Better Health For All

Unlike most visits to Ghana, this trip was particularly special and a “mission” rather than a reunion with friends and family. My yearning to make this a success had me constantly refreshing myself on the terms of reference and action plans for the trip, which, I guess, was the culmination of a partnership ‘journey’ that started in the latter part of 2018 involving various emails, teleconferences, text messages and phone calls!

My first day (and first time) at LEKMA hospital, started with some personal observations (and to have a moment to myself).  Afterwards, on the way to see the Medical Superintendent, Dr. Ameh, I saw one of the pharmacists that I recognised from one video conference call. I called him by his ‘English’ rather than Ghanaian name, thereby giving away who I was, but more reassuring was when he mentioned they were expecting me (as did Dr. Ameh when we met).  This bode well for the visiting team.  With initial introductions over, I went into planning times for the Global Point Prevalence Survey (GPPS) which took place over subsequent days with two Pharmacist colleagues.

Samantha arrived a few days later. The rest of the team arrived after Samantha, but the excitement made me go to the airport. Waiting like it was Christmas!  The next morning, we all met for the first time and were driven to LEKMA Hospital.

Our first day LEKMA was extremely pleasant with the usual warm Ghanaian hospitality.  The enthusiasm was apparent from the get-go.  We ran through the agenda for that day and duration of the visit followed by ward/departmental visits.

FPH Africa SIG Ghana Visiting Team (left to right)

• Mr Edwin Panford-Quainoo, Public Health Pharmacist, Liverpool School of Tropical Medicine
• Dr Rajesh Rajendran, Consultant Microbiologist, East Cheshire NHS Trust
• Dr Valérie Decraene, Consultant Epidemiologist, PHE Field Service
• Dr Sam Ghebrehewet, Head of Health Protection, Public Health England, North West (FPH Ghana Visiting Team and Partnership Project Lead)
• Dr Saran Shantikumar, Clinical Lecturer in Public Health, University of Warwick
• Ms Samantha Walker, Lead Nurse – Infection Prevention and Control, Countess of Chester Hospital NHS Foundation Trust
• Mrs Indu Das, Antimicrobial Specialist Pharmacist, East Cheshire NHS Trust

The second day had workshops on Antimicrobial Resistance (AMR), Antimicrobial Stewardship (AMS) and Infection Prevention and Control (IPC), with a fully engaged hospital team who gave frank and honest opinions about their hospital IPC practices and improvements needed. Workshop evaluation provided invaluable information that was consistent with observations.

On the Saturday, we visited the hospital to get a sense of the out-of-hours services [accident and emergency and out-patient departments (OPD)]. We used this opportunity to review OPD antibiotic prescriptions of the day (revealing interesting findings).  We visited three community pharmacies within walking distance of LEKMA Hospital who had been informed of the project and were fully engaged in completing a knowledge, attitude and practice survey.

We spent the Sunday recapping and reflecting on the previous days’ events in the idyllic setting of Sogakope. Even on our day off, the team could not help but be productive and were able to record a podcast, prepare a WHO grant application for implementing delayed/back-up prescribing at LEKMA Hospital and learn about Ghanaian music.

Monday was the advisory committee meeting, chaired by Prof. Afari. The morning of Tuesday 18th June, was feedback session with the LEKMA management and Ghana Public Health Association (GPHA).

In summary we were able to deliver:

1. Agreed and signed off a Memorandum of Understanding and ToR;
2. Established an AMS Advisory Committee;
3. Completed a Global Point Prevalence Survey;
4. Completed a healthcare workers Knowledge, Attitude and Practice survey;
5. Initiated IPC guidelines review based on the WHO infection prevention control and hand hygiene assessment tools;
6. Initiated discussion around prescribing guidelines (national) with the view of having simpler and more accessible local prescribing guidelines, i.e. within the context of the National AMR Plan and Prescribing Guidelines;
7. Initiated the discussion around laboratory data surveillance processes and regular production surveillance outputs, with a focus on drug-resistant organisms;
8. Agreed to implement delayed/back-up prescribing in the out-patient department of LEKMA Hospital.

We left Ghana with nothing but fond memories of a magnitude that we could not put into words and look forward to our next visit to Ghana.

Blog written by Edwin Panford-Quainoo, Liverpool School of Tropical Medicine

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The Faculty of Public Health Part B Membership exam is the final stage of the route to membership of the Faculty through examination, but by no means the last step of becoming a Specialist in Public Health. Examiners from across the UK and from all domains of Public Health develop scenarios to test candidates’ abilities to understand and explain public health concepts and respond appropriately to questions and challenges in various settings (examples are available on the Faculty website). As examiners, we are committed to maintaining the standards set by FPH, but also committed to developing the next generation of Public Health leaders as excellent communicators and experts in all aspects of Public Health.

I was asked to write this blog, on behalf of my fellow examiners, after I had tweeted some tips based on reflecting on performance in the exam. One of my Registrars wrote a blog on how to prepare and pass the exam – this blog gives the examiner perspective.  As examiners, we wrote an article to help highlight how best to approach the exam. We had become concerned that some candidates are developing an approach to the exam which structures their answers but reduces their chance to succeed. These tips below, buidling on the tweets, are offered to all candidates with the reminder that, as examiners and colleagues: we want you to pass!

1. Prepare to listen, hear the question, answer in a way that makes sense to that person, be it Director of Public Health (DPH), journalist or MP.

Too many candidates enter the room with their first answer prepared- forgetting to listen to the question. In a role play, examiners are keen to see that you are responding appropriately to the audience and answering the issues they raise. It is better to focus on listening to the question and answering the way you would in real life. Candidates are sometimes so determined to introduce themselves (which is not necessary) that they miss the first question altogether.

2. Be ready to present/explain tables and charts – it’s what we do – but remember your audience. Don’t treat the DPH like you would a lay person.

If there are tables and charts in the pack, it’s likely you will need to understand what they say, and demonstrate this. This is a core skill of Public Health and we expect this to be done well. A trap some candidates fall into is in guessing the next question: “would you like me to explain confidence intervals” to which a reasonable reply might be “of course not- I’m your DPH!”

3. Let the role player ask their questions. The pack doesn’t give you the structure, the questions do. Let us lead you through.

There are significant numbers of candidates who struggle because they don’t understand the format of the exam. The role player has a list of questions that they ask in order. These should elicit the information we need to mark the candidate. In general, scenarios are designed to build – so that the role play makes sense. Offering to give a speech, trying to tell us information that has not been requested, and answering questions you wish had been asked are all ways to run out of time and fail to complete the station.

4. Don’t be just anyone – speak with passion about public health principles. Care about outcomes, inequalities and efficiency.

This is a “show’s how” exam where we are looking to see you have internalised Public Health concepts. Great candidates engage with the role play and come across as advocates for Public Health. This is far better than the trite “This is an important public health problem” statement repeated at every station by some candidates. There are no marks available for this.

5. Have a good look at any data. Is it numbers, rates, percentages?  Be clear when explaining or answering questions.

Sometimes the scenario makes clear that the data has come from a poor quality source; a student project or similar. Might this mean that there are errors in the data? It’s vital that we use the right terms; confusing number of deaths with death rates is a sign a candidate hasn’t studied the material. Be accurate – the difference matters.

6. Check the role player is understanding you. Keep eye contact- sometimes role players will look confused or upset- this is part of the station.

There is little scope for conversation in most scenarios- sometimes we really have to rush to get through the questions. Taking notice of how role players respond is an important part of the exam. Picking up on responses is a key skill in the “listening” competency. If you are asked the same question twice, it usually means its important and you did not answer it correctly the first time. Don’t try and skirt round it or just repeat what you said the first time.

7. If you have to explain a table or graph – share it, show me, point it out.  Be sure I understand your explanation.

Great candidates really do this well. Positioning themselves in a way that allows them to share their papers, point at the information they are describing, and looking at the role player to see if they are understanding the explanation. Done badly, it can appear that candidates are just hoping not to be asked about it.

8. Be ready to say if you don’t know. No “I’ll email you” or “I’ll get back to you”, sometimes you just don’t know – that’s ok.

The issue with the answer “I’ll email you” or similar is that the question has been asked and needs to be answered. If asked “Do we need to close the shop?” the possible answers are Yes, No and I don’t know. All can be valid, and the mark scheme will make this clear. The questions are scripted to last 8 minutes and the role player strives to complete the station within that time. Sometimes a scenario runs faster and most candidates finish a station a minute or so early. It will be obvious from the role player that the scenario is complete. It is quite okay to use this spare time to look at your next scenario.

9. Remember to make eye contact. It’s a conversation.  The examiner role players are willing you on. 

Some candidates have clearly not prepared the “acting” side of the exam. Great candidates have a real conversation and engage the role player. This means they pick up on the mood and responses as well as the substance of the questions. Comments like “I know this must be difficult” and “I can see why you might think that” often reflect an understanding of the other point of view.

10. Be yourself. You have got this far because of who you are.  Serious people think you are amazing.  Show us why.

We really do want you to pass. Many examiners are also Educational Supervisors, they are all involved in training and want to give candidates the chance to shine. We don’t want an act – just you being your best you. Read the material, listen to the questions, engage in the scenario and show us why one day soon, you will be a consultant.

Links:

• Journal of Public Health ‘How to do well at the OSPHE’ https://academic.oup.com/jpubhealth/article/38/1/189/2362659
• Sample scenarios on the faculty website https://www.fph.org.uk/training-careers/part-a-b-exams/part-b-exam/part-b-exam-preparation/
• Registrar blog on Part B https://betterhealthforall.org/2018/06/06/the-winner-of-the-2018-fph-mcewan-award-shares-her-advice-on-preparing-for-the-part-a-exam/

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