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Competency based education in Public Health

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Competency-based education in Public Health, a model of employing Hybrid-PBL educational method in building core Public Health competencies at the undergraduate medical education.

Competency-based education in Public Health, a model of employing Hybrid-PBL educational method in building core Public Health competencies at the undergraduate medical education.

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  • 1. Competency-Based Education in Public Health A provisional non-tested model Tarek Tawfik Amin Professor Public Health and Community Medicine Faculty of Medicine, Cairo University. amin55@myway.com 3/20/2014 Competency-based learning 1Public Health
  • 2. 3/20/2014 Public Health Competency-based learning 2 Objective: To provide a provisional problem-based educational model aiming at enhancing the core Public Health competencies of undergraduate medical students. The objective of this presentation is:
  • 3. 3/20/2014 Public Health Competency-based learning 3 Introduction: oPublic health response to new threats, oGlobalization of complex health-related challenges *, oRadical new professional approaches empowering individuals and communities to promote health and prevent disease, oPublic health professionals prepared to react quickly and competently **. * - Sharma K, Zodpey S; Gaidhane A; Syed ZQ; Kumar R; Morgan A. Designing the Framework for Competency-Based Master of Public Health Programs in India. J P u b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(1), 30–39 -** Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424 DOI 10.1007/s10389-009- 0256-7. ***- An Environmental Scan of Best Practices in Public Health Undergraduate Medical Education REPORT 1: Peer-Reviewed Literature Scan MARCH 2009. Prepared by the Nevis Consulting Group for the Association of Faculties of Medicine of Canada (AFMC) Public Health Task Group. Public Health Competencies: ***  Competency: capacity to act effectively in a specific situation, mobilize knowledge and put knowledge into action.  Not only knowledge („know-how‟), includes the skills and attitudes („show-how‟).
  • 4. 3/20/2014 Public Health Competency-based learning 4 The process [development of competency-based curriculum] * Identification of public health competencies Specifications: -Competencies to be covered -Competencies to be enhanced -Methods -Evaluation and assessment Mapping of competencies and learning objectives Gap analysis for the current status Future planning and review * - Building the Public Health Workforce for the 21 Century. A Pan-Canadian Framework for Public Health Human Resources Planning. 2005.
  • 5. Cancer screening in undergraduate medical curriculum as a model to enhance core Public Health Competencies. 3/20/2014 Public Health Competency-based learning 5 The topic:
  • 6. Proposed Core competencies and competencies statements* 3/20/2014 Public Health Competency-based learning 6 * CDC, WHO, CanMED and others. , Competencies statements Core Public Health competency domains Principles of Epidemio logy Basic Biostatisti cs Social and behavior al sciences Health care system, policy, and planning Environ mental health Crosscu tting domains 3- Demonstrate critical appraisal of different screening modalities √ √ √ 4-Identify principles and limitations of screening tests √ √ √ 5-Identify risk factors for non-communicable diseases, implications for their prevention and control. √ √
  • 7. 3/20/2014 Public Health Competency-based learning 7 Proposed Core competencies and competencies statements (cont.) Competencies statements Core Public Health competency domains Principle s of Epidemi ology Basic Biostatisti cs Social and behavioral sciences Health care system, policy, and planning Environ mental health Crosscut ting domains 8-Demonstrate competence in identifying, obtaining, and critically reviewing literature form different sources √ √ 9-Identify the behavioral determinants for health behavior change √
  • 8. 3/20/2014 Public Health Competency-based learning 8 Proposed Core competencies and competencies statements Competencies statements Core Public Health competency domains Principle s of Epidemi ology Basic Biostatisti cs Social and behavioral sciences Health care system, policy, and planning Environ mental health Crosscut ting domains 13-Produce/deliver oral/written health education message of his/her own choice √ √ 14-Demonstrate ability to think critically √ √
  • 9. Proposed Educational methods 3/20/2014 Public Health Competency-based learning 9 Method/strategy  Hybrid.  Medical students: Undergraduate, 2nd-3rd year.  Pre-requites: basic science, cancer biology.  Duration: 2 weeks  Weeks:1st lecture, problem case, discussion sessions, self learning, 2nd week: discussions, presentation, self reflection, self learning.  Field contact: primary health care facility  Facilitators: Public Health faculty.
  • 10. 3/20/2014 Public Health 10 The PBL case: Breast cancer screening Problem Scenario Identify Facts Formulate and analyze problem Generate Hypotheses ID Knowledge Deficiencies Apply new knowledge Self-Directed Learning Evaluation Abstraction Identify main ideas/keywords Identify key questions Writing of learning objectives The figure from - COMPETENCY-TO-CURRICULUM TOOLKIT: Developing Curricula For Public Health Workers, Center for Health Policy Columbia University School of Nursing and Association of Teachers of Preventive Medicine (2004). - Caitlin Ryan Problem Based Learning Medical Science II (2009).
  • 11. 3/20/2014 Public Health Competency-based learning 11 The process: The three Cs of PBL process *. Contextual 1. Students are presented with a problem 2. PBL discussion, clarify the facts, define problem, brainstorm, identify learning needs . 3. Independent study (library, databases, experts ) Collaborative 4. Sharing information, peer teaching and collaborative working Constructive 5. Present solution to the problem 6. Review what learned , engage in self, peer and tutor review of process and reflections on contribution 1- Retention; 2- Integrated knowledge; 3- lifelong learning; 4- Early exposure; 5- Student-staff liaison; 6- Overall motivation. Advantages ** * Hartling L, Spooner C, Tjosvold L, and Oswald A: Problem-based learning in pre-clinical medical education: 22 years of outcome research. Med.Teacher 2010, 32:28-35. ** Miller SK. Comparison of student outcomes following problem-based learning instruction versus traditional lecture learning in a graduate pharmacology course. J Am Acad Nurse Pract 2003;15:550-6.
  • 12. - Mrs. C is a rural Egyptian housewife aged 52 years, with technical diploma education, and has 4 children. She showed up to the primary care physician complaining of lump in her left breast. Examination revealed a mass measuring 2 cm at the upper right quadrant of her left breast and the axilla was free. Mrs. C is diabetic with previous history of lumpectomy of a benign lesion from her right breast at the age of 39. She loss her period three years back, and mentioned the intake of hormonal contraception for 10 years. Mrs. C was so anxious about her condition as she mentioned the death of her mother with breast cancer at the age of 49 years plus she heard from a T.V show that breast cancer is a familial condition. 3/20/2014 Public Health Competency-based learning 12 The problem case: Relevancy to public health, Interest of the involved students, and Accessibility to search. * * - Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424
  • 13. 3/20/2014 Public Health Competency-based learning 13 Relevant learning questions: Examples 1. What are the common risk factors for breast cancer? 2. Does breast cancer can be prevented? 3. What are the available screening tests? 4. How effective are these tests? 5. Do these tests of value in reducing mortality? 6. Are women in rural areas receiving equal services as urban?
  • 14. 3/20/2014 Public Health Competency-based learning 14 Relevant sources and documents Textbook: - Breast Cancer Epidemiology Li, Christopher (Ed.) 2010, XIII, 417p. 19 illus. Springer. - Cancer Epidemiology: Principles and Methods IARC Nonserial Publication. Edited by I. Dos Santos Silva. 999; 425 pages. ISBN 92 832 0405 Open resources: -http://www.cdc.gov/cancer/breast/index.htm - http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/ - http://www.who.int/cancer/detection/variouscancer/en/ -http://www.who.int/cancer/nccp/en/ Documents: - National breast cancer screening guidelines / Egyptian cancer registry - Facilitator‟s case-book/guidelines - Student‟s guidelines notes and case portfolio. Availability of subject‟s experts: Epidemiologist, Oncologist, Primary physician, Health education consultant.
  • 15. 3/20/2014 Public Health 15 Learning Objectives: examples 1) Identify the different genetic/behavioral/environmental risk and protective factor for breast cancer 2) Recognize and communicate the recommended case-wise guidelines for breast cancer screening 3) Criticize the efficiency of different breast cancer screening methods. 4) Apply and interpret the basic epidemiological terms in describing the risk (Odds, relative risk). 5) Define the potential factors influence health disparity in Egypt especially the socio-economic and geography. An: Analysis K: Knowledge Ap: Application C: Comprehension Cognitive domains Bloom’s * Taxonomy Ev: Evaluation A p C A n K E v * Bloom BS, Englehart MD, Furst EJ, Hill WH, Krathwohl DR. Tax- onomy of educational objectives: handbook I: cognitive domain. New York: David McKay; 1956.
  • 16. 3/20/2014 Public Health 16 Competency-based education [Methods and assessment plan]:Skill stage (Dreyfus)* Objectives Bloom’s Taxonomy Teaching methods Assessment method New learner (awareness stage) - Identify the different risk and protective factors - Assess barriers and promoters for screening - Define potential factors influence health disparity Knowledge and comprehensi on Orientatio n lecture self learning Case study Written test (pre-post) Discussion sessions participation Advanced learner (proficiency stage) - Recognize and communicate the recommended case wise- guidelines for screening Application Analysis Case scenario Discussion Field Observation Self reflection Presentation s Experienced learner (mastery stage) - Value the risk for cancer based on patient’s risk factors background. Synthesis Evaluation Case study Self learning Field Observation checklist Written test* Dreyfus HL, Dreyfus SE. Mind over machine: the power of human intuition and experience in the era of the computer. Oxford: Basil Blackwell; 1986.
  • 17. 3/20/2014 Public Health Competency-based learning 17 Competency mapping: Examples Learning Objectives Competencies 3 4 5 8 9 13 14 -Identify the different risk and protective factor for breast cancer K C C K - Define the potential factors influence health disparity. K A p - Recognize and communicate the recommended case wise-guidelines for screening Ap A n - Criticize the different methods used in screening. Ev A p - Apply and interpret the basic epidemiological terms in describing the risk (Odds, relative risk). An A p K= Knowledge, C=Comprehension, An=Application, An=Analysis, Ev= Evaluation
  • 18. Current status More competencies Modifications Future plan 3/20/2014 Public Health Competency-based learning 18 Gap Analysis of the model:
  • 19. 3/20/2014 Public Health Competency-based learning 19 Thank you
  • 20. - Czabanowska , Moust JHC, Peter Schröder-Bäck P, Roebertsen H. Problem-based Learning Revisited, introduction of Active and Self-directed Learning to reduce fatigue among students. Journal of University Teaching & Learning Practice. 9(1), 2012. Available at:http://ro.uow.edu.au/jutlp/vol9/iss1/6. - Czabanowska K, Smith T, Ko KD , Sumskas L, Otok R, Bjegovic-Mikanovic V, Brand H. In search for a public health leadership competency framework to support leadership curriculum–a consensus study. European Journal of Public Health, 2013, 1– 6. doi:10.1093/eurpub/ckt158. - Sharma K, Zodpey S; Gaidhane A; Syed ZQ; Kumar R; Morgan A. Designing the Framework for Competency-Based Master of Public Health Programs in India. J P u b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(1), 30–39 - Brownie S, Thomas J, Bahnisch M . Exploring the Literature: Competency-based Education and Training & Competency-Based Career Frameworks. Report by the National Health Workforce Planning & Research Collaboration. Faculty of Health Sciences and University of Queensland Centre for Clinical Research, University of Queensland, Australia October 2011. - Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424 DOI 10.1007/s10389-009-0256-7. - An Environmental Scan of Best Practices in Public Health Undergraduate Medical Education REPORT 1: Peer-Reviewed Literature Scan MARCH 2009. Prepared by the Nevis Consulting Group for the Association of Faculties of Medicine of Canada (AFMC) Public Health Task Group.3/20/2014 Public Health Competency-based learning 20 References
  • 21. - Kristine M. Gebbie, KM; Weist EM; McElligott JE; Biesiadecki LA; Gotsch AR; Keck W et al. Implications of Preparedness and Response Core Competencies for Public Health. J P u b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(3), 224–230. - Mainor A; Leeman J, MDiv; Sommers J, Heiser C; Gonzales C; Farris RP et al . A Systematic Approach to Evaluating Public Health Training: The Obesity Prevention in Public Health Course. J P u b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 00(00), 1–7 - Building the Public Health Workforce for the 21 Century. A Pan-Canadian Framework for Public Health Human Resources Planning. 2005. - Competencies and Learning Objectives. a technical assistance document. Accreditation Criteria for Schools of Public Health, June 2011, and Accreditation Criteria for Public Health Programs, June 2011, for the accreditation criteria. - Cultural Competence Education for Students in Medicine and Public Health Report of an Expert Panel. Joint Expert Panel Convened by the Association of American Medical Colleges and the Association of Schools of Public Health. July 2012. - Public Health Education and Training in the Context of an Enlarging Europe. A guide towards a more effective, comparable and mobile work force across Europe. 2009. - Hai-chao LI and Chen W. Reform direction of medical education in China: implementing “competency-based” medical education. Chinese Medical Journal 2013;126 (17). - Hou SI. Integrating Problem-based Learning with Community-engaged Learning in Teaching Program Development and Implementation. Universal Journal of Educational Research 2(1): 1-9, 2014 http://www.hrpub.org DOI: 10.13189/ujer.2014.020101. - Hoover CR, Wong CC, Azzam A. From primary care to public health: using problem-based learning and the ecological model to teach public health to first year medical students. J Community Medicine, 2011, DOI 10.1007/s10900-011-9495-y.3/20/2014 Public Health Competency-based learning 21 References
  • 22. - Jabbari H, Bakhshian F,Alizadeh M, Alikhah H, Behzad MN. Lecture-based Versus Problem-Based Learning Methods in Public Health Course for Medical Students. Res Dev Med Educ, 2012, 1(2), 31-35. - Calhoun JG, Rowney R, Eng E, Yael Hoffman Y. Competency Mapping and Analysis for Public Health Preparedness Training Initiatives. Public Health Reports, 2005 Suppl 1 (120), 91-99. - COMPETENCY-TO-CURRICULUM TOOLKIT: Developing Curricula For Public Health Workers, Center for Health Policy Columbia University School of Nursing and Association of Teachers of Preventive Medicine (2004). - Caitlin Ryan Problem Based Learning Medical Science II (2009). - Miller SK. Comparison of student outcomes following problem-based learning instruction versus traditional lecture learning in a graduate pharmacology course. J Am Acad Nurse Pract 2003;15:550-6. Public Health Association of Canada (2007) Core competencies for public health in Canada. PHAC, Ottawa. (www.phac-aspc.gc.ca/core_competencies). - Hartling L, Spooner C, Tjosvold L, and Oswald A: Problem-based learning in pre- clinical medical education: 22 years of outcome research. Med.Teacher 2010, 32:28-35. Bloom BS, Englehart MD, Furst EJ, Hill WH, Krathwohl DR. Tax- onomy of educational objectives: handbook I: cognitive domain. New York: David McKay; 1956. 3/20/2014 Public Health Competency-based learning 22 References
  • 23. Details of the learning Questions, Objectives, Competencies and Mapping. 3/20/2014 Public Health 23
  • 24. Proposed Core competencies and core public health domains 3/20/2014 Public Health Competency-based learning 24 CDC, WHO, CanMED and others. , Competencies statements Core Public Health competency domains Principles of Epidemiology Basic Biostatistics Social and behavioral sciences Health care system, policy, and planning Environmen tal health Crosscutting domains 1-Apply the basic terminology and definitions of epidemiology √ 2-Describe a public health problem in person, time and place. √ √ 3-Critical appraisal of different screening modalities √ √ √ 4-Identify principles and limitations of screening programs √ √ √ 5-Identify risk factors for non- communicable diseases, implications for their prevention and control. √ √ √ 6-Define health issues form social perspectives √ √ 7-Describe health care disparities in relation to geographical, social and economical factors √ √
  • 25. Proposed Core competencies and core public health domains 3/20/2014 Public Health Competency-based learning 25 Competencies statements Core Public Health competency domains Principles of Epidemiology Basic Biostatistics Social and behavioral sciences Health care system, policy, and planning Environmen tal health Crosscutt ing domains 8-Demonstrate competence in identifying, obtaining, and critically reviewing literature form different sources √ √ 9-Identify the behavioral determinants for health behavior change √ 10-Describe the interaction of physical and social environment and health √
  • 26. Proposed Core competencies and core public health domains 3/20/2014 Public Health Competency-based learning 26 Competencies statements Core Public Health competency domains Principles of Epidemiology Basic Biostatistics Social and behavioral sciences Health care system, policy, and planning Environment al health Crosscutting domains 11-Demonstrate leadership skills , and team building skills √ 12-Demonstrate interpersonal communication skills (problem solving, listening, conflict resolution and decision) √ 13-Produce/deliver oral/written health education message of his/her own choice √ √ 14-Demonstrate ability to think critically √ √ √
  • 27. 3/20/2014 Public Health Competency-based learning 27 Relevant learning questions 1. What are the common risk factors for breast cancer? 2. Does breast cancer can be prevented? 3. What are the available screening tests for breast cancer? 4. How effective are these tests? 5. Do these tests of value in reducing mortality from Breast cancer? 6. What are the barriers to women getting these recommended screening tests? 7. What factors promote the uptake of screening? 8. How we are going to increase women’s awareness about breast cancer screening? 9. Are women in rural areas receiving equal health care services as urban? 10. Are the current policies-programs for breast cancer
  • 28. By the end of this case, undergraduate medical students should be able to: 3/20/2014 Public Health 28 Intended learning outcomes (ILO) 1) Recall the epidemiological features and risk factors responsible for the development of non-communicable disease with especial reference to cancer. 2) Identify the different genetic/behavioral/environmental risk and protective factor for breast cancer 3) Define the basic pillars for screening tests namely sensitivity/specificity/predictive values 4) Recognize and communicate the recommended case wise-guidelines for breast cancer screening 5) Criticize the different methods used in screening in terms of false positive/negative, labeling, lead time effect ect., 6) Apply and interpret the basic epidemiological terms in describing the risk (Odds, relative risk). 7) Value the risk for breast cancer on individual case based on patient‟s risk factors background. 8) Assess the potential barriers and promoters for breast cancer screening in Egypt especially in rural areas 9) Define the potential factors influence the health disparity among Egyptian K An: Analysis K:Knowledge Ap: ApplicationC: Comprehension Cognitive domains Bloom’s Taxonomy Ev: Evaluation Ap C C An K Ev Ev C C
  • 29. 3/20/2014 Public Health 29 Competency-based learning and assessment plan Skill stage (Dreyfus)* Objectives Bloom Taxonomy Teaching methods Assessment method New learner (awareness stage) 1. Recall the epidemiological features and risk factors responsible for the development of non-communicable disease with especial reference to cancer. 2. Identify the different genetic/behavioral/environmental risk and protective factor for breast cancer 3. Define the basic pillars for screening tests namely sensitivity/specificity/predictive values 8. Assess the potential barriers and promoters for breast cancer screening in Egypt especially in rural areas 9. Define the potential factors influence the health disparity among Egyptian population especially the socio-economic and geography. 10. Define the responsibility of primary care in assessing, guiding and educating individuals with risk factors. Knowledge and comprehension Orientation lecture Readings/self learning Case studies Written test (pre-post) Discussion sessions Advancer learner (proficiency stage) 4- Recognize and communicate the recommended case wise- guidelines for breast cancer screening 5- Criticize the different methods used in screening in terms of false positive/negative, labeling, lead time effect ect. Application Analysis Simulated case scenario Role play Searching /synopsis Observation Self reflection Presentations Experienced learner (mastery stage) 6- Apply and interpret the basic epidemiological terms in describing the risk (Odds, relative risk). 7- Value the risk for breast cancer on individual case based on patient’s risk factors background. Synthesis Evaluation Case study Observation checklist Simulated case
  • 30. 3/20/2014 Public Health 30 Competency mapping :K= Knowledge, C=Comprehension, An=Application, An=Analysis, Ev= Evaluation Learning Objectives Competencies 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1-Recall the epidemiological features and risk factors responsible for the development of non- communicable disease with especial reference to cancer. K C K K C K K 2-Identify the different genetic/behavioral/environmental risk and protective factor for breast cancer K C A p 3-Define the basic pillars for screening tests namely sensitivity/specificity/predictive values A p An Ap 8-Assess the potential barriers and promoters for breast cancer screening in Egypt especially in rural areas K KC Ev Ap K 9-Define the potential factors influence the health disparity among Egyptian population especially the socio-economic and geography. K C K C 10-Define the responsibility of primary care in assessing, guiding and educating individuals with risk factors. K C Ap 4-Recognize and communicate the recommended case wise-guidelines for breast cancer screening Ap An 5-Criticize the different methods used in screening in terms of false positive/negative, labeling, lead time effect ect. K C C 6-Apply and interpret the basic epidemiological Ap