Higher Specialist Training
Trainees who were appointed up to and until December 2006 as Specialist Registrars (SpRs) and Specialist Trainees (SpTs), follow the approved curricula relating to those training programmes. These trainees will also follow the guidance in the Department of Health's The Guide to Specialist Registrar Training (the 'Orange Book', published February 1998). This Guide explains in detail exactly what trainees can expect at various stages of their SpR training programmes - from entering the grade, through the assessment process, up to the conclusion of training and then leaving the grade.
Terms applicable to these trainees are:
- Specialist training;
- Specialist Registrars (SpRs) and Specialist Trainees (SpTs);
- The Guide to Specialist Registrar Training (the 'Orange Book'); and
- Record of in-training assessment (RITA) forms
Public Health training usually lasts five years, full-time. Part-time training is proportionately longer. The five years usually includes one year (full or part-time) on an academic course, and 48 months in higher specialist training posts.
Shortly after being accepted on to a training scheme, trainees are likely to spend a year in a part or full-time academic course that will usually lead to a Masters or Diploma in Public Health, and provide most of the basic training to take the Faculty's Part A MFPH Examination.
Although this is usually undertaken as the first part of the higher specialist training programme, periods spent on academic courses do not count towards the 48 months of higher specialist training required for the Certificate of Completion of Training (CCT).
Every post in public health is potentially available as a part-time post. Trainees should consult with their Training Programme Director/Faculty Adviser for more information on training part-time.
In order for part-time training to be counted towards the 48 required months of training, it must be at least half time (0.5). A unit of training is one week. Training time is counted full-time, or for part-time a proportional amount is counted i.e. whole time equivalent (wte).
Higher specialist training equips trainees to work as public health consultants. Once completed, trainees will have the skills and knowledge to:
- Quantitatively and qualitatively assess the population's health and heath needs, including managing, analysing, interpreting, and communicating information that relates to the determinants and status of health and well-being and allows development of effective action.
- Critically assess the evidence relating to the effectiveness of health and healthcare interventions, programmes and services, apply this to practice and improve services and interventions through audit and evaluation.
- Influence the development of policies, implement strategies to put the policies into effect and assess the impact of policies on health.
- Lead teams and individuals, build alliances, develop capacity and capability, work in partnership with other practitioners and agencies and effectively use the media to improve health and wellbeing.
- Promote the health of populations by influencing lifestyle and socio-economic, physical and cultural environment through methods of health promotion, including health education, directed towards populations, communities and individuals.
- Protect the public's health from communicable and environmental hazards by application of a range of methods including hazard identification, risk assessment and the promotion and implementation of appropriate interventions.
- Support commissioning, clinical governance, quality improvement, patient safety, equity of service provision and prioritisation of health and social care services.
- Collect, generate, synthesise, appraise, analyse, interpret and communicate intelligence that measures the health status, risks, needs and health outcomes of defined populations.
- Teach and research in public health.
Training Portfolio - Pre-August 2007 curriculum
The training portfolio lists the competencies which all trainees in public health should achieve during their training. Some of these competencies will be assessed in the MFPH examinations, but most will be assessed during training.
Trainees are encouraged to log each area of work/experience into a standard format which records the aims, methods, results and outcomes supported by personal reflection on the lessons learned. This portfolio will allow audit of each learning outcome against each piece of work recorded as evidencing the learning outcome.
The trainee will also maintain a record of out-of-hours calls, action taken and learning. The portfolio will be presented at each RITA for scrutiny. The portfolio provides a comprehensive record of the package of assessment for each trainee.
The Competencies are listed below:
Area of specialist public health practice 1 – Surveillance and assessment of the population’s health and well-being (including managing, analysing and interpreting information, knowledge and statistics)
- 1.1 Use routinely available data to describe the health of a local population and compare it with that of other populations, and to identify localities or groups with poor health within it.
- 1.2 Examine the scale of health problems in a locality in terms of incidence or prevalence and make comparison with other populations.
- 1.3 Understand the need to standardise rates of disease and be able to undertake direct or indirect standardisation.
- 1.4 Undertake a needs assessment for a target group or service.
- 1.5 Use routinely available data from ONS including the following: mortality, birth, morbidity, abortion, reproductive data, census data, population projection and estimates and infectious disease notification.
- 1.6 Access and use appropriately other routine data sources including health service utilisation data, laboratory reports, prescribing, cancer registry and public health common data set.
- 1.7 Demonstrate familiarity with methods of measuring morbidity and burden of disease within populations, for example Disability Adjusted Life Years and SF 36.
- 1.8 Use data from routine information sources to undertake time trend analysis and on a geographical basis to address local issues, using spreadsheet and database skills.
- 1.9 Analyse data on a small area basis and understand the limitations of the analysis, and how to combine small area measures with routine data.
- 1.10 Be familiar with the strengths and weaknesses of both quantitative and qualitative methodologies to describe the health needs of a population.
- 1.11 Demonstrate an understanding of the links between socio-economic status and health needs, and a capacity to examine rates of illness in different socio-economic groups using at least one index of social deprivation.
- 1.12 Assess the importance of different risk factors in a given population, including socio-economic, ethnic and genetic factors in the genesis of specific diseases or conditions.
Area of specialist public health practice 2 – Promoting and protecting the population’s health and well-being
- 2.1 Recognise inequity, discrimination and its impact on health.
- 2.2 Understand the theoretical models of behaviour change and their relevance in the context of health promotion.
- 2.4 Understand the principles involved in childhood immunisation programmes, occupational health and travel health procedures.
- 2.5 Understand fully local on call procedures for the control of infectious diseases
- 2.6 Understand the role of others in the control of infection, including environmental health, microbiology, genito-urinary medicine departments, infection and TB control nurses, hospital control of infection committees.
- 2.7 Appreciate the general principles of outbreak management, and understand the role of the consultant in communicable disease control, health authority, local authority, CDSC and media.
- 2.8 Deal with the public health consequences of single cases of common communicable disease, for example meningitis, meningococcal infection, food poisoning, gastro-enteritis, hospital acquired infection, blood borne viruses. tuberculosis and hep A.
- 2.9 Be familiar with the legal aspects of the following: the law relating to public health, Port Health, Section 47 National Assistance Act 1948, Human Rights Act 1998 and other relevant legislation.
- 2.10 Provide public health management of an outbreak with practical experience of at least two of the following: meningitis, food poisoning, gastro-enteritis, hospital acquired infection, blood borne viruses, tuberculosis and legionella.
- 2.11 Take a major role in, and prepare a written outbreak control report.
- 2.12 Be familiar with the general principles of investigating allegations of ill-health associated with long-term health exposures to non-infectious environmental hazards.
- 2.13 Understand the potential health effects of exposure to Non-Infectious environmental hazards, including risk assessment and management.
- 2.14 Be familiar with the general principles of emergency planning and managing a major chemical incident, including the role and legal responsibility of the local department of public health and other agencies.
- 2.15 Prepare press releases and deal with the media with respect to an incident.
- 2.16 Contribute effectively to the management of an actual or simulated chemical or other major incident.
Area of specialist public health practice 3 – Developing quality and risk management within an evaluative culture
- 3.1 Critically appraise the quality of primary research. Be familiar with the hierarchy of evidence and be able to grade research, understand strengths and limitations of different approaches.
- 3.2 Critically appraise the quality of a review (secondary research) in a relevant policy context.
- 3.3 Examine evidence of effectiveness for a specific intervention, e.g. drug, surgical procedure.
- 3.4 Demonstrate an understanding of different ways of assessing outcomes from a number of different perspectives, and recognise the role of measures of patient satisfaction, qualitative outcomes, patient acceptability and quality of life as key outcomes for health interventions.
- 3.5 Assess the evidence for proposed and existing screening programmes, using established criteria.
- 3.6 Appraise the evidence for the effectiveness of different health promotion programmes, understanding the need for a range of appropriate outcome measures.
- 3.7 Understand and apply the principles of evaluation, audit, research and development and standard setting in improving quality.
- 3.9 Use data collected at local level to evaluate the effectiveness or outcomes of an intervention or service.
- 3.10 Design, initiate and complete evaluation/audit projects with public health and outside public health in partnership with clinical or other colleagues.
- 3.12 Identify steps for the implementation of recommendations based on research where appropriate and possible.
Area of specialist public health practice 4 – Collaborative working for health
- 4.1 Recognise and value the potential contribution to improving health made by different agencies: health and other – in public, private and voluntary sectors.
- 4.2 Be able to bring an articulate public health perspective to a decision-making forum in health, social care or public policy.
- 4.3 Understand and value the different roles of public health practitioners in different settings.
- 4.4 Understand, contribute to and value the work of local authorities and their role in improving the public health.
- 4.5 Understand, contribute to and value the work of the non-statutory sector and their role in improving the public health.
- 4.6 Demonstrate an appreciation of the relevance of different organisational cultures among the organisations influencing public health and manage expectations for change.
- 4.7 Demonstrate effective intervention in a multi-agency setting, e.g. by participation or chairing a multi-agency group containing representatives from at least three different organisations
- 4.8 Demonstrate facilitative skills and an ability to work with colleagues from different professional and organisational backgrounds.
Area of specialist public health practice 5 – Developing health programmes and services and reducing inequalities
- 5.1 Provide professional advice to health authorities and other bodies understanding the impact of such advice on both populations and individuals
- 5.2 Demonstrate commitment to the promotion and protection of health, the prevention of disease, the reduction in inequalities and long-term achievement of equity in health.
- 5.3 Use performance indicators for the NHS and other relevant bodies in an appropriate fashion.
- 5.4 Provide a population perspective to the development of clinical guidelines and protocols in the light of current knowledge and practice.
- 5.5 Provide a population perspective to the development, implementation and monitoring of quality improvement programmes in health care in the light of current knowledge and practice.
- 5.6 Understand the population perspective to confidential enquiries and other clinical incidents in the light of current knowledge and practice.
- 5.7 Provide a population perspective to the development, implementation or monitoring of quality improvement programmes in screening in the light of current knowledge and practice.
- 5.8 Demonstrate an up-to-date knowledge of health issues and developments in clinical practice and awareness of broader policy developments that may impact on the health of the public.
- 5.9 Use health needs of a population to inform decisions about health and preventive measures, demonstrating an ability to propose realistic changes to meet identified needs.
- 5.10 Understand the competing and conflicting influences on public and political perception of the need for health care and preventive measures, and the difference between health needs and demands.
- 5.11 Understand concepts of direct and indirect discrimination in resource allocation decisions.
- 5.12 Understand the methods used to make explicit values and resources including health economics in the decision-making process, their strengths and weaknesses and able to apply these appropriately.
- 5.13 Be pragmatic and politically able in addressing issues associated with prioritisation, resource allocation and rationing in health and health care.
- 5.14 Ensure that the development of health programmes and services are informed by consideration of health inequalities.
Area of specialist public health practice 6 – Policy and strategy development and implementation
- 6.1 Understand the importance and impact of public policy and legislation on health at local, national and global levels.
- 6.2 Understand different methods of health impact assessment.
- 6.3 Analyse health problems in terms of risk factors, including consideration of avoidable, relative and absolute risk.
- 6.4 Understand the term attributable risk and able to apply the concept to identify potentially effective public health interventions.
- 6.5 Participate effectively in inter
- 6.7 Understand threats to health; communicate these to as wide an audience as possible and exploit opportunities to address them.
- 6.8 Be able to lead the collation and interpretation of advice from clinical colleagues to inform policy.
Area of specialist public health practice 7 – Working with and for communities
- 7.1 Be able to listen to and help local communities articulate their own health concerns.
- 7.2 Appreciate the importance, relevance and limitations of non-NHS data sources on health and determinants of health e.g. police, social services.
- 7.3 Understand how different ways of involving the public and communities can improve health, e.g. surveys, public meetings and focus groups.
- 7.4 Understand the importance of addressing the wider determinants of health within communities, e.g. housing, employment and education.
- 7.5 Identify and engage key stakeholders and partners for effective public health practice.
- 7.6 Understand and use appropriate methods of involving the public and communities in improving health and reducing inequalities.
- 7.7 Act as an advocate for the public health and articulate the needs of those with poor health in society, including those who are dispossessed, vulnerable and discriminated against.
- 7.8 Be able to work effectively with media in a pro-active and reactive manner including undertaking interviews with radio and television.
Area of specialist public health practice 8 – Strategic leadership for health
- 8.1 Prepare and give appropriate written and verbal presentations to multi-disciplinary groups, including senior health professionals and managers within the organisation.
- 8.2 Give appropriate verbal presentations to multi-agency groups (and lay) audiences external to the organisation.
- 8.3 Produce press releases and undertake pro-active engagement with media.
- 8.4 Demonstrate up-to-date knowledge of the organisation of the NHS, national and local government
- 8.5 Understand NHS funding arrangements, including resource allocation.
- 8.6 Understand the role of the Department of Health and its Regional Offices or relevant governmental structures.
- 8.7 Deal with the uncertainty and prolonged time-scales of public health work.
- 8.8 Demonstrate understanding of the essential role and the application of different types of leadership.
- 8.9 Demonstrate the ability to teach and to educate a wide range of audiences on public health issues.
- 8.10 Identify the steps needed to implement and secure change.
- 8.11 Prepare appropriate written work and give an appropriate verbal presentation of the work at executive/board or equivalent level.
- 8.12 Demonstrate objectivity, independence, integrity and foresight.
- 8.13 Demonstrate perseverance, resilience and diplomacy in dealing with opposition or antagonism to sound public health advice.
- 8.14 Recognise and allow for the potential self-interest of professional groups.
- 8.15 Demonstrate vision in designing a long-term strategy based on the assessment of research evidence of effectiveness.
Area of specialist public health practice 9 – Research and development
- 9.3 Conduct a literature review to look for primary and secondary research, using electronic databases; able to define a search strategy and summarise results of it.
- 9.5 Be able to decide on the data required to answer a specific question.
- 9.6 Undertake data collection and analysis using specially collected ad hoc health information.
- 9.7 Draw appropriate conclusions, set in context, and make recommendations from the results of own and others’ research.
- 9.8 Identify steps for recommendation based on research findings.
- 9.9 Turn complex research outcomes into information and knowledge that can be used to improve health.
Area of specialist public health practice 10 – Ethically managing self, people and resources (including education and continuing professional development)
- 10.1 Demonstrate insight and the ability to learn from experience, identify personal learning needs and take action to meet them using appropriate continuing professional development and apply the concept of learning styles and different approaches to teaching
- 10.2 Understand relevance of management skills and apply them for effective public health practice.
- 10.3 Use different types of written communication, including memos, minutes, notes, verbal and written briefings, research reports and electronic forms of communication.
- 10.4 Respond appropriately to verbal and written enquiries internal and external to the organisation.
- 10.5 Prepare agendas and take clear, concise and accurate minutes, function as an effective member of a committee and be able to summarise the key contents of a meeting and demonstrate the ability to chair a meeting.
- 10.6 Understand the principles of good communication and be able to use visual aid tools appropriately in different contexts for different audiences.
- 10.7 Manage own time and prioritise workload effectively and to negotiate and meet reasonable deadlines.
- 10.9 Understand and appreciate ethical and legal issues surrounding confidentiality, data protection information
- 10.10 Understand the principles of budget management
- 10.11 Act as a team member valued by others over a prolonged period of time.
- 10.12 Understand the principles of good employment practice, including fair and effective recruitment.
- 10.13 Demonstrate adherence to professional codes of ethics at all times including financial probity and professional confidentiality.
- 10.15 Appraise a business case
- 10.16 Demonstrate project management skills in specific pieces of work.
Public health skills are built on a knowledge base which is detailed in the MFPH Part A syllabus, including:
- Basic and clinical sciences including research method, epidemiological and statistical method, health needs assessment and evaluative technique.
- Disease causation and prevention including health promotion, screening, communicable disease and environmental hazard control and social politics.
- Organisation and delivery of health care, including health intelligence.
- Knowledge of the law as it affects the population's health.
- Leadership and management skills including change management and health economics.
- This knowledge base has been mapped to the nine key areas of public health practice and every learning outcome has a clearly identified knowledge base (other than those which define attitudes and behaviours).
- Trainees may attend a formal academic course or prepare for the examination under their own direction.
- The Part A MFPH examination is held twice yearly, in January and June. Trainees would normally be expected to sit this examination at the earliest opportunity depending on the length of their academic course.