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Public Health from a Foundation Year Perspective

A Walk into the Unknown

Choosing a Foundation Year 2 (FY2) rotation was daunting for most of us; the components of the available combinations bore little relationship to each other and a future surgeon might well have had to do four months of general practice and four of paediatrics just to get a four month stint in surgery.

I wanted to do obstetrics and gynaecology or paediatrics as I am heading into general practice with a particular interest in women's and children's health. There was no combination available including both specialities and it was the presence of public health in the obstetrics and gynaecology rotation that swung my vote in that direction.

Public health as a rotation to junior doctors was on offer for the very first time. I had very little idea of what public health is but thought it would probably be helpful to a future GP who wants to be a partner. So off I went to the floral town of Britain to work in the Suffolk PCT.

“What do you do, sit behind a desk and drink coffee all day?” “What is public health anyway?” are some of the questions that I have been asked by my fellow FY2s.

True, for the first two weeks I had many of the same questions. I felt that I was walking in a mist of unknown acronyms and complicated systems – but that happens in most jobs at first.

However, at the end of the rotation (I have 2 days left now) I feel most privileged to have had the opportunity to acquire a unique set of skills that are so very pertinent to today's medicine that I would never have gained anywhere else, even in the clinical setting that I much prefer.

I may have missed gaining clinical skills and experience that a clinical placement would have afforded me, but I know that I will be collecting those for the rest of my life. Public health has not altered my career decision but it was a once off, not to be missed opportunity that has changed my perspective for ever.

In a world of limited resources decisions about prioritisation have to be made daily. Public health has the privilege and public responsibility of making tough decisions on a population basis about clinical prioritisation. It taught me, in a more rigorous way than in any of my previous clinical jobs, to be evidence based in every area of practice and decision making. The strict adherence to action based only on evidence and the forceful reasoning inherent in this approach has indelibly marked my own practice, even in this early phase as a FY2 trainee. There can be no other way forward (except where no evidence exists – then it must be sought).

Question setting, literature searching, and critical appraisal were areas that I felt totally incompetent in prior to this placement. I would not claim to be proficient, but I have got on the ladder now and may even have climbed a rung or two. Clinical excellence must surely always be evidence based.

The emphasis on collective responsibility for health, the role of the state and the wider determinants of health and on partnerships enabled me to step back and take a more global perspective of medicine and the essential partnerships that make today's medicine work.

Meeting some of the enormous number of stakeholders in the NHS and watching, and then participating, in their interaction gave me the impression that I have opened the back of an old watch and seen how the cogs work (albeit some of them may need a fair amount of oil). Just as “no man is an island”, no structure in medicine, be it in primary or secondary care can be an ostrich. The awareness of so many other interested parties and their willingness to engage with providers and commissioners in the interests of improved clinical and, dare I mention it, cost effectiveness, I hope will add to the service that the teams that I work in can provide to their patients.

There were numerous other additional skills that I progressed in which are increasingly valuable in medicine (presentation, audit, research, publishing, communication, team working, leadership, meeting management and IT skills to name a few).

At the end of my placement my walk into the unknown has brought me out into a slightly different land where I know more than just the main domains of public health (health protection, health promotion and service improvement); I feel enthused and enabled to be a better clinician by my exposure to public health. I truly believe that it would be useful for every Foundation Year trainee to undergo some training in public health, especially those considering a future in general practice where the knowledge and skills to be gained are even more pertinent.

And in answer to the first question, no, I didn't drink coffee all day, I much prefer tea.

© Dr Nicola S Skrinchuk 2006, Foundation Year 2 doctor, West Suffolk Hospitals NHS Trust

"I feel enthused and enabled to be a better clinician by my exposure to public health. I truly believe that it would be useful for every Foundation Year trainee to undergo some training in public health, especially those considering a future in general practice where the knowledge and skills to be gained are even more pertinent."


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