A clear and interesting example of innovation through adaptation lies in the domain of Public Health Education.
Toward the end of 2016, we reported on Framing the Future, a taskforce created by the Education Committee of the Association of Schools and Programs of Public Health (ASPPH). Framing the Future was formed on the cusp of the 100th anniversary of the iconic Welch-Rose Report of 1915. Welch-Rose established a roadmap for public health education that would remain unchanged for a century.
Welch-Rose came into being from the eureka moment that medical science and public health, while both striving to safeguard the common good, were inherently different. By nature, one (public health) was preventative (proactive) and the other (medical science) was largely curative (reactive).
And no clear pathway for an education in public health – apart from medical science – existed.
Welch-Rose rightly and tightly linked, yet separated, these two disciplines. It defined the need for public health as its own discipline and further defined what should be covered in a school of public health. But it didn’t say how.
Welch-Rose didn’t provide the means. It didn’t define the manner in which this information was to be taught. And so public health quietly slipped on the same hindering turtleneck that virtually all other disciplines across all universities had gotten into – knowledge transfer by virtue of long, often dirge-like, lectures.
Fast forward 100 years and it seems inevitable that Public Health Education leaders, just like leaders in other disciplines around them, would be influenced by the leaps and bounds advancements in learning science. The past twenty years had completely changed our understanding of the way people learn and reshaped our opinions about the most valuable skills required by young professionals.
In 2014, in a moment of clarity for the ASPPH Education Committee, Dr. Barbara Rimer of University of North Carolina had a eureka thought of her own: ‘Why not start with a completely empty room approach and overhaul public health education with all of these advancements in learning, and release it for the 100th anniversary of Welch-Rose?’
The Committee immediately created Framing the Future, and Public Health Education would be changed forever.
What’s Most Important
“What’s going to make our students successful when they graduate?” asks Dr. Laura Magaña. Magaña is President and CEO of the Association of Schools and Programs for Public Health (ASPPH), one of the founding bodies of Framing the Future.
“What’s really critical are the professional competencies. Most of the time, these are not sufficiently emphasized in their education,” she says. “Skills like critical thinking, problem solving, collaboration, innovation, communication, adaptability. All of those competencies that make you succeed in a changing and unclear environment, regardless of what your job is.”
“In the past, we’ve called these the soft skills or the soft competencies, but they have become crucial for 21st century education. You can always learn content and obtain knowledge. Ultimately you’ll never stop learning because knowledge changes so fast!”
Education is more than just knowledge, Magaña says.
“It’s not that they’re just learning to be experts in a specific field, but they’re learning to be compassionate professionals that will make a difference in the world.”
Magaña was the Dean at the School of Public Health in Mexico for 14 years under the National Institute of Public Health. As Dean, she led the School to become the first school outside the United States to be accredited by CEPH. To accomplish this, she worked closely with former President and CEO Dr. Harrison Spencer, who tragically passed away just after appearing in our 2016 story (see sidebar).
“Of course, most of us need the knowledge base. But when you’re thinking about the future, the most important thing might be ‘what have you already done?’ It’s not just what you know but more how to gather the information you need to solve the problem.”
Is it the skills or the content you really want in them?“
Modern educational theory is deeply rooted in data describing the science of how people learn. Data prove that people learn best when they are doing something rather than exclusively (and passively) listening. Data also shown an educator’s use of integrated media keeps the learner engaged such that content retention rates are higher.
Laura Rasar King is Executive Director of the Council on Education for Public Health (CEPH), the accrediting body with responsibility for the evaluation of schools and programs of public health. CEPH accredits 210 public health training units in 46 states, the District of Columbia, Puerto Rico, and six countries. These units include 67 schools of public health, 127 public health programs located in settings outside schools, and 16 standalone baccalaureate programs.
Rasar King also serves as a member of the National Board of Public Health Examiners (NBPHE), the credentialing body for public health professionals (more than 6000 individuals certified since 2008).
She says the public health workforce is unrecognizable from the days of Welch-Rose, when public health was mostly done by physicians and through city health departments.
When advanced learning methodologies were being employed in other disciplines, the NBPHE board of directors could see that new credentialing best practices called for testing on professional skills and not academic knowledge.
“We decided to do a very large-scale job task analysis – a survey of people in public health to find out what they actually do” says Rasar King. “Not what they wish they did, or what they felt like they should do, but what they actually do in their day-to-day work activities.”
After a thorough literature search, the NBPHE committee crafted a comprehensive survey that asked respondents to rate how important 200 tasks were to their current jobs. The survey was distributed to individual public health professionals as well as to partner organizations.
“That survey was deployed in 2014 to a large sample size, and it was the first time any study like that had ever been done in public health, incorporating all different work settings across various different sectors.”
The survey, received more than 8100 responses and of those, nearly 4400 were from employed, nonstudents working in public health.
“Results informed the 2016 accreditation criteria revision along with some other recent workforce surveys, for example, Public Health WINS, that have been published,” Rasar King says. “We took all of this information and triangulated the data and said, ‘Okay, what are skills and knowledge are rising to the top?’
Insights from the survey were brought to the table along with the most up-to-date learning science, and workforce guidelines established by the Public Health Foundation1.
The result was a radically updated draft curriculum that was posted for comment (see sidebar)
CEPH received approximately 850 individual comments from individuals and institutions, spanning academia and practice. Commenters included public health faculty, employers, students, and alumni.
The entire exercise seemed to echo some of the pedagogical hypotheses being proffered by Magaña and her colleagues. The survey numbers had indicated public health graduates didn’t feel ready when they entered into the work force. Why was that?
Like Magaña, Rasar King postulates it’s because Public Health had not yet incorporated active learning into its curriculum.
“Active learning takes education completely out of the realm of just knowledge and turns it into skills.” she says. “And that’s a huge change for academics; it’s really the biggest change in a century. And that brings us all the way back to the Welch-Rose report. Public health training had essentially not changed in all that time. This was a lot for programs to adjust to.”
Making it Happen
Per the plan, Rasar King says CEPH has been working on implementation of the revised 2016 accreditation criteria for the last three years and it’s going well.
“We had a two-year implementation phase and we’re just now over the two-year mark. As with any change, there are early adopters that get right on board and then others who don’t even realize that anything is happening,” she says.
Rasar King says most accredited public health schools and programs are already significantly compliant with the new curricular standards and they are seeing some really interesting and innovative appraoches.
“70% of our schools and programs have either modified or created new core requirements for all MPH students. Another 13% have developed what we call an “integrated core,” which is really different. Integrated cores take the foundational knowledge and competencies and teach them around contemporary topic areas or case studies rather than in disciplinary silos.”
Dr. Sandro Galea is the Dean of the Boston University School of Public Health and Chair of the ASPPH Board of Directors. As you might expect, he is one of the early adopters Rasar King speaks of.
Galea is the former Chair of Epidemiology at the Columbia University Mailman School of Public Health, where, at the request of Dean Linda Fried, he led Task Force that oversaw a wholesale revision of that school’s curriculum. He subsequently oversaw the curricular transformation at Boston University.
“I’ve done this twice now,” he laughs, “which is okay.”
Sandro says developing an Integrated Core might seem daunting task, but is actually just the next step in ongoing improvements.
“It’s not like you flick on a switch and start doing it.” Galea says. “You’ve been doing it, intuitively, for years.”
Like most trailblazers, Galea’s forward thinking spills over from one center of influence to another. He is trained as a doctor and a physician, with a doctorate in epidemiology. Yet his formal training is not in education. How does one begin to adapt under those circumstances?
“It starts with thinking about it, carefully. And reading about it,” Galea says. “Thinking critically about what the future student will need. Your mission is really a function of the student excelling all the way down to their very life skills. If you are a true educator, it is instinctive that you do it this way.”
As Galea and his team built its Integrated Core, he says the real benefit of the new curriculum became quickly obvious. And it’s not what you might think.
Transforming Public Health Education Through an Integrated Core
“We started by recognizing that there was a need for much more flexibility in the training, coupled with the understanding around core learnings. That’s what we have with our new model. The new curriculum doesn’t really give somebody the core competencies, I think the core competencies come with the flexibility of the new guidelines.”
As an outgrowth of this flexibility, the Boston University School of Public Health offers multiple interdisciplinary certificates, which Galea says students really like that because it creates a path that is distinctly their and opens up the opportunity for them to do any number of things. Such in-program flexibility combines nicely with how the new guidelines have increased opportunities for differentiation across schools and programs.
“All schools and programs of Public Health offer a great variety of educational programs based on their strengths,” says Laura Magaña. “We are a very dynamic academic community and collectively we are always thinking about the best pathways to educate the future workforce that can ensure a better future for the health and well-being of the population, nationally and globally.”
Looking objectively at this group of educators, one is struck by how much they live out the very prophecies they are writing. As incoming students of Public Health evaluate improvements to these programs, they needn’t look much further for validation of how far the soft skills can take them.
1 The Public Health Foundation is an institution of organizational representatives with a set of competencies intended to describe what different levels of the workforce does in local government.