Vertical integrated public health
education for medical students
and graduates: opportunities to
grow public health advocates
and expand the public health
workforce
Prof Donna B Mak1,2, Dr Stephanie Davis1,2,3, Dr Alex Hofer4, Dr Indira Samarawickrema2,3, Dr Benjamin Scalley1,2,
1. Australasian Faculty of Public Health Medicine, RACP
2. School of Medicine, University of Notre Dame, Fremantle.
3. Australian National University
4. ex Kimberley Public Health Unit
A growing opportunity
• No. of med students
increasing rapidly
• 2964 graduates (2011)
• Highest in last 10 yrs
• Aust graduates doubled
since 2002
• International grads have
tripled1
Public health physicians: ZPG?
• PH physician
population stable over
last 10 yrs
• 400 on average
• PH training
• 60 PH trainees (2010)
• 12 fellows per year
(2012) 3
Do you think it is important to grow/nuture
the public health medical workforce? Why?
National Govt Specialist Training Program
(STP) funding to the rescue?
Funding of AFPHM training
placements
Unknown
8%
National
government
16%
Number of AFPHM trainees by
funding source (columns) and total
number of STP-funded RACP
positions (line), by year, 2002-4.
Chart Title
University/
NHMRC
18%
120
400
350
100
300
80
250
60
200
150
40
State government
58%
100
20
50
0
0
2002
2003
2004
2005
2006
2007
2008
AFPHM trainees, not STP-funded
Total RACP STP positions
2009
2010
2011
2012
STP-funded AFPHM trainees
2013
2014
Lack of vertical integration
Career level
Public health curriculum
Public health opportunities
Medical student
Australian Medical Council’s
standards for the assessment and
accreditation of medical schools
• Limited ++ in comparison with
other speciality clinical
placements
• John Snow Scholarship
http://www.amc.org.au/index.php/ar/bme/standards
Prevocational trainee
Australia Curriculum Framework
for Junior Doctors
http://www.cpmec.org.au/ACF-2010/index.cfm
Vocational trainee
Australasian Faculty of Public
Health Medicine (AFPHM)
Learning Objectives
https://www.racp.edu.au/page/competencies
• Public health RMO positions X3
in Australia, all in WA
• Clinical Service Improvement
(CSI) rotations in WA Health –
underused opportunity for
public health
• AFPHM training program
• Not specifically for medical
graduates: MAE & State Health
Dept public health officer
training programs
Specialist public health physician
AFPHM CPD
N/A
Specialist, other
nil
nil
Prevocational public health training
•
•
•
•
Established in 2001
24 week public health placement for junior doctors
Kimberley Public Health Unit
Funding: Prevocational GP Placement Program
(Commonwealth)
• Australia’s first accredited prevocational position in
public health medicine & primary health care
• Despite a call in 2006 for “more prevocational medical
placements in public health and remote area health”1,
these placements are still only available in WA
• RMO at Midwest PHU, Geraldton funded by WACHS
Rural Training Provider (started 2013)
Ref: Mak DB, Plant AJ, Toussaint S. “I have learnt … a different way of looking at people’s health” - an evaluation
of a prevocational medical training program in public health medicine and primary health care in remote Australia.
Medical Teacher 2006; 28:e149-55.
Mak DB, Plant AJ. Reducing unmet needs: a prevocational medical training program in public health medicine
and primary health care in remote Australia. Aust J Rural Health 2005; 13: 183-190.
Prevocational public health training
• Introduction to public health practices
•
•
•
•
Screening programs
Disease surveillance
Clinical audits & project work
Contact tracing
• Focus on remote & Aboriginal health
• Initially primary focus on
communicable disease
• Recent broadened scope to include
non-communicable disease
Photo (2012): Trachoma Screening Team (with Alex, KPHU
RMO) flying into Ringer’s Soak, a small remote community
170km south-east of Halls Creek
Prevocational public health training: impact
after 12 years
• Survey of 23 of 27 (85%) previous KPHU RMOs (2012)
• 17% are enrolled in/completed public health training
• 61% felt placement influenced future desire to work in public health “a lot” or
a “great deal”
• “for the program to be a success, it doesn’t necessarily have to recruit people
to public health or the Kimberley, it still provides a unique and valuable
experience to doctors who pursue other pathways”
• Objective output
• >20 audits
• 8 peer-reviewed publications (STIs, diabetes, RHD)
Ref: Hofer A, Parker J, Atkinson D, Moore S, Mak DB, Prevocational exposure to public health in the Kimberley: A pathway to rural, remote and
public health practice. Aust J Rural Health 2014;22(2):75-79
Medical students’ and prevocational doctors’
perceptions of what they need to be able to
contribute to public health
Identified by consultations with Fremantle Hospital RMO Society and AMAWA Doctors in Training
C’tee, Nov 2013, and Notre Dame SoM PPH domain c’tee during SWAT analysis, June 2014
• Experiential public health learning opportunities
• Prevocational public health positions in rural and metropolitan areas; must be promoted, and
available, to all prevocational medical practitioners and junior doctors enrolled in other speciality
training programs; able to be accredited towards other speciality training programs, e.g. as an
extended or special skills training option.
• Much bigger public health physician presence at careers information sessions in individual
hospitals, at state/regional careers information expos and in Master of Public Health degrees, e.g.
public health registrars giving oral presentations about public health medicine.
• Obvious public health presence at locations where prevocational medical practitioners learn
about and interact with specialities other than those in which they are working, i.e. hospitals.
Are we providing medical students and
prevocational doctors what they need to be able
to contribute to public health in Australia and
beyond?
• If yes, how?
Providing medical students and prevocational
doctors what they need to be able to contribute to
public health in Australia and beyond.
What are the
Enablers
Barriers
Where to from here?
• What would you/your organisation like to do to grow the public
health medical workforce?
• Who/which organisations should these workshop’s findings be shared
with?