Academic Public Health training: Regional guidance for Academic and Educational supervisors and Public Health Specialty Registrars in the South West
With the development of Public Health training, changes in the DFPH and MFPH exams and the introduction of the ARCP and e-portfolio there has been a growing need to review the role of academic supervisors (this term is equivalent to the term “trainers”). These changes have in some cases resulted in confusion concerning the respective roles of academic and service supervisors as well as some concern that there has been a loss in academic rigour and training with the adoption of the MFPH exam instead of the old style two project mini-thesis. The training programme Director therefore felt it was appropriate to bring together representatives from the various academic units to clarify and provide guidance for all relevant parties. In particular informal feedback from specialty registrars highlights that some specialty registrars are either unsure as to what is reasonable to expect from their academic supervisors or in some cases too intimidated to ask. Similarly, there is some anecdotal evidence that educational supervisors are sometimes less supportive of academic training than they should be. We hope this guidance document will act as a useful tool to facilitate discussions between academic supervisors, specialty registrars and educational supervisors and thereby maximise the educational value of any academic training. However the rhetoric will only be translated into reality if all parties actually use these materials as the basis for their discussions and reports.
What is academic Public Health training?
All specialty registrars require a core understanding and skills in academic Public Health. This will usually cover topics such as epidemiology, statistics, health services research, health economics, research governance etc.
A large amount of this training will occur as part of a formal masters programme undertaken in the first year of training. However, it is assumed that further learning opportunities, both “informal” and formal will occur across all phases of training. In particular, the application of theoretical knowledge and skills to everyday public health problems. It is the role of the academic trainer to support these activities, identify learning and training opportunities (for example by attendance on a short course), and provide guidance concerning the balance between academic rigour and the practicalities of a demanding service job.
Who are academic supervisors?
The South West currently has three academic centres: University of Bristol (UoB), University of the West of England (UWE) and the University of Exeter (UoE). At each location there are a number of staff who have achieved registration as a public health specialist either through having completed formal Public Health training or through the portfolio route (referred to as “consultant academic supervisors”).
In addition there may be other academic staff whose academic expertise is very relevant to Public Health training and who may therefore play a role in either project supervision or act as an academic trainer for specialty registrars who are located in service training posts (“non-consultant academic supervisors”). Specialty registrars who are either seconded to an academic department or formally based there as either an ACF or lecturer would have a consultant academic trainer as their lead trainer though may actually be working more closely with a non-consultant academic trainer depending on their piece of research. This is equivalent to being allocated an educational supervisor for a service location but working mainly with a service project supervisor. In the context of specialty registrars who are based in an academic centre, these roles are called ‘academic supervisor’ and ‘project supervisor’ hereon. This is an important distinction given the changes to the structure and quality assessment of training made in 2007.
Like other speciality training programmes, the Public Health programme is designed and run to meet national requirements set out in the ‘Gold Guide.’ Progression through training is assessed by ‘Annual Review of Competence Progression (ARCP) panels’ who look to academic, educational and activity supervisors to play distinct roles in assessing evidence and providing reports on a specialty registrar’s progress.
Role of academic supervisors
Each registrar is allocated an Academic Supervisor at the start of training, usually linked to the course of academic study. They support the trainee in: attaining relevant academic (teaching and research) competencies; preparation for academic courses and MFPH examinations; development of projects and submissions for publication or conferences. This role is unique to public health: it is a requirement for Phase 1 and optional for later phases of training.
According to Faculty guidance, Academic supervisors should show a commitment to training and ensure they:
- Provide supervision, support and advice to the trainee on an ongoing basis for the first phase of the training programme, particularly in relation to academic courses (such as MPH) the DFPH examinations and research projects.
- Assist the trainee to identify his or her academic learning needs, develop appropriate strategies and identify resources to meet these needs. This will also include giving advice in relation to specific academic topics and other work such as publication of material.
- Usually sign off academic activity sheets (The Educational Supervisor will normally sign off all Learning Outcomes).
- Provide information to the Educational Supervisor so that their report for ARCP can include an academic assessment (Trainees should ensure that there is at least one three-way (tripartite) meeting between the Registrar, Educational Supervisor and Academic Supervisor each year).
Academic supervisors need sufficient knowledge of specialty public health training (as per the 2015 Curriculum) to enable them to support appraisal, assessment and annual planning.
The roles of academic supervisors and academic activity supervisors in formal assessments
The activity supervisor’s role in assessment is to assess the quality of work on a defined project and record this on the relevant project activity summary sheet (ASS). The educational supervisor’s role in assessment is to look at evidence from one or more activity summary sheets relating to a particular learning outcome. In the academic context, activity supervision could come from a trained academic supervisor or another member of staff able to provide supervision and assessment appropriate to the task. By contrast, the educational supervisor’s role of deciding whether learning outcomes have been met for Academic Public Health should be fulfilled by a fully trained academic supervisor (either consultant or non-consultant) who meets the role and knowledge requirements set out above.
Training for academic supervisors
All academic supervisors must have completed the South West training modules. In addition, it is expected that supervisors would continue to develop and refresh their training skills through attendance at the annual training conference or ad hoc workshops and modules organised by Severn PGME or the Public Health training programme. The core training requirements for educational supervisors are set out by Severn Deanery and are as follows:
- Roles and Responsibilities of Educational Supervisors and an overview of the other key roles required in the training of doctors
- Guidance on required trainee assessments
- Appraisal processes and skills
- Educational theory and practice
- Annual Review of Competence Progression (ARCP) processes
- Equality and Diversity
- How to Support Trainees
Role of the Academic Public Health Lead (Specialty Tutor)
Within each of the three academic centres there is a nominated trainer who acts as the lead for that centre. This is equivalent to the specialty tutor at service locations. In the South West the respective roles are currently held by Ruth Kipping (UoB), Paul Pilkington (UWE) and Iain Lang (UoB). They should have a “light touch” overview of all specialty registrars in their centre and will allocate supervisors to new specialty registrars.
They may also be asked to review the academic needs of new specialty registrars who have either done a Masters a long time ago or have done an unconventional masters programme and so may require further training in some topics e.g. epidemiology. Specifically the Training Programme Director will seek the academic supervisor’s advice on meeting the specialty registrar’s learning needs for passing DFPH. The issue of whether such a specialty registrar is given a full five year or shortened (4.5 year contract) will need to be discussed with the educational supervisor and any recommendations made to the training programme director.
Additional supervisor support with difficulties in training at academic locations
It is important that both supervisor and specialty registrars understand their respective roles and duties. We believe the following guidance will facilitate this process by making it more explicit and standardised. However, there may be occasions where there are problems with this relationship or there may be conflicts of interest. It is therefore important that specialty registrars are aware of where to seek advice and help in these circumstances. The default person would be the Public Health lead at that location. If however this person is also the academic supervisor then there needs to be a second independent nominated supervisor, usually someone who is relatively experienced. We suggest that this is organised and agreed from the outset and that all parties are aware of this arrangement. Finally a specialty registrar can always seek advice from the training programme director.
Meeting between academic supervisor and specialty registrars
Frequency and purpose of meetings
We recommend that all specialty registrars meet their academic supervisors on at least three occasions over the year. At least one of these meetings should be a three-way meeting with the educational supervisor also being present. This is usually held before the ARCP meeting but could also be held immediately after as well. In general these meetings should be face-to-face but given the large distances involved in our Region, a teleconference meeting is acceptable. Specialty registrars should take responsibility for organising these meetings and academic supervisors should ensure that they make themselves available given reasonable advance notification. The purpose of these meetings is highlighted below. Some issues are generic and appear across all three phases of training whilst other phase-specific.
Topics to be addressed during Phase One:
- MSc course – progress, areas of potential academic difficulty, potential topics or datasets for dissertation, consider whether the dissertation could be considered for publication
- DFPH – help and support with topics that the specialty registrar may find difficult. Consider help with sample DFPH questions or marking mock papers
- Review phase one competencies
- Review need for any future courses (e.g. short course programme in Canynge Hall or other training courses at UoE or UWE) that the specialty registrar may wish to sign up for the future year.
- Help with MFPH practice
- Consider opportunities for teaching experience and possibly undertaking further teaching training
- Consider opportunities for publication
Topics to be addressed during Phase Two:
- Discuss career pathway – particularly if the specialty registrar wishes to consider an academic career
- Discuss potential secondments or applications for lecturer post
- Discuss how future service projects may provide educational opportunities to reinforce or practice academic skills e.g. analysis of routine survey data
- Consider opportunities for teaching experience
- Review need for any future courses
- Review opportunities to present work to academic meetings either regionally or nationally
The role of the academic trainer ARCP report
All academic supervisors must complete a report prior to the ARCP. This should be written after a three-way meeting usually 4-6 weeks before the ARCP meeting itself. The current template is shown below.
COMMENTS Evidence should be given that is linked to the evidence provided by the trainees in their portfolio(add additional sheets if necessary)
AREAS FOR IMPROVEMENT
RECOMMENDATIONS (state where special attention should be given in future)
It is our experience that academic reports can be rather superficial and not truly highlight both positive achievements and any training gaps that have been identified. It is not always clear how these will be resolved over the forthcoming year. This makes it hard for the ARCP panel to know how well the specialty registrar and supervisors have planned activities to maximise learning opportunities.
An exemplar report
We suggest the academic supervisor’s report should consider and address the following issues after the supervisor and specialty registrar have had a satisfactory review and discussion with the educational supervisor about the forthcoming year.
Review of previous year (assuming this is not the first report it is important that any previous recommendations are followed-up):
- X has had a very good year and should be congratulated for passing their DFPH on their first attempt. They have completed all 5 Phase 1 competencies in key area 8. I was particularly impressed with their systematic review that they submitted for their dissertation. This work, if extended with a formal meta-analysis is original and in my opinion suitable for publication. I would suggest that X discusses this further with their MSc project supervisor for that piece of work who can provide more academic support.
Document any formal academic training courses:
- Over the last year X has attended the MPH at the LSHTM. They have therefore not attended any other courses though have occasionally been to academic seminars at the UoB
Document past meetings with specialty registrar:
- We have met on three occasions over the last year (July 2018, Nov 2018, March 2019). The second meeting was done over the telephone for reasons of convenience. In addition there has been occasional email communications.
Highlight training opportunities and needs for forthcoming year:
- I would highly recommend that X goes on the one week short course at Canynge Hall on Systematic reviews and meta-analysis. This will provide X with the relevant skills and confidence to undertake their meta-analysis. I would be happy to help if there are any academic queries and we can facilitate access to stata software if this is an issue.
- Over the next year, X and their educational supervisor have identified a project around the high rate of teenage pregnancies in their local area. As part of this project X will be designing and undertaking a school based survey. This will provide an excellent opportunity to consider the validity of data collection and then the analysis of responses based on various socio-demographic factors (this will be used to complete learning outcome X). I would be happy to advise on the questionnaire design and analytical strategy. If the specialty registrar needs further experience with multi-variable regression analysis, then I would recommend they read the following textbook and consider attending the two day regression methods short course. This piece of work, once completed, would be ideally suited for an oral presentation at the Scientific Conference and I would encourage them to submit an abstract for this meeting.
- We are also currently looking for specialty registrars to help with our Public Health teaching for the 4th year medical students. This runs four times a year and it would be sensible for X to observe the next session done by Dr. Z. Then, once they have gone over the materials, they could deliver this on the next rotation. They could also register for a teaching course, in which case I would be happy to act as their learning mentor.
Consider future career:
- X currently hopes to become a Public Health consultant and does not have any specific academic aspirations. However, they may be interested to spend six months on an academic secondment in phase 3 of their training so that they can work with Prof Y., as he has a specific interest in teenage health issues which is a topic that X would like to learn more about. I have recommended they speak to Prof. Y and plan out what the learning objectives would be for such a secondment. This can then be factored into their longer term training programme assuming the ARCP panel feel they are making good progress.
The inter-relationship of academic and educational supervisors
It is common that educational and academic supervisors meet infrequently to discuss their specialty registrar’s progress. This is unfortunate as both supervisors would gain a more holistic impression of the specialty registrar’s strengths and weakness by discussing how the specialty registrar functions in different settings. In addition, it is essential to plan the academic component of any service project from the outset. Too often a specialty registrar will go to see their academic trainer for help after a project is complete. In this case if there is a design issue it is too late to alter things and the work may be seriously compromised.
We believe that the joint discourse between educational and academic supervisors with the specialty registrar brings added dimensions to planning future training opportunities that is of real value. It also encourages mutual respect for the roles of both supervisors. Some supervisors can have “stereotypical views” of their counter-parts which is not usually justified. This is important as all supervisors implicitly act as role models for specialty registrars. Hence an educational supervisor who feels that “ivory-tower” academic supervisors are out of touch with service work may give negative signals to their specialty registrar about academia. Similarly an academic supervisor may give a negative impression that all service work is “quick and dirty” and has little value. By discussing projects together, specialty registrars will get some experience of the real-world tensions of undertaking service work whilst still maintaining academic quality given the limitations imposed within the service setting. This is a useful educational experience in its own right.