Our Practice Is Our Passion: Development and Delivery of a 21st-Century Doctor of Public Health Program

Abstract

Twenty-first century advances have significantly altered the functions of public health professionals, resulting in a need for advanced level training in community health leadership and practice-oriented research without interruption of professional careers.

We present an example of an innovative Doctor of Public Health (DrPH) program developed at the University of South Florida College of Public Health. This program incorporates 21st century public health competencies within a competency-based curricular model, delivered in a hybrid format (fall or spring online delivery and a 1-week face-to-face summer institute) in collaboration between academic and practice-based public health professionals at local and national levels.

This revised competency-based program is an example of how to meet the needs of the 21st century public health practitioners while maintaining their connections to the practice world.

Twenty-first century advances have significantly altered the functions of public health professionals, who began as a workforce consisting of physicians, nurses, and biological scientists employed to address public health needs, such as sanitation, infectious diseases, immunizations, and food and water quality.¹ However, current public health challenges include environmental disasters, health equity, technological advances, effects of globalization, and the impacts of an aging and increasingly diverse society.¹ As a result, the Institute of Medicine (IOM) report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, noted that contemporary training needs should include informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics.¹ A baseline assessment of 33 accredited schools of public health conducted by the Association of Schools of Public Health (now known as the Association of Schools and Programs of Public Health [ASPPH]) revealed that the majority of Masters of Public Health (MPH) training programs addressed these training needs, with the exception of genomics, informatics, and community-based participatory research.² However, this report did not focus on the training needs associated with a Doctorate of Public Health (DrPH)—an advanced-level public health degree geared for practitioners who work in a variety of local, state, federal, and international settings.³

The IOM also recommended that advanced training in public health include community health leadership and practice-oriented research, a flexible competency-based educational program that addresses the learning styles of mid-level public health practitioners, new e-learning technologies via hybrid delivery, and a curriculum that emphasizes practice-oriented education.¹ To address these advanced training needs, ASPPH developed a framework, the DrPH Core Competency Model, which is defined by consensus-driven competencies and grounded in leadership and practice-based research skills.³ The DrPH Core Competency Model outlined seven competency domains essential to advanced DrPH training: leadership, advocacy, communication, management, community and cultural orientation, professionalism and ethics, and critical analysis.³ Because the roles and responsibilities of practitioners vary, the DrPH Core Competency Model places greater emphasis on evidence-based practice and leadership pertaining to public health assessment, policy development, and assurance.³

As a result of recommendations presented by the IOM report and the DrPH Core Competency Model, there is an opportunity to develop innovative methods for training advanced-level public health professionals. We present an example of an innovative DrPH program of study at the University of South Florida (USF) College of Public Health that incorporates 21st-century advanced public health competencies with an outcomes- and competency-based curricular model delivered in a hybrid format in collaboration with local and national public health professionals.

COMPONENTS OF THE DOCTOR OF PUBLIC HEALTH PROGRAM

Developed in 2009, the DrPH program at USF originally focused on having students build a particular line of public health research. The major difference between the PhD and DrPH was not the program of study but that DrPH students were required to have at least two years of public health work experience before admission. After three implementation cycles, a DrPH ad hoc committee was formed to review the program of study. Because of the practice-based nature of the degree and the strong collaborative relationships between USF College of Public Health and public health agencies and organizations, local public health leaders were involved in program development and plan for delivery. The goal was mutual learning and reciprocity fostered by inclusion of both academic and practice mentors who would enable maintenance of connections to the practice world locally, nationally, and internationally. Based on feedback from graduates, current students, faculty, and practice professionals, the DrPH program of study was then revised to foster advanced expertise and leadership skills while emphasizing translation of evidence-based practice in the execution of core public health functions. Development of the program and its mission were guided by principles of competency-based postsecondary education, the DrPH Core Competency Model,³ previous learning assessment, and mentoring programs.

Mission and Oversight

Based on a competency-driven curricular model delivered in a hybrid format, the mission of the DrPH program of study at USF is to

prepare practitioners for leadership and advocacy in public health practice through a scientific, interdisciplinary approach to understanding and solving public health problems in the public and private sectors, the United States, and worldwide (https://documents.health.usf.edu/display/COPH/2.5+Doctor+of+Public+Health).

This mission relates directly to the USF mission, including the creation of a community of students together with significant and sustainable university–community partnerships and collaborations, and designing, strengthening, and building sustainable healthy communities and improving quality of life.

The DrPH program is a college-wide degree with development and oversight from an interdepartmental DrPH Admissions and Advisory Committee (AAC). The AAC includes representatives from each of the departments within the college in addition to community partners, DrPH students, and alumni. The AAC reviews DrPH applicants, assigns faculty advisers, reviews and evaluates students’ previous learning portfolios that are submitted in students’ first semester, and monitors, reviews, and revises the DrPH program of study as needed.

Competency-Based Postsecondary Education

In 2010, the US Department of Education revised the definition of the credit hour to address the disconnect between course time (time being taught assessed by grades) and learning.⁴ Specifically, the newly defined credit hour includes innovative practices, such as online education, learning-based credit, and academic activities that do not rely on seat time in class. With the new definition, changes in the primary metric of learning includes evidence of student achievement of learning outcomes, such as competency-based approaches as opposed to credits or seat time.⁴ Generally speaking, competency-based approaches to secondary education emphasize outcomes (i.e., what a degree holder should know and be able to do). Students advance when they demonstrate mastery in predefined competencies rather than simply completing traditional credit hours.^5,6 Benefits of competency-based learning include improved workforce readiness, program efficiency through eliminating redundant coursework or unnecessary degree requirements, program effectiveness through the development of methods to validate that student learning has occurred and competencies have been achieved, and program fairness through recognition of learning that the student may have acquired outside of a classroom.^5,7

Two general types of competency-based learning models exist. The competency-focused curriculum model applies student learning assessment within the existing seat time system, whereas the competency-based curricular model breaks free of seat time to create new curricular models not tied to credit hours.⁵ Because of current USF policies, the DrPH program of study is based on a competency-focused curricular model that is tied to credit hours. Guidelines for implementing competency-focused or -based programs include aligning degree-based competencies (e.g., DrPH core competencies) with workplace skill requirements, a system of reliable assessments using competency-based rubrics based on learning objectives versus traditional assessment of grades earned for completion of coursework, and incorporating adult- and student-centered learning methods.^5,6

Doctor of Public Health Core Competencies

The DrPH Core Competency Model spearheaded by ASPPH provides a set of competency domains and recommendations for implementation that move from faculty-centric training to learner- and practice-centered training with attention given to adult learning principles and performance-based outcomes.³ Following this approach, the 90-credit hour DrPH program of study at USF comprises three curricular clusters: (1) advocacy, leadership, and community engagement; (2) management and ethics; and (3) evidence-informed public health (Table 1). Each of these has associated content domains and competencies that address three levels of learning: benchmark (knowledge or comprehension), milestone (apply or analyze), and capstone (evaluate or create). Required courses and practical experiences are matched to all levels of competencies to ensure the breadth and depth of each curricular domain. A specific course may be designated as addressing a specific competency (e.g., evidence-informed public health contributes to the following competency: apply theoretical and evidence-informed perspectives from multiple disciplines in the design and implementation of programs, policies, and systems). However, earning a passing grade in the course does not necessarily equate with meeting the competency, because the final grade may be influenced by a variety of assessments (e.g., attendance, class participation, knowledge exams, and so on).

TABLE 1—

Competencies and Components of the Doctor of Public Health Program at the University of South Florida

Domain	Definition	Benchmark Competency	Milestone Competency	Capstone Competency
Cluster 1: advocacy, leadership, and community engagement
Advocacy	The ability to influence decision-making regarding policies and practices that advance health using scientific knowledge, analysis, communication, and consensus building	Present positions on health issues, law, and policy in multiple sectors •PHC 6120: Community Partnerships and Advocacy	Analyze the impact of legislation, judicial opinions, regulations, and policies on population health •PHC 7932: Practical Applications 1: Policy, Advocacy, and Public Health	Influence health policy and program decision-making based on scientific evidence, stakeholder input, and public opinion data •Collaborate with practice-based mentor •Complete a practice-based dissertation
Leadership	The ability to create and communicate a shared vision for a positive future, inspire trust and motivate others, and use evidence-informed contextually and culturally appropriate strategies to enhance essential public health services	Demonstrate a commitment to public health professional values •PHC 7103: Transforming Public Health Practice	Influence others to achieve high standards of performance and accountability •PHC 7933: Practical Applications II: Public Health Leadership	Promote effective strategies to address the challenges presented to public health leadership •Collaborate with multidisciplinary researchers and practitioners •Collaborate with practice-based mentor •Complete a practice-based dissertation
Communication	The ability to assess and use communication strategies across diverse audiences to inform and influence individual, organization, community, and policy actions	Discuss the interrelationship between health communication and marketing •PHC 6411: Introduction to Social Marketing	Prepare oral and written communications from briefs, position papers, scientific articles, community pieces Guide an organization in setting communication goals, objectives, priorities, and strategies •PHC 6195: Public Health Data, Information, and Decision-Making •PHC 7317: Risk Communication in Public Health •PHC 7934: Writing for Scholarly Publication •PHC 7937: Advanced Seminar in Grant Writing	Integrate health literacy concepts in all communication and marketing initiatives •Collaborate with practice-based mentor •Complete a practice-based dissertation
Community/cultural orientation	The ability to communicate, interact, engage, and work with people across diverse communities and cultures for development of programs, policies, and research	Develop collaborative partnerships with communities, policymakers, and other relevant groups •PHC 7103: Transforming Public Health Practice •PHC 6801: Cultural Competency	Conduct community-based participatory intervention and research projects Engage communities in creating evidence-informed, culturally competent programs •PHC 6801: Cultural Competency •PHC 6442: Global Health Applications in the Field •PHC 6761: Global Health Assessment Strategies	Implement culturally and linguistically appropriate programs, services, and research •Collaborate with practice-based mentor •Complete a practice-based dissertation
Cluster 2: management and ethics
Management	The ability to provide fiscally responsible strategic and operational guidance within both public and private health organizations for achieving individual and community health and wellness	Develop capacity-building strategies at the individual, organizational, and community levels •PHC 710: Transforming Public Health Practice	Apply principles of human resource management Organize the work environment with defined lines of responsibility, authority, communication, and governance Implement strategic planning process Guide organizational decision making and planning based on internal and external environmental research •PHC 6104: Management of Public Health Programs (or) •PHC 6146: Health Services Planning and Evaluation (or) •PHC 6148: Strategic Planning and Healthcare Marketing; •PHC 6181: Organizational Behavior in Health Services	Evaluate organizational performance in relation to strategic and defined goals •Collaborate with practice-based mentor •Complete a practice-based dissertation
Professionalism and ethics	The ability to identify and analyze an ethical issue, balance the claims of personal liberty with the responsibility to protect and improve the health of the population, and act on the ethical concepts of social justice and human rights in public health research and practice	Demonstrate cultural sensitivity in ethical discourse and analysis •PHC 6412: Health Disparities, Diversity and Cultural Competence (or) •PHC 6442: Global Health Applications in the Field	Design strategies for resolving ethical concerns in research, law, and regulations •PHC 6934: Public Health Ethics	Develop tools that protect the privacy of individuals and communities involved in health programs, policies, and research •Collaborate with practice-based mentor •Complete a practice-based dissertation
Cluster 3: evidence-informed public health
Critical analysis	The ability to synthesize and apply evidence-informed research and theory from a broad range of disciplines and health-related data sources to advance programs, policies, and systems promoting population health	Interpret quantitative and qualitative data following current scientific standards Synthesize information and derive pertinent implications from multiple sources for research and practice •PHC 7934: Writing for Scholarly Publication •PHC 6195: Public Health Data, Information and Decision-Making •PHC 7154 Evidence-Informed Public Health I	Apply theoretical and evidence-informed perspectives from multiple disciplines in the design and implementation of programs, policies, and systems Translate research-informed approaches to public health practice •PHC 7612 Evidence-informed Public Health II •PHC 7937 Advanced Seminar in Grant Writing	Design needs and resource assessments for communities and populations Evaluate the performance and impact of health programs, policies, and systems •Collaborate with practice-based mentor •Complete a practice-based dissertation

Note. PHC = Public Health Course. All courses are offered online except the following, which are offered as part of the 1-week face-to-face summer intensive: PHC 7932 Practical Applications I: Policy and Public Health; PHC 7933 Practical Applications II: Public Health Leadership; PHC 6181 Organizational Behavior in Health Services; PHC 6934 Public Health Ethics; PHC 7612 Evidence-Informed Public Health: Part Two.

Consequently, each DrPH student is expected to achieve metacognitive knowledge on each competency (the highest level on the knowledge dimension) through a combination of previous learning activities, activities within the DrPH courses, field placement experiences, collaboration with senior public health practitioners in a mentoring relationship, and the required practice-based dissertation that demonstrates cognitive process dimensions (i.e., application, analysis, evaluation, and creation) relevant to advanced evidence-informed public health practice. Each DrPH competency is assessed by specific evaluation rubrics that evaluate the fulfillment of learning objectives associated with each benchmark, milestone, and capstone competency. This competency-focused outcome assessment will be implemented starting with the 2014–2015 academic year; thus, our ability to report outcome data for the first cohort of students was limited.

An additional distinguishing feature of this program is that students have the potential to earn advanced public health certificates in the DrPH content clusters (Table 1). This is especially valuable for prospective students who are uncertain about committing to a doctoral program because of professional and personal time commitments or their perceived low self-efficacy for doctoral study success. Likewise, current DrPH students who encounter professional or personal life events that hinder completion of the degree can earn certificates as evidence of competency and mastery of advanced public health skills.

Previous Learning Assessment

As previously described, the competency-focused curricular model allows for deviation from seat time learning toward an emphasis on demonstration of competence via a system of reliable assessments. Previous learning assessment and recognition pertain to the assessment of competencies that occur outside of the traditional credit hour (i.e., informal learning).⁸ Three assumptions behind previous learning assessment include learning can and does take place outside the classroom, learning outside of the classroom should be evaluated for credit, and educational practices that force adults to repeat learning of skills already attained is inefficient, costly, and unnecessary if the goal meets certain competencies.⁸ Previous learning assessment can assist programs of study in tailoring their programs to meet the needs of students with diverse experiences, in addition to the needs of the “real world” practice environment.⁸ Moreover, current literature indicates that students who earn credits through previous learning assessment are more likely to remain enrolled and complete programs of study than are those who do not earn such credits.⁹

Modes of previous learning assessment include standardized tests, challenge exams, assessment of nonaccredited training programs, essays, and portfolios.^8–11 There are two general approaches to previous learning assessment: course-matched and noncourse-matched.¹⁰ Course-matched previous learning assessment looks for equivalence between previous learning and specific courses or course outcomes, whereas the noncourse-matched approach does not require that the student’s previous learning match any prescribed course outcomes.¹⁰ The course-matched approach is useful for traditional academic programs that require accreditation and application to degrees.¹⁰ Regardless of the approach, the first step to previous learning assessment approaches is to determine the competencies and levels within the competencies (e.g., Blooms Taxonomy of Learning).¹⁰

To align with current USF systems, policies, and procedures pertaining to competency-focused curricular models, a course-matched previous learning portfolio approach was adopted at USF for the DrPH to help students with diverse experiences translate graduate-level previous learning into demonstrated competencies. During the first semester of study, students meet with their academic advisers to review guidelines for the development of the previous learning portfolio. Components of the previous learning portfolio are described in Table 2. The portfolio is submitted to the AAC oversight committee at the end of the DrPH student’s second semester in the program. The Competencies and Learning Outcomes and Documentation sections most directly provide a rationale for achievement of competencies. This section includes specific details and insights from the student’s past experiences, and makes systematic, logical connections to the theories and concepts of the DrPH competencies and associated courses. This section of the portfolio requires critical reflection to synthesize the meaning and impact of previous experience to articulate how learning was achieved, that is, the skills, abilities, behaviors, values, and attitudes (intentional or not) used to uncover core competencies at any level that were embedded in the experience. Documentation is also required to support the narrative by providing direct evidence of the learning outcome. Depending on the competency, examples of evidence may include previous graduate-level coursework, military experience, licenses that do not qualify for articulated credit, awards, publications, projects, trainings, fellowships, performance appraisals, and so on.

TABLE 2—

Components and General Evaluation Criteria for the Previous Learning Portfolio

Components	Description of Component	General Evaluation Criteria
Cover page	Name, academic adviser, practice-based mentor, contact information, start date	•Statement and description of learning including specific details and insights
Letter of intent	Addressed to the COPH DrPH AAC, the letter of intent includes the following: •Competencies you intend to request via previous learning •Areas of expertise you intend to demonstrate •Number of credits requested to earn via previous learning	•Documentation of meaning in performance and behavior
Table of contents	Sections of the portfolio by page number	•Description and analysis of the context in which the DrPH competencies and outcomes were developed
Competencies and learning outcomes	A narrative that provides specific details and insights from past experiences and makes systematic, logical connections to the theories and concepts of the DrPH competencies and associated courses in which credit is sought.	•Interpretation, analysis, and transference of knowledge, learning competencies, outcomes, and personal attributes into leadership roles
Course syllabi	A syllabus for each course pertaining to your portfolio content	•Synthesis of data and experiential situations for use in problem-solving and decision-making areas
Documentation	The evidence submitted to support achievement of competencies and associated learning outcomes. Documentation must specifically be identified with each competency and learning outcome.	•Association of professional knowledge or core competencies embedded in the learning experiences with concepts, theories, and research pertaining to the DrPH
CV	Updated CV	•Evidence of achievement of each competency and learning outcome
Unofficial transcripts	Unofficial graduate transcripts	•Demonstration of competency in writing
References	Standard APA format and referencing	•Demonstration of competency in writing

Note. AAC = Admissions and Advisory Committee; APA = American Psychology Association; COPH = College of Public Health; CV = curriculum vitae; DrPH = Doctor of Public Health.

Assessment of the previous learning portfolio by the AAC is based on standards and criteria established for the level of learning required by each competency. General evaluation criteria are described in Table 2. If activities in previous coursework do fulfill the established competencies, coursework may be transferred into the program based on USF policies. In addition, based on approval of competencies earned outside of seat time, required courses may be waived. This is followed by the development of an adjusted program of study tailored to the specific knowledge and skills that students need to address their areas of weakness, to meet overall program competencies and the 90-credit hour requirement.

Mentor Program

To assist with navigation through the doctoral program, each DrPH student is assigned an academic adviser (from the faculty) who helps the student select a practice-based mentor (from the practice community). The role of the academic adviser is to evaluate achievement of curricular competencies, whereas the role of the practice-based mentor is to develop and expand knowledge and skills through direct and indirect exposure to a range of advanced public health activities that include leadership. Mentors are selected based on the needs of the mentee identified through the previous learning portfolio. For example, completion of the previous learning portfolio not only identifies competencies that may have been met through previous learning but also identifies knowledge, skills and experiences that are needed to meet competencies and career goals. Once identified, the student, in collaboration with the academic adviser, searches for potential practice-based mentors who have the skills, experiences, and professional practice and leadership experience that meet the needs of the mentee. Upon identification and selection of the mentor, the mentee and mentor complete a mentorship agreement form that comprises three to five learning objectives and associated deliverables that are to be achieved within a specific time frame. Based on student needs, multiple mentors may be needed along the course of the student’s program of study. Mentors are not compensated monetarily but are awarded with USF College of Public Health affiliate faculty status, providing them with access to USF and College of Public Health resources and activities.

The DrPH mentee is expected to take an active role in communicating with the mentors at least once per month to discuss issues, receive guidance, and debrief on practice or leadership experiences. Examples of mentor and mentee activities include participating in meetings or conference calls with internal and external collaborators, observing or participating in program activities, engaging in policy-related activities, and exploring funding sources and resources that are most useful to the mentor’s agency, population of interest, and leadership style. The practice-based mentor also aims to develop and expand the DrPH student’s advanced public health practice skills, such as managing teams and projects, discussing the mentor’s own leadership style, providing leadership within the student’s current organization, providing leadership within the community at local, state, regional, national or international levels, and providing access and time with individuals in various other levels of leadership.

Evaluation of the mentor program includes the mentorship evaluation, which is completed by the DrPH student in collaboration with the mentor. Evaluation metrics include achievement of learning objectives, mentee and mentor expectations, and a mentee self-reflection of skills or leadership characteristics that were developed, skills and characteristics that need further development, a description of how the student plans to incorporate skills into current and future public health activities, and the most significant lesson taken away from the mentorship.

Program Delivery and Student Profile

The DrPH program at USF addresses the needs of contemporary public health professionals through its delivery of a competency-driven curriculum in a hybrid format. The DrPH degree is completed through credit-earning online delivery in the fall and spring semesters and a one-week on-campus DrPH summer institute. This combination of program delivery formats allows working professionals to broaden their grasp of public health management, practice, and research skills without interrupting their careers. The DrPH Summer Institute also offers a recurring venue for face-to-face meetings with advisers and mentors, networking with local and national leaders, and community building.

Supporting the advanced training focus of the degree, DrPH applicants are admitted with a minimum of an MPH, MSPH, or MHA degree and at least two years of public health experience. The changes in the program of study also necessitated changes in the admission criteria and the number of students admitted. Before these revisions, applicants were primarily accepted based on research focus, potential “fit” with departmental focus, and availability of faculty to serve as the student’s major professor, thus limiting the number of students accepted into the program to an average of 3.8 students per year. New requirements include a Statement of Public Health Experience (i.e., description of previous public health education or training, experience in applying the core areas of public health, and commitment to public health) in addition to a statement of DrPH Purpose and Objectives (i.e., rationale for interest in the DrPH program, the needs or challenges perceived as important in the field of public health, future public health career goals and objectives, plans for use of DrPH training, rationale for interest in the DrPH program of study, and any personal qualities, characteristics, and skills that will enable success in the field of public health). Students are now selected based on previous public health experience and career goals, including leadership and translation of public health research to practice in the United States and globally. This new focus, combined with a hybrid delivery format, has expanded the student profile to include in- and out-of-state or out-of-country working professionals. Admissions currently average eight students per year, with the number of applications increasing three-fold.

RELEVANCE TO SCHOOLS AND PROGRAMS OF PUBLIC HEALTH

Contemporary challenges in public health necessitate a transformation in how schools and programs of public health train advanced level public health professionals. Modifications in DrPH training programs should not only address 21st-century knowledge and skills but also should address the learning style of mid-level public health practitioners using innovative program designs and delivery methods. To date, there are 31 accredited DrPH programs in the United States, four of which are delivered in a hybrid format (Loma Linda University, University of Illinois Chicago, University of North Carolina Chapel Hill, and USF). Although the hybrid model provides an opportunity for the working professional to gain advanced training in public health, to our knowledge, the DrPH program at USF is the only program developed, implemented, and evaluated as a true competency-focused curriculum that incorporates previous learning experience and competency-based outcomes. Developed via an evidence-informed conceptual framework, the DrPH program of study presented herein is an example of how to meet the advanced training needs of the 21st-century public health practitioner while encouraging them to maintain connections to the practice world.