The Development of a Master of Public Health Program with an Initial Focus on Urban and Immigrant Health at the State University of New York,Downstate Medical Center

The State University Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve Students entered the program in June 2002. Currently, eighty students are enrolled in the program and eighteen have graduated from it in 2004 and 2005. With an initial focus on urban and immigrant health, the program aims to train public health professionals who can assist in addressing through population-based interventions the health issues of Brooklyn’s 2,465,326 people, of whom 38.5% are immigrants to the United States. Starting with four courses in the summer 2002 semester, the program now offers twenty-four courses over the three semesters of the academic year. The program is housed in the Department of Preventive Medicine and Community Health of the College of Medicine and is part-time in nature for most students. In addition to completing required course work, students must also complete a 250-hour practicum experience in which they apply theoretical knowledge in a public health practice setting. Student practicum experiences play a vital role in linking the program to communities and serve as conduits for the initiation of further community based collaboratives. This article describes the challenges encountered in initiating an MPH program in an academic medical center, the importance of both intramural and community support to its success, and the vital role it plays in addressing the health issues of various communities. The program became a leading priority of the Strategic Plan of the Downstate Medical Center in 2000, and received the full support of Downstate’s then new president, Dr. John C. LaRosa. This prioritization and support proved essential to the rapid development of the program. The Downstate MPH program offers a concurrent degree to medical students who are able to complete both degrees in a four year period. The Alumni Fund of the College of Medicine provides each MD/MPH student with a one-time scholarship which covers a quarter of the MPH tuition. Concurrent MPH degrees are also offered for graduate students enrolled in occupational therapy, nursing, and several other health programs. The Council on Education for Public Health (CEPH) conducted an accreditation site visit of the Downstate MPH program in December 2004. On June 10, 2005, the CEPH Board accredited the program for 5 years. Pascal James Imperato, MD, MPH & TM is Distinguished Service Professor and Chair, Department of Preventive Medicine and Community Health and Director of the Master of Public Health Program, SUNY Downstate Medical Center; Judith H. LaRosa, PhD, RN is Professor of Preventive Medicine and Community Health and Deputy Director of the Master of Public Health Program, SUNY Downstate Medical Center; Leslie Schechter, MA is the Administrator for the Department of Preventive Medicine and Community Health and the Master of Public Health Program, SUNY Downstate Medical Center.     

The Correlation between Global Health Experiences in Low-Income Countries on Choice of Primary Care Residencies for Graduates of an Urban US Medical School

This study sought to determine whether medical students who participate in a global health elective in a low-income country select residencies in primary care at higher rates compared with their classmates and US medical graduates in general. Given the projected increase in demand for primary care physicians, particularly in underserved areas, understanding possible factors that encourage training in primary care or enhance interest in the care of underserved populations may identify opportunities in medical school training. The authors used data from the Office of Student Affairs, SUNY Downstate College of Medicine and the National Residency Matching Program to compare rates of primary care residency selection from 2004 to 2012. Residency selections for students who participated in the SUNY Downstate School of Public Health Global Health Elective were compared with those of their classmates and with residency match data for US seniors. In 7 of the 8 years reviewed, students who participated in the SUNY Downstate School of Public Health Global Health Elective selected primary care residencies at rates higher than their classmates. Across years, 57 % of the students who completed the elective matched to primary care residences, which was significantly higher than the 44 % for the remainder of Downstate''s medical student class (p = 0.0023). In 6 of the 8 years, Downstate students who participated in the Global Health Elective selected primary care residencies at rates higher than US medical school seniors in general; rates were the same for both Downstate Global Health Elective students and US medical school seniors in 2009. Students who participated in a global health experience in a low-income country selected primary care residencies at higher rates than their classmates and US medical school graduates in general. Understanding how these experiences correlate with residency selection requires further investigation; areas of future study are discussed.     

Review of MPH Practicum Requirements in Accredited Schools of Public Health

Accreditation criteria by the Council on Education for Public Health (CEPH) state that prior to graduation, Masters of Public Health (MPH) students must demonstrate the application of knowledge and skills through a practice experience, commonly called the “Practicum.” The purpose of this research was to review those MPH Practicum requirements. Practicum guidelines from US-based schools of public health that were accredited as of October 2011 were reviewed. Data on each Practicum’s level of coordination, timing, and credit and contact hours as well as information about written agreements, preceptors, and how the Practicum was graded were collected. Seventy-four Practicums in 46 accredited schools of public health were reviewed. The majority (85 %) of accredited schools controlled the Practicum at the school-level. Among the Practicums reviewed, most did not require completion of any credit hours or the MPH core courses (57 and 74 %, respectively) prior to starting the Practicum; 82 % required written agreements; 60 % had stated criteria for the approval of preceptors; and 76 % required students to submit a product for grading at the conclusion of the Practicum. The results of this research demonstrate that the majority of accredited schools of public health designed Practicum requirements that reflect some of the criteria established by CEPH; however, issues related to timing, credit and contact hours, and preceptor qualifications vary considerably. We propose that a national dialogue begin among public health faculty and administrators to address these and other findings to standardize the Practicum experience for MPH students.     

Teaching Public Health Practitioners about Health Communication: The MPH Curriculum Experience

The dissemination of health information to the public often occurs through the mass media. Media strategies as a component of behavior change assume knowledge of communication theories and methods by public health practitioners. We surveyed the curricula of 52 accredited graduate programs leading to the Master's in Public Health (MPH) degree to assess their communication component. Graduate bulletins for admission year 1996 were examined for public health mission statement, goals and objectives of the MPH training program, and for course titles. Courses were identified as having a communication focus if the terms communication, information, marketing or media were used in the title. There were a total of 82 communication courses offered, with 65 courses in 26 Schools of Public Health (SPH), 13 courses in 18 Community Health and Preventive Medicine departments (CHPM), and 4 courses in 8 Community Health Education departments (CHE). The difference in mean number of health communication courses was significant by type of MPH program (p < 0.003) with SPH offering an average of 3 courses, CHPM departments offering an average of 1 course, and CHE offering an average of 0.5 course. The distribution of communication courses ranged from 10 courses to 0 courses per program. Seven SPH offered 3 or more communication courses, whereas 5 SPH offered no health communication courses in the MPH curriculum. These data point to a shortcoming in the training of MPH students in health communication theory and skills as ascertained by course titles in graduate bulletins.     

Advising the Newest Faces of Public Health: A Perspective on the Undergraduate Student

In the 20th century, public health education in the United States existed as a professional degree program, with training at the masters (MPH) and doctoral (PhD, DrPH, and ScD) levels.Today, the system is rapidly evolving as undergraduate majors, minors, and concentrations are establishing themselves around the country. This new focus of public health education, rooted in a liberal arts environment, is distinct from the professional training of graduate school. As such, undergraduate public health students have unique characteristics and needs that should be considered as part of the advisors’ responsibility to provide meaningful, relevant advising.The perspective and comments presented here are largely based on the authors’ nearly 30 years of combined experience in undergraduate public health education.HISTORICALLY, PUBLIC health and medicine were closely tied in the United States. In the early 1900s, the Flexner and Welch–Rose Reports distinguished between the two,¹ with the former addressing a failing medical education system and the latter recognizing public health as a separate entity with specific training needs. These documents set the stage for establishing formal public health education as a professional degree program. The educational structure was highly debated, with Welch advocating for a system that incorporated research and practical training, drawn respectively from German and English models. This system was epitomized in the Johns Hopkins School of Hygiene and Public Health (today The Bloomberg School of Public Health), founded in 1916. Other schools of public health, such as those at Harvard, Yale, Columbia, and Michigan, quickly followed. As the demand for training exceeded the capacity of existing programs, federal funds were later allocated for additional schools.¹Today, the Association of Schools of Public Health (ASPH) includes 41 fully accredited institutions and 6 associate members.² Each entity offers masters and doctoral degrees with a comprehensive curriculum rooted in 5 core disciplines: epidemiology, biostatistics, environmental health, health education and behavioral science, and health services administration. The Council on Education for Public Health accredits an additional 74 programs that support public health degrees that may or may not offer specific concentrations.³     

A Third world international health elective for U.S. medical students. The 16-year experience of the State University of New York,Health Science Center at Brooklyn

The Department of Preventive Medicine and Community Health at the State University of New York, Health Science Center at Brooklyn (SUNY, HSCB) instituted an eight-week third world international health elective for fourth year medical students in 1980. Since that time, ninety students have participated. The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system in a third world country, to provide medical service, and to have a crosscultural experience. The emphasis in this elective is on public health, preventive medicine, and primary care. There is a high level of student competition for this elective, with 46.9% of applicants having been accepted over a fifteen-year period. Although women comprise 40% of the average medical school class, they represent 50% of participants in this elective program. The percentage of African-American and Hispanic students has been 20%. These two minority groups represented from 8% to 10% of the student body during the period under study. Careful screening, including an examination of academic records and personal interviews, has resulted in the selection of highly motivated, adaptable, and dedicated students who have performed well at overseas sites. Student satisfaction levels with this elective are extremely high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to going overseas. This covers issues related to individual health and safety, travel and lodging, and the nature of the host country culture, health care system, and assignment site. Our students are especially experienced at cross-cultural understanding because of the unusual diversity of the patients they treat in Brooklyn, and the ethnic diversity of local hospital staffs and the medical school class. This Brooklyn experience in cross-cultural understanding has been cited by many participants as having been the best preparation for functioning in a foreign culture. The Alumni Fund of the College of Medicine has strongly and consistently supported this elective both with philosophical commitment and financial grants to help defray travel costs. This type of support is unusual among medical schools in New York City. Overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for students.     

A Survey of Physicians Who Studied Public Health During Medical School

Introduction:The need for more physicians trained in prevention, research methods, and management has been argued by many leaders in medical education. Columbia University attempts to address this need by providing medical students with a variety of options for studying public health.Methods:A survey of Columbia’s medical graduates who had taken elective courses in public health explored the reasons they began their studies, why some did not continue, their assessment of the value of public health courses, and their careers after graduation.Results:Responses were received from 60 graduates. Health policy, international health, and clinical prevention were the primary interests leading them to study public health. Courses in epidemiology, biostatistics, and policy and management were cited as most useful. The pressure of clinical training was the major reason why some did not complete the master of public health (MPH) degree in a timely fashion. Among students who had enrolled in the MPH program and finished medical school before 1990, 84% eventually received the MPH, although some took as many as 12 additional years to complete the degree. Medical students who studied public health did not differ greatly from their classmates in their specialty choices, but those who completed the MPH chose academic, governmental, and corporate practice settings more frequently than other young physicians, and devoted more time to non-clinical activities.Conclusion:Public health educators can serve a variety of career needs for future physicians. In addition to personal interests, the presence of role models is an important reason students begin studying public health.     

New Public Health education in the Republic of Macedonia: expectations, experiences and perspectives

Development of a strategy in public health (PH) education is crucial for Macedonia in providing modern education for actual PH practice. Establishing a School of Public Health (SPH) is vital for a country in a health transition with high rates of preventable diseases. The main strategic goals in modern PH education in Macedonia should be capacity building, improving the competencies of PH professionals, serving communities, participating in the policy, and partnership development. Expectations were expressed through two key points: strengthening institutional capacity in the area of PH and institutional development of SPH. The organizational structure of the new Center of Public Health is based on existing human resources and infrastructure. Medical Faculty initiated development of a postgraduate PH teaching program [Master of Public Health (MPH)] provided by the newly formed Center of Public Health within the Medical Faculty Skopje. The Macedonian MPH program has been developed with modular-type courses as a part-time teaching program in four semesters within a 2-year period. This program is designed to cover all the basics of PH sciences and practice, including basic and elective courses, workshops, research forum. and master's thesis with a credit transfer system in PH education. The main assets for SPH development are knowledge and skills of the constantly improving teaching staff. Successful preliminary evaluation of the Macedonian SPH project, being qualified “as a model for SPH development,” led to full Association of Schools of Public Health in the European Region (ASPHER) membership. Sustainability of this program will require continuing support although a remarkable beginning has been achieved. The next strategic goal is continuing development of SPH with fiscal and academic autonomy and preparing formal ASPHER Public Health Education European Review (PEER). This SPH recognized the main communicating message of the New Public Health: “Moving with the time.” New Public Health is determined by a dual approach: to be modern, and to grow and to build the tradition in PH education. The development of Macedonian SPH represents a new orientation toward science, philosophy, culture, and life and promotes new spirit and movement in PH in this region of Europe.     

The Hebrew University--Hadassah Braun School of Public Health and Community Medicine: its international role and experience

For more than 40 years the Hebrew University-Hadassah Braun School of Public Health and Community Medicine has been involved in the training of public health professionals from Israel and around the world. The Israeli MPH course has graduated more than 600 professionals who occupy senior posts in the Israeli health service system. The parallel International MPH (IMPH) course (in English) has produced almost 600 graduates from some 80 countries, especially in the developing world. They have returned home to make a major contribution to public health and the public's health is their countries. In recent years there has been a growing number of graduates from countries in Eastern Europe and those of the former Soviet Union. The School has defined its mission as improving the health of the population of Israel and internationally through training, research, and service. Recently a special PhD program for outstanding graduates of the IMPH has been instituted. This international experience has laid the foundation for growing collaboration and support for newly developing Schools of Public Health in Europe and elsewhere.     

MPH Program Adaptability in a Competitive Marketplace: The Case for Continued Assessment

In the last several years, the number of Master of Public Health (MPH) programs has increased rapidly in the US. As such, MPH programs, particularly smaller-sized ones, need to critically examine how their programs are meeting the needs and preferences of local public health practitioners. To assist in this necessity, the University of New Hampshire conducted a comprehensive educational assessment of its effectiveness as a smaller-sized, accredited MPH program. The aim of the assessment was to review the MPH program from the perspective of all stakeholders and then to agree on changes that would contribute to the fulfillment of the program’s mission, as well as improve program quality and reach. The program’s stakeholders examined the following components: policy development and implementation; target audience; marketing strategies; marketplace position; delivery model; curriculum design; and continuing education. Though assessment activities explored a wide array of program attributes, target audience, curriculum design, and delivery strategy presented significant challenges and opportunities for our smaller MPH Program to remain competitive. The effort put forth into conducting an in-depth assessment of the core components of our program also allowed for a comparison to the increasing number of MPH programs developing regionally. Since public health practice is changing and the education of public health practitioners must be adaptable, we propose that a routine assessment of an institution’s MPH program could not only meet this need but also assist with keeping smaller, unbranded MPH programs competitive in a burgeoning marketplace.     

Survey of accredited master of public health (MPH) programs with health education concentrations: a resource for strengthening the public health workforce

The authors designed survey research to assess accredited master of public health (MPH) programs with health education concentrations. A Web-based survey was distributed to program directors and was used to collect characteristics of program faculty, students, graduates, internships, employment, and competency development. Results indicate that students and graduates are diverse; 72% of students complete internships and 61% of graduates work in government or community public health-related agencies; 98% of faculty hold a doctoral degree and 67% have at least one degree from an accredited public health school or program; and 85% of programs build competencies in most of the Institute of Medicine-suggested areas. The authors conclude that accredited MPH programs with a concentration in health education train diverse public health practitioners highly likely to work in a government or community public health agency with competencies to enhance public health.     

Framework for the strategic and business planning of the Centre – School of Public Health, Belgrade

The science and practice of the New Public Health have a key role in the promotion of people’s health and in the reform of the health system. Serbia experienced many social and economic threats to public health during the 1990s when the health infrastructure both for curative and preventive services gradually deteriorated. Existing skills and knowledge of public health professionals are insufficient in virtually all fields of public health activities. The foundation of the Centre – School of Public Health, within the Medical School of Belgrade University has been a precondition for the improvement of professional training in public health. The objectives are described as (1) education of capable experts in the field of public health, (2) improvement of knowledge in the health sciences, (3) health promotion in cooperation with local communities, (4) training of competent researchers in the field of public health and (5) improvement of the process of decision making and policy formulation. The training programme covers five key areas of education in the domain of public health: (1) public health in Europe, (2) epidemiology and biostatistics, (3) health policy and management, (4) health promotion, health education and social sciences and (5) environment and health. In the first year, 27 students were admitted for the Master of Public Health programme and more than 350 participants attended various short courses for continuing education in public health and health management based on applied learning approach. The next developmental steps focus on sustainability of the programmes for continuing education and research and a wider national and international partnership.     

Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health

Background  

1) To elicit the opinions of the Public Health alumni of the MPH program; 2) To assess the applicability of the knowledge and skills acquired; 3) To identify the frequency of the public health competencies that the alumni performed.     

Teaching statistics in schools of public health

Biostatistics plays an important role in the education and training of public health students. The aim of this paper is to discuss issues associated with the teaching of biostatistics for master in public health (MPH) students. It characterizes the student body, describes the aims of teaching statistics, and considers how and what should be taught. This paper reflects my experience in both coordinating and teaching biostatistics in the Braun School of Public Health, which is part of the Hebrew University-Hadassah Medical Center. The school runs two MPH programs: an Israeli program and an international one.     

Development of a Master of Public Health programme in Tirana, Albania

In 2001, two Albanian institutions, the Department of Public Health, Faculty of Medicine, University of Tirana and the National Institute of Public Health obtained membership to the Association of Schools of Public Health for the European Region (ASPHER). Since 2000, these two institutions have been members of the Public Health for South Eastern Europe (PH-SEE) network. Furthermore, in the fall of 2001, the Open Society Institute (OSI) and ASPHER launched a project that culminated in the establishment of a School of Public Health (SPH) and the commencement of the first Master of Public Health (MPH) programme in Tirana. The MPH programme began in December 2005 and enrolled 32 students from different backgrounds. A suitable start for the development of the MPH programme was the implementation of key modules developed by the European MPH programme. In addition, specific modules reflecting the needs of Albania were designed according to the preferences and the heterogeneous lecturing faculty involved in public health training. International guest lecturers delivered other modules, with ASPHER and the PH-SEE network offering an excellent solution for complementary modules in different public health disciplines. However, the newly established SPH in Albania should now strive for other postgraduate teaching programmes, undergraduate programmes, and especially service training and continuing education.     

Promoting Environmental Health Policy Through Community Based Participatory Research: A Case Study from Harlem, New York

Community–academic partnerships have demonstrated potential for studying and improving community and environmental health, but only recently have their policy impacts been systematically studied. This case study highlights the evolution, research, and policy processes and outcomes of a community based participatory research (CBPR) partnership that has had multilevel impacts on health policy concerning diesel bus emissions and related environmental justice issues. The partnership between West Harlem Environmental ACTion, Inc. (WE ACT) and the Columbia University Center for Children’s Environmental Health was explored using a multimethod case study approach. The conversion of New York City’s bus fleet to clean diesel and the installation by the EPA of permanent air monitors in Harlem and other “hot spots” were among the outcomes for which the partnership’s research and policy work was given substantial credit. Lessons for other urban community–academic partnerships interested in using CBPR to promote healthy public policy are discussed. Dr. Minkler is with Health and Social Behavior, School of Public Health, University of California, Berkeley, CA, USA; Ms. Shepard is with West Harlem Environmental ACTion, Inc., 271 West 125th Street Suite # 308, New York, NY, 10027, USA.     

Bringing comprehensive health education to the New York City Public Schools: a private-public success story.

The New York Academy of Medicine has pioneered a far-sighted effort which successfully introduced two model health education curricula into the New York City Public Schools at both the elementary and middle school levels. The curriculums for kindergarten through sixth grades, Growing Healthy, are currently being used in 525 of New York''s 625 elementary schools, and the curriculum for seventh and eighth grades, Being Healthy, is in place in 60 of 200 junior high schools. These curricula offer a comprehensive approach to health education that promotes emotional well-being as well as physical health by improving health behaviors, attitudes, and academic performance of students through hands-on and interactive activities which develop decision-making skills and the ability to make healthful choices. The program has met with ongoing success and expanding influence, as the result of several important factors. First, the New York Academy of Medicine took a leadership role in supporting a venture outside its own walls and became an active advocate for comprehensive health education in the public schools. The Academy''s standing as a prestigious yet independent medical association brought influence to the organizing efforts and contributed the credibility needed to get the program off the ground. Second, the Division of Student Support Services of the New York City Public Schools gave strong acceptance and cooperation leading to ongoing financial support and institutionalization of the program. Added to that is the enthusiasm of teachers, administrators, and other in-school personnel who have made the lessons of Growing Healthy and Being Healthy meaningful by reaching hundreds of thousands of students across New York City. Another important factor is the oversight and longevity which has been provided by the unusual gathering of doctors, educators, public health specialists, funders, and city administrators who created an effective private-public coalition 15 years ago and have remained committed to working together. Last through its ongoing efforts, the Academy''s Office of School Health Programs has stayed at the forefront of developments in health education. By continuing to evaluate their activities and by constantly integrating new materials into the existing curricular framework, they have demonstrated that a comprehensive health education program can be both meaningful to children and responsive to community needs by reflecting current public health issues and concerns.     

Feasibility of an Extended MPH Degree Program for fully employed practicing health professionals.

This report describes the first four years of operation of the Extended MPH Degree Program of the University of Washington School of Public Health and Community Medicine and the features that might explain its initial success. The format of the curriculum is radically different from the traditional two-year program of studies leading to the master of public health degree. Over a three-year span of intensive, on-campus courses and seminars, students are able to fulfill all academic and institutional requirements necessary for the MPH degree. Many more applicants have enrolled for the Extended Degree Program than for the regular MPH program. The 94 students who have matriculated into the program are employed mainly in government agencies in eight western states and British Columbia; most have their prior professional training in nursing and medicine with a median of nine years professional experience. The academic performance of these students is comparable to that of regular full-time MPH program students. The administrative, fiscal, and instructional problems raised by such a transformation have been overcome and the demand for the program and our experience to date suggest that extended MPH degree programs are both feasible and desirable.     

Integration of academia and practice in preparedness training: the Harvard School of Public Health experience

Given the need for public health professionals well trained in emergency preparedness and response, students in public health programs require ample practical training to prepare them for careers in public health practice. The Harvard School of Public Health Center for Public Health Preparedness has been instrumental in the creation and implementation of a course entitled, "Bioterrorism: Public Health Preparedness and Response." This course features lectures on specific applications of public health practice in emergency preparedness and response. In addition, it provides students the opportunity to operationalize and apply their knowledge during an interactive tabletop exercise. In light of their university affiliations and expertise in providing preparedness training, other Academic Centers for Public Health Preparedness have the opportunity to be instrumental in providing similar training to graduate students of public health.