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 Table of Contents  
BRIEF COMMUNICATION
Year : 2009  |  Volume : 22  |  Issue : 2  |  Page : 244

Applied Topics in the Essentials of Public Health: A Skills-Based Course in a Public Health Certificate Program Developed to Enhance the Competency of Working Health Professionals


Department of Health Management and Policy, University of New Hampshire, New Hampshire, USA

Date of Submission02-Aug-2008
Date of Acceptance16-Jul-2009
Date of Web Publication21-Aug-2009

Correspondence Address:
R M Caron
#319 Hewitt Hall, 4 Library Way Durham, New Hampshire 03824-3563
USA
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Source of Support: None, Conflict of Interest: None


PMID: 20029749

  Abstract 

Introduction: In addition to understanding core public health fundamentals, health professionals must also be equipped with the skills necessary to implement strategies to promote population health. In response, the University of New Hampshire (UNH) has developed a unique Public Health Certificate (PHC) Program designed to strengthen knowledge and skills in basic public health competencies of working health professionals. A distinctive feature of this program is its culminating course "Applied Topics in the Essentials of Public Health," which entails a practical, applied learning experience where students explore a variety of essential public health services (EPHS) relevant to their career goals.
Objectives: 1) Explain the rationale for educating working health professionals about public health; 2) Describe the UNH
graduate PHC Program, its framework and innovative process for implementing a skills-based course to improve the competency of practitioners to perform the EPHS; 3) Review the benefits and challenges of implementing a skills-based course for working health professionals; and 4) Evaluate the PHC Program.
Discussion: The UNH PHC Program and its capstone course serve as a model for providing a unique, skills-based learning opportunity for working health professionals pursuing advanced public health education in U.S.-based or international public health education programs. This novel course design allows for students to develop the skills necessary to perform the EPHS.

Keywords: public health; essential public health services; public health certificate; education; public health professional; Work force development


How to cite this article:
Caron R M, Tutko H. Applied Topics in the Essentials of Public Health: A Skills-Based Course in a Public Health Certificate Program Developed to Enhance the Competency of Working Health Professionals. Educ Health 2009;22:244

How to cite this URL:
Caron R M, Tutko H. Applied Topics in the Essentials of Public Health: A Skills-Based Course in a Public Health Certificate Program Developed to Enhance the Competency of Working Health Professionals. Educ Health [serial online] 2009 [cited 2020 Oct 22];22:244. Available from: https://www.educationforhealth.net/text.asp?2009/22/2/244/101536

Introduction



Rationale for educating working health professionals about public health:  The public health system includes the public, private and voluntary organizations in a locale necessary to improve the health of populations (CDC, 2008a). This system utilizes the ten Essential Public Health Services (EPHS) which detail the activities that should be undertaken to prevent disease and promote health in all communities (CDC, 2008b). The implementation of this fundamental framework requires a public health workforce not only educated in the core public health sciences but equipped with the interdisciplinary skills necessary to execute strategies to establish and maintain health within the communities they serve.



Improving the public health infrastructure at a national and international level requires educated public health professionals defined as “…a person educated in public health or a related discipline who is employed to improve health through a population focus” (IOM, 2003a). Physicians, nurses, and other allied health professionals represent a vital part of the public health workforce. Studies have documented the need for health professionals to understand health from an ecological perspective to improve the delivery of healthcare and health outcomes (IOM, 2003a, 2003b; Allan et al., 2004). In addition to possessing an understanding of core public health concepts, such as health determinants, health professionals must also be equipped with the skills necessary to implement strategies to promote health within their patient population and the greater community they serve. For example, they need to know how to measure the health status of a population and how to effectively educate people about health issues. As stated in the Institute of Medicine (IOM) report Improving Health in the Community: A Role for Performance Health Monitoring:

For too long, the personal healthcare and public health systems have shouldered their respective roles and responsibilities separately from each other…we need to invest in a process that mobilizes expertise and action from a variety of community, state, and organizational entities if we are to substantially improve community and population health (IOM, 1997).

Lack of formal education among public health professionals:  The public health workforce in the United States consists of approximately 500,000 individuals who are employed by an array of organizations involved in public health practice including governmental public health agencies, healthcare organizations, community-based organizations, voluntary organizations, not-for-profit agencies, academia and other groups (USDHHS, 2001). Yet, in the U.S., previous research has documented that many practicing public health professionals do not possess any formal education in public health (CDC, 2001; IOM, 2003a; Kennedy, et al., 1999; Turnock, 2001; USDHHS, 2001). For example, a 2001 study of governmental public health agencies found that just slightly more than one half of all governmental public health workers in the U.S. have formal public health training (USDHHS, 2001). As a result, there have been several calls for action to increase the quantity of educated practitioners entering the public health field and for working health professionals to keep their knowledge and skills current through continuing education efforts. For example, the IOM report Who Will Keep the Public Healthy? recommended creativity as a key to assist in training the public health workforce (IOM, 2003a). In addition, the IOM report The Future of Public Health charged academic institutions specializing in public health with educating public health workers and new students to practice public health in diverse venues (IOM, 1988).



Learning needs of working health professionals:  Designing an advanced public health education program for a working health professional proves challenging. The program must employ pedagogical methods that factor in the learning needs and preferences of this target audience, including: 1) the ability to immediately apply what they learn to their professional work; 2) flexibility to tailor their learning to their professional interests and aspirations; and 3) an adaptable schedule to balance the demands of school, work and family. Thus, a program targeting working health professionals must provide both quality education and an adjustable format.



Since public health practice is changing and the education of health practitioners must be adaptable, the purpose of this paper is to describe how the University of New Hampshire’s (UNH) Public Health Certificate (PHC) Program and its skills-based course “Applied Topics in the Essentials of Public Health,” which requires 32 hours of skill-building workshops, offer a unique model for other public health education programs to adopt, so that they may contribute to the call to educate the public health workforce.



One university’s response to the call to educate public health professionals:  Compared with an average of 118 governmental public health workers per 100,000 inhabitants in other New England states, New Hampshire possesses approximately 83 governmental public health workers per 100 000 residents (Gebbie, 2000). Furthermore, a 2004 report estimated that approximately half of New Hampshire’s state governmental public health workforce will be retiring in five years (ASTHO, 2004). The remainder of New Hampshire’s public health workforce is employed by a broad range of organizations involved in public health practice that has yet to undergo enumeration. Hence, the number and level of formal education attainment by these practitioners remains unknown.



New Hampshire has two accredited Master of Public Health (MPH) Programs, one at Dartmouth Medical School and one at UNH. However, until recently, there was no graduate PHC Program offered in the state to link those with public health experience to an intermediate form of graduate public health education. Based on the identified needs to replenish the supply of public health practitioners and provide continuing education opportunities for working public health professionals, the UNH MPH Program heeded the IOM’s call for action by establishing a PHC Program in order to further assist in educating the public health workforce in our relatively rural state. The UNH PHC Program provides another graduate study option for working public health professionals for whom a two-year MPH degree may not be feasible. In addition, the PHC provides a bridge for student enrollment into the UNH MPH Program by allowing the graduate credit from successfully completed courses in the PHC Program to be transferred towards the UNH MPH degree.



Overview of the Public Health Certificate Program offered at the University of New Hampshire:  In 2006, the UNH PHC Program started to provide working health professionals the opportunity to earn a graduate certificate in public health. This Program is administered by the Department of Health Management and Policy in the College of Health and Human Services located on the main campus in Durham, New Hampshire. However, all courses are offered on UNH’s satellite campus located approximately 40 miles away in Manchester, New Hampshire, due to its commuter-accessible location. The PHC Program is a non-residential program directed by a part-time administrator with oversight by the MPH Program Director, both of whom are faculty members of the Department of Health Management and Policy.



Applicants must possess a baccalaureate degree from an accredited educational institution, in order to be eligible to apply for the UNH PHC Program. Work experience is encouraged and fluency in speaking, writing and reading English prior to enrolling in the PHC Program is strongly recommended.



PHC courses are offered in a traditional face-to-face setting on weekday evenings from 5:30-9:30 p.m. The semesters during the academic year are eight weeks long. The summer schedule offers a variety of courses ranging from five to ten weeks in duration. The PHC can be completed on a part-time basis over one year. However, students have up to three years to complete the graduate certificate. Students must maintain a grade of 80% (B-) out of a 100% scale, in order to graduate from the PHC Program.



The PHC’s on-site curriculum is comprised of four graduate courses: Public Healthcare Systems; Epidemiology; one elective course; and Applied Topics in the Essentials of Public Health. The ‘Public Healthcare Systems’ course provides students with a solid foundation about the organization of the public health field and the role of economic, political and social impact factors. The ‘Epidemiology’ course familiarizes students with the analytical tools required for a public health professional to be able to assess disease occurrence and formulate prevention measures. Students are allowed one elective course, which offers them the opportunity to tailor their coursework to a particular aspect of public health that is of interest to them. ‘Applied Topics in the Essentials of Public Health’ is the capstone course for the PHC Program. This course requires students to attend approved workshops on concepts related to the ten EPHS (Table 1). After attending the required workshops, the student will write an integrating paper summarizing what s/he has learned during these workshops in relation to the EPHS and identifying the types of skills s/he will need in order to be a more effective public health professional. Additional information about the UNH PHC Program is available at the website of the UNH Graduate School and of the UNH College of Health and Human Services, Department of Health Management and Policy.



Table 1:  Ten Essential Public Health Servicesa







Objectives



Design of a skills-based course:  The UNH PHC Program is unique in that it offers a culminating, skills-based course ‘Applied Topics in the Essentials of Public Health’, to afford the student the opportunity to acquire experience in translating theory into practice. This course is a practical, applied learning experience where students explore a variety of EPHS relevant to their career interests and goals by participating in workshops to build their skills to accomplish the EPHS. Through this design, the ‘Applied Topics in the Essentials of Public Health’ course links a knowledge-based curriculum to public health competency development. Upon completion of this course, a student will be able to: describe and analyze competencies needed to adequately perform at least four different EPHS; explain what competencies s/he needs to develop in the future to be a more effective public health professional; and to write a cogent document that demonstrates high quality professional writing in the form of an integrating paper.



Course administration and deliverable:  To enroll in the course, a student must have participated in at least six approved workshops. The rationale for participating in six workshops is that it provides sufficient opportunity for the students to practice their skills in the different EPHS. The workshops must: total a minimum of 32 contact hours; address at least four different EPHS; be offered by a recognized public health agency, healthcare organization or educational institution; provide some form of documentation demonstrating student participation; and be completed within a three-year time period. To be approved, a workshop must maintain a population health (as opposed to clinical care) focus and promote building skill(s) (not just knowledge) necessary to perform an EPHS. For example, a workshop that teaches the specifics of how to develop and implement a community action plan to reduce the asthma burden satisfies these criteria. This workshop maintains a population focus and builds student capacity to address the EPHS of “Develop[ing] policies and plans that support individual and community health efforts.” In contrast, a presentation about a community’s general experience addressing the asthma burden would not be approved. Though the presentation would be population-focused, it does not build a student’s skill to successfully implement an EPHS. These aforementioned workshop criteria are designed to ensure a quality-productive learning experience that will directly build student capacity to perform the ten EPHS.



In addition to assisting PHC students with locating eligible workshops, the PHC Program offers two workshops annually that meet the specified requirements. Table 2 identifies representative workshops for the ‘Applied Topics in the Essentials of Public Health’ course. Once a potential workshop opportunity has been identified, students are encouraged to submit a workshop approval form to the course instructor (who is also the PHC Administrator) at least one month prior to the workshop. This form documents key facts about the workshop in order for the instructor to determine if the proposed workshop meets the above guidelines and to identify the primary EPHS associated with the skills built in the workshop. The course instructor reviews and e-mails the student if the workshop is approved. To assist in monitoring student compliance with the course prerequisite, the instructor maintains an Excel workbook that tracks for each student the title and dates of workshops attended, contact hours and the EPHS associated with the workshop. Students are required to submit all documentation regarding workshop attendance prior to registering for the capstone course. Once the instructor verifies that the student has successfully met the course prerequisite and submitted his/her workshop documentation, the student is allowed to register for the course.



Table 2:  Applied Topics in the Essentials of Public Health – Representative Workshops







Once the course prerequisite has been met, a student will write an integrating paper that summarizes how the workshops attended enhanced his/her competency to perform the EPHS. To address this question, a student is strongly encouraged to group the workshops attended by the ten EPHS and identify for each workshop the three to five core public health competencies that the workshop most helped him/her to develop. To assist in this process, students are referred to a cross-walk of core public health competencies organized by EPHS that is available through the Council on Linkages between Academia and Public Health (2001). In the integrating paper, the student is required to describe and analyze not only what competencies s/he developed but also how the workshop assisted in building the competency and how this competency will help him/her to become a more effective public health practitioner. Table 3 provides an example of an acceptable level of detail for describing how a workshop achieved these stated objectives.



Table 3:  Instructor Guidelines for Student Analytic Assessment of Competencies Developed in a Workshop



Title of Workshop Attended: Basic Data Analysis



Essential Public Health Service Related to this Workshop: Monitor Health Status to Identify and Solve Community Health Problemsa








In the integrating paper, the student also provides an analysis of the additional skills s/he needs in order to be a well-rounded, competent public health professional. Using the ten EPHS as a guide, the student provides an analysis of 1) the types of additional competencies needed to more effectively perform the ten EPHS, and 2) how developing these competencies will support the student in his/her public health career trajectory. For example, a student may identify that s/he wants to increase skill levels with respect to the EPHS “Monitoring health status to identify and solve community health problems.” In this case, the student would review the competency domains from the Council on Linkages between Academia and Public Health (the Council) required to perform this EPHS and identify which competency domain(s) (e.g., analytic/assessment skills) and/or specific skills (e.g., define a problem, determine appropriate uses and limitations of qualitative and quantitative data) within this domain s/he would like to further develop and then provide a thoughtful analysis of why this would help him/her in his/her future career path (The Council, 2001).



The integrating paper is evaluated based on content, critical thinking, structure and style. In addition to evaluating the student’s work, the instructor also shares information regarding the work of professional associations and educational outlets the student may want to explore in order to enhance competency areas identified in the paper.



Benefits and Challenges:  The benefits of incorporating a skills-based course in a PHC Program targeting adult working health professionals are: it capitalizes on their learning preferences by directly applying knowledge learned in the classroom via skill-building workshops; it enables them to tailor coursework; it facilitates “real-time” application of skills learned to their professional work setting; and provides the opportunity to develop a logical plan for future skill-building based on interests and career direction. For example, if a student identifies that s/he would like to further develop financial planning and management skills, then s/he could begin to identify workshops or graduate coursework to increase competency in this area. Also, if a student is unsure about a future career path but has some interest areas, then s/he can further explore these areas and alter the career course, if necessary.



The curriculum design of the PHC Program and its capstone course incorporates flexibility to allow working public health professionals the ability to customize their coursework. Unlike most other PHC Programs, students can take a public health course of interest from the UNH MPH Program course offerings as their one elective course. In addition, students self-select the EPHS they focus on in their capstone course. The course instructor proactively advises students to use this opportunity to explore the EPHS of most interest to them and/or those that will help them in their current or future career aspirations. Also, although the first three courses in the PHC are on-site, the capstone course is accommodating in that there are no set classroom hours. The instructor and student meet at a mutually convenient time and/or use e-mail correspondence to communicate about the student’s progression.



The main challenge of including a skills-based course in a PHC Program comprised of an adult working population is their committed schedule. Although the PHC Program is designed to be completed in one year, current students are typically taking longer. For some, taking time to attend a workshop is difficult due to family and work obligations. Thus, students have up to three years to meet their workshop requirement and are allowed to partake in three of their six workshops online. Finally, courses successfully completed in the PHC Program may be transferred into the UNH MPH Program, thus making the time commitment required to obtain an MPH degree potentially more feasible.



Another challenge is devising a detailed, yet flexible, criteria set that a workshop must meet to ensure a quality skill-building experience. For example, criteria were developed to clarify that a workshop must directly build skills to perform, and not just to increase knowledge about an EPHS. Annually, the Program’s administration reviews the workshop criteria set and amends them accordingly based on the experience of the previous year.



Another significant challenge faced by many students is financing their education. The current in-state tuition for completing the UNH PHC is US $6924. The out-of-state tuition for completing the UNH PHC is US$7620. To try to provide guidance to students with finding resources to fund their education, we promote UNH scholarship opportunities, direct students to consult with the UNH Financial Aid Department, and encourage them to explore employer tuition assistance. We advise students about these opportunities via one-on-one consultations, Open House events, e-mail and Blackboard. The most typical ways current PHC students are funding their education is via employer tuition assistance and/or personal resources.



Lastly, if the public health workforce is going to be significantly improved, it requires more than a PHC Program or accredited MPH Program. This challenge requires the acknowledgment and support of employers who want educated public health professionals on staff. There needs to be flexibility built into the work schedule of these employees so they can attend the PHC Program. These employers need to become familiar with the Program’s model and endorse its mission and support their employees’ participation via compensated time off from work and tuition reimbursement programs for graduate certificate programs, in addition to graduate degree programs.



PHC Program evaluation:  Based on the identified needs to educate public health practitioners and provide continuing education opportunities for working public health professionals in New Hampshire, UNH began a small, local MPH Program in 2001, which, on average, has 50 enrolled graduate students. The mission of this graduate program in the state’s public university is “…to provide society with knowledgeable and professionally educated people to enhance the public health infrastructure and the health of populations in northern New England, with a special focus on New Hampshire…” (UNH, 2008). To further support the mission of the UNH MPH Program, the PHC Program was developed. The PHC is a small, newer program and since its inception, ten people have enrolled in the UNH PHC Program. Of these, one student has graduated and transferred into the UNH MPH Program. Two additional students are still completing their PHC, but have already applied for and been accepted to the UNH MPH Program.



Though individual course evaluations are not completed for the ‘Applied Topics in the Essentials of Public Health’ course due to confidentiality principles for the small number of students, informal conversations with students have revealed the utility of this course for helping them appreciate the host of different skills required to be a competent public health professional, in addition to determining future pathways for continued growth as a public health professional. As more students matriculate through the PHC Program, the administration plans to undertake formal evaluation processes to further assess student and alumni perspectives on the PHC Program’s value.



Discussion



As public health challenges evolve in complexity, it becomes increasingly vital that working health professionals possess the competencies necessary to identify and effectively respond to them. Creating a flexible Public Health Certificate Program, and in particular, a hands-on culminating course focused on skill development, serves as a promising way to equip working health professionals with these necessary competencies.



The ‘Applied Topics in the Essentials of Public Health’ course serves as a model for incorporating relevant public health competencies into knowledge-based PHC programs. This culminating course provides a unique, experiential learning opportunity for working health professionals to garner the skills required to perform the EPHS. This non-traditional, skills-based course stands in contrast to other PHC Programs where the successful completion of the five core courses in the field of public health, i.e. Epidemiology, Biostatistics, Environmental Health, Social and Behavioral Health, and Health Administration, is the certificate requirement (Davis, et al., 2006). The skills attained at the completion of this course will also enhance the capacity of health professionals involved in direct healthcare delivery to meet the public health and healthcare needs of the populations they serve. For example, building skills in how to collect and manipulate data would help a school nurse identify the major health risks leading to disease and injury within the student population. Based on this data, s/he might decide to implement a program to screen for these major health risks, or develop a program to partner with parents and primary healthcare providers of high risk children to promote the adoption of healthy behaviors.



Smaller MPH Programs and international public health programs may want to consider this PHC Program and/or skills-based course as an implementation model due to its ability to provide education and skills necessary to promote health and prevent disease with a relatively small investment in resources. For instance, a program does not need to spend significant resources offering workshops to help students meet their skills-based course requirement since students could attend public health skill-building workshops offered by other organizations in the area or via distance-learning. Furthermore, administration of a PHC Program is not quite as labor-intensive as an MPH Program since it is a shorter curriculum.



We plan to continuously evaluate the UNH PHC Program’s strengths and weaknesses so that the PHC Program’s growth and development will meet the educational needs of public health practitioners. This continued assessment of the PHC Program’s infrastructure and its graduates will allow for evaluation and adjustment of the Program in the future. Since public health practice is changing and the education of public health practitioners must be adaptable, we propose the UNH PHC Program and its capstone course ‘Applied Topics in the Essentials of Public Health’ could contribute to the call for enhancement of the working health professionals’ competencies in diverse settings.



Acknowledgements



The authors would like to acknowledge the founding director of the UNH MPH Program, Professor John Seavey, for his time and leadership in starting both the MPH and the PHC Programs. The authors are also grateful to the reviewers of this work for their constructive critique.



References



Allan, J., Agar Barwick, T., Cashman, S., Cawley, J.F., Day, & C., Douglass et al. (2004). Clinical prevention and population health: Curriculum framework for health professions. American Journal of Preventive Medicine, 27, 471-476.



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Centers for Disease Control and Prevention (CDC) (2008a). National Public Health Performance Standards Program. Retrieved July 2, 2009, from http://www.cdc.gov/od/ocphp/nphpsp/overview.htm



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Institute of Medicine (2003b). The Future of the Public’s Health in the 21st Century. Washington, DC: National Academies Press.



Kennedy, V.C., Spears, W.D., Loe, H.D. Jr., & Moore, F.I. (1999). Public health workforce information: A state-level study. Journal of Public Health Management and Practice, 5, 10-19.



Turnock, BJ. (2001). Public Health: What It Is and How It Works. Gaithersburg, MD: Aspen Publishers, Inc.



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