Competencies for Applied Epidemiologists in Governmental Public Health Agencies

1. Competencies for Applied Epidemiologists in Governmental Public Health Agencies Centers for Disease Control and Prevention Council of State and Territorial Epidemiologists

2. OrApplied Epidemiology Competencies (AECs) for short!

3. Overview • Background • Goals and Rationale • Methods • Organization of the Competencies • Validation of the Competencies • Applied Epidemiology Competencies • Uses and Dissemination

4. Background

5. Definition of Epidemiology • Epidemiology is “the study of the distribution and determinants of health-related states and events in specific populations, and the application of this study to control of health problems.”* • Epidemiology is one of the core sciences of public health *Last JM. A Dictionary of Epidemiology. 4th edition. New York: Oxford University Press, 2001:62.

6. Definition of Epidemiologist • A person who investigates the occurrence of disease, injury or other health-related conditions or events in populations to describe the distribution of disease or risk factors for disease occurrence for the purpose of population-based prevention and control. — CSTE Workforce Summit, January 2004

7. Definition of Competency • A competency is an action-oriented statement that delineates essential knowledge, skills, and abilities in the performance of work responsibilities. • A competencies is describable and observable. — Center for Public Health Practice, Rollins School of Public Health, 2002

8. Problem • Insufficient number of public health epidemiologists • “Epidemiologists” without adequate training • Lack of clear career ladders for epidemiologists • Independent, uncoordinated efforts to define the field • National efforts focused only on academic epidemiology

9. Goals and Rationale

10. Goals and Objectives of the AECs • Goal to improve the practice of epidemiology in public health agencies. • Objectives to create a comprehensive list of competencies that: • Define the discipline of applied epidemiology; and • Describe what knowledge, skills, and abilities four levels of practicing epidemiologists working in government public health agencies should have to accomplish required tasks.

11. Rationale for Competency Development • Standardization of skill levels for hiring • Method to evaluate, reward, and promote workers • Road map for training existing workforce • Guidelines for academia • Improved ability to define the field • Utility for future certification processes

12. Methods

13. Competency Development Method • Reviewed existing competencies/framework • Expert Panel—cross-cutting representation • Subgroups: • Leadership group • Review panel • Consultant/editor • Assessment and validation • Summer 2005—Tier 2 Competencies • Early 2006—Tier 1, 2, 3a and 3b Competencies • Quantitative and qualitative comments

14. Four Tiers of Practice • Tier 1—entry level or basic • Tier 2—mid-level • Tier 3a—supervisory • Tier 3b—senior scientist

15. Differentiating Between TiersExample: Surveillance Evaluation • Tier 1(entry-level or basic epidemiologist): • Support evaluation of surveillance systems • Tier 2(mid-level epidemiologist/team leader): • Conduct evaluation of surveillance systems • Tier 3(senior-level epidemiologist): • a. Supervisor/Manager—Ensure evaluation of surveillance systems • b. Senior Scientist (PhD)—Design and conduct evaluation of surveillance systems

16. Organization of the Competencies

17. Competency Framework for Public Health Professionals • Assessment and Analysis • Basic Public Health Sciences • Communication • Community Dimensions of Practice • Cultural Competency • Financial and Operational Planning and Management • Leadership and Systems Thinking • Policy Development/Program Planning Source: Council on Linkages between Academia and Public Health Practice

18. Competency Construct I. Skill Domain Area 1. Competency A • Subcompetency • Sub-subcompetency/learning objective • Sub-subcompetency/learning objective • Subcompetency • Subcompetency • Competency B • Subcompetency • Subcompetency

19. Skill Domain 1: Assessment and Analysis Tier 2 Competencies • Identify public health problems • Conduct surveillance • Investigate acute and chronic conditions • Apply good ethical/legal principles to study design and data collection, dissemination, and use • Manage data • Analyze data • Summarize results, and draw conclusions • Recommend evidence-based interventions and control measures • Evaluate programs

20. Skill Domain1:Assessmentand Analysis Tier 2 Competencies • Identify public health problems • Conduct surveillance • Investigate acute and chronic conditions • Apply good ethical/legal principles to study design and data collection, dissemination, and use • Manage data • Analyze data • Summarize results and draw conclusions • Recommend evidence-based interventions and control measures • Evaluate programs

21. Example: Assessment and Analysis Tier 2 Subcompetencies • Conduct surveillance • Design surveillance for particular public health problem • Identify surveillance data needs • Implement new or revise existing surveillance system • Identify key findings • Conduct evaluation of surveillance systems

22. Example: Assessment and AnalysisTier 2 Subcompetencies • Conduct surveillance • Design surveillance for particular public health problem • Identify surveillance data needs • Implement new or revise existing surveillance system • Identify key findings • Conduct evaluation of surveillance systems

23. Example: Assessment and AnalysisTier 2 Sub-subcompetencies • Identify surveillance data needs • Create case definition • Describe sources, quality and limitations of surveillance data • Define data elements to be collected or reported • Identify mechanisms to transfer data from source to public health agency • Define timeliness required for data collection • Determine frequency of reporting • Describe potential uses of data to inform surveillance system design • Define functional requirements of supporting information system

24. Validation of the Competencies

25. Validation Process • 2005: Web survey for Tier 2 only • 76%–98% of respondents supported competencies • 2006: Web survey of complete competency set, Tiers 1–3 • Three states targeted for >75% participation • 80% of respondents self-identified as Tier 1 and 2 • 75% worked in state or local agencies • Review panel reviewed comments and recommended appropriate changes

26. Limitations to Validation Process • Surveys not systematic • Respondents self-reported tier level and other identifying data, thus room for bias • Questions asked about only the major competencies in each skill domain • No subcompetency or sub-subcompetencies evaluated in survey

27. Does Everyone Have to Be Competent in ALL Competencies? Yes and No (it depends) an epidemiologist’s favorite answer!

28. Does Everyone Have to Be Competent in ALL Competencies? • Mastery of the competencies develops over a continuum of applied epidemiology practice, not a single point in an individual’s career • Infectious disease, chronic disease, maternal and child health, and environmental epidemiology may emphasize different competency areas

29. Applied Epidemiology Competencies …It’s about time!

30. Competency Skill Domains • Assessment and Analysis • Basic Public Health Sciences • Communication • Community Dimensions of Practice • Cultural Competency • Financial and Operational Planning and Management • Leadership and Systems Thinking • Policy Development

31. 1: Assessment and AnalysisTier 2 Competencies • Identify public health problems • Conduct surveillance • Investigate acute and chronic conditions • Apply good ethical/legal principles to study design and data collection, dissemination, and use • Manage data • Analyze data • Summarize results, and draw conclusions • Recommend evidence-based interventions and control measures • Evaluate programs

32. 2: Basic Public Health SciencesTier 2 Competencies • Use knowledge of causes of disease to guide epidemiologic practice • Use laboratory resources to support epidemiologic activities • Apply principles of informatics, including data collection, processing, and analysis, in support of epidemiologic investigations

33. 3: CommunicationTier 2 Competencies • Prepare written and oral reports and presentations that communicate necessary information to professional audiences, policy makers, and the general public • Demonstrate the basic principles of risk communication • Incorporate interpersonal skills in communication with agency personnel, colleagues, and the public • Use effective communication technologies

34. 4: Community Dimensions of PracticeTier 2 Competencies • Provide epidemiologic input into epidemiologic studies, public health programs, and community public health planning processes at the state, local, or tribal level • Participate in development of community partnerships to support epidemiologic investigations

35. 5: Cultural CompetencyTier 2 Competencies • Describe population by various parameters • Establish relationships with groups of special concern • Design surveillance systems to include underrepresented groups • Conduct investigations using languages and approaches tailored to population • Use standard population categories or subcategories when performing data analysis • Use knowledge of specific sociocultural factors in the population to interpret findings • Recommend public health actions that would be relevant to the affected community

36. 6: Financial and Operational Planning and Management Tier 2 Competencies • Conduct epidemiologic activities within the financial and operational plan of the agency • Assist in developing fiscally sound budget • Implement operational and financial plans • Assist in preparing proposals for extramural funding • Use management skills • Use skills that foster collaborations, strong partnerships, and team building to accomplish epidemiology program objectives

37. 7: Leadership and Systems ThinkingTier 2 Competencies • Support epidemiologic perspective in agency strategic planning process • Promote organization’s vision • Use performance measures to evaluate and improve program • Promote ethical conduct • Promote workforce development • Prepare for emergency response

38. 8: Policy Development Tier 2 Competencies • Bring epidemiologic perspective in development and analysis of public health policies

39. Uses and Dissemination

40. Intended Uses of the Competencies • Practitioners • Assess current skills • Create career development plans • Plan specific training and educational activities

41. Intended Uses of the Competencies • Employers • Create career ladders for employees • Develop position descriptions and job qualifications • Develop training plans for employees • Assess epidemiologic capacity of an organization • Educators • Design education programs that meet needs of public health agencies • Incorporate critical elements of epidemiologic practice into existing coursework

42. Dissemination • Oral presentations at meetings • Downloadable documents: • CSTE website: www.cste.org/competencies.asp • CDC website: www.cdc.gov/od/owcd/cdd/aec/ • Quick reference fact sheets • One-page executive summary and complete preface document • Fact sheets for each tier

43. Dissemination • Online competency toolkit for users • PowerPoint presentations • Interactive quiz • Engage users in the field of epidemiology • Introduce users to the AECs • Epidemiology position descriptions • Training resource guide • AEC brochure • Evaluation checklists

44. Dissemination • Special Issue of Public Health Reports: Competency-Based Epidemiologic Training in Public Health Practice • March/April 2008 • Commentaries on the need for competencies and their uses • Development of the AECs • Competency-based applied epidemiology training • Innovative partnerships between academia and practice • Evaluation of epidemiology training programs

45. Dissemination • Public Health Literature Editorial: Professional Competencies for Applied Epidemiologists: A Roadmap to a More Effective Epidemiologic Workforce by Guthrie S. Birkhead, MD and Denise Koo, MD, MPH Journal of Public Health Management & PracticeNovember/December 2006  Volume 12 Number 6 Pages 501 - 504

46. Online Resources: • www.cdc.gov/od/owcd/cdd/aec/ • www.cste.org/competencies.asp • Complete competency documents • One page competency summaries by tier • Competency toolkit • Competency self-assessment • Summary of training resources • Competency PowerPoint slide sets • Sample position descriptions • Publications related to competencies • Contents of the toolkit also available from CSTE: 770-458-3811

47. The Driving Force of the AECs:Leadership Group Conveners: Denise Koo, MD, MPH—Centers for Disease Control and Prevention Matt Boulton, MD, MPH—University of Michigan School of Public Health and CSTE Co-Chairs: Gus Birkhead, MD, MPH—New York State Department of Health and CSTE Kathy Miner, PhD, MPH, CHES—Rollins School of Public Health, Emory University Consultant and Editor: Jac Davies, MPH—CSTE Consultant and Editor, formerly with Washington State Department of Health

48. The Driving Force of the AECs:Expert Panelists • Kaye Bender, RN, PhD, FAAN—University of Mississippi Medical Center School of Nursing • Roger H. Bernier, PhD, MPH—Centers for Disease Control and Prevention • Mike Crutcher, MD, MPH—Oklahoma State Dept Health • Richard Dicker, MD, MSc—Centers for Disease Control and Prevention • Gail Hansen, DVM, MPH—Kansas Department of Health and Environment • Richard Hopkins, MD, MSPH—Centers for Disease Control and Prevention • Sara Huston, PhD—North Carolina Division of Public Health • Miriam Link-Mullison, MS, RD—Jackson County Health Department • Hal Morgenstern, PhD—University of Michigan School of Public Health • Lloyd Novick, MD, MPH—Onondaga County (New York) Department of Health • Len Paulozzi, MD, MPH—Centers for Disease Control and Prevention • William M. Sappenfield, MD, MPH—Centers for Disease Control and Prevention • Greg Steele, DrPH, MPH—Indiana University School of Medicine • Lou Turner, DrPH, MPH—North Carolina State Laboratory of Public Health • Mark E. White, MD—Centers for Disease Control and Prevention

49. The Driving Force of the AECs:Review and Other Panelists • Review Panelists: • James Gale, MD, MS—University of Washington • Kristine Gebbie, DrPH, RN,—Columbia School of Nursing • Maureen Lichtveld, MD, MPH—Centers for Disease Control and Prevention • Kristine Moore, MD, MPH—University of Minnesota • Art Reingold, MD—University of California at Berkeley • CSTE National Office Staff: • Pat McConnon, MPH, Executive Director • LaKesha Robinson, MPH • Jennifer Lemmings, MPH

50. Partner Organizations • American Public Health Association (APHA) • Association of Schools of Public Health (ASPH) • Association of State and Territorial Health Officials (ASTHO) • National Association of County and City Health Officials (NACCHO)