We're going to be talking about public health frameworks, in particular, public health is an area where it's very difficult to organise your thoughts, and know exactly what to talk about and in what order. I think the key to doing it well is to occupy a space where you use a few key frameworks, and those frameworks really help you to talk about the core principles of a given public health issue. nicely in your interview station.
Most public health issues are very, very complicated. There are whole consultancy agencies, and public health specialists, and global health agents, and WHO. All of these different organisations, and their only job is to think about how to best improve public health issues globally.
Within Australia, policymakers and governments, and councils, etc. all play a role. I guess the difficult thing is,
How in your one to two minutes do you address all those issues?
How are you expected to show that you're insightful and that you've done some research on a public issue that they've just handed you?
Worse still, you have to answer multiple questions about it.
So this is the framework I would take.
Step One, identify the issue clearly and make a clear definition about what specific aspect of it you're talking about.
For instance, at Melbourne University last year there was a station about the National Disability Insurance Scheme. There are two different groups of students in that regard. You may have been someone who knew the issue very clearly, you may have been someone who had no idea what the issue was. I think that those two groups fit for most public health stations where you're given an issue to deal with. You may be knowledgeable, you may not be knowledgeable at all.
I think in the instance of the National Disability Insurance Scheme you can say,
"The National Disability Insurance Scheme is a public funding scheme across Australia, that is implemented by the federal government to help support people with disability."
I think either branch that you occupy, you could still say that clearly.
Just to give a bit more reasoning behind Step One lets take a different example, for instance, something like antibiotic resistance.
That's a public health issue, that's something that Australians we consider at both local and national levels, and we have different programs. Antibiotic stewardship and other things that we try to implement and improve our use of antibiotics, and subsequently, the antibiotic resistance we have in the community. If I'm just going to start talking about antibiotic resistance without doing step one, it's very difficult for me to ground myself.
Am I talking about the public issue in the future?
Am I talking globally, am I talking about the pharmaceutical company development of antibiotics?
Am I talking about individual patients and the management therein?
Am I talking about the political nature of antibiotics, and how there's a lot of psychological elements to it?
There are a lot of difficult things in talking about antibiotics.
So you start by saying,
"I'd like to talk about antibiotic resistance, it's obviously quite a broad topic. So I think we should focus on Australia and the policies that we put in place to help avoid antibiotic resistance growing in the population of bacteria that we have in Australia, without consideration for some of the global issues that are there."
You can see how that approach in the interview is already showing, even without saying very much, that I understand a lot more about this issue, but I'm only going to talk about this sliver of my knowledge. Even, if you actually don't know anything about the other more extraneous things, it just gives me that sense.
"Wow, this person really knows about all these different things about the issue, they're in on the global aspects of WHO, all these different things and you really know what's going on."
That's a really good way to start a public health station on a specific issue.
In summary, Step One, define what the issue is about and where it applies to, and restate the issue clearly.
Step Two, is to talk about the different levels of application and they are the national level, the state or community level, and the individual level.
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You really, really want to talk about public health issues with distinct levels in mind. If you talk about public health generally, you'll end up doing poorly.
Let us go back to our example, antibiotic resistance.
You may talk very vaguely about what the problems are.
You might talk about the misuse of antibiotics in upper respiratory tract infections, or people coming with the cold expecting antibiotics.
You might talk about education but when you talk in these general terms.
It makes the interviewer feel like you're confused about what is going on in the interview station. If you talk about it in a more regimented and structured way, for example,
"Thinking about antibiotic resistance, I like to look at it at different levels. At a national level, antibiotic resistance is a responsibility in the health portfolio of the government and in particular, it's their responsibility to make it so that hospitals and doctors have clear protocols, and procedures in the prescription of antibiotics. I think it's an issue because at the moment it's not that strict, and doctors largely especially GPs have the power to prescribe antibiotics without too much oversight. I guess it goes more broadly to some of the systems that we use. If there was strict antibiotic criteria like opiates, or drugs of addiction, controlling the scripts. In somewhere like the Netherlands, they have that type of system where they look at the number of antibiotics that each doctor or GP prescribes. If we have that type of system, we could better control how we use antibiotics and by proxy, reduce the amount of our antibiotic resistance that exists in the community. Then at a community level and at an individual level."
I think it's a very succinct way of breaking down what can be a confusing and multi-layered issue that is difficult to conquer.
Step Three, talk about the biopsychosocial model of health at the individual level. I told you that we go for the national level, the community level, the individual and maybe even international if you have enough time and you feel so inclined.Once you get the individual, it's really important and useful to talk about the biopsychosocial model. We'll talk about this in some of the other framework podcasts we do in rural health, and indigenous health, where this model is even more useful.
Even in public health, when you think about the interventions that you implement, you need to think about how to in fact see individual. So again, back to antibiotic resistance as our model, what are the things that an individual does that contributes to antibiotic resistance? When I say individual of course, you can think of different groups the population, doctors, but I think it's good to think about general public. Where it's a public health issue, think about the public at large.
So it's really important for individuals to understand how antibiotics work. That goes back to their grassroots education and the teaching in biology and other things. It's also really important for people to understand the risks associated with antibiotics, and why that it's not a cure-all when you're having cold.
Third, at a more fundamental level, the psychological impact that goes with getting your medicine at the doctor, at the GP, expecting something a transactional reciprocation that most of our health care system comes to expect.
They publicise all the modern advancements in Medicine and that we'll live to 120, so people go to the doctor and expect an answer, or something they can do to fix their health. That's completely reasonable but what that means is as a GP, I'm feeling pressured to give you something that isn't indicated.At a biological level, it's dangerous.
Think of the adverse effects, there's a possibility getting rashes, diarrhoea, clostridium difficile, which is a complication of antibiotics thats actually quite lethal, and we see quite a lot in hospital.
At a psychological level, we have this entrained transactional and relational thing with our doctors in our healthcare system that we expect to get antibiotics, or some treatment in return, but when we go with a virus and cold, or flu, that's really not the best treatment. The best treatment is conservative and so at a psychological level, both as individuals and as doctors, how do we manage patient expectations and how do we make them feel like we've still treated them successfully, but without giving them what they've come to get in a sense.
Then at a social level thinking about their education, how we teach people about antibiotics and not giving antibiotics, and changing the stigma around or expectations around the prescription of antibiotics. Obviously those issues are somewhat integrated with the previous step, so obviously, the biopsychosocial model is also integrated in the community.
Nationally, we could talk about how at a national level we should be doing things that affect how people socially interact, and they should be implementing education programs.
I think it comes out best in a medical interview, after you've talked about the more core general issues, and then you come down to the individual. As an interviewer on an MMI station, how do we process this complex issue if you spit ball about why people want their antibiotics from the start, the biopsychosocial model is succinct.
More generically, in public health MMI stations.
There is an important concept known as determinants of health. There are lots of different determinants of health, they're basically some modifiable and unmodifiable risk factors that all people have in their own healthcare. The biology and psychological and social elements are only some of them, there's also economic, ethnic, all sorts of different determinants of health. I'll provide a link, to some determinants of health, but I think the biopsychosocial model is what we use as doctors in evaluating people's mental health, and evaluating a person as a whole in a holistic sense.
When you're talking about how people in the community think about certain issues, it's really useful to use that same framework.
Step four, actually goes throughout all the steps.
Plead your ignorance, don't pretend that you know everything about public health. Most of the experts have studied, at least medicine and often, other degrees, spent years and years working in this space, and they still don't have the right answers. With any intervention, where you're affecting sometimes millions of people, it's a cost-benefit analysis of what the best process is.
There's no cure-all, there's always going to be some payoffs and sacrifices to be made that will affect the population in different ways. You shouldn't, even in follow-up questions, feel like you have to have all the answers. That goes all the way back to when we were talking about the National Disability Insurance Scheme, and how some students just panicked and didn't even bother answering the question at all. They just went quiet or cried, they said I don't know what then NDIS is and they didn't answer. Now obviously if that happens, move on in the next interview station.
But it is possible to answer well, even without knowing the public health issue well. That process is about pleading ignorance saying,
"Unfortunately I haven't gone through medicine yet, I'm not aware of the National Disability Insurance Scheme but these are the places that I would go to get information. I would speak to my local GP to get a sense of what the local community aspects are to it, I'd speak to my local Parliament member and maybe email and read about it online, etc"
Putting all these different bits and pieces together, you have,
Step One - define your public health issue clearly, and talk through the aspects of it and what region you want to talk about.
Step Two - break it down at (optional international,) national community and individual level.
Step Three - when you get to individual, talk about the biopsychosocial model and how that leads to the public acting in certain ways.
Step Four - always plead ignorance and always talk about how you would refer to experts, look up the WHO website, talk to a public health expert in follow-up interview station questions when they ask you about how you would implement your money in public health activities.
Those are the four steps and that's the framework that we use in our public health station answering advice. It's not perfect, there are some medical interview stations where you'll need specific information about certain issues or you'll need to allocate resources.
It's a good framework to try and improve in public health stations. I hope you found this podcast useful, and all the links that we've put in the transcript as well.
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Side note, when thinking all things antibiotic resistance you really have to play this old flash game, Pandemicstaph aureus
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