Comparison of public health and preventive medicine physician specialty training in six countries: Identifying challenges and opportunities.

RATIONALE: Public health and preventive medicine (PHPM) has been recognized internationally as a physician specialty, but national parallels and differences exist between training contexts. This paper reviews PHPM training and employment in Canada, France, Italy, Japan, the United Kingdom, and the USA. METHODS: Information gathered from relevant accreditation bodies and literature searches was used to create descriptive profiles of national training demographics and structure and a narrative outlining trends and challenges facing the specialty. RESULTS: Notable similarities and differences exist between national contexts. Key themes were differences in training strategies and practice scope, specialty stakeholders, certification structure, and funding. Recognition challenges faced the specialty across all six countries. Other challenges included unclear competencies and training strategies and a need for PHPM specialists to highlight their role in combating population health threats. Additional differences existed between comparator countries on the structure of training, funding sources for training programs, availability of training posts, and linkages with other physician specialties. CONCLUSION: Highlighting these themes is a first step to fostering training collaborations between PHPM specialist physicians to augment transnational action on global public health challenges and also supports PHPM physician educators with innovative solutions from abroad that might address domestic specialty challenges.

Injuries to deployed U.S. Army soldiers involved in HMMWV crashes, 2002-2006.

Highly mobile multipurpose wheeled vehicle (HMMWV or Humvee) crashes present an important issue for the U.S. military. The aim of this study was to provide a descriptive analysis of occupants of military motor vehicle (MMV) crashes involving HMMWVs that occurred among deployed U.S. Army Soldiers. Crash-related data were collected from the U.S. Army Combat Readiness/Safety Center on MMV crashes among active duty Army personnel between 1999 and 2006. Records for 964 occupants with injuries from HMMWV crashes were analyzed, which represented 52% of the total occupants of MMV crashes. A significant association was observed between injury and engagement in combat, odds ratio 1.49 (1.03, 2.16). The risk of injury was greatest for gunners, odds ratio 2.37 (1.43, 3.92), and injury cost related to the crash was significantly related to prior deployment status (p < 0.001) and role of Soldier in the vehicle (Operator p = 0.005, Gunner p = 0.003). There was also a decrease over time in the number of crashes resulting in injury (p < 0.001). These data support the development of interventions that address the specific risks detailed, including the use of combat simulation training, increased protection for vulnerable positions, and enforcement of safety regulations.

Public health physician specialty training in Canada and the United States.

Today's interconnected world has produced a distinct need for physician specialists in public health and preventive medicine. As the industrialized world confronts aging populations, rising health care costs, and a growing epidemic of chronic disease, it is clear that the focus of health care must become more preventive than curative.Although public health and preventive medicine exists in various forms worldwide, the literature has not yet examined different national strategies for postgraduate medical training in this unique specialty. This examination of present-day public health physician training in Canada and the United States represents a first step in addressing this gap.Using a standardized template for review, the authors compare key aspects of public health physician specialty training in both countries, including the definition and scope of the specialty; oversight and location of training; length of postgraduate training; specific clinical, academic, and practicum requirements; residency program funding; availability of residency positions; certification; and the roles of specialists.The authors explore similarities and differences between public health physician specialists in Canada and the United States in an effort to highlight training improvements for incorporation into each country's training program and to identify potential avenues of collaboration and cooperation across the border.