An Academic–Practice Partnership at the University of Washington School of Public Health: The Student Epidemic Action Leaders (SEAL) Team

Abstract

In 2015, the University of Washington School of Public Health, Department of Epidemiology established the Student Epidemic Action Leaders (SEAL) team to provide public health students with experience in field epidemiology in state and local public health communicable disease divisions. The University of Washington Department of Epidemiology developed the SEAL team in collaboration with the Washington State Department of Health to offer public health graduate students opportunities to contribute to the real-time needs of public health agencies during a communicable disease event and/or preparedness event. The SEAL team combines classroom and field-based training in public health practice and applied epidemiology. During the first 2 years of the SEAL team (2016-2018), 34 SEALs were placed at 4 agencies contributing more than 1300 hours of assistance on 24 public health projects.

Field epidemiologists play an important role in preparing for and responding to public health challenges worldwide by supporting disease surveillance, pandemic influenza response, disaster preparedness, national food recalls, and outbreak investigations, among other population health events, as part of a public health system charged with monitoring, detecting, and reducing the impact of health threats.^1,2 The capacity of public health agencies to support sustained responses, such as those required for the 2014 outbreak of Ebola and the 2016 outbreak of Zika virus, has been stretched partly because of a changing workforce, limited training opportunities, and budget reductions.^3-9 National assessments of epidemiologic capacity at US public health agencies revealed gaps in training, technology, and workforce retention at the state and local levels.^3,6,7,10 The reduced abilities to implement new surveillance technologies and provide all 10 essential public health services are 2 indicators of diminished epidemiologic capacity. Furthermore, despite a decline in the annual rate of job cuts, 1 in 4 local health departments continues to struggle with budget restrictions.³

In the past decade, academic–practice partnerships at local and state health departments and schools of public health have explored models for epidemiologic capacity building by embedding graduate students in public health agencies.^11-18 This approach can augment the epidemiologic workforce at public health agencies and support the training of the next generation of field epidemiologists.¹⁸ We describe one such academic–practice partnership, the Student Epidemic Action Leaders (SEAL) team.

The University of Washington (UW) School of Public Health, Department of Epidemiology developed the SEAL team in 2015 to provide UW School of Public Health graduate students with opportunities to gain hands-on experience working on field epidemiology projects at state and local public health agencies in Washington State. The SEAL team was established as a collaboration between the UW School of Public Health and the Washington State Department of Health (Washington State DOH) and has since expanded to other public health agencies in the greater Seattle, Washington, area. The SEAL team built on existing models of academic–practice partnerships between schools of public health and public health agencies,^11-18 partnering with Seattle-area public health agencies to identify key areas of need and opportunities for collaboration.

Methods

SEAL Team Development

Learning objectives of the SEAL team were informed by the Centers for Disease Control and Prevention (CDC) and Council of State and Territorial Epidemiologists (CSTE) Applied Epidemiology Competencies² and the Association of Schools and Programs of Public Health Master’s in Public Health Core Competencies¹⁹ (Box). Learning objectives are completed during two 10-week academic quarters, totaling 60 hours of coursework and assignment time. Curriculum development and program operations are led by the SEAL team director (J.B.) and a UW School of Public Health doctoral candidate and graduate research assistant (M.S.). To ensure minimal training burden on public health agency staff members working with SEAL team students, Washington State DOH partners, including epidemiologists and program managers, reviewed the curriculum and provided input on skills considered essential for SEAL team members to develop before field placements.

Box.

Learning objectives before deployment for students in the Student Epidemic Action Leaders (SEAL) team,^a University of Washington School of Public Health^b

1. Summarize the purpose of public health practice and how applied epidemiologists contribute to work at various public health agencies.

2. Describe the role of communicable disease epidemiology and public health surveillance in protecting the health of the community.

3. Identify notifiable diseases, what can cause an outbreak, and the steps for an outbreak investigation.

4. Distinguish among various epidemiological study designs and when each one should be used in public health practice.

5. Recognize the roles and responsibilities of individuals and agencies participating in an outbreak investigation.

6. Assist in an outbreak investigation at a state or local health department.

7. Demonstrate collaborative, leadership, and problem-solving skills.

8. Collect, manage, analyze, and/or interpret surveillance and outbreak data for various audiences.

9. Explain the ethical and legal principles that guide collection, maintenance, use, and dissemination of public health data.

10. Display effective interviewing skills and capacity for questionnaire/survey design.

11. Develop or contribute to after-action reports and hot wash exercises (ie, discussions and evaluation of agency performance) during an event evaluation.

12. Describe the importance of, and challenges to, communicating public health information within a public health agency, with the public, with the media, and with other audiences.

13. Complete Incident Command System training and prepare to respond with a public health agency in an emergency situation.

^aThe SEAL team provides graduate students in public health with training in applied epidemiology methods and topics in public health practice. Students then participate in field assignments with Seattle-area public health agencies, gaining hands-on experience working on real public health issues while also providing support to agency staff members.

^bLearning objectives were informed by the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists Applied Epidemiology Competencies² and the Association of Schools and Programs of Public Health Master’s Degree in Public Health Core Competencies.¹⁹ Learning objectives are addressed during the first 2 quarters of SEAL classroom training; however, additional experiential learning occurs during field assignments. Students are expected to demonstrate comprehension through homework assignments and classroom participation, under the assumption that they will continue to develop these skill sets throughout their careers. No formal evaluation is required before deployment to field assignments.

Training the Next Generation of Field Epidemiologists

The SEAL team has enrolled 3 cohorts (2016-2017, 2017-2018, and 2018-2019); at the time of publication, 2 cohorts had completed the program. The application process includes a student statement of purpose that describes background experience, demonstrated commitment to and understanding of the SEAL team purpose, and relevance of the SEAL team to future goals. Applications are reviewed and scored by the SEAL director and graduate research assistant. Thirteen of 14 applicants were accepted during the first year, 21 of 25 applicants in the second year, and 18 of 24 applicants in the third year. SEAL team members remain in the program for a 12-month calendar year that begins in January and includes the summer, and students have the option of extending program membership into the following winter quarter (January–March) to ensure uninterrupted field assignment support at partner agencies. SEAL team members are unpaid but receive 1-2 academic credits per quarter.

In the first quarter, students enroll in “Field Epidemiology: SEAL Team,” a 2-credit course taught by the SEAL faculty director and restricted to SEAL team members. First-quarter students complete approximately 30 hours of training in several topics, including outbreak investigation, interviewing skills, and questionnaire development. In-class time consists of instructor and guest lectures, hands-on activities, and simulations. Online training modules (eg, Northwest Center for Public Health Practice²⁰; North Carolina Institute for Public Health²¹) and homework exercises focused on critical thinking and applying new concepts augment in-class training. Students receive feedback on written assignments but are not formally tested for proficiency. The course assigns various readings, such as recent articles on public health issues in Morbidity and Mortality Weekly Report and in the local and regional news media. In the first quarter, SEAL team members are also expected to complete training on patient and data confidentiality, the Health Insurance Portability and Accountability Act,²² and the Federal Emergency Management Agency’s Incident Command System (specifically, trainings 100, 200, and 700).²³

In their second quarter, SEAL team members enroll in “Surveillance Systems and Public Health Decision Making,” a 2-credit Department of Epidemiology course that covers public health surveillance systems and activities, as well as how to use surveillance data to make strategic program and policy decisions. During subsequent quarters, students receive 1 academic credit, with the expectation that they complete at least 1 field assignment each quarter.

Field Assignments: Partnering With Public Health Practice

For public health agencies, field assignments consist of basic epidemiologic support activities on high-priority agency projects. For students, field assignments are intended to provide opportunities to learn and work on real-world, time-sensitive public health issues alongside public health practitioners.

The protocol for identifying and filling field assignments is conducted through field assignment request forms, which are completed by public health agencies and evaluated by the SEAL leadership team (Figure) based on student capability, interest, and availability. Field assignments have included the following activities: developing and testing questionnaires for use in outbreak investigations; surveillance system evaluation, comparison, and testing using statistical software; case follow-up, health care provider communications, and data collection of reportable conditions; translation of public health data and epidemiological disease information into presentations and fact sheets for use at public health agencies statewide; and special projects addressing issues that, because of capacity constraints, otherwise might not be prioritized (Table 1). One project with Washington State DOH involved creating a flow diagram to assist managers at restaurants when making decisions about employee hygiene, illness, and work exclusion. In another project with the Tacoma–Pierce County Health Department, SEAL team members used statistical software to standardize and automate how cases of hepatitis C virus infection were classified at the agency along a continuum of care, eliminating the need for staff members to perform this task manually.

Figure.

Form completed by health departments to request Student Epidemic Action Leaders (SEAL) team assistance, University of Washington School of Public Health. The SEAL team provides graduate students in public health with training in applied epidemiology methods and topics in public health practice. Students then participate in field assignments with Seattle-area public health agencies, gaining hands-on experience working on real public health issues while also providing support to agency staff members.

Table 1.

Completed field assignments by Student Epidemic Action Leaders (SEAL) team members, cohorts 1 and 2: University of Washington School of Public Health, 2016-2017^a

Assignment	Year(s)	Public Health Agency	No. of SEAL Team Members Assigned	Total Hours	Activities
Cohort 1 (n = 13 students)
Foodborne Complaint Reporting System, phase 1	2016	Washington State DOH	4	83	Interviewed key stakeholders at other state health departments about centralized reporting systems for foodborne complaints; compiled information into a presentation to support development of a system in Washington State; developed a survey for local health departments in Washington State to gauge interest and readiness.
Zika virus surveillance	2016	Washington State DOH	3	44	Worked with Washington State DOH zoonotic epidemiologist to develop a database for Zika testing data and entered data into the database.
Zika virus response: health care provider calls	2016-2017	PHSKC	7	303	Provided daily support to public health nurses and other staff members to approve government-run Zika testing, answer health care provider questions, and manage paperwork on testing requests and results.
Case report forms for electronic disease surveillance	2016-2017	Washington State DOH	2	12	Revised 2 case report (salmonella and pertussis) forms to match the new electronic disease surveillance database as a pilot project to determine process value and feasibility.
Prion disease surveillance	2016	Washington State DOH	1	15	Created a reference sheet for human prion disease and conducted research to support development of detailed recommendations for funeral homes.
Support for an outbreak of Escherichia coli at a restaurant	2016	Washington State DOH	1	6	Tested and revised a questionnaire for use with control individuals for a case-control study.
Washington Disease Reporting System, phases 1 and 2	2016-2017	Washington State DOH	2	59	Developed case reporting forms, updated guidance, and reviewed content with subject matter experts to support statewide transition to a new electronic disease reporting system.
Elevated blood lead levels among pediatric refugees	2017	Washington State DOH	2	36	Worked with the Washington State DOH Refugee Health Program to determine the completeness of elevated blood lead level reporting among pediatric refugee arrivals in Washington State; identified potential sources of lead exposure among cases.
Mumps outbreak in King County	2017	PHSKC	2	79	Conducted case interviews and communicated with providers about protocols and standards for laboratory testing at the state laboratory.
Cohort 2 (n = 21 students)
Washington Disease Reporting System, phases 3 and 4 and final testing	2017	Washington State DOH	8	163	Developed case reporting forms, updated guidance, and reviewed content with subject matter experts.
Mumps outbreak at UW	2017	UW DEHS	1	23	Streamlined a database to track and manage data; communicated with staff members at PHSKC; conducted weekly basic descriptive epidemiology (eg, epidemic curves).
Foodborne Complaint Reporting System, phase 2	2017	Washington State DOH	4	93	Analyzed survey data from local health jurisdictions’ foodborne complaint systems.
Waterborne disease outbreaks in Washington State	2017	Washington State DOH	1	20	Illustrated the descriptive epidemiology of 2-3 decades of waterborne outbreak data in Washington State.
Hepatitis C database: continuum of care	2017	TPCHD	2	45	Used Stata and R statistical software to automate rapid classification of county hepatitis C patients along a continuum of care to eliminate need for manual coding and facilitate follow-up.
Zika virus response, phase 2	2017	PHSKC	2	100	Communicated updated information on Zika screening and laboratory reporting guidance from the Centers for Disease Control and Prevention to health care providers.
Foodborne illness communications	2017	Washington State DOH	1	10	Developed an epidemiological fact sheet about common foodborne illnesses to support communications staff members.
Food safety: employee and manager training	2017	Washington State DOH	1	15	Compiled available guidance materials for restaurant management staff members on awareness and proper actions for employee health and symptom reporting; developed a flow diagram to support decision making.
Surveillance system comparison: ESSENCEb and Washington State ESSENCE	2017-2018	Washington State DOH	2	31	Using R statistical software, compared syndromic surveillance data from the national ESSENCE database with the Washington State ESSENCE database; conducted descriptive data analysis, comparison of data from 2 unique databases, and data validation.
Surveillance system comparison: Comprehensive Hospital Abstract Reporting System (CHARS) and Washington ESSENCEb	2017-2018	Washington State DOH	2	85	Developed procedures and automated code (R statistical software) for conducting comparisons between inpatient syndromic surveillance data (Washington ESSENCE) and CHARS data that can be incorporated into routine data validation.
Rabies in King County: data analysis	2017	PHSKC	2	38	Assisted with patient interviews to assess risk of rabies exposure and facilitate testing of bats for rabies at Washington State Public Health Laboratories; entered interview data for analysis.
Hepatitis B and high-risk women	2017-2018	PHSKC	2	37	Conducted active case follow-up for perinatal hepatitis B to determine pregnancy status and other key information using a new quality improvement tool aimed at prioritizing high-risk women.
Hepatitis C: test and cure	2017-2018	PHSKC	3	60	Abstracted data from electronic medical records to determine whether patients started treatment for hepatitis C and were cured.
Civil surgeons and immigration	2017-2018	Washington State DOH	1	12	Identified telephone numbers for civil surgeons (ie, physicians who conduct medical examinations of green card applicants seeking status adjustment) in Washington State, and called to confirm they are conducting status adjustment examinations, to inquire about preferred contact methods, and to announce a training and future survey.

Abbreviations: DOH, Department of Health; ESSENCE, Electronic Surveillance System for the Early Notification of Community-Based Epidemics; PHSKC, Public Health–Seattle & King County; TPCHD, Tacoma–Pierce County Health Department; UW DEHS, University of Washington Department of Environmental Health and Safety.

^a The SEAL team provides graduate students in public health with training in applied epidemiology methods and topics in public health practice. Students then participate in field assignments with Seattle-area public health agencies, gaining hands-on experience working on real public health issues while also providing support to agency staff members.

^b ESSENCE is a surveillance platform that assists public health agencies in detecting disease outbreaks earlier through monitoring of indicators related to “syndromes” or precursors to full disease onset. Washington State DOH uses this platform to support local syndromic surveillance efforts, reducing the time before a public health response to an outbreak is initiated.

The duration of field assignments and the number of SEAL team members requested varied by agency need and situational factors (Table 1). For example, 1 student assisted for 2 days with questionnaire design and piloting for a restaurant outbreak, whereas a team of 5 SEAL team members worked on a rotating schedule for 3 months to support Zika virus disease response activities, followed by a new cohort of SEAL team members who continued this work. Two assignments that were extended several times during the first 2 cohorts illustrate this process and the varied activities SEAL team members engaged in on these assignments. SEAL team members assigned to Public Health–Seattle & King County to assist with Zika virus disease surveillance activities communicated with health care providers about CDC requirements for testing at state laboratories, answered questions about general screening criteria, and ensured completeness and accuracy on testing forms submitted by providers. Agency staff members requested that the field assignment be extended, allowing more SEAL team members the opportunity to gain experience on this project and for the SEALs to provide continuous support.

In 2017, Washington State DOH asked SEAL team members to assist with preparations for a new statewide electronic disease reporting system. Multiple rotations of SEAL team members were invited to participate in various stages of this long-term project, including developing electronic case report forms for specific diseases, aligning existing and new forms to support a smooth transition between the old and new system, and testing data entry before official rollout across the state. In these cases, SEAL team leadership worked with the hosting agencies to balance the needs of the agencies and students, either by inviting the current SEAL students to extend their commitment or by offering other SEAL team members the opportunity to join the project.

Outcomes

Since 2016, 34 students from 4 departments at the UW School of Public Health (epidemiology, environmental and occupational health sciences, health services, and global health) have completed SEAL training and received field assignments at 4 public health agencies for a total of more than 1300 hours of service during 2 academic years (Table 1). All SEAL team members completed at least 1 field assignment, and 21 completed ≥2 field assignments.

Field Assignment Feedback

In December 2017, SEAL team leadership sent an anonymous Google Form survey to all 21 field supervisors at participating agencies who oversaw field assignments with the first 2 cohorts, seeking information about their experiences working with SEAL team members. The survey included 3 scaled items (Table 2). The first question, “How would you rate your overall experience working with the SEALs?” offered 5 possible responses: far below expectations, somewhat below expectations, meeting expectations, somewhat above expectations, and far above expectations. The second and third questions, “Would you consider having the SEALs work with you on future projects?” and “Would you recommend the SEAL team to colleagues looking for assistance on projects or other public health activities?” offered 5 possible responses: definitely not, probably not, not sure, probably yes, and definitely yes.

Table 2.

Responses from public health agency field supervisors to a survey rating their experience with Student Epidemic Action Leaders (SEAL) team members and field assignments, cohorts 1 and 2, University of Washington School of Public Health, 2017^a

Question	No. of Respondents
How would you rate your overall experience working with the SEAL team?
Far below expectations	0
Somewhat below expectations	3
Meeting expectations	2
Somewhat above expectations	6
Far above expectations	5
Total	16
Would you recommend the SEAL team to colleagues looking for assistance on projects or other public health activities?
Definitely not	0
Probably not	1
Not sure	1
Probably yes	2
Definitely yes	10
Total	14
Would you consider having SEAL team members work with you on future projects?
Definitely not	0
Probably not	1
No sure	1
Probably yes	1
Definitely yes	11
Total	14

^a The SEAL team provides graduate students in public health with training in applied epidemiology methods and topics in public health practice. Students then participate in field assignments with Seattle-area public health agencies, gaining hands-on experience working on real public health issues while also providing support to agency staff members.

Sixteen public health agency field supervisors responded to the first question, several of whom had hosted SEAL team members on multiple projects. Of the 16 respondents, 13 said the SEAL team members provided assistance that met or exceeded their expectations, and 12 of 14 said they would welcome SEAL team members back to work on future projects. In open-field text responses, supervisors described SEAL team members as “professional,” “hardworking,” and “quick learners.” Seven supervisors said that the SEAL team was a useful resource for time-sensitive projects requiring additional epidemiologic support, and they highlighted the skills and knowledge SEAL team members developed during classroom training. Two supervisors expressed interest in longer-term placements for some projects to allow more specific training for SEAL team members and to ensure project completion; 2 supervisors suggested that before beginning an assignment, more detailed information about communication and project expectations (eg, timelines) among SEAL leaders, SEAL team members, and supervisors would be beneficial. Two supervisors indicated interest in identifying permanent roles for graduates within their agencies.

As with any new initiative, the SEAL team encountered challenges in its first 2 years. First, preliminary confusion arose about what should compose a field assignment, how long it should be, and how many students should be requested. In response, further effort has been made through email reminders and participation of the SEAL team director on statewide health jurisdiction telephone calls each fall to clarify how SEAL team members can best be used. In response to the concern about communicating time commitment expectations between SEAL team members and agency supervisors, SEAL team leadership improved communication, clarified expectations, and ensured satisfaction either by placing new SEAL team members at an agency or by providing epidemiologic support to the SEAL team members already assigned to an agency. For example, on 1 assignment, SEAL team members were faced with a statistical coding challenge that stalled work on the project. Supervisors expressed frustration with the delay, and the SEAL team members indicated a need for more support. Ultimately, SEAL team members met with the SEAL graduate research assistant who provided guidance on how to fix the coding issue and communicated with the field supervisors about progress on the project.

Course Evaluations

Students are asked to submit an evaluation for every class completed while at the UW School of Public Health. Evaluations assess student satisfaction with the course content, structure, and instructor on a 0-5 scale, where 0 = very poor, 1 = poor, 2 = fair, 3 = good, 4 = very good, and 5 = excellent. Across both years, students scored the SEAL team class a median score of 4 or higher (Table 3).

Table 3.

First-quarter course evaluation scores for the Student Epidemic Action Leaders (SEAL) team, University of Washington School of Public Health, 2017^a

Course Evaluation Measures	2016 Median Score (IQR) (n = 13 Respondents)	2017 Median Score (IQR) (n = 15 Respondents)
Overall rating	4.8 (4.0-5.0)	4.6 (4.0-5.0)
Course as a whole	4.8 (4.0-5.0)	4.6 (4.0-5.0)
Course content	4.7 (4.0-5.0)	4.4 (4.0-5.0)
Instructor’s contribution	4.8 (4.0-5.0)	4.6 (4.0-5.0)
Instructor’s effectiveness in teaching the subject matter	4.8 (4.0-5.0)	4.5 (4.0-5.0)
Use of class time	4.6 (4.0-5.0)	4.1 (3.0-5.0)
Amount learned in the course	4.2 (4.0-5.0)	4.2 (4.0-5.0)
Relevance and usefulness of course content	4.8 (5.0-5.0)	4.8 (4.5-5.0)
Evaluative and grading techniques	4.8 (4.0-5.0)	4.7 (4.0-5.0)
Reasonableness of assigned work	4.8 (5.0-5.0)	4.0 (3.0-5.0)

^a The SEAL team provides graduate students in public health with training in applied epidemiology methods and topics in public health practice. Students then participate in field assignments with Seattle-area public health agencies, gaining hands-on experience working on real public health issues while also providing support to agency staff members.

^b Based on a scale from 0 to 5, where 0 = very poor, 1 = poor, 2 = fair, 3 = good, 4 = very good, and 5 = excellent.

Lessons Learned

Academic–practice partnerships help to build capacity at public health agencies around the country.^11-18 Programs such as the SEAL team leverage these partnerships and ensure students are engaged in epidemiologic work of high impact in their communities.^6-8,10 Learning through action, particularly on timely topics, can inspire early career epidemiologists and bolster future epidemiologic capacity. By fostering epidemiologically trained individuals to support public health agencies, particularly during resource-straining events, the SEAL team provides realistic training and experience for future field epidemiologists.

The SEAL team was originally founded by a faculty member in the UW School of Public Health Department of Epidemiology (J.B.) in close collaboration with Washington State DOH because of a mutual interest in academic–practice partnerships and a need for increased student training opportunities in applied epidemiology. However, it took several months before local health departments were willing to invite SEAL team members to work on projects. Concerns about training requirements and burden on health department staff members may have limited agencies’ interest in working with students. After multiple field assignments were completed with Washington State DOH, however, positive feedback about the SEAL team was shared with other public health agencies, which then invited SEAL team members to assist with projects. As of April 2018, 2 local health departments in Washington and 1 UW-based department had hosted SEAL team members. Continued skepticism among some agency staff members and the limitation of traveling to jurisdictions outside of the Seattle area may partially explain why the program has not yet expanded to more agencies. Looking ahead, SEAL leadership hopes to acquire additional funds to support work in other parts of the state, possibly focused in the summer months when students have fewer academic obligations. In addition, SEAL team members have successfully completed projects remotely with agencies in the Seattle area, which could be a model for successful collaboration with agencies in other parts of the state or Pacific Northwest region.

Another important step in maximizing the utility of the SEAL team is recognizing what SEAL team members can reasonably do and identifying projects that fall within their capabilities. SEAL team members receive 60 hours of training, yet it can take years to master certain skills, such as interviewing techniques and the conducting of outbreak investigations. Although SEAL team members do not offer the same advanced skills as a veteran agency employee, they do have enough basic training to assist with entry-level epidemiologic tasks. Agencies overwhelmed with a long list of to-do items can identify projects that may be completed by someone with basic public health training for SEAL team members to work on to allow their upper-level staff members to focus on more advanced work. Alternatively, agencies or programs with few epidemiologic staff members can invite SEAL team members to provide expertise, as evidenced by a project completed by SEAL team members with the Tacoma–Pierce County Health Department that involved statistical coding and automation of a manual process. SEAL leadership should help public health agencies identify projects that fall within the skill set of SEAL team members while also meeting agency priorities, without adding undue burden on an already overburdened staff.

Next Steps

As the SEAL team establishes itself as a resource for public health agencies in the region, new collaborations are being explored. Health departments serving smaller populations often have epidemiologic capacity needs that strain the local public health system and limit assessment and response efforts.⁹ Partnerships with such agencies, particularly in rural areas, can bring much needed epidemiologic support to agencies that might not otherwise have an epidemiologist on staff. Field assignments at these rural agencies would also offer SEAL team members the opportunity to learn about public health challenges that are unique to rural communities.

Most field assignments during the first 2 years of the SEAL team centered around communicable disease topics. After positive feedback from field supervisors on an assignment completed with the Washington State DOH Refugee Health Program (Table 1), SEAL leadership began exploring the possibility of inviting field assignments in noncommunicable disease areas, such as environmental health, maternal and child health, and substance use. Welcoming noncommunicable disease field assignments will open the door to new partnerships with other public health agency divisions and could improve versatility and broaden the skill sets of SEAL team graduates.

Another area of exploration involves undergraduate public health majors in the UW School of Public Health with SEAL team activities. In June 2018, the SEAL team ran a pilot internship with public health undergraduates, introducing them to field epidemiology and foodborne illnesses during a half-day training. With oversight from 2 SEAL team members and SEAL leadership, 5 undergraduate interns spent approximately 80 hours during the summer on a Washington State DOH field assignment in partnership with the University of Colorado School of Public Health and Colorado Integrated Food Safety Center of Excellence. They developed epidemiologic fact sheets for the risk of foodborne illness associated with various foods and dietary supplements, exploring various topics related to a specific food item, such as commercial and home production, food safety, and outbreaks, to inform creation of fact sheets. SEAL team leadership and the 2 assigned SEAL team members reviewed and provided feedback to undergraduate student interns on the fact sheets throughout the process, eventually submitting them for final review and approval by the Colorado Integrated Food Safety Center of Excellence team.

Beginning in fall 2018, after each field assignment concludes, a survey will be sent to field supervisors assessing the value of the SEAL team members’ contributions to their work, to assess whether the project helped further agency goals and whether outputs from SEAL team members were worth inputs from the agency. This information will help inform future decisions about training requirements for SEAL team members, field assignment scope, and how to balance student and agency needs. This information will also inform future evaluations of program effectiveness. To evaluate the long-term effects of the SEAL team, a survey will be distributed each fall, beginning in fall 2018, to all SEAL team alumni to determine if and how the SEAL team influenced their academic and professional careers. Ideally, this information will be compared with schoolwide or department-level alumni data.

Programs such as the SEAL team have the potential to support public health agencies in the United States. The public health workforce will always face current and emerging public health threats, and there will always be a need for well-trained epidemiologists to prepare for and respond to these threats. Embedding students in public health agencies during their graduate training; exposing them to the methods, processes, and demands of applied epidemiology; and showing them the value and impact of the work of public health agencies, the SEAL team and other academic–practice partnerships will prepare students for a future of service and commitment to improving population health.