Developing Competencies for Applied Epidemiology APHA Conference, Dec 12, 2005

1. Developing Competencies for Applied EpidemiologyAPHA Conference, Dec 12, 2005 Centers for Disease Control and Prevention Council of State and Territorial Epidemiologists

2. Developing Competencies for Applied Epidemiology Denise Koo, MD, MPH Director, Career Development Division Office of Workforce and Career Development Centers for Disease Control and Prevention Kathleen R. Miner, PhD, MPH, CHES Associate Professor and Associate Dean for Applied Public Health Rollins School of Public Health, Emory University Guthrie Birkhead, MD, MPH Director, Center for Community Health New York State Dept of Health & Council of State and Territorial Epidemiologists

3. Outline • Background • Goals and Rationale • Definition of Competency • Description of Process • Current Status of Competencies for Epidemiologists • Next Steps • Discussion

4. 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 • Only national effort focused on academic epidemiology

5. Workforce Shortages Source: State Public Health Employee Worker Shortage Report: A Civil Service Recruitment and Retention Crisis

6. Epidemiologic Workforce Development • Context: organizational epidemiologic capacity • Define, measure, monitor key functions • Definition of a public health epidemiologist • Activities and duties of a PH epidemiologist • Epi and non-epi competencies for epidemiologists • Identification of gaps • Numbers, types, levels • Skill areas • Strategic plan to recruit, (re)train, retain

7. “If you don’t know where you’re going, any road will get you there.” --Lewis Carroll

8. Need • Definition of the epidemiology profession at various levels of practice: local, state, federal • National process to define competencies, including: • Definition of a public health epidemiologist • Competencies needed now and in future • Key (co-lead) partners: CSTE and CDC

9. Goals of Epi Competencies Process • Core competencies for epidemiologists practicing in governmental public health agencies • Local, state or federal • Legal mandate for public health activities • Epi and non-epi competencies for epidemiologists • Expected levels of proficiency

10. Rationale • Definition of needed skills for hiring • Method to measure, reward, promote workers • Roadmap for training existing workforce • Guidelines for academia • Improved ability to define the field • Utility for any certification process

11. Roles and Responsibilities Conveners: Matt Boulton, MD, MPH--MI Dept of Health and CSTE Denise Koo, MD, MPH—Centers for Disease Control and Prevention Co-Chairs: Gus Birkhead, MD, MPH--NY State Dept of Health and CSTE Kathy Miner, PhD, MPH, CHES--Emory University Consultant and Editor: Jac Davies, MPH--formerly with WA State Department of Health

12. Expert Panelists • Kaye Bender, RN, PhD-U MS School of Nursing • Roger Bernier, PhD, MPH--CDC National Immunization Program • Mike Crutcher, MD, MPH—OK State Dept Health and ASTHO • Hal Morgenstern, PhD—U MI SPH • Miriam Link-Mullison, MS, RD—Jackson County HD, IL and NACCHO • Greg Steele, DrPH, MPH—IN University School of Medicine • Lou Turner, DrPH—NC State Laboratory of PH • Mark White, MD—CDC Office of Global Health • Lloyd Novick, MD, MPH—Onondaga County Dept of Health and NACCHO • Sara Huston, PhD—NC DHHS • Bill Sappenfield, MD—CDC Division of Reproductive Health • Len Paulozzi, MD—CDC Injury Center • Richard Hopkins, MD, MPH—FL Dept of Health • Eddie Bresnitz, MD, MS—NJ State Dept Health • Barbara DeBuono, MD, MPH—Pfizer • Richard Dicker, MD, MSc—CDC

13. Review Panelists • Kris Moore, MD, MPH--U MN • Art Reingold, MD—U CA, Berkeley SPH • Jim Gale, MD, MS—U WA SPH • Maureen Lichtveld, MD, MPH—Tulane SPH • Kristine Gebbie, RN, DrPH—Columbia

14. 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

15. “For sale by owner—Encyclopedia Britannica, excellent condition. No longer needed, husband knows everything.” U of Texas at Austin, Dept of Advertising

16. From Competencies to Competents Identifying Competencies for Applied Epidemiology Professionals

17. “Competence, like beauty and contact lenses, is in the eye of the beholder.” L. Peters

18. Characteristics of Professionals Professionals are: • defined by specific identity and scope of responsibilities (competencies); • problem solvers; • non-routine decision makers; • have a core body of knowledge; • held to ethical practice; and, • life long learners in their field.

19. “Hermits have no peer pressure.” Steven Wright

20. Instructional/ Individual Competencies They: • Assess an individual’s ability to do specific tasks. • Structure professional preparation. • Determine the measurement indicators. • Assume measurement in the short term. • Require higher levels of performance to be built upon lower level ones.

21. The Anatomy of an Instructional/ Individual Competency Statement Single Verb + Specific Content Instructional Design Assessments Indicators

22. Bloom’s Taxonomy complexity EVALUATION SYNTHESIS ANALYSIS APPLICATION COMPREHENSION KNOWLEDGE

23. Levels of Practice Tier 1 Tier 2 Tier 3 Competency Framework • Skill Domain Area: • 1. Competency A • Sub-competency • Sub-sub competency/learning objective • Sub-competency • Sub-competency • 2. Competency B • Sub-competency • Sub-competency • Sub-competency

24. Competency Framework • Skill Domain: Communication • 1. Competency: Prepare written and oral reports and presentations that communicate epidemiologic findings to professional audiences, policy makers, and the general public. • Sub-competency: Identify audience, methods and content for communication of epidemiologic findings • Identify target audience for communication • Sub-competency: Communicate epidemiologic findings to professional audiences through written reports and oral presentations.

25. Competency Framework • Skill Domain: Leadership and Systems Thinking • 1. Competency: Promote shared vision to drive action. • Sub-competency: Assist in strategic planning. • describe process for organizational strategic planning. • identify internal and external issues that may impact delivery of essential public health services

26. Competency Framework • Skill Domain: Cultural Competency • 1. Competency: Describe population by race, ethnicity, culture, socioeconomics, education, professional background, age, religion, and sexual orientation • 2. Competency: Establish relationships with groups of special concern. • i. Sub-competency: Study the historical context of populations’ history and past treatment by the public health system.

27. “There is no educational value in the second kick from a mule.” • Anon

28. Competency Truths • Competencies are dynamic. • Competencies foster professional identity. • Application crosses more than one generation of leadership.

29. "It's not true that life is one damn thing after another. It's the same damn thing over and over."                          Edna St. Vincent Millay

30. Competency Development Process • Examination of existing competency sets • Epidemiology • Public Health • Mapping of existing competencies to Core Competencies for Public Health Professionals (from Council on Linkages) • Revision of existing and creation of new competencies to address unique elements of epidemiologic practice

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

32. Revision Process • Two in-person meetings, multiple conference calls • Utilized web-based survey to assess expert panel’s views on competencies and to collect specific input • Focused on crafting language that reflects unique aspects of epi practice • Recognized that COL competencies apply to all public health professionals, including epis • Recognized that competencies will differ depending on level of experience and job expectations

33. Intended Users • Tier 1: frontline epidemiologist • New MPH/MS grad, <2 years experience • BA with at least 2 years’ experience • Tier 2: Mid-level (“journey”) epidemiologist • Master’s with 2-5 years experience; doctorate in epi; other professional degree with epi training (e.g., EIS) • May supervise epi team or unit • Tier 3: Senior epidemiologist (2 tracks) • a: supervisors/managers • b: doctoral-level senior epi scientists

34. Timeline • Before October 04 • Compile and review existing competency sets • Prepare “discussion draft” • Oct 04 – 1st in-person meeting of panel • Developed FIRST DRAFT of competencies focusing on Tier 2 competencies • Dec 04 – SECOND DRAFT distributed • Feb 05 – Comments on draft via web tool; THIRD DRAFT developed from comments • Mar 05 – 2nd in-person meeting

35. Timeline • March-May 05 – Further revisions captured in 4th draft • May 05 -- Prepared 5th draft for presentation at CSTE annual meeting in New Mexico • June 05 – Posted draft on web for widespread review and comment • June-October 05 -- Developed Tier 1 and 3 competencies • July 05 – ASTHO/NACCHO joint annual meeting in Boston (informal discussions) • November 05-January 06 -- additional validation • December 05 – APHA

36. Partner Organizations Solicited for Comment • American College of Epidemiology • Association of Schools of Public Health • Association of Maternal and Child Health Programs • Association of State/Territorial Directors of Nursing • Association of American Medical Colleges • Association of Teachers of Preventive Medicine • Association of State and Territorial Health Officers • American Public Health Association • APHA Epidemiology Section • Chronic Disease Directors • CDC Office of Workforce and Career Development • CDC Associate Director for Science • National Association of Health Data Organizations • National Environmental Health Association • National Association of Local Boards of Health • National Association of County and City Health Officials • Public Health Foundation • Society for Epidemiologic Research • State and Territorial Injury Prevention Directors Association

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

38. Example: Analytic/AssessmentSub-Competencies • Conduct surveillance • Determine whether to conduct surveillance for a particular PH problem • Identify surveillance data needs • Implement new or revise existing surveillance system • Interpret key findings • Conduct evaluation of surveillance systems

39. Example: Analytic/Assessment Sub-Sub-Competencies • Identify surveillance data needs • Create case definition • Describe sources, quality and limitations of surveillance data • Identify mechanisms to transfer data from source to public health agency • Define timeliness required for data collection • Define necessary frequency of reporting • Describe potential uses of data to inform surveillance system design

40. Skill Domain 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

41. Skill Domain 3: CommunicationTier 2 Competencies • Prepare written and oral reports and presentations that communicate epidemiologic findings 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 • Employ available and suitable communication technologies

42. Skill Domain 4: Community Dimensions of PracticeTier 2 Competencies • Provide epidemiologic input into epidemiologic studies and community public health planning processes at the state or local level • Participate in development of community partnerships to support epidemiologic investigations • Engage the public in the public health work and decision making of the Health Department when needed using mechanisms suitable to the circumstances

43. Skill Domain 5: Cultural CompetencyTier 2 Competencies • Describe population • Establish relationships with groups of special concern • Design surveillance systems to include under-represented groups • Conduct investigations using languages and approaches tailored to population • Use standard population categories or subcategories when performing data analysis

44. Skill Domain 5: Cultural CompetencyTier 2 Competencies • Utilize knowledge of specific socio-cultural factors in the population to interpret findings • Recommend public health actions that would be meaningful to the affected community • Communicate findings using mechanisms tailored to that community

45. Skill Domain 6: Financial and Operational Planning and ManagementTier 2 Competencies • Conduct epidemiologic activity in a manner that is aligned with financial and operational plan of the agency • Use skills that foster collaborations, strong partnerships, and team building to accomplish epidemiology program objectives • Clarify roles and responsibilities of all participants in epidemiologic activities

46. Skill Domain 7: Leadership and Systems ThinkingTier 2 Competencies • Promote shared vision to drive action • Conduct performance driven work • Promote ethical conduct • Promote workforce development • Prepare for emergency response

47. Skill Domain 8: Policy DevelopmentTier 2 Competencies • Participate in development of public health policies • Participate as a team member in evaluating policies affecting epidemiology programs

48. Differentiating Between Tiers Example: Surveillance • Tier 1 (frontline epidemiologist): • Support evaluation of surveillance systems • Tier 2 (mid-level epidemiologist/team leader): • Conduct evaluation of surveillance systems • Tier 3 (senior level): • Supervisor/Manager -- Assure evaluation of surveillance systems • Senior Scientist (PhD) -- Design and conduct evaluation of surveillance systems

49. Differentiating Between TiersExample: Basic Public Health Sciences • Tier 1 (frontline epidemiologist): • Recognize the role of laboratory resources in epidemiologic activities • Tier 2 (mid-level epidemiologist/team leader): • Use laboratory resources to support epidemiologic activities • Tier 3 (senior level): • Supervisor/Manager -- Assure the use of laboratory resources to support epidemiologic activities • Senior Scientist (PhD) -- Develop processes for using laboratory resources to support epidemiologic activities

50. Differentiating Between Tiers Example: Financial and Operations • Tier 1 (frontline epidemiologist): • N/A • Tier 2 (mid-level epidemiologist/team leader): • Assist in preparation of proposals for extramural funding • Tier 3 (senior level): • Supervisor/Manager -- Develop Requests for Proposals for extramural funding to support additional epidemiologic activities and special projects within and outside agency • Senior Scientist (PhD) -- Prepare proposals for extramural funding, for review and input from managers