High marks for Columbia's new public health curriculum
A fully re-envisioned Master of Public Health program was launched by Columbia University's Mailman School of Public Health in the fall of 2012, ushering in the most sweeping changes in public health education in decades. Detailing the experience leading up to the launch and since, the principal architects of the new curriculum have published two articles in the current online edition of the American Journal of Public Health that together provide insight into the rationale for the changes needed in public health education, the goals and dimensions of the curriculum design, as well as the results of a preliminary survey suggesting that students and faculty are enthusiastic about the result.
"Our new Columbia MPH was created to give future public health professionals the scientific and leadership skills to prevent disease and preserve health in the face of ever more complex challenges," says Linda P. Fried, MD, MPH, Dean of the Mailman School. "It will position them to lead most effectively in the 21st century. We our proud of the result and believe our experience in rethinking and revising public health education can be a model for others."
The Case for Change
In "MPH Education for the 21st Century," Dean Fried and co-authors highlight four major drivers of change: globalization, urbanization, population aging, and health disparities, each of which public health—the science for the actions we must take as societies and communities to protect our health—has the potential to ameliorate or even to transform into opportunities. (For example, cities can be both vectors of disease as well as laboratories that create new standards for health.) To accomplish this, they argue, educators must give students a cohesive vision of public health across disciplines; train them in the science of complex, large-scale solutions that prevent disease across the full extent of our now-longer lives; and foster professional skills that empower them to turn science into action.
The first article summarizes nearly 100 years of scholarship on public health education and identifies common themes, including recommendations to emphasize learning that is founded on a life-course approach to prevention, integrated across disciplines and grounded in real-world issues, and that imparts professional skills, particularly in leadership and innovation. Despite many calls for more public health leadership, the authors write, there has been little attention given on how public health schools can train such leaders. "We suggest that the time is ripe to turn the history of research and recommendations into action by creating and developing leadership curricula and courses for our students as the next step for schools of public health," they write.
Leadership training is one of seven core strategies of a public health education of the future that the authors put forward. Others include: a global perspective on health; a life-course approach, understanding that one's health in later life is determined by events many decades before and to the present; active engagement across disciplines; critical thinking; teamwork and collaboration; and technical skills.
Teach in the Same Way We Work
In "MPH Education for the 21st Century," Melissa D. Begg, ScD, Vice Dean for Education, and co-authors outline the ambitious design of the new degree program, which they observe is "more rigorous, more interdisciplinary, and more comprehensive than any we've previously offered." Its aim: "to teach public health in the same way that we work in public health: in interdisciplinary teams, bringing to bear strong disciplinary skills, and integrating knowledge and practice across disciplinary boundaries to address complex health challenges, with effective leadership, management, innovation, and partnership capabilities."
Traditionally, schools of public health, including the Mailman School, taught core courses independently with little focus on integration and without school-wide requirements, and little attention paid to cross-disciplinary study. In April 2009, Dean Fried first articulated a vision for a new MPH degree. Her case hinged on the idea that public health education must effectively prepare the field's leaders for 21st Century health challenges. Over the next three years, the design for the new curriculum developed through a process, led by Sandro Galea, MD, MPH, chair of Epidemiology, and subsequently implemented by Dean Begg, involving more than 170 faculty, staff, and students (as well as hundreds of alumni and employers of the School's graduates).
The centerpiece of the new Columbia MPH is an integrated core semester taught by interdisciplinary faculty that provides a comprehensive introduction to public health and highlights areas of intersection. Students complete two novel courses: "Integration of Science and Practice," which employs case studies and other methods to foster decision-making and critical-thinking skills, and "Leadership and Innovation," which emphasizes skills in leadership, communication, professionalism and developing new ideas. The School's fieldwork requirement, known as the practicum, was reorganized to provide enhanced structures, preparation, and evaluation methods. Finally, more than 20 new New York State-approved certificate programs were added to give students options for further specialization or cross-disciplinary study.
In 2010, the Rockefeller Commission published recommendations that echoed the rationale articulated by Dean Fried on preparing health professionals to meet 21st Century health needs. It also called for rigorous evaluation and communication of results. "We think that our goals and methods of the new Columbia MPH may offer the first comprehensive response to the call of the Rockefeller Commission report," write Dean Begg and colleagues.
High Levels of Enthusiasm
A survey of students in January 2013, one month following the completion of the first term of the new Columbia MPH curriculum, indicate "high levels of enthusiasm" for the overall experience (78% positive), course quality (83% positive), and quality of instruction (90%). Faculty were also positive: 93% reported that their students were intellectually engaged. Students also did well academically with a decline in the number of incomplete grades over the prior year. The School continues to collect extensive data on the curriculum; future studies will extend to how useful it is to students after they graduate, and its impact on career trajectories.
In June, the Mailman School hosted "Innovations in Public Health Education," a national conference attended by close to 50 deans and associated deans of public health schools. The current articles represent a continuation of that line of inquiry.