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Introduction
Public Health training is currently in a state of flux.
Traditionally a medical background was required to enter Public Health Specialist Training to be a Public Health consultant. The two main consultant roles are as Consultant in Communicable Disease Control (CCDC) or Director of Public Health (DPH). A smaller number of individuals become generalist Consultants in Public Health, or Consultants in Academic Public Health.
The Specialist Training programme takes five years and is overseen by the Faculty of Public Health (FPH). Medical applicants are usually required to have completed a minimum of two years' post-full registration (i.e. three years post qualification) clinical medicine before starting the training scheme.
Recently the scheme has also been opened up to non-medical graduates who have 4 years' experience in a health-related field. Over time it is expected that all Consultant/Specialist jobs will be open equally to medics and non-medics, although currently CCDCs must still have a medical background.
SHO, Foundation Training and LAT posts
In some deanery areas there are opportunities for Senior House Officer (SHO) jobs in Public Health as a 'taster' before committing to a full Specialist Registrar (SpR) rotation; increasingly such posts are being offered as part of the new Foundation programme for run-through medical training in the second Foundation year (F2).
Some deaneries also offer LAT (Locum Appointment for Training) posts. These are fixed-length SpR posts, for a maximum of 1 year. After this time the post-holder must reapply for a full SpR post; however the period spent in the LAT post counts towards training and any subsequent rotation can be shortened by this length of time.
Structure of Training rotation
The Training scheme last 5 years during which Trainees rotate around attachments which vary in length between 3 months to 2 years. These are usually in the Deanery region, but if an individual has a particular interest may sometimes be further afield at national centres or even abroad (e.g. with the WHO). There are currently minimum lengths of time which must be spent in a Primary Care Trust (PCT) setting and working in Health Protection but this may change with the present reorganisation. For examples of work carried out in attachments see Hot topics, and to get an idea of the breadth of subjects relevant to Public Health look at recent news stories here.
One year of training - usually early in the scheme - is devoted to taking a Masters in Public Health (MPH) or equivalent MSc, either at a local affiliated University or the London School of Hygiene and Tropical Medicine or Liverpool.
Upon successfully completing the Training scheme the individual is awarded a CCT (Certificate of Completion of Training, previously CCST) which entitles them to apply for Consultant posts.
Exams
During the Training scheme Trainees are expected to pass Part A (formally Part I) & Part B of the Membership of Faculty of Public Health (MFPH) exams. Part B is a new exam called the OSPHE (Objective Structured Public Health Exam) which will be similar in idea to OSCEs (Objective Structured Clinical Exam) in clinical medicine. Part A is normally sat after the MSc/MPH year.
Assessment procedures
Specialist Registrars (medics) and Specialist Trainees (non-medics) are also assessed annually under a system called Record of In Training Assessment (RITA), which is common to all medical specialties in the UK at Specialist Registrar level.
Portfolio route
Aside from the Training Scheme described above, for a limited time recognition as Public Health Specialists is being given to individuals who have amassed relevant skills during their working lives but who have not undergone formal Public Health training. Completion of this 'portfolio route' makes participants eligible for the UK Voluntary Register of Public Health Specialists.
It is anticipated that this retrospective 'portfolio route' to recognition will be temporary; eventually all professionals wishing to specialise in Public Health will need to take part in a Training Scheme, albeit a flexible one which can be extensively tailored to their needs.
NHS reorganisation
As well as reorganisation of PH training there is also another round of NHS changes, including the likely merger of small PCTs in each region. Closer links with local government have also been mooted (a move which would take Public Health back to its roots). The structural changes in part reflect a shift in the function of local NHS organisations from care providers (i.e. staff provide direct patient care) to commissioners (i.e. the organisation can 'outsource' or buy in private care from elsewhere if they wish).
Although these actions are unlikely to affect training dramatically they may alter the location of some placements.
A day in the life of a Public Health trainee
Day-to-day work will vary depending on what attachment you are on. Click here to read a bit more about what it's like to be a PH trainee.
30 November 2005 Copyright T. Porter
This article is taken from Public Healthy.com (www.publichealthy.com). Public Healthy.com includes up-to-date news and information on Public Health training, research and practice in the UK.
About the author:
Dr Tom Porter is a Specialist Registrar in Public Health in the UK and runs Public Healthy.com (www.publichealthy.com).
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