Public Health residency program in Italy

Background

Writing about the Public Health Education System in Italy is not that easy, because the Public Health (PH) environment is constantly changing, and it is difficult to find the exact same pattern in different Italian Universities.

In 2005, the Italian Ministerial Decree 285, still in force, provided guidance to standardize goals and outline specific courses, in order to obtain a nationwide PH professional profile. 

Almost ten years after the Decree, The Italian Committee of Medical Residents in Hygiene, Preventive Medicine and Public Health of the Italian Society of Hygiene, Public Health and Preventive Medicine (S.It.I.) set up a working group to assess how ministerial guidelines had been implemented and what was the quality of training provided in Italian University Schools of Public Health. The purpose of this comparative analysis was to evaluate the PH teaching system in Italy and identify how to implement an innovative and homogeneous PH training program. 
Recent PH specialists in Italy have an average of 35.2 years and are females in 67.2% of cases. More than two thirds of them are employed, with higher employment rates in the North of Italy (77% in the North, 68% in central Italy, and 60% in the South). 2 years after graduation 93.5% of PH specialist is employed, but only 5.8% of young PH specialists have a permanent contract, with 11.2% opted to stay in training pursuing a PhD degree (2017). According to a survey conducted in 2017 by Odone et al., national mobility is relatively low with 80% of employed subjects working in the same region where they attended the PH residency program; this result might be linked to the fact that respondents were enrolled in the PH residency program when the application process was still managed at the local level (before the introduction of the national residency test in 2013) and might increase in the near future, since it is now managed at the central national level.

The residency

The post-graduate medical residency in “Hygiene and Preventive Medicine” (School of Public Health—SPH from now on) is currently a 4-year training program, delivered by University-based schools accredited jointly by the Italian Ministry of Education and the Ministry of Health. There are 35 SPHs in Italy, located in 17 out of 20 Italian regions. Each year, a Ministerial Decree defines the number of available contracts for all residencies including PH (255 contracts for PH in 2019), as well as the national entry requirements and application process rules. The application process is managed at the national level, and entrance is based on the score obtained in a multiple-choice national test named “SSM”; this national management of the residency programs was introduced in 2013 in order to promote meritocracy and transparency in the selection process in the whole country and has the same structure as the “MIR” in Spain and the “PNS/Harrison’s” in Portugal.

The 4-year training program includes both professional activities, research activities and lectures. 

It is composed by a period of a variable number of years (from a few months to 2 years or more) spent in the PH University Department, to learn how the Department works, to work on research projects and attend lectures. 

Lectures cover a wide range of topics during the 4-year program, including epidemiology and biostatistics, physics, forensic medicine, occupational medicine, health economics, health promotion, vaccinology. 

Every school also include internships, from 6 months to one year long, in local health care services, where residents can work on vaccines, epidemiology of NCDs and degenerative diseases, occupational health, environmental and Public hygiene, primary care and accreditation services. 

Professional activities that have to be experienced during residency include: 

• Epidemiological studies and analysis of present health statistics
• Organizational analysis of healthcare structures
• Activities in the healthcare education field
• Participation in health promotion campaigns (vaccinations, smoking cessation, physical activity, healthy lifestyles)
• Community protection interventions
• Health Technology Assessment

Italian schools also work together with other health authorities like ministerial companies and research institutes, in which residents can spend some months during the program. 

In the majority of schools, it is possible to spend maximum 18 months abroad in other schools, both in and outside of Europe, with a different regulation in each school.

Extracurricular activities

The Italian Committee of Medical Residents in Hygiene, Preventive Medicine and Public Health 
It is common, for PH residents, to do extracurricular/non-mandatory activities. 

The Italian Committee of Medical Residents in Hygiene, Preventive Medicine and Public Health of the S.It.I, has its own working groups in which the residents can sign and participate, working on specific topics such as Digital Health, Primary Care, Health Inequalities, Environmental Health, Medical Education, Climate Change, etc. 

Social Networks

Many schools have their own Facebook, Instagram and Twitter Profile (ej. Facebook - Firenze, Bologna, Torino, Foggia), and there is a specific Facebook group created by PH Residents aiming to help the newly graduated students attracted by PH to choose the school that better fits their interests. 

Finally, a noteworthy project designed and handled by 7 medical doctors (including 3 PH Residents) is currently promoting health and healthy lifestyle in the population using the social networks; the project (active on Facebook, Instagram and Website) is named Icaroe – Salute sui Social. 

Author
Marco Del Riccio – MD, PH Resident, University of Florence
[email protected]
Find me on LinkedIn and Twitter

References

• Costantino C, Maringhini G, Albeggiani V, Monte C, Lo Cascio N, Mazzucco W. Perceived need for an international elective experience among Italian medical residents. Euromed Biomed J 2013; 8(3): 10-5.
• Giraldi G, Rinaldi A, D’Andrea E, Lucchetti P, Messano GA, d’Alessandro E. Correlation between legal protection of the environment and health. Ig Sanita Pubbl 2012; 68(2): 367-73.
• Ministero dell'Istruzione dell'Università e della Ricerca, 2017. Decreto interministeriale recante gli standard, i requisiti e gli indicatori di attività formativa e assistenziale delle Scuole di specializzazione di area sanitaria n. 402. Avaialble at: http://www.miur.gov.it/-/decreto-interministeriale-recante-gli-standard-i-requisiti-
• Claudio Costantino, Sandro Cinquetti, Elena Garavelli, Claudio Marcantoni, Claudia Murru, Giovanni Pieroni, Gaetano Privitera, Walter Ricciardi, Francesco Soncini, Dario Tedesco, Maria Triassi, Francesco Vitale, Francesca Campanella; The key role of public health medical resident education for future public health challenges (Epidemiol Prev 2014; 38(6) Suppl 2: 115-119)
• Odone et al. Public Health Reviews (2017) 38:24 DOI 10.1186/s40985-017-0069-0
• Garavelli E, Marcantoni C, Costantino C, et al. Education and training among Italian postgraduate medical schools in public health: a comparative analysis. Ann Ig. 2014;26(5):426–434. doi:10.7416/ai.2014.2002
• DM 1 agosto 2005. Riassetto Scuole di Specializzazione di Area Sanitaria. GURI n. 285 del 434 E. Garavelli et al. 5 novembre 2005 (Suppl Ord n. 176, allegato Ordinamenti didattici Scuole di Specializzazione di Area Sanitaria). Available from: http://attiministeriali. miur.it/anno-2005/agosto/dm-01082005.aspx . Last accessed on September 2014