Training an Injury Workforce

Perennially a hot topic, the issue of professional training in injury prevention has lately been discussed by the Executive of the Australian Injury Prevention Network (AIPN). In order to extend this debate into a wider forum, the AIPN Executive has contributed the following item as a discussion starter. It explains some of the key issues as well some of the suggested possibilities. AIPN would like to get you all thinking and, hopefully, sharing your views.

An obvious starting point for this topic is to consider what training is needed, and for whom. Equally obvious, perhaps, is that the range of needs will be very diverse.

At one end of a continuum, people have identified a need for specific skills development for injury practitioners. There is also general agreement that too few good injury prevention programs are being written up in the literature and that strategic skills development would encourage more practitioners to prepare and submit papers for publication, as well as to write papers in a way that does justice to the program or the effort involved. This is based on a belief that many practitioners currently lack the necessary skills to prepare abstracts, present papers, review the literature to develop an awareness of precedent, etc. Discussions with delegates to the recent national conference indicated that there is interest in developing skills in program design and implementation.

Another concern is that there is no way for the necesssary injury control skills to be passed on to many of those taking up injury prevention at the coal face.

At the other end of the continuum, there is the need for professional training leading to formal credentials.

Currently, universities throughout Australia offer generalist postgraduate courses which go some way to meeting this need. There is also a limited number of injury-based accredited courses. Another avenue is the kind of professional traineeship offered by some State health departments. Some culminate in a formal qualification. Recent discussion has also begun to highlight a lack of people with doctoral-level qualifications in injury research and prevention, and of doctoral and post-doctoral training positions.

Outlined below are some suggestions for responding to the diversity of training needs. It is important to note that these suggest-ions, as outlined, do not represent mutually exclusive approaches, but overlap to varying degrees. Neither do they exhaust the possibilities.

Before proceeding to examine the possibilities, some observations are pertinent:

• There are few people for whom injury prevention is their core business, and many for whom it's an adjunct activity. Many injury workers have not come to the work with University training and, therefore, gaining entry into post-graduate level degree courses presents a barrier to this group. Both characteristics have implications for designing training programs.
• A somewhat widespread belief holds that injury prevention courses should be targeted primarily at those workers already active in the field. A contrary view is that, if more workers in fields other than injury prevention had been introduced to injury prevention principles in their training, injury prevention specialists would have fewer problems making themselves understood. Thus, it has been argued that some level of injury prevention training should be incorporated into training courses for health-sector disciplines such as medicine, nursing, health promotion and public health, at undergraduate and postgraduate levels, as well as in training for professions such as engineering, architecture, building, design, etc.
• It has been suggested that, at the moment, no real market exists for injury prevention courses. This has been countered, however, by the belief that if the supply were properly set up, the market would materialise.
• Funding is clearly a crucial consideration. Although some very worthwhile training options are already available, a solid injury training infrastructure doesn't yet exist. For some, this signals the need to lobby for a substantial allocation of funds to build the necessary infrastructure. But others argue that we should not sit back and wait for our complaints about lack of national infrastructure in injury control to produce the required funds. They assert, rather, that the structure is already out there; it simply needs to be harnessed correctly to create and market a national training program.
• The National Public Health Partnership Group is in the process of developing terms of reference for a Working Group on Workforce Development. The National Injury Prevention Advisory Council (NIPAC) will be keeping abreast of developments in this regard and will seek to ensure that the specific needs of the injury constituency are known and considered by the Working Group when it is established.

Directory of available offerings

A very basic response could be for the AIPN to simply compile a list of all available courses and make this available to its membership. A directory of this kind could, for example, could provide details of Edith Cowan University's Postgraduate Certificates in Injury Prevention and in Road Safety Studies, each of which allows students to proceed to postgraduate diploma and masters courses. Students without graduate status can undertake Executive Certificate courses in both injury prevention and road safety studies. All certificate courses are provided on a fee-paying basis by distance education. Similar references would be included for other university-based courses, as well as training opportunities offered by other types of organisations such as the National Safety Council, professional traineeships with State Health departments. This information would be supplemented with on-going information about relevant one-off seminars and workshops, and reminders about more general opportunities (eg NHMRC Fellowships).

National multi-institutional tertiary training program

A national course in injury prevention at the Certificate, Diploma or Masters Level. It would be offered as a flexible learning course by several universities throughout Australia coming together in a collaboration to ensure that the necessary expertise is available to cover the required territory. Many of the relevant subjects are generic in nature (eg introductory epidemiology, program evaluation, etc.) and are already available in flexible learning mode. Tertiary institutions, often in partnership, currently mount public health courses in most States and Territories. A national course would draw on what these institutions have available to form its generic core, and supplement this with specific injury subjects to complete the injury control course package. These injury subjects could be offered by universities already active in this area (eg Curtin, Flinders, Monash or Edith Cowan Universities). In the first instance, to avoid being too ambitious, such a degree course would be offered at the Certificate level, requiring students to complete the equivalent of 4 subjects in one year. Students would select, from among the collaborating institutions, the University from which they wished to graduate.

Skills-based training sessions and resources

Although AIPN has neither the resources nor the membership numbers to initiate the commercial provision of skills training, it has been suggested that collaboration with other groups could enable the development and conduct of workshops or seminars. In order to reach the membership, such sessions would need to be offered regionally as well as in capital cities. Linking them to events such as the PHA or AAHPP conferences could also facilitate access. In the latter context, 'back to back', morning/afternoon workshops on abstract writing and paper presentation and on project development could meet some current needs for many practitioners.

A medium term aim would include the production of 'how-to' guides. A number of other organisations are likely to have an interest in jointly developing such resources (eg professional public health and health promotion organisations; State and regional health department offices; etc. The editors of professional journals and the managers of funding bodies could conceivably be involved in skills development in relation to abstract and paper writing, and grant applications.

Any skills development would need to be done professionally.

Training on the Internet

The Center for Injury Control at the Emory University in the USA is preparing to pilot an interactive course on injury on the World Wide Web in the near future. The course, which has been taught as part of Emory University's MPH curriculum since 1994, is designed to provide the public health generalist with a background and knowledge of issues, research needs, and future directions of injury prevention and control. The course will provide each lecture and slides on the Internet, as well as involving students in `real time' discussions in chat rooms. Although the pilot course will not have academic credit, if successful it is planned to do so in the future. Students would, of course, need to have access to a computer and a high speed modem, and would be expected to commit to spending up to two hours a day, five days a week, studying the lectures and participating in discussions, in addition to completing daily reading assignments. Mid-term and final examinations would be required to demonstrate proficiency in the subject.

Another Internet offering, already up and running, is the `Supercourse' emanating out of the University of Pittsburg. The course is designed to provide an overview on epidemiology and the Internet to medical and health-related students world-wide. The available lectures are contributed from many sources, and the efforts of a large number of skilled reviewers and translators ensure that all lectures are peer reviewed and some are available in more than one language. The lecture topics, which are wide-ranging in their coverage, also include lectures specific to injury epidemiology(if you want to take a look, visit the Supercourse website: http://www.pitt.edu/~super1/

Higher degrees and post-doctoral training

It has been suggested that there must be a focus on increasing both the participation rates, and successful completion rates, amongst members of the existing injury workforce in undertaking programs designed to develop high level professional skills and qualifications. Strategies could include seeking funds to earmark a number of traineeships and fellowships for injury research and prevention. Another track would be to develop new forms of doctoral candidature(eg professional doctorates designed to be more relevant to the needs of program practitioners than conventional doctorates, which are more attuned to the interests of researchers and academics.

Finding ways forward...

The AIPN Executive welcomes any feedback you can provide on the above, and would be delighted to receive your suggestions for alternative approaches. The Executive hopes that broadening the discussion will help to crystallise the best strategies for furthering this issue. Your comments should be directed to either

Rod McClure,
Tel: 041 776 6515,
e-mail: R.McClure@spmed3.herston.uq.edu. au, or

Ian Scott,
Tel: 03 9427 1008, Fax: 03 9421 3831,
e-mail: iscott@peg.pegasus.oz.au