Overview of the Certified in Public Health (CPH) Program USPHS Scientific & Training Symposium Public Health Leadership: The Key to a Healthier Nation  Pleasure to be with you. I am Terry Dwelle, state health officer for North Dakota, the chair of the NBPHE Being with you brings back many good memories of my time as a commissioned officer in the USPHS I was in active duty in the Indian Health Service and the reserves for 10 years. You are a major part of the public health workforce in this nation. As a state health officer I personally would like to thank you for all the incredible work and expertise you provide our nation and the world and the professional way you support us at the state and local level. Dr. Rick Kurz and I appreciate the opportunity to discuss the National Board of Public Health Examiners with you and the status of the current Certified in Public Health (CPH) examination. Richard S. Kurz PhD Terry L Dwelle MD MPHTM FAAP CPH June 20, 2011

Learning Objectives Describe the Certified in Public Health (CPH) process Explain the eligibility and the maintenance of certification requirements Provide examples of institutionalization of the CPH process learning objectives for USPHS talk: Describe the Certified in Public Health (CPH) process Explain the eligibility and the maintenance of certification requirements for the CPH process Provide examples of institutionalization of the CPH process in the field of public health

Brief history of CPH process NBPHE is independent non-profit organization incorporated in 2005 includes representatives from a broad range of partner organizations Staff: Executive Director Molly Eggleston, MPH, CHES, CPH The National Board of Public Health Examiners (NBPHE) -independent non-profit organization – 501c6 - sets standards for graduates from Council on Education for Public Health (CEPH)-accredited schools and programs of public health. Brief History: Both ASPH (Association of Schools of Public Health) and APHA (American Public Health Association) established task forces on the credentialing of public health workers in the late 1980’s stimulated, in part by a call from the U. S. Surgeon General for such an effort In 1999, APHA and ASPH formed a joint Task Force on Public Health Workforce Credentialing National Board of Public Health Examiners incorporated in September 2005 August 2008, Initial NBPHE Examination and have just completed the 4th exam cycle in February, 2011. 3

NBPHE partner organizations According to the by-laws of the NBPHE, board members include representatives from these partner organizations listed here; APHA (American Public Health Association) NACCHO (National Association of County and City Health Officials ASTHO (Association of State and Territorial Health Officers) ASPH (Association of Schools of Public Health) APTR (Association for Prevention Teaching and Research)

Purpose of the Certified in Public Health exam To ensure that students and graduates from schools and programs of public health accredited by the Council on Education for Public Health (CEPH) have mastered the knowledge and skills relevant to contemporary public health practice This is the mission statement of the NBPHE To ensure that students and graduates from CEPH accredited schools and programs have mastered the knowledge and skills relevant to contemporary public health practice I was always amazed that public health unlike all other major health professions had no standardized means of recognition of competency and skills. We now have one. Certification is a major way of beginning a standardization system for public health to ultimately improve the quality of the work we do as public health professionals.

Academic eligibility criteria Alumni from CEPH-accredited school or program; completed all degree requirements by December 30, 2011. Student at CEPH-accredited school or a program who has completed or is concurrently enrolled in 21 credits on 12/30/11.  In order to be eligible to sit for the exam All candidates must have a graduate level (Masters or Doctoral) degree from a CEPH-accredited school or program of public health. Those graduating the same year as their exam date must have completed all degree requirements - coursework, internships, and thesis, by Dec 31. Walking in a graduation ceremony or receipt of a diploma is not necessary, so long as all degree requirements have been met and verified by the accredited institution. Alumni - retroactive for 3 years from the CEPH accreditation date (e.g. Accredited in 2010, so alumni 2007on) Currently there are 44 accredited schools and 35 accredited PH training programs in the world.

Exam Development NBPHE contracted with the National Board of Medical Examiners® to develop the exam, including: Training of test item writers Editing and validation of items Test form development Administration of the exam through the Prometrics network Analysis of test results NBPHE contracted with the world’s best in test development - National Board of Medical Examiners® to develop the exam, including: Workshops to training test item writers Editing and validation of items Test form development Administration of the exam using the Prometrics network Analysis and reports of test results

Strong Psychometric Properties Items Deleted Mean item Difficulty (P value) Mean item discrimin-ation Reliability Coefficient KR20 2008 19 .68 .31 .91 2009 15 .66 .34 .93 2010 9 .67 .30 .90 2011 12 .65 .29 The CPH test has performed very well as demonstrated by these strong psychometric properties including; Mean item difficulty or IP value Mean item discrimination score The KR20 reliability coefficient All of these values are evidence of excellent test performance. The first column lists the number of items deleted in each exam due to inadequate performance using a variety of factors. I am not a psycho-metrician. That’s why we have contracted with the NBME to help guide us through this process. This exam is an excellent examination for the material tested.

Why did I take the exam? Test my knowledge base Identify gaps Accountability Why did I take the exam? I didn’t need it to maintain my position as SHO. This just lists some the personal reasons I took the exam. I was curious to see if my knowledge base was similar to other professionals in the field of public health. As with my other professional certification tests I wanted to use the test report to help me identify gaps in my knowledge to inform future continuing education needs. Certification and its subsequent maintenance requirements is an accountability tool encouraging life long learning. It provides me with the assurance of professional competency. I need this stimulus in my busy life to encourage appropriate training and continued development of skills and competencies in public health.

Why maintain the CPH credential Maintenance of Certification = 50 hours of Continuing Education / 2 years Re-assessment /10 years Maintenance of certification is utilized by almost every other professional field has it - teachers, medical specialists, psychologists, funeral directors, hospital administrators, social workers, American College of Health Care Executives, etc.) NCCA (National Commission for Certifying Agencies) standards guide NBPHE MOC decisions. To maintain CPH certification for the NBPHE requires; 50 hours of continuing education by a certified provider every 2 years. And a reassessment process every 10 years.

Richard J. Cohen, PhD President, Public Health Management Corporation (PHMC) The PHMC, as a public health institute, supports the exam and maintenance fees of all eligible employees. Our CPH professionals demonstrate their leadership and provide essential and effective services to our community.   Employers like the Public Health Management Corporation supports it.

Bruce Dixon, MD, Director, Allegheny County Health Dept. In pursuit of our mission to assure quality public health services in an urban county, the Allegheny  County Health Department will provide the initial registration fee for any employee to become Certified in Public Health.  A well-trained and up-to-date workforce, such as CPH professionals, is essential to the effective delivery of public health services. Local Public Health Supports it Dr. Dixon (FL) The Department provides the registration fees for employees to become CPH certified.  A well-trained workforce, such as CPH professionals, is essential to the effective delivery of public health services

1st Lt. Andrew B. Wallace, CPH, U.S. Air Force I am happy to say I am recently CPH certified! I enjoyed studying for the test and have encouraged many of my peers to sit for the exam. Lt. Andrew Wallace for the US Air Force recently took the exam He encourages his peers to sit for the exam.

Adewale Troutman, MD, MPH, MA, CPH, Director, S Adewale Troutman, MD, MPH, MA, CPH, Director, S. Fla’s Public Health Practice & Leadership Institutes The CPH provides evidence that we as public health professionals have attained a nationally recognized level of expertise to assure the conditions in which people can be healthy.  I believe that everyone eligible who is in the field should take the exam. Adewale Troutman, Director of S Florida’s PH Practice and Leadership Institutes states that; The CPH helps us (as pH professionals) assure the conditions in which people can be healthy.  He encourages everyone in the field to become certified.

Got CPH? at booth #308 in the exhibit hall Visit the National Board of Public Health Examiners at booth #308 in the exhibit hall Join the ranks of CPH professionals! 1-866-514-7569 http://www.nbphe.org/ I encourage you to join the ranks of CPH professionals worldwide Get certified this year.

Overview of the Certified in Public Health (CPH) Program USPHS Scientific & Training Symposium Public Health Leadership: The Key to a Healthier Nation  Thank you very much for inviting me to present today regard the National Board of Public Health Examiners Certification Examination. It is a pleasure to be with you. I am Dr. Richard Kurz and I am the Dean of the School of Public Health at the University of North Texas Health Science Center in Fort Worth Texas. I represent the accredited schools of public health on the Board as a member of the Association of Schools of Public Health. Richard S. Kurz PhD Terry L Dwelle MD MPHTM FAAP CPH June 20, 2011

Learning Objectives Identify the benefits of the CPH examination Identify why the examination is needed now Describe the examination process and its outcomes Describe the spread of the examination among public health organizations

Benefits of CPH for the Field Advances the field by promoting education Increases our credibility with other professionals Responds to the call of public and private employers for a credential to certify currency in the field Provides a mechanism for and encourages continuing education and currency among public health professionals Puts graduates of all programs on an equal footing Helps to build a professional community Enhances marketability on individual and field levels Demonstrates competence and enhances portability Advances the field by promoting education As has been noted, the exam in tied to educational attainment. As the exam becomes a standard in the field among professionals, the demand for education should increase. This will of course help those of us in universities but it will also help to professionalize the field as has occurred for other professions. Increases our credibility with other professional It is important to emphasis that we are the only major health related profession that lacks certification. Without such a process, we appear to be less than a profession and more a collection of interesting and perhaps important skills. However, the need for a population perspective on health is clear if we are to solve the current access, cost, and quality problems and we, as public health professionals, provide this approach. Responds to the call of public and private employers for a credential to certify currency in the field The demand for credibility come not only from our fellow professionals but also from the array of organizations and enterprises that hire us. Accountability both in and outsider of government circles is increasingly a societal demand and the CPH exam is and will be an important approach for enhancing confidence in our field. Provides a mechanism for and encourages continuing education and currency among public health professionals Learning management systems have become more sophisticated and readily available to public health professionals. The allow us to track and document our life long learning. The CPH process – the exam and continuing education – provides a formal mechanism to demonstrate and certify our current competence and motivate us to continue on the path to further professional growth. It will also likely be a more salient point as we attend to motivate employers to support continued professional development. Puts graduates of all programs on an equal footing This one is obvious. The field has accredited programs but the question always remains as the how my education or that of someone that I want to hire compares to that individuals who graduated from a better know or more established school or program. The CPH exam gives us a way to answer that question. Helps to build a professional community Accreditation is not only happening for schools and programs but also for health departments at the local, regional, and state levels. If my organization has reached a certain standard, then I want its workers to demonstrate that they have reached the accepted standard as well. Professionals expect to act autonomously to some degree and the basis for such action should be demonstrated, ongoing excellence in our knowledge and skills. Enhances marketability on individual and field levels Society expects to may more for a quality product or service. The CPH exam is a societally relevant way to demonstrate our quality -- as have other professions – and with an improved perception of our field, reimbursement for it should increase. With no culturally relevant standard, employers may use cost as the most important or only decision criterion. Demonstrates competence and enhances portability Passing the CPH is a testament to the mastery of the scientific knowledge and core content of public health. In other words, the exam confirms what you know and hence makes your education and background more easily transferable to other positions and geographic areas.

Why certify now? Evolution from public health solely being a supplementary degree for physicians and other health professionals Increase in geographical diversity of CEPH-accredited schools and programs Increase in number of graduates from CEPH-accredited institutions Heightened societal requirements for professional accountability Further development of core public health curriculum Greater responsiveness of academic public health to public health practice Marketing efforts and national attention to prevention Evolution from public health solely being a supplementary degree for physicians and other health professionals Public health has arrived. Schools and programs now provide terminal education in biostatistics, epidemiology, environmental health, health promotion, and health management and policy as well as other areas both the masters and the doctoral level. Some schools are now offering the DrPH degree without concentration as the highest practice degree in our field, similar to the MD or DO in medicine or the JD in law. Indeed, undergraduate education in public health through majors, minors, and certificates is the fastest growing area on college and university campuses. Increase in geographical diversity of CEPH-accredited schools and programs There are now 46 schools of public health and there soon will be 50. These schools are in 25 states and the DC AND the number is growing. Only the central northwestern region really lacks schools at this time. Schools are also beginning to be accredited internationally. Programs have much wide dispersion in the US. Increase in number of graduates from CEPH-accredited institutions The number of graduates from individual schools and as a whole is growing. As this occurs, a standardized measure of our competence as a workforce is needed to increase our credibility as a profession. Heightened societal requirements for professional accountability Public health professionals have chosen a field with high social demand professional accountability. We deal with may issues that directly and immediately affect the health and well being of Americans, such as disease outbreaks, product recalls, and biosecurity. As our role in such circumstances increases, the CPH exam provides a clear indication to the our communities, states, and the national that we are equipped to effectively deal with these matters. Further development of core public health curriculum What is emphasized in core public health curriculum has changed with time and will continue to change as our field develops. The CPH exam and continued continuing education gives the field an ongoing assessment of the extent to which our workforce reflects new needed knowledge and skills. Greater responsiveness of academic public health to public health practice Related to the last item, the CPH exam emphasizes the importance of academic training for public health practice. The schools have at times been seen as too focused on theoretical instruction and training for research. The link to school and program degree emphasizes the important of practice in our curricula. Marketing efforts and national attention to prevention And finally, the certification increases attention toward public health with several audiences – certainly the general public but also other professionals, governmental officials and industry.

Overview of the CPH Examination Computer based examination Proctored testing center (Prometric) 200 items; all single best answer, multiple-choice 4½ hour standard time form So if we have established why we want the exam and why we want it now, what is the examination process like? The total amount of time at the testing center is 4.5 hours. This time is comprised of: 15 minutes – Tutorial* Four 1 hour Exam Sections (with approximately 50 questions in each section) 15 minutes of break time – To be taken between exam sections Questions jumbled by domain and type no calculators means…

Examination Results Examination Year Pass Rate 2008 84% 2009 74% 2010 88% 2011 86%

Examination Results Students performed well overall on the 2010 and 2011 exams, although with somewhat lower total scores than alumni. First-takers are typically better performers than repeaters. The difficulty of the examination is comparable across years.

What does the examination cover? Core & Cross-cutting domains Biostatistics Environmental Health Sciences Epidemiology Health Policy and Management Social and Behavioral Sciences Cross-cutting competencies The Certified in Public Health exam is the only exam to test professionals’ command of all of the core public health concepts and principles and cross-cutting competencies. The CPH exam tests the five core areas of public health (biostatistics, epidemiology, ….) and the Seven Cross-Cutting Competencies: • Communication and Informatics • Diversity and Culture • Leadership • Public Health Biology • Professionalism • Program Planning • Systems Thinking Item writers start with PH competencies published by ASPH & expand & contextualize based on their expertise & experience

CPH Exam is graded pass/fail Not like nursing or other licensure exams: No – if getting certain types of questions right, skips similar questions moving forward No -- stop exam once you’ve answered enough correctly to pass This slide shows the results for an examinee. How Will My Exam be Scored? The examination was crafted to assess knowledge germane to core and cross-cutting public health competencies, regardless of academic concentration in preparation. However, NBPHE recognizes that the diversity of the field and our educational approaches to it vary considerably. As such, experts examine each item for its performance (i.e. was the answer coded correctly, was the correct answer chosen as expected or was the item clearly confusing), for its difficulty (again, based on performance and based on expert opinion), and for its usefulness in contributing to the overall score (i.e. if 100% of examinees answered correctly it is not an informative item). At the conclusion of this item analysis, NBPHE conducts a content–based analysis to generate statistical information for determining the minimum passing standard (Angoff and Hofstee procedures). A Standard Setting Committee determined the score required to achieve certification using results from the study and performance data on the exam. More information is available from NBPHE. The CPH exam is scored overall as pass/fail. A score report is provided to each examinee that includes: Total score for the entire exam; Separate scores for each of the 5 core competencies; Separate score for all cross–cutting competencies combined; and Whether the examinee´s score is sufficient for certification NBPHE does not share exam results outside of NBPHE Scores for students are withheld until their graduation is verified.

When is the examination offered in my area? Any day 2/3 – 27/12 Use Prometric Book your choice with the Scheduling Permit Appointments on a first-come, first-served basis.

What study resources are available from NBPHE? Sample tutorial 18 sample questions ASPH MPH competency set www.publichealthexam.org FREE

Evidence of Institutionalization of the CPH Process Allegheny County HD American Legacy Foundation American Public Health Association Army Nurse Corps Incentive Special Pay Association of State & Territorial Health Officials California State University, East Bay Centers for Disease Control and Prevention Cherokee Nation Healthy Nation Clinical Connexion Denver Health Medical Center Richmond Behavioral Health Authority University Hospital at UNMDJ U.S. Department of Veteran’s Affairs CPH credential can increase an applicants or employees value. Increasingly employers are supporting their employees who become CPH by paying or reimbursing for CPH or maintenance fees, preferential hiring or promoting CPH. By employing CPH professionals, you are assured of a better prepared workforce and make a statement of your value for quality and accountability. Hiring CPH professionals is an indicator of your commitment to a robust public health infrastructure. It is a measure of a strong workforce to protect the public and your commitment to manage a forward-looking learning organization.

Questions? at booth #308 in the exhibit hall Visit the National Board of Public Health Examiners at booth #308 in the exhibit hall Join the ranks of CPH professionals! 1-866-514-7569 http://www.nbphe.org/