Innovations in Graduate Public Health Education: The Instituto Nacional de Salud Pública

Abstract

During the past 10 years, the Instituto Nacional de Salud Pública (National Institute of Public Health) in Mexico has meticulously revised its educational model. This analysis resulted in the transformation of its educational model by tracing a new path in the pedagogical structure and faculty development to meet current challenges and students’ needs.

The first stage dealt with the national and international accreditation standards that came with the 21st century. The second stage responded to evidence of cognitive research showing that students are better prepared when they are engaged, active, and responsible for their own learning.

This transformation was grounded on the use of information and communication technologies and on a competency-based educational approach that has led the expansion and innovation of educational practice.

The Escuela de Salud Pública de México (ESPM; School of Public Health of Mexico) was founded in 1922 with funding from the Mexican government. Since then, the ESPM has had a major role in training the Mexican public health workforce.¹ ESPM was originally created to train personnel, for example, medical officers, nurses, specialists in sanitary services, and laboratory technicians, to control infectious diseases that were widespread in Mexico. ESPM embraced the sanitary movement that aimed to prevent and control infectious diseases and improve food safety in the country.

The creation of the ESPM strengthened the movement that aimed to combat waste and sewer gas; improve water quality, urban health, and food safety; control alcoholism; and eradicate illnesses such as yellow fever, plague, typhoid fever, and smallpox. Decades later, the need arose for innovation and change in the ESPM. Mexico was suffering a severe economic crisis, and research and information was needed for effective decision making about the future of the Mexican public health system.

This need brought about the foundation of the Instituto Nacional de Salud Publica (INSP; National Institute of Public Health) in 1987 by merging the ESPM with two newly created research centers: one for infectious diseases, and the other in public health.² Since then, the INSP has aimed to improve health and well-being by training the public health workforce and producing evidence through mission-oriented research. Thus, the INSP assumed its role in constructing a better and healthier society.

During the past few decades, a new wave of health and educational reforms has required, once again, public health schools to transform and adapt to a new era of modernism, change, and innovation.³ Recently, a defined movement toward competency-based education has taken place, reshaping educational institutions around the world. The movement emphasizes active learning, student engagement, and more global, flexible, and technologically oriented curricula.⁴ The current health challenges are arising in a new world: one that is more complex, unpredictable, and globalized. These challenges require professionals who can integrate their knowledge and skills with the ability to work and communicate well in interdisciplinary and often international teams.

Bearing in mind this enormous educational challenge, in 2005 the INSP sought international accreditation from the Council on Education for Public Health and moved to the competency-based educational model, transforming the approach of its educational programs. INSP adopted new ways to blend learning and technology. The principal actors involved in our educational transformation were students, alumni, faculty, employees, and the community. By 2006 the INSP was accredited by the Council on Education for Public Health, becoming the first institute outside the United States accredited by this council. In 2011 the INSP was reaccredited for seven years, meeting all the criteria.

PEDAGOGICAL STRUCTURE AND FACULTY DEVELOPMENT

It was a challenge to transition from a teacher-centered, content-based education model to one centered on the students and their competencies. One driving force was the commitment of the INSP to work for international and national accreditations. The transformation of our traditional educational model, which was centered on an instructor, developed defined curricula to a competency-based educational model, which implied a shift from a teacher-centered to a learner-centered orientation in a short period.

However, reengineering our educational programs presented a major challenge, because it involved the complete transformation of the classroom experience as well as professor methods and evaluations.⁵ The challenge was to transform the previous pedagogical structure—which relied exclusively on traditional lectures—into one that allowed more discussion, collaboration, and teamwork, with a focus on the learners. The reorientation was centered on learning, problem solving, and narrowing the relation between theory and practice.

We focused on integrating new pedagogical tools such as case studies, learning-based projects, and collaborative work. INSP has been working to increase learner competencies through resolving case studies under the training of experts and engaging in intellectual tasks specific to a particular work setting. Abstract thinking skills, required in many technical jobs today, are learned effectively through a combination of practice and explicit teaching in a meaningful context.

We realized quickly that one of the main challenges was not only training the professors in new teaching strategies and learning-based technology but also reforming commonly used teaching materials. In other words, we had to untrain the faculty from teaching their old way so they could incorporate new change and innovation in the classroom. Professors in public health, as in many other fields, tend to rely on traditional teaching methods. They are used to giving long lectures with little interaction (as they themselves received as students); therefore, this is the role in which they tend to be most comfortable.

The adopted paradigm places the student in the center of the educational process. The students become active agents that search for information. They must analyze and apply the information, compare and synthesize it, and relate everything they learn to real work situations that will prepare them for what they will confront outside the classroom. So, one of the main tasks set before us at the institute was to transform how professors taught and the educational resources they used.

Faculty members needed a motivation to be and an interest in being trained—and untrained—to fully implement the new educational paradigm. The training we required for faculty included teaching strategies, adult learning, technology in the classroom, and evaluation in a competency-based program. To achieve these goals we developed a 160-hour diploma course for our faculty.

The diploma course was well received among the academic community. Since 2006, about 50 (30.5%) faculty members complete the diploma course every year, and it is now offered online. In addition, the INSP organizes practical teaching workshops twice a year to strengthen faculty competencies. Some topics include conceptual maps, rubrics, and social networks for educational purposes; learning styles; coaching; and the use of case studies. With this yearly teacher-training program, the faculty members are developing the necessary skills to teach a competency-based curriculum.³

INSP launched the e-portfolio strategy.⁶ An e-portfolio is a compilation of the work that students have done to reflect the way they have learned.⁷ Assessing progress with an e-portfolio provides evidence of students’ competencies. This strategy supports students’ intellectual growth and facilitates their responsibility in their own learning process.⁸ Today, selected professionals are piloting the program, and good results are expected in the near future.

DIVERSE ACADEMIC PROGRAMS TO MEET LEARNERS’ NEEDS

INSP has followed the growing trend of variation in learning and now offers diverse formats for its academic programs. We have created 30 educational programs, including Master of Public Health (MPH), Master of Science in public health (MSc), Doctor of Philosophy (PhD), and Doctor of Public Health (DrPH), and every three years the academic body reexamines the competencies to guarantee that they are appropriate and relevant.

To respond to the various needs of our students, the MPH is now offered in three formats: a full-time program, an executive version offered on weekends, and a program that is completely online. Generally, the MPH full-time program receives younger students who want to pursue a career in public health, whereas the executive program is designed to train public health officials working in federal programs in Mexico City and the surrounding areas. Students in the executive program meet on Fridays and Saturdays and work online during the week. This blended format has proven to be very effective, as demonstrated by graduation rates of between 87% and 91%—which are consistently higher than are those for the other two formats—and by student and employer satisfaction.

We designed the online MPH as a complete virtual program to serve all Mexican states and Latin American countries. The courses are developed on an asynchronous platform, which allows professors to manage their courses and establish dynamic communication with their students through online learning activities. This educational platform facilitates access to relevant course information. The format also allows professors to design course activities, customize the format of their documents, and apply collaborative tools and assessments.

A tutor is assigned to every 15 students. The students dedicate approximately two hours daily to individual and group assignments. They also go online in real time once a week for two hours and work with their professors and their colleagues using a commercial platform. Before 2005 there was only the full-time program. Since then, the virtual and executive programs have been expanding, and in 2013, 50% of the graduates came from our full-time programs, 27% from the virtual program, and 23% from the blended executive program.

The online MPH program, like the other formats, has good graduation rates: more than 80%, which is higher than is that which specialized literature in the field has shown for general online programs⁹; this is owing to the successful combination of synchronous and asynchronous activities. INSP takes special care to ensure the commitment and dedication of students working at middle and higher positions at the State Ministries of Health. In the past three years, more than 400 students have graduated from the three types of program.

In 2008, the INSP offered a DrPh program for the first time. We designed this innovative program to train public health leaders in Mexico and Latin America, using a b-learning (blended learning) format. The main goal of the DrPh program is to train leaders who are oriented toward on-the-ground jobs in a variety of public health settings. This is different from the PhD program, which mainly prepares students for academic work and research. The need for this type of professional became evident two decades ago, and in recent years the need has increased, as new challenges in public health arise and require more of these types of leaders.¹⁰

Students attend the INSP during fall and spring semesters for a month. During this time, they take core doctoral seminars. The rest of the year they follow online courses and work with tutors on their dissertations. To participate in this program, students are required to work in a leadership position in the health systems, and their practicum has to be done in a different institution, usually one related to their dissertation.

UPGRADING THE LEARNING ENVIRONMENT

INSP has maintained a continuous education program that has been strategic for maintaining an up-to-date public health workforce in the fields arising in public health. The ministries of health at federal and state levels are directly involved in developing and financing the annual program, and they promote personnel participation. The education program aids in lining up the objectives of the INSP with the priorities and needs of the Ministry of Health. Our educational program, through the three formats, offers about 250 courses with approximately 10 000 professionals enrolled annually.

To contribute to the public good and strengthen its human resources, the institute is developing an online repository of learning tools, resources, and multimedia. With this repository, professionals, students, and faculty can more easily augment their learning experiences. By using educational technological tools, the learning environments we have developed at the INSP have enhanced human resources. These educational technological tools have benefited other health sectors as well as the general public by disseminating evidence-based knowledge.

By including information and communication technology in our programs, we are using social networks, mobile applications, and other technologies as teaching resources. Since 2010 all face-to-face programs have included a virtual education platform. This allows students to review online materials and supports the concept of an inverted classroom in which students review all the materials and videos at home. They can then use class time to discuss the materials and work in teams.

INSP has developed massive online open courses on influenza and cholera in response to recent epidemics in Mexico in conjunction with the Ministry of Health’s strategy. These courses reached more than 70 000 health professionals, who completed the course during different health emergencies in Mexico. Another course, Early Breast Cancer Detection, is being developed to train primary care doctors and nurses of the Mexican Institute of Social Security; it will reach approximately 16 000 primary care professionals.

In 2010 the INSP designed and implemented a training program for early breast cancer detection, focusing on risk factors, self-examination, methods of diagnosis, current laws and regulations, and the survival and reincorporation into everyday life of breast cancer patients. This addressed many primary health care staff groups in three states of Mexico. An efficiency rate higher than 80% was obtained after two years of implementing the program.

In the near future the INSP will develop larger online open courses to reach the public health workforce, which needs to update skills, learn current on-the-job competencies,¹¹ and build workforce capacity across sectors.¹² Student competencies are evaluated through the activities, exercises, presentations, and exams that are incorporated into the instructional design of each course.

To ensure high-quality programs, courses, and resources, in 2006 the INSP founded the Department of Educational Innovation and Technology with a multidisciplinary group of instructional designers, multimedia professionals, Web experts, programmers, and online tutors. Since 2010, this department has had 18 full-time personnel who work with faculty members to develop, implement, and evaluate all educational programs.

We have been able to offer education that includes online, blended, project-based, and community-based learning. Our programs are achieving better student engagement and satisfaction because the content is relevant to local, national, and global situations and because it can be customized to the specific needs of our students. The content also is customized to meet the needs of the Mexican frontline health workforce.

By creating an innovative learning environment, the INSP has positioned itself as a leading institute, both nationally and internationally. This innovation has contributed to the improvement in education and the assessment of learning outcomes, equity, cost-effectiveness, and student satisfaction. INSP will continue to reengineer its programs to ensure the best practices in public health education and educational innovation.

In the years to come, we will continue to innovate and provide personalized learning, using state-of-the-art technology and services to reinforce our role as a leader in public health education in the region and globally. This role is further solidified through cultivating collaborative and global alliances with other academic and public health institutions. For instance, the Ecohealth Alliance, with funds from the International Development Research Centre to collectively promote the ecohealth approach for the control of vector-borne diseases in Latin America, has trained 147 tutors in six countries in the region with a blended educational format.

Also, our network with Harvard and the Mexican nongovernmental organization Tómatelo a Pecho (Take It to Heart) has trained more than 3000 health professionals to work in breast cancer prevention. In all cases, collaboration results in stronger and better courses. Although the consensus process takes time, it is worth the effort to collaborate with the best possible professors and produce the best materials and content. These collaborations create partnerships that advance the public health agenda and strengthen health systems by building a strong and well-trained workforce.