(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.
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
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 fromthe 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
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
