Insights into training and examination performance from the first UK National Public Health Training Audit

OBJECTIVES

To investigate predictors of a supportive training relationship and examination success using data from the first UK Public Health Training Audit.

STUDY DESIGN

Secondary analysis of data from a national cross-sectional survey of UK public health trainees, conducted in April 2003.

METHODS

All UK public health trainees were sent a questionnaire including questions on training experience and examination performance. Possible predictive factors of a supportive trainer-trainee relationship and success at Part I and Part II of Membership of Faculty of Public Health examinations were first investigated in univariate analyses, and subsequently using logistic regression.

RESULTS

Two hundred and ninety responses were received (62% response). Supportive trainers gave feedback [odds ratio (OR) = 11.2, 95% confidence interval (CI) 3.7-34.0, P<0.001], spent at least 1 h/week with their trainee (OR = 5.2, 95% CI 1.7-15.4, P = 0.003), held 3-monthly progress meetings (OR = 2.9, 95% CI 1.4-6.1, P = 0.006), and encouraged wide training experience (OR = 2.5, 95% CI 1.2-5.4, P = 0.016). Predictors of success in the Part I examination by the end of the second year of training were medical background (OR = 4.4, 95% CI 1.6-12.2, P = 0.004) and perceived adequacy of examination support (OR = 4.2, 95% CI 1.7-10.0, P = 0.001). Predictors of success in the Part II examination by the end of the fourth year of training were access to examiners (OR = 4.6, 95% CI 1.3-16.2) and wide experience (OR = 4.1, 95% CI 1.1-14.5).

CONCLUSION

Trainees feel supported when provided with adequate trainer contact time, feedback and wide experience. Part I examination success appears to be more likely amongst trainees with a medical background and those given examination support. Part II success is related to the breadth of a trainee's experience and access to examiner support.

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.

'Not too much, not too little, but just enough?': observations on continuing professional development in Public Health in the north of England

Three inquiries about Public Health continuing professional development were undertaken in the Northern and Yorkshire Region of the National Health Service during 1995-96. Public Health Physicians were asked about their experience of continuing education and for their views on a regional policy for continuing professional development. Health Authority Chief Executives were asked about their reactions to Public Health Physicians continuing educational needs. The overall response rates for the Public Health Physicians were very disappointing. Most of the Chief Executives (a much smaller group) responded to the inquiry. A large minority of Public Health Physicians believed that their continuing education in the preceding two years had been adequate. Most wished their future continuing education activities to be multi-disciplinary. One finding with considerable significance for those managing Public Health education, both specialist and continuing, was that many of those with teaching responsibilities had not been trained to teach. Despite apparent concordance between the views of Chief Executives and those of Public Health Physicians; on some important points there were inconsistencies in the comments of Chief Executives, which suggested lack of understanding of both the roles of their professional colleagues and the need for their continuing education. The inquiries gave rise to a sense of apathy and under-confidence, manifested in some reluctance to accept policing of continuing education. There is a need to experiment with learning and teaching approaches in order to progress from the current traditional educational methods.

Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey. The International Medical Commission on Bhopal

OBJECTIVE

To examine the role of exposure to the 1984 Bhopal gas leak in the development of persistent obstructive airways disease.

DESIGN

Cross sectional survey.

SETTING

Bhopal, India.

SUBJECTS

Random sample of 454 adults stratified by distance of residence from the Union Carbide plant.

MAIN OUTCOME MEASURES

Self reported respiratory symptoms; indices of lung function measured by simple spirometry and adjusted for age, sex, and height according to Indian derived regression equations.

RESULTS

Respiratory symptoms were significantly more common and lung function (percentage predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow between 25% and 75% of vital capacity (FEF25-75), and FEV1/FVC ratio) was reduced among those reporting exposure to the gas leak. The frequency of symptoms fell as exposure decreased (as estimated by distance lived from the plant), and lung function measurements displayed similar trends. These findings were not wholly accounted for by confounding by smoking or literacy, a measure of socioeconomic status. Lung function measurements were consistently lower in those reporting symptoms.

CONCLUSION

Our results suggest that persistent small airways obstruction among survivors of the 1984 disaster may be attributed to gas exposure.

Establishing baseline data in cancer registration in northern England: implications for Health of the Nation targets

OBJECTIVE

To assess the completeness and accuracy of cancer surveillance data relevant to Health of the Nation targets.

DESIGN

A comparison of locally ascertained data on cancer with recorded cancer registry sources in selected diagnoses.

SETTING

The district of South West Durham within the Northern Regional Health Authority.

PATIENTS

All patients with lung, skin, and malignant cervical cancer who were resident and diagnosed in the district or identified in the Northern Region Cancer Registry during the calendar period 1989-91.

MAIN RESULTS

Of 544 cases of cancer identified from all available sources, 448 (95.8%) were registered, ranging from 93.9% for malignant cervical cancer to 96.7% for skin cancer. In 448 cases which were both identified locally and registered, 53 (11.8%) showed disagreements between local sources and register data, involving classification of site and timing of registration. Twenty three cases were identified locally but were not registered, 22 registered but not identified locally, and 51 registered with the casenotes missing locally.

CONCLUSIONS

Any real achievement of Health of the Nation targets may be masked by changes over time in the accuracy and completeness of information systems. In assessing the achievement or otherwise of targets, it is important to be aware of any differences in the completeness and accuracy of the baseline data compared to future measurements.

Public health medicine training and the NHS changes

The current round of mergers between Health Authorities and Family Health Service Authorities (FHSAs), when set in the competitive context of markets, has profound implications for training in Public Health Medicine. This paper considers the phases in the management of change and the costs, benefits and principles for trainers, trainees and organisations as mergers take place. Particular emphasis is placed on understanding the motives of and learning from the change that is taking place.