Audit: what's in the name?

Medical audit is based on a cyclical model which is ideally suited to operational work that is (1) regularly repeated in similar situations; (2) clearly and directly linked to outcomes; (3) amenable to criteria of quality. The work of public health physicians is both operational (e.g. investigation of outbreaks of communicable disease) and strategic (e.g. health needs assessment). A cyclical model is not appropriate to strategic activity. Evaluation of that activity is essential--but should not be constrained/limited by inappropriate adherence to the audit cycle.