Abstract
Schools of Public Health historically introduced core curriculum courses in the first year of the Master of Public Health program as independent perspectives; these perspectives included epidemiology, biostatistics, environmental health, public health biology, health behaviors, and health policy.
We performed a pilot project that integrated the core areas around diabetes as a cross-cutting public health issue to provide early exposure to the interdisciplinary nature of public health. In each core curriculum course, diabetes was explored in the curriculum and related to other core courses.
Based on positive evaluations, this project will be replicated using a different health issue. Such an issue can be easily introduced as an overarching umbrella under which students are motivated to work through interdisciplinary collaboration.
Public health is interdisciplinary in nature. However, Schools of Public Health (SPH) have historically introduced the core curriculum of public health in the first year of the Master of Public Health (MPH) program from independent perspectives, including epidemiology, biostatistics, environmental health, public health biology, health behavior, and health policy. This approach created a delay and a challenge for the demographically and educationally diverse pool of incoming students in their understanding of the interconnection among core areas of public health. To improve the appreciation for the conceptual and practical coordination of the core courses among the students, we introduced a global public health theme of diabetes mellitus in the curriculum.
INNOVATION
To facilitate students’ appreciation of the interdisciplinary nature of public health, the SPH developed a pilot project for first year MPH students that focused on a particular public health issue that was analyzed through the lens of the theories and methods of the course in question, as well as other courses in the core curriculum. We convened a “First Year MPH Experience Task Force,” which included core-course instructors and which was chaired by the Associated Dean for Academic Affairs. During meetings held in the late spring and early summer, task force members proposed the first year interdisciplinary integration concept and provided topic ideas for a central theme. In addition to the usual curricula in each course, the first year interdisciplinary core curriculum course instructors in the MPH program developed case studies and discussions around the increased burden of diabetes in the population.
Diabetes was the public health issue that created a platform for students to understand and appreciate the interdisciplinary nature of public health, rather than learn about each area of public health in relative isolation. Some examples of the incorporation follow. In biostatistics, students performed univariate, bivariate, and multivariate analyses on national survey data elements in National Health and Nutrition Examination Survey that were related to empirical measures of diabetes and other socieoeconomic covariates.
The Principles and Methods of Epidemiology II, a required course for Epidemiology majors, incorporated diabetes as a theme for several workshops. During the first workshop, students ranked five diabetes translational research grant applications that were recently funded by the National Institutes of Health and discussed their rationale for ranking. The second workshop was an examination of the sampling strategy of an existing diabetes cohort study. In the workshop for assessing reliability and validity of measurements, monofilament screening for diabetic neuropathy was used as an example. In the final workshop, students critically reviewed controversial epidemiological research of a popular diabetes drug and its consequences in public health.
In a large traditional didactic section of our “Introduction to Environmental Health” course, in the first core-concept assignment, students had to read epidemiology articles that addressed the contentious issue of low-dose arsenic and diabetes; the assignment was given in the fourth week of the semester following coverage of “Toxic Elements” in the classroom. The students were required to complete four online short-answer questions at various levels of difficulty to assess knowledge, comprehension, analysis, and synthesis of topic information in the context of diabetes. We encouraged replication of the realities of collaborative public health practice group work, although we required unique submissions to maintain individual accountability. We held discussions in class the following week; the questions and responses were reviewed, and we emphasized the potential link between background exposures to inorganic arsenic through drinking water and type 2 diabetes mellitus in the context of issues previously raised by the biostatistics, health behaviors, health policy, epidemiology, and public health biology courses. A grade based on the response to one of the four questions was assigned; students were not informed which of the four questions would be graded until after the in-class review. This assignment model was repeated following the “Toxic Organic Compounds” lecture in the fifth week of class. The environment–diabetes homework assignments comprised 10% of the final course grade (five percent each) and were delivered in the first half of the course in an effort to set standards and expectations for later assignments.
In the online version of Environmental Health, diabetes was introduced as a dynamic and life-long condition that resulted from constant human interaction with environmental circumstances and exposures. In one written assignment, students discussed the causal contribution of environmental toxicants on diabetes using a toxicant compound of their interest. Students introduced the putative association with real and current issues within local, regional, or national boundaries. Students were also asked to weigh the evidence on the suspected association with their evaluation of peer-reviewed journal articles. In all, diabetes was repeatedly discussed as a unifying human health outcome that was affected by multiple environmental toxicants, including chemical, physical, and microbial agents.
In the policy and behavioral science classes, the interplay between health behaviors and health outcomes related to diabetes was explored within the context of developing and implementing health policy. In all, students were able to explore the issues around diabetes-related journal articles and diabetes in general from epidemiological, statistical, environmental, biological, behavioral, and policy perspectives.
EVALUATION
We evaluated the pilot project from both the faculty and student perspectives. From the faculty feedback, there was better coordination of content between courses arising from the presemester and postsemester core course team meetings, as well as enjoyment in exploring the topic area from a variety of perspectives. However, there was consensus that although students were informed in the MPH orientation week that this project was underway, some students did not fully recognize that the diabetes theme was being included in all core courses in the academic year. Still, many students became cognizant of the common diabetes theme across courses when explicitly discussed by instructors; the diabetes “link” across core disciplines was not necessarily obvious without guidance.
For student evaluations in individual courses, the students had some mixed responses to the innovation. For example, in the biostatistics course, students did not perceive that there was an integrated health issue being addressed in the course, perhaps because of the fact that students were more focused on statistical methods rather than the research question. However, in the environmental health course, students recognized the application of biostatistical, behavioral, policy, epidemiological, and biological principles, in addition to environmental health concepts when interpreting the assigned research papers and when responding to the short-answer queries. Upon broader evaluation, we observed passionate, diverse, and thoughtfully considered perspectives and experiences by the students. Furthermore, a survey of registered first year students suggested that the integration of the diabetes core helped to link principles to the first year core MPH coursework.
CONCLUSIONS
Based on the generally positive evaluations of both students and faculty, this innovation will be replicated using a different health issue in future years, with some modifications in the core courses to explicitly state when the integrating theme will be presented and analyzed. Faculty will endeavor to create more explicit links between core curriculum courses using the common health issue as a platform. This will be accomplished by specifying several core concepts for each class, sharing these across instructors in advance of the semester, and explicitly articulating the common themes to students in all core courses—thus integrating uniformity with a consistent message to underscore the interrelated nature of the core disciplines using a selected health issues, such as diabetes, as a common theme. With this modification, such an enhancement to the core curriculum can be easily incorporated in the first year of the MPH program using a team approach that focuses on the interdisciplinary nature of public health. Although there are challenges in timing coordinating course schedules of faculty and pedagogical approaches to deliver a cohesive programmatic theme across the core areas of public health, the benefits far outweigh the costs of undertaking such an innovation. Specifically, students learn early on in their educational career in the MPH program that public health is interdisciplinary and that all core areas are integral to the investigation and evaluation of common health phenomena.