A Trainee's Perspective

Hilary Mossop

Specialty Registrar

"Before joining the public health training scheme I worked as information manager for the Health Protection Agency.  Whilst I enjoyed working with epidemiological information I felt my role was limited to producing data and reports rather than doing anything with the information.  Now as a public health trainee I feel that I am able to use my skills in data analysis to highlight public health problems but I can also work on solutions to these problems.  For example, work around teenage pregnancy rates indentified that teenagers were not accessing long acting reversible contraception (LARC).  To address the problem we arranged a programme of training for GPs, practice nurses and school nurses to help promote LARC and developed a local enhanced service to improve access to LARC and to incentivise GP’s to offer teenagers a range of contraception options.

What I enjoy most about the public health training scheme is the variety of the projects we get involved with and the range of skills that you either utilise or acquire in your different placements.  For example, I have just finished my three month attachment with the Health Protection Agency where I was heavily involved in the initial response to swine flu as well as covering the reactive desk to ensure that the usual cases of E.Coli O157, TB and Legionnaires were dealt with.  I am now back working in a PCT where I am involved in reviewing stroke services to ensure that patients who have a TIA are scanned and treated as soon as possible to reduce their risk of a subsequent stroke.  This involves reviewing patient pathways to identify where delays are occurring and working with clinicians and commissioners to ensure barriers to improving services are addressed.  I am also leading on a project aimed at identifying best practice in maternity care for migrant women across the region.  This will involve undertaking a tendering exercise to commission research into the health beliefs of migrant women, giving me experience in project and budget management.

Some of the more unusual experiences during the training scheme have included interviewing prisoners at HMP Hewell, looking down drains whilst on a placement with environmental health and listening in to 999 calls at ambulance control.

Public Health training isn’t for everyone though and as with all jobs there are numerous challenges which you will face.  The timescales for projects tend to be long and you will usually have several projects on the go at any one time, so you need to be able to plan your time effectively and be persistent to see your project through to its conclusion.  Affecting change can be difficult in the NHS particularly when everyone has competing priorities and viewpoints and where finance and time are often a barrier.  You have to be able to stay focussed on the big picture and be able to convince others of the benefits of a particular intervention/change to service.   The majority of training in public health is on-the-job and supervision is often hands-off so you need to be self-motivated and able to see every task as a learning opportunity, other trainees are of course a huge source of support when needed.  And finally the Faculty of Public Health exams are tough and will take over your life for at least a short while, but they will soon be over and all the hard work will have been worth it!"

Tom Fowler

Specialty Registrar

"Before starting the training scheme I was working in a university, doing research into child and adolescent mental health.  I was involved in research looking at adolescent alcohol and tobacco initiation and progression to heavier use. This got me really interested in how to apply research in an evidence based way to address health problems in the population.  
 
Since starting the scheme I have been involved in a wide range of projects. In collaboration with Mike Caley (another trainee) I undertook a suicide audit for  Birmingham and Solihull which was one of the first in the country. This work was published, in the Journal of Public Health, and now forms the basis of Birmingham’s suicide reduction strategy. It still seems strange that something I did could potentially be influencing the lives of people in this way. I was also heavily involved in a local sexual health needs assessment. This work identified gaps in our provision and was also used to lobby for changes to national policy on the way outcomes are measured in the  chlamydia screening programme.
 
I feel my most notable success was the work done on genetic services in Birmingham. This showed increased levels of genetic risk for recessive disorders in some of Birmingham’s communities. As a result of this work I was able to secure extra resources and commission a large initiative (over £1,000,000) to extend the current services. Our approach of focusing on the genetic risk of individuals, helping people to make informed choices and using family members as advocates for getting people who could benefit from services to access them has provoked a great deal of interest from  many people, including the Department of Health.
 
I cannot imagine any other job where there is the potential to have such a large impact at both the strategic and implementation stages of addressing health issues. Yet I have also been able to keep my academic links and am an honorary research fellow in the Department of Public Health at Birmingham University.
 
Perhaps the best thing about the training scheme is the strong links I have built with other trainees. These are a varied and interesting bunch of people who I have found I can learn a lot from but also actually quite like. Due to the strong links between trainees there is a forum for asking questions and learning from each other that is a great resource. Plus the occasional night out is quite a lot of fun as well. I have just completed my Faculty of Public Health Exams and am looking forward to the next lot of new challenges and opportunities that the training scheme can provide"

Dr. Nadia Lewis

Academic Specialist Registrar

"I came into Public Health after completing my house officer posts in the UK and then spending several years in Australia, working in a variety of hospital specialities, with a final placement in General Practice.

It was during this final placement that I started to think seriously about Public Health as a career option; the General Practice in which I worked was extremely proactive with regards to health promotion, and having been saddened by the “revolving door” problems I saw in acute hospitals, and the frustrations of working in poorly designed healthcare services, I decided I really wanted to pursue this.

I was lucky to have the opportunity to work as a Clinical Teaching Fellow (teaching graduate medical students) at the University of Warwick, before being accepted as a Walport Academic Clinical Fellow onto the West Midlands Public Health Training Scheme. There are many ways of combining academia and Public Health and following the Walport route is just one of them. It offers the opportunity to work both in academic and NHS settings (i.e. to complete Public Health training) and indeed to try to link the two. One of the highlights for me has been being involved in teaching at both Bachelor and Masters degree level.

Examples of work I have been involved in include: evaluating the motivations and health needs of users of NHS Direct Online services, delivering and evaluating a family-based childhood obesity treatment intervention in Warwickshire, developing e-learning resources for GP trainees in the West Midlands relating to the “Healthy People” module in their curriculum, developing an index of new and emerging medical digital technologies to aid collaborative work between Warwick Medical School and Warwick Business School.  I have also been involved with development of a Falls and Bone Health strategy for Warwickshire Primary Care Trust.

More recently I have been heavily involved in the Health Protection Agency and NHS response to swine flu, and this experience has inspired my PhD proposal (to be submitted imminently!) focussing on modelling of the initial pandemic within the West Midlands, hopefully answering some of the “what if” questions, and linking this to how the Health Protection Agency and NHS managed the outbreak, to explore whether application “lean” process principles (used mainly in the manufacturing industry) would be an appropriate way of improving the efficiency of future emergency responses.

Moving out of a clinical setting and into Public Health is like stepping into the unknown, and getting used to new patterns of working and different types of stresses can take some time. The support network of other trainees on the scheme though really is fantastic in the West Midlands. It is impossible to capture the variety of activities that you can be involved in as a Public Health trainee in just a few words, but there is huge scope for “finding your niche” and for moving forwards."