From Hygiene to Public Health Education

This article is a review of the development of health education in Brazil (identified as “hygiene” in early times, it has evolved to “public health education”). The field has passed through infancy and adolescence facing all kinds of problems and is entering adulthood with health education leadership now in the hands of an increasing number of specialists trained in the country. The authors suggest that to hasten progress, more attention should be given to integration of health education to health programs, to stimulation of research, to preparation of health personnel, and to administrative support of health education services.

[METHODS FOR DETERMINING OF TRAINING NEEDS FOR HEALTH LEADERS]

The article presents the results of a study of health needs of the Republic of Kazakhstan leaders in basic and periodic training. The methodological basis of the study was to establish the relationship between the dynamics of the development of infrastructures of public and private health care organizations, on the one hand and the change in the number of their leaders, on the other. Analytical studies have allowed to develop a method for determining the needs of policy-makers in education to ensure long-term planning, adequate funding, and improve the quality of their training and retraining.

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.

[What kind of training can be suitable to promote integrity within the Public Health Service? The experience of the ASL in Modena]

The aim of this article is to present a training experience on the Italian Law "to prevent and contrast corruption in the Public Administration", carried on in the Public Health Service of Modena. It has been two years since the Law 190/2012 was approved, and with this contribution we would like to explore what type of training is congruous with the legislator's aims. Necessary, the consulter has had to assume the institutional mandate (imposed by the Law), but moreover he tried to understand what are the management approaches and organizational cultures that derive from it. Therefore, in addition to the "normative code" derived from the Law, it was necessary (during the training) to assume a "community code" that derives from building alliances and people's sense of responsibility. This step was crucial to start speaking of anti-corruption. Due to these premises, we assume the idea of a training as a stimulus for changing and strengthening capabilities in complex organizational contexts. In this case, instead of static, equilibrium and linearity, people's uncertainty and freedom prevails; relationships and individuals' identification with organizations is weak. Thus, the consulter has to project and develop people's capacity to think and to increase knowledge. Here knowledge means understanding problematic contexts and not building theoretical models to be applied. This contribution would like to prove how it is necessary to develop a knowledge connected to people actions and behaviors; it is a co-construct process done with some key- individuals in the organization, starting from concrete problems instead of abstract subjects. The consulter has used the indications that derives from the Law, but he has projected and developed a training system based on information and sensitization aimed at powering best practices that already exists in the organization. In fact, the key factor of this experience was to take the point of view of different professional experiences in the organization and to work on case studies that people themselves have proposed on the subjects derived from the application of the Law.

Building public health capacity in Madhya Pradesh through academic partnership

Engaging in partnerships is a strategic means of achieving objectives common to each partner. The Post Graduate Diploma in Public Health Management (PGDPHM) partners in consultation with the government and aims to strengthen the public health managerial capacity. This case study examines the PGDPHM program conducted jointly by the Public Health Foundation of India and the Government of Madhya Pradesh (GoMP) at the State Institute of Health Management and Communication, Gwalior, which is the apex training and research institute of the state government for health professionals. This is an example of collaborative partnership between an academic institution and the Department of Public Health and Family Welfare, GoMP. PGDPHM is a 1-year, fully residential course with a strong component of field-based project work, and aims to bridge the gap in public health managerial capacity of the health system through training of health professionals. The program is uniquely designed in the context of the National Rural Health Mission and uses a multidisciplinary approach with a focus on inter-professional education. The curriculum is competency driven and health systems connected and the pedagogy uses a problem-solving approach with multidisciplinary faculty from different programs and practice backgrounds that bring rich field experience to the classroom. This case study presents the successful example of the interface between academia and the health system and of common goals achieved through this partnership for building capacity of health professionals in the state of Madhya Pradesh over the past 3 years.

EPPM and willingness to respond: the role of risk and efficacy communication in strengthening public health emergency response systems

This study examines the attitudinal impact of an Extended Parallel Process Model (EPPM)-based training curriculum on local public health department (LHD) workers' willingness to respond to representative public health emergency scenarios. Data are from 71 U.S. LHDs in urban and rural settings across nine states. The study explores changes in response willingness and EPPM threat and efficacy appraisals between randomly assigned control versus intervention health departments, at baseline and 1 week post curriculum, through an EPPM-based survey/resurvey design. Levels of response willingness and emergency response-related attitudes/beliefs are measured. Analyses focus on two scenario categories that have appeared on a U.S. government list of scenarios of significant concern: a weather-related emergency and a radiological "dirty" bomb event (U.S. Department of Homeland Security, 2007). The greatest impact from the training intervention on response willingness was observed among LHD workers who had low levels of EPPM-related threat and efficacy perceptions at baseline. Self-efficacy and response efficacy and response willingness increased in intervention LHDs for both scenarios, with greater response willingness increases observed for the radiological "dirty" bomb terrorism scenario. Findings indicate the importance of building efficacy versus enhancing threat perceptions as a path toward greater response willingness, and suggest the potential applicability of such curricular interventions for boosting emergency response willingness among other cadres of health providers.

Knowledge transfer on complex social interventions in public health: a scoping study

OBJECTIVES

Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field.

METHOD

A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications.

RESULTS

From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high.

CONCLUSION

Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization.

Using public health legal counsel effectively: beliefs, barriers and opportunities for training

Effective use of public health law can be a powerful tool to advance the mission of public health departments to protect and promote the health of the population. However, there is little known about the way that public health officials think about law, use law, and/or interact with their legal counsel. The purpose of this paper is to examine some of the beliefs and barriers facing public health officials and legal counsel in their efforts to collaborate and to describe specific opportunities to better facilitate the use of law and collaboration, particularly in the area of training and education. Our findings are based on two studies: (1) a mixed methods study of state and local public health officials and their legal counsel, including surveys and qualitative interviews; and (2) a survey-based needs assessment of training for public health law. While state health officials and legal counsel view the role of public health law in similar ways, variation exists in organization, interactions and perceptions of collaboration on issues of public health law. Tremendous opportunity exists for improving collaboration between legal counsel and public health agencies through additional education and training opportunities. Improving the use of law in public health is possible - if practitioners and legal educators work together to fulfill its promise.

[An exploratory synthesis of knowledge brokering in public health]

There is a call for public health policies and interventions to be evidence-based. Also, using knowledge brokers to foster the use of research results is increasingly recommended. This article presents an exploratory synthesis of the current state of knowledge on this new strategy We conducted a scoping study by consulting the main databases. Nineteen articles were included in the analysis, which was designed with a grid developed iteratively. The synthesis shows that knowledge brokering initiatives include i) planning activities (stakeholder identification, creation of networks and partnerships, context analysis, problem identification, needs identification), ii) support to the brokers (training, technical support, development of a practice guide), and iii) the brokerage activities themselves (information management, liaison between knowledge producers and users, training of users). Only four articles presented empirical data on the effects of brokers' activities. Three were associated with increased knowledge in the target audience. No study showed any impact on clinical behaviours or on public policy content. This synthesis highlights the challenges involved in knowledge brokering activities, as well as the characteristics and skills a broker should possess. While knowledge brokering appears promising, efforts must now be made to evaluate it more systematically to demonstrate its effectiveness.

Where is leadership training being taught in U.S. dental schools?

Since leadership is vital in all professions and organizations, the purpose of this study was to determine where in dental schools leadership for predoctoral students is taught and to what degree it is emphasized in order to establish a baseline from which to generate recommendations for best practices. Academic deans of U.S. dental schools were surveyed to determine where in the curriculum leadership is taught and emphasized. The response rate was 39 percent returned completed surveys. These responses were representative of all geographic regions of the country, with equitable distribution between private and public institutions. The results showed that leadership training is delivered in many different parts of the curriculum and at various levels. Generally, the respondents indicated that leadership education is delivered in the setting of practice management, community out-reach, or public health. In some cases, specific training programs are dedicated to leadership development. Thus, several models for leadership development were identified, showing design flexibility in addressing regional and national needs. In the future, it would be of value to assess the effectiveness of the various models and whether single or multiple pathways for leadership training are most beneficial.

Clinical engineering development in the Uruguayan public health system

Establishment of the clinical engineering department with a network of 5 operational centers to strengthen public medical equipment management and maintenance, in the context of the Health System reform with the purpose of ensuring universal access to the health services in the Republic of Uruguay.

Tracing experiences of NHS change in England: a process philosophy perspective

For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration.

What contribution can international relations make to the evolving global health agenda?

This article presents two approaches that have dominated International Relations in their approach to the international politics of health. The statist approach, which is primarily security-focused, seeks to link health initiatives to a foreign or defence policy remit. The globalist approach, in contrast, seeks to advance health not because of its intrinsic security value but because it advances the well-being and rights of individuals. This article charts the evolution of these approaches and demonstrates why both have the potential to shape our understanding of the evolving global health agenda. It examines how the statist and globalist perspectives have helped shape contemporary initiatives in global health governance and suggests that there is evidence of an emerging convergence between the two perspectives. This convergence is particularly clear in the articulation of a number of UN initiatives in this area - especially the One World, One Health Strategic Framework and the Oslo Ministerial Declaration (2007) which inspired the first UN General Assembly resolution on global health and foreign policy in 2009 and the UN Secretary-General's note "Global health and foreign policy: strategic opportunities and challenges". What remains to be seen is whether this convergence will deliver on securing states' interest long enough to promote the interests of the individuals who require global efforts to deliver local health improvements.

New culprits and old threats in infectious diseases: the work of disease detectives

The A.J. Orenstein Memorial Lecture, Medical School, Univ. of the Witwatersrand, Johannesburg, 12 August 2009

Teaching methods in the healthcare management major

INTRODUCTION

Organisation and management are factors of paramount importance in higher education for achieving higher quality of training, better professional adaptation, and more effective career pursuance of the students.

AIM

The present study analyses the use of various teaching methods for the students in the major of Healthcare Management as they are employed in two medical universities.

MATERIALS AND METHODS

We conducted a detailed questionnaire survey which included the students in the Healthcare Management major in the Faculty of Public Health (FPH) at Sofia Medical University (SMU) and the Medical Faculty of Plovdiv Medical University (PMU). The students were surveyed for two consecutive academic years (2004/2005 and 2005/2006). The logical units of study were 198 students completing their baccalaureate programs in Healthcare Management: 145 (73.23+/-3.15%) in the FPH, SMU and 53 (26.77+/-3.15%) in the PMU (the greater number of students from the SMU was due to the greater number of students admitted into the Sofia Medical University). The technical units of study were the Faculty of Public Health in the Medical University in Sofia and the Medical faculty in the Medical University in Plovdiv. The survey was carried out using our own questionnaire form comprising 51 questions (open and closed), some of them allowing more than one answer. The collected sociological data were analysed using SPSS v. 13.0, and the diagrams were made using Microsoft Excel' 97. We used the alternative, non-parametric and graphic analyses to illustrate the processes and events at a level of significance P < 0.05.

RESULTS

The most frequently used teaching method in both Medical Universities is the lecture (30.43+/-3.63% for PMU and 26.32+/-1.91% for SMU). This format of teaching is also considered to be the easiest with regard to learning the study material by 22.75+/-3.25% of the PMU graduates and 27.56+/-2.38% of the SMU graduates. The PMU students regard seminars, individual work and discussions as the format that afford the easiest way to acquire knowledge (22.16+/-3.21%, 21.56+/-3.18%, (18.56+/-3.01%, respectively). The most frequently used teaching method is the lecture; for the SMU student, it is used in 91.67+/-5.64% of all cases, while for PMU it is 8.33+/-5.64%.

CONCLUSION

Students prefer the classical teaching methods. They are the most familiar and the most frequently used formats by lecturers, although they do not require a higher level of activity on the part of the students, who in T. Popov's view "...demonstrate passive attitude towards the educational process".

Leadership in public health

The modern public health model for leadership will unlikely be the omniscient figure with easy answers.51 Rather the public health leader of the future may well be the transcendent, collaborative «servant leader»50,52 who knits and aligns disparate voices together behind a common mission. They pinpoint passion and compassion, promote servant leadership, acknowledge the unfamiliar, the ambiguous, and the paradoxical, communicate succinctly to reframe, and understand the «public» part of public health leadership. By working between and above the levels of leadership of self, others and organizations, these transcendent leaders can ultimately shift the paradigm from «no hope» to «new hope» and create a renewed sense of community.

Such leadership will be vital as the 21st century progresses. Beginning the journey to new hope may start by motivating underdogs who nurture the spirit, discover a passion to serve, cultivate interdependence, and create uncommon bonds. These emerging leaders can tap into their unique talents, passion, and compassion to promote a mission of «the highest attainable standard of health» for all, in every community.

Philanthropies croisées: a joint venture in public health at Lyon (1917-1940)

Since the end of the First World War the Rockefeller Foundation has spearheaded a large-scale programme in the field of education for the health professions (doctors and nurses). In several countries throughout the world, but with its efforts concentrated on Europe, it has financed schools, constructed information networks, granted research scholarships and awarded training bursaries. In so doing it has not, however, been in the business of propagating an irresistible "American model," nor has it pursued a huge undertaking in disinterested aid. Through an attempt to contextualize these programmes, to bring to light the existence of common reference points, to retrace the work with local participants and to appraise cleavages within the philanthropic apparatus, this article proposes a fine-grained reading of the role of the Rockefeller Foundation at the Faculté de Médecine (Faculty of Medicine) and the Ecole d'Infirmières et d'assistantes sociales (Training School for Nurses and Social Workers) in Lyon between 1917- and 1940. It analyses these institutions in terms of the transactions, negotiations and appropriations that highlight their joint-venture character and it identifies their varied impact.

Strengthening the performance and effectiveness of the public health system

Health funders at the national, state, and local levels have made substantial commitments to improve the functionality of the public health system. Using a variety of approaches, they have sought to develop the capabilities, services, and competencies that enhance public health practice. These efforts include developing the operational capacity of public health agencies and raising performance expectations for governmental public health organizations.

Control of the Asian tiger mosquito: technical and administrative aspects

The Community legislator, through Directives 2004/17/CE and 2004/18/CE, wanted dictate to the Member States some "guidelines" to be used in the field of public procurement of services, in order to promote, through an inner market growth, developing appropriate operational protocols to document in the race; that, has the aim at testify the consolidated technical capacity of Company which conferred the health reclamation provided by the "Plans to put public health emergencies". By its nature, the legislative regulatory act which is capable of directing the gradual harmonization of national laws, giving also each state full autonomy on the form and means to be taken. Therefore, the objectives of the Community directives must be properly incorporated and interpreted, including the legislative adaptation about the regulation of the disinfestations Enterprises.

Public health decision-makers' informational needs and preferences for receiving research evidence

OBJECTIVES

The purpose of this study was to identify decision-makers' preferences for the transfer and exchange of research knowledge. This article is focused on how the participants define evidence-based decision-making and their preferences for receiving research evidence to integrate into the decision-making process.

METHODS

Semistructured interviews were conducted with a purposive sample of 16 Ontario public health decision-makers from six Ontario public health units in this fundamental qualitative descriptive study. The sample included nine program managers, six directors, and one Medical Officer of Health. Participants were asked to define the term evidence-based decision-making and identify preferred research dissemination strategies. The interviews were audio-taped, transcribed verbatim, and coded for emerging concepts.

RESULTS

Participants defined evidence-based decision-making as a process whereby multiple sources of information were consulted before making a decision concerning the provision of services. To facilitate integration of research evidence into the decision-making process, public health administrators appreciate receiving, in both electronic and hard copy, systematic reviews, executive summaries of research, and clear statements of implications for practice from health service researchers.

CONCLUSIONS

Although consensus exists among participants concerning the definition of evidence based public health decision-making, ongoing efforts are required to continue to promote the use of research evidence in program planning and public health policy. It is also important to continue to improve the ease with which public health decision-makers access systematic reviews, as well as to ensure the relevance and applicability of the results to the practice setting.

Concerns in workforce development: linking certification and credentialing to outcomes

Investments in public health workforce development are based on the assumption that capacity and competencies are linked with the effectiveness and efficiency of providing essential public health services. However, evidence of the effects of workforce quantity or quality on the performance of core public health functions is limited. A review of public health, health care, and teacher education literature was conducted to determine the state of research in the field and to identify promising approaches and study designs for application to public health workforce training. A total of 861 articles and abstracts were reviewed from the health literature and 470 from teacher education literature. Sixty-five reports in the public health or health care literature and 68 in the education literature met the inclusion criteria. Eleven studies in public health or health literature reported positive correlations and 3 determined no substantial correlation to credentials. In the education literature, 10 studies reported a positive link, whereas 9 studies reported mixed or nonsignificant results. We conclude that a paucity of quality research or compelling evidence exists linking certification or credentialing to any related outcome. Until further research is conducted, discussions on the need for public health workforce certification and credentialing will be based on good-faith expectations for improving individual and organizational performance.

Strategies for achieving research utilization in the Bangladesh population program: implications for health education. 1980-81

Effective research utilization in program planning and implementation is a continuing problem in both developed and less developed nations. This is particularly so in social programs. This paper addresses the issue from the standpoint of some twelve years of experience in the Bangladesh population program. The focus of this paper is on communication between administrators and researchers-the problems that arise, and the strategies that may be used to facilitate communication in order to improve use of research findings.

The hierarchy of work pursuits of public health managers

How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine diverse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P < 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health sample and for the hospital clinician-managers (n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.

Training needs for mid-level managers and immunisation coverage in Western Kenya

OBJECTIVES

To determine the current status of immunisation coverage in Western Kenya before intervention, to identify strengths and weaknesses of the existing programme in order to design educational interventions that could improve the services provided and find out the training needs of the mid-level managers of Kenya Expanded Programme of Immunisation.

DESIGN

Cross-sectional descriptive study.

SETTING

All thirty nine districts in Rift Valley, Western and Nyanza provinces.

SUBJECTS

Mid-level managers of Kenya Expanded Programme on Immunisation in the 39 districts and the provinces. These included Provincial Logisticians, Provincial Medical Officers of Health, District Medical Officers of Health, District Public Health Nurses, District Records and Health Information Officers, District Disease Surveillance Officers, and District Public Health Officers.

MAIN OUTCOME MEASURES

Number of staff trained on EPI, coverage rates and perceived training needs of the mid-level managers.

RESULTS

A total of eighty eight mid-level managers participated in the interviews. Most of these were District Public Health Nurses (40.9%) and District Health Information and Records Officers (23.9%). Only 49 (25%) of the District Health Management Team members had undergone training at the supervisory level. Eighteen districts (43.6%) had no member of the District Health Management Team that had ever been trained at the supervisory level. Using rates of Pentavalent 1 and measles coverage, Nyanza Province had the highest immunisation dropout rate (Pentavalent 1--measles) whereas Rift Valley Province had the lowest. The annual cumulative coverage for all the provinces by antigen was 80% for Pentavalent 1 and 2 and 60% for measles. The most requested need for inclusion in the training curriculum was maintenance of the cold chain equipment.

CONCLUSIONS

Most of the members in the study area have not been trained on Expanded Programme on Immunisation and may be ill-equipped to manage the complicated programmes needed to maximise delivery of services. The immunisation coverage in this area is low while the dropout rates are high. We therefore recommend that all the mid-level managers of Expanded Programme on Immunisation in this area be trained comprehensively through the Merck Vaccine Network--Africa programme using the World Health Organisation approved mid-level managers course.

Preparing for and responding to public health emergencies in China: a focus group study

To gather information that would assist China's central government and local governments in public health emergency management, we conducted focus groups to identify current problems. In three provinces, selected to reflect differing economic and social status, we met with two groups each, composed of public health officials and practitioners. Sampling to achieve a mix and for convenience, we followed a guide to cover five topics. Eleven common problems emerged. China's central government and local governments should take immediate action to solve these remaining problems in public health emergency management.

An action research protocol to strengthen system-wide inter-professional learning and practice [LP0775514]

BACKGROUND

Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT). The project is funded by the Australian Research Council under its industry Linkage Program.

METHODS/DESIGN

The program of research will examine in four inter-related, prospective studies, progress with IPL and IPP across tertiary education providers, professional education, regulatory and registration bodies, the ACT health system's streams of care activities and teams, units and wards of the provider facilities of the ACT health system. One key focus will be on push-pull mechanisms, ie, how the education sector creates student-enabled IPP and the health sector demands IPL-oriented practitioners. The studies will examine four research aims and meet 20 research project objectives in a comprehensive evaluation of ongoing progress with IPL and IPP.

DISCUSSION

IPP and IPL are said to be cornerstones of health system reforms. We will measure progress across an entire health system and the clinical and professional education systems that feed into it. The value of multi-methods, partnership research and a bi-directional push-pull model of IPL and IPP will be tested. Widespread dissemination of results to practitioners, policymakers, managers and researchers will be a key project goal.

Recommendations from the Exploring Accreditation for State and Local Health Departments: do we have the political will?

Acting upon several years of related work from a variety of public health practice arenas, 4 leading public health organizations received funding to conduct a study of the desirability and feasibility of establishing a national voluntary public health accreditation system. The study was conducted by a 25-member Steering Committee, with representatives from public health organizations at the local, state, and federal levels. The study was advised by input from additional numbers of public health experts participating in workgroups, as consultants, or in public comment groups. Public health nursing was represented by 3 members of the Steering Committee, including the chair, and by 7 other nurses who served on work groups or as staff to the process. The report of the study committee, released in the fall of 2006, contained answers to 2 questions related to the desirability and feasibility of such a program. Additionally, the report contained recommendations regarding the program's initial implementation. This article summarizes those recommendations and discusses the policy implications for their implementation, with a special emphasis on the role of the public health nursing community in the establishment of a national voluntary public health accreditation system.

Lessons Learned From the Multistate Learning Collaborative

Given the recent interest in public health accreditation programs and related efforts, there is a need to learn from the shared experiences of states that have developed, implemented, and evaluated their own efforts. The Multistate Learning Collaborative provided such an opportunity. Five states were selected to participate in this national peer group. The states represented in the Collaborative reflect different accreditation and assessment models, varying levels of maturity, and various designs based on the context and needs of a given state. However, despite these differences, common themes, critical elements, and shared challenges have emerged.

Enhancing the Maryland environmental public health workforce: a collaborative approach

The practice of environmental public health (EPH)-ensuring food, water, and sanitation protection-is the traditional cornerstone of public health. Demands on the EPH infrastructure have broadened, however, to involve issues such as chemical and physical hazards in the environment, the role of the built environment in health, and disaster preparedness. Maryland, with its varied geography and population densities, faces many of the EPH challenges that are present elsewhere throughout the nation. A strong and stable EPH workforce is an essential ingredient in addressing these challenges. Yet significant workforce obstacles exist, including recruitment shortfalls, inability to retain qualified staff, impending retirements, inadequate training opportunities, insufficient compensation, and the absence of a robust career advancement pathway. Recognizing the importance of EPH protection for Maryland's future, state and local agencies and academic institutions are working collaboratively to address EPH challenges. Much progress has been made: Communication and interaction between state and local agencies have been strengthened; practitioners and academic institutions have collaborated to improve EPH training opportunities; and workforce development efforts have been made to address recruitment and retention challenges. Although there have been significant accomplishments, much work remains. It is imperative that these efforts continue and that they be supported at all levels of government. Coordination and communication, as well as the training, recruitment, and retention of the workforce, are critical to a strong and responsive EPH infrastructure.

Use of communication technology among public health professionals in New South Wales, Australia

We explored how six forms of communication technology (teleconferencing, web bulletin boards, web conferencing, videoconferencing, media streaming and satellite television) are currently being used in public health work in NSW. Twelve public health professionals working in the NSW health service were interviewed. Teleconferencing and videoconferencing were the most commonly used forms of communication technology. Factors that facilitated use included ease of access to facilities and assistance in organising and setting up the technique. Barriers to use included cost and the perception that the equipment was hard to set up and operate. Participants identified factors that assisted them to engage with these techniques.

Trainees’ experiences of multidisciplinary public health training schemes in England

From 1999 onwards most English NHS regions launched multidisciplinary public health training schemes. These schemes were open to those from backgrounds other than medicine and followed on from the announcement of a new multidisciplinary Public Health Specialist post-a post equivalent to the traditional medical Consultant in Public Health Medicine. This article documents the issues arising during the first few years of the multidisciplinary public health training schemes. It also includes a number of case studies from trainees who have passed through the training schemes, examining the positive and negative experiences of these trainees. The paper reveals how the schemes initially varied considerably by region, in respect of pay and other terms and conditions. The case studies from ex-trainees reveal a number of positive and negative features of the training schemes.

Using problem-based learning in public health service based training

OBJECTIVES

This study explored the suitability and benefits of problem-based learning (PBL) in competency-based postgraduate public health training. The PBL was delivered within a rural retreat and included site visits.

METHODS

Qualitative semistructured interviews with trainee public health officers and key informants.

RESULTS

The learning approach (retreat-PBL combination with site visits) was valuable and relevant. Trainees reported a high learning impact with increased knowledge about the problems examined and rural public health practice. They also expressed an openness to work rurally.

CONCLUSION

Collaboratively developed and delivered, experiential rural public health PBL provides a positive learning experience for trainees undertaking competency-based training in public health and could play an important workforce role. PBL appears to be suitable in rural and non-rural public health training settings.

Views from the executive suite: lessons from the introduction of performance management

Performance management introduced to the senior health executive levels in the New South Wales public health care system included the senior executive service in 1989 and, as a key element of that service, performance agreements in 1990. This is the first qualitative study examining senior health executives? personal experiences of these changes. In consideration of what has been learnt from the most relevant literature and this study, this paper concludes that the introduction and implementation performance management is a continuous process. This process includes the key steps of planning, measuring, monitoring and evaluating. It can be used as a means to achieve overall effective organisation performance by bringing in a two-way management process for the organisation and its senior health executives.

Problem-based learning in public health workforce training: a discussion of educational principles and evidence

Problem-based learning (PBL) has been implemented within numerous undergraduate health curricula but less so in workforce training. Public health practice requires many of the skills that PBL aims to develop such as teamwork, self-directed learning and the integration of multiple sources of information within problem solving. This paper summarises the historical development of PBL and the educational principles underpinning it. It hypothesises that the public health workforce would benefit from some exposure to this type of learning and highlights some of the practical issues for its implementation.