Dr Rebecca Tooher, School of Population Health

1. Dr Rebecca Tooher, School of Population Health Developing a capstone experience for undergraduate public health students at the University of Adelaide

2. SPH BHlthSc Working Party • Dino Pisaniello • Annette Braunack-Mayer • John Lynch • Caroline Laurence • Shona Crabb • Adriana Milazzo • Paul Rothmore • Catherine Chittleborough • Gillian Laven • Tanya Wittwer • Dylan Coleman • Jenny Baker • Vivienne Moore • Rebecca Tooher University of Adelaide

3. Curriculum renewal in UG PH • BHlthSc at University of Adelaide – since 1990 • Broad degree with mixture of population health and biomedical sciences at first year • Then students choose from various majors • Large first year intake – 350 equiv full time student load • Has trebled in last five years (from 110 in 2008 to 360 in 2013) • Retention from first year to second year has been declining • From 94% in 2001 to 56% in 2012 (down to 50% in 2010) • All students take public health in first year but far fewer go on to second year public health (not compulsory) University of Adelaide

4. Retention in PH at second year University of Adelaide

5. New Pop Hlth majors for BHlthSc • Health Promotion • Indigenous Health • Single PH major • Epidemiology University of Adelaide

6. Steps in the curriculum renewal process • To fit with new UG curriculum structures • To fit with University Program and Course approval timelines (long lead time before teaching) • ALTC Threshold Learning Outcomes • AQF • Blooms taxonomy • RSD framework • ASPH UG Learning Outcomes • CDAMS Indigenous curriculum • New Level II courses • New Level III courses • Reconfiguration of existing capstone/s University of Adelaide

7. Structure of new majors Level I + or Level II Level III + or or or University of Adelaide

8. Development of new courses • Year level attributes • First year - enabling, inspiring and introductory • Second year - focused content • Third year - pre-professional and advanced topics/methods • Core competencies for PH graduates • Well developed research literacy • Well developed data numeracy and literacy • Highly developed communication skills • Mapped curriculum against frameworks to ensure coherence and identify any gaps University of Adelaide

9. Course development process • Concurrently developed/revised 3 new Level II courses and 4 new Level III courses • Series of workshops (2-3 hours) with working party to jointly develop • Learning outcomes • Learning and teaching modes and activities • Assessment • Course approval documentation then developed for approval by small teams led by one member of WP University of Adelaide

10. Retention into second year after new majors University of Adelaide

11. Retention into third year with new majors • Evaluation III – 39 • Epidemiology in Action III – 22 • Health Promotion III – 40 • Indigenous Health III – 28 • In total 60 unique students in Semester 1 • Retention from Level II to Level III: 62.5% • Public Health Theory & Practice: 26 • Public Health Internship: 13 • 39 students undertaking 1 or more Pop Hlth major University of Adelaide

12. Capstone Course • Guiding principles: • To tie together all of the student learning over the 3 years • No new content but rather application of knowledge & skills • Must come at the end • Must be available for all students doing PopHlth majors • Literature also suggested the following useful: • Authentic focus for major project or work-integrated learning • Focus on career readiness and demonstrating graduate attributes • Wide variety in ways these things are interpreted University of Adelaide

13. Aims • To integrate theoretical knowledge and professional and workplace skills in the application of knowledge gained throughout the public health/population health major. Role of the teacher Role of the student University of Adelaide

14. Learning Objectives • Identify, locate and appraise relevant evidence using different sources including the peer reviewed literature, policy & practice literature & grey literature. • Construct an effective environmental scanning process to quantify the local epidemiology of a public health problem or issue. • Apply ethical and theoretical frameworks to achieve a holistic understanding of public health problems and issues, and health determinants in a given population. • Formulate appropriate public health intervention or policy objectives and strategies using theory, available evidence and cultural awareness. • Specify evaluation frameworks for a range of public health interventions or policies • Use appropriate professional communication skills (including information seeking & presentation skills) to engage stakeholders and others to explore public health problems and issues. • Demonstrate ability to work in teams to solve problems. • Identify personal strengths and development needs related to professional skills expected of a beginning public health practitioner or researcher. Find relevant literature/data and use critically Apply epidemiological skills to describe PH issues Consider ethics & social determinants of health Develop practice or policy responses Know how to evaluate them rigorously Excellent communication and engagement Team skills for problem-solving Develop professional identity University of Adelaide

15. Structure of the course • Fortnightly PH-issue based seminars • Led by each of our school’s research groups • Alternate fortnight student led tutorial discussions • Students to go away as a group and research the previous week’s issue to fill in any gaps in knowledge, identify uncertainties etc. • Each group will lead at least one tutorial in the semester • Work on major project (individual) • Majors Mini-conference • Students present their projects either as orals or posters • First, second and honours yr students + staff to attend University of Adelaide

16. Assessment • Individual Public Health Portfolio (20%) • Each student to gather exemplars of their work over the 3 yrs of the major • Reflection on selection of exemplars, own strengths and development needs • Demonstrating emerging sense of professional identity • Could use portfolio to support first job application? • Participation in seminars and tutorials (10%) • Including working as team and leading one tutorial • Here need to work as a group but not marked as a group University of Adelaide

17. Assessment • Major project (55%) – 4000 words • Student chooses from list of broad topics but shapes project with guidance of academic mentor • Topic & rationale for choice • Use epidemiology to describe issue • Identify stakeholder perspectives • Including interviewing one /gp stakeholders and incorporating findings • Put issue in local/global policy context • Make recommendations about policy or intervention response • Specify an evaluation framework • Identify important research-practice/policy gaps • Can be more/less theoretical depending on issue/student * Opportunity for student to demonstrate & integrate all their skills University of Adelaide

18. Assessment • Majors Mini-conference presentation (15%) • Presentation of major project • Student chooses either oral or poster • Assessed by panel of peers and panel of academics • Provides opportunity to present to large group if desired • Provides opportunity for vertical integration with Level I and II University of Adelaide

19. Issues encountered in development • We already had a ‘capstone’ – our Public Health Internship but: • Not available to all students because of GPA required for entry • Limited availability of placements limits growth • So we needed to ensure that this capstone and the internship had equivalent learning outcomes/assessment/unit weighting • For 2014 we offered both – students can only take one • Where the internship fits into future PH program open – could move to postgrad or honours year • Could expand internship to take full semester credit providing for employers a) quality students b) more time for development of project and integration of student into workplace setting University of Adelaide

20. Issues encountered in development • We realised that our timetable for PH would need to change if capstone to come at the end of the major • Needed to structure to allow students to take a second (non Pop Hlth) major if they wished • Capstone in S2 • Made unit weighting same as Internship • Allowed space for a second unrelated major University of Adelaide

21. Issues encountered in development • Took a while to recognise that no new content should be introduced • Because capstone common to all majors not every student has covered exactly the same coursework prior to capstone • Potentially could be gaps of knowledge • Developed series of online resources to cover these gaps which students can use as needed (not assessed) University of Adelaide

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25. Alignment with Uni strategic plan • Strengthens research-teaching nexus • PH issues based seminars led by School’s research groups • Academic mentoring provided by active researchers • Graduate career readiness • Explicit focus of this capstone • A capstone experience or equivalent now required in all UG programs • Focus on graduate attributes • Especially communication, independence, critical thinking University of Adelaide

26. Issues-based seminars • Topics based on interest and availability of key research groups in the school • Good engagement from senior research leaders • Provided guidance (based on major project requirements) but variation in how these have been shaped Almost by accident have ended up capturing different facets of public health policy/practice/use of evidence (as well as different health issues) University of Adelaide

27. Issue-based seminars • Regulation and laws for prevention of childhood obesity • Big picture PH policy-making • Heat and health • Effective interagency collaboration for health protection • Risk communication • Arthritis and musculoskeletal conditions & PH • Mismatch btwn size of problem & its public profile/hlth system response • Self-management as a concept • Child development and equity • Taking epidemiology the next step – so if this is true what do we do? University of Adelaide

28. At the halfway point in semester • Students are responding really well to the format • Loving the idea of their portfolio – a chance to take stock of what they have learned and recognise both strengths and weaknesses • Very engaged group – I am observing emerging sense of professional identity • They have started to say “when we are dealing with x problem…” or “We will be the ones who have to lead the solutions to this…” • Very positive response to the Majors Mini-Conference and very interesting range of topics University of Adelaide

29. Major report topics • Health system factors influencing differences in maternal and child mortality in Australia and Pakistan – lessons to be learned. • Impact of otitis media and hearing loss on developmental outcomes for Indigenous children in remote and rural locations. • Investigation of the Playford Alive strategy and the impact of town planning for creating healthy environments with reference to the new SA Public Health Act • Relationship between depression and stigmatisation in LGBT young people in high school settings. University of Adelaide

30. Major report topics • Managing antibiotic resistance in nursing home populations at risk for infections. • Control of alcohol sales in the Northern Territory and the impact on health outcomes. • The black hole of cancer data – what happens in the space between diagnosis and outcome? Does treatment choice impact on outcomes? • What is the evidence for positive psychology in schools for preventing mental health problems in young people? • Risk reduction strategies for alcohol consumption in young adults in urban locations. University of Adelaide

31. What the students tell me… • Informative, adult-based, engaging, interactive group discussion – closer to what it would be like in the workforce • Being able to draw on personal experience and apply to learning • Like the way the course brings together learning over the three years – so earlier years all the topics segmented whereas this course helps to see the underlying issues – the things that underpin all public health • Picking up on the complexity of public health issues – thinking about how to make things happen University of Adelaide

32. What the students tell me… • Guest speakers (seminar leaders) – passionate people – make me feel passionate about public health too • Like the structure with the student –led tutorial which leads to rich discussion and raw opinion that we can debate and deconstruct • Like the way it is loosely structured – we can research our own ideas • Portfolio – reinforces what you have learned – like a summing up of the whole degree – feel more ready for the workforce University of Adelaide

33. What the research groups tell me • I was a bit apprehensive at first about the amount of work required in presenting to the class. However, once I realised it was really about how I approached an existing research project it was easy • Preparing for the class and interacting with the students made me think about the work from new angles and was useful in terms of consolidating my ideas about the developing conceptual basis underpinning our approach • As an academic chiefly focused on research, my involvement in the Heat and Health Seminar was refreshing and enjoyable • Useful to test research ideas with ‘end-users’ rather than fellow researchers • Tried to present real world dilemma of research and practice in a world constrained by funding, political/public interest and funder imperatives University of Adelaide

34. What have I learned for next year so far? • Need to lock research groups in early • Need to build in lots of practice with graphs and data • Individual mentoring works well with a class size this big but would be a bigger challenge with more students • Students will rise up to challenges we set them • This is our group of, on average, poorer performing students (highest achievers in the Internship) but all of them are taking this seriously and performing well • We treat them like future colleagues and they are starting to think of themselves that way AND behave as if they believe it University of Adelaide

35. Pragmatic serendipity • Pragmatic change made to one of the issue based seminars – research group unavailable • Invited 3 senior public health policymakers from SA Health to come and talk to the students about how they use public health skills and knowledge and apply evidence to the policy-making process • Pertussis vaccine in pregnancy • SA Health Healthy Eating Guidelines in SA govt workplaces • Oral health policy • This makes sense in terms of closing the loop for students – likely to incorporate for next year University of Adelaide

36. rebecca.tooher@adelaide.edu.au University of Adelaide