The future of public health doctoral education in Africa: transforming higher education institutions to enhance research and practice.

The African Union and the Africa Centers for Disease Control and Prevention issued a Call to Action in 2022 for Africa's New Public Health Order that underscored the need for increased capacity in the public health workforce. Additional domestic and global investments in public health workforce development are central to achieving the aspirations of Agenda 2063 of the African Union, which aims to build and accelerate the implementation of continental frameworks for equitable, people-centred growth and development. Recognising the crucial role of higher education and research, we assessed the capabilities of public health doctoral training in schools and programmes of public health in Africa across three conceptual components: instructional, institutional, and external. Six inter-related and actionable recommendations were derived to advance doctoral training, research, and practice capacity within and between universities. These can be achieved through equitable partnerships between universities, research centres, and national, regional, and global public health institutions.

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 METHODS: А search and selection of historical documents was performed, including laws, rules, regulations, government plans, programmes, scientific publications from periodical medical press, journals, specialized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.

Columbia University Master of Public Health Core Curriculum: Implementation, Student Experience, and Learning Outcomes, 2013-2018.

OBJECTIVES: Public health education must respond to 21st-century public health challenges in an ever-evolving landscape. We describe implementation and educational outcomes of the Columbia University Master of Public Health (MPH) Core (hereinafter, Core) curriculum since its inception. METHODS: This retrospective evaluation combined 6 years (2013-2018) of student survey data collected from students (N = 1902) on the structure and delivery of the Core curriculum to quantify implementation, student experience, and learning outcomes, both during study (Core Evaluation Survey [CES]) and after graduation (Graduate Exit Survey [GES]). We used χ2 tests and analysis of variance to compare outcomes across years, and we used McNemar tests to compare differences in outcomes from the same students at different time points. RESULTS: Of 1902 respondents to the CES, 1795 (94.4%) completed the Core curriculum. During the study period, 81.7% of students were able to integrate concepts across Core curriculum modules with ease; postgraduation, a similar proportion of respondents were able to apply Core curriculum content to departmental and certificate coursework and applied field experiences. On-time graduation rates were high (range, 85%-93%). CONCLUSIONS: The high percentage of students who reported their ability to integrate concepts and who completed the Core during the study period likely reflected changes to teaching team structures, training, attention to inclusion and equity, and collaboration to implement active learning strategies. The Core curriculum meets its intended goals by providing critical learning abilities to support ongoing interdisciplinary work.

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.

Dual MD-MPH Degree Students in the United States: Moving the Medical Workforce Toward Population Health.

OBJECTIVE: A growing need exists to train physicians in population health to meet the increasing need and demand for physicians with leadership, health data management/metrics, and epidemiology skills to better serve the health of the community. This study examines current trends in students pursuing a dual doctor of medicine (MD)-master of public health (MPH) degree (MD-MPH) in the United States. METHODS: We conducted an extensive literature review of existing MD-MPH databases to determine characteristics (eg, sex, race/ethnicity, MPH area of study) of this student cohort in 2019. We examined a trend in the MD community to pursue an MPH career, adding additional public health and health care policy training to the MD workforce. We conducted targeted telephone interviews with 20 admissions personnel and faculty at schools offering MD-MPH degrees in the United States with the highest number of matriculants and graduates. Interviews focused on curricula trends in medical schools that offer an MD-MPH degree. RESULTS: No literature describes the US MD-MPH cohort, and available MD-MPH databases are limited and incomplete. We found a 434% increase in the number of students pursuing an MD-MPH degree from 2010 to 2018. The rate of growth was greater than the increase in either the number of medical students (16%) or the number of MPH students (65%) alone. Moreover, MD-MPH students as a percentage of total MPH students more than tripled, from 1.1% in 2010 to 3.6% in 2018. CONCLUSIONS: As more MD students pursue public health training, the impact of an MPH degree on medical school curricula, MD-MPH graduates, and MD-MPH career pursuits should be studied using accurate and comprehensive databases.

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.

As escolas estaduais de saúde pública: contribuições pedagógicas e político-institucionais para o SUS / State schools of public health: pedagogical and political-institutional contributions to SUS

O investimento em aperfeiçoamento profissional sempre foi objetivo prioritário durante minha carreira no serviço público. Acredito que o incentivo à capacitação técnica e humana daqueles que conduzem a burocracia brasileira seja o caminho mais sólido para garantirmos políticas públicas que façam a diferença e beneficiem toda a população, tanto em médio quanto em longo prazo. Assim, enxergo a gestão da educação na saúde como um mecanismo essencial para o pleno desenvolvimento do Sistema Único de Saúde (SUS). A Constituição Federal de 1988 estabelece como competência do SUS a ordenação e a formação de Recursos Humanos na área da saúde. A Lei federal 8.080, de 1990, reforça e completa esse conceito. O dispositivo legal, além de incluir a ordenação da formação de recursos humanos entre as atividades do SUS, afirma que entes da federação têm como prerrogativa participar, no seu âmbito administrativo, da formulação e da execução da política de formação e desenvolvimento de recursos humanos para a saúde. Pensar as diferentes relações institucionais, operando em um sistema por natureza complexo, é um desafio para poucos. Esse aprimoramento da visão estratégica dentro da gestão de saúde, discernindo suas prioridades e enxergando com nitidez suas limitações, proporciona a superação de desafios e, consequentemente, a melhoria do sistema. Dessa forma, a Política Nacional de Educação Permanente em Saúde (PNEPS) é, ao mesmo tempo, um conceito e uma estratégia político-pedagógica. Digo isso porque ela estabelece relações orgânicas entre o ensino e o serviço; a docência e a atenção à saúde; o trabalho e a gestão. Além disso, reconhece o caráter educativo do trabalho, porque entende o trabalho como lugar de problematização. As Escolas Estaduais de Saúde Pública (EESP), vinculadas às Secretarias Estaduais de Saúde, são espaços institucionais fundamentais para desenvolver essas ações. Reúnem funções pedagógicas que aprecio muito e que são fundamentais para a formação dos profissionais do SUS. O Conass, pelas razões apresentadas, tem clareza sobre a importância da educação permanente em saúde e o papel das EESP. Por essa razão, vem desenvolvendo, ao longo dos anos, um conjunto de ações de apoio ao tema. Esta publicação, que muito nos orgulha, insere-se no contexto do projeto de apoio à ampliação e ao fortalecimento das EESP. Nos apresenta um quadro claro e objetivo da história, missão, natureza jurídica, público-alvo e ações desenvolvidas pelas EESP, bem como as ações concebidas para ampliá-las. Estamos fortemente empenhados em contribuir para o permanente fortalecimento dessas Escolas e reunindo esforços para, em breve, constituir uma potente rede colaborativa de EESP. Por fim, nunca é demais lembrar que promover a disseminação da informação, a produção e difusão do conhecimento, assim como a inovação e o incentivo à troca de experiências, integra a missão do Conass. Este livro vem em boa hora. A ciência continua sendo um porto seguro, no qual ancoramos nossas maiores esperanças de que nada, além da ciência, nos livrará da negação da realidade. Iniciativas como esta só reforçam o pacto indelével que temos com o avanço constante da educação, na sua valorização e no papel importantíssimo que ela desempenha em fortalecer a saúde pública no Brasil.

Gestores do RS e TO participam de encontro virtual sobre covid-19

O Instituto de Saúde Coletiva realiza um encontro com gestores estaduais para debater estratégias de enfrentamento à covid-19 nas áreas de Trabalho e Educação em Saúde. Os convidados desta semana são: Teresinha Valduga (Rio Grande do Sul), Fabíola Sandini e Robson José da Silva (Tocantins). Os encontros virtuais fazem parte das atividades de cooperação técnica promovidas pelo ISC/UFBA junto ao Ministério da Saúde. O objetivo é desenvolver uma proposta de monitoramento e avaliação da Educação Permanente em Saúde (EPS) no país. Durante as sessões, os convidados compartilham as experiências em relação ao enfrentamento da covid-19 e respondem perguntas dos internautas sobre as ações de cada estado. A ideia é alcançar gestores, profissionais de saúde, pesquisadores e estudantes, mas também toda a comunidade disposta a participar das discussões.

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.

Term Limits in Academic Public Health Administration.

OBJECTIVES: Term limits might be appropriate for leadership positions in academic public health. This study assessed the appointment processes and terms for deans, directors, and chairs of schools and programs of public health and their views on term limits. METHODS: A 10-question survey was developed for the Association of Schools and Programs of Public Health and provided electronically to 127 deans and program directors in November and December 2019, of whom 58 (46%) responded. RESULTS: Of 54 respondents to the question on term limits, 45 deans and directors of schools and programs of public health served with no terms or limits and 9 served with terms of 3-5 years with no limits on the number of terms. Respondents largely agreed with most arguments for or against term limits. Of 51 respondents, most indicated completely or moderately valid support for 2 arguments for term limits: diversity (n = 40) and succession planning (n = 40). Of 51 respondents, most indicated completely or moderately valid support for 3 arguments against term limits: stable and continuous leadership (n = 40), time for leadership development (n = 37), and loss of institutional memory (n = 35). Twenty-seven of 53 responding deans and directors viewed the most appropriate terms and limits as being more restrictive than their current terms; the other 26 viewed the most appropriate terms as being the same as their current terms. No respondents preferred less restrictive limits than their current terms. CONCLUSION: Although term limits for deans, directors, and chairs are rare in schools and programs of public health, many deans and directors view term limits as appropriate. Schools and programs may reconsider their current policies for term limits.

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.

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.

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.

The development of Emergency Management and Homeland Security Degree program at historically black colleges and universities: The case of Texas Southern University, Houston, Texas.

This article shares the experience of establishing the Emergency Management and Homeland Security degree program at Texas Southern University (TSU), Houston, Texas. Emergency management programs are evolving and keep increasing and the nature of jobs of emergency managers are becoming more complex. Consequently, there is increasing need to have minority emergency managers who would be able to relate directly with other minorities impacted by disasters. This study uses the case of TSU to discuss the challenges and successes of developing a fairly unknown program at a historically black college and university and how the obstacles were overcome. It further discusses the process of the degree program development, the curriculum, and the present state of the program. This article concludes there are many advantages in training emergency managers of color in the field. These would be professionals in the field with the added advantage of being people of color. They would understand planning for and responding to those affected because they most likely have the same background and similar experience. Additionally, the developer of any new program should expect some form of opposition from faculty, staff, and administration but once central administration buys in, the program is worth the while.

[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.