Adequacy of training in preventive medicine and public health: A national survey of residency graduates

Purpose. To evaluate training in general preventive medicine and public health, determining which experiences and institutional sponsors best prepare residents for practice and where improvements are most needed. Method. A 1991 survey of the 1,070 graduates of preventive medicine residencies from 1979 through 1989 asked the graduates to measure the adequacy of their training in preventive medicine topic areas by using a Likert-type scale of 1 (poor) to 4 (excellent). Adequacy was analyzed for variation against practice emphasis during training, training program sponsor, and other variables. The statistical methods included Student's t-test, analysis of variance, and linear regression. Results. A total of 797 graduates (74.5%) responded, The overall mean ratings of adequacy of training were 3.1 (SD, 0.9) for epidemiology, 2.5 (SD, 1.0) for clinical preventive medicine, 2.4 (SD, 0.9) for environmental health, 2.3 (SD, 0.9) for health administration, 2.3 (SD, 0.9) for health education and behavioral sciences, and 2.2 (SD, 0.9) for occupational medicine. Training was rated highest for topics emphasized during practice experiences. Adequacy varied by type of institution sponsoring the residency. Women rated their training as being less adequate than did men in all areas except clinical preventive medicine. The graduates tended ultimately to practice in topic areas emphasized during training. Conclusion. The graduates' ratings suggest that improvements are most needed in health administration, environment health, health education, and occupational medicine. Potential improvement strategies include highly focused practice experiences and increased emphasis on training in actual practice settings and community sites.