Improving the Use of Competencies in Public Health Education

Abstract

Competency-based education is the present and future of public health education. As programs have adopted competencies, many have struggled and continue to struggle with actual implementation and curricular redesign.

We experienced these problems at The University of Oklahoma College of Public Health; thus, we propose an adaptable and replicable process to better implement competencies and evaluate student mastery of them throughout any public health program.

We specifically recommend adopting mission-based competencies followed by a longitudinal evaluation plan like the model provided.

Competency-based education is predicted to radically transform the traditional time-based education system in the United States.¹ The Council on Education for Public Health (CEPH) differentiates competency-based education from traditional education by claiming that competencies “clearly define what the student will do to demonstrate learning for a workforce-related need,” as opposed to merely achieving institutional instructional goals.² In the public health field, the Association of Schools and Programs of Public Health (ASPPH) developed a set of competencies to guide the programs, but many schools tended to adopt the proposed set with little understanding of how the competencies were to reflect their own missions. Through its accreditation process, CEPH is helping public health programs transition to a competency-based learning model. We describe common competency-adoption problems and one program’s solution to those problems.

PROPER USE OF COMPETENCIES

As shown in Figure 1, competencies are to interrelate with a school’s mission, goals, and objectives and to drive and reflect instructional goals and objectives. Like other schools, our college (The University of Oklahoma College of Public Health) struggled to develop relevant competencies that directly related to our mission. Because one of our primary reasons for adopting competencies was to meet CEPH requirements, we initially adopted the ASPPH-drafted competencies verbatim. Our college’s impression was that we could guarantee CEPH’s acceptance of our competencies if we adopted those drafted by ASPPH. Consequently, we had 12 domains and 119 individual competencies that did not correlate to our specific mission statement.

FIGURE 1—

Hierarchy and interrelations of objective statements in a competency-based learning model.

Source. Council on Education for Public Health.²

Our college realized several outcomes from this approach. First, the faculty was insufficiently consulted when adopting the competencies; consequently, they had little interest in or understanding of them. Second, because of the lack of interest and understanding, course content did not change with the introduction of the competencies. Third, measuring student mastery of each of the 119 competencies was impossible. Because the competencies were not mission-driven, many were irrelevant or improperly tailored; implicitly, we struggled with the volume of competencies, which impeded their measurement and application. Fourth, we had insufficient processes for evaluating their attainment with respect to timing and methods.

Our experience is far from unusual: major barriers identified in establishing public health competencies have been (1) low faculty interest, (2) lack of awareness and understanding of competency-based education, and (3) insufficient time to deploy and assess competency-based methods.³

We have realized that a significant part of the problem is a lack of understanding of how competencies fit within an educational process. As Figure 2 shows, a school should first identify competencies relevant for its program; it should accomplish this goal by holding stakeholder meetings and incorporating faculty into the drafting and adoption process. All competencies should relate to the school’s mission, vision, and values. Then the school needs to use a “zero-based” curricular design that “zeroes” out the current curriculum and develops new course content and offerings based on the competencies. To be clear, faculty should not shoehorn the competencies into the current course content, but the content and curriculum should be reconceived as a way to help students achieve the competencies. This process also should encourage thoughtful staging of courses (from basic to advanced) as a student progresses through the program. In a correctly designed program, the number of required credit hours and associated classes would be minimized, jointly taught, and better targeted.

FIGURE 2—

Correct and incorrect methods for integrating competencies in the public health curriculum.

Next, competencies need to measure student progress. Valid evaluations should provide multifaceted feedback to students, instructors, and program directors, and they should include longitudinal student-centered evaluation methods. Best practices of student-centered evaluation involve “active engagement of students in setting goals . . . , monitoring their progress toward those goals, and determining how to address any gaps,”⁴ which is critical to improve the student’s ability for self-regulated learning.⁵ The competency evaluation should occur throughout the program and provide differentiated support and experiences based on individual learning needs.

As shown in Figure 3, we propose a specific model of longitudinal competency evaluation. This model adapts to the timing and general experiences of an MPH student. The parts include

1. an adviser facilitates the self-assessment of ability level of program competencies;

2. after 21 course hours, the student completes the National Board of Public Health Examination;

3. before beginning the practicum, the student and adviser should evaluate progress toward the competencies and set goals for the practicum;

4. after the practicum, the student, adviser, and preceptor evaluate progress; and

5. at the end of the program, a capstone course is used to evaluate competency attainment through a project and an oral examination.

FIGURE 3—

Proposed Master of Public Health competency evaluation timeline.

Each course evaluation also determines attainment of the competencies listed in the syllabus, and within our program, we are considering adding student portfolios and peer assessments. Of course, student mastery also will continue to be measured by grades on assignments linked to specific competencies.

Our process makes individual progress and program evaluation simpler. Program administrators can aggregate individual results to evaluate the attainment of the desired competencies across all students in a degree program. Degree programs can more appropriately document the progression of attaining desired competencies. The key points of our innovations are

1. Start with the school’s and program’s mission.

2. Use stakeholders and faculty to build competencies that complement the mission.

3. Build courses based on competencies.^6,7 Do not just identify competencies in current courses. The Competency-to-Curriculum Toolkit suggests that to build competency-based courses, the steps are:

   • (a) specify the audience,
   • (b) develop learning objectives,
   • (c) assess the time availability of the learner,
   • (d) determine how and when learning will be measured,
   • (e) determine expected outcomes,
   • (f) determine content and availability,
   • (g) match teaching methods to the audience,
   • (h) develop curriculum, and
   • (i) evaluate the learner after the materials have been presented.⁶
4. Evaluate longitudinal student learning of competencies across the student’s program: set a baseline of competency knowledge at the beginning, and design multiple means to measure learning and achievement of competencies:

   • Portfolios (faculty provide the assessment)
   • Peer assessments
   • National examinations (the National Board of Public Health Examiners provides the assessment)
   • Capstone projects (faculty and external stakeholders provide the assessment)
   • Oral examinations (faculty and external stakeholders provide the assessment)

5. Use the student’s practicum to promote and develop competencies: design the practicum to address deficits in competencies, and at its conclusion, the adviser, student, and preceptor should evaluate progress gaining the competencies.

CONCLUSIONS

Competency-based education is the present and future of health professional educational programs,³ but many programs struggle with transitioning to it. As programs struggle, they experience many of the same issues in terms of adoption, implementation, and evaluation. The implementation of competencies can become a paperwork function with little actual value, or universities can make the effort to incorporate them into the curriculum and evaluative processes.

We recognize that transitioning to useful, meaningful competencies is a major challenge for many public health programs. However, we believe that, in the future, competitive programs will be those that are innovatively solving these challenges and implementing the necessary changes to the competency-driven curricular path. Our specific program has created a replicable process to answer some of these challenges, but other programs’ experiences will be essential to learning how to fully integrate competencies in public health education.