RESUMO
Little is known about the current experiences of Public Health/General Preventive Medicine (PH/GPM) residents and graduates in the United States. This cross-sectional study of PH/GPM residents and graduates examined their knowledge of the field and career choices after graduation. We developed a questionnaire to address medical education, graduate medical training prior to Preventive Medicine (PM), current PM training, and post-graduation goals. Data was stratified by residency status (resident vs graduate), and board-eligibility (dual-eligible vs solely PH/GPM). Bivariate analysis of quantitative data was performed using Fisher's test. Qualitative data were organized into themes and analyzed quantitatively. Of those invited to participate, a total of 153 (18.25%) PH/GPM residents and graduates responded to the survey. We found diversity in prior medical education/training among respondents. Overall, debt burden at the start of training was low compared to national trends. Compared to residents, a higher proportion of graduates were board-eligible in another specialty (p<0.001). Most respondents felt that their programs provided them with opportunities to acquire skills essential for a career in PM. Ninety-one percent of graduates were board-certified in PH/GPM. Respondents expressed a wide range of career interests, including government work and academia. Difficulty with marketing themselves as PM physicians was frequently cited as a reason for the difficulty in securing a PM job. The results inform the PM community with current trends in PH/GPM training and career obstacles faced by PM graduates.
RESUMO
BACKGROUND: Clusters of COVID-19 cases amplify the pandemic and are critical targets for intervention, but comprehensive cluster-level data are not collected systematically by federal or most state public health entities. This analysis characterizes COVID-19 clusters among vulnerable populations housed in congregate living settings across an entire community and describes early mitigation efforts. METHODS: The Cuyahoga County Board of Health identified and interviewed COVID-19 cases and exposed contacts, assessing possible connections to congregate living facilities within its jurisdiction from March 7, 2020, to May 15, 2020, during the first phase of the pandemic, while state of Ohio stay-at-home orders were in effect. A multi-disciplinary team-based response network was mobilized to support active case finding and develop facility-focused containment strategies. RESULTS: We identified a cascade of 45 COVID-19 clusters across community facilities (corrections, nursing, assisted living, intermediate care, extended treatment, shelters, group homes). Attack rates were highest within small facilities (P < .01) and large facilities requiring extensive support to implement effective containment measures. For 25 clusters, we identified an index case who frequently (88%) was a healthcare worker. Engagement of clinical, community, and government partners through public health coordination efforts created opportunities to rapidly develop and coordinate effective response strategies to support the facilities facing the dawning impact of the pandemic. CONCLUSIONS: Active cluster investigations can uncover the dynamics of community transmission affecting both residents of congregate settings and their caregivers and help to target efforts toward populations with ongoing challenges in access to detection and control resources.
