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Supporting Faculty and Administrators: Teaching tobacco in an integrated public health core course

Supporting Faculty and Administrators: Teaching tobacco in an integrated public health core course. Donna J. Petersen, MHS, ScD Connie Kohler, DrPH UAB School of Public Health April 2004. Public Health Education.

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Supporting Faculty and Administrators: Teaching tobacco in an integrated public health core course

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  1. Supporting Faculty and Administrators: Teaching tobacco in an integrated public health core course Donna J. Petersen, MHS, ScD Connie Kohler, DrPH UAB School of Public Health April 2004

  2. Public Health Education • “It’s not one damn thing after another, it’s the same damn thing over and over again” Edna St. Vincent Millay

  3. Accreditation Criterion V.B. Instruction • Each professional degree program …shall assure that each student develops …an understanding of the areas of knowledge which are basic to public health: • Biostatistics • Epidemiology • Environmental health sciences • Health services administration • Social and behavioral sciences

  4. Criterion V.B. Instruction • Schools and programs of public health have traditionally met this criterion by requiring a set of courses in each of these core disciplines of public health • There may be one set of “core” courses, or there may be options for meeting the “core” requirements for the MPH

  5. UAB School of Public HealthCore Curriculum • We, like many others had required all MPH students to complete: Biostatistics I and II (6 credit hours) Introduction to Epidemiology (3) Fundamentals of Environmental Health (3) Intro to Population-Based Health Programs (3) Behavioral Science and Health (3) Biological Basis of Public Health (3 unless waived)

  6. Public Health Curricula Requiring a set of courses in these disciplines promotes depth in each area • But such a structure does not lend itself to an examination of the breadth of public health • Nor does it facilitate the study of critical issues in public health across the disciplines

  7. UAB Core Curriculum • As part of a five-year strategic plan to educate the public health professionals of the future, we undertook a complete review of our MPH curricula with a focus on this “core” curriculum • Complaints about redundancy, irrelevancy and excessiveness were of prime concern • We also considered new emphases on work-force development, professional competencies and the call for public health education to be more applied, more practice-based

  8. UAB Core Curriculum • We wanted a curriculum that provided a good foundation in the public health sciences but one that also fostered a more comprehensive understanding of the nature of public health practice and discovery • We also wanted to increase exposure to public health practitioners and to emphasize current events

  9. UAB Core Curriculum Our curriculum reform included three components, all interrelated: • Monthly Public Health Grand Rounds • Case Study Course • Integrated Public Health Core Curriculum

  10. UAB Core Curriculum • Three new committees were formed • Public Health Grand Rounds began the following fall with funding support from the Dean’s Office • The Integrative Experience (case-study) course was piloted over a year (four quarters) before it was formally adopted as a required component of the curriculum; the course is team-taught and tuition revenue is shared across the six departments

  11. UAB Integrated Core Curriculum • The core curriculum committee elected to develop a quasi-problem-based core curriculum in which principles are learned by examining real-world examples • The integrated core curriculum would be team-taught and would feature all the disciplines examined around a series of public health topics, organized as distinct modules • These modules would highlight critical issues in public health and together, constitute a survey of public health topics of continuing and emerging importance to community health

  12. UAB Integrated Core Curriculum • We developed the skeletal structure of the course and selected the module topics: • Fall Semester, 9 credit hours • History of Public Health • Hanta virus • Tobacco • Polio

  13. UAB Integrated Core Curriculum • Spring Semester, 6 credit hours • Lead • Breast Cancer • STD’s and HIV/AIDS • Injury Control • Food Safety • Public Health Disasters

  14. UAB Integrated Core CurriculumStructure • Class meets in the Fall • Mondays 9-11 • With a weekly HELP session from 11-12 • Wednesdays 9-12 • Fridays 9-11 • Class meets in the Spring • Mondays 9-11 • With a weekly HELP session from 11-12 • Wednesdays 9-12 • Students also attend weekly skills-building lab sessions of no more than 20 students, led by TA’s

  15. UAB Integrated Core CurriculumStructure • Each module begins with a film followed by a multidisciplinary faculty discussion • Subsequent lectures feature content from the specific disciplines, as each relates to the general topic, building on previous discipline-specific material and on material covered by the other disciplines • All faculty are present at every lecture and can offer clarifying comments or pose questions

  16. UAB Integrated Core CurriculumStructure • Modules may feature presentations from other faculty with particular expertise, or from public health professionals • At least half of our monthly Public Health Grand Rounds presentations relate directly to the module topic of the core • Lab sessions within each module build skills linked to the module topic

  17. UAB Integrated Core CurriculumStructure • Each module ends with a concluding multidisciplinary faculty discussion with substantial participation by the students • Student’s knowledge is assessed at the end of each module through a computerized quiz of primarily objective questions • Each semester ends with an in-class final exam with an emphasis on essay questions that allow students to demonstrate their ability to synthesize information in the analysis and resolution of public health problems

  18. UAB Core Curriculum • While the structure is relatively fixed, the content is fairly flexible • Lectures can be modified or swapped out • Lecture examples are continuously updated • Module discussions can (and do) address current events • Grand Rounds speakers reflect the latest advances in the field

  19. UAB Core Curriculum • Perhaps the greatest benefit of this method of instruction is our ability to emphasize the breadth of public health while also engaging in deep analyses of critical topics in public health . . . • Like TOBACCO

  20. Module III: Tobacco • We begin the Fall semester with a module on the history of public health, which allows us to introduce each of the disciplines and highlight their unique contributions • We follow this with a module on Hanta Virus which allows us to demonstrate the interrelationship of the disciplines

  21. Module III: Tobacco • Tobacco is, then, the first module to take on a topic of great importance to public health, and examine it thoroughly both from the perspective of individual disciplines and then collectively across the disciplines • Tobacco is the longest module in the entire two semester course

  22. Module III: Tobacco • We begin by screening “The Tobacco Wars”, A History Channel Production within the series “The Twentieth Century with Mike Wallace” • We follow this with an interdisciplinary discussion of the faculty with the students; these are not planned

  23. Module III: Tobacco • We then give a series of lectures, designed to both build knowledge within individual disciplines and to address specific aspects of tobacco in public health • Biological Basis of Tobacco • Behavioral Approaches to Tobacco Prevention • Errors in Hypothesis Testing (BST) • Preventing Initiation of Tobacco Use

  24. Module III: Tobacco Lectures Continued • One-Sample Testing (BST) • Community-Based Tobacco Control • Epidemiology: Study Design • Two Groups Paired Testing (BST) • Epidemiology: Measures of Effect • Epidemiology: Critiquing Journal Articles • Air Pollution • Toxicology

  25. Module III: Tobacco Lectures Continued • Epidemiology: Study Design II • Tobacco Policy: Health Economics • Tobacco Policy: The US Tobacco Program • Epidemiology: Causality • An Overview of Cancer in the US • Clinical Approaches to Smoking Cessation • Role of Tobacco in Maternal and Child Health • Two Groups Unpaired Testing (BST)

  26. Module III Labs • There are four scheduled lab sessions during this module • A data exercise using BRFSS/YRBS • A health behavior exercise on smoking interventions • An epidemiology study design exercise • An environmental health exercise on indoor air and dose/response

  27. Module III: Tobacco • Because of the importance and the richness of the topic, every year the featured Grand Rounds speaker during this module lectures on some aspect of tobacco • We also show another film, entitled “The Last Cigarette” one evening during the module for the entire student body

  28. Module III: Tobacco Grand Rounds Speakers • 2001: Dr. Cheryl Healton, Legacy Foundation • The Master Settlement Agreement • 2002: Dr. Bert Hirschorn, WHO Consultant • Commerciogenic Disease: The Tobacco Papers • 2003: Dr. Tom Miller, Prattville, AL Councilman • The Prattville City Council Smoking Ordinance

  29. UAB Integrated Core CurriculumLearning Objectives • Upon completion of the Integrated Core Curriculum students will demonstrate competence in: • the basic public health sciences including environmental health science, epidemiology, biostatistics, health behavior, health policy and the biological basis of public health;

  30. UAB Integrated Core CurriculumLearning Objectives • Data analysis and policy analysis skills; • Communication skills, both written and oral, for professional and community audiences; • Program planning and administration skills;

  31. UAB Integrated Core CurriculumLearning Objectives • Public health systems and the organization of health services in the US and abroad; • Recognition and analysis of ethical or legal issues in public health and in professional practice;

  32. UAB Integrated Core CurriculumLearning Objectives • Identifying and considering cultural, behavioral, genetic, environmental, political, geographic and socioeconomic factors in health, the global nature of health and the needs of special populations such as mothers and children, ethnic minorities and vulnerable populations; and,

  33. UAB Integrated Core CurriculumLearning Objectives • the integration of core public health disciplines in public health problem analyses and decision-making processes. • We also include learning objectives for each discipline, and for each module

  34. Tobacco Module Learning Objectives • “By the end of this module, you will understand the role of lifestyle choice and behavior in health, the importance of environmental exposures to toxic agents, the role of data and research in contributing to our understanding about risk and disease, and the impact of social and political systems on risk exposure and disease reduction”

  35. UAB Core Curriculum: Challenges • Why do we do this? • Obviously, this is extremely demanding of faculty time and increases opportunity costs • This structure does potentially sacrifice some continuity within disciplines • This structure requires an intensive investment in teaching assistants • This structure imposes a heavy workload on students and not all of them can handle it

  36. UAB Core Curriculum: Challenges • Obviously too, each of the faculty members has had to give up some control and to instead contribute to a shared enterprise, in which we all succeed or fail collectively

  37. UAB Core Curriculum: Benefits • We believe the investment is worthwhile: • Teaching quality improved • No sacrifice in specific discipline content • Redundancy eliminated (except by design) • Integration adds tremendous value • Teaching method models a community of public health professionals working together • Students learn to appreciate and respect all the disciplines • Current events covered as they happen

  38. UAB Core Curriculum: Tobacco • Again, perhaps most significantly, this model of teaching basic public health allows us to provide traditional content in the context in which it is practiced: • by thoroughly examining public health issues, like tobacco, from the perspective of each discipline severally and collectively toward understanding and resolving persistent public health challenges

  39. Administrative Support • We agreed that we wanted our best teachers to participate in this course, without regard to rank, tenure-status or level of extramural funding • To do this, we secured assurances from our tenure and promotion committee that no one would be penalized for contributing to this effort

  40. Administrative Support We also secured an agreement to share the tuition revenue: • 50% of the tuition revenue is divided equally across the six departments • 50% of the tuition revenue is allocated based on the proportion of total hours actually taught by each department • This funding mechanism recognizes both the individual and collective responsibilities of the faculty members involved

  41. Administrative Support • The Dean’s office agreed to provide funds to cover some of the fixed costs: space, equipment and supplies for the teaching assistant’s office; textbooks for faculty; routine photocopying; and maintenance of the course Website • We are currently recruiting a full-time coordinator to support this course and the on-line version we offer for non-traditional students • Each department protects the time of the faculty assigned to the core

  42. Evaluation • Scores on student evaluations were initially comparable to those from the individual courses but over time have increased • Recent alumni rate their competence in public health skill areas higher and their MPH education more relevant to their work than do older alumni • Faculty in other courses have consistently noted that the students from the integrated core are better prepared for discipline-specific courses

  43. Evaluation • Students in our Case Study class, taken as an integrative experience at the end of the MPH program have developed several cases on tobacco from the development of various local ordinances, to local business decisions to go smoke-free, to nicotine in bottled water, to how to spend tobacco settlement dollars

  44. Tobacco in the Core Curriculum • Our inability to address issues like tobacco led us to develop our integrated core curriculum • With the ongoing support of the administration and the faculty, we have been able to continuously improve upon this method of teaching and provide our students a better understanding of the world of public health • Our challenge now is to keep the content fresh and unfortunately, tobacco is still an important topic and so will be a major component for years

  45. The UAB School of Public Health Learn more about us at www.uab.edu/publichealth Thank you!

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