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Public Health Education
Unbound
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Diane R. Bewick, RN, BScN, MScN, DPA, CCHN (c)
Chief Nursing OfficerDirector of Family Health Services, Middlesex-London Health UnitAdjunct Professor, Faculty of Health Sciences, Western University
London, Ontario
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The public health professional …
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“No attempt to improve public health will succeed that does not recognize the fundamental importance … of highly skilled and motivated health professionals.”
Advice …
“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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“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.
Warning …
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people
The public health professional
quality of lifeprolong life
promote healthprevention disease
organized measures
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Official Public Health
Agencies
Family Health Teams
Canadian Cancer Society
CCAC
Community Health Centre
Boards of Education
Ontario Early Years
Centres
Heart & Stroke
Foundation
Housing
Education
Poverty
Literacy
Primary Care
Providers
Global
The public health professional
Social Support
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Official Public Health
Agencies
The public health professional
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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• undergraduate programs…variety of disciplines
Public Health Professionals
• disciplines form the base …
• professionals will benefit…from education
• education will increase health of the province
• discipline specific standards/competencies
• regulation/registration/certification
*Unique contribution
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Public Health Competencies
Discipline Specific Core Competencies, Standards and Certification
MPH
Core Competencies
Public
Health Core Competencies
Inter-professional Competencies
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Public Health Professionals(20 categories)
AMOH/MOH
51
Epidemiology
65
Health Promoters
262
Dental Hygienists/ Dental Assistants
289
Dietitian/Nutritionist
210
Public Health Inspectors
830
Public Health Nurses
2,630
2,860
*PHO (Labs), MOHLTC, MCYS
2005
6,400
1,400
*7,800
- 63
- 72
- 416
- 286
- 203
- 900
- 2,717
- (167/DH)
- (232)(3,848)
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Public Health Workforce Issues
6. Shortages
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.
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1. Role scope and clarity
Synthesis of 8 Papers (CAN)… convergence of issues
2. Leadership skills to support practice and provide voice
5. Stronger educational preparation in public health
3. Professional development
4. Intra-professional collaboration
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• public health professional - general
Context Summary
• 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 & BiostatisticsAssociate Director, Program Development
Schulich Interfaculty Program in Public HealthSchulich 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)
synthesis
Fact Memorization SearchingAnalysisSynthesis
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 decision-
maker 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
Problem Defining Cases
Decision-making Cases
Evaluation/ Policy Cases
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Four Types of Cases
Skills Practice Cases
Problem Defining Cases
Decision-making Cases
Evaluation/ Policy Cases
Describe a situation facing a protagonist. Students must diagnose problem(s) and formulate possible solutions.
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Four Types of Cases
Skills Practice Cases
Problem Defining Cases
Decision-making Cases
Evaluation/ Policy Cases
Describe a decision faced by the protagonist. Students must choose among a finite set of alternatives.
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Four Types of Cases
Skills Practice Cases
Problem Defining Cases
Decision-making Cases
Evaluation/ Policy Cases
Illustrate organizational success or failure. Students synthesize policy lessons to be extracted from the situation.
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Four Types of Cases
Skills Practice Cases
Problem Defining Cases
Decision-making Cases
Evaluation/ Policy Cases
Describe situations requiring execution of specific technical skills in order to draw conclusions
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Four Types of Cases
Skills Practice Cases
Problem Defining Cases
Decision-making Cases
Evaluation/ Policy Cases
Illustrate an organizational success or failure. Students synthesize policy lessons to be extracted from the situation.
Describe situations requiring execution of specific technical skills in order to draw conclusions
Describe a decision faced by the protagonist. Students must choose among a finite set of alternatives.
Describe a situation facing a protagonist. Students must diagnose problem(s) and formulate possible solutions.
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Mauffette-Leenders et al., 2007, p. 19
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John M Garcia, PhD
Professor of Practice & Interim DirectorSchool of Public Health and Health Systems
Faculty of Applied Health SciencesBurt 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
42
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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)
45
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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
47
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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
48
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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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Competency domains
601/602
SCB Env Epi Comm Mgmt/admin
Policy
Public Health Sciences
+ + ++ +++ + + +
Analysis and Assessment
+ ++ +++ +++ + + +++
Policy/ProgramPlanning/Implement/Evaluation
+ + + + ++ +++ +++
PartnershipsCollaboration
Advocacy
+++ ++ + + +++ +++ +++
Communication + + + + +++ ++ ++
Diversity/Inclusiveness
+++ +++ + + +++ +++ +++
Leadership +++ + + + +++ +++ +++
Competencies in curriculum development
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The MPH “Building” – Core coursesCapstone(PHS 602)
Practicum(PHS 641)
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)
F-1
W-1
S-1/F-2
W-2
S-2
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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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2006 2007 2008 2009 2010 2011 2012 20130
50
100
150
200
250
300
4555
63 62
77 76
9486
0 0
1930
40 40
65
4845
98
134
159
185
215
236 239
1 4 8 10 15 12 11 8
MPH Student Numbers by Year
Incoming Students ₁ Graduating Students ₂ Total # of Students ₃ Withdrawals ₄
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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 community-based 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 HealthCentre for Public Health Capacity Development Health Security Infrastructure Branch
Building a Solid Foundation for Public Health Practice
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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 baccalaureate-trained, and further specific training in public health is no longer mandatory. Instead, public health nurses learn on the job through formal and informal in-service training.”
“Health Canada’s Skills Enhancement for Health Surveillance program is a web-based 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..”
“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 diseaseepidemiology are an essential part of capacity building for many aspects of public health practice and leadership, but are not widely available..”
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•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
Skills Online
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Modules Currently Available• 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
Facilitated modules
Self-directed modules
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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
National Schools and Programs of Public Health
• be a leader in new online module production
• 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’sLecturer, 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
81
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Distance Learning
82
1800s
1930s
1996
2000s
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
85
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MOOCs
PROS CONS
• Free or low cost for learners
• Self-directed/paced
• Less barriers than traditional
education
• Computerized interactions globally
• Limitless scalability
• Financial efficiency for institutions
• Credit for courses often costs money
• Lack of direct human interaction
• May lack prestige/acceptability
compared with traditional education
• Sustainability
• Quality control
• High drop-out rates
86
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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
87
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NextGenU• Not a MOOC – a DOOHICHE
Democratically Open, Outstanding Hybrid of Internet-aided, Computer-aided,
and Human-aided Education
88
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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
90
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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
91
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Upcoming Courses
92
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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
93
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Countries Using NextGenU• Climate Change and Health
– Brazil, Bulgaria, Canada, Christmas Island, Denmark, Egypt, Great Britain, Hrvatska/Croatia, Hong Kong, India, Nigeria, Pakistan, Saudi Arabia, Turkey, United States
• 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– 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
94
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Emergency Medicine
95
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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
96
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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