Developing a speciality: regearing the specialist public health workforce

OBJECTIVES: To identify issues surrounding the future training needs of the specialist public health workforce following the most recent restructuring of the National Health Service (NHS) in England. METHODS: All directors of public health (DsPH) based in strategic health authorities and nine senior staff working in public health at the regional level were invited to participate in a semi-structured telephone interview. RESULTS: Twenty-six people were interviewed. Many interviewees expressed concern that because consultants and specialists in public health will be working in much smaller teams than hitherto, they will have to generalize their skills to cover a much wider range of functions (including board-level duties). This may result in a loss of specialist expertise. Successful public health practice in the new structures will require new ways of interorganizational working that will add an administrative burden to specialists in public health. Also, the creation of a board-level post in each primary care trust (PCT) has resulted in more time spent on corporate responsibilities and less on public health for DsPH, who are often the only fully trained specialist in public health in their PCT. Furthermore, interviewees expressed their anxiety about the lack of diversity in the posts available to specialists in public health and particularly to those newly completing their specialist training. Generally, interviewees felt that traditional public health roles and responsibilities were being eclipsed by corporate and managerial ones. Professional development activities were being carried out, but in a rather ad-hoc fashion. Interviewees were hopeful that public health networks would lead professional development initiatives once they were more established. CONCLUSIONS: It is important that excellence in public health is maintained through a set of accreditable standards, whilst corporate skills, essential to successful public health practice in the new UK NHS, are developed among specialists in public health.     

以胜任力为导向的公共卫生硕士校外实践培养体系的构建探索

目的 探索构建以胜任力为导向的公共卫生硕士（MPH）校外实践培养体系。方法 通过文献检索,分析国内外MPH专业学位培养模式,以胜任力为导向创新设计一个全面的、可行的MPH校外实践培养体系。结果 中山大学-广州市CDC高水平公共卫生人才培养示范基地针对实践时长2年以上的MPH探索构建了“4+N+综合评价”的实践体系,“4”代表基于实践的教学、专业实践、公共卫生项目管理参与和科研训练,分别培养MPH“公共卫生科学”“操作与实践”“人群健康管理”“卓越技能”能力。“N”代表拓展实践,培养MPH“综合能力与职业精神”能力,以综合评价来评估培养效果。结论 本研究构建以胜任力为导向的MPH“4+N+综合评价”校外实践体系,培养新时期社会需求的高层次应用型公共卫生人才。     

Medical education in France, Germany, Italy and the United Kingdom compared

1. The purpose of the visit was to compare postgraduate medical education and training in the United Kingdom with that in France, the Federal Republic of Germany, and Italy. 2. Except in Italy, there appeared to be widespread agreement that specific postgraduate training for general practitioners was essential to improve the quality of practice and to relieve the undergraduate curriculum from the necessity to provide comprehensive medical training to prepare a graduate for independent practice. The main difficulty appeared to be the development of good 'teaching' practices. 3. Direct comparison between training programmes for specialist practice is not straightforward in view of the different staffing structure in continental hospitals and the existence of private specialist practice to which patients have direct access. Training appears to be generally longer in the United Kingdom, possibly due to the necessity of passing postgraduate diploma examinations, but outside the university hospitals the fully trained specialist (consultant) enjoys a higher status and independence than most hospital specialists in other countries. The absence of equivalent bodies to the Royal Colleges and Faculties places responsibility upon universities for specialist training on the continent; standards are not coordinated nationally, and vary significantly from region to region. 4. The need for continuing medical education for all doctors is accepted; this is essentially voluntary, although there are variable direct and indirect incentives. Programmes are organized on a local or regional basis in most countries, but in Germany and the U.K. there is a growing trend towards national coordination of both training programmes and the provision of continuing education. 5. The recent reorganization of the National Health Service in the United Kingdom provides opportunities for 'public health' doctors to become involved in the coordination of clinical services and to relate these to the needs of the public at large, as well as to provide preventive health services. These opportunities do not exist in France, Germany and Italy, where public health services remain discrete from clinical medicine, and postgraduate training is largely confined to formal teaching at designated institutes which are university based only in Italy. Opportunities for university staff to become involved in the organization and delivery of health care appear to be greater, therefore, in the United Kingdom than in other countries.     

The health promoting school: progress and future challenges in Welsh secondary schools

Data were obtained from a random sample of 87 secondary schoolsin Wales (UK) about the organization and provision of healtheducation teaching, the implementation of health related policies,and the involvement of outside agencies and professionals inthe planning and delivery of health education programmes. Theresults suggest that schools have made progress in curriculumdevelopment. However, if the concept of the health promotingschool is to be translated into practice, greater attentionwill need to be given us the development of broadly based policiesfor health covering both pupils and staff and the better integrationof school programmes with community resources. Greater understandingof the health promoting school concept by teaching staff andthe development of examples of good practice in embedding healtheducation into national curriculum subjects, are also advocated.     

Quality of training in public health in the UK: results of the first national training audit

OBJECTIVES: Since 1997, UK public health training has undergone major changes, including the creation of specialist registrars (SpRs), introduction of a competency framework, admission of non-medical (specialist) trainees and National Health Service organizational change. It was therefore considered timely to audit the quality of this training. STUDY DESIGN: Cross-sectional survey of all UK public health trainees, conducted in April 2003. METHODS: The survey questions were based on 75 previously identified standards, with three sections: induction (30 standards), health protection (13 standards) and general training (32 standards). Results were calculated for the UK. Deaneries were compared on 10 key standards, as was the training of SpRs and specialist trainees. RESULTS: Two hundred and ninety responses were received (62% response rate). Only 16 (21%) of 75 standards were met by at least 80% of respondents, with problems in induction, health protection, secretarial facilities and examination support. Across 10 key standards (including initial welcome, trainer support, breadth/relevance of work and facilities), 59% indicated that their training had met at least eight standards. Results for individual deaneries were significantly different (P = 0.02), although 13 of 16 had median scores of eight out of 10, or over. Deaneries with specialists scored lower than those without (median scores eight vs nine, P = 0.003). Median specialist and SpR scores on the 10 key standards were seven and eight, respectively (P<0.001). In addition, SpRs were more likely to be 'on-call' [odds ratio (OR) = 66.8, 95% confidence interval (CI) 17.2-259.4, P<0.001] and to feel prepared for this role (OR = 10.7, 95% CI 1.4-79.8) than specialists. CONCLUSION: This was the first UK National Audit of Public Health Training. Few standards were achieved amongst respondents, although the levels set may be considered to be high and the response rate (62%) was less than optimal, potentially biasing results. Despite these caveats, recent organizational change in England appears to have led to significant training disruption among respondents. Nevertheless, repeating such an audit annually within deaneries could help to improve public health training throughout the UK.     

Influencing public health without authority

This paper analyzes the present processes, products and needs of post-graduate public health education for the health programming, implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars. Large number of institutions has cropped up in India in the recent years to meet the growing demand of public health specialists/practitioners in various national health projects, international development partners, national and international NGOs. Throwing open MPH courses to multi-disciplinary graduate's is a new phenomenon in India and may be a two edged sword. On one hand it is advantageous to produce multi-faceted Public health postgraduates to meet the multi tasking required, on the other hand getting all of them to a common basic understanding, demystifying technical teaching and churning out products that are acceptable to the traditional health system. These Institutions can and must influence public health in the country through producing professionals of MPH/ MD degree with right attitude and skill-mix. Engaging learners in experimentation, experience sharing projects, stepping into health professionals' roles and similar activities lead to development of relatively clear and permanent neural traces in the brain. The MPH institutes may not have all efficient faculties, for which they should try to achieve this by inviting veterans in public health and professionals from corporate health industry for interface with students on a regular basis. The corporate and public health stalwarts have the capacities to transmit the winning skills and knowledge and also inspire them to adopt or adapt in order to achieve the desired goals.     

Development of a Master of Public Health programme in Tirana, Albania

In 2001, two Albanian institutions, the Department of Public Health, Faculty of Medicine, University of Tirana and the National Institute of Public Health obtained membership to the Association of Schools of Public Health for the European Region (ASPHER). Since 2000, these two institutions have been members of the Public Health for South Eastern Europe (PH-SEE) network. Furthermore, in the fall of 2001, the Open Society Institute (OSI) and ASPHER launched a project that culminated in the establishment of a School of Public Health (SPH) and the commencement of the first Master of Public Health (MPH) programme in Tirana. The MPH programme began in December 2005 and enrolled 32 students from different backgrounds. A suitable start for the development of the MPH programme was the implementation of key modules developed by the European MPH programme. In addition, specific modules reflecting the needs of Albania were designed according to the preferences and the heterogeneous lecturing faculty involved in public health training. International guest lecturers delivered other modules, with ASPHER and the PH-SEE network offering an excellent solution for complementary modules in different public health disciplines. However, the newly established SPH in Albania should now strive for other postgraduate teaching programmes, undergraduate programmes, and especially service training and continuing education.     

Developing the public health practitioner workforce in England: lessons from theory and practice

FOCUS: The paper focuses on public health practitioners who collectively represent one of three key workforce groups identified by England's Chief Medical Officer as critical to the successful delivery of national public health policy priorities. QUESTION: We report on two areas of work which attempt to address the following two-part question: in developing the public health practitioner workforce in England, what is needed, and how do we do it? APPROACH: First, we describe a five-component conceptual framework for developing the public health workforce which is grounded in data derived from a national Open Space event hosted by the University of the West of England in March 2005. The five components are (i) strategic support and oversight; (ii) national technical and professional support; (iii) national career building; (iv) local organisational development, and (v) sub-regional skills development. Key elements of each component are described in the paper. Second, we describe in some detail a new multidisciplinary skills development programme which illustrates one of the framework components (sub-regional skills development). The programme, established in January 2005, is aimed at three key groups of public health practitioners: health visitors (specialist community public health nurse), school nurses and environmental health officers. Its main features and some initial evaluation findings are presented. CONCLUSIONS: To be effective, activities aimed at supporting the development of the public health practitioner workforce should, where possible, aim to be congruent with core public health principles of self-determination and collective responsibility. We also conclude that leadership and vision at a national level, combined with local implementation of evidence-based training programme such as the one described could help to achieve much greater and more rapid progress in skilling up the existing public health practitioner workforce than has been possible up to now. But we note that this requires sustained investment, robust sector-wide delivery frameworks, and a group of committed local public health champions.     

Specialist public health capacity in England: working in the new primary care organizations

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.     

'Think differently and be prepared to demonstrate trust': findings from public hearings, England, on supporting lay people in public health roles

Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery.     

某高校公共卫生专业研究生入学动机及12年趋势分析

目的 探讨某高校2008～2019年公共卫生专业硕士研究生入学动机及其变化趋势,为研究生培养策略的制定提供科学依据。方法 整群抽取某高校2008～2019年公共卫生专业所有通过全国统一硕士入学考试的复试学生进行心理测评。采用选择频数和百分比描述入学动机的各个选项,线图描述变化趋势,x2检验分析影响因素。结果 公共卫生专业硕士研究生入学动机主要为:想掌握专门知识和技能（94.2%）、想提高自己的教养水平（92.8%）、为了今后就职方便（70.1%）、想做学问（66.8%）,2008～2019年变化波动平缓;性别、家庭居住地区、父母受教育程度是入学动机的影响因素。结论 公共卫生专业硕士研究生入学动机比较稳定,主要为谋求个人发展及更好就业,需要有积极的社会导向弥补公共卫生专业人才的缺口。     

Building public health skills and capacity in the English regions

Local public health departments have variable access to a public health intelligence function, and information skills are scarce. Public health observatories are supporting the development of professional standards for public health intelligence specialists and offer training opportunities for both defined public health specialists and generalist public health specialists. In addition observatories support public health practice through educational programmes in health impact assessment, health equity audit, public health intelligence, and the provision of toolkits and advice on methods. Observatories have a key role in supporting and developing networks, in particular public health analysts, and the use of interoperable websites is enhancing these opportunities.     

New competencies for public health graduates: a useful tool for course design

Objective: The objective of this paper is to provide a brief overview and context for the new Australian Network of Public Health Institutions (ANAPHI) Foundation Competencies for Master of Public Health Graduates in Australia, and to outline the current status of the quality agenda for public health training and competency standards for Master of Public Health (MPH) education in Australia. Approach: We summarise the complex history and process of developing competency standards for Master of Public Health courses in Australia, including the logic for a competency‐based set of training guidelines. An abridged example of a competency and its underpinning knowledge is provided. Conclusions and implications: This set of competency standards will be useful for MPH course designers, and critical to maintaining the standard of MPH courses in the current (and changing) health policy context, both in Australia and internationally.     

Mind the gap: developing the PH workforce in the North East and Yorkshire and Humber regions: a scoping stakeholder study

OBJECTIVES: The aim of this study was to identify key issues around public health workforce development in the North of England, considering the gap between need and current capacity and the training requirements to deliver the public health and health improvement agenda. METHODS: Interviews were carried out with over 50 professionals in a variety of stakeholder organizations, seeking their views on priorities for workforce development and perceived opportunities and threats to the development of a good public health workforce. RESULTS: There was general recognition of a gap between current public health resources and what is needed to meet the public health agenda. Priorities included both increasing capacity at the specialist end of public health and raising general public health awareness at all levels of public organizations. Major barriers identified to meeting these needs included organizational difficulties, professional barriers and shortages of appropriate training and resources. Opportunities were seen to be presented by the increased amount of joint working and by national and local raising of awareness of public health issues. CONCLUSIONS: Across the health sector, local authorities, training organizations and voluntary sectors, similar issues and expectations were mentioned at both specialist and practitioner levels. However, it has not been possible in North East England to translate this finding into practical programmes in the absence of nationally identified resources to address the issue.     

The establishment of an industry-based education program in public health

Commonwealth reforms have led to staff of the Department of Health and Aged Care needing a greater knowledge of public health, to more effectively evaluate evidence and to quickly acquire competence in new emerging areas. The department's requirements of a training program could not be met by existing university-based public health courses. A consortium of five universities and the department worked together to develop an industry-based course that would meet the Commonwealth's needs. The course was constituted within university regulations; had an incremental and articulated structure with exit points at certificate, diploma and Masters levels; was relevant to the work of staff; offered subjects which complemented the staff's existing skills, training and career aspirations; drew upon expertise across the universities; and was flexible in its delivery. The Commonwealth's and universities' experience has been sufficiently positive to conclude that a corporate public health postgraduate program has a place alongside university-based programs.     

Mini-symposium — Public Health Observatories: Building public health skills and capacity in the English regions

Local public health departments have variable access to a public health intelligence function, and information skills are scarce. Public health observatories are supporting the development of professional standards for public health intelligence specialists and offer training opportunities for both defined public health specialists and generalist public health specialists. In addition observatories support public health practice through educational programmes in health impact assessment, health equity audit, public health intelligence, and the provision of toolkits and advice on methods. Observatories have a key role in supporting and developing networks, in particular public health analysts, and the use of interoperable websites is enhancing these opportunities.     

Regional collaboration in public health training and research among countries of South Eastern Europe

It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. KEY POINTS: South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. A regional approach in public health training would enable an efficient use of resources in countries of South East Europe.     

Improving access to and provision of public health education and training in the UK

This paper examines some of the challenges facing public health education and training in the UK, especially those relating to the wider workforce. It identifies key drivers for the need to improve access to and provision of public health education and training, such as the establishment of the Voluntary Register for Public Health Specialists and the launch of the Public Health Skills and Career Framework. The paper also touches briefly on developments in public health education and training in the USA, noting where lessons could be learnt by both countries. The paper notes how the traditional approach of structured training, while still valuable for those wishing to work at the specialist level, needs to be combined with an approach that enables other workers to achieve competence in public health. This challenge is being met, in part, through provision of online resources and teaching, and the development of Teaching Public Health Networks. The challenges facing the UK are similar to those facing the public health sector in the USA. As such, the two countries can learn from one another in order to address this important workforce development issue.