Academic training in public health medicine in the UK: findings from an electronic mail census.

The last three years have seen considerable changes in the process of public health medicine (PHM) training in the UK. Reforms following the Calman report have ensured the development of training programmes with defined objectives, assessment and duration. These changes have been broadly welcomed, but raise challenges for academic training where there has been more flexibility in the past. Between gaining sufficient PHM service experience and completing specialist training, there is a narrowing window of opportunity for an academic career, and time and funding for a higher degree may be problematic. Furthermore, there are wider problems within academic medicine related in part to the research assessment exercise, which have led to difficulty in recruiting to higher level posts and put clinical lecturer posts at risk. This is despite increasing emphasis on teaching public health to medical students. Apart from the survey of lecturers by Goldacre et al., which contained a small atypical sample of lecturers in PHM, little information is available about the group of public health doctors pursuing an academic career. To address this issue we decided to locate and survey all academic trainees in PHM. We defined a lecturer in PHM as a non-tenured clinical lecturer, a registrar with an academic attachment, or someone in an equivalent junior academic post, such as a research training fellow. We compiled an initial list from multiple sources and through an iterative process developed a complete list of lecturers and their e-mail addresses (detailed methods are available from the authors). The total numbers of trainees in PHM by region was obtained from the Faculty of PHM Workforce Database and the total number of medical and dental students by region from the Higher Education Statistics Unit. A pre-piloted e-mail questionnaire with 24 closed and three open questions was sent to all lecturers on 1 June 1998. Nonresponders received two e-mail reminders and a final telephone reminder. We have not reported the qualitative findings here. There were 59 lecturers in PHM in post (Table 1) with a median of four per region (range 1–12). Twenty-two (37 per cent) were based in London. Forty-five (76 per cent) were based in one of the 25 medical school departments of public health (or equivalent): median one per school (range 0–5). Six medical schools had no lecturers on the census date, although three had made recent appointments. The response rate to the questionnaire was 88 per cent. Table 2 shows the median lengths of respondents training in current and previous posts. A median of a further 1.7 years (range 0–5) was considered necessary before being ‘fully trained’ and capable of applying for a senior lecturer post. Figure 1 shows the qualifications, grants and publications held at the start of the current post and on the day of the census, and the division of time between service work, research, teaching and administration. Fifty-five per cent thought that their post prepared them well or very well for research. Whereas a fifth (21 per cent) had research degrees and 18 per cent were registered for one, 71 per cent supervised research. Ten lecturers, currently without research degrees, stated that they had not been given an opportunity to study for one.