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TOPHC – April, 1, 2014 Public Health Education Unbound.

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1 TOPHC – April, 1, 2014 Public Health Education Unbound

2 TOPHC – April, 1, 2014 Diane R. Bewick, RN, BScN, MScN, DPA, CCHN (c) Chief Nursing Officer Director of Family Health Services, Middlesex-London Health Unit Adjunct Professor, Faculty of Health Sciences, Western University London, Ontario

3 TOPHC – April, 1, 2014 The public health professional …

4 TOPHC – April, 1, 2014 “No attempt to improve public health will succeed that does not recognize the fundamental importance … of highly skilled and motivated health professionals.” Advice … “Our national aim should be to produce a cadre of outstanding public health professional … who have clear roles, responsibilities and career paths.” National Advisory Committee on SARS and Public Health, 2003

5 TOPHC – April, 1, 2014 “To aim the public health system with more powers and duties without the necessary resources is to mislead the public and to leave Ontario vulnerable …” The SARS Commission, 2005 Resources are not simply funding but perhaps more importantly competent, committed public health professionals. Warning …

6 TOPHC – April, 1, 2014 people The public health professional quality of life prolong life promote health prevention disease organized measures

7 TOPHC – April, 1, 2014 Official Public Health Agencies Family Health Teams Canadian Cancer Society CCAC Community Health Centre Boards of Education Ontario Early Years Centres Heart & Stroke Foundation Housing Education Poverty Literacy Primary Care Providers Global The public health professional Social Support

8 TOPHC – April, 1, 2014 Official Public Health Agencies The public health professional ON *PHO - labs 1,000

9 TOPHC – April, 1, 2014 Local public health units are the backbone of the public health system… Operational Health Protection, 2004

10 TOPHC – April, 1, 2014 undergraduate programs…variety of disciplines Public Health Professionals disciplines form the base … professionals will benefit…from education education will increase health of the province discipline specific standards/competencies regulation/registration/certification *Unique contribution

11 TOPHC – April, 1, 2014 Public Health Competencies Discipline Specific Core Competencies, Standards and Certification MPH Core Competencies Public Health Core Competencies Inter-professional Competencies

12 TOPHC – April, 1, 2014 Public Health Professionals (20 categories) AMOH/MOH 51 Epidemiology 65 Health Promoters 262 Dental Hygienists/ Dental Assistants 289 Dietitian/Nutritionist 210 Public Health Inspectors 830 Public Health Nurses 2,630 2,860 *PHO (Labs), MOHLTC, MCYS - 63 - 72 - 416 - 286 - 203 - 900 - 2,717 - (167/DH) - (232) (3,848)

13 TOPHC – April, 1, 2014 Public Health Workforce Issues 6. Shortages 1.Leadership and management 2.Career path 3.Opportunities/time for professional development 4.Lack of support for their profession 5.Undervalued within their organization.

14 TOPHC – April, 1, 2014 1.Role scope and clarity Synthesis of 8 Papers (CAN) … convergence of issues 2. Leadership skills to support practice and provide voice 5.Stronger educational preparation in public health 3.Professional development 4.Intra-professional collaboration

15 TOPHC – April, 1, 2014 public health professional - general Context Summary Public Health Professional – OPHA’s Identified-who -common characteristics -unique contribution introduced public health workforce issues

16 TOPHC – April, 1, 2014 Marlene Janzen Le Ber, BScN, MScN, PhD, CHE Assistant Professor, Epidemiology & Biostatistics Associate Director, Program Development Schulich Interfaculty Program in Public Health Schulich School of Medicine & Dentistry Cross Appointed to Faculty of Health Sciences (School of Health Studies) Cross Appointed to Interfaculty Program in Public Health Western University

17 TOPHC – April, 1, 2014 Education of Health Professionals for the 21 st Century The Lancet Commission (Frenk, et al., 2010) Transforming education to strengthen health systems in an interdependent world 20 professional and academic leaders from diverse countries Common strategy for PSE for public health, nursing and medicine

18 TOPHC – April, 1, 2014 Three Generations of Educational Reform (Frenk et al., 2010)

19 TOPHC – April, 1, 2014 Levels of Learning (Frenk et al., 2010)

20 TOPHC – April, 1, 2014 Transformative Learning (Frenk et al., 2010) synthesis Fact MemorizationSearching Analysis Synthesis Seeking Professional CredentialsAchieving core competencies for effective teamwork Non-critical Adoption of Educational Models Creative adaptation of global resources to address local priorities

21 TOPHC – April, 1, 2014 Models of interprofessional and transprofessional education

22 TOPHC – April, 1, 2014 Health Professionals Leaders who can address these issues Scientists who understand the issues Practitioners who set standards –All who understand complexity –Translate this to policy and practice –Learn to work in novel, and lead in transdisciplinary, and sustained ways (Fried et al. 2013)

23 TOPHC – April, 1, 2014 Graduate Public Health Education (Fried et al., 2013)

24 TOPHC – April, 1, 2014 Training Leaders in Public Health Integrative action requires integrative learning Systems problems require holistic analysis and holistic approach to actions Beyond public health disciplines to collaboration among public health practice, academics, government and the private sector Requires grounding in pragmatic approach that “builds a scientific foundation on the real-world needs of defining public health problems” (Fried et al., 2013, p. e4) Team based learning

25 TOPHC – April, 1, 2014

26 Schulich Interfaculty Program in Public Health Our Distinction Novel niche of the intersection of Leadership, Sustainability and Policy Full-time one year (12 month) on site professional degree program (non thesis based program) Experential Learning/ Case method learning

27 TOPHC – April, 1, 2014 Schulich Interfaculty Program in Public Health Our Distinction Cohort of students from diverse health professional and educational backgrounds Special focus on health issues in Southwestern Ontario, First Nations across Canada and internationally Interfaculty contribution to the program

28 TOPHC – April, 1, 2014 What exactly is a case? Mauffette-Leenders et al (2007) “A case is a description of an actual situation, commonly involving a decision, a challenge, an opportunity, a problem or an issue faced by a person or persons in an organization. The case requires the reader to step figuratively into the position of a particular decision maker.” (p. 3) Ellet (2007) “A … case imitates or simulates a real situation. Cases are verbal representations of reality that put the reader in the role of a participant in the situation.” (p. 3)

29 TOPHC – April, 1, 2014 What is NOT a case? It is NOT just an interesting story It is NOT investigative journalism It is NOT research (which requires the truth, the whole truth, nothing but the truth, etc.) It is NOT fiction (but some distortions, simplifications and omissions may be required in order to represent the situation so it can be taught in a typical 80 minute class) It is NOT a news summary

30 TOPHC – April, 1, 2014 Student Preferences Current issue and situation Issues and challenges are relevant to career interest Can identify with protagonist (see self in the position of the decision- maker in the near future) Organization itself is well-known, respected and not disguised Geographical area of the world where students expect to be working or are currently living Issues in the case are urgent and important to the organization Excitement over the issue; can personally relate to the issue/problem Cases with an interesting dilemma, characters with personalities, and cases with compelling action requirements Short, well organized

31 TOPHC – April, 1, 2014 Attributes of a Good Case Pedagogical usefulness – achieves learning goals and is “teachable” Interesting, engaging and relevant to students Poses a problem/decision with no obvious right answer Requires the use of information in the case to figure out a reasonable answer/approach Requires judgement, critical thinking and decision making skills Is information rich – has numbers, industry information, insights into organization and has some complexity

32 TOPHC – April, 1, 2014 Three Core Elements Reality Realism makes a case an effective learning vehicle Empiricism lends credibility to concepts learned in the classroom Theory An underlying theory is essential for effective teaching One person’s/ organization’s action is not necessarily a guide for practice Originality What is new here? concept? context? Novelty enhances scholarship and links well to research Charles Dhanaraj

33 TOPHC – April, 1, 2014 Four Types of Cases Skills Practice Cases Problem Defining Cases Decision- making Cases Evaluation/ Policy Cases

34 TOPHC – April, 1, 2014 Four Types of Cases Skills Practice Cases Problem Defining Cases Decision- making Cases Evaluation/ Policy Cases Describe a situation facing a protagonist. Students must diagnose problem(s) and formulate possible solutions.

35 TOPHC – April, 1, 2014 Four Types of Cases Skills Practice Cases Problem Defining Cases Decision- making Cases Evaluation/ Policy Cases Describe a decision faced by the protagonist. Students must choose among a finite set of alternatives.

36 TOPHC – April, 1, 2014 Four Types of Cases Skills Practice Cases Problem Defining Cases Decision- making Cases Evaluation/ Policy Cases Illustrate organizational success or failure. Students synthesize policy lessons to be extracted from the situation.

37 TOPHC – April, 1, 2014 Four Types of Cases Skills Practice Cases Problem Defining Cases Decision- making Cases Evaluation/ Policy Cases Describe situations requiring execution of specific technical skills in order to draw conclusions

38 TOPHC – April, 1, 2014 Four Types of Cases Skills Practice Cases Problem Defining Cases Decision- making Cases Evaluation/ Policy Cases Illustrate an organizational success or failure. Students synthesize policy lessons to be extracted from the situation. Describe situations requiring execution of specific technical skills in order to draw conclusions Describe a decision faced by the protagonist. Students must choose among a finite set of alternatives. Describe a situation facing a protagonist. Students must diagnose problem(s) and formulate possible solutions.

39 TOPHC – April, 1, 2014 Mauffette-Leenders et al., 2007, p. 19

40 TOPHC – April, 1, 2014

41 John M Garcia, PhD Professor of Practice & Interim Director School of Public Health and Health Systems Faculty of Applied Health Sciences Burt Matthews Hall, Room 2311 University of Waterloo

42 TOPHC – April, 1, 2014 Overview UW School of Public Health and Health Systems Master of Public Health Other Academic Programs of UW SPHHS 42

43 TOPHC – April, 1, 2014 School of Public Health and Health Systems Created in 2012 from Dept of Health Studies and Gerontology More than 30 years of innovation and development 9 academic programs, 5 new/planned –BSc, MSc, PhD –MPH –BHP and MHI –MHE, BPH, DrPH Addition of 9 new faculty recent review of four programs (1 st listed)

44 TOPHC – April, 1, 2014 44 MPH Program: Rationale and Mission Rationale: need for greater #s and capacity of public health professionals MPH degree recognized academic benchmark credential Need for expanded access to public health training (hence blended curriculum/mainly on-line, regular tuition fees) First intake, August 2006 Mission: help produce new generation of public health leaders and managers Brand: aspire, inspire, transform

45 TOPHC – April, 1, 2014 Public Health "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations [public, non-profit and private], communities and individuals“ (Winslow, 2002) 45

46 TOPHC – April, 1, 2014 46

47 TOPHC – April, 1, 2014 What are core competencies? “…the set of cross-cutting skills, knowledge and abilities necessary for the broad practice of public health.” U.S. Council on Linkages Between Academia and Public Health Practice, 2004 47

48 TOPHC – April, 1, 2014 Core competencies, PHAC Public Health Sciences Assessment and Analysis Policy & Program Planning, Implementation and Evaluation Partnerships, Collaboration & Advocacy Diversity and Inclusiveness Communication 48

49 TOPHC – April, 1, 2014 Example of a core competency – Public health sciences domain A public health practitioner is able to… 1.1 Demonstrate knowledge about the following concepts: the health status of populations, inequities in health, the determinants of health and illness, strategies for health promotion, disease and injury prevention and health protection, as well as the factors that influence the delivery and use of health services.

50 TOPHC – April, 1, 2014 Example of a core competency – Public health sciences domain (continued) 1.2 Demonstrate knowledge about the history, structure and interaction of public health and health care services at local, provincial/territorial, national, and international levels. 1.3 Apply the public health sciences to practice. 1.4 Use evidence and research to inform health policies and programs. 1.5 Demonstrate the ability to pursue lifelong learning opportunities in the field of public health.

51 TOPHC – April, 1, 2014 MPH Admission criteria year Honours Bachelor's degree (or equivalent) in a health-related field, from a recognized university minimum 75% average in final two years of study (equivalent to last 20 half-credit courses) minimum 1 year prior work experience in a public health setting or other relevant setting personal essay, resume, and letter –the education, work and life experiences that have brought you to the decision to apply to the Master of Public Health program –how the Master of Public Health will help you in your future career university-level course in basic statistics recommended

52 TOPHC – April, 1, 2014 Program requirements General stream: 9 core courses 3 electives practicum Socio-behavioural stream: 9 core courses, 2 stream courses 1 elective Practicum Environmental stream: In approval process, similar model

53 TOPHC – April, 1, 2014 Competency domains 601/ 602 SCBEnvEpiCommMgmt/ admin Policy Public Health Sciences ++++++++++ Analysis and Assessment ++++++ ++ Policy/Program Planning/ Implement/ Evaluation +++++++++ Partnerships Collaboration Advocacy ++++++++++ Communication+++++++++ Diversity/ Inclusiveness +++ ++ Leadership++++++ Competencies in curriculum development

54 TOPHC – April, 1, 2014 The MPH “Building” – Core courses Capstone (PHS 602) Practicum (PHS 641) Health Policy (PHS 603) Stream coursesElectives Principles of Epidemiology for Public Health (PHS 606) Health and Risk Communication in Public Health (PHS 608) Management and Administration of Public Health Services (PHS 609) Biostatistics in Public Health (PHS 605) Social Cultural and Behavioural Aspects of Public Health (PHS 607) Public Health and the Environment (PHS 604) Foundations of Public Health (PHS 601) F-1 W-1 S-1/F-2 W-2 S-2

55 TOPHC – April, 1, 2014 Elective course offerings – beyond core PHS 614 Evaluation of Public Health Programs (stream requirement) PHS 617 Population Intervention for Health Promotion and Disease Prevention (stream requirement) PHS 623 Risk and Exposure Assessment (stream requirement) PHS 624 Environmental Toxicology (stream requirement) PHS 632 Health Economics & Public Health PHS 635 Public Health, Environment and Planning PHS 636 Applied Epidemiology PHS 637 Public Health Informatics PHS 638 Selected Topics in Public Health –Social Justice and Public Health PHS 661 GIS and Public Health PHS 662 Global Health PHS 663 Human Development and Health

56 TOPHC – April, 1, 2014

57 Students Working at federal, provincial and local level, some international Government, non-governmental, private sectors MDs, nurses, dentists, public health inspectors, health educators and promoters, psychologists, social workers, engineers, community activists, computer professionals, statistics, planning, etc. Range of substantive interests – chronic disease prevention, healthy growth and development, healthy environment, disaster planning/management, environmental health, infectious disease control, social determinants of health Aspire to be future leaders in public health – policy, management, director level

58 TOPHC – April, 1, 2014 Graduating Class, October 2014

59 TOPHC – April, 1, 2014 MPH Alumni Survey (spring 2012) 81% employed (76% fulltime), 8% studying further, 8% homemaker/caregiver, 4% looking for employment/unemployed Employed by: PHA/RHA (33%), provincial/territorial government (26%), federal government (19%), NGO/health charity (11%), other including community- based organizations and international agencies Range of roles: MOH, policy and program analysts, public health inspection/environmental health, health promotion, epidemiology, health communications etc.

60 TOPHC – April, 1, 2014 Other UW SPHHS Programs Master of Health Informatics –Public Health and Health Systems Field, complementing Cheriton School of Computer Science program –to identify, design and manage informatics solutions relevant to health and health systems –Competencies adapted from COACH Bachelor of Health Promotion Master of Health Evaluation –Preparation of professional evaluators –Competencies for evaluation practice established by the Canadian Evaluation Society Future – BPH, DrPH??

61 TOPHC – April, 1, 2014 André La Prairie, Manager Skills Enhancement for Public Health Health Security and Infrastructure Branch Public Health Agency of Canada

62 TOPHC – April, 1, 2014 62 Skills Enhancement for Public Health Centre for Public Health Capacity Development Health Security Infrastructure Branch Building a Solid Foundation for Public Health Practice

63 TOPHC – April, 1, 2014 Flexible (online) learning options to build knowledge, skills and competencies in public health

64 TOPHC – April, 1, 2014 “Nurses new to the north need opportunities to develop the breadth of skills and depth of knowledge needed to practice independently.” “Most public health nurses today are baccalaureate- trained, and further specific training in public health is no longer mandatory. Instead, public health nurses learn on the job through formal and informal in- service training.” “Health Canada’s Skills Enhancement for Health Surveillance program is a web- based distance education program aimed at front-line and supervisory workers in local health departments. While not intended to substitute for master’s level training, and still under development, it aims to provide basic, high-quality training in epidemiology, surveillance and information management..” “A thorough review of public health training programs is also needed—new entrants to the public health workforce should be appropriately qualified, and existing public health workers should be provided with opportunities to acquire additional skills if necessary.” “It has also been argued that short courses in infectious disease epidemiology are an essential part of capacity building for many aspects of public health practice and leadership, but are not widely available..”

65 TOPHC – April, 1, 2014 65 Online continuing professional development program for front-line public health professionals 10 online facilitated modules, 2 self-directed modules; English and French Content mapped to the Core Competencies for Public Health in CanadaCore Competencies for Public Health in Canada Skills Online

66 TOPHC – April, 1, 2014 Modules Currently Available Basic Epidemiological Concepts Measurement of Health Status Epidemiologic Methods Outbreak Investigation & Management Epidemiology of Chronic Diseases Introduction to Surveillance Applied Epidemiology: Injuries Communicating Data Effectively Introduction to Biostatistics Evidence-based Public Health Practice (English only) Introduction to Public Health in Canada Introduction to Literature Searching Facilitated modules Self- directed modules

67 TOPHC – April, 1, 2014 Modules Under Development Privacy and Confidentiality Core Competency Toolkit Health Literacy Introduction to Core Competencies Introduction to Program Evaluation International Health Regulations

68 TOPHC – April, 1, 2014 Challenges

69 TOPHC – April, 1, 2014 Challenges

70 TOPHC – April, 1, 2014 Challenges

71 TOPHC – April, 1, 2014 Challenges

72 TOPHC – April, 1, 2014 Challenges

73 TOPHC – April, 1, 2014 Challenges

74 TOPHC – April, 1, 2014 Challenges

75 TOPHC – April, 1, 2014 Challenges

76 TOPHC – April, 1, 2014 Challenges

77 TOPHC – April, 1, 2014 Challenges

78 TOPHC – April, 1, 2014 Our Future 78 National Schools and Programs of Public Health be a leader in new online module production links with CPHA (network and professional designation) offer module content to schools and other programs expand to alternate learning formats, including MOOCs

79 TOPHC – April, 1, 2014 Future considerations Need for a pan-Canadian and provincial public health human resources strategy –Is this possible and if so, what would it include? How does this related to plans for public health organizational and system capacity building strategies? Role of Public Health Network? –Increasing number and diversity of MPH programs – do they address demand? –Do MPH program address front line practitioner and management needs? Evolving “National Network of Schools and Programs of Public and Population Health” (NNSPPPH) –Credentialing of public health professionals? –Accreditation of schools and academic programs? –Requirement for public health practitioner participation in planning? In-service professional development programs, human resources changes local public health agencies? Uptake, dissemination Role of MPH Programs in developing expert leaders for public health MOOCs and free access to educational content

80 TOPHC – April, 1, 2014 Jennifer L Chu, MD, MPH, FRCPC Staff Physician, Department of Emergency Medicine, St. Michael’s Lecturer, Department of Medicine, University of Toronto Director of Basic and Clinical Sciences, NextGenU

81 TOPHC – April, 1, 2014 Overview Overview of distance learning and MOOCs Introduction to NextGenU Future direction of public health and MOOCs/NextGenU 81

82 TOPHC – April, 1, 2014 Distance Learning 82 1800s 1930s 1996 2000s 2010s

83 TOPHC – April, 1, 2014 Internet Usage

84 TOPHC – April, 1, 2014 What are MOOCs?

85 TOPHC – April, 1, 2014 MOOCs Coursera, EdX, Udacity largest MOOCs in the US ALISON (Advanced Learning Interactive Systems Online) one of largest MOOCs mostly used in developing countries MOOCs being developed globally 85

86 TOPHC – April, 1, 2014 MOOCs PROSCONS Free or low cost for learners Self-directed/paced Less barriers than traditional education Computerized interactions globally Limitless scalability Financial efficiency for institutions Credit for courses often costs money Lack of direct human interaction May lack prestige/acceptability compared with traditional education Sustainability Quality control High drop-out rates 86

87 TOPHC – April, 1, 2014 Kampala Declaration WHO identified a need for 12.9 million more trained health workers by 2035 WHO also stated this will require greater use of training innovation - especially information and communication technologies 87

88 TOPHC – April, 1, 2014 NextGenU Not a MOOC – a DOOHICHE Democratically Open, Outstanding Hybrid of Internet-aided, Computer-aided, and Human-aided Education 88

89 TOPHC – April, 1, 2014

90 Course Development Identify existing expert-derived core competencies Organize competencies into modules Match competencies with existing internet resources from highly reputable sources All resources must be freely available and advertisement-free Develop peer and mentor-based activities Evaluation Review from advisory committee Sponsorship from accredited organizations 90

91 TOPHC – April, 1, 2014 Current Courses Alcohol, Tobacco Use and Other Substance Use Disorders Climate Change and Health Emergency Medicine Environmental Health War and Health 91

92 TOPHC – April, 1, 2014 Upcoming Courses 92

93 TOPHC – April, 1, 2014 Pilot Tests Emergency Medicine course piloted at the Uniformed Service University of the Health Sciences and University of Missouri with senior medical students Environmental Health piloted with MPH students at Simon Fraser University (BC) No significant difference found in standardized testing between control students and NextGenU students 93

94 TOPHC – April, 1, 2014 Countries Using NextGenU Climate Change and Health –Brazil, Bulgaria, Canada, Christmas Island, Denmark, Egypt, Great Britain, Hrvatska/Croatia, Hong Kong, India, Nigeria, Pakistan, Saudi Arabia, Turkey, United States Environmental Health –Argentina, Australia, Bangladesh, Belgium, Canada, El Salvador, Germany, Great Britain, Hrvatska/Croatia, Hungary, India, Italy, Kenya, Nigeria, Pakistan, Philippines, Russian Federation, Saudi Arabia, Singapore, Sri Lanka, Thailand, United Arab Emirates, United States War and Health –Canada, Ecuador, Malaysia, Switzerland, United States Emergency Medicine –Afghanistan, Australia, Bangladesh, Belgium, Bahrain, Brazil, Canada, Columbia, Czech Republic, Germany, Denmark, Ecuador, El Salvador, Estonia, Egypt, Spain, France, Great Britain, Greece, Hong Kong, Hrvatska/Croatia, Hungary, Indonesia, Ireland, India, British Indian Ocean Territory, Italy, Kenya, Latvia, Malaysia, Nigeria, Netherlands, Philippines, Portugal, Romania, Qatar, Saudi Arabia, Spain, Sri Lanka, Sudan, Sweden, Switzerland, Singapore, Trinidad and Tobago, Taiwan, US Minor Outlying Islands, United Arab Emirates, United States, Venezuela, South Africa 94

95 TOPHC – April, 1, 2014 Emergency Medicine 95

96 TOPHC – April, 1, 2014 Future Direction Continue to develop courses in basic sciences, clinical medicine and public health Preventative medicine residency curriculum currently under development Goal to create a free MPH 96

97 TOPHC – April, 1, 2014 97

98 TOPHC – April, 1, 2014 GROUP DISCUSSION

99 TOPHC – April, 1, 2014 Discussion at Tables After introducing each other, choose one person to record Where do you see the challenges for the future? What would be needed –To build on existing strengths (strongest collective capacities) at your place of work? –To build additional capacities (greatest area of collective improvement needed) at your place of work? How would you go about enabling collective capacity building to happen at your workplace? In the future?

100 TOPHC – April, 1, 2014 Thank you

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