History of development of undergraduate public health education in Bulgaria.

OBJECTIVE: The study aims to present a historical review and analysis of the establishment and development of undergraduate public health (PH) education in Bulgaria from 1878 until 2019. METHODS: А search and selection of historical documents was performed, including laws, rules, regulations, government plans, programmes, scientific publications from periodical medical press, journals, specialized monographs, and books. A retrospective analysis of the normative documents related to the organization of the sanitation and public health activities, and to the provision of professional undergraduate education of the public health workforce in Bulgaria has been carried out. The required competences and tasks of the specialists exercising public health control services were extracted. RESULTS: The development in the public health educational activities were followed in three consecutive periods: the newly independent state (1878-1944); the socialist state (1945-1990); the democratizing state (1990-2019). The development of organized PH activities began after the liberation of Bulgaria in 1878. The historical analysis reveals a direct link between the major socioeconomic changes in the country and the organization of PH undergraduate education which passed through dynamic transformations. The professional education in the sphere of PH started with the training of feldshers, followed by sanitary feldsher and sanitary health inspectors performed in secondary vocational medical schools during the socialist period, reaching the stage of undergraduate university PH education provided by medical colleges associated with universities in the third period. CONCLUSION: Despite the continuous development in the organization of undergraduate PH education in Bulgaria, its content is still not fully compatible with the basic European PH services and actions. There is a growing need for wider standardization and integration of undergraduate PH education in the EU so that the specialty can reach the status of a regulated health profession similar to medicine, nursing, and others.

Defining Core Competencies for Epidemiologists in Academic Settings to Tackle Tomorrow's Health Research Challenges: A Structured, Multinational Effort.

Only a few efforts have been made to define core competencies for epidemiologists working in academic settings. Here we describe a multinational effort to define competencies for epidemiologists, who are increasingly facing emerging and potentially disruptive technological and societal health trends in academic research. During a 1.5-year period (2017-2019), we followed an iterative process that aimed to be inclusive and multinational to reflect the various perspectives of a diverse group of epidemiologists. Competencies were developed by a consortium in a consensus-oriented process that spanned 3 main activities: 2 in-person interactive meetings held in Amsterdam, the Netherlands, and Zurich, Switzerland, and an online survey. In total, 93 meeting participants from 16 countries and 173 respondents from 19 countries contributed to the development of 31 competencies. These 31 competencies included 14 on "developing a scientific question" and "study planning," 12 on "study conduct and analysis," 3 on "overarching competencies," and 2 on "communication and translation." The process described here provides a consensus-based framework for defining and adapting the field. It should initiate a continuous process of thinking about competencies and the implications for teaching epidemiology to ensure that epidemiologists working in academic settings are well prepared for today's and tomorrow's health research.

Global health on the front lines: an innovative medical student elective combining education and service during the COVID-19 pandemic.

BACKGROUND: An innovative medical student elective combined student-directed, faculty-supported online learning with COVID-19 response field placements. This study evaluated students' experience in the course, the curriculum content and format, and its short-term impact on students' knowledge and attitudes around COVID-19. METHODS: Students responded to discussion board prompts throughout the course and submitted pre-/post-course reflections. Pre-/post-course questionnaires assessed pandemic knowledge and attitudes using 4-point Likert scales. Authors collected aggregate data on enrollment, discussion posts, field placements, and scholarly work resulting from course activities. After the elective, authors conducted a focus group with a convenience sample of 6 participants. Institutional elective evaluation data was included in analysis. Authors analyzed questionnaire data with summary statistics and paired t-tests comparing knowledge and attitudes before and after the elective. Reflection pieces, discussion posts, and focus group data were analyzed using content analysis with a phenomenological approach. RESULTS: Twenty-seven students enrolled. Each student posted an average of 2.4 original discussion posts and 3.1 responses. Mean knowledge score increased from 43.8 to 60.8% (p <  0.001) between pre- and post-course questionnaires. Knowledge self-assessment also increased (2.4 vs. 3.5 on Likert scale, p <  0.0001), and students reported increased engagement in the pandemic response (2.7 vs. 3.6, p <  0.0001). Students reported increased fluency in discussing the pandemic and increased appreciation for the field of public health. There was no difference in students' level of anxiety about the pandemic after course participation (3.0 vs. 3.1, p = 0.53). Twelve students (44.4%) completed the institutional evaluation. All rated the course "very good" or "excellent." Students favorably reviewed the field placements, suggested readings, self-directed research, and learning from peers. They suggested more clearly defined expectations and improved balance between volunteer and educational hours. CONCLUSIONS: The elective was well-received by students, achieved stated objectives, and garnered public attention. Course leadership should monitor students' time commitment closely in service-learning settings to ensure appropriate balance of service and education. Student engagement in a disaster response is insufficient to address anxiety related to the disaster; future course iterations should include a focus on self-care during times of crisis. This educational innovation could serve as a model for medical schools globally.

Exploring the evolution of engagement between academic public health researchers and decision-makers: from initiation to dissolution.

CONTEXT: Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic-government relationships. METHODS: We conducted in-depth interviews with 52 faculty at one school of public health and 24 government decision-makers at city, state, federal and global levels. Interviews were transcribed and coded deductively and inductively using Atlas.Ti. Responses across codes and respondents were extracted into an Excel matrix and compared in order to identify key themes. FINDINGS: Eight key drivers to engagement were identified, namely (1) decision-maker research needs, (2) learning, (3) access to resources, (4) student opportunities, (5) capacity strengthening, (6) strategic positioning, (7) institutional conditionalities, and (8) funder conditionalities. There were several elements that enabled initiation of relationships, including the role of faculty members in the decision-making process, individual attributes and reputation, institutional reputation, social capital, and the role of funders. Maintenance of partnerships was dependent on factors such as synergistic collaboration (i.e. both benefit), mutual trust, contractual issues and funding. Dissolution of relationships resulted from champions changing/leaving positions, engagement in transactional relationships, or limited mutual trust and respect. CONCLUSIONS: As universities and government agencies establish relationships and utilise opportunities to share ideas, envision change together, and leverage their collaborations to use evidence to inform decision-making, a new modus operandi becomes possible. Embracing the individual, institutional, networked and systems dynamics of relationships can lead to new practices, alternate approaches and transformative change. Government agencies, schools of public health and higher education institutions more broadly, should pay deliberate attention to identifying and managing the various drivers, enablers and disablers for relationship initiation and resilience in order to promote more evidence-informed decision-making.

Comparison of public health specialty training in Australia and England.

OBJECTIVES: The objective of the study is to explore common challenges and distinct features of specialty public health training in Australia and England, given similarities in public health issues faced, shared histories and common political structures. STUDY DESIGN: The study design used in the study is a document review. METHODS: Using current curricula, along with other publicly available documents, we reviewed organisational, selection and content elements of public health specialty training in these two countries. RESULTS: In both countries, specialist public health training is coordinated and accredited through Faculties of Public Health housed within Royal Colleges of Physicians. However, eligibility, recruitment to training and funding routes differ. In England, entrants are accepted from a range of backgrounds including medicine, whereas only medical doctors are eligible in Australia. England has a national, annual recruitment process; Australia does not and has a less structured training path. In Australia, specialty advanced training is three years (excluding a Master's in Public Health [MPH]), whereas in England, training is generally five years (including an MPH). Curricula cover broadly common domains of public health practice although there are differences. Methods to assess readiness for consultant practice differ. CONCLUSIONS: Fostering an understanding of the specialist role of public health professionals in different countries establishes routes to share learning, encourage greater collaboration and creates opportunities for benchmarking.

A Public Health of Consequence: Shifting the Cultural Narrative From Churning Grants to a Scholarship of Consequence.

A confluence of challenges is impeding faculty members' ability to prioritize research with the goal of achieving a public health of consequence: research designed to improve conditions to produce a healthier society. Together, these challenges create a "churn" culture in which faculty focus on generating new business (i.e., grant funding and associated incentives) to replace lost revenue (i.e., expiring grants); this culture can relegate public health impact to a back seat.We share three strategies and related insights from our efforts to shift our department's cultural narrative from churn to a "scholarship of consequence": crafting research proposals of consequence, fostering thought leadership through collaborative writing, and mentoring faculty with a view to a scholarship of consequence.We describe each of the strategies and interim progress. Although they are a work in progress, we conclude that despite initial concerns, our evaluation metrics indicate improvement.

Applied Learning for Undergraduates: Integrating NCHEC Competencies and CEPH Public Health Domains in a Public Health Practice Course.

To meet Council on Education for Public Health (CEPH) accreditation standards for a standalone undergraduate public health program, faculty at the University of North Carolina Wilmington conducted a matrix exercise to assess curricular alignment with the CEPH Domains of Public Health (PHDs) and the National Commission for Health Education Credentialing (NCHEC) competencies. Addressing gaps in the undergraduate public health program identified by the matrix exercise drove development of a new course, Public Health Practice. The course was designed to use real world experience to provide students with the tools and skills needed for the practice of public health. Written assignments such as a needs assessment and a logic model were used to simultaneously expose and prepare students to address real-life public health challenges and to introduce students to selected CEPH PHDs and NCHEC competencies. This integration of competencies and domains into a course curriculum may be of benefit to undergraduate public health programs seeking to develop courses with applied learning aligned with CEPH and NCHEC requirements.

Competent with patients and populations: integrating public health into a medical program.

BACKGROUND: As the global burden of chronic disease grows, and infectious disease threats loom large, the need for medical graduates with expertise in public health medicine (PHM) is growing. A recurrent challenge is integrating this broad knowledge into crowded medical curricula and making PHM relevant. This study describes the process of integrating public health content into an Australian graduate entry medical course. METHODS: A redesign of the PHM curriculum at Deakin University School of Medicine was conducted in 2014 to make the curriculum practice-based and solution-oriented. Central to the redesign was the development of a curriculum map. RESULTS: Public health is now taught from a practice-based framework adapted from the World Health Organization emphasizing skills aligned with the Australasian Faculty of Public Health Medicine domains that prepare students for specialisation. Learning outcomes are structured to build depth and application in student knowledge. Mapping the curriculum provided the ability to measure alignment of learning outcomes with course, university and accrediting body outcomes. Regular feedback from students indicates engagement has improved along with perceived relevance to future careers. CONCLUSIONS: Doctors with public health skills are increasingly sought after in Australia, particularly in rural areas. Deakin graduates are well placed to meet this demand.

[Investigation on the current status of the cultivation of the master of public health (MPH) in colleges in China].

In order to understand the status of the cultivation of the masters of public health (MPH) in colleges in China and improve the cultivation model, an electronic questionnaire survey were conducted among 22 schools of public health in colleges. The result showed that the size and the enrolment scale of Chinese MPH students were relatively small, and the training objectives were still unclear. There was no obvious difference between the curriculum setting for MPH and academic master degree. The practical skill-oriented courses and emergency response ability of public health practice were insufficient. The cultivation model of MPH should be improved in future.

Evaluation of Training Program for the Maternal and Child Health Workforce at Tulane University.

Objectives Despite significant investments in Maternal and Child Health (MCH), the United States still lags behind other countries in key MCH indicators. A well-trained workforce is needed to improve MCH. The Division of MCH Workforce Development of HRSA's Maternal and Child Health Bureau provides funding to schools of Public Health to support Centers of Excellence in MCH, which is focused on preparing the next generation of MCH leaders through specialized training and mentorship. One such center, the Tulane Center of Excellence in MCH (CEMCH), is housed at the Tulane University School of Public Health and Tropical Medicine. This study evaluated the perceived effectiveness and acceptability of the CEMCH leadership training program. Methods A mixed-methods approach was used, consisting of semi-structured interviews and quantitative surveys which were analyzed through inductive methods based in grounded theory and non-parametric methods respectively. Results Results indicated an overall high level of program satisfaction by all stakeholders. Mentorship and personal attention emerged as an important benefit for both former and current Scholars. The opportunity to gain real-world understanding of MCH work through program activities was an added benefit, although these activities also presented the most challenges. Community stakeholders generally did not view the program as providing immediate organizational benefit, but recognized the distal benefit of contributing to a well-trained MCH workforce. Conclusions for Practice These results will be used to inform other MCH training programs and strengthen Tulane's CEMCH. A well-trained MCH workforce is essential to improving MCH, and high-quality training its foundation.

Public health education and health system needs in Pakistan: a mixed methods study.

BACKGROUND: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs. AIMS: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs. METHODS: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce. RESULTS: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic (i.e. with no specific concentration track) and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills. CONCLUSIONS: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways.

To what extent can PBL principles be applied in blended learning: Lessons learned from health master programs.

INTRODUCTION: Maastricht University has been actively exploring blended learning approaches to PBL in Health Master Programs. Key principles of PBL are, learning should be constructive, self-directed, collaborative, and contextual. The purpose is to explore whether these principles are applicable in blended learning. METHODS: The programs, Master of Health Services Innovation (case 1), Master Programme in Global Health (case 2), and the Master of Health Professions Education (case 3), used a Virtual Learning Environment for exchanging material and were independently analyzed. Quantitative data were collected for cases 1 and 2. Simple descriptive analyses such as frequencies were performed. Qualitative data for cases 1 and 3 were collected via (focus group) interviews. RESULTS: All PBL principles could be recognized in case 1. Case 2 seemed to be more project-based. In case 3, collaboration between students was not possible because of a difference in time-zones. Important educational aspects: agreement on rules for (online) sessions; visual contact (student-student and student-teacher), and frequent feedback. CONCLUSION: PBL in a blended learning format is perceived to be an effective strategy. The four principles of PBL can be unified in PBL with a blended learning format, although the extent to which each principle can be implemented can differ.

Factors that influence full-time MPH Students' willingness in China: would You apply again for an MPH graduate degree if you had another opportunity?

BACKGROUND: Current and emerging challenges to public health in the 21st century are vastly different from those faced in previous centuries. And the shortage of health personnel and their low level of educational qualifications hindered the development of Chinese public health services. In order to fulfill this requirement, the Ministry of Education initiated a full-time, Master of Public Health (MPH) graduate programme in 2009. This study aimed to evaluate the level of graduate students' satisfaction with full-time Master of Public Health (MPH) education in China, and whether they would apply again for an MPH graduate degree if they had another opportunity to do so, as well as to identify the factors influencing their decision-making process. METHODS: An anonymous, web-based survey questionnaire containing 61 items was distributed to 702 MPH students in 35 universities or colleges. The questions covered the categories of student admission, training goals, lecture courses, practical training, research activities and mentorship. Levels of satisfaction were compared between MPH students who would choose MPH again as their graduate degree if they had another opportunity to do so and those who would not. Key influencing factors of training satisfaction were identified using logistic regression models. RESULTS: A total of 65.10% of the participants would apply again for MPH education if they had another opportunity to do so. The factors influencing students' willingness included their university type, the time since admission and their initial willingness. In addition, the four common factors (admissions & lecture courses, research activities & mentorship, practical training and training goals) emerging from factor analysis were all significantly positively correlated with student willingness (p < 0.001). CONCLUSIONS: Most MPH students surveyed were highly satisfied with their MPH education and, although they advocated for improvements and reforms in some aspects, they would still choose MPH as their graduate degree again if they had another opportunity to do so.

[Public Health as an Applied, Multidisciplinary Subject: Is Research-Based Learning the Answer to Challenges in Learning and Teaching?] / Public Health als anwendungsorientiertes Fach und Multidisziplin ­ "Forschendes Lernen" als Antwort auf die Herausforderungen für Lehren und Lernen?

Public health education aims at enabling students to deal with complex health-related challenges using appropriate methods based on sound theoretical understanding. Virtually all health-related problems in science and practice require the involvement of different disciplines. However, the necessary interdisciplinarity is only partly reflected in the curricula of public health courses. Also theories, methods, health topics, and their application are often taught side-by-side and not together. For students, it can become an insurmountable challenge to integrate the different disciplines ("horizontal integration") and theories, methods, health topics, and their application ("vertical integration"). This situation is specific for education in public health but is representative for other interdisciplinary fields as well. Several approaches are available to achieve the horizontal integration of different disciplines and vertical integration of theories, methods, health topics, and their application. A curriculum that is structured by topics, rather than disciplines might be more successful in integrating different disciplines. Vertical integration can be achieved by research-based learning. Research-based learning places a student-led research project at the centre of teaching. Students choose a topic and a research question, raise their own questions for theories and methods and will hopefully cross the seeming chasm between science and practice. Challenges of research-based learning are enhanced demands on students, teachers and curriculum design.

Exploring Proxy Measures of Mutuality for Strategic Partnership Development: A Case Study.

Partnerships between academic and clinical-based health organizations are becoming increasingly important in improving health outcomes. Mutuality is recognized as a vital component of these partnerships. If partnerships are to achieve mutuality, there is a need to define what it means to partnering organizations. Few studies have described the elements contributing to mutuality, particularly in new relationships between academic and clinical partners. This study seeks to identify how mutuality is expressed and to explore potential proxy measures of mutuality for an alliance consisting of a hospital system and a School of Public Health. Key informant interviews were conducted with faculty and hospital representatives serving on the partnership steering committee. Key informants were asked about perceived events that led to the development of the Alliance; perceived goals, expectations, and outcomes; and current/future roles with the Alliance. Four proxy measures of mutuality for an academic-clinical partnership were identified: policy directives, community beneficence, procurement of human capital, and partnership longevity. Findings can inform the development of tools for assisting in strengthening relationships and ensuring stakeholders' interests align with the mission and goal of the partnership by operationalizing elements necessary to evaluate the progress of the partnership.

From Classroom to Capitol: Building Advocacy Capacity Through State-Level Advocacy Experiences.

This commentary provides insight from Community Health Education and Master of Public Health students on the benefits of participating in a state-level Advocacy Experience and provides a theoretical framework for increased advocacy intention among students as a result of participating in a state-level Advocacy Experience. Providing students the opportunity to translate what they learn about advocacy in the classroom into advocacy in action with policy makers is vital to the career development of our future health education professionals and is key to increasing advocacy capacity within our profession. This article builds on previous work from emerging public health professionals highlighting the role of policy advocacy in professional development and provides additional perspectives from the next generation of health education specialists.

EpiAssist: Service-learning in public health education.

BACKGROUND: Although public health degree programs typically require practica and other field experiences, service-learning courses, with a focus on civic engagement and the application of classroom learning in real world settings, can go beyond these requirements and provide benefits to students and community-based practice partners. The goal of this paper is to assess potential benefits of service-learning programs for both graduate-level public health students and state and local public health agency partners. METHODS: EpiAssist is a new service-learning program developed at the School of Public Health of the Texas A and M University Health Science Center, USA, in January 2015. EpiAssist was integrated into a new course, Methods in Field Epidemiology. The integration of service-learning was guided by a partnership with the Texas A and M Center for Teaching Excellence. RESULTS: State, regional, and local public health partners requested EpiAssist via email or telephone. A listserv was used to recruit student volunteers to meet requests. 54 of 86 registered EpiAssist students (63%) participated in at least one of ten service-learning and three training activities between January and June, 2015. Service-learning activities included questionnaire development, in-person and telephone data collection, and data analysis. Training topics for students included the Epi Info™ software, community assessment and communicable disease reporting. Students and partner organizations provided generally positive assessments of this service learning program through an online evaluation. DISCUSSION: Service-learning provides students with enhanced classroom learning through applied public health experience in state, regional and local health departments. These experiences provide both needed surge capacity to public health departments and valuable hands-on field experience to students.