Developing Competencies for Applied Epidemiology

APHA Conference, Dec 12, 2005

Centers for Disease Control and PreventionCouncil of State and Territorial Epidemiologists

Developing Competencies for Applied Epidemiology

Denise Koo, MD, MPH Director, Career Development Division

Office of Workforce and Career DevelopmentCenters for Disease Control and Prevention

Kathleen R. Miner, PhD, MPH, CHESAssociate Professor and Associate Dean for Applied Public Health

Rollins School of Public Health, Emory University

Guthrie Birkhead, MD, MPHDirector, Center for Community Health

New York State Dept of Health&

Council of State and Territorial Epidemiologists

Outline

Background Goals and Rationale Definition of Competency Description of Process Current Status of Competencies for

Epidemiologists Next Steps Discussion

Problem

Insufficient number of public health epidemiologists

“Epidemiologists” without adequate training Lack of clear career ladders for epidemiologists Independent, uncoordinated efforts to define the

field Only national effort focused on academic

epidemiology

Workforce Shortages

30

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Source: State Public Health Employee Worker Shortage Report: A Civil Service Recruitment and Retention Crisis

Epidemiologic Workforce Development Context: organizational epidemiologic capacity

Define, measure, monitor key functions Definition of a public health epidemiologist Activities and duties of a PH epidemiologist Epi and non-epi competencies for epidemiologists Identification of gaps

Numbers, types, levels Skill areas

Strategic plan to recruit, (re)train, retain

“If you don’t know where you’re going, any road will get you there.”

--Lewis Carroll

Need

Definition of the epidemiology profession at various levels of practice: local, state, federal

National process to define competencies, including: Definition of a public health epidemiologist Competencies needed now and in future

Key (co-lead) partners: CSTE and CDC

Goals of Epi Competencies Process Core competencies for epidemiologists practicing

in governmental public health agencies Local, state or federal Legal mandate for public health activities

Epi and non-epi competencies for epidemiologists Expected levels of proficiency

Rationale

Definition of needed skills for hiring Method to measure, reward, promote workers Roadmap for training existing workforce Guidelines for academia Improved ability to define the field Utility for any certification process

Roles and Responsibilities

Conveners:Matt Boulton, MD, MPH--MI Dept of Health and CSTEDenise Koo, MD, MPH—Centers for Disease Control and

Prevention

Co-Chairs:Gus Birkhead, MD, MPH--NY State Dept of Health and CSTEKathy Miner, PhD, MPH, CHES--Emory University

Consultant and Editor:Jac Davies, MPH--formerly with WA State Department of

Health

Expert Panelists• Kaye Bender, RN, PhD-U MS School of Nursing• Roger Bernier, PhD, MPH--CDC National Immunization Program• Mike Crutcher, MD, MPH—OK State Dept Health and ASTHO• Hal Morgenstern, PhD—U MI SPH• Miriam Link-Mullison, MS, RD—Jackson County HD, IL and NACCHO• Greg Steele, DrPH, MPH—IN University School of Medicine• Lou Turner, DrPH—NC State Laboratory of PH• Mark White, MD—CDC Office of Global Health• Lloyd Novick, MD, MPH—Onondaga County Dept of Health and NACCHO• Sara Huston, PhD—NC DHHS• Bill Sappenfield, MD—CDC Division of Reproductive Health• Len Paulozzi, MD—CDC Injury Center• Richard Hopkins, MD, MPH—FL Dept of Health• Eddie Bresnitz, MD, MS—NJ State Dept Health• Barbara DeBuono, MD, MPH—Pfizer• Richard Dicker, MD, MSc—CDC

Review Panelists

• Kris Moore, MD, MPH--U MN• Art Reingold, MD—U CA, Berkeley SPH• Jim Gale, MD, MS—U WA SPH• Maureen Lichtveld, MD, MPH—Tulane SPH• Kristine Gebbie, RN, DrPH—Columbia

Definition of Epidemiologist

A person who investigates the occurrence of disease, injury or other health-related conditions or events in populations to describe the distribution of disease or risk factors for disease occurrence for the purpose of population-based prevention and control.

CSTE Workforce Summit, January 2004

“For sale by owner—Encyclopedia Britannica, excellent condition. No longer needed, husband knows everything.”

U of Texas at Austin, Dept of Advertising

From Competencies to Competents

Identifying Competencies for Applied Epidemiology Professionals

“Competence, like beauty and contact lenses, is in the eye of the beholder.”

L. Peters

Characteristics of ProfessionalsProfessionals are:

defined by specific identity and scope of responsibilities (competencies);

problem solvers;

non-routine decision makers;

have a core body of knowledge;

held to ethical practice; and,

life long learners in their field.

“Hermits have no peer pressure.”

Steven Wright

Instructional/ Individual CompetenciesThey: Assess an individual’s ability to do specific

tasks. Structure professional preparation. Determine the measurement indicators. Assume measurement in the short term. Require higher levels of performance to be

built upon lower level ones.

The Anatomy of an Instructional/ Individual Competency Statement

Single Verb + Specific Content

Instructional Design

Indicators

Assessments

Bloom’s Taxonomy

KNOWLEDGE

COMPREHENSION

APPLICATION

ANALYSIS

SYNTHESIS

EVALUATION complexity

Competency FrameworkSkill Domain Area:

1. Competency A

i. Sub-competency

a. Sub-sub competency/learning objective

ii. Sub-competency

iii. Sub-competency

2. Competency B

i. Sub-competency

ii. Sub-competency

iii. Sub-competency

Levels of Practice

Tie

r 1

Tie

r 2

Tie

r 3

Competency Framework Skill Domain: Communication

1. Competency: Prepare written and oral reports and presentations that communicate epidemiologic findings to professional audiences, policy makers, and the general public.

i. Sub-competency: Identify audience, methods and content for communication of epidemiologic findings

a. Identify target audience for communication

ii. Sub-competency: Communicate epidemiologic findings to professional audiences through written reports and oral presentations.

Competency Framework Skill Domain: Leadership and Systems

Thinking

1. Competency: Promote shared vision to drive action.

i. Sub-competency: Assist in strategic planning.

a. describe process for organizational strategic planning.

b. identify internal and external issues that may impact delivery of essential public health services

Competency Framework Skill Domain: Cultural Competency

1. Competency: Describe population by race, ethnicity, culture, socioeconomics, education, professional background, age, religion, and sexual orientation

2. Competency: Establish relationships with groups of special concern.

i. Sub-competency: Study the historical context of populations’ history and past treatment by the public health system.

“There is no educational value in the second kick from a mule.”

Anon

Competency Truths

Competencies are dynamic.

Competencies foster professional identity.

Application crosses more than one generation of leadership.

"It's not true that life is one damn thing after another. It's the same

damn thing over and over."                         

Edna St. Vincent Millay

Competency Development Process Examination of existing competency sets

Epidemiology Public Health

Mapping of existing competencies to Core Competencies for Public Health Professionals (from Council on Linkages)

Revision of existing and creation of new competencies to address unique elements of epidemiologic practice

Competency Framework for Public Health Professionals Analytic Assessment Basic Public Health Sciences Communication Community Dimensions of Practice Cultural Competency Financial Planning and Management Leadership and Systems Thinking Policy Development/Program Planning

Source: Council on Linkages between Academia and Public Health Practice

Revision Process

Two in-person meetings, multiple conference calls Utilized web-based survey to assess expert panel’s

views on competencies and to collect specific input

Focused on crafting language that reflects unique aspects of epi practice

Recognized that COL competencies apply to all public health professionals, including epis

Recognized that competencies will differ depending on level of experience and job expectations

Intended Users Tier 1: frontline epidemiologist

New MPH/MS grad, <2 years experience

BA with at least 2 years’ experience

Tier 2: Mid-level (“journey”) epidemiologist

Master’s with 2-5 years experience; doctorate in epi; other professional degree with epi training (e.g., EIS)

May supervise epi team or unit

Tier 3: Senior epidemiologist (2 tracks)

a: supervisors/managers

b: doctoral-level senior epi scientists

Timeline Before October 04

Compile and review existing competency sets Prepare “discussion draft”

Oct 04 – 1st in-person meeting of panel Developed FIRST DRAFT of competencies focusing on

Tier 2 competencies

Dec 04 – SECOND DRAFT distributed Feb 05 – Comments on draft via web tool; THIRD

DRAFT developed from comments Mar 05 – 2nd in-person meeting

Timeline March-May 05 – Further revisions captured in 4th

draft May 05 -- Prepared 5th draft for presentation at

CSTE annual meeting in New Mexico June 05 – Posted draft on web for widespread

review and comment June-October 05 -- Developed Tier 1 and 3

competencies July 05 – ASTHO/NACCHO joint annual meeting

in Boston (informal discussions) November 05-January 06 -- additional validation December 05 – APHA

Partner Organizations Solicited for Comment American College of Epidemiology

Association of Schools of Public Health Association of Maternal and Child Health Programs Association of State/Territorial Directors of Nursing Association of American Medical Colleges Association of Teachers of Preventive Medicine Association of State and Territorial Health Officers American Public Health Association APHA Epidemiology Section Chronic Disease Directors CDC Office of Workforce and Career Development CDC Associate Director for Science National Association of Health Data Organizations National Environmental Health Association National Association of Local Boards of Health National Association of County and City Health Officials Public Health Foundation Society for Epidemiologic Research State and Territorial Injury Prevention Directors Association

Skill Domain 1: Analytic/AssessmentTier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply ethical/legal principles to study design,

data collection, dissemination, and use Manage data Analyze data Summarize results/draw conclusions Recommend interventions/control measures Evaluate programs

Example: Analytic/AssessmentSub-Competencies

Conduct surveillance Determine whether to conduct surveillance for

a particular PH problem Identify surveillance data needs Implement new or revise existing surveillance

system Interpret key findings Conduct evaluation of surveillance systems

Example: Analytic/Assessment Sub-Sub-Competencies Identify surveillance data needs

Create case definition Describe sources, quality and limitations of

surveillance data Identify mechanisms to transfer data from

source to public health agency Define timeliness required for data collection Define necessary frequency of reporting Describe potential uses of data to inform

surveillance system design

Skill Domain 2: Basic Public Health SciencesTier 2 Competencies

Use knowledge of causes of disease to guide epidemiologic practice

Use laboratory resources to support epidemiologic activities

Apply principles of informatics, including data collection, processing, and analysis, in support of epidemiologic investigations

Skill Domain 3: CommunicationTier 2 Competencies Prepare written and oral reports and

presentations that communicate epidemiologic findings to professional audiences, policy makers, and the general public

Demonstrate the basic principles of risk communication

Incorporate interpersonal skills in communication with agency personnel, colleagues, and the public

Employ available and suitable communication technologies

Skill Domain 4: Community Dimensions of Practice

Tier 2 Competencies Provide epidemiologic input into epidemiologic studies and community public health planning processes at the state or local level

Participate in development of community partnerships to support epidemiologic investigations

Engage the public in the public health work and decision making of the Health Department when needed using mechanisms suitable to the circumstances

Skill Domain 5: Cultural CompetencyTier 2 Competencies Describe population

Establish relationships with groups of special concern

Design surveillance systems to include under-represented groups

Conduct investigations using languages and approaches tailored to population

Use standard population categories or subcategories when performing data analysis

Skill Domain 5: Cultural CompetencyTier 2 Competencies Utilize knowledge of specific socio-cultural

factors in the population to interpret findings

Recommend public health actions that would be meaningful to the affected community

Communicate findings using mechanisms tailored to that community

Skill Domain 6: Financial and Operational Planning and ManagementTier 2 Competencies Conduct epidemiologic activity in a manner that

is aligned with financial and operational plan of the agency

Use skills that foster collaborations, strong partnerships, and team building to accomplish epidemiology program objectives

Clarify roles and responsibilities of all participants in epidemiologic activities

Skill Domain 7: Leadership and Systems Thinking

Tier 2 Competencies Promote shared vision to drive action

Conduct performance driven work

Promote ethical conduct

Promote workforce development

Prepare for emergency response

Skill Domain 8: Policy DevelopmentTier 2 Competencies Participate in development of public health

policies

Participate as a team member in evaluating policies affecting epidemiology programs

Differentiating Between Tiers Example: Surveillance Tier 1 (frontline epidemiologist):

Support evaluation of surveillance systems

Tier 2 (mid-level epidemiologist/team leader): Conduct evaluation of surveillance systems

Tier 3 (senior level): Supervisor/Manager -- Assure evaluation of

surveillance systems Senior Scientist (PhD) -- Design and conduct

evaluation of surveillance systems

Differentiating Between TiersExample: Basic Public Health Sciences Tier 1 (frontline epidemiologist):

Recognize the role of laboratory resources in epidemiologic activities

Tier 2 (mid-level epidemiologist/team leader): Use laboratory resources to support epidemiologic

activities

Tier 3 (senior level): Supervisor/Manager -- Assure the use of laboratory

resources to support epidemiologic activities Senior Scientist (PhD) -- Develop processes for using

laboratory resources to support epidemiologic activities

Differentiating Between Tiers Example: Financial and Operations Tier 1 (frontline epidemiologist):

N/A

Tier 2 (mid-level epidemiologist/team leader): Assist in preparation of proposals for extramural funding

Tier 3 (senior level): Supervisor/Manager -- Develop Requests for Proposals

for extramural funding to support additional epidemiologic activities and special projects within and outside agency

Senior Scientist (PhD) -- Prepare proposals for extramural funding, for review and input from managers

Intended Uses of Applied Epidemiology Competencies Help public health agencies:

Define skills needed when hiring epidemiologists Provide performance standards for measuring,

rewarding and promoting workers

Support education for epidemiologists by: Providing a roadmap for continuing education of

practicing epidemiologists Providing a tool for academia to target the

education of future public health epidemiologists Provide guidance to epidemiologists on career

paths and needed training

Intended Outcomes

Improve definition of the discipline

Inform development of any epidemiology certification process

Increase comparability of epidemiology positions across public health agencies

End result: public health workforce prepared to meet epidemiologic challenges

Competency Web Survey Results: 369 Respondents Self-identified as:

Tier 3 – 167 (45%)

Tier 2 – 158 (43%)

Tier 1 – 44 (12%)

Level of practice: Local – 60 (16%)

State – 198 (54%)

Federal – 86 (23%)

Academia – 15 (4%)

Other/Unknown – 10 (3%)

Survey Results: Support for Analytic/Assessment Competencies Identify public health problems (95%) Conduct surveillance (93%) Investigate acute and chronic conditions (93%) Apply ethical/legal principles to study design,

data collection, dissemination, and use (96%) Manage data (93%) Analyze data (95%) Summarize results/draw conclusions (98%) Recommend interventions/control measures

(92%) Evaluate programs (76%)

Summary of Comments General Comments

Is it realistic to expect an individual to have skills in all of these areas? Should the competencies apply to a group rather than to individuals?

Competencies should be developed for specific categories of epidemiologists (e.g. chronic disease, infectious disease, State Epidemiologists, etc)

How will competencies be measured? How will practicing epidemiologists gain the

necessary skills to meet all these competencies?

Summary of Comments General Comments

Some competencies are confusing and need to be reworded

Distinction between Tiers may not be appropriate – there is a lot of blurring between these levels, especially in local health departments

Tier definitions should allow for more on-the-job experience and not just rely on degrees

Who is really an epidemiologist? How to define a Tier 1? Should it include public health nurses, sanitarians, others?

Summary of Comments Some competencies were seen to be missing

Knowledge transfer/training of others/mentoring

Specific skills (e.g. GIS, statistical software, forensic epidemiology)

Communicating to different audiences Handling adversarial situations Creating partnerships with community groups,

other agencies, etc Budget management

Summary of Comments

Some competencies seen as not appropriate for Tier 2 epidemiologists. Questions raised about: Designing interventions Program evaluation Management-related competencies Policy development Competencies that seem specific to infectious

disease only (e.g. laboratory testing)

Next Steps

Collect comments on Tiers 1, 3 Collect comments from pilot state/local HDs Present comments to expert panel (in-person

meeting Feb/March 06) Revise competencies Disseminate competencies Present at Congress of Epidemiology, June

2006 (Seattle)

Discussion Questions Practitioners:

Does this sound like what you do?

Are these competencies helpful?

How would you use them?

Academia: Is this similar to what you teach now?

If not, will you use them to plan future courses for enrolled students?

Would your school offer continuing education in these areas?

Discussion Questions

All: Do these competencies offer opportunities for

practice and academic communities to work together to develop the applied epidemiologic workforce?

For more information, please see:www.cste.org

Thank you for your participation in the process!!