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Abstract

Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.

Keywords

public health pedagogy public health education educational scholarship public health practice

The growth in public health educational programs during the past several decades provides a compelling incentive for scrutinizing the art and science of public health pedagogy. In 1990-1991, there were 24 schools of public health.¹ As of December 2016, the Council on Education for Public Health (CEPH) website listed 59 accredited schools of public health, 113 accredited master of public health (MPH) programs, and 44 applications for new schools, graduate programs, or undergraduate programs.² This expansion coincides with transformations in the educational charge of academic public health. Developments include the Framing the Future initiative by the Association of Schools and Programs of Public Health (ASPPH), which provided guidelines for the redesign of public health education. The initiative comprised the 2013 Blue Ribbon Public Health Employers’ Advisory Board report and the 2015 report A Master of Public Health Degree for the 21st Century.^3,4 The latter report called for a sweeping redesign of the MPH degree in response to a changing public health practice landscape and workforce.⁴

Concurrently, several major assessments of the public health workforce identified needed critical skills. These assessments included the 2013 Job Task Analysis Survey by the National Board of Public Health Examiners and assessments of public health leaders and workers conducted in 2013-2014 by the Association of State and Territorial Health Officials.^5
–7 In 2014, the Council on Linkages Between Academia and Public Health Practice issued a revised set of foundational skills needed for the broad practice of public health.⁸ These efforts provided impetus for a substantial revision to the accreditation criteria for schools and programs of public health adopted by CEPH in fall 2016.⁹ The new criteria include a stronger emphasis on the content and outcomes of public health education, including identification of foundational competencies required of all graduates and an assessment of instructional effectiveness.

These developments in public health oblige public health educators to consider the manner in which our students are taught. Along with identifying the skills and competencies required by public health professionals, questions about the best curricula and learning methods for developing these competencies and the means for assessing their attainment need to be answered. In other words, in addition to specifying what to teach, we should also examine how to teach public health and evaluate our efforts if we are to reach our education and training goals. To respond to the many educational changes and challenges, schools and programs of public health would benefit from greater involvement in pedagogical research and the development of additional platforms to support the dissemination and implementation of educational research findings.

Current Efforts to Promote Public Health Pedagogy

Many schools and programs of public health are actively engaged in innovative curriculum development, as demonstrated by the March 2015 supplement to the American Journal of Public Health, which included numerous articles describing such efforts.¹⁰ Multiple avenues for sharing public health pedagogical research, curricula, and best teaching practices are offered by schools and programs of public health, professional organizations, and journals, including the Harvard University T.H. Chan School of Public Health online library of case studies and other teaching resources.¹¹ Several public health organizations include as part of their scope of activities a focus on pedagogy. Organizational websites, such as those for ASPPH and the Association for Prevention Teaching and Research, offer educational resources and teaching modules.^12,13 The website for the Association of Teachers of Maternal and Child Health has a section for sharing syllabi, and the association sponsors an innovative teaching award and a mentorship project for maternal and child health programs at institutions of higher learning.¹⁴ The American Public Health Association’s (APHA’s) Academic Public Health Caucus sponsors sessions at the APHA annual meeting that focus on public health teaching and curriculum development.¹⁵ ASPPH also includes sessions and a poster event focusing on public health education at its annual meeting. The Association for Prevention Teaching and Research sponsors sessions related to teaching prevention and population health at its annual meeting for a membership comprising primarily medical school-based preventive medicine and population health programs and departments and public health programs not affiliated with schools of public health.

Additionally, several opportunities for publishing peer-reviewed educational scholarship targeting public health are available. Public Health Reports has a regular department, From the Schools and Programs of Public Health, for articles by faculty and students from ASPPH-member organizations on topics related to academic public health and practice-based activities.¹⁶ The open-access journal Frontiers in Public Health sponsors a section on public health education and promotion, including pedagogy for public health professionals.¹⁷ The Society for Public Health Education recently introduced a new journal, Pedagogy in Health Promotion, for disseminating work on curriculum and educational program design, assessment, and administration.¹⁸

Models From Other Fields

Examining how related fields promote sharing of scholarship and best teaching practices to support evidence-based education is also important. Among various health professions, numerous avenues exist for disseminating educational research and innovative practice. More than 20 peer-reviewed journals are devoted to education in medicine, including Academic Medicine, Best Evidence in Medical Education, Teaching and Learning in Medicine, and an annual medical education issue in JAMA. ¹⁹ The journal Medical Education publishes “Really Good Stuff,” a section devoted to brief reports of lessons learned through innovation in medical education.²⁰ At least 15 journals are geared toward education in other health professions, including nursing, dentistry, and pharmacy.¹⁹

Several repositories for curricula and teaching modules exist. MedEdPORTAL, sponsored by the Association of American Medical Colleges in collaboration with the American Dental Education Association and the American Psychological Association, is as an open-access clearinghouse of peer-reviewed teaching and assessment resources for the health professions (https://www.mededportal.org). Other repositories include MedEdWorld, an international online community for sharing information, ideas, experiences, and expertise in health professions education (http://www.mededworld.org). CES4Health is a free online resource for disseminating peer-reviewed, community-engaged scholarship in formats such as videos, manuals, and curricula (http://www.ces4health).

Finally, an expansive literature on pedagogy, teaching, and learning is indexed by the Institute of Educational Sciences (https://eric.ed.gov). The site serves as an important repository of resources for educational research and course development, including journal articles, reports, conference papers, and books.

Methods for Pedagogical Assessment

The revised accreditation criteria from CEPH emphasize assessing learning outcomes. A number of useful frameworks for teaching and evaluating professional performance based on adult learning models are available, which public health educators can apply as they adapt their curricula to meet the new expectations.²¹

The notion of professional learning as a process is incorporated into competency development and assessment frameworks in other fields. During the past several decades, competency-based education in medicine has adopted a developmental approach based on the concept of progression along a series of defined milestones.²² This approach reflects the often-cited “Miller’s pyramid,” which portrays clinical skills development as a 4-step process leading from knowledge at the base to independent performance at the apex. The model helps focus assessment on outcomes appropriate for each stage.²³ The American Psychological Association also calls for a developmental approach to competency assessment, including determining aspects to be mastered at particular stages.²⁴

Many educational scholars emphasize the importance of formative and summative assessment, particularly when evaluating student performance from a developmental perspective.^24

–27 Formative assessment provides students with feedback to improve future performance, whereas summative assessment provides a concrete measure of student performance rated according to defined expectations. Both types of feedback are important and support the self-regulated learning expected of adults and professionals.²⁸

The professional development literature also provides approaches for assessing experiential learning, such as the MPH practicum. One essential element is student self-assessment through critical reflection to help foster creative problem solving and analysis of how to improve future performance.^{25,29

–34} Reflection can be included as part of a triangulated assessment of field practice compiling evidence from various sources, including student, preceptor, and faculty.³¹ New York University has incorporated triangulation and critical reflection into its internship in various formats, including an online discussion forum.³⁵

Assessment rubrics are another important tool for evaluating the level of student achievement for learning outcomes. Rubrics help achieve efficiency, transparency, and fairness in grading. They clarify expectations to students by identifying grading criteria aligned with performance standards consistent with curricular goals and learning objectives.^31,36 Rubrics provide concrete feedback to students on level of performance and areas needing improvement.²⁶ They also help achieve greater reliability when grading is done by multiple assessors (eg, for a thesis or portfolio).³⁷

An Action Agenda for Public Health Education

Academic institutions, professional organizations, and educators can take numerous actions to implement an agenda that supports pedagogical scholarship and practice-based evidence in public health education. Avenues for dissemination include conferences, journals, websites, blogs, electronic mailing lists, and newsletters. The growth of online platforms for professional information sharing offers many possibilities for research dissemination and development of learning communities.

We offer an initial action agenda (Box) with the hope that this agenda will encourage continuing dialogue and discussion. The goal of the action agenda is to provide multiple suggestions for specific steps that public health schools, programs, organizations, and faculty can take to promote pedagogical scholarship. Furthermore, the goal is to help create environments that foster educational scholarship and innovation and provide evidence-based educational material for dissemination. Fulfilling the agenda will require commitment by the leadership of schools and programs of public health to support educational scholarship at their institutions. In addition, schools and programs of public health must commit to a collaborative approach for sharing lessons and educational materials with one another in the spirit of open scientific and professional exchange.

Box An action agenda for public health pedagogical scholarship

Schools and Programs of Public Health

Champion and support research on curriculum innovation.

Recognize the value of educational scholarship and reward it in promotion and tenure systems.

Establish leadership positions (eg, associate dean for instructional development) to promote and support educational scholarship.

Provide small grants to support educational scholarship.

Provide faculty development opportunities for pedagogical research (eg, workshops, webinars, forums).

Create teaching academies and support master teachers.

Partner with university educational advancement offices.

Commit to a collaborative approach to information sharing with other schools and programs of public health.

Association of Schools and Programs of Public Health

Participate in MedEdPORTAL (www.mededportal.org).

Develop technical assistance materials to support educational scholarship.

Develop standards for peer review of public health curricula.

Include a website section focusing on educational scholarship.

Follow the Association of American Medical Colleges model of projects and interest groups focused on education.

Convene regular webinars and online discussion groups on pedagogy.

Support the use of standardized questions to examine student outcomes.

Provide seed grants to sponsor cross-school/program educational research.

Expand efforts to solicit educational scholarship and devote more space to these articles in Public Health Reports.

American Public Health Association

Sponsor public health pedagogy learning institutes at the annual meeting.

Expand efforts of the Academic Public Health Caucus for community building and presenting educational scholarship at the annual meeting.

Offer a regular feature column in the American Journal of Public Health dedicated to public health education and pedagogical scholarship.

Council on Education for Public Health

Promote educational scholarship in accreditation criteria.

Public Health Educators

Commit to sharing, disseminating, and peer reviewing educational research.

Public health professional organizations also have a critical role in disseminating educational research. ASPPH can join the MedEdPORTAL as a public health partner and expand efforts to solicit educational scholarship for submissions to Public Health Reports. The ASPPH Education Committee can help create opportunities for pedagogical research across schools and programs of public health, including creating standardized questions to track aggregate educational outcomes. Other efforts by ASPPH could include coordinating the development of materials to support educational innovation and scholarship and standards for peer review of public health curricula. ASPPH could promote dissemination through its website, webinars, and online discussion groups. Future efforts can follow the Association of American Medical Colleges model of sponsoring special projects and member interest groups focused on professional education to facilitate pedagogical advancement and information sharing.^38,39

APHA has an important role in supporting learning communities for educational scholarship. It can sponsor learning institutes focused on public health pedagogy at its annual meeting. The Academic Public Health Caucus can offer additional opportunities for networking and information sharing with a focus on pedagogy. The American Journal of Public Health could offer a regular feature column and section dedicated to public health education and pedagogical scholarship.

As the accrediting entity, CEPH can continue to promote a focus on the quality and outcomes of public health education, as demonstrated in the 2016 accreditation revisions. Future accreditation criteria could include explicit mention of the importance of educational scholarship to fulfill the research and educational missions of schools and programs of public health and encourage the reporting of such activities in self-studies.

Finally, public health faculty can commit to engaging in pedagogical research and assessment beyond standardized evaluation surveys completed by students at the end of a course. For example, instructors can assess classwide student achievement in attaining course-specific learning objectives and competencies and systematically evaluate teaching methods used in a course. Participation and leadership by public health faculty will be essential for implementing and sustaining learning communities that share materials, strategies, and lessons learned and provide peer review for curricula. These efforts will help faculty benefit from improved instructional techniques and effectiveness. Ultimately, the goal is implementation of innovative and effective pedagogical and assessment techniques that respond to changes in our discipline and to teaching a new generation of students.

Public Health Implications

The moment is right for advancing an agenda of evidence-based education in public health. Despite challenges, including inadequate financial resources and limited faculty time and support, we have described several feasible starting points. The next generation of public health professionals will be expected to tackle complex issues requiring perspectives and skills reflecting global, transdisciplinary, interprofessional, and systems approaches. Assuring that our students develop the competencies needed to make an impact on public health in the 21st century will require innovative and creative pedagogy. Ongoing assessment of our curricula, teaching methods, and pedagogical practices will contribute to measuring our success in meeting the demands of the second 100 years of public health education.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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