Student Practicum as a Bridge to Governmental Public Health Practice

The student practicum is an essential and required component of accredited public health education that provides students with hands-on experience in public health practice. In a 1999 report from the Association of Schools and Programs of Public Health’s (ASPPH’s) Council of Public Health Practice Coordinators, academic public health practice was defined as “the strategic, organized, and interdisciplinary application of knowledge, skills, and competencies necessary to perform essential public health services and other activities to improve the population’s health.”¹ As such, schools and programs of public health accredited by the Council on Education for Public Health (CEPH) emphasize the student practice experience, which CEPH describes as a planned, supervised, and evaluated project that should take place in various professional settings and “should include local and state public health agencies to the extent possible and appropriate.”²

As the voice of accredited academic public health, ASPPH represents domestic and international CEPH-accredited schools and programs of public health. Schools and programs of public health that are accredited by CEPH must go through a rigorous accreditation process to assure students of a high-quality education. The accreditation process requires schools and programs of public health to complete a comprehensive self-study and submit a report to CEPH.³ This report must address a number of criteria, including but not limited to the institution’s mission, governance, resources, faculty members, academic offerings, and practice offerings. CEPH criterion 2.4 states that “all graduate students must develop skills in basic public health concepts and demonstrate application of these concepts through a practice experience that is relevant to the students’ areas of specialization.”² Criterion 2.4 is the basis of the research performed by ASPPH to examine the student practicum and its role in public health education.

To our knowledge, little has been done to measure the collective work and geographic reach of students from schools and programs of public health who are working in governmental public health agencies in the context of the practice experience, or practicum. ASPPH therefore conducted a study to gather information on the practice experiences of students placed in governmental public health agencies, including state and local health departments. The objectives of this research were to (1) improve ASPPH’s understanding of the ways that students engage with governmental public health through the practicum and (2) understand the role that the practicum plays in bridging academia and practice and strengthening the pipeline to the governmental public health workforce.

Methods

ASPPH conducted a review of publicly available CEPH self-study reports from the 89 institutions that were full members of ASPPH at the time of data collection in 2014. ASPPH identified data points related to student practicums; however, because the self-study reports were 1 to 7 years old and ASPPH members provided varying degrees of detail, ASPPH needed additional information. Therefore, it used CEPH criterion 2.4 to develop a survey that allowed for uniform comparisons and current data across ASPPH membership.

The resulting survey focused on geographic distribution of placements, facilitating factors and barriers to placement, and student contributions—all of which were gathered in the context of governmental public health. ASPPH collected these data from its members for practicums completed from fall term 2010 to spring term 2014. ASPPH identified faculty and staff members who were responsible for organizing student practicum experiences at the then 89 CEPH-accredited ASPPH member schools and programs of public health. ASPPH emailed the survey, which was developed with SurveyMonkey,⁴ to 159 faculty and staff members, and asked them to forward the survey to others involved in the organization and oversight of practicum programs. ASPPH allowed for multiple respondents from each institution to account for differences within and among member institutions, with the requirement that the respondent be involved in organizing practicum experiences for students. ASPPH staff members conducted follow-up via telephone and email to ensure the best possible response rate. ASPPH coded and analyzed quantitative data with Microsoft Excel and Tableau (version 8.2)⁵ and then used Microsoft Excel to identify themes in qualitative data. Because this study did not involve human subjects, it was considered exempt from institutional review board review.

Results

ASPPH collected survey responses from 107 people at 81 ASPPH-member, CEPH-accredited institutions, resulting in a 91% (80 of 89) institutional response rate. A total of 78 domestic and 3 international members responded to the survey, of which 53 were schools of public health and 28 were programs of public health.

Geographic Reach

A total of 76 schools and programs of public health, in 36 US states and Grenada, identified the US state or territory in which at least 1 student had been placed at a federal, state, tribal, or local health department during the 4-year period from fall 2010 to spring 2014. The responses indicated that ASPPH members placed students for the practicum experience in governmental public health agencies in all 50 US states, the District of Columbia, and 4 US territories (Guam, the Northern Marianas Islands, Puerto Rico, and the US Virgin Islands). During the study period, the 76 responding institutions placed students in governmental public health agencies in an average of 5 states. The median number of states in which member institutions placed students in practicums during the study period was 3 (range, 1-47).

The District of Columbia had the highest number of practicum placements, with 30 of 76 (39.5%) institutions placing at least 1 student there during the 4-year period, followed by New York (n = 25, 32.9%), Georgia (n = 24, 31.6%), and California (n = 22, 28.9%). The states and territories with only 1 member institution placing students in governmental public health agencies in these locations were Arkansas, Delaware, North Dakota, the Northern Marianas Islands, and the Virgin Islands.

Placement Facilitators

Of the 81 responding institutions, 65 (80.2%) indicated that students established their own practicum experiences with governmental public health agencies. Sixty-eight (84.0%) responding institutions indicated that they used existing relationships between faculty and governmental public health agency staff members to establish practicums for students. The most common examples of these types of relationships were having a governmental public health agency staff member employed as an adjunct faculty member (33 responding institutions) and having an academic health department (19 responding institutions). Respondents said that when students were offered opportunities to learn about and network with agency staff members, they had opportunities to explore possibilities for student practicums. Furthermore, 58 (71.6%) responding institutions indicated that formal agreements with governmental public health agencies facilitated student practicum placements. Respondents indicated 2 types of formal agreements: memoranda of understanding and affiliation agreements. Finally, 34 (42.0%) responding institutions indicated that funding was an important facilitator for placement. The 3 most common funding models were direct funds to students, institutional funding, and available funds at governmental public health agencies to place students in practicums (Tables 1 and 2).

Table 1.

Models for providing funding to support practicum placements in governmental public health agencies for students at US schools and programs of public health

Funding Models	Details
Funds for students	Provision of reimbursement for travel from an academic institution to allow students to complete practicums in health departments in rural and underserved communities not in close proximity to the academic institution
	Provision of a stipend through a government-funded center focusing on practice located at an academic institution, such as a regional Public Health Training Center or academic health department
	Provision of a stipend through shared funding from an academic institution and health department
	Provision of a stipend through a paid internship program with the federal government, as with the Centers for Disease Control and Prevention
Funds for the governmental public health agency	Academic institution provides funds to the health department to support its ability to host a student practicum
Funds for the academic institution and the governmental public health agency	Shared funding, provided by a third party, between the academic institution and the health department for research

Table 2.

Facilitators and barriers to placing students at US schools and programs of public health in practicums at governmental public health agencies: survey of ASPPH-member, CEPH-accredited schools and programs of public health, United States, 2010-2014

Variable	Responding Institutions (n = 81), No. (%)
Facilitators
Relationships between faculty and  health department staff members	68 (84.0)
Students establish practicum  opportunity	65 (80.2)
Formal agreements with health  departments	58 (71.6)
Funding is provided	34 (42.0)
Adjunct faculty are employed at  health departments	33 (40.7)
Academic health departments	19 (23.5)
Shared funding between school or  program of public health and  health department for research	16 (19.8)
Other	14 (17.3)
Barriers
Lack of resources at health  department (eg, time, staff  members)	51 (63.0)
Financial	37 (45.7)
Bureaucratic	35 (43.2)
Lack of interest from students	24 (29.6)
Lack of a formal agreement with  health department	20 (24.7)
Lack of interest from health  department	20 (24.7)
Lack of interest from school or  program of public health	1 (1.2)
Other, please explain	9 (11.1)

Abbreviations: ASPPH, Association of Schools and Programs of Public Health; CEPH, Council on Education for Public Health.

Barriers to Placement

Fifty-one (63.0%) responding institutions indicated that the most common barrier to placement was limited or no resources at governmental public health agencies, such as time or staff members needed to mentor students. Respondents cited the availability of mentorship time as the most common resource barrier, including when governmental public health agency staff members had too many responsibilities to be able to adequately supervise students. Respondents emphasized this barrier for understaffed governmental public health agencies. Additional barriers included financial constraints (37 responding institutions) and bureaucratic barriers (35 responding institutions). Respondents noted a lack of funding as a frequent barrier because many governmental public health agencies cannot provide paid practicums for students. The most common bureaucratic barrier was the lack of a formal agreement between the academic institution and governmental public health agencies (n = 20 responding institutions). Respondents also cited a lack of interest from students (24 responding institutions) or governmental public health agencies (20 responding institutions) as barriers to student placement. Three respondents indicated no barriers to placing students in governmental public health agencies (Table 2).

Student Contributions

Of the 81 responding institutions, 65 (80.2%) offered examples of student contributions to governmental public health agencies through the practicum. ASPPH identified 7 themes in the free-text responses, the most common of which was data analysis, which was mentioned by 40 of 65 (61.5%) responding institutions. One respondent said, “Students routinely provide analysis of existing data for the purpose of extending program funding or as part of continuing quality improvement initiatives. Students also participate in all phases of research, from study design to data collection and analysis and write-up of final results.” Additionally, 27 of 65 (41.5%) respondents cited program planning, implementation, and evaluation as important student contributions (Table 3). One institution provided the following example:

A [student] assisted a local health department with planning for electronic health record implementation. She conducted process mapping and staff training in every clinic, with careful attention to identifying metrics to be captured in the new system to make evaluation/report running easy and built in on the front end. After the [practicum], the clinical director hired her to stay on to see the electronic health record planning through to completion.

Table 3.

Practicum contributions by students at US schools and programs of public health to governmental public health agencies: survey of ASPPH-member, CEPH-accredited schools and programs of public health, United States, 2010-2014

Student Practicum Contribution	Responding Institutions (n = 65), No. (%)
Data analysis	40 (61.5)
Program planning and evaluation	27 (41.5)
Data collection	18 (27.7)
Report development	13 (20.0)
Policy development	11 (16.9)
Manuscript, poster, and presentation development	12 (18.5)

Abbreviations: ASPPH, Association of Schools and Programs of Public Health; CEPH, Council on Education for Public Health.

Discussion

The results suggest that many CEPH-accredited schools and programs of public health successfully place students in governmental public health agencies both in and outside the institutions’ home states, showing that students can gain experiences in a broad range of public health situations representing the diversity of the United States. ASPPH member institutions indicated placing students for their practicums in governmental public health agencies in all 50 US states, 4 US territories, and the District of Columbia. In addition, the 3 states with the most institutional placements by responding institutions—New York, Georgia, and California—have a high concentration of governmental public health agencies that can attract students who may not be able to gain similar experiences by working with governmental public health agencies in their own region because of limited resources or unavailability of mentors.

The most common student contributions (ie, data analysis, program planning, and evaluation) indicated by responding institutions were critical skills for graduate students in public health to master in practical settings. The varied projects and needs at governmental public health agencies can expose them to a range of public health issues under the guidance of experienced mentors, making these placements excellent learning opportunities for students. Some evidence also suggests that students’ contributions can further the missions of governmental public health agencies by supporting work that full-time staff members would otherwise not have time to complete. One respondent said, “Students helped fill in the workload gap where staff [members] had been cut at health departments, specifically on essential programs such as HIV surveillance and county health assessments.”

Given that an average of 12% of all positions in state health agencies (approximately 303 positions per state health agency) were vacant as of 2012 and that the workforce of local health departments decreased by an estimated 12% from 2008 to 2013, students may play an increasingly important role in helping to meet the goals of local, state, and tribal health departments.^6,7 Students bring enthusiasm and the benefits of their ongoing education (ie, greater understanding of new technologies, access to current research, and access to faculty experts) to projects at governmental public health agencies. The student practicum experience may also be a useful way to recruit new staff members with the training and skills needed at governmental public health agencies. As respondents indicated, practicum placements may influence where students work after graduation and may lead to the direct hiring of students by the agency that sponsored them for the practicum.

The student practicum experience is an avenue by which schools and programs of public health can expose students to the work of governmental public health agencies. CEPH-accredited schools and programs of public health give students opportunities to learn about governmental public health, often facilitated by faculty relationships with governmental public health agency staff members. This exposure can encourage students to establish practicums with agencies. Practicums also allow students to contribute to public health issues through the work of governmental public health agencies.

According to a 2013 report from the National Association of County and City Health Officials, the United States has about 2800 local health departments and state health departments in all US states and territories.⁷ Further research could identify governmental public health agencies that are interested in working with CEPH-accredited ASPPH member institutions and facilitate partnerships between academic public health and public health practice. The data in our study were collected from academic institutions only. Gathering feedback directly from governmental public health agencies, site preceptors, and students would provide a more comprehensive understanding of the relationships developed, the students’ contributions, the effect that the practicum has on future employment, and how best to strengthen linkages between schools and programs of public health and governmental public health agencies.

Conclusion

The student practicum is an essential and required component of accredited public health education that provides students with hands-on experience in public health practice. Our research confirms the importance of giving students opportunities to complete their practicums with governmental public health agencies to complement their public health education and support the work of such agencies across the country. Additionally, the student practicum serves as a bridge to prepare students for the governmental public health workforce.