Dr. Stephen Ash has served as associate clinical dean at the United Kingdom campus of American University of the Caribbean School of Medicine (AUC) since 2012, and he was the AUC site director at Ealing Hospital near London from 1995 to 2018. (The AUC home campus is in Sint Maarten; the AUC UK Track is operated through the University of Central Lancashire [UCLan] in Preston.) He earned a degree in medicine and surgery from London University’s Medical University, and his areas of interest include human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), tuberculosis, chronic viral hepatitis, skin and soft tissue infections, ultrasonography, and tissue elastography. We asked Dr. Ash about his broad expertise, as well as his long-running connection with AUC.
Q: You’ve been with AUC UK for nearly 30 years now! How has AUC changed over that time?
A: Immeasurably and for the better. The educational experience has improved beyond recognition. Take the wellness initiative and other forms of student support; these were just unavailable in the early days. Credit also has to go to Adtalem [AUC’s parent company], which, following acquiring AUC, made available numerous and worthwhile resources for faculty and students.
Q: How did you first become involved with AUC?
A: I was director of medical education at a busy hospital in West London. I got a letter from the AUC UK clinical dean (at the time), who was based at a hospital about 10 miles away from me, asking if my hospital would like to join in taking AUC students for their core clinical clerkships. The AUC students are so impressive: their dedication, enthusiasm, and work ethic. They became very popular with the doctors, nurses, and other staff at the hospital.
Q: What are your duties as associate clinical dean?
A: As associate clinical dean, I look after the nine National Health Service (NHS)-affiliated hospitals we have in the United Kingdom. I oversee our UK visa licensing. I help organize UK conferences and other events for our students such as symposia and Observed Structured Clinical Examinations (OSCEs). I like to have student contact and I do a bit of teaching at some of the hospital sites, as well as at the UK Track Preston campus.
Q: What can you tell us about the Selected Longitudinal Integrated Clinical Experiences (SLICE) program recently instituted at AUC UK?
A: I have always thought that medical schools do not provide the necessary learning experiences for their students to acquire the holistic clinical skills to look after patients with long-term or chronic illnesses. Most schools’ curricula involve their students meeting either acutely ill patients in a hospital, or a one-off encounter with a patient with a chronic illness in a clinic setting. The SLICE program pairs up students in their first semester at AUC (currently a small number of students on the UK Track Preston campus) one-to-one with a volunteer patient with a chronic condition. They meet regularly over Zoom, but also in person at healthcare appointments, and this experience is designed to last for the whole four years of the MD course. SLICE started in February 2023 with just four students, as a pilot. It looks like it is very successful, with unique learning benefits for the students. The patients have found it of value to them, as well. We are looking to expand the program and offer it to all students in the near future.
Q: Your medical interests are well-rounded within infectious disease and internal medicine. What drew you to your specialty interests, including medical education?
A: Infectious disease is fascinating. Every bit of your body can be involved with an infectious process. I was involved with looking after an ever-increasing number of patients with HIV in the 1980s and 1990s — a very emotional time full of ups and downs. … I’ve always loved teaching medical students and junior doctors. It is an honor to be involved in the training of so many future doctors. What a reward and level of satisfaction I have received.
Q: You’ve done research on sepsis, particularly on the condition’s associated metabolic changes. What should people know about sepsis? What did your research reveal?
A: Sepsis occurs when an infection triggers a chain reaction throughout the body. It is a life-threatening condition. Always suspect sepsis in your differential diagnosis. It isn’t always obvious. Early treatment can be life saving. … In my research, I was trying to find out how one could mitigate against the wasting (catabolism) and muscle weakness associated with many infections. I had an interest in intravenous feeding at the time and showed that extra calories and protein were unable to alleviate the muscle breakdown.
Q: What sparked your interest in the study and treatment of HIV/AIDS?
A: Remember that in the 1980s and early 1990s, there were many things we didn’t know about HIV, and fear and stigma were predominant at the time. It was invariably fatal to have HIV. I lost so many patients, with many of whom I had developed a close bond. There was a time when I attended funerals on a weekly basis. A bright research worker at Cambridge in the UK asked me to join him in developing “passive immunotherapy” for people with advanced AIDS. I am sure it kept some of the patients alive long enough to start the combination antiretroviral therapy that was so effective when it was introduced in 1996.
Q: It’s been a while, but what was it like working with the Elton John AIDS Foundation? Did you meet Sir Elton himself?
A: Yes, I was the medical advisor to the Elton John AIDS Foundation for around 10 years (he was not a “Sir” at the time), in addition to my usual job at Ealing Hospital in London. I met Elton several times, and he invited me to many of his charitable events. I have many funny stories to tell! Elton is such a hardworking man, a brilliant musician who is also dedicated to the cause of defeating HIV/AIDS. He used to call me to say he was just passing the hospital and could he pop in to say hello to the patients. It was a great morale booster for a sick patient. I was always amused by the look on people’s faces when they recognized him as he walked by in the hospital corridors.
Q: A 2024 report by the UK Health Security Agency shows that tuberculosis (TB) cases in England have increased in recent years. To what do you attribute this trend?
A: Most adult TB is a reactivation of childhood exposure to the TB organism. There is a theory, and I think a good one, that low vitamin D is associated with reactivation of TB. Vitamin D is important in the production of gamma-interferon by macrophages, a process that is important in defending the body against TB. My department was the busiest in Europe in terms of the number of patients we saw with TB. The vast majority of them had low vitamin D levels.
Q: What are the diagnostic and therapeutic applications of ultrasonography — another of your specialty interests?
A: You can do so much at the bedside with ultrasound in terms of confirming a diagnosis, as well as undertaking a procedure with better safety and accuracy. It is a modality that doctors in nearly all specialties will be using in the future, and now is the time to start learning the technique. We have our own ultrasound machine in Preston, and I teach the students various procedures with it. Advances in technology have made the machines smaller and portable; there are even battery-operated machines that use Bluetooth with an app on your smartphone.
Q: What are the principles and applications of ultrasound elastography?
A: I could go on about this: How long have you got? There are many ways to use elastography, but the basic principle is this: Solid organs/structures in the body resonate to sound with an expected elasticity, and any part that shows more “stiffness” than usual may need attention. For example, a liver with cirrhosis (fibrosis hardens the liver) will resonate at a higher frequency than a healthy liver. A software adaptation to a good ultrasound machine can pick that up and quantify it.
Q: What do you like best about your work at AUC?
A: AUC is a family. What I like best is to see the transition that a student makes over the course of time and to have been involved in their development. I keep in touch with so many of the students who have been to the United Kingdom, mostly by email. Many of them have gone on to do great things. Naturally, I am very proud.
Q: What are your favorite things to do on or near the Preston UCLan campus?
A: I helped with the temporary relocation of AUC students and staff from Sint Maarten to Preston in 2017 [because of Hurricane Irma]. Before that time, I had never been to Preston! I have grown fond of the town. The campus is very modern, with terrific facilities. There are lots of good restaurants. The nightlife is great, but I’m a little too old now to keep up! The scenery in the surrounding countryside is so picturesque.
Q: Finally, many current and future medical students will read this interview — do you have any advice for them?
A: Be determined and never give up on yourself. AUC is a truly unique medical school. Doing core clerkships in the United Kingdom is something you’ll never regret or forget.
Thank you, Dr. Ash, for the opportunity to learn more about you and your wide range of medical expertise! To see Dr. Ash in action, check out the Empowering HIV Prevention – Treatment and Conquering Bias in Healthcare on-demand webinar.
If a career in medicine interests you, learn more about AUC and our medical sciences curriculum, as well as the requirements for admission.
