Vertical integrated public health education for medical students

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 Mak 1, 2, Dr Stephanie Davis 1, 2, 3, Dr Alex Hofer 4, Dr Indira Samarawickrema 2, 3, Dr Benjamin Scalley 1, 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 tripled 1

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% University/ NHMRC 18% Number of AFPHM trainees by funding source (columns) and total number of STP-funded RACP positions (line), by year, 2002 -4. Chart Title 120 400 350 100 300 80 250 60 200 150 40 State government 58% 100 20 0 50 2002 2003 2004 2005 2006 2007 2008 AFPHM trainees, not STP-funded Total RACP STP positions 2009 2010 2011 2012 2013 STP-funded AFPHM trainees 2014 0

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 Australia Curriculum Framework for Junior Doctors • Public health RMO positions X 3 in Australia, all in WA • Clinical Service Improvement (CSI) rotations in WA Health – underused opportunity for public health http: //www. amc. org. au/index. php/ar/bme/standards Prevocational trainee http: //www. cpmec. org. au/ACF-2010/index. cfm Vocational trainee Australasian Faculty of Public • AFPHM training program Health Medicine (AFPHM) Learning • Not specifically for medical Objectives graduates: MAE & State Health https: //www. racp. edu. au/page/competencies Dept public health officer training programs Specialist public health physician AFPHM CPD N/A Specialist, other 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: e 149 -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 170 km 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 So. M 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?