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Of the 10 Essential Public Health Services outlined by the U.S. Department of Health and Human Services, four services rely heavily on epidemiologic functions,1 yet there is concern that there are not enough skilled epidemiologists in the public health workforce.2 In its 2004 report, “National Assessment of Epidemiologic Capacity: Findings and Recommendations,” the Council of State and Territorial Epidemiologists (CSTE) reported an increase in epidemiologists working in state and territorial health departments—from 1,366 epidemiologists in the 2003 report (surveyed in 2001–2002) to 2,580 epidemiologists in the 2004 report (surveyed in 2004). In 2004, only 43% of infectious disease epidemiologists reported academic training in epidemiology.1 Furthermore, 64% of epidemiologists working in state and territorial health departments who responded to a 2001–2002 CSTE survey about their abilities to respond to foodborne disease outbreaks indicated that they did not have the capacity to conduct analytic epidemiologic investigations.3
Staff epidemiologists need formal training in epidemiologic methods. However, working professionals may not have the time or financial resources to enroll full-time in an academic epidemiology program. In 2002, the Institute of Medicine emphasized the importance of offering formal training in public health through alternative pathways such as certificate programs.4
To address the need for applied epidemiology training for working public health professionals, the Certificate in Field Epidemiology program was developed and implemented by the North Carolina Center for Public Health Preparedness (NCCPHP) and the Office of Executive Education within the North Carolina Institute for Public Health (NCIPH), the service and outreach arm of the University of North Carolina at Chapel Hill (UNC) School of Public Health (SPH), as well as the UNC SPH Department of Epidemiology. The Certificate in Field Epidemiology is an Internet-based, 12-credit, graduate-level program that can be completed in 16 months and requires no travel to the UNC campus.
The UNC SPH is a leader in the field of public health distance education. An Internet-based interdisciplinary master of public health (MPH) program was launched in 1998, and the school offered its first distance-learning certificate program, the Certificate in Core Public Health Concepts, in 2000. Since then, UNC SPH has offered the Certificate in Community Preparedness and Disaster Management, the Certificate in Field Epidemiology, the Occupational Health Nursing Certificate, and the Certificate in Public Health Leadership.
NCCPHP and the Department of Epidemiology at UNC SPH have substantial experience developing face-to-face and distance-based curricula, educational products, and courses. One of the certificate program courses, “Principles of Epidemiology for Public Health,” has been taught in the Department of Epidemiology as an Internet-based course since 1998. To launch the Certificate in Field Epidemiology, NCCPHP and the Department of Epidemiology developed three additional Internet-based courses offered through the Department of Epidemiology.
The UNC SPH information technology group, Instructional and Information Systems (IIS), provides support for distance-based education at the school. This group provides technical and instructional design services to UNC SPH faculty, including creating Internet-based courses that incorporate audio, video, synchronous and asynchronous communication, and interactive multimedia. IIS offers an orientation to the course website, and the university maintains a computer help desk available to registered students and faculty.
The Office of Executive Education at the NCIPH is responsible for marketing the certificate program and provides the application, admissions, residency, registration, and payment and refund processes associated with the certificate program. This office had experience running the successful Core Public Health Concepts Certificate Program, which was organized across five SPH departments. Evaluation Services at the NCIPH develops and implements evaluation plans for both the Core and Field Epidemiology certificates.
The Certificate in Field Epidemiology is a graduate-level program for public health professionals and others who wish to learn the principles and methods of field epidemiology. It is designed to help the public health workforce respond to emerging and reemerging health threats, including the threat of bioterrorism. All courses are taught by faculty from the Department of Epidemiology. Students enter the program in the fall and enroll in one course per semester, completing the program in 16 months. The Certificate is administered by the NCIPH and the Department of Epidemiology.
The Certificate in Field Epidemiology curriculum is linked to two complementary sets of epidemiology competencies: those developed by the Northwest Center for Public Health Practice5 and the Tier I and II Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs),6 developed by the Centers for Disease Control and Prevention (CDC) and CSTE. The AECs were recently adopted nationally, and some competencies overlap between the two sets. However, the Northwest Center for Public Health Practice Epidemiology Competencies cover some concepts that are either insufficiently covered or altogether absent from the AECs; therefore, both inform the program.
The program consists of four semester-long sequential courses (Figure). The first course, “Principles of Epidemiology for Public Health,” introduces the meaning, scope, and applications of epidemiology to public health practice and the use of vital statistics data in the scientific appraisal of community health. “Methods in Field Epidemiology” focuses on skills and tools needed to conduct outbreak investigations and communicate findings to the public. “Principles and Methods of Applied Infectious Disease Epidemiology” encompasses the interactions among an infectious agent, host, and environment; modes and dynamics of transmission; the role of immunity in infectious disease epidemiology; and disease elimination strategies. Finally, “Fundamentals of Public Health Surveillance” provides conceptual foundations and practical skills for designing and implementing surveillance systems and using surveillance data to conduct and evaluate public health programs and research.
UNC's Blackboard e-Education platform™ (Release 6.3.1-505), an Internet-based course-management system, was used to deliver course content and provide tools to create and administer courses, such as self-graded quizzes, discussion forums, chat functions, and grade maintenance.7
Traditional graduate-level residential courses have an instructor-centered lecture format, which relegates students to a passive learning role.8 In contrast, cooperative learning enables students to become more involved with the course material and articulate their understanding of the material through problem-solving exercises with other students.9 All four certificate program courses use activities that allow students to contribute, participate, and apply epidemiologic concepts and methods to real-life case studies in field epidemiology, surveillance, and infectious disease epidemiology.
Each semester-long course earns three graduate credit hours. The workload is typical of graduate-level courses at UNC and requires students to work on course material for three to four hours each week (not counting time spent attending class) for every credit hour earned. Therefore, a student taking a three-credit course should expect to work a total of nine to 12 hours each week.
Courses are divided into modules lasting one to four weeks. Each module uses a standardized format that contains instructions for completing the module, module learning objectives, lectures, case studies, required and suggested readings, and group discussion questions or projects. Some modules also have short quizzes, exams, and individual projects.
To facilitate learning, asynchronous discussion boards are used for group discussion questions and projects. All courses also incorporate live interactive Internet-based videoconferences using Adobe® Acrobat® Connect™ Pro, which allows faculty and teaching assistants to interact “live” with students several times during each course.10 Adobe Connect is also used for guest lectures, question-and-answer sessions, and a journal club. All Adobe Connect videoconferences are archived for later viewing.
In each course, students are assigned to groups of eight to 10 students to work on group projects and discussion questions.
Department of Epidemiology graduate students serve as teaching assistants, with one teaching assistant per four student groups (a 1:32 to 1:40 ratio). Teaching assistants work closely with their groups, reviewing case studies, monitoring discussions or group projects, and answering questions via e-mail, phone, or Adobe Connect. Teaching assistants and course faculty jointly grade exams and individual projects.
Before each course, teaching assistants participate in an orientation that covers course software, course format, course tools, e-mail etiquette, and technical support, as well as the point of view of an Internet-based student. The orientation also covers teaching assistant time commitment and course duties, and a review of the mid-course teaching assistant performance evaluation survey.
Teaching assistants meet with faculty each week to discuss course content, technical issues, teaching assistant concerns, and student issues, and to receive further training. Students submit issues to the faculty for discussion during these meetings.
Before beginning the certificate program, students attend a formal software orientation conference call provided by the Certificate Education Director and the course's technical support person. The orientation covers a brief overview of the program and an Internet course orientation including how to use the Blackboard course software, e-mail requirements, computer hardware and software requirements, and whom to contact for technical support during the course. Students receive orientation documents before the call and must have computer access to walk through an example course during the orientation. All students must also test their Internet browsers, plug-ins, and navigation skills using an automated online computer assessment before the course begins.
Students in Internet-based courses require more feedback from faculty and teaching assistants than do students in traditional courses. Course faculty and teaching assistants respond to student e-mails within 24 hours, and teaching assistants participate in group project discussion boards to answer questions or make comments.
In each module, students may anonymously provide feedback on the module and its components. In Blackboard, each module also contains a hidden text box that is available only to faculty and teaching assistants. This text box is used to document problems with course content or instruction and note possible corrections. Small changes are usually completed during the course; more substantial changes are completed before the next offering of the course.
Members of the NCIPH Evaluation Services team are responsible for performing all course and program evaluation. Participant satisfaction and competency improvement are evaluated following each course. The survey instrument measures participants' prior training and epidemiology experience, course satisfaction, and self-confidence to perform competencies addressed in the course. Faculty modify the course based on feedback provided in these evaluations. Each course also includes a mid-course student evaluation of teaching assistant performance and an end-of-course evaluation of faculty, teaching assistants, course content, and use of technology.
Using the AECs and the Northwest Center for Public Health Practice Epidemiology Competencies, course developers included competencies in the course evaluation for two levels: knowledge (the ability to apply and describe a competency) and proficiency (the ability to synthesize, critique, or teach the skill).
After graduating from the program, students complete a participant satisfaction evaluation of the certificate program. Another Internet-based survey is conducted six months later to determine whether participants have applied new skills or concepts learned in the program to their current jobs, shared knowledge or materials from the program with others, and gained knowledge that helped them perform new job responsibilities in responding to health threats for which they had no prior training.
The Certificate in Field Epidemiology has enrolled state and local public health practitioners, public health veterinarians, environmental health specialists, physicians in emergency medicine and public health, health educators, surveillance officers, public health nurses, epidemiologists, immunization and infection control practitioners, and others.
The first cohort included participants from 25 U.S. states and territories, Canada, and Indonesia (Table 1). Of the 90 participants enrolled in the first Certificate course, 35 completed all four courses in the anticipated 16-month time period. As of March 2007, 14 participants from the first cohort were still enrolled in the program and 10 had transferred to other academic programs at UNC (nine to an MPH or doctor of philosophy program and one to another Certificate program). Of the 17 participants who withdrew from the program, a majority did so due to Hurricane Katrina. The number of students who completed each course was 61 for “Principles of Epidemiology for Public Health,” 57 for “Methods in Field Epidemiology,” 54 for “Principles and Methods of Applied Infectious Disease Epidemiology,” and 49 for “Fundamentals of Public Health Surveillance.”
Only 23% of students enrolled in the Certificate in Field Epidemiology program indicated previous experience in online learning; however, after completing their first course, 90% indicated that they strongly liked (65%) or liked (25%) the online format. In course-specific evaluations (Table 2), 95% of participants strongly agreed/agreed that they were satisfied with “Principles of Epidemiology for Public Health” (72% response rate), 93% strongly agreed/agreed that they were satisfied with “Methods in Field Epidemiology” (98% response rate), 96% strongly agreed/agreed that they were satisfied with “Principles and Methods of Applied Infectious Disease Epidemiology” (89% response rate), and 90% strongly agreed/agreed that they were satisfied with “Fundamentals of Public Health Surveillance” (100% response rate).
In the first cohort, 27% of the students attended the live Adobe Connect sessions, and 47% viewed the archived sessions. Students reported that use of live interactive meetings enhanced the connection between students and the faculty and teaching assistants. We have since incorporated more of these sessions into the courses and will consider having students use the technology for group exercises.
Twenty-six of the 35 students (74%) who graduated responded to the overall certificate program evaluation. All 26 students reported that the program was worth the time and effort they spent on it, 25 participants (96%) would recommend the program to others, and 24 participants (92%) thought the program was worth the cost of tuition. In addition, there were 293 applicants to the program from August 2006 through January 2008.
Public health workers need training in field epidemiology and should be able to apply their training using interdisciplinary approaches. Applying distance-learning methods that use a lifelong learning framework to train the public health workforce is an essential strategy for improving the public health system infrastructure and meeting the nation's public health needs.
Critical success factors for Internet-based academic programs include high-quality, engaging teaching materials, highly involved faculty and teaching assistants, and attentive student and technical support services. Crucial to the program's success are faculty who have experience in course content, technical issues, and Internet course design, teaching, and delivery. Courses should be pilot-tested with the target audience, and faculty need to constantly refine and update the course materials. An extremely high level of customer service among administrative staff and members of the teaching staff is necessary for student success. With nontraditional students (those working full-time, traveling, and with other life demands), it is important that the administrative hassles that often take place in the academic environment be streamlined as much as possible. Students rely on administrative staff to take care of issues that arise at a distance to allow them to focus on their studies.
It is important to design the courses to fit the characteristics of the target audience. Our participants are primarily working professionals who travel for work and must respond to public health emergencies. Participants will also have other obligations associated with their personal lives. To allow for maximum flexibility in scheduling, we redesigned three of the courses from a one-week module format with weekly assignments to an extended module format lasting three to four weeks, with assignments due at the end of the module. The shift toward a more flexible schedule also allows faculty and teaching assistants to devote more time to student interaction because grading and reviewing assignments are no longer weekly tasks.
Course materials should be well organized and use a consistent format. Instructors should not assume that all Internet-based students are equally fluent in computer technology, and instructions should outline all steps necessary to use software programs and complete assignments. If instructions are confusing, students can get anxious and frustrated.
Feedback from all participants, including students, faculty, and teaching assistants, allows the faculty to continually evaluate and improve the curriculum and course design. Course evaluation should occur throughout the course, so changes can be made quickly that enhance the overall learning experience.
Technical support and training for faculty, teaching assistants, and students must be provided before and throughout the course. Guiding faculty and teaching assistants on how to interact with distance-based students, including via e-mail or discussion boards, is an important component of this support. Giving both faculty and teaching assistants orientation and training will greatly enhance the teaching experience and can result in an excellent experience for students.
Giving students an orientation to course software and format before the course begins reduces the amount of time spent on technical support once the course is underway. Providing technical support for course software to students during the course is imperative as well. Anxiety or frustration with software-related issues may lead to unsatisfactory experiences with the overall course, no matter how excellent the course content and faculty interactions may be.
Students may believe that an Internet-based course will be easier and less time-consuming than a classroom-based course. Our courses are designed to have the same rigor as classroom-based courses, and because communication is primarily written rather than verbal, Internet-based courses can take more time than classroom-based courses. Students in the Certificate in Field Epidemiology program read and acknowledge a statement informing them of course expectations, including time commitment, deadline and grading policies, computer issues, and procedures for withdrawing from the course.
Faculty and teaching assistants also need to understand that the volume of written material produced in an Internet-based course can far exceed that of a classroom-based course. In addition to regular assignments, exams, and group projects, Internet-based faculty and teaching assistants must read group discussion board postings and respond to e-mails. This extra time spent reading can be offset by reduced lecture time, because Internet-based lectures are recorded and can be used with minor modifications for numerous offerings of the courses.
The Certificate in Field Epidemiology program at the UNC SPH can help fill the gap of formal education in applied epidemiology at health departments. No other U.S. certificate program focuses on field epidemiology, linking a graduate-level curriculum to nationally recognized epidemiology competencies, and providing working professionals an alternative to residential programs.
The authors appreciate the assistance of Anne J. Menkens for editing this article and Elizabeth P. Mahanna for assisting with evaluation.
Articles for From the Schools of Public Health highlight practice- and academic-based activities at the schools. To submit an article, faculty should send a short abstract (50–100 words) via e-mail to Allison Foster, ASPH Deputy Executive Director, at gro.hpsa@retsofa.
Monetary support for development and implementation of this program came from the Office of the Executive Vice Chancellor and Provost at the University of North Carolina at Chapel Hill and the Cooperative Agreement U90/CCU424255-02 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent official views of CDC.