The way I see it

I have an embarrassing secret

Authors: Kate Mandeville 

Publication date:  13 Feb 2008

Kate Mandeville has decided to out herself through these pages

I have an embarrassing secret. One that I have had to keep to myself all the way through medical school, one that I have disguised with my cover story of a wannabe tropical medicine specialist, and one that I only now feel comfortable coming out with to my friends. Yes, I want to go into public health.

Bad representation

I realise that it may not be top of anyone’s list, but I believe that’s mainly down to the bad representation it gets at medical school. The vision and scope of public health are swallowed up by a medical curriculum stuffed full of clinical facts. One of my friends even asked disbelievingly, “You mean you want to go intostatistics?” Public health is far more than just age standardised rates and death certificates.

In fact, I was so enthused about the specialty that I arranged my foundation year 2 (F2) taster week in it. The taster week is a special component of the second year of foundation training which aims to encourage junior doctors to spend a week’s work experience in their intended career before deciding on their specialist training pathway.

Not surprisingly, I was rather underwhelmed by the selection of taster weeks offered by my postgraduate centre. Tempting if I wanted to be an obstetrician, paediatrician, or psychiatrist, but much less exciting for those heading in different career directions. So I decided to go off-road and arrange my own attachment.

My cover story of tropical medicine isn’t a complete lie: I am actually very interested in infectious diseases. However, I prefer the monitoring and epidemic aspects to the clinical features and management. The Health Protection Agency, with its roles of coordinating the investigation of national outbreaks, advising the government on risks posed by various infections, and responding to international health alerts, sounded ideal for a week’s experience. The Centre for Infections in north London coordinates these activities, and I contacted their head of training, Hilary Kirkbride, who kindly accepted me on their introductory course for the week and also arranged several meetings with current public health specialist registrars.

My taster week

The Centre for Infections was everything I’d hoped for. Sliding security gates, restricted areas, and rumours of anthrax in a laboratory somewhere. After marvelling at the plasma screen at the entrance displaying the risk status for that day, I settled into the modern seminar room for the course.

The title was “Introductory Course in the Epidemiology and Surveillance of Infectious Diseases,” and in spite of the title, it was fascinating. I learnt all about the national systems in place for surveillance of tuberculosis, HIV, gastrointestinal infections, and sexually transmitted diseases. We had lectures from leaders in emerging infectious diseases, hospital acquired infections, and Creutzfeldt-Jakob disease. In the afternoon, we worked through real life outbreak investigations on hepatitis B and cryptosporidium infection. Finally, we heard about the recent Winter Willow exercises in preparation for a UK epidemic of avian influenza—the biggest emergency planning event since the end of the Cold War.

During breaks I met up with several public health specialist registrars. This was the first time I had met public health trainees, so it was a golden opportunity to find out what public health was actually like at the coal face. I was surprised to find that most trainees have membership of at least one college—be it paediatricians, physicians, or general practitioners. These meetings made me realise how clinical experience can be extremely valuable in public health, especially in the area of health protection.

In conclusion, I have found out that the taster week is much more flexible and adaptable than at first appearance. Don’t hesitate to modify it to your career intentions, as you’ll come out with a much more valuable experience.

And if you’re considering public health: face your fears. It’s worth coming out—you may enjoy it much more than you think.

“We host a range of specialist health protection attachments at the Centre for Infections, including public health and microbiology specialist registrars. However, this is the first time we have been contacted about an F2 taster week and we were delighted to be able to give somebody much earlier in their training the opportunity to see what we do.

“We felt that the introductory course would provide Kate with a good overview of our work—with up to date information from national experts and practical opportunities to work through real exercises.

“As a specialist centre of the Health Protection Agency we don’t participate in F2 training, although other parts of the agency do. And while we don’t have dedicated arrangements for F2 taster weeks we would certainly do our best to accommodate F2 trainees looking for a taste of health protection in the future.”

Hilary Kirkbride, head of training, Centre for Infections, north London

“A survey of our foundation year trainees who had completed a four month placement in public health showed that all trainees found the post rewarding. At entry only 10% of the trainees were interested in a career in public health. However, at the end of their posting 60% were considering a public health career. Their reasons were that they did not realise how interesting and versatile a public health career was and that there were opportunities to work in a range of areas from emergency planning, to international health, to developing local and national strategies for health. Kate is right: enter the portals of public health and you may be very surprised at what you find.”

Premila Webster, programme director for public health at Oxford Deanery

Kate Mandeville foundation year 2 trainee in hepatology St Mary’s Hospital, London

Cite this as BMJ Careers ; doi: