Presentation - Canadian Public Health Association

Report
Public
Health Education
Unbound
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2014
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Diane R. Bewick, RN, BScN, MScN, DPA, CCHN (c)
Chief Nursing Officer
Director of Family Health Services, Middlesex-London Health Unit
Adjunct Professor, Faculty of Health Sciences, Western University
London, Ontario
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The public health professional …
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Advice …
“No attempt to improve public health will succeed
that does not recognize the fundamental importance
… of highly skilled and motivated health
professionals.”
“Our national aim should be to produce
a cadre of outstanding public health
professional … who have clear roles, responsibilities
and career paths.”
National Advisory Committee on SARS and Public Health, 2003
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Warning …
“To aim the public health system with more powers
and duties without the necessary resources is to
mislead the public and to leave Ontario vulnerable …”
The SARS Commission, 2005
Resources are not simply funding but perhaps more
importantly competent, committed public health
professionals.
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The public health professional
organized measures
quality of life
prolong life
promote health
prevention disease
people
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The
public health
professional
Poverty
Housing
Family
Health
Teams
Heart &
Stroke
Foundation
Literacy
Ontario
Early Years
Centres
Canadian
Cancer
Society
CCAC
Official
Public
Health
Agencies
Community
Health
Centre
Boards of
Education
Primary
Care
Providers
Education
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Global
Social
Support
The public health professional
Official Public
Health
Agencies
ON
*PHO - labs 1,000
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Local public
health units are
the backbone of
the public health
system…
Operational Health Protection, 2004
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Public Health Professionals
•
undergraduate programs…variety of disciplines
•
disciplines form the base …
•
discipline specific standards/competencies
•
regulation/registration/certification
•
professionals will benefit…from education
•
education will increase health of the province
*Unique contribution
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Public Health Competencies
Discipline
Specific Core
Competencies,
Standards and
Certification
Public
Health Core
Competencies
MPH
Core
Competencies
Inter-professional Competencies
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Public Health Professionals
(20 categories)
AMOH/MOH
51 - 63
Epidemiology
65 - 72
Dietitian/Nutritionist
210- 203- (232)
Public Health Inspectors
830 - 900
Public Health Nurses
2,630 - 2,717
(3,848)
2,860
Health Promoters
262 - 416
Dental Hygienists/ Dental
Assistants
289 - 286 - (167/DH)
*PHO (Labs), MOHLTC, MCYS
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Public Health Workforce Issues
1. Leadership and management
2. Career path
3. Opportunities/time for professional development
4. Lack of support for their profession
5. Undervalued within their organization.
6. Shortages
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Synthesis of 8 Papers (CAN)
… convergence of issues
1.
Role scope and clarity
2.
Leadership skills to support practice and
provide voice
3.
Professional development
4.
Intra-professional collaboration
5.
Stronger educational preparation in public
health
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Context Summary
•
public health professional - general
•
Public Health Professional – OPHA’s
Identified
•
- who
- common characteristics
- unique contribution
introduced public health workforce issues
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Marlene Janzen Le Ber, BScN, MScN, PhD, CHE
Assistant Professor, Epidemiology & Biostatistics
Associate Director, Program Development
Schulich Interfaculty Program in Public Health
Schulich School of Medicine & Dentistry
Cross Appointed to Faculty of Health Sciences (School of Health Studies)
Cross Appointed to Interfaculty Program in Public Health
Western University
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Education of Health
Professionals for the 21st Century
• The Lancet Commission (Frenk, et al., 2010)
• Transforming education to strengthen
health systems in an interdependent world
• 20 professional and academic leaders
from diverse countries
• Common strategy for PSE for public
health, nursing and medicine
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Three Generations of
Educational Reform (Frenk et al., 2010)
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Levels of Learning (Frenk et al., 2010)
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Transformative Learning (Frenk et al., 2010)
Fact Memorization
Searching
synthesis
Analysis
Synthesis
Seeking Professional Credentials
Achieving core competencies for
effective teamwork
Non-critical Adoption of Educational
Models
Creative adaptation of global
resources to address local priorities
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Models of interprofessional and
transprofessional education
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Health Professionals
• Leaders who can address these issues
• Scientists who understand the issues
• Practitioners who set standards
– All who understand complexity
– Translate this to policy and practice
– Learn to work in novel, and lead in
transdisciplinary, and sustained ways (Fried et al.
2013)
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Graduate Public Health Education
(Fried et al., 2013)
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Training Leaders in Public Health
• Integrative action requires integrative learning
• Systems problems require holistic analysis and holistic
approach to actions
• Beyond public health disciplines to collaboration among
public health practice, academics, government and the
private sector
• Requires grounding in pragmatic approach that “builds
a scientific foundation on the real-world needs of defining
public health problems” (Fried et al., 2013, p. e4)
• Team based learning
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Schulich Interfaculty Program in
Public Health
Our Distinction
• Novel niche of the intersection of Leadership,
Sustainability and Policy
• Full-time one year (12 month) on site
professional degree program (non thesis based
program)
• Experential Learning/ Case method learning
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Schulich Interfaculty Program in
Public Health
Our Distinction
• Cohort of students from diverse health
professional and educational backgrounds
• Special focus on health issues in Southwestern
Ontario, First Nations across Canada and
internationally
• Interfaculty contribution to the program
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What exactly is a case?
• Mauffette-Leenders et al (2007)
“A case is a description of an actual situation,
commonly involving a decision, a challenge, an
opportunity, a problem or an issue faced by a
person or persons in an organization. The case
requires the reader to step figuratively into the
position of a particular decision maker.” (p. 3)
• Ellet (2007)
“A … case imitates or simulates a real situation.
Cases are verbal representations of reality that put
the reader in the role of a participant in the
situation.” (p. 3)
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What is NOT a case?
• It is NOT just an interesting story
• It is NOT investigative journalism
• It is NOT research (which requires the truth, the
whole truth, nothing but the truth, etc.)
• It is NOT fiction (but some distortions,
simplifications and omissions may be required in
order to represent the situation so it can be
taught in a typical 80 minute class)
• It is NOT a news summary
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Student Preferences
• Current issue and situation
• Issues and challenges are relevant to career interest
• Can identify with protagonist (see self in the position of the decisionmaker in the near future)
• Organization itself is well-known, respected and not disguised
• Geographical area of the world where students expect to be working
or are currently living
• Issues in the case are urgent and important to the organization
• Excitement over the issue; can personally relate to the
issue/problem
• Cases with an interesting dilemma, characters with personalities,
and cases with compelling action requirements
• Short, well organized
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Attributes of a Good Case
• Pedagogical usefulness – achieves learning goals and
is “teachable”
• Interesting, engaging and relevant to students
• Poses a problem/decision with no obvious right
answer
• Requires the use of information in the case to figure
out a reasonable answer/approach
• Requires judgement, critical thinking and decision
making skills
• Is information rich – has numbers, industry
information, insights into organization and has some
complexity
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Three Core Elements
Reality
• Realism makes
a case an
effective
learning vehicle
• Empiricism
lends credibility
to concepts
learned in the
classroom
Theory
• An underlying
theory is
essential for
effective
teaching
• One person’s/
organization’s
action is not
necessarily a
guide for
practice
Originality
• What is new
here?
• concept?
• context?
• Novelty
enhances
scholarship and
links well to
research
Charles Dhanaraj
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Four Types of Cases
Skills
Practice
Cases
Evaluation/
Policy
Cases
Problem
Defining
Cases
Decisionmaking
Cases
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Four Types of Cases
Skills
Practice
Cases
Evaluation/
Policy
Cases
Problem
Defining
Cases
Decisionmaking
Cases
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Describe a
situation facing a
protagonist.
Students must
diagnose
problem(s) and
formulate possible
solutions.
Four Types of Cases
Skills
Practice
Cases
Evaluation/
Policy
Cases
Problem
Defining
Cases
Decisionmaking
Cases
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Describe a decision faced by the
protagonist. Students must choose
among a finite set of alternatives.
Four Types of Cases
Skills
Practice
Cases
Illustrate
organizational
success or
failure. Students
synthesize
policy lessons
to be extracted
from the
situation.
Evaluation/
Policy
Cases
Problem
Defining
Cases
Decisionmaking
Cases
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Four Types of Cases
Describe situations
requiring execution of
specific technical skills in
order to draw conclusions
Skills
Practice
Cases
Evaluation/
Policy
Cases
Problem
Defining
Cases
Decisionmaking
Cases
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Four Types of Cases
Describe situations
requiring execution of
specific technical skills in
order to draw conclusions
Illustrate an
organizational
success or
failure. Students
synthesize
policy lessons
to be extracted
from the
situation.
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Skills
Practice
Cases
Evaluation/
Policy
Cases
Problem
Defining
Cases
Decisionmaking
Cases
Describe a
situation facing a
protagonist.
Students must
diagnose
problem(s) and
formulate
possible
solutions.
Describe a decision faced by the
protagonist. Students must choose
among a finite set of alternatives.
Mauffette-Leenders et al., 2007, p. 19
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John M Garcia, PhD
Professor of Practice & Interim Director
School of Public Health and Health Systems
Faculty of Applied Health Sciences
Burt Matthews Hall, Room 2311
University of Waterloo
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Overview
• UW School of Public Health and Health
Systems
• Master of Public Health
• Other Academic Programs of UW SPHHS
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42
School of Public Health and Health
Systems
• Created in 2012 from Dept of Health Studies and
Gerontology
• More than 30 years of innovation and development
• 9 academic programs, 5 new/planned
–
–
–
–
BSc, MSc, PhD
MPH
BHP and MHI
MHE, BPH, DrPH
• Addition of 9 new faculty
• recent review of four programs (1st listed)
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MPH Program: Rationale and Mission
Rationale:
• need for greater #s and capacity of public health professionals
• MPH degree recognized academic benchmark credential
• Need for expanded access to public health training (hence
blended curriculum/mainly on-line, regular tuition fees)
• First intake, August 2006
Mission:
• help produce new generation of public health leaders and
managers
Brand:
• aspire, inspire, transform
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Public Health
• "the science and art of preventing disease,
prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations [public,
non-profit and private], communities and
individuals“ (Winslow, 2002)
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45
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46
What are core competencies?
• “…the set of cross-cutting skills,
knowledge and abilities necessary for the
broad practice of public health.”
U.S. Council on Linkages Between Academia and
Public Health Practice, 2004
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Core competencies, PHAC
• Public Health Sciences
• Assessment and Analysis
• Policy & Program Planning,
Implementation and Evaluation
• Partnerships, Collaboration & Advocacy
• Diversity and Inclusiveness
• Communication
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Example of a core competency –
Public health sciences domain
• A public health practitioner is able to…
1.1 Demonstrate knowledge about the following
concepts: the health status of populations,
inequities in health, the determinants of
health and illness, strategies for health
promotion, disease and injury prevention and
health protection, as well as the factors that
influence the delivery and use of health
services.
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Example of a core competency –
Public health sciences domain (continued)
1.2 Demonstrate knowledge about the history, structure
and interaction of public health and health care
services at local, provincial/territorial, national, and
international levels.
1.3 Apply the public health sciences to practice.
1.4 Use evidence and research to inform health policies
and programs.
1.5 Demonstrate the ability to pursue lifelong learning
opportunities in the field of public health.
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MPH Admission criteria
• year Honours Bachelor's degree (or equivalent) in a health-related
field, from a recognized university
• minimum 75% average in final two years of study (equivalent to last
20 half-credit courses)
• minimum 1 year prior work experience in a public health setting or
other relevant setting
• personal essay, resume, and letter
– the education, work and life experiences that have brought you
to the decision to apply to the Master of Public Health program
– how the Master of Public Health will help you in your future
career
• university-level course in basic statistics recommended
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Program requirements
General stream:
• 9 core courses
• 3 electives
• practicum
Socio-behavioural stream:
• 9 core courses, 2 stream courses
• 1 elective
• Practicum
Environmental stream:
• In approval process, similar model
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Competencies in curriculum development
Competency
domains
601/
602
SCB
Env
Epi
Comm
Mgmt/
admin
Policy
Public Health
Sciences
+
+
++
+++
+
+
+
Analysis and
Assessment
+
++
+++
+++
+
+
+++
Policy/Program
Planning/
Implement/
Evaluation
+
+
+
+
++
+++
+++
+++
++
+
+
+++
+++
+++
+
+
+
+
+++
++
++
Diversity/
Inclusiveness
+++
+++
+
+
+++
+++
+++
Leadership
+++
+
+
+
+++
+++
+++
Partnerships
Collaboration
Advocacy
Communication
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The MPH “Building” – Core courses
S-2
Capstone
(PHS 602)
W-2
Practicum
(PHS 641)
S-1/F-2
W-1
F-1
Health Policy
(PHS 603)
Stream courses
Electives
Principles of Epidemiology
for
Public Health
(PHS 606)
Health and Risk
Communication
in Public Health
(PHS 608)
Management and
Administration of Public Health
Services
(PHS 609)
Biostatistics in
Public Health
(PHS 605)
Social Cultural and
Behavioural Aspects of
Public Health
(PHS 607)
Public Health and
the Environment
(PHS 604)
Foundations of Public Health (PHS 601)
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Elective course offerings – beyond core
•
PHS 614 Evaluation of Public Health Programs (stream requirement)
•
PHS 617 Population Intervention for Health Promotion and Disease Prevention
(stream requirement)
•
PHS 623 Risk and Exposure Assessment (stream requirement)
•
PHS 624 Environmental Toxicology (stream requirement)
•
PHS 632 Health Economics & Public Health
•
PHS 635 Public Health, Environment and Planning
•
PHS 636 Applied Epidemiology
•
PHS 637 Public Health Informatics
•
PHS 638 Selected Topics in Public Health
–
Social Justice and Public Health
•
PHS 661 GIS and Public Health
•
PHS 662 Global Health
•
PHS 663 Human Development and Health
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MPH Student Numbers by Year
300
250
239
236
215
200
185
159
150
134
98
100
94
86
77
63
45
65
62
55
50
76
48
45
40
30
19
0
1
0
15
10
8
4
40
12
11
8
0
2006
2007
2008
Incoming Students ₁
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2009
Graduating Students ₂
2010
2011
Total # of Students ₃
2012
Withdrawals ₄
2013
Students
• Working at federal, provincial and local level, some
international
• Government, non-governmental, private sectors
• MDs, nurses, dentists, public health inspectors, health
educators and promoters, psychologists, social workers,
engineers, community activists, computer professionals,
statistics, planning, etc.
• Range of substantive interests – chronic disease prevention,
healthy growth and development, healthy environment,
disaster planning/management, environmental health,
infectious disease control, social determinants of health
• Aspire to be future leaders in public health – policy,
management, director level
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Graduating Class, October 2014
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MPH Alumni Survey (spring 2012)
• 81% employed (76% fulltime), 8% studying further, 8%
homemaker/caregiver, 4% looking for
employment/unemployed
• Employed by: PHA/RHA (33%), provincial/territorial
government (26%), federal government (19%),
NGO/health charity (11%), other including communitybased organizations and international agencies
• Range of roles: MOH, policy and program analysts,
public health inspection/environmental health, health
promotion, epidemiology, health communications etc.
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Other UW SPHHS Programs
• Master of Health Informatics
– Public Health and Health Systems Field, complementing
Cheriton School of Computer Science program
– to identify, design and manage informatics solutions relevant to
health and health systems
– Competencies adapted from COACH
• Bachelor of Health Promotion
• Master of Health Evaluation
– Preparation of professional evaluators
– Competencies for evaluation practice established by the
Canadian Evaluation Society
• Future – BPH, DrPH??
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André La Prairie, Manager
Skills Enhancement for Public Health
Health Security and Infrastructure Branch
Public Health Agency of Canada
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Skills Enhancement for Public Health
Centre for Public Health Capacity Development
Health Security Infrastructure Branch
Building a Solid Foundation for Public Health Practice
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62
Flexible (online)
learning options
to build
knowledge,
skills and
competencies in
public health
www.phac-aspc.gc.ca/php-psp/ccph-cesp/about_so-apropos_cd-eng.php
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“Nurses new to the north need opportunities to develop the
breadth of skills and depth of knowledge needed to practice
independently.”
“Most public health nurses today are baccalaureatetrained, and further specific training in public health
is no longer mandatory. Instead, public health nurses
learn on the job through formal and informal inservice training.”
“A thorough review of public health training programs is also
needed—new entrants to the public health workforce should
be appropriately qualified, and existing public health workers
should be provided with opportunities to acquire additional
skills if necessary.”
“It has also been argued that short courses in infectious disease
epidemiology are an essential part of capacity building for many
aspects of public health practice and leadership, but are not widely
available..”
“Health Canada’s Skills Enhancement for Health Surveillance program is a webbased distance education program aimed at front-line and supervisory workers in
local health departments. While not intended to substitute for master’s level training,
and still under development, it aims to provide basic, high-quality training in
epidemiology, surveillance and information management..”
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Skills Online
•Online continuing professional development program for front-line public health professionals
• 10 online facilitated modules, 2 self-directed modules; English and French
• Content mapped to the Core Competencies for Public Health in Canada
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65
Modules Currently Available
Facilitated
modules
Selfdirected
modules
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•
Basic Epidemiological Concepts
•
Measurement of Health Status
•
Epidemiologic Methods
•
Outbreak Investigation & Management
•
Epidemiology of Chronic Diseases
•
Introduction to Surveillance
•
Applied Epidemiology: Injuries
•
Communicating Data Effectively
•
Introduction to Biostatistics
•
Evidence-based Public Health Practice (English only)
•
Introduction to Public Health in Canada
•
Introduction to Literature Searching
Modules Under Development
• Privacy and Confidentiality
• Core Competency Toolkit
• Health Literacy
• Introduction to Core Competencies
• Introduction to Program Evaluation
• International Health Regulations
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Challenges
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Challenges
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Challenges
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Challenges
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Challenges
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Challenges
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Challenges
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Challenges
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Challenges
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Challenges
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Our Future
• be a leader in new online
module production
National Schools and
Programs of Public Health
• links with CPHA (network and
professional designation)
• offer module content to schools
and other programs
• expand to alternate learning
formats, including MOOCs
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Future considerations
•
Need for a pan-Canadian and provincial public health human resources
strategy
–
–
–
•
Is this possible and if so, what would it include? How does this related to plans for public
health organizational and system capacity building strategies? Role of Public Health
Network?
Increasing number and diversity of MPH programs – do they address demand?
Do MPH program address front line practitioner and management needs?
Evolving “National Network of Schools and Programs of Public and Population
Health” (NNSPPPH)
–
–
–
Credentialing of public health professionals?
Accreditation of schools and academic programs?
Requirement for public health practitioner participation in planning?
•
In-service professional development programs, human resources changes
local public health agencies? Uptake, dissemination
•
Role of MPH Programs in developing expert leaders for public health
•
MOOCs and free access to educational content
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Jennifer L Chu, MD, MPH, FRCPC
Staff Physician, Department of Emergency Medicine, St. Michael’s
Lecturer, Department of Medicine, University of Toronto
Director of Basic and Clinical Sciences, NextGenU
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Overview
• Overview of distance learning and MOOCs
• Introduction to NextGenU
• Future direction of public health and
MOOCs/NextGenU
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Distance Learning
2000s
1930s
1800s
1996
2010s
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Internet Usage
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What are MOOCs?
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MOOCs
• Coursera, EdX, Udacity largest MOOCs in
the US
• ALISON (Advanced Learning Interactive
Systems Online) one of largest MOOCs
mostly used in developing countries
• MOOCs being developed globally
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MOOCs
PROS
CONS
• Free or low cost for learners
• Credit for courses often costs money
• Self-directed/paced
• Lack of direct human interaction
• Less barriers than traditional
• May lack prestige/acceptability
education
compared with traditional education
• Computerized interactions globally
• Sustainability
• Limitless scalability
• Quality control
• Financial efficiency for institutions
• High drop-out rates
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Kampala Declaration
• WHO identified a need
for 12.9 million more
trained health workers by
2035
• WHO also stated this will
require greater use of
training innovation especially information
and communication
technologies
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NextGenU
• Not a MOOC – a DOOHICHE
Democratically Open, Outstanding
Hybrid of Internet-aided, Computer-aided,
and Human-aided Education
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Course Development
• Identify existing expert-derived core competencies
• Organize competencies into modules
• Match competencies with existing internet resources
from highly reputable sources
• All resources must be freely available and
advertisement-free
• Develop peer and mentor-based activities
• Evaluation
• Review from advisory committee
• Sponsorship from accredited organizations
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Current Courses
• Alcohol, Tobacco Use and Other Substance
Use Disorders
• Climate Change and Health
• Emergency Medicine
• Environmental Health
• War and Health
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Upcoming Courses
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Pilot Tests
• Emergency Medicine course piloted at the
Uniformed Service University of the Health
Sciences and University of Missouri with senior
medical students
• Environmental Health piloted with MPH
students at Simon Fraser University (BC)
• No significant difference found in standardized
testing between control students and
NextGenU students
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Countries Using NextGenU
•
Climate Change and Health
–
•
Environmental Health
–
•
Argentina, Australia, Bangladesh, Belgium, Canada, El Salvador, Germany, Great Britain,
Hrvatska/Croatia, Hungary, India, Italy, Kenya, Nigeria, Pakistan, Philippines, Russian
Federation, Saudi Arabia, Singapore, Sri Lanka, Thailand, United Arab Emirates, United States
War and Health
–
•
Brazil, Bulgaria, Canada, Christmas Island, Denmark, Egypt, Great Britain, Hrvatska/Croatia,
Hong Kong, India, Nigeria, Pakistan, Saudi Arabia, Turkey, United States
Canada, Ecuador, Malaysia, Switzerland, United States
Emergency Medicine
–
Afghanistan, Australia, Bangladesh, Belgium, Bahrain, Brazil, Canada, Columbia, Czech
Republic, Germany, Denmark, Ecuador, El Salvador, Estonia, Egypt, Spain, France, Great
Britain, Greece, Hong Kong, Hrvatska/Croatia, Hungary, Indonesia, Ireland, India, British Indian
Ocean Territory, Italy, Kenya, Latvia, Malaysia, Nigeria, Netherlands, Philippines, Portugal,
Romania, Qatar, Saudi Arabia, Spain, Sri Lanka, Sudan, Sweden, Switzerland, Singapore,
Trinidad and Tobago, Taiwan, US Minor Outlying Islands, United Arab Emirates, United States,
Venezuela, South Africa
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Emergency Medicine
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Future Direction
• Continue to develop courses in basic
sciences, clinical medicine and public health
• Preventative medicine residency curriculum
currently under development
• Goal to create a free MPH
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GROUP DISCUSSION
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Discussion at Tables
• After introducing each other, choose one person to
record
• Where do you see the challenges for the future?
• What would be needed
– To build on existing strengths (strongest collective capacities) at
your place of work?
– To build additional capacities (greatest area of collective
improvement needed) at your place of work?
• How would you go about enabling collective capacity
building to happen at your workplace? In the future?
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Thank you
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TOPHC

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