[Current issues related to education in the five core disciplines of public health at the school of public health in a private university].

Objectives　In Japan, schools of public health (SPH) have engaged in professional education focusing on five core disciplines: epidemiology, biostatistics, social and behavioral science, health policy and management, and occupational and environmental health. However, empirical information is lacking regarding the current state of this education and its associated challenges in Japan. In this article, we showcase this issue, using the master of public health (MPH) course at Teikyo University Graduate School of Public Health (Teikyo SPH) as an example.Methods　We summarized the current objectives and classes required to complete the MPH course at Teikyo SPH, using the course guideline published in 2022. Current issues and possible future directions in the course were summarized based on the opinions of Teikyo SPH faculty members.Results　For epidemiology, lectures and exercises were designed to focus on how to formulating public health issues, collecting and evaluating data, and causal inference. Issues related to the design included ensuring that students had the necessary skills to apply epidemiology to emerging issues, and catching the course up with evolving techniques. For biostatistics, lectures and exercise classes focused on understanding data and statistics, as well as performing analyses. Issues included the understanding of theories, setting the course level, and a lack of appropriate education materials for emerging analytical methods. For social and behavioral science, lectures and exercise classes focused on understanding human behaviors and actions for problem solving. Issues included learning various behavioral theories in a limited timeframe, the gap between the lectures and various needs, and nurturing professionals who had the skills to perform in practical settings. For health policy and management, lectures, exercise classes, and practical training classes focused on identifying and solving problems in the community and around the world, and on integrating the disparate viewpoints of health economics and policy. Issues included few alumni who actually found work globally, a lack of students working in local or central administrations, and insufficient perspectives on rational/economic thinking and macro-economic transitions. For occupational and environmental health, lectures, exercise classes, and practical training classes focused on learning the occupational and environmental impacts of public health issues, and their countermeasures. Challenges included enriching the topics with regard to advanced technologies, environmental health, and socially vulnerable populations.Conclusion　Through these reflections on MPH education at Teikyo SPH, the following recommendations are considered essential in order to prepare improvements to the program: reorganizing the curriculum to meet the needs of the day, accepting students with various backgrounds, addressing the increasing knowledge and skills that need to be acquired by the students, and enhancing the powers of professors to implement changes.

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.

Teaching systems science to public health professionals.

OBJECTIVES: Systems thinking aims to understand the overall behavior of a system by examining the interdependencies of parts of the system. The objective of this study is to increase awareness of systems thinking and systems modeling in public health research and practice. STUDY DESIGN: A short course was offered to public health professionals using a combination of teaching modalities: didactic lectures, group discussions, hands-on programming, and experiential learning. METHODS: Course participants completed surveys and provided feedback on the effectiveness of the course. A description of participant backgrounds, survey responses, and feedback were summarized. RESULTS: Overall, participants offered quantitative and qualitative feedback suggesting that course content was useful and effective for incorporating systems thinking/modeling in their public health practice. CONCLUSIONS: Systems thinking can be taught through formal modes of instruction to public health workers, but more research and case studies are needed to identify who should be taught and when and how such instruction should take place given competing priorities of public health workers.

[Examination of the effects of a role-playing training program for the improvement of planning and management skills of public health nurses].

Objectives　The Japan Health Insurance Association (JHIA) conducts training in each branch facility to improve the ability of public health nurses (PHNs). The headquarters of the PHNs of JHIA and the researchers conducted a training program for leaders of PHNs at each JHIA branch. The goal of the program was to create a training plan using role-play to acquire facilitation skills. This study aimed to examine the effects of training.Methods　The study was designed in accordance with the Instructional Designs. The training goals were as follows: (1) understanding the role of facilitation and the facilitator in the debriefing session after the role-play, (2) understanding facilitation techniques, (3) being confident in performing as facilitators in the debriefing session; and (4) conducting the debriefing sessions using facilitation skills. The evaluation of the training was based on the Kirkpatrick model from the viewpoint of confidence in using facilitation, knowledge of facilitation, and conduct of training and utilization of facilitation technology. Questionnaire evaluations were conducted three times before the training, immediately after the training, and three months after the training. In August 2016, 4.5 hours of training were conducted in one day.Results　There were 79 participants in the training group. The mean points of knowledge and confidence were 2.6-3.6 before training, 6.3-7.9 after training, and 6.0-6.9 at 3 months after training. The participants rated their interest in three questions of the training as high as 8.1-8.6. In addition, 64.6% of participants held a role-play session at each branch within three months of the initial training. In the role-play session planned by the participants, the practitioners implemented the explanation of the purpose and the rules at each branch 96.1% and 98.0%, respectively. Participants who had attended facilitation training prior to our program scored higher points of knowledge and confidence before and after three months. Three months after the training, 79 participants responded to the question of the role of the facilitator in role-playing. The descriptions were categorized into "opinions on the basics and planning of role-play training" and "opinions on the roles in retrospectives."Conclusion　The participants evaluated the training contents and the materials used as appropriate, and their knowledge and confidence in facilitation improved after the training. To maintain and improve facilitation skills, the educational system needs to implement training using role-playing at each branch consistently.

MCH Workforce Capacity: Maximizing Opportunities Afforded by a Changing Public Health System.

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation.

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.

Enhancing Access to Quality Online Training to Strengthen Public Health Preparedness and Response.

OBJECTIVES: To improve access to quality online training materials developed from 2010 to 2015 by 14 Preparedness and Emergency Response Learning Centers (PERLCs) by creating quality standards and enhancing searchability through a new Web-based public health training catalog. METHODS: The PERLC-developed training materials (n = 530) were evaluated for their capability to support development of preparedness competencies as established by 2 evidence-based competency frameworks. Inclusion/exclusion criteria and evaluation guidelines regarding training quality (design, technology, and instructional components) were systematically applied to PERLC products to create a training catalog. Twenty emergency preparedness professionals pilot tested content and provided feedback to improve catalog design and function. RESULTS: Seventy-eight percent of PERLC resources (n = 413) met our quality standards for inclusion in the catalog's searchable database: 358 self-paced courses, 55 informational briefs, and other materials. Twenty-one training bundles were curated. DISCUSSION: We established quality guidelines, identified strengths and weaknesses in PERLC resources, and improved accessibility to trainings. Guidelines established by this work can be generalized to trainings outside the preparedness domain. Enhancing access to quality training resources can serve as a valuable tool for increasing emergency preparedness competence.

Infiltrating history into the public health curriculum.

The insertion of history into the medical school curriculum has been discussed over a long period of time. But the role of history in the public health curriculum has not been the subject of much discussion, despite the changes in UK public health training and the advent of multidisciplinary public health. This article reviews the history of inserting history into the curriculum in a leading public health postgraduate institution. It discusses the strategies used to secure acceptance for history; the positioning of history within the curriculum both as a core and a special subject; and the different curriculum content and learning approaches which have been used over time. It reviews recent developments in distance learning and the launch of a history Massive Open On line Course. It concludes that no one approach can be recommended for inserting history and that flexibility, persistence, alliances and the willingness to adapt to local circumstances are important. Students themselves are now more receptive to historical approaches and can appreciate the value of a discipline which teaches critical skills of analysis and assessment of evidence. It remains to be discussed how the discipline and such approaches can be transferred into wider professional public health training and at the undergraduate level.

Master or apprentice: rethinking entry points and training in Public Health.

Background: The Public Health workforce needs to adapt to a policy environment in which the need to improve public health is not only a key challenge but also has to be delivered within financial constraints. Methods: A total of 14 qualitative individual interviews or focus groups (of up to 10 people), were conducted with senior Public Health staff in 12 local authorities and in Public Health England in the Yorkshire and the Humber region of England. Thematic analysis was applied to the transcribed interviews. Results: Despite cuts in training budgets, junior staff were increasingly expected to deliver Public Health functions. There is also an absence of a career ladder for this core Public Health workforce. There were concerns that financial constraints would lead to reductions in Public Health skills with fewer staff to provide critical analysis. Formal qualifications were increasingly less valued. Instead staff were expected to have a broader skill set with an emphasis on experience. Entry points into Public Health careers need rethinking. There was an expectation that Public Health departments would 'grow their own'. Conclusions: Apprenticeship schemes could help maintain or enhance the professional status of Public Health and provide a training route for Public Health practitioners.

Comparing student outcomes in traditional vs intensive, online graduate programs in health professional education.

BACKGROUND: Health professions' education programs are undergoing enormous changes, including increasing use of online and intensive, or time reduced, courses. Although evidence is mounting for online and intensive course formats as separate designs, literature investigating online and intensive formats in health professional education is lacking. The purpose of the study was to compare student outcomes (final grades and course evaluation ratings) for equivalent courses in semester long (15-week) versus intensive (7-week) online formats in graduate health sciences courses. METHODS: This retrospective, observational study compared satisfaction and performance scores of students enrolled in three graduate health sciences programs in a large, urban US university. Descriptive statistics, chi square analysis, and independent t-tests were used to describe student samples and determine differences in student satisfaction and performance. RESULTS: The results demonstrated no significant differences for four applicable items on the final student course evaluations (p values range from 0.127 to 1.00) between semester long and intensive course formats. Similarly, student performance scores for final assignment and final grades showed no significant differences (p = 0.35 and 0.690 respectively) between semester long and intensive course formats. CONCLUSION: Findings from this study suggest that 7-week and 15-week online courses can be equally effective with regard to student satisfaction and performance outcomes. While further study is recommended, academic programs should consider intensive online course formats as an alternative to semester long online course formats.

Building Professionalism Through Management Training: New England Public Health Training Center's Low-Cost, High-Impact Model.

CONTEXT: Evolving practices, accreditation, and priorities established in Public Health 3.0 are adding to the long-identified need for management training among public health practitioners. PROGRAM: The New England Public Health Training Center is addressing this need with a flexible, open-source, 16-topic training program. The program is designed to build competencies for current and future managers, preparing them for their day-to-day tasks and for the kinds of adaptation suggested by Public Health 3.0 advocates. IMPLEMENTATION: The training program uses live expert instructors for 10 webinars and 2 in-person trainings. Experts have also created the content for multiple self-paced E-Learnings that trainees undertake in addition to the instructor-led sessions. A webinar platform with breakout rooms and an advanced learning management system allows for online discussion and mentor interaction. The course has now been offered, evaluated, and modified 3 times, and the materials are available for noncommercial use by the public health community. EVALUATION: Using the Kirkpatrick training evaluation model, the recent cohort was satisfied (87.5%) with the training, reported identifying actions to apply information learned to their work (85.8%), and experienced statistically significant knowledge gains. Earlier trainees reported work-related behavior change. DISCUSSION: Management training offers the hope of increasing professionalism; creating better, more effective workplaces and programs; and preparing practitioners for an evolving public health landscape. Early results indicate that NEPHTC's program, Managing Effectively in Today's Public Health Environment, is a useful tool in realizing that hope.

Evaluation of an online training for improving self-reported evidence-based decision-making skills in cancer control among public health professionals.

OBJECTIVES: The purpose of this evaluation was to assess the effect of the online evidence-based cancer control (EBCC) training on improving the self-reported evidence-based decision-making (EBDM) skills in cancer control among Nebraska public health professionals. STUDY DESIGN: Cross-sectional group comparison. METHODS: Previously developed EBDM measures were administered via online surveys to 201 public health professionals at baseline (comparison group) and 123 professionals who took part in the training. Respondents rated the importance of and their skill level in 18 EBCC skills. Differences were examined using analysis of variance models adjusted for gender, age, years at agency, and years in position, and stratified by respondent educational attainment. RESULTS: Among professionals without an advanced degree, training participants reported higher overall skill scores (P = .016) than the baseline non-participant group, primarily driven by differences in the partnerships and collaboration and evaluation domains. No differences in importance ratings were observed. Among professionals with advanced degrees, there were no differences in skill scores and small differences in importance scores in the expected direction (P < .05). Respondents at baseline rated the following facilitators for EBDM as important: expectations from agency leaders and community partners, high priority placed on EBDM by leadership, trainings, and positive feedback. They also reported using a variety of materials for making decisions about programs and policies, though few used individual scientific studies. CONCLUSIONS: EBCC led to improved self-reported EBDM skills among public health professionals without an advanced degree, though a gap remained between the self-reported skills and the perceived importance of the skills. Further research on training content and modalities for professionals with higher educational attainment and baseline skill scores is needed.

Advancing MCH Interdisciplinary/Interprofessional Leadership Training and Practice Through a Learning Collaborative.

Purpose The Interdisciplinary Leadership Learning Collaborative (ILLC), under the sponsorship of AUCD and the Maternal and Child Health Bureau, brought together six teams, composed of 14 MCHB and UCEDD training programs to enhance their leadership training. Description Using adult learning principles, interactive training methods, and skill-focused learning, the ILLC built upon the evidence-based Interdisciplinary Leadership Development Program of the University of North Carolina at Chapel Hill. The program began with a 4-day on-site intensive and then continued through monthly conference calls, a mid-term on-site workshop, and a summary virtual workshop to present programmatic accomplishments and share plans for sustainability. Coaching/consultation for the teams around particular challenges was also part of the program. Assessment All teams reported enhancements in intentional leadership training, threading of leadership concepts across clinical, didactic, and workshop settings, and new collaborative partnerships for leadership training. Teams also identified a number of strategies to increase sustainability of their intentional leadership training efforts. Conclusion for Practice The learning collaborative is a productive model to address the growing need for interdisciplinary MCH leaders.

A Logic Model for Evaluating the Academic Health Department.

Academic Health Departments (AHDs) are collaborative partnerships between academic programs and practice settings. While case studies have informed our understanding of the development and activities of AHDs, there has been no formal published evaluation of AHDs, either singularly or collectively. Developing a framework for evaluating AHDs has potential to further aid our understanding of how these relationships may matter. In this article, we present a general theory of change, in the form of a logic model, for how AHDs impact public health at the community level. We then present a specific example of how the logic model has been customized for a specific AHD. Finally, we end with potential research questions on the AHD based on these concepts. We conclude that logic models are valuable tools, which can be used to assess the value and ultimate impact of the AHD.

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.

Should the history of epidemiology be taught in epidemiology training programs?

BACKGROUND: Currently, there is no evidence concerning the presence of historical content in the epidemiology curricula of the United States and abroad. Similarly, it is not known how epidemiologists view this topic in the context of master's or doctoral level course work. METHODS: We attempted to fill these knowledge gaps with data from 2 online surveys-Survey I administered to persons in charge of all epidemiology training programs in North America and Survey II to epidemiologists practicing around the world. RESULTS: A substantial minority (39%) of graduate programs in epidemiology in the United States teach a course on the history of the field. In both surveys, the most common reasons selected for teaching such a course were "To build a sense of identity as an epidemiologist" and "As a tool for achieving a deeper understanding into specific methods and concepts." CONCLUSION: The majority of respondents, from 63 countries, agreed that the history of epidemiology should be included in curricula for graduate students in epidemiology.

Promoting innovative thinking.

Innovation is the engine of scientific progress, yet we do not train public health students to think creatively. I present the key concepts within an evidence-based method currently taught at the University of Texas. Habitual thought patterns involve deeply held framed expectations. Finding alternatives generates originality. Because frame breaking is difficult, a series of innovation heuristics and tools are offered including enhancing observation, using analogies, changing point of view, juggling opposites, broadening perspective, reversal, reorganization and combination, and getting the most from groups. Gaining cognitive attributes such as nonjudgment, willingness to question, mindfulness, and plasticity is also emphasized. Students completing the class demonstrate substantial increases on a standardized test of idea fluency and originality, more joyful attitudes toward science, and more pluralistic approaches.

A call to action: training public health students to be effective agents for social change.

In the 21st century, we face enormous public health challenges that differ fundamentally from those of the last century, because these challenges involve widespread societal change and complexity. To address these challenges, public health professionals need to be able to place their work in a larger social context, understand local and global perspectives on a deeper level, and effectively engage a wide variety of stakeholders. To confer these skills, we need to change the way we train our students. We present two examples of low-cost innovative approaches to teaching public health that promote active engagement with individuals across a wide range of backgrounds and fields and that train students to be effective agents for change.

Solutions that stick: activating cross-disciplinary collaboration in a graduate-level public health innovations course at the University of California, Berkeley.

Since 2011 we have taught a public health innovations course at the University of California, Berkeley. Students gain skills in systematic innovation, or human-centered design, while working in small interdisciplinary teams on domestic and global health projects with client organizations. To support acquisition of meaningful problem-solving skills, we structured the course so that the majority of learning happens in scenarios that do not involve faculty. Taken by students representing 26 graduate programs (as diverse as epidemiology, city planning, and mechanical engineering), it is one of the 10 highest-rated courses offered by the School of Public Health. We present the blueprints for our course with the hope that other institutions whose students could benefit will borrow from our model.