VCs. 5 open-questions enabled respondents to expand views of VCs. Closed-questions responses underwent quantitative descriptive analysis. Open-question responses underwent qualitative thematic analysis. Results Response rate was 61.4%. 86.3% reported VCs were conducted via telephone calls. 58% didn't feel comfortable conducting VCs. 64.7% didn't feel VCs positively contributed to training. 90.2% stated Face-To-Face (FTF) clinics offer greater training opportunities. 74.51% stated they were less likely to discuss VCs with consultants(compared to FTF clinics). 98.04% hadn't received training in conducting VCs. Qualitative analysis revealed four main themes: (1) Patient Selection: certain patient cohorts are unsuitable for VCs. VCs are useful in relaying simple results; not for patients with complex needs; (2) Practical Considerations: there must be access to required technologies for patients and medical staff. Medicolegal concerns were raised by several respondents; (3) Patient Care: the inability to examine patients is a challenge which impacts patient care. The lack of non-verbal cues impeded communication; (4) Training Impact: Respondents felt VCs weren't beneficial to training. There was a sense that training opportunities had been missed. Conclusion This study found high rates of dissatisfaction with VCs among geriatric trainees. This may be due to: (1) Inadequate training/preparation; (2) Inappropriate patient selection or (3) Lack of video-conferencing technologies. There is a sense that VCs have negatively impacted geriatric medicine training. Current policy advocates for the continuation of VCs. If VCs continue, additional resources may be needed to address any accompanying training deficit.

Post-CSCST fellowships: beyond subspecialization.

The transition from higher training to consultanthood is a crucial point in the medical training pathway. Despite comprehensive higher training programs, studies of new consultants have reported a disparity in their sense of preparation for non-clinical and clinical duties. Post- "Certificate of Satisfactory Completion of Specialist Training" (CSCST) fellowships have traditionally been undertaken as a means to access subspecialty clinical training which is otherwise unavailable in higher training programs. However, fellowships have a role beyond this subspecialization model, particularly in meeting the non-clinical training needs of new CSCST graduates.The design and goals of fellowship posts should be considered in this context, to align them with the reported needs of new consultants. Special consideration should be given to defining roles of independence for the fellow and to the nature of the mentorship relationship, distinguishing these posts from higher specialist training. Well-designed post-CSCST fellowships have an important role in facilitating the successful transition to consultanthood.

879 Attitudes to Research and Academic Careers Among Surgical Trainees and Medical Students: A Survey of Attendees at the 2021 Oxford Surgical Innovation Conference

Abstract Introduction Participation in research throughout medical training is essential in developing and implementing evidence-based practice. Increasing competitiveness across many surgical specialties has led to increased desire to participate in research by medical students and surgical trainees of all grades, with the aim of increasing their employability. Method The Oxford surgical innovation conference (OxSI) took place on the 23rd of April. The 121 attendees were surveyed regarding their attitudes to medical research, levels of research experience, and their confidence in seeking out and engaging with research opportunities. Survey respondents included clinical medical students, foundation trainees, core surgical trainees and higher specialist trainees. Results From 121 surveyed attendees at OxSI 2021, we received 88 responses (72%). 90% of respondents were interested in/pursuing a surgical career, with 70% interested in a career in academic surgery specifically. Furthermore, 97.8% agreed that engaging in research and innovation are an important part of surgical training. However only 48.9% were actively engaged in research. Furthermore only 26.2% of respondents were confident in engaging in independent research, with 56.8% stating they would not know how to engage in research or pursue new surgical innovations without outside assistance. Conclusions There is significant interest among medical trainees in research and academic surgical careers. However, many struggle to engage with research due to time constraints, or inadequate exposure to research opportunities. This survey suggests a larger study examining barriers to research exposure and participation could assist in addressing the discrepancy between desire to engage with research and opportunities to do so.

Factors that influence psychiatric trainees' choice of higher training specialty: mixed-methods study.

Factors influencing trainees' decisions about choosing and remaining in higher training subspecialties have not been widely researched. We administered telephone questionnaires to higher specialist trainees in the north-east of England to ascertain what influences these decisions. Thematic analysis was employed to develop overall constructs. Twenty-seven trainees were interviewed, resulting in six overall constructs. These were: supervisory experiences; perceived work-life balance; career prospects; training and working environments; interest in the chosen subspecialty; and previous experience within the chosen subspecialty. Most trainees interviewed felt they had made the right specialty choice. This study demonstrates the particular importance of exposure to a specialty and perceptions of the supervisory experience in determining trainees' choices of, and decisions to remain in, a particular psychiatric specialty. Factors highlighted in this study must inform training, recruitment and workforce planning in order to bolster the recruitment and retention of trainees into higher specialty training.

Perceptions of Higher Specialist Trainees and Fellows of the Proposed Sláintecare Consultant Contract and Implications for Workforce Planning in Ireland

To explore the perceptions of higher specialist trainees and fellows in Ireland with respect to the Irish Department of Health’s recent proposal to implement a drafted, non-negotiated, consultant contract under a new model for healthcare, termed the Sláintecare plan. A customized survey, incorporating multiple-choice and Likert-scale questions and a free-text option, was disseminated to doctors enrolled in Irish higher specialist training (HST) programmes and pre-consultant HST graduates (fellows). Responses were compiled and analysed. There were a total of 1109 respondents across all specialities. Trainees were particularly concerned regarding the Sláintecare contract’s potential impact on their abilities to engage in patient advocacy and provide optimal patient care in the future, the maintenance of specialist skillsets, their ownership of intellectual property and a stable location of the practice. Of respondents, 93.7% (1003/1070) indicated that they would consider working abroad rather than accept the proposed contract. This study highlights the perceptions and concerns of the higher specialist trainees and fellows of Ireland. A large proportion may emigrate rather than accept the Sláintecare proposals. Concerns exist surrounding the ability to advocate for patients, to provide patient care, the proposed working conditions and perceived potential to deskill under this contract’s terms.

Postgraduate training in Cancer Genetics-a cross-specialty survey exploring experience of clinicians in Ireland.

BackgroundAs genomic profiling of constitutional and tumour-derived DNA becomes increasingly critical in cancer risk estimation, prognostication and treatment, there is a growing need for clinicians involved in cancer care to up-skill in Cancer Genetics. In the Republic of Ireland (ROI), this is particularly crucial, given a paucity of vocationally trained Clinical Geneticists per capita compared to other European countries.AimsWe aimed to assess the self-reported confidence of postgraduate medical/surgical trainees in ROI in requesting, interpreting, and managing genomic data in patients with cancer, and to assess their selfreported experience, and demand for future training in this area.MethodsA cross-sectional survey of postgraduate trainees in four specialties (Medical and Radiation Oncology, Surgery, and Obstetrics and Gynaecology (O&G)), training in ROI, was undertaken. A bespoke electronic questionnaire was designed to capture data regarding preceding experience, and confidence across several hypothetical clinical scenarios involving genomic testing. The survey was circulated to eligible participants by training programme administrators, after relevant institutional ethical approval. Data was collected anonymously.ResultsThe study cohort included 62 respondents. A paucity of cancer genetics training at every level was demonstrated, with “hardly any” or “none at all” reported by 47(76%), 62(100%), and 50(81%) during undergraduate, core specialty, and higher specialist training, respectively. A relative lack of confidence in all clinical scenarios was apparent, particularly among Surgery/O&G trainees. Most respondents would value more training in Cancer Genetics.ConclusionsThis study demonstrates an unmet need in dedicated Cancer Genetics training for postgraduate specialty trainees in ROI.

The road to consultancy: an epidemiological study.

Modern medical and surgical training pathways have developed globally in response to changing expectations and requirements for trainees. To determine the demographic, educational, and training characteristics of consultants in a model 4 teaching hospital, and to evaluate the requirements met by consultant physicians and surgeons prior to their appointment to consultancy. A single-centre study conducted by prospectively distributing written questionnaires. Data was collected and analysed using Microsoft Excel and SPSS. This questionnaire was offered to 166 consultants, 110 of whom responded (66.0%). The vast majority were Irish (91.8%) and 70.9% male. The mean age to appointment was 35.7 ± 2.6 years. Radiology was the specialty with the youngest mean age at appointment: 34.4 ± 2.6 years, while surgery had the oldest: 36.7 ± 2.7 (P = 0.035). Overall, 80.9% trained via Higher Specialist Training (HST) schemes (89/110) and 68.2% completed a higher degree (75/110). Geriatric medicine and dermatology had the highest rate of completed higher degrees (100.0%, 3/3 and 3/3 respectively), followed by surgeons (92.3%; 24/26) and cardiologists (71.4%; 5/7). The overall duration of HST varied greatly; the mean surgical, medical and anaesthesiology durations were 6.7 ± 1.8 years, 6.6 ± 1.7 years, and 5.3 ± 2.0 years. A total of 75.4% of consultants completed fellowship (83/110). This study highlights variations in postgraduate Irish medical training pathways and discrepancies in training requirements expected in each specialty. The establishment of a modern guideline for young trainees working towards consultancy may be imperative in ensuring trainees have insight into training requirements expected in their specialty.

Inclusion of medical fitness to drive in medical postgraduate training curricula.

Transport mobility and access to driving are important factors in social inclusion and wellbeing. Doctors have an important role to play in supporting safe mobility through applying the knowledge developed in the field of traffic medicine and incorporating state of the art national and international medical fitness to drive (MFTD) guidelines. Little is known about the profile of MFTD in postgraduate curricula for core and higher specialist training. We profiled the inclusion of MFTD in the curricula of postgraduate core, higher and streamlined medical and surgical specialties in the Republic of Ireland (ROI) and the UK. All publicly available syllabi of basic and higher/ streamlined specialist training in postgraduate medical and surgical colleges in both jurisdictions were analysed (n = 122). In Ireland 25% of basic training schemes included MFTD in the curriculum. Two-thirds of curricula of higher specialty and streamlined training schemes also included MFTD. For the UK 44% of core and 36% of higher training scheme curricula included MFTD. Just under one-quarter of all curricula reviewed included MFTD for more than one medical condition or treatment. Common topics in both Irish and UK curricula included seizures/epilepsy, syncope and visual disturbances. There are notable deficits in MFTD training for specialists in Ireland and the UK. Common conditions which can significantly impair MFTD such as stroke, diabetes and alcohol use disorders are severely underrepresented and curricula should be revisited to include relevant training and guidance on MFTD for trainees.

Comparison of chest X-ray interpretation by Emergency Department clinicians and radiologists in suspected COVID-19 infection: a retrospective cohort study.

Objectives:We describe the inter-rater agreement between Emergency Department (ED) clinicians and reporting radiologists in the interpretation of chest X-rays (CXRs) in patients presenting to ED with suspected COVID-19.Methods:We undertook a retrospective cohort study of patients with suspected COVID-19. We compared ED clinicians’ and radiologists’ interpretation of the CXRs according to British Society of Thoracic Imaging (BSTI) guidelines, using the area under the receiver operator curve (ROC area).Results:CXRs of 152 cases with suspected COVID-19 infection were included. Sensitivity and specificity for ‘classic’ COVID-19 CXR findings reported by ED clinician was 84 and 83%, respectively, with a ROC area of 0.84 (95%CI 0.77 to 0.90). Accuracy improved with ED clinicians’ experience, with ROC areas of 0.73 (95%CI 0.45 to 1.00), 0.81 (95%CI 0.73 to 0.89), 1.00 (95%CI 1.00 to 1.00) and 0.90 (95%CI 0.70 to 1.00) for foundation year doctors, senior house officers, higher speciality trainees and ED consultants, respectively (p < 0.001).Conclusions:ED clinicians demonstrated moderate inter-rater agreement with reporting radiologists according to the BSTI COVID-19 classifications. The improvement in accuracy with ED clinician experience suggests training of junior ED clinicians in the interpretation of COVID-19 related CXRs might be beneficial. Large-scale survey studies might be useful in the further evaluation of this topic.Advances in knowledge:This is the first study to examine inter-rater agreement between ED clinicians and radiologists in regards to COVID-19 CXR interpretation.Further service configurations such as 24-hr hot reporting of CXRs can be guided by these data, as well as an ongoing, nationwide follow-up study.

The transition to consultant: Identifying gaps in higher specialist training

New consultants consistently feel better prepared for the clinical rather than non-clinical aspects of their role. However, deficiencies in generic competencies have been linked to burnout and patient complaints. This study explored how higher specialty training prepares doctors for the transition to consultant in genitourinary medicine. New consultants felt less prepared for non-clinical aspects of their role. Prior practical experience was the greatest influencing factor in levels of preparedness, with increased responsibility and leadership driving deeper learning. Observation of others helped individuals develop a professional identity but also learn about the wider processes within their service. The learning environment positively influenced preparedness but highlighted a need for dedicated time to learn non-clinical aspects. To ensure future trainees feel prepared for the non-clinical aspects of the consultant role, practical experience of non-clinical areas with high levels of leadership and responsibility within a supportive learning environment is essential.

Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation

BackgroundWorkforce studies show a declining proportion of UK junior doctors proceeding directly to specialist training, with many taking career breaks. Doctors may be choosing to delay this important career decision.AimTo...

Peter John Bowers

Peter John Bowers was born in Sunderland, the son of Arthur Clifford Bowers (a general practitioner, who died in 1947) and Doris Bowers. As a child, Peter excelled in both...