THE CAREER DEVELOPMENT PROGRAM IN MATERNAL AND CHILD HEALTH

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(Received November 21, 1967; revision accepted for publication February 4, 1968.)

ADDRESS: (H.M.\V. ) University of California School of Public health, Earl \Varren Hall, Berkeley,

California 94720.

SPECIAL

ARTICLES

THE CAREER

DEVELOPMENT

PROGRAM

IN

MATERNAL

AND

CHILD

HEALTH

Helen M. Wallace, M.D., MPH, Samuel Dooley, M.D., Victor Eisner, M.D., MPH, and Constance Fraser, M.A., MPH

Froni the Division of ilfaternal and Child Health of the University of

California School of Public Health at Berkeley

ABSTRACT. Studies have indicated a need to

re-(ruit and train vouig physicians with specialty

1)oard training for positions in the field of maternal

and child health. To meet this need, a program has

been established at tile University of California

School of Public Health at Berkeley in conjunction

with the departments of pediatrics of three schools

of medicine. The program consists of 2 years of

pediatric clulical training and 1 year of public

health training with a major in maternal and child

health, and it is designed to encourage young

physi-chins to complete specialty training in pediatrics

while obtaining the degree of master of public

health.

Evaluation after 4 years of operation indicates

that the program is meeting its objectives.

Pedi-(Itrics, 41: 1 135, 1968, TIIAINEESHIP5, PEDIATRICS,

SCHOOLS, PUBLIC HEALTH.

ECRUITMENT OF MEDICAL PERSONNEL into

the field of public health has always been

difficult and has lagged behind needs. Studies of

medical personnel in the field of maternal and

child health conducted in 1962’ indicated that

more physicians needed to be recruited to fill

al-ready existing full-time positions ill state and

local health departments, and that they needed

to be recruited at an earlier age. At that time,

20% of tile 261 full-time medical positions in

state and local maternal and child health and

crippled children agelicies in the United States

were vacant. The need to recruit physicians

with specialty board training was shown by the

finding that only 54% of tile 209 physicians

then employed in these positions were certified

l)y a medical specialty board. At the same time

a study of United States pllvsicians majormg ill

maternal and child llealth in ScilOols of public

health2 showed that only 163 physicians had

received this training in the past 14 years.

Eighty percent of these had had clinical

train-ing in pediatrics, although only about half were

i)oard certified. These physicians had entered schools of public health at a mean age of 36.4

‘ears, an average 10.6 years after graduation

from medical school. Because of these facts the

Conference on Maternal and Child Health

Teaching in Graduate Schools of Public Health

recommended in 1962 establishment and

funding of career development programs for

young physicians to meet the long-range needs

for physicians ill niatei-nal and child llealth.

This paper vill describe some of tile aspects

of the Maternal and Child Health Career

Dc-vebopment Program established at tile

Univer-sity of California School of Public Health in

conjunction with three medical schools.

PROGRAM CONTENT

The Maternal and Child Health Career

Dc-velopment Program#{176} at the University of

Cali-fornia School of Public Health has two

compo-nent parts: a program for pediatricians, which

was started in 1963, aIld a program for obste-tricians, started in 1966.

Tile objectives of tile )OflhIll are: (1

identification and recruitment of interested

medical students, interns, and first-year

pediat-nc residents to the maternal and child health

field;0 (2) training of physicians at tile outset

of their careers in both public health, with a major in maternal and child health, and clinical

pediatrics; (3) identification of interested

phv-sicians currently employed part time in state

and local health departments and recruitment

of these physicians to full-time employment in the field of maternal and child health.

0 The term “maternal and child health” is used

in this paper to include the areas of care of

handi-capped children, mental retardation, and

compre-hensive care of mothers and children.

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1136 MATERNAL AND CHILD HEALTH

Graduates of this program would be

pre-pared for ( 1 ) the development and

administra-tion of maternal and child health programs at

local, national, state, or international level; (2) teaching positions in medical school pediatric departments or in maternal and child health departments in schools of public health; (3) research in maternal and child health areas; (4) practice with emphasis on community as-pects of maternal and child health involving part-time consultant positions with state and

local health departments.

The 3-year program consists of 2 years of

residency training in a university hospital

affihi-ated Witil a medical school and 1 year of

public health training with a major in maternal and child health in the school of public health.

The residency training is provided in the

de-partments of pediatrics of three medical

schools on the West Coast (the University of

California ill San Francisco, Stanford

Univer-sity in Palo Alto, and the University of

Wash-ington in Seattle) and the Department of

Ob-stetrics and Gynecology of the University of

California Medical School in San Francisco.t

The first and third years of the pediatric

program consist of residency training. The first

year is similar to the usual residency in

pediat-rics. The third year of training, which is the

second year of pediatric residency training, is designed to further orient the trainee toward the field of maternal and child health and corn-rnunity pediatrics, as well as to complete his clinical training. The manner of accomplishing

this varies somewhat among the three medical

schools.

The obstetric program follows 2 prior years of residency training in obstetrics and gynecol-ogy at the University of California Medical School. It consists of 2 years of further resi-dency training in obstetrics and gynecology,

f The pediatric residency training has been

under the general direction and supervision of

I)rs. Edward Shaw, Melvin Grumbach, Moses

Grossman, and Ann Sproul (University of

Califor-nia); Drs. Norman Kretchmer, Robert Alway, and

Luigi Luzzatti (Stanford University); and Dr.

Robert Deisher (University of Washington). The

obstetric training has been under the direction

and supervision of Dr. Ernest Page. A new faculty

member in maternal health, who will hold a joint

appointment in both the School of Public Health

and the Medical School, will be responsible for

the obstetric trainees starting in September 1968.

followed by a final year at the School of Public Health. In this year the trainee will major in maternal and child health, with special empha-sis on maternal health including family

plan-ning. This portion of the program recruited its

first trainee in 1966.

The second year of the training program, which is spent at the School of Public Health,

is divided into two parts:

1. A 3-month period after completion of the

first year of pediatric residency training and

prior to entrance to the School of Public

Health. This period may be spent in a health

department observing and often participating

in maternal and child health programs; in a de-partment of pediatrics of a medical school,

with some observation of maternal and child

health services in the community; in a tax-sup-ported hospital Wllich has community-oriented health services; or in the School of Public Health participating in a research project.

2. A 9-month period at the School of Public Health, registered as a candidate for the

de-gree of Master of Public Health with a major in maternal and child health.

The maternal and child health faculty

con-ducts a semi-monthly seminar for the career

development students. It is intended for those

students in all 3 years of the training program

who are in the San Francisco Bay area. This seminar has now been held for 2 years. In the

first year of its operation, tile contest consisted

of presentation of individual “cases” of fami-lies with multiple problems, requiring the

ser-vices of a number of community agencies. In

the second year, the content emphasized public health principles and methodology in delivery of care to mothers and children, with selected field visiting as demonstration. This pattern is being continued in the third year.

Immediately following the academic year at the School of Public Health, the career devel-opment students participate in a 3- to 4-week field trip to Puerto Rico. This trip is planned with the maternal and child health faculty of the University of Puerto Rico School of Public Health, and it is supervised by the Professor of Maternal and Child Health there and by one of the members of our own faculty. The special

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SPECIAL ARTICLES

FACULTY LIAISON AND

ADMINISTRATION

Iii the planning stages of the training

pro-gram, an advisory committee was formed to

guide the development of policy. The functions

of this committee, as originally established,

were to

(

1) set broad policy regarding the training program, (2) periodically review and evaluate the program, (3

)

recommend modifi-cations as experience is gained in the program,

and (4

)

review policies for selection of train-ees. It is composed of faculty members from

the School of Public Health and the three mcd-ical schools.

Trainees for each of the three programs are

selected by the department of pediatrics of each medical school and by the maternal and

child health faculty of the School of Public Health. This has worked well.

For the first and third years of training

(pe-diatric residency) , each of the three medical schools has designated a faculty member to be

in charge of the Career Development Program

and its students. The maternal and child health

faculty in the School of Public Health is re-sponsible for the year of public health training.

The summer program of 3 months of public health, observation, participation, or research at the end of the first year is usually planned

by the department of pediatrics of the medical

school and reviewed with the maternal and

child health faculty of the School of Public

Health. In addition, since the program has

been under way, the maternal and child health

faculty meets regularly with the responsible

faculty member from each medical school with

his separate trainee or trainees, to review the

individual program for each trainee. The

ma-ternal and child health faculty also spends con-siderable time with the trainees to assist them in planning their employment career for the future.

FUNDING

The original funding for the Career

Devel-opment Program ill Pediatrics was provided by

the Rosenberg Foundation, which generously

provided funds for a half-time faculty member

ill each of the two departments of pediatrics in the two medical schools in tile Bay area. Subse-quently, the entire funding provided for this

program has come from the U.S. Children’s

Bureau. It now consists of funds for

fellow-ships, plus a faculty member in charge of the entire Career Development Program ill

Pediat-rics.

The funding of fellowships for the Career Development Program in Obstetrics and

Gyne-cology is also provided by the U.S. Children’s

Bureau.

TRAINEES

In the beginning of the program (1963),

the trainees selected were recent medical

school graduates who had just completed their internship. More recently, ve have succeeded

in recruiting another type of trainee to the pro-gram-an “older” group (in their thirties), usually with some experience in some phase of

public health, who wish to receive preparation

in both pediatrics and public health. The train-ing program is now accepting and preparing both of these groups. Since 1963 14 trainees

have entered the program, and 5 had

com-pleted it by 1967.

All of the five trainees who completed their

training in June 1967 plan to be employed full-time in the field of maternal and child health. One is employed as pediatric consultant

in a regional center for mentally retarded

chil-dren. The second is employed in a local health

department as tile assistant health officer in

charge of maternal and child health. The third

is employed in a preschool program in a local

board of education. The fourth is taking an ad-ditional year of training in pediatrics and child health. The fifth is planning employment in the near future.

FUTURE PLANS

The training plan for the future includes two additional steps to broaden the experience of tile trainee and prepare him for future

em-ployment:

1. Assignment of each career development

student to a family to follow for 3 years.

In-eluded in this plan is a study of the community agencies serving this family.

2. Assignment of each career development student to a community program of

compre-liensive health care of children and ‘outh.

SUMMARY

A training program has l)een developed to

identify and recruit young physicians for

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ma-1138 MATERNAL AND CHILD HEALTH

ternal and child health, with a specialty ni

ci-tiier 1)ediatricS or obstetrics. After 4 years, this )rOgrarn is meeting its objectives.

REFERENCES

1. \Vallace, H. M., Hammersly, M., Hunt, E. P.,

and Luten, L. : Physicians in maternal and

child health and in crippled childrens

programs-1962. Anler. J. Pub. Health,

55:842, 1965.

2. Wallace, H. M., and Hunt, E. P. : Foilowu1)

study of MCH trainees in schools of public

health. Pub. Health Rep., 78:603, 1963.

3. Committee On Relationships Between Schools

of Public Health and Maternal and Child

Health and Crippled Childrens Services,

Ma-ternal and Child Health Section, APHA.

Professional Education for Maternal and

Child Health. New York: American Public

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1968;41;1135

Pediatrics

Helen M. Wallace, Samuel Dooley, Victor Eisner and Constance Fraser

HEALTH

THE CAREER DEVELOPMENT PROGRAM IN MATERNAL AND CHILD

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1968;41;1135

Pediatrics

Helen M. Wallace, Samuel Dooley, Victor Eisner and Constance Fraser

HEALTH

THE CAREER DEVELOPMENT PROGRAM IN MATERNAL AND CHILD

http://pediatrics.aappublications.org/content/41/6/1135

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American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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