Curriculum Revitalization Initiative at Tulane

Abstract

Tulane School of Public Health and Tropical Medicine launched its curriculum revitalization initiative to examine the Master of Public Health degrees (MPH). The initiative will enhance excellence in MPH education and incorporate innovative teaching approaches.

Taskforces determined the MPH core should provide the foundation for public health, integrate knowledge across public health areas, and develop skills and methods needed in practice. The MPH is being updated to provide specialized study that builds skills and practical applications based on theory and evidence-based approaches. Eleven graduate certificates were developed to provide a second area of specialization.

Practica are viewed as increasingly important for students without practical experience. Teaching methods will incorporate more technology including online modules for a blended classroom approach.

The Tulane School of Public Health and Tropical Medicine (SPHTM) launched its curriculum revitalization initiative in Fall 2013 to guide the evolution of its Master of Public Health (MPH) and Master of Science in Public Health (MSPH) degrees. The goal of the initiative is to promote excellence in these programs, adapt teaching to reflect student body characteristics, and incorporate innovative educational approaches. This initiative continues Tulane’s long tradition of pioneering public health education and research. Tulane was founded in 1834 to combat a major public health crisis at the time—a yellow fever epidemic in New Orleans. The New Orleans School of Tropical Medicine and Hygiene¹ was established in 1912 and was the first to combine hygiene with tropical medicine to address diseases with laboratory methods, foreshadowing evidence-based public health. Tulane SPHTM takes a global health approach to current public health challenges that are as profound today as those a century ago. The Tulane SPHTM curriculum revitalization initiative recognizes that MPH programs must keep pace with the rapidly evolving challenges of global public health.

FACTORS INFLUENCING PUBLIC HEALTH EDUCATION AT TULANE

The Tulane SPHTM examined global health factors, national trends and influences, and the SPHTM’s strengths, characteristics, and capabilities to develop a framework for the curriculum revitalization initiative. Several factors affect the school’s MPH curriculum.

Global and National Public Health Landscape

The obesity epidemic and emerging infectious diseases require a global health approach that extends beyond national boundaries. In the United States, the implementation of the Patient Protection and Affordable Care Act² and health care reform requires public health professionals with the skills and innovative approaches to bring evidence-based methods and population science to health care.

Technology is now a tool to advance preventive services, increase the reach of health education, and expand population-based approaches to health and wellness.

Evolution of Public Health Education: Framing the Future

National public health leaders have recognized the changes occurring in public health today. The Association of Schools and Programs of Public Health spearheaded the development of a new blueprint for public health education.³ The Columbia University Mailman School of Public Health launched its Columbia MPH, which revamped the public health core curriculum as an integrated course.⁴

These initiatives have triggered discussions on the structure of the MPH, the need to increase the specialization of MPH programs, and new approaches to more fully integrate the public health core curriculum for the MPH degree.

Influence of Undergraduate Public Education

The nationwide growth in the number of bachelor’s degree programs in public health is pushing MPH education to the next level, and SPHTM provides one example of this impact. SPHTM established its Bachelor of Science in Public Health in 2006, and it has grown from an initial five students to more than 550 in the 2013–2014 academic year. Approximately 81% of the graduates of the Tulane Bachelor of Science in Public Health class of 2014 entered a graduate or professional school, and 42% pursued the MPH at Tulane or other schools. The rising popularity of undergraduate public health programs is generating a pool of matriculating students who enter MPH programs with basic public health knowledge.

The Tulane Bachelor of Science in Public Health program provides a foundation in public health principles, concepts, and applications within the overall context of a liberal arts education. Concepts and skills once taught in MPH programs are now incorporated into undergraduate public health education.

Students are entering MPH programs with greater knowledge of public health theory; however, they lack work experience and the practical framework to apply this knowledge. This challenges MPH programs to provide more in-depth conceptual knowledge while placing greater emphasis on developing practical experience through the practicum and culminating experience.

Characteristics of Matriculating Students

The background and characteristics of students entering the MPH and MSPH programs in 2013–2014 were quite different from those of students entering in the early 1980s (Table 1). Students in the 1980s and 1990s were typically mid-career professionals with public health experience who sought formal public health education to complement their practical experience. Current students are typically younger, enter the MPH program soon after receiving a bachelor’s degree, do not have other professional education, and have little or no practical experience. In the past 10 years, the increase in students entering master’s programs directly from undergraduate schools has dramatically increased, and many have had undergraduate public health degrees. The MPH will be their primary professional degree when they enter the public health workforce.

TABLE 1—

General Characteristics of Matriculating MPH and MSPH Students at Tulane School of Public Health and Tropical Medicine, LA

Characteristic	Early 1980s	Mid-1990s	Early 2000s	2013–2014
Average age, y	Mid-30s	29–30	27–29	23.5
Other professional degreea	Most	Some	Some	Few
Public health experience	Most	Most	Some	Few
Practical experience	Most	Most	Some	Seldom
Approximate % full time	40%	60%	75%	90%
Entered directly from undergraduate school	Very rare	Rare	Few	Most
MPH credits required	24	30–36	36–40	42–45

Note. MPH = Master of Public Health; MSPH = Master of Science in Public Health.

^aFor example, Doctor of Medicine, Bachelor of Science in Nursing, and Doctor of Dental Surgery.

The criteria for MPH and MSPH degrees have evolved in response to the changing student characteristics: MPH programs have increased the didactic credits to provide knowledge in public health sciences and included a practicum and an applied culminating experience to provide experience in the practical applications of public health.

Students and Technology

Current SPHTM students have grown up with technology and rely on computers and the Internet for learning, interacting with peers, and leisure activities. They expect advanced technology to be a basic classroom feature and an integral tool for teaching and learning. In many cases, students are more tech savvy and better able to utilize technology and communications media than some faculty. The Internet provides ready access to knowledge and information. Instant communication transmits information immediately and promotes greater interactions and networking among people dispersed across the world.

The students of today learn differently than did those a decade ago and expect a full array of technology in the classroom. Teaching methods must evolve to target younger students and include the means to provide practical applications, build skills, evoke thinking, and use technology. Technology provides the opportunity to instill lifelong learning habits in students by using the Internet to seek new knowledge to address problems as they arise.

APPROACH AND PROCESS

Within this context, the SPHTM launched its curriculum revitalization initiative to move Tulane’s MPH forward to meet the needs of students and employers and to test new and innovative methods for teaching and learning. The rapidly changing public health milieu requires MPH and MSPH education to evolve to ensure graduates have critical thinking skills, are able to make decisions based on scientific evidence, and develop the fundamental skills to address new issues as they arise

In fall 2013, SPHTM created two faculty task forces, the Core Curriculum Task Force and the MPH Task Force, to examine the MPH and MSPH programs. The task forces are critically examining the MPH and MSPH programs and core courses to align education with the demands of the workforce. SPHTM faculty are also scrutinizing the way they teach, in the context of developing professionals with critical thinking and problem-solving skills and incorporating innovative teaching methods that reflect the learning styles of current students.

The task forces reviewed reports of national public health workforce surveys by the Association of State and Territorial Officers,⁵ the National Association of County and City Health Officials,⁶ and the Association of Schools and Programs of Public Health Blue Ribbon Employers Panel.⁷ SPHTM obtained input from its alumni and employers to realign the programs with workplace needs. The task forces also considered the impact of undergraduate public health education on the MPH, changing job demands in public health, and the need to limit student debt for education. The revitalization of the MPH and MSPH is an ongoing process that will progress in a stepwise fashion for the next few years. The Tulane SPHTM Alumni Board is conducting surveys of SPHTM alumni and employers to provide ongoing feedback.

Master of Public Health Task Force

The MPH Task Force came to the consensus that the MPH and MSPH degrees should (1) provide fundamental public health knowledge through the core, (2) have specialized concentrations providing both a theoretical basis and practical skills, and (3) incorporate methods to apply and integrate knowledge and skills across public health areas. Because students cannot be taught everything they will need to know throughout their public health careers, the MPH must provide fundamental public health concepts and critical thinking and applied skills, including analytical skills, problem-solving abilities, and evidence-based methodology, and create the foundation for lifelong learning.

A key feature of the Framing the Future Initiative is that an MPH program should provide specialized advanced education.² The SPHTM has 16 MPH and MSPH concentrations across six departments that provide specialized study in an area of public health. Historically, the MPH curriculum has been a departmental discipline, with programs assembled from an array of courses providing breadth of study. The SPHTM will refocus on MPH programs (concentrations) as the educational unit for specialization, with more depth of study and sequencing of courses for specialization. The emphasis on programs (concentrations) is consistent with Framing the Future’s recommendations for specialized advanced study, and it aligns with evaluation rubrics for accrediting bodies.

The practicum and culminating experience have become extremely important components of the MPH and MSPH degrees. Because a large proportion of students have minimal experience, the practicum and the culminating experience have become increasingly important for developing practical skills, providing practical experience, and developing interdisciplinary abilities to work as a part of a team.

Core Curriculum Task Force

The MPH core curriculum at SPHTM has been a set of stove-piped disciplinary courses in traditional areas. Although student evaluations of the individual core courses have generally been positive, the consensus is that the MPH core as a whole needs improvement. Both student and alumni feedback have noted the strong methodological foundation provided by the core courses but highlighted its emphasis on concepts and the need to provide a context for applying theory. The Core Curriculum Task Force has recognized the separation of the individual core courses and the need to apply knowledge and skills across disciplinary areas to address public health issues. It reviewed several models for the MPH core curriculum, including development of a large integrated course such as that established at Columbia. Although the task force found such a course interesting, it did not seem workable with the SPHTM organization and resources available. The Core Curriculum Taskforce endorsed a middle course that would increase integration of core courses.

The task forces reviewed formats for using various technologies in teaching and SPHTM’s technical capability to support teaching. SPHTM has an extensive computing infrastructure for teaching through the distance learning programs. For more than 20 years, SPHTM has used distance learning technologies to deliver the MPH and MSPH programs and professional education to mid-career professionals all over the world. Although developed for geographically dispersed students, this technology can be used to enhance teaching in the traditional classroom. The same technology and innovative teaching methods can enhance student learning in the traditional classroom.

Evaluations of the effectiveness of the distance learning programs have consistently shown that distance-learning students perform as well as on-campus students. One evaluation conducted over a five-year period from 2004 to 2009 compared the performance of students in a distance learning section of a toxicology course with those in an on-campus section. The course was taught by the same instructor and used the same materials and the same exams. The distance learning format used a real-time virtual classroom. Over this period, the distance-learning mid-career students consistently performed slightly better than the students in the traditional classroom (Table 2).

TABLE 2—

Comparison Between Distance Learning and On-Campus Average Scores on Three Exams in Principles of Toxicology Course at Tulane School of Public Health and Tropical Medicine, LA

	Distance Learning		Traditional On-Campus
Year	Average	Median	Average	Median
2004	85.66	86.67	84.24	86.00
2006	84.52	86.67	83.30	84.67
2007	83.75	87.33	81.82	84.00
2008	85.10	87.67	84.10	84.00
2009	86.37	87.33	83.05	85.33

In the past few years, newer technical tools and software have become available that increase teaching effectiveness. Preliminary information has indicated that blended learning formats combining online modules with face-to-face class meetings are especially effective. Interactive exercises, drills, and quizzes can be embedded in online modules to enhance student learning. Face-to-face sessions are used for problem-solving and critical thinking exercises.

ACTIONS AND IMPLEMENTATION OF REVITALIZATION

Although the Tulane SPHTM curriculum revitalization initiative is in its early stages, a framework has emerged to guide the process. Elements include MPH program specialization, graduate certificates, greater emphasis on practica, integrated public health core, and blended learning teaching models using the flipped classroom.

Master of Public Health Program Review

A review of the MPH and MSPH programs across the six departments showed inconsistencies in program structure and requirements. The structure and course requirements for MPH concentrations vary widely, and few had a sequenced progression of learning. Several concentrations consist of multiple course options that make it difficult to measure program competencies. Some faculty value this flexibility as a way to individualize programs of study, and others see the lack of structure as a collection of courses rather than a coherent degree program.

The review also revealed that SPHTM has an excessive number of courses; many are not tied to a program, and many are not regularly taught. Historically, faculty have created courses on the basis of interest, a current topic, or the need to create a new course as a requirement for tenure. As a result, many courses are not closely associated with a program. Although the large number of courses creates a wide breadth of options, they distract from the programs’ focus on specialized study. A moratorium has been placed on the development of new graduate courses until the programs are revamped and course offerings are streamlined. The MPH and MSPH program competencies and course requirements will be updated, and each will have an assessment plan. This will result in a more streamlined and focused curriculum for the MPH and MSPH programs.

Master of Public Health Core Curriculum

SPHTM currently has six independent core courses; this structure is strongly embedded in the curriculum, is based on the departmental administrative organization and governance, and has been the center of the SPHTM professional master’s programs for 40 years. Although faculty are not ready to embrace a major structural change, they are working to coordinate better and integrate common examples and case studies across the core courses. The first step is to develop a set of case studies that will integrate concepts across the core disciplines, demonstrate disciplinary and methodological perspectives on topics, and develop multiple approaches to problem solving. These studies will provide a perspective on a topic that will demonstrate the interdisciplinary nature of public health issues. The development of comprehensive case studies is proving to be very time consuming. Each core course progresses at a different rate, and students may view the use of the same case study as redundant. However, the discussion is in itself creating more coordination among the core courses.

The core courses provide a foundation in each of the areas of public health and present their theory, concepts, and methods. Faculty believe that students must have this fundamental knowledge and methodological skills as a basis for practical applications. Feedback from students has indicated that they would like to cover more applications to provide a context for this knowledge. The debate is over how much fundamental knowledge is needed for the typical MPH graduate who is not majoring in a particular area.

Another point of debate is the level at which the MPH core course should be taught. With more students entering with a background in public health, further questions have arisen regarding what prior knowledge should be expected and the depth of study needed in core areas. Changes to the structure of the MPH core curriculum will take a stepwise approach to allow faculty time to adapt to new models for it.

Blended Learning With a Flipped Classroom

Technology as a teaching tool is the wave of the future. Three of the core courses will pilot a blended learning model using the flipped classroom. Didactic material is being converted to an online format in a modularized design, which will create enduring materials that can be used for the core courses and serve as resources in other settings. In the flipped classroom model, students will view the module before a class meeting, that is, the homework occurs before the class meets and will count as class time. The online format will allow for the incorporation of graphics, gaming exercises, animation, and skill-building exercises to enhance learning. Students with undergraduate public health education may move through the material quickly and avoid redundant material, and others may take more time if needed to master the material. A posttest will guide their assessment of learning. The instructor-led class time will be focused on problem-solving exercises, case studies, and application of knowledge and skills as well as on reinforcing important concepts and answering questions.

The flipped classroom will produce an online resource that may have multiple uses throughout the MPH curriculum. Students can use the modules for review, and other faculty can refer students to modules when these skills are used in other classes. For example, a nutrition class that analyzes data may refer students to a biostatistics module to supplement their teaching. The modules will optimally help reduce redundancy in the curriculum, reinforce learning, and integrate the core principles into a disciplinary context. The greatest benefit will be in the practical application and problem-solving exercises.

Putting core material into a flipped classroom has challenges. Developing the online modules is time consuming and resource intensive. An instructional designer assists faculty with the online component. Creating the modules will streamline and focus materials, which will lead to difficult decisions regarding what to include and what to drop. The online modules will free up class time for case study analysis and problem-solving exercises. Many faculty are skeptical of the model and feel students will not do the work ahead of time or will skip class. To compare the two models, the biostatistics core will be taught by the same instructor in both formats, and we will look at student performance in and opinions of each class.

Graduate Certificates

The MPH Task Force led the development of 11 graduate certificates that are designed to provide a second area of specialized study to complement the MPH and MSPH concentrations. This area is modeled on the certificate programs recently developed at the Columbia University Mailman School of Public Health. The graduate certificates include both foundation and advanced courses in the second area. The public health core courses and the programmatic required courses cannot be used toward the certificates. The new graduate certificate program began in fall 2014 and includes biostatistics, bioinformatics, epidemiology methods, genetic epidemiology, clinical and translational research, community health and nutrition programs, maternal and child health, disaster management and resilience, methods in monitoring and evaluation, and program management.

Most of the graduate certificates—for example, those in biostatistics or epidemiology methods—are intended for students in other concentrations who seek a credential in a second area. Others, such as genetic epidemiology, provide more advanced study in an area. These graduate certificate programs are only open to students currently enrolled in the MPH or MSPH program. They will be evaluated and monitored for the value they add to the MPH degree. A polling of the Alumni Board indicated widespread support for the graduate certificate programs and provided employers with a way to assess students’ achievements beyond their concentration. As the utility of the certificates is measured and their value to employers assessed, they may be opened as free-standing nondegree graduate certificates.

Enhancing Practica

Because many current students lack work experience, the importance of providing a quality practicum experience is greater than ever before. Each department facilitates practica on a student-by-student basis. Although many practica are excellent and provide a mentored practice experience, some could be improved. Evaluation of the overall practicum experience is hampered by the dispersed process within departments and reliance on individual advisors. To enhance practica, SPHTM is launching a computerized tracking system that compiles student information about the practica site; preceptors; evaluations by the preceptors, students, and advisors; practica reports; and presentations. The compilation of this information will facilitate the overall practica evaluation and additional placements and provide feedback to students, faculty, and preceptors. This system will enable SPHTM to identify and track outcomes to assess the effectiveness of the practica as a learning experience. The central tracking mechanism will enhance management of the practica and allow for better tracking and assessment of experiences.

SUMMARY

The Tulane SPHTM has launched an initiative to revitalize its MPH and MSPH programs so graduates are prepared to meet the challenges of the 21st century. This transition presents opportunities for enhancing learning and for focusing on problem solving and applications through case studies. Today’s students use technology as a learning tool, and SPHTM is revamping teaching to accommodate the learning styles of these students. Technology is a powerful teaching tool; creative instructors can use Web-based applications that are not available in a traditional lecture. Revamping the core courses benefits the entire MPH and MPSH curriculum.

The revitalization initiative is not without challenges. Change is always difficult. The way faculty have traditionally designed curricula and taught will have to change, and time will be needed to accept and learn new teaching methods. The curriculum revitalization framework provides a path forward, and it will be shaped as the process evolves. The cost of implementing curriculum revitalization will be a factor in how fast the initiative proceeds. One of the major limitations is faculty and staff time to revamp the core courses, enhance practica, and integrate technology into teaching. Faculty are experts in their fields but need staff support in integrating technological tools into their teaching, and the cost of technology will be substantial. The curriculum revitalization initiative has been launched, and SPHTM is proceeding to invigorate the MPH and MSPH programs and continue to produce leaders in public health.