Public Health Education Unbound

TOPHC – April , 1, 2014TOPHC – April , 1, 2014

Public Health Education

Unbound


Diane R. Bewick, RN, BScN, MScN, DPA, CCHN (c)

Chief Nursing OfficerDirector of Family Health Services, Middlesex-London Health UnitAdjunct Professor, Faculty of Health Sciences, Western University

London, Ontario


The public health professional …


“No attempt to improve public health will succeed that does not recognize the fundamental importance … of highly skilled and motivated health professionals.”

Advice …

“Our national aim should be to produce a cadre of outstanding public health professional … who have clear roles, responsibilities and career paths.”

National Advisory Committee on SARS and Public Health, 2003


“To aim the public health system with more powers and duties without the necessary resources is to mislead the public and to leave Ontario vulnerable …”

The SARS Commission, 2005

Resources are not simply funding but perhaps more importantly competent, committed public health professionals.

Warning …


people

The public health professional

quality of lifeprolong life

promote healthprevention disease

organized measures


Official Public Health

Agencies

Family Health Teams

Canadian Cancer Society

CCAC

Community Health Centre

Boards of Education

Ontario Early Years

Centres

Heart & Stroke

Foundation

Housing

Education

Poverty

Literacy

Primary Care

Providers

Global


Social Support


Official Public Health

Agencies


ON*PHO - labs 1,000


Local public health units are the backbone of the public health system…

Operational Health Protection, 2004


• undergraduate programs…variety of disciplines

Public Health Professionals

• disciplines form the base …

• professionals will benefit…from education

• education will increase health of the province

• discipline specific standards/competencies

• regulation/registration/certification

*Unique contribution


Public Health Competencies

Discipline Specific Core Competencies, Standards and Certification

MPH Core Competencies

Public Health Core Competencies

Inter-professional Competencies


Public Health Professionals(20 categories)

AMOH/MOH51

Epidemiology65

Health Promoters262

Dental Hygienists/ Dental Assistants

289

Dietitian/Nutritionist210

Public Health Inspectors830

Public Health Nurses2,6302,860

*PHO (Labs), MOHLTC, MCYS

2005 6,4001,400

*7,800

- 63

- 72

- 416

- 286

- 203

- 900

- 2,717

- (167/DH)

- (232)(3,848)


Public Health Workforce Issues

6. Shortages

1. Leadership and management

2. Career path

3. Opportunities/time for professional development

4. Lack of support for their profession

5. Undervalued within their organization.


1. Role scope and clarity

Synthesis of 8 Papers (CAN)… convergence of issues

2. Leadership skills to support practice and provide voice

5. Stronger educational preparation in public health

3. Professional development

4. Intra-professional collaboration


• public health professional - general

Context Summary

• Public Health Professional – OPHA’s

Identified - who- common characteristics- unique contribution

• introduced public health workforce issues


Marlene Janzen Le Ber, BScN, MScN, PhD, CHE

Assistant Professor, Epidemiology & BiostatisticsAssociate Director, Program Development

Schulich Interfaculty Program in Public HealthSchulich School of Medicine & Dentistry

Cross Appointed to Faculty of Health Sciences (School of Health Studies)Cross Appointed to Interfaculty Program in Public Health

Western University


Education of Health Professionals for the 21st Century

• The Lancet Commission (Frenk, et al., 2010)

• Transforming education to strengthen health systems in an interdependent world

• 20 professional and academic leaders from diverse countries

• Common strategy for PSE for public health, nursing and medicine


Three Generations of Educational Reform (Frenk et al., 2010)


Levels of Learning (Frenk et al., 2010)


Transformative Learning (Frenk et al., 2010)

synthesis

Fact Memorization SearchingAnalysisSynthesis

Seeking Professional Credentials Achieving core competencies for effective teamwork

Non-critical Adoption of Educational Models

Creative adaptation of global resources to address local priorities


Models of interprofessional and transprofessional education


Health Professionals• Leaders who can address these issues• Scientists who understand the issues• Practitioners who set standards

– All who understand complexity– Translate this to policy and practice– Learn to work in novel, and lead in

transdisciplinary, and sustained ways (Fried et al. 2013)


Graduate Public Health Education

(Fried et al., 2013)


Training Leaders in Public Health• Integrative action requires integrative learning• Systems problems require holistic analysis and holistic

approach to actions• Beyond public health disciplines to collaboration among

public health practice, academics, government and the private sector

• Requires grounding in pragmatic approach that “builds a scientific foundation on the real-world needs of defining public health problems” (Fried et al., 2013, p. e4)

• Team based learning



Schulich Interfaculty Program in Public Health

Our Distinction• Novel niche of the intersection of Leadership,

Sustainability and Policy

• Full-time one year (12 month) on site professional degree program (non thesis based program)

• Experential Learning/ Case method learning


Schulich Interfaculty Program in Public HealthOur Distinction

• Cohort of students from diverse health professional and educational backgrounds

• Special focus on health issues in Southwestern Ontario, First Nations across Canada and internationally

• Interfaculty contribution to the program


What exactly is a case?• Mauffette-Leenders et al (2007)

“A case is a description of an actual situation, commonly involving a decision, a challenge, an opportunity, a problem or an issue faced by a person or persons in an organization. The case requires the reader to step figuratively into the position of a particular decision maker.” (p. 3)

• Ellet (2007)“A … case imitates or simulates a real situation. Cases are verbal representations of reality that put the reader in the role of a participant in the situation.” (p. 3)


What is NOT a case?

• It is NOT just an interesting story• It is NOT investigative journalism• It is NOT research (which requires the truth, the

whole truth, nothing but the truth, etc.)• It is NOT fiction (but some distortions,

simplifications and omissions may be required in order to represent the situation so it can be taught in a typical 80 minute class)

• It is NOT a news summary


Student Preferences• Current issue and situation• Issues and challenges are relevant to career interest• Can identify with protagonist (see self in the position of the decision-

maker in the near future)• Organization itself is well-known, respected and not disguised• Geographical area of the world where students expect to be working

or are currently living• Issues in the case are urgent and important to the organization• Excitement over the issue; can personally relate to the

issue/problem• Cases with an interesting dilemma, characters with personalities,

and cases with compelling action requirements• Short, well organized


Attributes of a Good Case• Pedagogical usefulness – achieves learning goals

and is “teachable”• Interesting, engaging and relevant to students• Poses a problem/decision with no obvious right

answer• Requires the use of information in the case to figure

out a reasonable answer/approach• Requires judgement, critical thinking and decision

making skills• Is information rich – has numbers, industry

information, insights into organization and has some complexity


Three Core Elements

Reality•Realism makes a case an effective learning vehicle•Empiricism lends credibility to concepts learned in the classroom

Theory•An underlying theory is essential for effective teaching•One person’s/ organization’s action is not necessarily a guide for practice

Originality•What is new here? • concept?• context? •Novelty enhances scholarship and links well to research

Charles Dhanaraj


Four Types of CasesSkills Practice

Cases

Problem Defining Cases

Decision-making Cases

Evaluation/ Policy Cases



Cases




Describe a situation facing a protagonist. Students must diagnose problem(s) and formulate possible solutions.



Cases




Describe a decision faced by the protagonist. Students must choose among a finite set of alternatives.



Cases




Illustrate organizational success or failure. Students synthesize policy lessons to be extracted from the situation.


Four Types of Cases

Skills Practice Cases




Describe situations requiring execution of specific technical skills in order to draw conclusions


Four Types of Cases

Skills Practice Cases




Illustrate an organizational success or failure. Students synthesize policy lessons to be extracted from the situation.

Describe situations requiring execution of specific technical skills in order to draw conclusions

Describe a decision faced by the protagonist. Students must choose among a finite set of alternatives.

Describe a situation facing a protagonist. Students must diagnose problem(s) and formulate possible solutions.


Mauffette-Leenders et al., 2007, p. 19



John M Garcia, PhD

Professor of Practice & Interim DirectorSchool of Public Health and Health Systems

Faculty of Applied Health SciencesBurt Matthews Hall, Room 2311

University of Waterloo


Overview• UW School of Public Health and Health

Systems• Master of Public Health• Other Academic Programs of UW SPHHS

42


School of Public Health and Health Systems

• Created in 2012 from Dept of Health Studies and Gerontology

• More than 30 years of innovation and development• 9 academic programs, 5 new/planned

– BSc, MSc, PhD– MPH– BHP and MHI– MHE, BPH, DrPH

• Addition of 9 new faculty• recent review of four programs (1st listed)


MPH Program: Rationale and Mission Rationale: • need for greater #s and capacity of public health

professionals• MPH degree recognized academic benchmark credential• Need for expanded access to public health training (hence

blended curriculum/mainly on-line, regular tuition fees)• First intake, August 2006Mission: • help produce new generation of public health leaders and

managersBrand: • aspire, inspire, transform


Public Health• "the science and art of preventing disease,

prolonging life and promoting health through the organized efforts and informed choices of society, organizations [public, non-profit and private], communities and individuals“ (Winslow, 2002)

45



What are core competencies?• “…the set of cross-cutting skills,

knowledge and abilities necessary for the broad practice of public health.”

U.S. Council on Linkages Between Academia and Public Health Practice, 2004

47


Core competencies, PHAC• Public Health Sciences • Assessment and Analysis• Policy & Program Planning,

Implementation and Evaluation• Partnerships, Collaboration & Advocacy• Diversity and Inclusiveness• Communication

48


Example of a core competency – Public health sciences domain

• A public health practitioner is able to…

1.1 Demonstrate knowledge about the following concepts: the health status of populations, inequities in health, the determinants of health and illness, strategies for health promotion, disease and injury prevention and health protection, as well as the factors that influence the delivery and use of health services.


Example of a core competency – Public health sciences domain (continued)

1.2 Demonstrate knowledge about the history, structure and interaction of public health and health care services at local, provincial/territorial, national, and international levels.

1.3 Apply the public health sciences to practice.

1.4 Use evidence and research to inform health policies and programs.

1.5 Demonstrate the ability to pursue lifelong learning opportunities in the field of public health.


MPH Admission criteria• year Honours Bachelor's degree (or equivalent) in a health-related

field, from a recognized university• minimum 75% average in final two years of study (equivalent to last

20 half-credit courses)• minimum 1 year prior work experience in a public health setting or

other relevant setting• personal essay, resume, and letter

– the education, work and life experiences that have brought you to the decision to apply to the Master of Public Health program

– how the Master of Public Health will help you in your future career

• university-level course in basic statistics recommended


Program requirementsGeneral stream: • 9 core courses• 3 electives• practicumSocio-behavioural stream:• 9 core courses, 2 stream courses • 1 elective• PracticumEnvironmental stream:• In approval process, similar model


Competency domains

601/602

SCB Env Epi Comm Mgmt/admin

Policy

Public Health Sciences

+ + ++ +++ + + +

Analysis and Assessment

+ ++ +++ +++ + + +++

Policy/ProgramPlanning/Implement/Evaluation

+ + + + ++ +++ +++

PartnershipsCollaboration

Advocacy

+++ ++ + + +++ +++ +++

Communication + + + + +++ ++ ++

Diversity/Inclusiveness

+++ +++ + + +++ +++ +++

Leadership +++ + + + +++ +++ +++

Competencies in curriculum development


The MPH “Building” – Core coursesCapstone(PHS 602)

Practicum(PHS 641)

Health Policy (PHS 603)

Stream courses Electives

Principles of Epidemiology for

Public Health(PHS 606)

Health and Risk Communication in Public Health

(PHS 608)

Management and Administration of Public Health

Services(PHS 609)

Biostatistics in Public Health

(PHS 605)

Social Cultural and Behavioural Aspects of

Public Health (PHS 607)

Public Health and the Environment

(PHS 604)

Foundations of Public Health (PHS 601)

F-1

W-1

S-1/F-2

W-2

S-2


Elective course offerings – beyond core

• PHS 614 Evaluation of Public Health Programs (stream requirement)

• PHS 617 Population Intervention for Health Promotion and Disease Prevention (stream requirement)

• PHS 623 Risk and Exposure Assessment (stream requirement)

• PHS 624 Environmental Toxicology (stream requirement)

• PHS 632 Health Economics & Public Health

• PHS 635 Public Health, Environment and Planning

• PHS 636 Applied Epidemiology

• PHS 637 Public Health Informatics

• PHS 638 Selected Topics in Public Health– Social Justice and Public Health

• PHS 661 GIS and Public Health

• PHS 662 Global Health

• PHS 663 Human Development and Health


2006 2007 2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

4555

63 62

77 76

9486

0 0

1930

40 40

65

4845

98

134

159

185

215

236 239

1 4 8 10 15 12 11 8

MPH Student Numbers by Year

Incoming Students ₁ Graduating Students ₂ Total # of Students ₃ Withdrawals ₄


Students• Working at federal, provincial and local level, some international• Government, non-governmental, private sectors• MDs, nurses, dentists, public health inspectors, health

educators and promoters, psychologists, social workers, engineers, community activists, computer professionals, statistics, planning, etc.

• Range of substantive interests – chronic disease prevention, healthy growth and development, healthy environment, disaster planning/management, environmental health, infectious disease control, social determinants of health

• Aspire to be future leaders in public health – policy, management, director level


Graduating Class, October 2014


MPH Alumni Survey (spring 2012)• 81% employed (76% fulltime), 8% studying further, 8%

homemaker/caregiver, 4% looking for employment/unemployed

• Employed by: PHA/RHA (33%), provincial/territorial government (26%), federal government (19%), NGO/health charity (11%), other including community-based organizations and international agencies

• Range of roles: MOH, policy and program analysts, public health inspection/environmental health, health promotion, epidemiology, health communications etc.


Other UW SPHHS Programs• Master of Health Informatics

– Public Health and Health Systems Field, complementing Cheriton School of Computer Science program

– to identify, design and manage informatics solutions relevant to health and health systems

– Competencies adapted from COACH• Bachelor of Health Promotion• Master of Health Evaluation

– Preparation of professional evaluators– Competencies for evaluation practice established by the

Canadian Evaluation Society• Future – BPH, DrPH??


André La Prairie, Manager

Skills Enhancement for Public Health Health Security and Infrastructure Branch

Public Health Agency of Canada

TOPHC – April , 1, 2014TOPHC – April , 1, 2014 62

Skills Enhancement for Public HealthCentre for Public Health Capacity Development Health Security Infrastructure Branch

Building a Solid Foundation for Public Health Practice


Flexible (online) learning options to build knowledge, skills and competencies in public health

www.phac-aspc.gc.ca/php-psp/ccph-cesp/about_so-apropos_cd-eng.php


“Nurses new to the north need opportunities to develop the breadth of skills and depth of knowledge needed to practice independently.”

“Most public health nurses today are baccalaureate-trained, and further specific training in public health is no longer mandatory. Instead, public health nurses learn on the job through formal and informal in-service training.”

“Health Canada’s Skills Enhancement for Health Surveillance program is a web-based distance education program aimed at front-line and supervisory workers in local health departments. While not intended to substitute for master’s level training, and still under development, it aims to provide basic, high-quality training in epidemiology, surveillance and information management..”

“A thorough review of public health training programs is also needed—new entrants to the public health workforce should be appropriately qualified, and existing public health workers should be provided with opportunities to acquire additional skills if necessary.”

“It has also been argued that short courses in infectious diseaseepidemiology are an essential part of capacity building for many aspects of public health practice and leadership, but are not widely available..”


•Online continuing professional development program for front-line public health professionals• 10 online facilitated modules, 2 self-directed modules; English and French• Content mapped to the Core Competencies for Public Health in Canada

Skills Online

http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/about_cc-apropos_ce-eng.php

http://www.youtube.com/watch?v=xmbeBc-V838&feature=c4-overview&list=UUHMIr4rDriZWLoEZap3kaGw


Modules Currently Available• Basic Epidemiological Concepts• Measurement of Health Status• Epidemiologic Methods• Outbreak Investigation & Management• Epidemiology of Chronic Diseases• Introduction to Surveillance• Applied Epidemiology: Injuries• Communicating Data Effectively• Introduction to Biostatistics• Evidence-based Public Health Practice (English only)• Introduction to Public Health in Canada• Introduction to Literature Searching

Facilitated modules

Self-directed modules

http://www.youtube.com/watch?v=xmbeBc-V838&feature=c4-overview&list=UUHMIr4rDriZWLoEZap3kaGw


Modules Under Development

• Privacy and Confidentiality• Core Competency Toolkit• Health Literacy• Introduction to Core Competencies• Introduction to Program Evaluation• International Health Regulations


Challenges


Challenges


Challenges


Challenges


Challenges


Challenges


Challenges


Challenges


Challenges


Challenges


Our Future

National Schools and Programs of Public Health

• be a leader in new online module production

• links with CPHA (network and professional designation)

• offer module content to schools and other programs

• expand to alternate learning formats, including MOOCs


Future considerations• Need for a pan-Canadian and provincial public health human resources

strategy– Is this possible and if so, what would it include? How does this related to plans for public

health organizational and system capacity building strategies? Role of Public Health Network?

– Increasing number and diversity of MPH programs – do they address demand? – Do MPH program address front line practitioner and management needs?

• Evolving “National Network of Schools and Programs of Public and Population Health” (NNSPPPH)

– Credentialing of public health professionals?– Accreditation of schools and academic programs?– Requirement for public health practitioner participation in planning?

• In-service professional development programs, human resources changes local public health agencies? Uptake, dissemination

• Role of MPH Programs in developing expert leaders for public health

• MOOCs and free access to educational content


Jennifer L Chu, MD, MPH, FRCPC

Staff Physician, Department of Emergency Medicine, St. Michael’sLecturer, Department of Medicine, University of Toronto

Director of Basic and Clinical Sciences, NextGenU


Overview• Overview of distance learning and MOOCs• Introduction to NextGenU• Future direction of public health and

MOOCs/NextGenU

81


Distance Learning

82

1800s

1930s

1996

2000s

2010s


Internet Usage


What are MOOCs?


MOOCs• Coursera, EdX, Udacity largest MOOCs in

the US• ALISON (Advanced Learning Interactive

Systems Online) one of largest MOOCs mostly used in developing countries

• MOOCs being developed globally

85


MOOCsPROS CONS

• Free or low cost for learners• Self-directed/paced• Less barriers than traditional

education• Computerized interactions globally• Limitless scalability • Financial efficiency for institutions

• Credit for courses often costs money• Lack of direct human interaction• May lack prestige/acceptability

compared with traditional education• Sustainability• Quality control• High drop-out rates

86


Kampala Declaration• WHO identified a need

for 12.9 million more trained health workers by 2035

• WHO also stated this will require greater use of training innovation - especially information and communication technologies

87


NextGenU• Not a MOOC – a DOOHICHE

Democratically Open, Outstanding Hybrid of Internet-aided, Computer-aided,

and Human-aided Education

88



Course Development• Identify existing expert-derived core competencies• Organize competencies into modules• Match competencies with existing internet resources from

highly reputable sources• All resources must be freely available and advertisement-free• Develop peer and mentor-based activities• Evaluation• Review from advisory committee• Sponsorship from accredited organizations

90


Current Courses• Alcohol, Tobacco Use and Other Substance

Use Disorders• Climate Change and Health• Emergency Medicine• Environmental Health• War and Health

91


Upcoming Courses

92


Pilot Tests• Emergency Medicine course piloted at the Uniformed

Service University of the Health Sciences and University of Missouri with senior medical students

• Environmental Health piloted with MPH students at Simon Fraser University (BC)

• No significant difference found in standardized testing between control students and NextGenU students

93


Countries Using NextGenU• Climate Change and Health

– Brazil, Bulgaria, Canada, Christmas Island, Denmark, Egypt, Great Britain, Hrvatska/Croatia, Hong Kong, India, Nigeria, Pakistan, Saudi Arabia, Turkey, United States

• Environmental Health– Argentina, Australia, Bangladesh, Belgium, Canada, El Salvador, Germany, Great Britain,

Hrvatska/Croatia, Hungary, India, Italy, Kenya, Nigeria, Pakistan, Philippines, Russian Federation, Saudi Arabia, Singapore, Sri Lanka, Thailand, United Arab Emirates, United States

• War and Health– Canada, Ecuador, Malaysia, Switzerland, United States

• Emergency Medicine– Afghanistan, Australia, Bangladesh, Belgium, Bahrain, Brazil, Canada, Columbia, Czech

Republic, Germany, Denmark, Ecuador, El Salvador, Estonia, Egypt, Spain, France, Great Britain, Greece, Hong Kong, Hrvatska/Croatia, Hungary, Indonesia, Ireland, India, British Indian Ocean Territory, Italy, Kenya, Latvia, Malaysia, Nigeria, Netherlands, Philippines, Portugal, Romania, Qatar, Saudi Arabia, Spain, Sri Lanka, Sudan, Sweden, Switzerland, Singapore, Trinidad and Tobago, Taiwan, US Minor Outlying Islands, United Arab Emirates, United States, Venezuela, South Africa

94


Emergency Medicine

95


Future Direction• Continue to develop courses in basic

sciences, clinical medicine and public health• Preventative medicine residency curriculum

currently under development• Goal to create a free MPH

96



GROUP DISCUSSION


Discussion at Tables• After introducing each other, choose one person to record

• Where do you see the challenges for the future?

• What would be needed– To build on existing strengths (strongest collective capacities) at your

place of work? – To build additional capacities (greatest area of collective improvement

needed) at your place of work?

• How would you go about enabling collective capacity building to happen at your workplace? In the future?


Thank you

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Public Health Education Unbound