Post-graduate medical education in public health: the case of Italy and a call for action

Effect of a three-years preventive medicine vocational education program on county-level healthcare workforce development in China: a cross-sectional study

BACKGROUND

This study aims to analyze the demand and supply of these professionals within healthcare institutions at the county level after the Chinese government launched a three-year vocational education program of preventive medicine in 2016.

METHODS

A national cross-sectional design and multistage cluster sampling method were employed for this study. At the county level, a total of 132 Centers for Disease Control and Prevention (CDCs), 346 medical institutions, 20 medical colleges and 1,083 graduate students were selected. Self-designed questionnaires were used to assess the demand and supply of these professionals. Descriptive statistics were applied to describe key data features.

RESULTS

The county-level CDCs and medical institutions required an average annual total of 15,007 preventive medicine professionals. However, vocational colleges have only enrolled 2,025 of these students per year. Moreover, approximately two-thirds of the provinces continued to face significant demand for preventive medicine professionals, Additionally, medical institutions prioritized clinical skills while the CDCs emphasized preventive expertise as essential qualities for preventive medicine professionals. The requirement for personal qualities were consistently of the utmost importance in healthcare institutions. Furthermore, the self-assessments conducted among graduate students in medical institutions have revealed a relative insufficiency of their professional skills.

CONCLUSIONS

There was a general shortage of professionals in vocational preventive medicine education in China; however, certain provinces exhibited a surplus supply relative to demand, and prospective graduates primarily secure employment within medical institutions. The enhancement and refinement of professional skills are imperative in order to align with the specific demands of the preventive medicine position.

A New Model for Ranking Schools of Public Health: The Public Health Academic Ranking

Objectives: As there is no ranking designed for schools of Public Health, the aim of this project was to create one. Methods: To design the Public Health Academic Ranking (PHAR), we used the InCites Benchmarking and Analytics™ software and the Web Of Science™ Core Collection database. We collected bibliometric data on 26 schools of Public Health from each continent, between August and September 2022. We included 11 research indicators/scores, covering four criteria (productivity, quality, accessibility for readers, international collaboration), for the period 2017-2021. For the Swiss School of Public Health (SSPH+), a network gathering faculties across different universities, a specific methodology was used, with member-specific research queries. Results: The five top schools of the PHAR were: London School of Hygiene and Tropical Medicine, Public Health Foundation of India, Harvard T.H. Chan School of Public Health, SSPH+, Johns Hopkins Bloomberg School of Public Health. Conclusion: The PHAR allows worldwide bibliometric ordering of schools of Public Health. As this is a pilot project, the results must be taken with caution. This article aims to critically discuss its methodology and future improvements.

Impact of the COVID pandemic on mental health and training opportunities of Public Health Residents from 4 European countries: A cross-sectional study

Objectives

There is little evidence on the impact of the COVID-19 pandemic on Public Health Residents' (PHR) mental health (MH). This study aims at assessing prevalence and risk factors for depression, anxiety and stress in European PHR during the COVID-19 pandemic.

Methods

Between March and April 2021, an online survey was administered to PHR from France, Italy, Portugal and Spain. The survey assessed COVID-19 related changes in working conditions, training opportunities and evaluated MH outcomes using the Depression Anxiety Stress Scales-21. Multivariable logistic regressions were applied to identify risk factors.

Results

Among the 443 respondents, many showed symptoms of depression (60.5%), anxiety (43.1%) and stress (61.2%). The main outcome predictors were: female gender for depression (adjOR = 1.59, 95%CI [1.05-2.42]), anxiety (adjOR = 2.03, 95%CI [1.33-3.08]), and stress (adjOR = 2.35, 95%CI [1.53-3.61]); loss of research opportunities for anxiety (adjOR = 1.94, 95%CI [1.28-2.93]) and stress (adjOR = 1.98, 95%CI [1.26-3.11]); and COVID-19 impact on training (adjOR = 1.78, 95%CI [1.12-2.80]) for depression.

Conclusions

The pandemic had a significant impact on PHR in terms of depression, anxiety and stress, especially for women and who lost work-related opportunities. Training programs should offer PHR appropriate MH support and training opportunities.

Self-Rated Health and Psychological Distress among Emerging Adults in Italy: A Comparison between Data on University Students, Young Workers and Working Students Collected through the 2005 and 2013 National Health Surveys

Background. The present study aimed at comparing self-reported physical health and mental health among university students, workers, and working students aged between 19 years and 29 years. Method. Using data from National Health Surveys held in 2005 and 2013, a cross-sectional study was conducted on 18,612 Italian emerging adults grouped into three groups: university students, workers, and working students. The odds ratios of self-reported anxiety or depression, poor general health, and poor mental health and physical health (as assessed through SF-12) were estimated through logistic regression models adjusted for potential confounders. Results. Compared with workers, students showed an increased risk of anxiety or depression and a lower risk of poor general health. Students and working students showed an increased risk of reporting weak mental health compared with that in workers, while students displayed a lower risk of poor physical health. Significant differences were not found between the 2005 and 2013 surveys. Conclusions. These results are of considerable importance for psychologists as well as educational and occupation-based institutions for planning prevention programs and clinical interventions.

Professional satisfaction of health professional undergraduates and influencing factors in Hebei province, China

BACKGROUND

Professional satisfaction of health professional students can impact on their medical professional achievement. Understanding the professional satisfaction of health professional students and identifying its relative factors is beneficial to strengthen the professionalism education of health professional students, and provide solid foundation for future medical achievements.

METHODS

A self-made questionnaire was used to survey undergraduate students of six medical universities in Hebei province. The survey included three aspects: students' basic situation, professional selection and cognition, and basic situation of colleges. The Kruskal-Wallis H test was used to compare the professional satisfaction of students with different characteristics. All covariates were used in the ordinal logistics regression analysis to identify the independent factors associated with professional satisfaction.

RESULTS

A total of 1238 (97.7%) students responded to the questionnaire in the survey, and 66.0% were women. Students with public health majors had decreased satisfaction compared with those with clinical-related majors. Professional satisfaction decreased among women compared with men. The non-first-choice students had lower professional satisfaction compared with the first-choice students. Students who chose their volunteer with the help of others had lower professional satisfaction compared with students who independently chose their volunteer. Students who did not understand the employment status had lower professional satisfaction compared with students who understood the employment status. Students with fewer employment prospects had lower professional satisfaction compared with students with bright employment prospects. Students generally dissatisfied with the canteen had lower professional satisfaction compared with students satisfied with the canteen. Students who were very satisfied or satisfied with teaching levels were more likely to have professional satisfaction.

CONCLUSIONS

The professional satisfaction of health professional undergraduates in Hebei province is high. Employment-related aspects and university environment influence professional satisfaction including canteens, understanding of employment status, teachers' teaching level, etc., which are the main factors affecting professional satisfaction, but the factors such as student employment prospects and majors cannot be changed in the current environment.

Using Employment Data From a Medical University to Examine the Current Occupation Situation of Master's Graduates in Public Health and Preventive Medicine in China

Aims: The purposes of this study are (1) to understand the current employment situation of master's graduates in Public Health and Preventive Medicine (PHPM) and (2) to provide evidence for career guidance and training of competent PHPM personnel. Methods: The master's graduates of the School of Public Health from the years 2014-2018 who majored in PHPM were chosen as research subjects. Questionnaires were distributed, and completed questionnaires were collected. The employment situation and characteristics of these graduates were analyzed based on the questionnaire data. Results: The employment rate of these graduates was 95.45%. They were employed mainly in hospitals, followed by colleges and centers for disease control and prevention. The initial salaries were low. Graduates whose jobs barely or not at all matched their areas of specialization were 23.64 or 6.36%, respectively. Nevertheless, the percentage of students who had remained with their jobs since graduation was 82.73%. A total of 40% of the graduates were neutral about or dissatisfied with their jobs. Furthermore, 29% of them claimed that they were undervalued by their employers. Last, but not least, graduates were encouraged to gain experience in creativity, organizational or management skills, social networking experience, and interpersonal and professional skills. Conclusion: Overall, the employment status of master's graduates in PHPM is good. Problems such as low initial salaries, jobs not matching graduates' areas of specialization, and feelings of being undervalued by employers were observed. It is necessary to improve employment outcomes by revising training models, formulating employment policies, and implementing training efforts.

Leadership in Public Health: Opportunities for Young Generations Within Scientific Associations and the Experience of the "Academy of Young Leaders"

This paper outlines the characteristics of scientific leadership and the role of Scientific Associations with their specific activities. The recent activities of the Lombard Academy of Public Health are subsequently described, including the creation, in 2019, of the Academy of young leaders in public health. Comparing to other sectors, scientific leadership dynamics take into consideration different aspects. Besides awards (Nobel Prize or several other) and prestigious affiliations, eventual indicators might be academic roles, fundraising abilities, relevant positions among scientific associations, editors of prestigious journals or editorial series and, more recently, high bibliometric indicators. The peculiar topics of public health encompass interactions with institutions, authorities, politicians, involved in different levels in health policies. Recently, in Italy, the Ministry of Health has identified parameters to be accreditated as a scientific and technical association. The role of SItI (Italian Society of Hygiene), EUPHA, ASPHER, and WFPHA appears relevant in PH, in national and international contexts, with Italian praiseworthy members constantly achieving leading roles. Considering that few training opportunities aimed to improve research and leadership skills are available, Accademia Lombarda di Sanità Pubblica (ALSP) designed the AYLPH (Academy of Young Leaders in Public Health) program. AYLPH program is a 1-year training to shape leadership skills among young professionals. A set of didactic, theoretical and practical methods was offered and evaluated.

The accreditation system of Italian medical residency programs: fostering quality and sustainability of the National Health Service

Background and aim: In June 2017, University and Health Ministries jointly enacted a decree implementing a new accreditation system for the Italian post-graduate medical schools (residency programs). We report the innovations introduced through the reform. Methods: Universities were called to submit post-graduate medical school projects to the National Observatory on medical residency programs, the inter-institutional committee responsible for the entire accreditation process, through an interactive web platform. The adherence to minimum standards, requirements and the performances were measured. After this first assessment, universities were asked to provide programs of improvement for critical schools. At the end of the evaluation, residency schools were proposed for a full or a partial accreditation. Results: Of the 1,431 post-graduate medical school projects submitted to the National Observatory by 37 public and 4 private Universities, 672 (47.0%) obtained a full accreditation, 629 (43.9%) a partial accreditation, with a gap to be filled within a two-year period according to a specific improvement programme, while 130 (9.1%) were not accredited. Further, 1,254 out of the 1,301 schools with a full or partial accreditation were activated according to the available public financial resources, excluding those performing the lowest. Annual surveys were in place to investigate the residents’ level of satisfaction concerning the quality of the training programs. The National Observatory further developed an experimental methodology to conduct on-site visits to support quality improvement. Conclusions: This reform can be considered an important initiative to guarantee high standards in the quality of care and to face the challenge of sustainability for the National Health System. (www.actabiomedica.it)

The educational background of the Top Managers of the Italian Health Authorities: results of a study on eight Regions

A survey to investigate the educational background of the Health Top Managers recently appointed by Italian Regions as CEOs (Chief Executive Officer) of Local Health Authorities (ASL) and General Hospitals was performed in April 2019, approximately one year after the entry into force of the new law for their selection (D.Lgs 171/2016). The study follows a similar one carried out by Bocconi University in 2013 and focuses on 8 Italian Regions (Piedmont, Lombardy, Liguria, Umbria, Lazio, Basilicata, Sicily, Sardinia). The study examined the CVs of the 112 recently appointed CEOs: the average age is 58.7 years, with the proportion of female surprisingly low (16%). About half of them (50.5%) have a Degree in Medicine and Surgery. Among Managers with a non-medical degree (49.5%), Law (21) and Economic sciences (21) are the most common degrees. Among medical doctors, 33 (58.9%) are specialists in Hygiene and Preventive Medicine. Overall, our data are consistent with those recorded in 2013 (except a decrease in medical graduates -18.5%) and confirm the diversified backgrounds of Health Managers. The background in Public Health, acquired from the 35 Schools of Hygiene and Preventive Medicine, remains relevant among Managers of the Italian National Health Service.

The contribution of professors of Hygiene to the progress and development of public health in Italy: one hundred years of history

In 1917 Achille Sclavo, a distinguished researcher and founder of the Italian Society of Hygiene, ended up the first term as Rector of the University of Siena. Since then, the contribution of professors of hygiene in Italian universities has ranged over several relevant topics including vaccinations, environmental hygiene, hospital hygiene, healthcare organization and management, with an important contribution to the health reform of 1978 by Augusto Giovanardi and Alessandro Seppilli. Several Academic Schools (Roman, Neapolitan, Genoese, Sicilian, Venetian, Lombard, etc.) have produced excellent researchers, teachers and mentors who have also occupied important positions in the panorama of the Italian health system. This note analyzes the main research topics, the most famous institutes and departments of hygiene and public health and the contributions of the most famous professors for the development of the discipline, the management of the post- graduated Schools in hygiene and preventive medicine, the commitment in scientific associations and the role of some of them in important institutional positions. Even through its contribution and constant commitment to the institutions, Italian public health has achieved the reputation of being one of the best known and appreciated in the international scientific community.

Risk Management in healthcare: results from a national-level survey and scientometric analysis in Italy

Risk management in healthcare, intended as all processes employed to detect, monitor, assess, mitigate, and prevent risks in healthcare facilities and safeguard patient safety, is a crucial component of Italy' National Health Service. Aim of the current study is to assess the role and progress of  research and training, in the field of Risk Management. We carried out a scientometric analysis to quantify and describe scientific outputs on Risk Management at the global and national level, over the last forty years; in addiction, we conducted a national-level cross-sectional survey to systematically retrieve and assess research and training activities within Italian postgraduate medical programmes in Hygiene and Preventive Medicine.   We report increasing scientific production on Risk Management-related topics from 1980 to 2017 at the global level (12% annual increase rate). Clinical Trials and Systematic reviews/meta-analysis make up for respectively 5% and 6% of global scientific output. Italy ranks 4th for scientific production, after USA, UK and Germany. 88% of Italian postgraduate medical programmes in Hygiene and Preventive medicine research on Risk Management, 42% through international collaborations. The main research themes are Healthcare-Associated Infections (HAIs) (97%), analysis of organizational models for safety in healthcare (62%), while training is focused on internships (87%) and academic lectures (73%). While research provides the evidence required to plan, implement and monitor effective interventions in healthcare risk management, training allows its dissemination in a synergic action to promote the value of patient safety and quality of care.

The University Degree in Environment and workplace prevention techniques: a quasi unicum Course in the European panorama for non-medical professionals involved in prevention activities

The University Degree programme in Environment and workplace prevention techniques (Tecniche della Prevenzione nell'Ambiente e nei Luoghi di Lavoro) is a 3-year course established in Italy in 2000 by the Ministry of University to train healthcare professionals responsible for prevention activities such as environment and food controls, and workplaces prevention, operating both in the National Health Service and in private settings. Frontal teaching activities and training programmes include a background in bio-medical sciences, epidemiology, public health, social sciences and law, including the inspection and control tasks of health and safety in living and working environment, food hygiene, environmental controls and veterinary public health, which represent the field of specific competences of graduates. Currently, 38 courses have been activated in 30 Italian Universities, but relatively few similar courses are present in Europe (similar programmes were found in France, Spain, UK and Belgium) causing the lack of internalization and student exchange programmes. It is essential to identify similar training tasks in other European countries, in order to enhance cultural exchanges and the development of research activities in these strategic areas.

Career Paths of Public Health Medicine Specialists in South Africa

Public health (PH) skills are core to building responsive and appropriate health systems, and PH personnel including medical specialists are embedded in many countries' health systems. In South Africa, the medical specialty in PH, Public Health Medicine (PHM), has existed for over 40 years. Four years of accredited training plus success in a single national exit exam allows specialist registration with the Health Professions Council of South Africa (HPCSA). However, there are few posts designated specifically for PHM specialists in SA's health system. In view of uncertain roles, this research was designed to determine specialists' career paths, their work, job satisfaction, and perspectives on the future of the specialty. We combined three databases to generate the study population and invited all specialists to participate in an online or hard-copy survey. We found that in 2010, PHM was a small specialty of less 200 physicians. Of the 151 contactable, eligible physicians, 55.6% completed the questionnaire. Participants represented an aging group (median age = 49) of specialists and recent graduates were increasingly women. They largely worked in academic institutions (as managers, teachers, and researchers) and in the public sector health system; were motivated by a sense of social justice and their training was formative, exposing them to work settings which they later entered; were largely highly satisfied at work, but many worked in non-specialist positions. Indeed, one fifth had not registered with the HPCSA as specialists. They were concerned about the specialty's poor visibility and identity, but did not see other PH professionals as a threat. They believed that the specialty should refine its competencies, demonstrate its value and advocate for service positions at all levels of the public sector health service. PHM has a contribution to make-reorienting services to protect communities, preventing ill health, analyzing disease burdens locally, identifying innovations in a resource-constrained health service, largely preoccupied with curative care services.

Stakeholders' perspectives on Public Health Medicine in South Africa

South Africa (SA) is reforming its health system in preparation for an anticipated national health insurance (NHI) scheme that aims to improve the delivery of affordable, equitable, accessible health care. Public health (PH) language is explicit in the policy and skilled PH professionals would be expected to play a key role in its implementation. In South Africa, training of doctors as Public Health Medicine (PHM) specialists is funded by the state, yet there are few positions for PHM specialists in the health services. We explored stakeholders' perspectives about this absence, and their views on PHM specialist' roles and contribution in an era of health reform. A qualitative study was conducted in 2012-13, using in-depth interviews with thematic analysis, which elicited perspectives of 31 key stakeholders nationally reflecting diverse employer and institutional backgrounds. While some were surprised by the absence of PH professionals in SA's health system, most agreed the reason was due to factors internal to the profession, such as its low profile and uncertain identity. External factors such as legislation and political preferences for health managers impacted on the employment of PH professionals. However, given the competencies required to implement an ambitious restructuring of the health sector, all believed that PH and PHM personnel were vital. In view of the health system's dominant curative orientation, embedding PH personnel in the services should ensure that health protection, promotion and prevention strategies will inform health priorities. This study, the first known from a low and middle-income country, contributes to the international literature about the identity and roles of PHM physicians, who are versatile professionals with broad skills-sets. In SA, through consultation with health sector employers about potential roles, curricular redesign and trainee recruitment, PHM can graduate fit-for-purpose specialists to work in a range of institutions to address health system reform.

Knowledge about E-Cigarettes and Tobacco Harm Reduction among Public Health Residents in Europe

Introduction: Although electronic cigarettes (e-cigarettes) and other tobacco-related products are becoming widely popular as alternatives to tobacco, little has been published on the knowledge of healthcare workers about their use. Thus, the aim of this study was to elicit the current knowledge and perceptions about e-cigarettes and tobacco harm reduction (THR) among medical residents in public health (MRPH). Material and Methods: A Europe-wide cross-sectional study was carried out amongst MRPH from the countries associated with the European Network of MRPH from April to October 2018 using an online questionnaire. Results: 256 MRPHs agreed to participate in the survey. Approximately half the participants were women (57.4%), with a median age of 30 years, and were mainly Italian (26.7%), Spanish (16.9%) and Portuguese (16.5%). Smoking prevalence was 12.9%. Overall, risk scores significantly differed for each investigated smoking product when compared with e-cigarettes; with tobacco cigarettes and snus perceived as more risky, and nicotine replacement therapy (NRT) and non-NRT oral medications seen as less risky (p < 0.01 for all). Regarding the effects of nicotine on health, the vast majority of MRPHs associated nicotine with all smoking-related diseases. Knowledge of THR was low throughout the whole sample. Conclusions: European MRPH showed a suboptimal level of knowledge about e-cigarettes and THR. Training programs for public health and preventive medicine trainees should address this gap.

A new Journal section on Health System's Research: purpose and rationale

N/A.

A new Journal section on Health System's Research: purpose and rationale

N/A.