- Email: [email protected]
Improving access to and provision of public health education and training in the UK
Public Health (2008) 122, 1047e1050
www.elsevierhealth.com/journals/pubh
Minisymposium
Improving access to and provision of public health education and training in the UK Paul Pilkington* University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK Available online 26 July 2008
KEYWORDS Public health; Training; Education; Access; Provision
Summary This paper examines some of the challenges facing public health education and training in the UK, especially those relating to the wider workforce. It identifies key drivers for the need to improve access to and provision of public health education and training, such as the establishment of the Voluntary Register for Public Health Specialists and the launch of the Public Health Skills and Career Framework. The paper also touches briefly on developments in public health education and training in the USA, noting where lessons could be learnt by both countries. The paper notes how the traditional approach of structured training, while still valuable for those wishing to work at the specialist level, needs to be combined with an approach that enables other workers to achieve competence in public health. This challenge is being met, in part, through provision of online resources and teaching, and the development of Teaching Public Health Networks. The challenges facing the UK are similar to those facing the public health sector in the USA. As such, the two countries can learn from one another in order to address this important workforce development issue. ª 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
Introduction This paper examines some of the challenges facing public health education and training in the UK, especially those relating to the wider workforce. It identifies key drivers for the need to improve access to and provision of public health education and training, such as the establishment of the Voluntary Register for Public Health Specialists and the launch of the Public Health Skills and Career
Framework. The paper also touches briefly on developments in public health education and training in the USA, noting where lessons could be learnt by both countries.
Specialist training in public health Historically, public health education and training in the UK has focused on the training of the specialist
* Tel.: þ44 (0) 117 32 88860; fax: þ44 (0) 117 32 88437. E-mail address: [email protected] 0033-3506/$ - see front matter ª 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2008.03.008
1048 workforce, through the provision of 5-year regionally based training programmes in public health.1 The strengths of the training programmes are that they provide high-quality, structured training in all the major aspects of public health, both in academic and service public health settings. Those on specialist schemes not only have the opportunity to complete a Master’s course in public health, but also have access to a programme of tutorials that can address gaps in knowledge. This access to education and training aids the completion of the Faculty of Public Healtha examinations, and the fulfilment of 167 learning outcomes across nine key areas of public health practice, including: surveillance and assessment of the population’s health and well-being; assessing evidence of effectiveness; policy and strategy development; strategic leadership and collaborative learning; health improvement; health protection; health and social care quality; public health intelligence; and academic public health.2 Fulfilment of these outcomes is required for completion of specialist training. Graduates of the specialist training programme are then eligible to apply for consultant-level posts in public health, primarily in the National Health Service, but also roles in academic public health and regional, national and international settings. In recent years, access to specialist public health education and training has been widened by opening up training schemes and membership of the Faculty of Public Health by examination to those from all backgrounds, not just medicine.3 The quality and appropriateness of training has also been addressed, with the development of a competency-based portfolio assessment, and changes to the examinations to make them more relevant to public health practice. All these developments have served to improve public health education and training at the specialist level.
Need for improved public health education and training However, recent developments have highlighted the need for improved provision of and access to public health education and training in the UK. One major development was the creation of the Voluntary Register for Public Health Specialists in 2003.4 In addition to registering those working in public health following completion of a specialist a The Faculty of Public Health is the standard setting body for specialists in public health in the UK. It is a joint faculty of the three Royal Colleges of Physicians of the UK (London, Edinburgh and Glasgow).
P. Pilkington training scheme, the register is also open to those working at a senior level in public health but who had not been through any structured training programme in public health. Applicants for either the ‘Generalist Specialist’ (general public health specialist) or ‘Defined Specialist’ (from specialist areas of public health such as health promotion, public health intelligence, public health pharmacy and health protection) must submit a portfolio of evidence demonstrating both ‘shows how’ (skills, experience etc.) and ‘knows how’ (knowledge) competencies.4 In order to fill gaps or update knowledge to achieve the ‘knows how’ competencies, individuals preparing for the Voluntary Register have often been faced with trying to arrange ad-hoc training sessions to fit in with their fulltime job. Often the prospect of undertaking a Master’s course is either not feasible (because of cost or work commitments) or necessary (because gaps are small and require focused education on a particular topic area). Even for those who have already undertaken a Master’s, further study is often required, as demonstrated by the need for tutorials on the specialist training scheme. A second major development is the work to produce the Public Health Skills and Career Framework.5 This initiative, aimed at specialists, practitioners and the wider workforce, is designed to be a ‘route map’ that will facilitate career development in public health. It recognizes that many of those working in public health are ‘underdeveloped, underutilised, and unregulated’ and have little career direction.5 The Framework outlines competencies across the same nine areas of public health practice used by those undertaking specialist training in public health, but splits these competencies into core and defined across nine levels of public health practice. This enables all those working in public health to work towards competence at a level appropriate to them, their role and their future aspirations. It is, in part, a response to the need to engage the wider public health workforce in the UK, especially those not traditionally thought of as being public health workers. Such a move follows recommendations from those such as Derek Wanless, who in his influential report spoke of a ‘fully engaged scenario’ requiring public health action across many levels of society.6 As with the establishment of the Voluntary Register, the Public Health Skills and Career Framework will stimulate demand for accessible public health education and training. This will not be limited to specialist areas of public health practice. It will require those across a wide range of professional backgrounds to access public health
Public health education and training in the UK education and training; for example, those working in the leisure industry, education, the media, the private sector and the emergency services, among others. This will provide a challenge to current providers of public health education and training.
Responding to the challenge Increasingly, there will be demand for flexible delivery of education and training to meet the needs of those working across the spectrum of public health practice. This might be in the form of workshops (both inside and outside academic institutions), short courses or block teaching whereby a module is delivered over a number of days or weeks, rather than throughout a traditional semester. In addition to more flexible organization of face-to-face teaching, use of information technology to facilitate distance learning can help to increase the accessibility of education and training for those unable to take time out from their jobs. Online resources and communication methods such as podcasting mean that an increasing number of Master’s courses in public health (as well as more ad-hoc teaching and training) can be delivered fully online. In order to meet the needs of those working towards registration on the Voluntary Register and those following the Public Health Skills and Career Framework, education and training will need to be targeted towards specific competencies. Ways must be found to engage those in the wider public health workforce who have not traditionally accessed (or even considered accessing) public health education and training. However, it is important that education and training is not just seen as a way of ticking a box in a set of competencies. It must be seen as a continuing process of professional development. While there are already opportunities for public health education and training outside of the traditional higher education provision, more work needs to be done to increase provision and accessibility to those working across all spheres of public health practice. The Teaching Public Health Network (TPHN) initiative, funded by the Department of Health, is a means of responding to the need for improved access to and provision of public health education and training.7 Launched in 2006, nine regional networks exist across England. Activities of the networks, which are partnerships between academic and service public health organizations, include: assessing existing provision of education and training in the local area; developing responses appropriate to the area through the funding and development of courses and events; and
1049 integrating public health education and training within the curricula of other professional groups whose work impacts upon public health. Although still at an early stage, the activities of the networks show signs of improving access to the provision of education and training in public health.7 However, there is still much work to do to meet the needs of the public health community. The TPHN initiative is reminiscent of the Public Health Training Centre programme in the USA. As with the teaching networks, the training centres are collaborations between regional service and academic public health organizations, whose aim is to improve provision of public health education and training.8 This programme began in 2000 and has had success in training a range of public health workers through a variety of teaching methods.8 As with the TPHN initiative, the creation of public health training centres was, in part, a response to the need to provide public health workers from across the whole spectrum of public health activity with education and training opportunities. Given the longer existence of the training centres in the USA, are there are particular lessons that could be used by the teaching networks in the UK? Certainly the training centres appear to have been particularly successful at using distance-based and other related technologies to reach the widest number of public health workers. By 2005, over 190,000 public health workers had received training.8 As with the development of education and training in the UK, the USA has taken a competency-based approach, with training focused on an agreed set of key competencies (defined as ‘the 10 essential public health services’).8 The training centres have also placed a priority on providing training for those workers associated with medically underserved areas and populations. The UK-based teaching networks could utilize both the distance learning and targeted approach to widen provision of training and education in the UK. While the UK can learn from the USA in the provision of public health education and training to the wider workforce, the UK is stronger in its provision of specialist training programmes. Unlike the UK, where structured training for those specializing in public health is historically strong (being available nationwide and funded through national mechanisms), this is not the case in the USA.Although Federal agencies such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) offer some internships and fellowships, opportunities are limited and there is no specialist training programme for those from multidisciplinary backgrounds. And although there is a public health related residency
1050
P. Pilkington
programme for doctors in the US, this focuses on preventive medicine rather than public health. These doctors usually offer their services in secondary care rather than being employed in mainstream public health service-delivery organisations.9 In 2006, the American Public Health Association (APHA) recommended increased investment in training programmes in order to address issues around recruitment, retention and quality of training.10 Following the UK model of specialist training could help to achieve this.
Conclusions This paper has outlined some of the challenges facing public health education and training in the UK. The emergence of the Voluntary Register and the Public Health Skills and Career Framework have highlighted the need to improve provision of and access to education and training for a wide spectrum of the public health workforce. The traditional approach of structured training, while still valuable for those wishing to work at the specialist level, needs to be combined with an approach that enables other workers to achieve competence in public health. The TPHN initiative is one response to this situation, and it does offer the potential to increase availability of and access to public health education and training. Although only looked at briefly in this paper, the challenges facing the UK are similar to those facing the public health sector in the USA. As such, the two countries can learn from one another in order to address this important workforce development issue.
Ethical approval None declared
Funding None declared
Competing interests None declared
References 1. Faculty of Public Health. Public health e specialising in ‘the bigger picture’. London, UK: Faculty of Public Health; 2006. 2. Faculty of Public Health. Learning outcomes for public health database. London, UK: Faculty of Public Health. Available from: http://outcomes.fph-groups.org.uk/learning_outcomes/; 2007 (last accessed 19 December 2007). 3. Pilkington P, Dowling S, Barnes G, Lindfield T, Pritchard A. Trainees’ experiences of multidisciplinary public health training schemes in England. Public Health 2007;121:432e7. 4. Sim FM, Griffiths J. Origin and development of the UK Voluntary Register for public health specialists. Public Health 2007;121:443e8. 5. Skills for Health, Public Health Resource Unit. Multi-disciplinary/multi-agency/multi-professional public health skills and career framework. Final draft. Post-consultation version. Bristol, UK: Skills for Health; Oxford, UK: Public Health Resource Unit. Available from: http://www.phru. nhs.uk/Pages/PHD/public_health_career_framework.htm; 2007 (last accessed 19 December 2007). 6. Wanless D. Securing good health for the whole population: final report. London: HM Treasury/Department of Health; 2004. 7. Sim F. Teaching public health networks: connecting with shaping the future. J R Soc Promot Health 2007;127:215e8. 8. Association of Schools of Public Health. Public health training centres: five years of progress in public health workforce development. 2005. 9. Ducatman AM, Vanderploeg JM, Johnson M, et al. Residency training in preventive medicine, challenges and opportunities. Am J Prev Med 2005;28(4):403e12. 10. Perlino CM. The public health workforce shortage: left unchecked, will we be protected?. Washington DC, USA: American Public Health Association; 2006.
Available online at www.sciencedirect.com
www.elsevierhealth.com/journals/pubh
Minisymposium
Improving access to and provision of public health education and training in the UK Paul Pilkington* University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK Available online 26 July 2008
KEYWORDS Public health; Training; Education; Access; Provision
Summary This paper examines some of the challenges facing public health education and training in the UK, especially those relating to the wider workforce. It identifies key drivers for the need to improve access to and provision of public health education and training, such as the establishment of the Voluntary Register for Public Health Specialists and the launch of the Public Health Skills and Career Framework. The paper also touches briefly on developments in public health education and training in the USA, noting where lessons could be learnt by both countries. The paper notes how the traditional approach of structured training, while still valuable for those wishing to work at the specialist level, needs to be combined with an approach that enables other workers to achieve competence in public health. This challenge is being met, in part, through provision of online resources and teaching, and the development of Teaching Public Health Networks. The challenges facing the UK are similar to those facing the public health sector in the USA. As such, the two countries can learn from one another in order to address this important workforce development issue. ª 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
Introduction This paper examines some of the challenges facing public health education and training in the UK, especially those relating to the wider workforce. It identifies key drivers for the need to improve access to and provision of public health education and training, such as the establishment of the Voluntary Register for Public Health Specialists and the launch of the Public Health Skills and Career
Framework. The paper also touches briefly on developments in public health education and training in the USA, noting where lessons could be learnt by both countries.
Specialist training in public health Historically, public health education and training in the UK has focused on the training of the specialist
* Tel.: þ44 (0) 117 32 88860; fax: þ44 (0) 117 32 88437. E-mail address: [email protected] 0033-3506/$ - see front matter ª 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2008.03.008
1048 workforce, through the provision of 5-year regionally based training programmes in public health.1 The strengths of the training programmes are that they provide high-quality, structured training in all the major aspects of public health, both in academic and service public health settings. Those on specialist schemes not only have the opportunity to complete a Master’s course in public health, but also have access to a programme of tutorials that can address gaps in knowledge. This access to education and training aids the completion of the Faculty of Public Healtha examinations, and the fulfilment of 167 learning outcomes across nine key areas of public health practice, including: surveillance and assessment of the population’s health and well-being; assessing evidence of effectiveness; policy and strategy development; strategic leadership and collaborative learning; health improvement; health protection; health and social care quality; public health intelligence; and academic public health.2 Fulfilment of these outcomes is required for completion of specialist training. Graduates of the specialist training programme are then eligible to apply for consultant-level posts in public health, primarily in the National Health Service, but also roles in academic public health and regional, national and international settings. In recent years, access to specialist public health education and training has been widened by opening up training schemes and membership of the Faculty of Public Health by examination to those from all backgrounds, not just medicine.3 The quality and appropriateness of training has also been addressed, with the development of a competency-based portfolio assessment, and changes to the examinations to make them more relevant to public health practice. All these developments have served to improve public health education and training at the specialist level.
Need for improved public health education and training However, recent developments have highlighted the need for improved provision of and access to public health education and training in the UK. One major development was the creation of the Voluntary Register for Public Health Specialists in 2003.4 In addition to registering those working in public health following completion of a specialist a The Faculty of Public Health is the standard setting body for specialists in public health in the UK. It is a joint faculty of the three Royal Colleges of Physicians of the UK (London, Edinburgh and Glasgow).
P. Pilkington training scheme, the register is also open to those working at a senior level in public health but who had not been through any structured training programme in public health. Applicants for either the ‘Generalist Specialist’ (general public health specialist) or ‘Defined Specialist’ (from specialist areas of public health such as health promotion, public health intelligence, public health pharmacy and health protection) must submit a portfolio of evidence demonstrating both ‘shows how’ (skills, experience etc.) and ‘knows how’ (knowledge) competencies.4 In order to fill gaps or update knowledge to achieve the ‘knows how’ competencies, individuals preparing for the Voluntary Register have often been faced with trying to arrange ad-hoc training sessions to fit in with their fulltime job. Often the prospect of undertaking a Master’s course is either not feasible (because of cost or work commitments) or necessary (because gaps are small and require focused education on a particular topic area). Even for those who have already undertaken a Master’s, further study is often required, as demonstrated by the need for tutorials on the specialist training scheme. A second major development is the work to produce the Public Health Skills and Career Framework.5 This initiative, aimed at specialists, practitioners and the wider workforce, is designed to be a ‘route map’ that will facilitate career development in public health. It recognizes that many of those working in public health are ‘underdeveloped, underutilised, and unregulated’ and have little career direction.5 The Framework outlines competencies across the same nine areas of public health practice used by those undertaking specialist training in public health, but splits these competencies into core and defined across nine levels of public health practice. This enables all those working in public health to work towards competence at a level appropriate to them, their role and their future aspirations. It is, in part, a response to the need to engage the wider public health workforce in the UK, especially those not traditionally thought of as being public health workers. Such a move follows recommendations from those such as Derek Wanless, who in his influential report spoke of a ‘fully engaged scenario’ requiring public health action across many levels of society.6 As with the establishment of the Voluntary Register, the Public Health Skills and Career Framework will stimulate demand for accessible public health education and training. This will not be limited to specialist areas of public health practice. It will require those across a wide range of professional backgrounds to access public health
Public health education and training in the UK education and training; for example, those working in the leisure industry, education, the media, the private sector and the emergency services, among others. This will provide a challenge to current providers of public health education and training.
Responding to the challenge Increasingly, there will be demand for flexible delivery of education and training to meet the needs of those working across the spectrum of public health practice. This might be in the form of workshops (both inside and outside academic institutions), short courses or block teaching whereby a module is delivered over a number of days or weeks, rather than throughout a traditional semester. In addition to more flexible organization of face-to-face teaching, use of information technology to facilitate distance learning can help to increase the accessibility of education and training for those unable to take time out from their jobs. Online resources and communication methods such as podcasting mean that an increasing number of Master’s courses in public health (as well as more ad-hoc teaching and training) can be delivered fully online. In order to meet the needs of those working towards registration on the Voluntary Register and those following the Public Health Skills and Career Framework, education and training will need to be targeted towards specific competencies. Ways must be found to engage those in the wider public health workforce who have not traditionally accessed (or even considered accessing) public health education and training. However, it is important that education and training is not just seen as a way of ticking a box in a set of competencies. It must be seen as a continuing process of professional development. While there are already opportunities for public health education and training outside of the traditional higher education provision, more work needs to be done to increase provision and accessibility to those working across all spheres of public health practice. The Teaching Public Health Network (TPHN) initiative, funded by the Department of Health, is a means of responding to the need for improved access to and provision of public health education and training.7 Launched in 2006, nine regional networks exist across England. Activities of the networks, which are partnerships between academic and service public health organizations, include: assessing existing provision of education and training in the local area; developing responses appropriate to the area through the funding and development of courses and events; and
1049 integrating public health education and training within the curricula of other professional groups whose work impacts upon public health. Although still at an early stage, the activities of the networks show signs of improving access to the provision of education and training in public health.7 However, there is still much work to do to meet the needs of the public health community. The TPHN initiative is reminiscent of the Public Health Training Centre programme in the USA. As with the teaching networks, the training centres are collaborations between regional service and academic public health organizations, whose aim is to improve provision of public health education and training.8 This programme began in 2000 and has had success in training a range of public health workers through a variety of teaching methods.8 As with the TPHN initiative, the creation of public health training centres was, in part, a response to the need to provide public health workers from across the whole spectrum of public health activity with education and training opportunities. Given the longer existence of the training centres in the USA, are there are particular lessons that could be used by the teaching networks in the UK? Certainly the training centres appear to have been particularly successful at using distance-based and other related technologies to reach the widest number of public health workers. By 2005, over 190,000 public health workers had received training.8 As with the development of education and training in the UK, the USA has taken a competency-based approach, with training focused on an agreed set of key competencies (defined as ‘the 10 essential public health services’).8 The training centres have also placed a priority on providing training for those workers associated with medically underserved areas and populations. The UK-based teaching networks could utilize both the distance learning and targeted approach to widen provision of training and education in the UK. While the UK can learn from the USA in the provision of public health education and training to the wider workforce, the UK is stronger in its provision of specialist training programmes. Unlike the UK, where structured training for those specializing in public health is historically strong (being available nationwide and funded through national mechanisms), this is not the case in the USA.Although Federal agencies such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) offer some internships and fellowships, opportunities are limited and there is no specialist training programme for those from multidisciplinary backgrounds. And although there is a public health related residency
1050
P. Pilkington
programme for doctors in the US, this focuses on preventive medicine rather than public health. These doctors usually offer their services in secondary care rather than being employed in mainstream public health service-delivery organisations.9 In 2006, the American Public Health Association (APHA) recommended increased investment in training programmes in order to address issues around recruitment, retention and quality of training.10 Following the UK model of specialist training could help to achieve this.
Conclusions This paper has outlined some of the challenges facing public health education and training in the UK. The emergence of the Voluntary Register and the Public Health Skills and Career Framework have highlighted the need to improve provision of and access to education and training for a wide spectrum of the public health workforce. The traditional approach of structured training, while still valuable for those wishing to work at the specialist level, needs to be combined with an approach that enables other workers to achieve competence in public health. The TPHN initiative is one response to this situation, and it does offer the potential to increase availability of and access to public health education and training. Although only looked at briefly in this paper, the challenges facing the UK are similar to those facing the public health sector in the USA. As such, the two countries can learn from one another in order to address this important workforce development issue.
Ethical approval None declared
Funding None declared
Competing interests None declared
References 1. Faculty of Public Health. Public health e specialising in ‘the bigger picture’. London, UK: Faculty of Public Health; 2006. 2. Faculty of Public Health. Learning outcomes for public health database. London, UK: Faculty of Public Health. Available from: http://outcomes.fph-groups.org.uk/learning_outcomes/; 2007 (last accessed 19 December 2007). 3. Pilkington P, Dowling S, Barnes G, Lindfield T, Pritchard A. Trainees’ experiences of multidisciplinary public health training schemes in England. Public Health 2007;121:432e7. 4. Sim FM, Griffiths J. Origin and development of the UK Voluntary Register for public health specialists. Public Health 2007;121:443e8. 5. Skills for Health, Public Health Resource Unit. Multi-disciplinary/multi-agency/multi-professional public health skills and career framework. Final draft. Post-consultation version. Bristol, UK: Skills for Health; Oxford, UK: Public Health Resource Unit. Available from: http://www.phru. nhs.uk/Pages/PHD/public_health_career_framework.htm; 2007 (last accessed 19 December 2007). 6. Wanless D. Securing good health for the whole population: final report. London: HM Treasury/Department of Health; 2004. 7. Sim F. Teaching public health networks: connecting with shaping the future. J R Soc Promot Health 2007;127:215e8. 8. Association of Schools of Public Health. Public health training centres: five years of progress in public health workforce development. 2005. 9. Ducatman AM, Vanderploeg JM, Johnson M, et al. Residency training in preventive medicine, challenges and opportunities. Am J Prev Med 2005;28(4):403e12. 10. Perlino CM. The public health workforce shortage: left unchecked, will we be protected?. Washington DC, USA: American Public Health Association; 2006.
Available online at www.sciencedirect.com