Holland R, Hoysal N, Gilmore A, Acquilla S
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 TTJ, UK.
Public Health. 2006 Mar;120(3):237-48. doi: 10.1016/j.puhe.2005.08.019. Epub 2005 Dec 15.
Since 1997, UK public health training has undergone major changes, including the creation of specialist registrars (SpRs), introduction of a competency framework, admission of non-medical (specialist) trainees and National Health Service organizational change. It was therefore considered timely to audit the quality of this training.
Cross-sectional survey of all UK public health trainees, conducted in April 2003.
The survey questions were based on 75 previously identified standards, with three sections: induction (30 standards), health protection (13 standards) and general training (32 standards). Results were calculated for the UK. Deaneries were compared on 10 key standards, as was the training of SpRs and specialist trainees.
Two hundred and ninety responses were received (62% response rate). Only 16 (21%) of 75 standards were met by at least 80% of respondents, with problems in induction, health protection, secretarial facilities and examination support. Across 10 key standards (including initial welcome, trainer support, breadth/relevance of work and facilities), 59% indicated that their training had met at least eight standards. Results for individual deaneries were significantly different (P = 0.02), although 13 of 16 had median scores of eight out of 10, or over. Deaneries with specialists scored lower than those without (median scores eight vs nine, P = 0.003). Median specialist and SpR scores on the 10 key standards were seven and eight, respectively (P<0.001). In addition, SpRs were more likely to be 'on-call' [odds ratio (OR) = 66.8, 95% confidence interval (CI) 17.2-259.4, P<0.001] and to feel prepared for this role (OR = 10.7, 95% CI 1.4-79.8) than specialists.
This was the first UK National Audit of Public Health Training. Few standards were achieved amongst respondents, although the levels set may be considered to be high and the response rate (62%) was less than optimal, potentially biasing results. Despite these caveats, recent organizational change in England appears to have led to significant training disruption among respondents. Nevertheless, repeating such an audit annually within deaneries could help to improve public health training throughout the UK.
自1997年以来，英国公共卫生培训经历了重大变革，包括设立专科住院医师（SpRs）、引入能力框架、接纳非医学（专科）受训人员以及国民医疗服务体系的组织变革。因此，认为对该培训质量进行审核很及时。
2003年4月对所有英国公共卫生受训人员进行横断面调查。
调查问卷基于先前确定的75项标准，分为三个部分：入职培训（30项标准）、健康保护（13项标准）和一般培训（32项标准）。计算了英国的调查结果。对各地区培训中心在10项关键标准方面进行了比较，对专科住院医师和专科受训人员的培训情况也进行了比较。
共收到290份回复（回复率62%）。75项标准中只有16项（21%）至少80%的受访者表示达到，在入职培训、健康保护、秘书设施和考试支持方面存在问题。在10项关键标准（包括初次欢迎、培训师支持、工作广度/相关性和设施）方面，59%的人表示他们的培训至少达到了8项标准。各地区培训中心的结果有显著差异（P = 0.02），尽管16个地区培训中心中有13个的中位数得分在10分中达到8分或以上。有专科受训人员的地区培训中心得分低于没有的（中位数得分分别为8分和9分，P = 0.003）。专科受训人员和专科住院医师在10项关键标准上的中位数得分分别为7分和8分（P<0.001）。此外，与专科受训人员相比，专科住院医师更有可能“随时待命”[优势比（OR）= 66.8，95%置信区间（CI）17.2 - 259.4，P<0.001]，并且感觉为该角色做好了准备（OR = 10.7，95%CI 1.4 - 79.8）。
这是英国首次对公共卫生培训进行全国性审核。受访者中达到的标准很少，尽管设定的标准可能被认为较高，且回复率（62%）并非最佳，可能会使结果产生偏差。尽管有这些注意事项，但英国近期的组织变革似乎已导致受访者的培训受到重大干扰。尽管如此，每年在各地区培训中心重复进行这样的审核有助于改善全英国的公共卫生培训。
