509275

HPPXXX10.1177/1524839913509275H ealth Promotion PracticeMatson et al. / Public Health Leadership Certificate 2013

The Public Health Leadership Certificate: A Public Health and Primary Care Interprofessional Training Opportunity Christine C. Matson, MD1 Jeffrey L. Lake, MS2 R. Dana Bradshaw, MD, MPH1 David O. Matson, MD, PhD1 This article describes a public health leadership certificate curriculum developed by the Commonwealth Public Health Training Center for employees in public health and medical trainees in primary care to share didactic and experiential learning. As part of the program, trainees are involved in improving the health of their communities and thus gain a blended perspective on the effectiveness of interprofessional teams in improving population health. The certificate curriculum includes eight one-credit-hour didactic courses offered through an MPH program and a two-credithour, community-based participatory research project conducted by teams of trainees under the mentorship of health district directors. Fiscal sustainability is achieved by sharing didactic courses with MPH degree students, thereby enabling trainees to take advantage of a reduced, continuing education tuition rate. Public health employee and primary care trainees jointly learn knowledge and skills required for community health improvement in interprofessional teams and gain an integrated perspective through opportunities to question assumptions and broaden disciplinary approaches. At the same time, the required community projects have benefited public health in Virginia.

Introduction >> Passage of the Patient Protection and Affordable Care Act (March 23, 2010) and the Health Care and Education Reconciliation Act (March 30, 2010) created breakthrough opportunities for interprofessional models in health profession education, and were quickly followed by federal requests for proposals to “plan, develop, and operate joint degree programs to provide interdisciplinary and interprofessional graduate training in public health and other health professions (HRSA-10-236; HRSA, 2010a). Broadened training for public health and primary care professionals has been encouraged by expanding training in the “public health model” to include aspects of the “medical model” and vice versa. Examples range from the basic principles in

1

Eastern Virginia Medical School, Norfolk, VA, USA Department of Health, Richmond, VA, USA

2

Keywords: career development/professional preparation; community intervention; continuing education; training; community-based participatory research; health research; partnerships / coalitions; workforce development

Authors’ Note: The Commonwealth Public Health Training Center activities described in the article were supported by a grant (UB6HP20184) from the Health Resources and Services Administration (HRSA). Drs. David and Christine Matson and Dr. Bradshaw were all directly involved with the grant. Jeffrey L. Lake was one of the grant collaborators. Address correspondence to David O. Matson, Eastern Virginia Medical School, 700 West Olney Road, Norfolk, VA 23501, USA; e-mail: matsondo@evms. edu.

Health Promotion Practice March 2014 Vol. 15, Suppl 1 64­S–70S DOI: 10.1177/1524839913509275 © 2014 Society for Public Health Education

Supplement Note: This article is published in the supplement “Public Health Training Centers,” which was supported by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) through a Cooperative Agreement (UBGHP20199) to Rollins School of Public Health, Emory University.

64S

the constitution of the World Health Organization (1946), to the Report on the General Professional Education of the Physician (American Association of Medical Colleges, 1982), the American Association of Medical Colleges’ “Learning Objectives for Medical Student Education” (Bordage et al., 1998), and the Institute of Medicine’s Who Will Keep the Public Healthy? (Gebbie, Rosenstock, & Hernandez, 2003; see also Gebbie, Potter, Quill, & Tilson, 2008). Calls for the convergence of public health and medical training continue (Clayton et al., 2012). The 2010 health care laws underpinned HRSA’s most recent Strategic Plan (HRSA, 2012), whose objectives include “[integrating] primary care and public health” (under Goal 1) and “[supporting] the development of interdisciplinary health teams” (under Goal 2). This climate seemed ideal for the submission, in 2010, of a Public Health Training Center (PHTC; HRSA 10-270; HRSA, 2010b) application that included among its proposed activities a leadership certificate to be offered both to public health workforce employees and primary care medical resident trainees. To qualify for the certificate, eligible candidates would undergo a course of didactic and experiential learning in teams comprised of public health professionals and primary care medical residents, giving them the opportunity to form new, blended perspectives on community health assessment and improvement. Partners in the Commonwealth PHTC included the Virginia Department of Health; all of the state’s family medicine residency training programs and all but one of its MPH Programs; Norfolk State University, a historically Black university; and the Virginia Public Health Association. Here, we report results through completion of the first cohort of trainees in this certificate curriculum.

Leadership Certificate >>

Curriculum Development

Development of the Public Health Leadership Certificate (PHLC) was prompted by three areas of identified need in Virginia’s public health workforce. First, a survey of regional health department employees revealed a perceived need for additional training in “leadership” (see Table 1). Most of the skills included in the survey are commonly taught in MPH degree curricula, with the exception of leadership. Second, the Virginia Department of Health human resources database revealed that only 13% of health department employees had received any formal preemployment training in public health principles. Third, even though physicians comprise only 3% of the Virginia Department of Health workforce, they



Table 1 Response to the Question, “In your current job, to what extent would you benefit from additional training in each of the following skills?”a

Skill

Great Benefit (%)

  1. Computer software skills (Word, PowerPoint, Excel, etc.)  2. Leadership skills   3. Developing private/public speaking skills  4. Foreign language  5. Oral communication/public speaking skills   6. Database design skills (SAS, SPSS, Excel)   7.  Disease outbreak investigation   8. Written communication, for example, analytic writing and report generation   9. Legal considerations in public health 10. Communicable disease follow-up 11.  Grant writing 12. Electronic communication, including Internet and INPHO 13. Quality Improvement and assurance strategies 14. Data analysis and utilization, including statistics 15. Survey design and implementation

49 35 35 35 35 32 28 28

27 23 22 22 19 17 12

a. Data obtained as part of an unpublished workforce survey administered in 2006, to Virginia Department of Health employees, Eastern Region, n = 390 (51% response rate), by the Eastern Virginia Medical School/Old Dominion University Graduate Program in Public Health. DO Matson was Director of the Program at the time of the survey.

fulfill mission-critical roles. For example, health district director positions are open only to individuals holding a MD degree, and a scarcity of qualified applicants has meant that, for the past 20 years, about a third of the state’s health districts have had to share a director with another district. The leadership certificate program was informed by three important factors: (1) environmental drivers for public health and primary care integration, (2) state workforce needs, and (3) the evidence-base supporting the benefits of adult learning theory, including inter-

Matson et al. / PUBLIC HEALTH LEADERSHIP CERTIFICATE

65S

Table 2 Public Health Leadership Certificate Courses and Sequence Year 1

2

Term

Courses

Leadership Theories, Skills, and Application Developing Effective Community-Based Programs Spring Community Assessment Community Practicum I Summer Strategic Action Planning Monitoring and Evaluating Public Health Programs Health Disparities Fall Social Marketing Health Policy and Economics Spring Coalitions and Partnerships Community Practicum II Introduction to Global Health

Required

Fall

Yes

All courses are offered in the classroom in the evening and via synchronous and/or asynchronous distance instruction, as determined by the course director and the location of certificate students. Every course addresses health equity, as it relates to the course topic. In addition, two selective courses focusing on aspects of health equity have been commissioned by contract for the leadership certificate and will be offered through subcontract with a leading historically black university in Virginia.

Yes

Selection of Certificate Trainees Yes Yes Yes Yes Selectivea Yes Selectivea Yes Yes Selectivea

a. Sample selective courses available to leadership certificate trainees during their five academic terms.

Twenty leadership trainees can be accommodated each year. Ten of these trainees are nominated by the Virginia Department of Health administrative partner in consultation with health district directors, and ten are nominated by directors of the primary care residency programs. Criteria include expressed interest in the program, as assessed through a personal statement, and potential for leadership in public health and/or primary care. Nominees are reviewed and selected by the PHLC program’s admissions committee. In the interest of equity, the program gives stipends from PHTC funds to accepted trainees, to cover the costs associated with being in the program; thus, inclusion does not depend on a trainee’s ability to pay tuition or required travel costs. Special Role of the Community Practicum in the Leadership Certificate Curriculum

professional learning, and its close relationship with leadership theory (Argyris & Schön, 1974; Merriam & Caffarella, 1998; Mezirow & Associates, 2000). The PHLC curriculum (see Table 2) incorporates topics identified by workforce survey respondents. Topics not already addressed in courses offered by the Eastern Virginia Medical School/Old Dominion University (EVMS/ODU) collaborative MPH Program—the host program of the leadership certificate—were incorporated into new selective courses. In addition, leadership curriculum courses were benchmarked against similar courses taught at public health teaching institutions elsewhere. The 10 required credit hours are sequenced for completion over five academic terms and include eight, didactic one-credit-hour courses (one of which may be selected by the trainee from three optional courses) and a two-credit-hour sequence, Community Practicum Parts I and II. Most of the certificate courses are taken alongside MPH degree students, thereby reducing overall instructional costs; trainees pay tuition at a substantially reduced continuing education rate, enabling many more individuals to take advantage of the certificate program. 66S HEALTH PROMOTION PRACTICE / March 2014

The community practicum—called a community health improvement research project or CHIRP—is taught and performed using the community-based participatory research process (Ahmed, Beck, Maurana, & Newton, 2004) and provides a curriculum-based link between research and practice. As part of the practicum, primary care trainees, usually for the first time, work in a public health setting, alongside public health trainees. The CHIRP provides an opportunity for trainees to apply concepts and skills learned “in the classroom” in a just-in-time fashion. During Community Practicum I, didactic instruction covers topics such as how to formulate a study question in public health that is both answerable and practicable, proposal preparation, what study design best addresses the study question, unique features of conducting projects in a public health setting, and how to plan a project from idea to results reporting. Even for these “didactic” courses, instructors are encouraged to employ active learning techniques (Prober & Heath, 2012) rather than traditional pedagogy, as befits these adult learners. To complete the CHIRP, trainees are assigned to teams, usually composed of three to four members,

based on their suggested, potential CHIRP topics and their expressed interest in projects suggested by Virginia’s regional health district directors. Each team is provided access to two mentors—a health district director and a practicum advisor from an MPH degree teaching faculty—as well as faculty members who serve as academic advisors and contribute their subject matter expertise and research skills to the project. CHIRP projects give health district directors the opportunity to engage academicians and community members in mitigating local public health problems, such as adolescent smoking. All projects must have a health equity component and must affect the needs of priority populations. Proposed project ideas are reviewed by the team’s heath district director and the state deputy commissioner of health—assuring that CHIRPs synchronize with state health department initiatives, funding sources, and expertise—and by academic advisors. A CHIRP manual, adapted from a community practicum manual first developed for EVMS/ODU MPH degree students in 1997, describes the conduct of the CHIRP. All projects are approved by the institutional review board of the Virginia Department of Health and appropriate local institutional review boards. Project ideas are presented at trainee annual meetings (discussed below) and final team reports are written in formats suitable for publication in peer-reviewed journals or for technical reports for the state’s public health community. Community Practicum projects receive financial support from the PHTC budget, including support for any necessary team travel. The multiyear goal of the community practicum is to develop and implement an integrated public health research agenda for collaborating MPH degree-offering institutions, the Virginia Department of Health, and Virginia’s historically Black colleges and universities. The Commonwealth PHTC aims to acquire sufficient, promising data in its current funding cycle to justify additional external grant support, at the end of the 5-year funding cycle, for the network itself and/or for specific issues under study. Interactions of Certificate Trainees in Different Cohorts Leadership certificate trainees are required to attend orientation sessions held in conjunction with the Virginia Public Health Association’s annual spring meeting, which combines the association’s annual business meeting with presentations on public health “hot topics.” During the leadership trainee sessions in the first year of attendance, project ideas are presented; team members meet face to face with each



other, the health district director preceptor and practicum advisors; and project timelines and roles are established. At the next spring Virginia Public Health Association meeting, teams present the results of their projects (addressing another highly ranked need, presentation skills; see Table 1) to their entire cohort of teams, as well as to incoming, first-year community practicum trainees. Trainees also must attend the fall meeting of the Virginia Public Health Association, which is highly scientific in nature. The Virginia Public Health Association meetings, didactic certificate courses and community practicum assure substantial interaction between primary care residents and the public health community, thereby addressing one of the certificate program’s primary purposes: attracting primary care residents to the public health model or practice. Other interactions among team members include conference calls, social media connections and other routine communications. Practicum Results of Leadership Certificate Cohort 1 Cohort 1 trainees presented their CHIRP findings at the spring 2012 meeting of the Virginia Public Health Association. By the end of June, 2012, the primary care residents presented their CHIRP results to their “home” primary care residency, thereby introducing the PHLC Program—and public health-primary care community engagement—to all primary care residents in these residency programs. The titles of the eight CHIRPs conducted by Cohort I of the PHLC Program are as follows: 1. Availability of Fresh Fruits and Vegetables in Convenience Stores Located in U.S. Department of Agriculture–Defined Food Deserts. 2. Tobacco Cessation and Prevention in Youth at Tazewell High School Using a Peer-Directed Campaign. 3. A Study of Rocky Mountain Spotted Fever Diagnosis in Selected Health Districts in Virginia. 4. Parents’ Perception of Their Child’s Body Mass Index (also presented at the annual meeting of the North American Primary Care Research Group, December, 2012). 5. Central Virginia Sexually Transmitted Infection Recidivism Risk Factors. 6. A Descriptive Study of Teen Pregnancy Rates and Associated Modifying Factors in Virginia. 7. The Dental Home: Do Virginian Adults Have Access to Preventive Dental Care? A Comparison Study Between the Virginia Peninsula and Roanoke Valley [two widely separated regions of Virginia].

Matson et al. / PUBLIC HEALTH LEADERSHIP CERTIFICATE

67S

Figure 1  Correlation of Average Teen Pregnancy Rates (Y Axis) With Average Percentage of the Population Living in Poverty (PLIP, X Axis), by Locality in Virginia

8. Perceptions of Advance Directives in the Population Living in Long-Term Care Facilities.

Initial CHIRP findings have been noteworthy. Among other things, the teams documented a significant correlation between teen pregnancy rates in Virginia and the percentage of the local population living in poverty (see Figure 1), that youth in the area of Tazewell High School are 8 to 10 times more likely to smoke if friends or relatives also smoke, and that public health clients who self-identified as having an early sexual debut (specifically at age 11 or 12 years) were 3.4 times more likely than a comparison group at the same clinic to have a repeat sexually transmitted infection (STI) as an adult (95% confidence interval = 1.5-7.6). In addition, the latter CHIRP found that clients previously diagnosed with a STI were 9.2 times more likely to have a repeat STI (95% confidence interval = 1.3-68). One CHIRP was accepted and presented at an international conference; two were the basis for scientific manuscripts, and one led to the creation of a video, developed by local teens, to educate teenagers on the dangers of smoking. Trainees’ Assessment of the First Two Cohorts in the Leadership Certificate Curriculum As of November, 2012, three cohorts have enrolled in the Leadership Certificate Program. The first cohort has completed its CHIRPs, the second cohort is developing and executing its CHIRPs, and the third cohort is

68S HEALTH PROMOTION PRACTICE / March 2014

in its first academic term. At the end of Grant Year 2, 19% of the 42 PHLC Program trainees were male (n = 8) and 81% were female (n = 34). Their racial/ethnic distribution was 10% Asian, 20% Black or African American, and 70% White. Overall program evaluations have been conducted by a contracted, external assessor, who used the triangulation method of assessment, which employs a combination of different evaluation techniques. Learner-participants (primary group) were assessed via an online survey and face-to-face focus group, and the faculty, supervisors/preceptors, and project leaders were assessed via telephone interviews. Evaluation results (see Table 3) show overall alignment of participants’ perceptions of their certificate program experience with the Commonwealth PHTC’s program goals, especially Goal 1 (“Design and implement training programs focused upon community-based assessments, community-level interventions and collaborative research projects”), Goal 3 (“Design and implement training initiatives across the educational pipeline to build the future public health workforce”), and Goal 5 (“Work actively with the Virginia Department of Health to identify and respond to the public health training needs of the public health workforce in the Commonwealth”). The primary care residents had the most difficulty finding the additional time needed to participate in the leadership certificate program. Their time constraints, however, were largely beyond their control, because of federal work limits for medical residents (a strictly enforced 80-hour work week), as well as the lead-time required for a residency program director to adjust their work schedules. Our general observation—supported by greater enrollment of residents in Cohort 2—was that these difficulties were easing. Both public health and primary care trainees frequently commented that working with other professions showed them a “whole new world,” perhaps reflecting a mutual questioning of each other’s professional assumptions (Argyris & Schön, 1974) and a transformative learning experience (Mezirow & Associates, 2000).

Discussion >> We developed the PHLC program to fulfill several needs of the Virginia Department of Health, especially the need for leadership training for current public health professionals and the need to expose prospective physician employees to the public health model. The program provided some public health trainees their first opportunity to undertake formal instruction

Table 3 External Assessor’s Summary of Leadership Evaluation at the End of Program Year 2   1.  Overall, the respondents indicated that the Public Health Leadership Certificate Program was “very good.”   2.  Many indicated that they learned a significant amount of information . . . that is “useful,” and “solid.”   3. The professors’ expectations resulted in a workload that was often unrealistic for some of the respondents, especially given that most instructors were using distance-learning techniques for the first time.   4. Some instructors were not as accommodating as others to the full-time jobs and schedules held by the trainees, and the instructors’ familiarity with and effective use of distance learning technology varied to the point of slightly affecting the quality of the course experience.   5. The respondents indicated that the conferences provided great information, but trainees would have liked more time to ask questions and interact with conference facilitators.   6. In open-ended discussions, the sentiments appeared to be that logistical challenges such as the different academic levels of team members, lack of an exorbitant amount of time to commit to the CHIRP (community health improvement research project), lack of clarity at the beginning of the CHIRP, and the workload of the program participants affected participant satisfaction.   7. Fifty percent or more of the respondents indicated that the CHIRP helped them demonstrate various competencies either “very well” or “okay.”   8. Consistently, 62% to 76% indicated that “applicability,” “practicality,” and “multiculturalism” of coursework connected to their day-to-day work “well” or “very well.”   9. Fully 81% to 100% indicated that they were either “very confident” or “somewhat confident” in demonstrating many of the competencies proposed in the certificate program. 10. With regard to experiences in the program that contributed to their professional growth, over 60 comments fell into 6 common themes of increased competence, confidence, or experience: leadership, business course, advocacy and services, health disparities/equity, networking, and evaluation.

in the profession in which they practice and provided some primary care resident trainees their first significant exposure to public health principles. Meeting the requirements of the leadership certificate program was challenging for many of these fully employed adult learners; yet the opportunity to apply immediately lessons learned enhanced the transfer of knowledge from the classroom to “real life.” Several trainees reported that working in teams of individuals with significantly different levels of training and expertise was challenging. However, it is unclear whether the challenge made the experience more or less fruitful for learning new skills; at least, trainee satisfaction was variable. Resurveying the trainees’ later postgraduation may elucidate some of the longer term effects of the leadership certificate program. Planned next steps include incorporating more opportunity for reflective practice to enhance problem solving and more attention to the health care and public health policy-making process, as trainees reported little confidence in their ability to influence policy decisions. In addition, the CHIRPs suggest that greater primary assessment to inform rigorous research designs would enable Virginia to secure greater federal public health funding.



Overall, expectations of the benefits of interdisciplinary thinking and community engagement in meeting community needs have been affirmed. PHLC leaders have witnessed a robust collaboration among those involved in public health training and service in Virginia. References Ahmed, S. M., Beck, B., Maurana, C. A., & Newton, G. (2004). Overcoming barriers to effective community-based participatory research in US medical schools. Education for Health (Abingdon), 17, 141-151. American Association of Medical Colleges. (1982). Physicians for the twenty-first century: The GPEP Report: Report of the Panel on the General Professional Education of the Physician and College Preparation for Medicine. Washington, DC: Author. Argyris, C., & Schön, D. (1974). Theory in practice: Increasing professional effectiveness. San Francisco, CA: Jossey-Bass. Bordage, G., Davis, W. K., Fallon, H., Getto, C., Hallock, J. A., Johnston, M. A., & Woolliscroft, J. O. (1998). Learning objectives for medical student education: Guidelines for medical schools. Retrieved from https://members.aamc.org/eweb/upload/Learning ObjectivesforMedicalStudentEducReport.pdf Clayton, E., Alegria, M., Allan, S., Benjamin, G., Berkowitz, B., Challoner, D., & Wallace, P. (2012). Primary care and public health exploring integration to improve population health.

Matson et al. / PUBLIC HEALTH LEADERSHIP CERTIFICATE

69S

Retrieved from http://www.iom.edu/Reports/2012/Primary-Careand-Public-Health.aspx

Health Resources and Services Administration. (2012). Strategic plan. Retrieved from http://www.hrsa.gov/about/strategicplan.html

Gebbie, K. M., Potter, M. A., Quill, B., & Tilson, H. (2008). Education for the public health profession: A new look at the Roemer proposal. Public Health Reports, 123(Suppl. 2), 18-26. Gebbie, K. M., Rosenstock, L., & Hernandez, L. M. (Eds.). (2003). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: National Academies Press. Health Care and Education Reconciliation Act of 2010. 111th Congress, Public Law 152. U.S. Government Printing Office. Health Resources and Services Administration. (2010a). Interdisciplinary and inter-professional joint graduate degree (HRSA-10-236). Health Resources and Services Administration. (2010b). Public Health Training Centers Program (HRSA-10-270).

Merriam, S. B., & Caffarella, R. S. (1998). Learning in adulthood: A comprehensive guide. San Francisco, CA: Jossey-Bass.

70S HEALTH PROMOTION PRACTICE / March 2014

Mezirow, J., & Associates. (2000). Learning as transformation: Critical perspectives on a theory in progress. San Francisco, CA: Jossey-Bass. Patient Protection and Affordable Care Act of 2010. 111th Congress Public Law 148. U.S. Government Printing Office. Prober, C. G., & Heath, C. (2012). Lecture halls without lectures— a proposal for medical education. New England Journal of Medicine, 366, 1657-1659. World Health Organization. (1946). Constitution of the World Health Organization. Retrieved from http://apps.who.int/gb/bd/ PDF/bd47/EN/constitution-en.pdf

Copyright of Health Promotion Practice is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

The public health leadership certificate: a public health and primary care interprofessional training opportunity.

This article describes a public health leadership certificate curriculum developed by the Commonwealth Public Health Training Center for employees in ...
126KB Sizes 0 Downloads 3 Views