Impact of UK academic foundation programmes on aspirations to pursue a career in academia

Medical Education 2010: 44: 996–1005 Objectives This study aimed to determine the role played by academic foundation programmes in influencing junior doctors’ desire to pursue a career in academic medicine. Methods We conducted an online questionnaire‐based study of doctors who were enrolled on or had completed academic foundation programmes in the UK. There were 92 respondents (44 men, 48 women). Of these, 32 (35%) possessed a higher degree and 73 (79%) had undertaken a 4‐month academic placement during Foundation Year 2. Outcomes were measured using Likert scale‐based ordinal response data. Results From a cohort of 115 academic foundation trainees directly contacted, 46 replies were obtained (40% response rate). A further 46 responses were obtained via indirect notification through local programme directors. From the combined responses, the majority (77%) wished to pursue a career in academia at the end of the academic Foundation Year (acFY) programme. Feeling well informed about academic careers (odds ratio [OR] 16.9, p = 0.005) and possessing a higher degree (OR 31.1, p = 0.013) were independently associated with an increased desire to continue in academia. Concern about reduced clinical experience whilst in academic training dissuaded from continuing in academia (OR 0.15, p = 0.026). Many respondents expressed concerns about autonomy, the organisation of the programme and the quantity and quality of academic teaching received. However, choice of work carried out during the academic block was the only variable independently associated with increasing the desire of respondents to pursue a career in academia following their experiences in the acFY programme (OR 6.3, p = 0.007). Conclusions The results support the provision of well‐organised academic training programmes that assist junior clinical academics in achieving clinical competencies whilst providing protected academic time, information about further academic training pathways and autonomy in their choice of academic work.     

Education of preventive medicine residents: alcohol,tobacco, and other drug abuse

BACKGROUND: Generalist physicians' addiction training is inadequate, but general preventive medicine residency (PMR) programs have not been studied. We determined PMR programs' alcohol, tobacco, and other drug abuse (ATOD) training from 1995 to 2000 and identified barriers to this education. METHODS: Interviewer-administered telephone survey of program directors (PDs) of accredited PMR programs in the United States. RESULTS: We interviewed all 41 PMR PDs. While 78% of PMR PDs reported interest in increasing ATOD education, for 68% it was not a high educational priority. Tobacco ranked in the top third of preventive medicine topics by 58%, while alcohol and other drugs ranked in the bottom third by 48% and 52%, respectively. Twenty-two percent of programs required a clinical ATOD rotation, most commonly smoking-cessation clinics. Only 29% of PMR PDs felt that residents were well prepared in clinical aspects of ATOD, while 60% felt that residents were prepared in ATOD research and public health issues. The most commonly reported barriers to ATOD training were lack of resident interest and defined competencies (64% each); limited faculty time (59%); limited teaching time (54%); lack of available teaching materials (53%); and lack of faculty expertise (51%). CONCLUSIONS: While the majority of PMR PDs recognize the importance of incorporating teaching about addictions into training, much of the ATOD education in PMRs focuses on tobacco alone. Setting educational standards, defining competencies, investing in faculty development, and creating ATOD curricular modules are important next steps toward preparing preventive medicine physicians to effectively reduce the public health toll of addictions.     

Bronchial Epithelial Mucin in Rats Infected With Mycoplasma pulmonis

After 80 years, US training for clinical specialties is essentially hospital-based supervised practice. Needs for specialists are barely met, particularly since one third of residents are foreign citizens. Training must be more efficient, shorter, and relevant to community practice. Numbers of trainees in preventive medicine are entirely inadequate. Residencies have grown rapidly, but comprise only 1% of programs and positions. Younger physicians are recruited through community impact on health care, students, and teachers. These preventive medicine residents function outside hospitals, work fewer hours, are paid more than clinical residents, and obtain an academic year’s graduate education. They work fewer hours, but receive less pay than clinicians. The nation must examine the concept of training physicians for nonclinical preventive medicine functions and, if training continues, must develop methods of making training and career more attractive.     

Preventive practicum training in healthcare organizations. The Meharry model.

BACKGROUND: Practicum training for preventive medicine residents often occurs in agencies whose community is geographically defined and whose governance is closely linked to public election. We were unsure about the financial ability of such departments to support training and are concerned that over-reliance on traditional health departments might not be best for either medically indigent populations or preventive medicine. We, therefore, sought to apply a public health model--based on a strategic partnership between nursing and preventive medicine--to a large health care organization. The result was formation of a mini-health department, suitable for fully accredited preventive medicine practicum training, within the Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN. This Center serves a defined population of 21,594 patients and about 1600 employees. The theoretical framework for the new department was based on demonstration of a close fit between the competencies expected of preventive medicine physicians by the American College of Preventive Medicine (ACPM) and activities required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Because of JCAHO requirements, many healthcare organizations already pay for preventive medicine services. CONCLUSIONS: By placing preventive medicine training faculty into existing budget slots at our institution, systemwide personnel costs for prevention decreased by about $36,000 per year, even as personnel funding for preventive medicine physicians increased from about $24,000 to $376,000 per year. Moreover, there was dramatic, sustained improvement in 17 indicators of preventive care quality as determined by an external peer review organization. In addition to providing a new venue for training, this model may also improve the quality and reach of preventive services, decreased fixed costs for service delivery, and yield new employment opportunities for preventive medicine physicians.     

Elaboración de una herramienta para la vigilancia de indicadores de calidad de la docencia en la formación especializada de Medicina Preventiva y Salud Pública

This study describes the process of developing an instrument intended for use in assessing satisfaction with the quality of training in preventive medicine and public health for resident physicians. To develop this instrument, the National Survey of Satisfaction with Medical Residency was adapted by an expert panel consisting of 23 resident physicians in preventive medicine and public health belonging to 9 autonomous communities in Spain. The adaptation of the survey to the specialty rotations included new dimensions and items and was evaluated with a 5-point Likert scale. The most important dimensions were planning and the achievement of specific objectives, supervision, delegation of responsibilities, resources and work environment, personal assessment, encouragement, support, and whether the rotation resulted in a publication or research project, etc. The development and utilization of this tool will enable future trainees in preventive medicine and public health to make an informed choice about their training itineraries.     

The AMA Residency Training in Adolescent Preventive Services Project: report of the working group. The American Medical Association.

PURPOSE: To improve resident education in provision of adolescent preventive health care. The American Medical Association (AMA) Residency Training in Adolescent Preventive Services Project Working Group convened to identify specific goals and objectives (G&Os) for pediatric and family medicine resident education in adolescent clinical preventive services and recommend strategies to achieve these G&Os. METHODS: Iterative review process involving members of the working group, nine experienced teaching faculty and 16 resident physicians from family medicine and pediatric training programs, and an advisory board. RESULTS: We achieved consensus on appropriate G&Os for pediatric and family medicine residency education in adolescent clinical preventive services. Faculty and residents expressed concerns about achieving G&Os because of challenges to implementing effective training and evaluation strategies. Suggestions for achieving G&Os included development of an adolescent clinical preventive services curriculum and evaluation program that could be adapted for use in a variety of training program structures. Faculty and residents anticipated the success of a training curriculum would be influenced by: (a) availability of adequate numbers of skilled teaching faculty; (b) availability of time and support for faculty development and teaching efforts; and (c) exposure of residents to adequate numbers of adolescent patients in settings where there are clear expectations for delivery of comprehensive preventive services. CONCLUSIONS: The AMA Residency Training in Adolescent Preventive Services Project Working Group presents G&Os for organizing training experiences in adolescent clinical preventive services in family medicine and pediatric residency training programs and recommends strategies to achieve these G&Os.     

Experiences with a combined residency in internal and preventive medicine

BACKGROUND: The importance of integrating preventive medicine training into other residency programs was reinforced recently by the residency review committee for preventive medicine. Griffin Hospital in Derby CT has offered a 4-year integrated internal medicine and preventive medicine residency program since 1997. This article reports the outcomes of that program. METHODS: Data were collected from surveys of program graduates and the American Boards of Internal and Preventive Medicine in 2005-2007, and analyzed in 2007-2008. Graduates rated the program in regard to job preparation, the ease of transition to employment, the value of skills learned, the perceived quality of board preparation, and the quality of the program overall. Graduates rated themselves on core competencies set by the Accreditation Committee for Graduate Medical Education. RESULTS: Since 1997, the program has enrolled 22 residents. Residents and graduates contribute significantly toward quality of care at the hospital. Graduates take and pass at high rates the boards for both for internal and preventive medicine: 100% took internal medicine boards, 90% of them passed; 63% took preventive medicine boards, 100% of them passed). The program has recruited residents mainly through the match. Graduates rated most elements of the program highly. They felt well-prepared for their postgraduation jobs; most respondents reported routinely using preventive medicine skills learned during residency. Graduates either have gone into academic medicine (31%); public health (14%); clinical fellowships (18%); or primary care (9%); or they combine elements of clinical medicine and public health (28%). CONCLUSIONS: Integrating preventive medicine training into clinical residency programs may be an efficient, viable, and cost-effective way of creating more medical specialists with population-medicine skills.     

Training internal medicine residents to screen for domestic violence

Internal medicine residency programs will need to train residents about domestic violence to comply with the Residency Review Commission standards. To assess the effectiveness of an educational intervention intended to increase screening of patients for domestic violence by internal medicine resident physicians and identify characteristics associated with increased screening, we used a quasi-experimental, pretest/posttest trial. This was conducted in an internal medicine residency program and its affiliated primary care clinic with categorical internal medicine and combined medicine/pediatrics resident physicians. Exit interview surveys of patients were conducted at baseline and following the educational program. Patients were questioned about demographics and if they were asked about domestic violence during the current visit. Physicians were questioned about demographics and attitudes and beliefs related to domestic violence. Prior to the intervention, only 0.8% (1 of 122) of patients reported being asked about domestic violence. After the intervention, the percentage asked rose to 17% (20 of 116). The odds ratio (OR) for being asked about domestic violence after training was 25.2 (6.1-104). Patients who were younger than 50 years were more likely to be asked (OR 2.5, 1.5-4.6). Caucasian physicians were more likely to ask (OR 2.8, 1.1-7.6). Patients reporting they were taught breast self-examination at that day's visit were also more likely to be screened (OR 2.9, 1.1-7.9). We found evidence that moderately intense training and focusing on results can increase resident physician screening rates for domestic violence. To do so effectively, we recommend a training session similar to this one and continued monitoring of outcome in the clinical setting.     

A threat to the public health workforce: evidence from trends in preventive medicine certification and training

Evidence of a growing need for preventive medicine specialists is the congruence between needed competencies for practice in the current health care environment, as identified by the Council on Graduate Medical Education (COGME) and in other national reports, and the core competencies of preventive medicine residents. The total number of certified specialists in preventive medicine is 6091. The proportion of self-designated preventive medicine specialists among all U.S. physicians is on the decline and the greatest decline has been among those in public health (PH) and general preventive medicine (GPM). In addition, the total number of preventive medicine residents is on the decline, and the decline has been greatest among those training in PH and combined PH/GPM. One of the reasons for this decline has been inadequate funding due to the absence of Medicare graduate medical education (GME) financing for population-based vs. individual patient care services and meager and diminishing Title VII support. A paucity of faculty is apparent in medical schools with residency training and board certification in preventive medicine. Several actions may help reverse this trend and assure adequate numbers of preventive medicine specialists: expansion of Title VII to increase the number of residents receiving stipends and tuition, adding infrastructure support for faculty development and funding of demonstration projects in distance learning and in joint generalist/ preventive medicine residency training. Medicare GME reform should include recognition of population-based services and inclusion of preventive medicine residencies in provisions for "nonhospital-based" training and in up-weighting methodologies for primary care training. Expansion of Veterans Affairs, National Institute for Occupational Safety and Health, and Department of Defense support is also needed as is attention to resident debt reduction.     

External Practicum-Year Residency Training in Occupational and Environmental Medicine: the University of Pennsylvania Medical Center Program

We describe a competency-based training program that allows physicians employed full-time in occupational and environmental medicine to satisfy the supervised practicum year of training required by the American Board of Preventive Medicine (ABPM). The program is designed for trainees with greater clinical experience than the 1 clinical year required by the ABPM. To date, 25 physicians from clinic-based, academic, corporate, and government employment across most geographic regions of the United States have been admitted into the program. Most completed a master's in public health (MPH) in a distance-learning, on-job, on-campus, or executive program. The practicum-year training has been highly successful, as evidenced by improvements in resident self-assessment of competency, resident satisfaction with the training, faculty evaluation of resident performance, and success rate in the ABPM examination. The program has opened a new pathway for physicians making a mid-career shift to occupational and environmental medicine to obtain high-quality, in-depth education and board certification.     

Maternity leave for practicing family physicians.

BACKGROUND. Approximately 37% of all medical students and 36% of family medicine residents in training in the United States are women. The American Academy of Family Physicians (AAFP) has developed a recommended parental leave policy for residents in training but has not established a similar policy for physicians in practice. The purpose of this study was to assess the prevalence of maternity leave policies for practicing family physicians. METHODS. A 14-item self-administered survey questionnaire was designed and mailed to 940 AAFP members randomly selected from the total active female membership. RESULTS. A 52% response rate was obtained. The mean age of respondents was 35 years. Only one third of the physicians not in solo practice reported having a stated maternity leave policy in their current place of practice. Academic programs, when compared with single specialty family practice groups, multispecialty groups and health maintenance organization (HMO) or preferred provider organization (PPO) groups, were more likely to have maternity leave policies and to provide salary on leave. Practice groups with eight or more partners were more likely to have policies that provided salary and benefits while on leave. Ninety percent of respondents requested maternity leave guidelines for practicing family physicians. CONCLUSIONS. Women family physicians expressed strong interest in the development of maternity leave guidelines for their specialty. Guideline components are outlined.     

Junior doctors'' views about careers in academic medicine

OBJECTIVE: To investigate junior doctors' views about careers in academic medicine. DESIGN: Postal questionnaire survey. SETTING: National Health Service in England. SUBJECTS: Doctors in university posts at specialist registrar level, Medical Research Council and Wellcome Trust training fellows, and specialist registrars in National Health Service posts. RESULTS: Incentives to pursue an academic career which respondents rated as strong related to the challenge of research and the intellectual environment of research units. The strongest disincentives were perceived difficulties in obtaining research grants and uncertainty regarding pay parity with National Health Service colleagues. Medical Research Council and Wellcome fellows had much more protected research time than other academic doctors but were less satisfied with their clinical training. Academic doctors who were not fellows reported spending less than half their time on research and the great majority agreed that their research suffers when there is pressure on the service side. CONCLUSIONS: The job content of academic posts should be kept under regular review to ensure that clinical service pressures do not inappropriately erode research time while also ensuring that postholders have adequate clinical training. Training programmes need flexibility to accommodate the needs of clinical academics in their progress through higher specialist training.     

Residency Training in Preventive Medicine

In responding to questionnaires, directors of 37 of the 49 approved residency programs in preventive medicine (excluding aerospace medicine) reported that 285 physicians had entered such training in the academic years, 1960 to 1968. Of these, 92% proceeded into the second year, but only 45% continued into the third. Gainful employment, military service, and residency programs in other specialties were major avenues of loss. The chief difficulty in recruitment appeared to be lack of teaching and indoctrination in preventive medicine during medical school. The greatest monetary difficulties were related to instability of governmental funding and the fact that residents in preventive medicine usually do not fulfill a “service function” in academic settings. A significant number of full-time faculty positions in departments of preventive medicine are vacant. Respondents provided a number of suggestions for improvement.     

GP recruitment and retention: a qualitative analysis of doctors' comments about training for and working in general practice

BACKGROUND AND AIMS: General practice in the UK is experiencing difficulty with medical staff recruitment and retention, with reduced numbers choosing careers in general practice or entering principalships, and increases in less-than-full-time working, career breaks, early retirement and locum employment. Information is scarce about the reasons for these changes and factors that could increase recruitment and retention. The UK Medical Careers Research Group (UKMCRG) regularly surveys cohorts of UK medical graduates to determine their career choices and progression. We also invite written comments from respondents about their careers and the factors that influence them. Most respondents report high levels of job satisfaction. A noteworthy minority, however, make critical comments about general practice. Although their views may not represent those of all general practitioners (GPs), they nonetheless indicate a range of concerns that deserve to be understood. This paper reports on respondents' comments about general practice. ANALYSIS OF DOCTORS' COMMENTS: Training Greater exposure to general practice at undergraduate level could help to promote general practice careers and better inform career decisions. Postgraduate general practice training in hospital-based posts was seen as poor quality, irrelevant and run as if it were of secondary importance to service commitments. In contrast, general practice-based postgraduate training was widely praised for good formal teaching that met educational needs. The quality of vocational training was dependent upon the skills and enthusiasm of individual trainers. Recruitment problems Perceived deterrents to choosing general practice were its portrayal, by some hospital-based teachers, as a second class career compared to hospital medicine, and a perception of low morale amongst current GPs. The choice of a career in general practice was commonly made for lifestyle reasons rather than professional aspirations. Some GPs had encountered difficulties in obtaining posts in general practice suited to their needs, while others perceived discrimination. Newly qualified GPs often sought work as non-principals because they felt too inexperienced for partnership or because their domestic situation prevented them from settling in a particular area. Changes to general practice The 1990 National Health Service (NHS) reforms were largely viewed unfavourably, partly because they had led to a substantial increase in GPs' workloads that was compounded by growing public expectations, and partly because the two-tier system of fund-holding was considered unfair. Fund-holding and, more recently, GP commissioning threatened the GP's role as patient advocate by shifting the responsibility for rationing of health care from government to GPs. Some concerns were also expressed about the introduction of primary care groups (PCGs) and trusts (PCTs). Together, increased workload and the continual process of change had, for some, resulted in work-related stress, low morale, reduced job satisfaction and quality of life. These problems had been partially alleviated by the formation of GP co-operatives. Retention difficulties Loss of GPs' time from the NHS workforce occurs in four ways: reduced working hours, temporary career breaks, leaving the NHS to work elsewhere and early retirement. Child rearing and a desire to pursue interests outside medicine were cited as reasons for seeking shorter working hours or career breaks. A desire to reduce pressure of work was a common reason for seeking shorter working hours, taking career breaks, early retirement or leaving NHS general practice. Other reasons for leaving NHS general practice, temporarily or permanently, were difficulty in finding a GP post suited to individual needs and a desire to work abroad. CONCLUSIONS: A cultural change amongst medical educationalists is needed to promote general practice as a career choice that is equally attractive as hospital practice. The introduction of Pre-Registration House Officer (PRHO) placements in general practice and improved flexibility of GP vocational training schemes, together with plans to improve the quality of Senior House Officer (SHO) training in the future, are welcome developments and should address some of the concerns about poor quality GP training raised by our respondents. The reluctance of newly qualified GPs to enter principalships, and the increasing demand from experienced GPs for less-than-full-time work, indicates a need for a greater variety of contractual arrangements to reflect doctors' desires for more flexible patterns of working in general practice.     

Veterinary medicine and public health at CDC

People readily associate the role of veterinarians with private veterinary practice focused on pets and farm animals, but the true dimensions and contributions of veterinary medicine are much broader and reflect expanding societal needs and contemporary challenges to animal and human health and to the environment. Veterinary medicine has responsibilities in biomedical research; ecosystem management; public health; food and agricultural systems; and care of companion animals, wildlife, exotic animals, and food animals. The expanding role of veterinarians at CDC reflects an appreciation for this variety of contributions. Veterinarians' educational background in basic biomedical and clinical sciences compare with that of physicians. However, unlike their counterparts in human medicine, veterinarians must be familiar with multiple species, and their training emphasizes comparative medicine. Veterinarians are competent in preventive medicine, population health, parasitology, zoonoses, and epidemiology, which serve them well for careers in public health. The history and tradition of the profession always have focused on protecting and improving both animal health and human health.     

Predictors and correlates of prevention research careers: a national study of residency graduates

BACKGROUND: Factors associated with research productivity among residency graduates are not well understood. The objectives of this study are to describe research productivity among preventive medicine residency (PMR) graduates and to identify factors that are correlated with high levels of productivity. METHODS: A detailed survey was mailed to all (n = 1,070) graduates from U.S. PMRs between 1979 and 1989. Main outcome measures for this analysis were (1) 25% of the workweek or more research time and (2) 20 or more publications since training completion. RESULTS: A total of 797 completed surveys were received for a response rate of 75%. Among respondents, 33% devoted at least 25% of their time to research and 13% had 20 or more publications. Independent positive predictors (P < 0.05) based on education and training of high research productivity as measured by both outcomes included research self-motivation, training at the Centers for Disease Control and Prevention, and clinical board certification. Concurrent correlates of current high research productivity by both outcomes included employment by the federal government or academia and academic appointment. CONCLUSIONS: Factors associated with high research productivity could be utilized to improve the resident selection process and promote research careers. This could enhance research programs and education and promote the overall prevention research agenda.     

社会工作理念方法融入全科医师规范化培训的探讨

全科医学教育是全科医学发展的核心,我国多数医学院校临床医学教育本科阶段并未细分全科医学专业,全科住院医师规范化培训是现阶段全科医学教育的重点之一。全科医学强调“生理-心理-社会”为一体的全人关怀,社会工作作为一门社会科学,其理念方法与全科医学在目标、内容、功能、作用等方面具有趋同性、相似性、互补性和互促性。探讨从教育理念、课程设置、考核标准、管理体系等四个维度将社会工作理念方法融入全科住院医师规范化培训,丰富全科住培内涵建设,有利于帮助全科住培医师提升服务质量和医疗职业道德等水平。     

Postgraduate preventive medicine: Where do we stand today

It appears that the specialty of preventive medicine is declining as a viable specialty, with inadequate numbers of practitioners and with a declining number of physicians entering residency training programs. However, additional data are needed to make rough estimates of the level of need in the future. Even without that data, we must begin to address the potential shortage in trained manpower, because there is a trend that cannot be ignored pointing to a potential shortage. Several points must be pursued. All medical students must be exposed to the excitement we all feel about preventive care. Our teaching programs in medical schools must be strengthened to assure that there is rigor in these programs and that the potential of preventive medicine is conveyed. It is imperative to examine the field to discover why so many of our self-designated specialists in preventive medicine are not board-certified. Obviously one reason could be that a hungry job market is taking individuals who have not been trained in preventive medicine; another reason could be that for some reason specialists in the field of preventive medicine may feel that board-certification is not necessary for their career goals. This issue raises many questions about the importance of academic training in preventive medicine. It also points to the importance of addressing mid-career training needs on the part of those self-designated specialists. The question of financing must be addressed as well. Efforts must be developed to assure that the preventive field is reimbursed by major third-party payors, Medicare and Medicaid. Perhaps through these reimbursement mechanisms a way could be found to provide, at least in part, resident stipends. In addition, other mechanisms must be developed to provide support for residents in training in preventive medicine. If as a people we are to fulfill our potential of healthiness and achieve the Objective For Health Promotion and Disease Prevention, we must have trained personnel to do the job.     

An elective rotation in applied epidemiology with the Centers for Disease Control and Prevention (CDC), 1975–1997

Introduction: To increase awareness of and interest in public health and epidemiology, CDC initiated an elective in epidemiology and public health for senior medical students in 1975 and for veterinary students in 1982.Methods: A review of CDC records to describe participation in the elective, to assess whether students subsequently enrolled in another CDC training program, the Epidemic Intelligence Service (EIS), and, if enrolled, employment status following EIS. A review of documentation of board certification in preventive medicine to determine how many participants later chose this specialty, one indicator of public health and prevention as a career choice.Results: From 1975 through 1997, 632 students participated in the elective. Of these, 438 (69%) were assigned to infectious disease areas, 95 (15%) to environmental health, 59 (9%) to chronic disease, and 40 (7%) to other areas. Students participated in at least 278 official investigations of important public health problems including infectious disease outbreaks, natural disasters, chronic disease problems and access to health care. Of 530 students who had completed the elective through June 1995, 91 (17%) were enrolled in EIS by July 1997. Of 83 completing EIS by July 1997, 65 (78%) had continued in public health careers: 35 with CDC; 17 with local or state health departments; 7 with other federal agencies; 4 in academic public health; and 2 in international health. Of those not enrolling in EIS, at least 5% were certified by the American Board of Preventive Medicine, compared with 34% of those completing EIS.Conclusion: An elective rotation in public health and applied epidemiology is valuable in introducing future physicians and veterinarians to the practice of public health, and can provide important role models for encouragement to pursue careers in public health.