Advancing the ‘One Health’ workforce by integrating ecosystem health practice into veterinary medical education: The Envirovet Summer Institute

Abstract

Objectives:

The objectives of this study were to assess whether the Envirovet programme served to increase the number of practising ecosystem health professionals, as well as to measure the lasting professional and personal impact of the programme on participants.

Design:

Impact programme evaluation.

Setting:

An emerging strategy among global health programmes is to promote ‘One Health’ – namely, the understanding that human, animal and environmental health are inextricably linked – as a unifying framework of coordinated education, research and practice. Established in 1991, the Envirovet Summer Institute was created to increase worldwide knowledge and capacity of veterinary medicine students and practitioners to support ecosystem health as a critical component of the One Health approach.

Method:

A semi-structured questionnaire was electronically administered to past programme participants.

Results:

The majority of respondents (65 of 88, 74%) indicated that they had held an ecosystem health employment position since their participation in Envirovet. The reach of Envirovet went beyond participants’ own experiences, by influencing local organisations, programmes, colleagues, family and friends. Furthermore, Envirovet reportedly inspired past participants to make environmentally conscious lifestyle choices and spurred them to make changes professionally, including guiding on-the-job decisions and strengthening network contacts.

Conclusion:

Envirovet offers an established example of One Health training. Additional educational programmes might usefully include One Health principles coupled to a comparable evaluation plan to establish a larger, more comprehensively trained and increasingly effective global health workforce.

Keywords

Ecosystem health global health One Health programme evaluation training programmes

Introduction

In recent decades, there has been growing effort to reduce and reverse the detrimental environmental practices that impact on societies, economies, biodiversity, and human health. Whether it is the promotion of more sustainable practices for natural resource utilisation (Brown et al., 1987), the reduction of chemical contamination of the environment, or a greater understanding of the effects of environmental change on the emergence of infectious diseases (Smolinkski et al., 2003), the academic community increasingly recognises the importance of developing educational solutions to address global environmental and health crises (Danielsen et al., 2009; Ehrlich and Ehrlich, 1991; Hoff and McNutt, 1994). One such method has been through the development of an ecosystem approach to health as part of professional education (Beasley, 1993; Howard and Rapport, 2004).

A functional, all-encompassing definition of ecosystem health is complex, as ‘health’ itself is more than the mere absence of disease (Beasley, 1993; Rapport et al., 1998). A general description of ecosystem health would need to take into account various measurable characteristics used to describe a dynamic community of living organisms with non-living components of the environment that interact as a system. These characteristics could include measurements of biodiversity, integrity, resilience, vigour or disease rates, while also examining descriptors and environmental parameters such as air or water quality.

Recognising the complex and important linkages among humans, animals and ecosystems, the ‘One Health’ paradigm has increasingly become a guiding force for health initiatives and scientific endeavours (Zinsstag et al., 2011). Although the term ‘One Medicine’ was used throughout the late 19th and early 20th centuries (Dukes, 2000), Calvin Schwabe is credited for the revival of this framework in the 1980s (Conrad et al., 2009; Schwabe, 1984). Today, the One Health framework advocates a transdisciplinary approach through which organisations promote cooperation and collaboration among human, animal, plant and ecosystem health sectors and professionals, acknowledging that the health of each sector is dependent upon the health of the others (Kahn et al., 2012). Using such an approach, practitioners aim to move beyond theory to also focus on best practices for operationalising One Health strategies (Conrad et al., 2013; Rubin, 2013). Several organisations, including the US Centers for Disease Control and Prevention, the World Organization for Animal Health, the Food and Agriculture Organization, and the World Health Organization, have adopted One Health as a focus for all or some of their work (Centers for Disease Control and Prevention, 2013; Fleck and Braine, 2011; World Organisation for Animal Health, 2014).

The interconnectedness of humans, animals and ecosystems makes a One Health approach essential to the success of any advancing health education programme. Numerous methods for the successful implementation of such an approach have been suggested (Hueston et al., 2013). One long-term solution to addressing global health issues is to build capacity through the education and training of professionals who understand and embrace One Health concepts (Conrad et al., 2009). In response, a limited number of academic institutions have begun to offer courses, degrees, workshops and training programmes centred around the One Health framework (Barrett et al., 2010). By encouraging students to adopt a professional career based on the One Health framework, success in educational efforts to increase the number of leaders collaboratively working to solve emerging global health problems may potentially be realised (Gibbs, 2014).

The Envirovet Summer Institute

Veterinarians are classically trained in the prevention, diagnosis and treatment of disease and injury in both domestic and wild animals, but there have been few opportunities for veterinarians to focus on developing their skills specifically aimed at improving ecosystem health at the human–animal interface (Mazet et al., 2006; Nielsen, 1992). Established in 1991, the Envirovet initiative was created in order to increase the knowledge and capacity of veterinary medical professionals to support ecosystem health globally (Gilardi et al., 2004). As an intensive 60–70 hours/week, 6- to 7-week summer programme, the Envirovet Summer Institutes apply an immersion style of education composed of lectures, laboratory projects, field demonstrations and hands-on experience to deliver training to approximately 400 programme participants from 47 nations in various stages of their careers (Figure 1). In recent years, the programme has involved collaboration between the University of Illinois, Urbana-Champaign; the University of California (UC), Davis’ Karen C. Drayer Wildlife Health Center; the White Oak Conservation Center; the St Catherine’s Island Foundation and Florida Atlantic University’s Harbor Branch Oceanographic Institute. Many additional governmental agencies, non-governmental organisations and universities in the USA and Canada as well as in Tanzania, South Africa, Kenya and Brazil have partnered with Envirovet to enable students to experience both the first-hand realities of One Health challenges and the benefits of transdisciplinary approaches to ecosystem health research, teaching and practice.

Figure 1.

The Envirovet Summer Institute’s One Health framework included a focus on didactic lectures, laboratory projects and field experiences through three structured sessions. All three include aspects of the topics presented in the figure.

While the programme has been in existence for over 20 years, the original Envirovet curriculum with its primary focus on aquatic ecosystem health has been expanded in scope and breadth to include a greater number of key programme partners and a broader range of course material. Since 2001, the programme has been composed of three main components. Session I introduces the concept of wildlife and ecosystem health with special attention given to the importance of enhancing environmentally focused critical analysis and problem-solving skills. Session II focuses on expanding participants’ knowledge of aquatic animal and ecosystem health and the utilisation of aquatic biodiversity as an early warning system for environmental contamination and other forms of ecosystem mismanagement. Finally, Session III immerses participants in ecosystem health applications within the social and economic constraints of a developing country context in which students spend time in local communities, learning directly from both scientific and non-scientific stakeholders dealing with the challenges of sustaining their livelihoods in the face of environmental degradation. All three sessions combined to produce a comprehensive programme specifically tailored to enable gains in ecosystem health through uniquely cross-trained professionals.

To assess whether the programme has attained its goals, as well as to measure the lasting impact of the programme on participants, an outcome evaluation was conducted.

Methods

Evaluation variables

In April 2013, 197 past programme participants who had enrolled in Envirovet Summer Institutes between 1991 and 2010 and for whom an email address was known were contacted by programme administrators and encouraged to participate in an Envirovet alumni survey. Programme participants received a web link to a survey organised by the programme evaluation team utilising the web-based survey tool SurveyMonkey™ as the primary data collection method. Informed consent was obtained at the beginning of the survey, and the research was determined to be exempt from Ethics Board review by the University of California, Davis, Institutional Review Board (433928-1). The survey consisted of both qualitative and quantitative measures as outlined below.

Study demographics

Demographic indicators were used to construct a comprehensive picture of the past programme participant pool. Information on gender, years since Envirovet and highest level of education attained were requested from all respondents. Years since Envirovet participation were calculated using the respondents’ age at survey participation minus their reported age during Envirovet participation. Current level of educational attainment was listed as ‘Doctoral/professional degree or international equivalent’, ‘Masters degree or international equivalent’, ‘Bachelors degree or international equivalent’, ‘Associate degree or international equivalent’, ‘Some college (tertiary schooling), no degree’, and ‘Secondary School Diploma or below’, which took into account the variation of degree categories across countries. Respondents were asked to indicate their current place of residence by state if residing in the USA and by country if residing elsewhere. Additionally, questions about ethnicity and race (modelled after US Census Bureau classifications) were asked, acknowledging both racial and national-origin groups.

Occupational history

In order to determine the number of respondents who were employed in an ecosystem health career or related position after Envirovet participation, the survey respondent’s occupational history was selected as the key outcome measure. Questions pertaining to the participant’s current and past occupations since the time of enrolment in Envirovet, including job title and responsibilities, helped measure the ability of the programme to reach its overarching goal of encouraging veterinarians and allied health professionals to steer their careers towards ecosystem health. Each respondent was asked to identify whether their current and past occupational positions were a part of the ecosystem health profession. To help the respondent determine whether the position qualified as an example of an ecosystem health profession, the following definition was provided:

Any job, trade or employment that is ‘oriented toward preserving the functions of ecosystems, even though the system may be considerably altered as a result of human domination’ (Rapport et al., 2010). This can include, but is not limited to, such areas of employment as: research, education, governmental, and non-governmental positions where one has influence on ecosystem health management or policy, the practice of veterinary or human medicine or public health in an ecosystem health context, etc.

Scaled programme questions

Questions pertaining to the personal perception of the knowledge, skills and ability to carry out content learned in the Envirovet programme were asked of each survey respondent. Utilising the Likert Scale method (Likert, 1932), questions were both specific to the short-term skills gained during the respondent’s participation in Envirovet and to the perceived impact of the programme on his or her life after its completion. A total of 10 statements were listed on the survey, and respondents were asked to choose the answer (Strongly Disagree, Somewhat Disagree, Neither Agree or Disagree, Somewhat Agree, Strongly Agree or Not Applicable) that best described their agreement with the statement.

Programme impact and improvement short-answer questions

In addition to standardised measures, the respondents were also given the opportunity to provide written comments concerning their participation in the Envirovet programme. Short-answer questions were asked of the respondents. Open-ended questions guiding these responses included topics such as the immediate actions taken after the programme, additional skill sets gained, the perceived long-term effects of the programme and suggestions for programmatic improvement.

Analysis

The general associations between each demographic indicator and the main outcome variable (having an ecosystem health position versus never having an ecosystem health position) were explored using contingency table analysis techniques. A Fisher’s exact test or chi-square test was used for all analyses comparing categorical variables. In order to explore how responses to the scaled questions varied by occupational outcome, contingency tables were constructed and a Fisher’s exact test was used to obtain a p value for each question. As part of a grounded theory approach to qualitative data analysis (Glaser and Strauss, 2009), open-ended survey responses were first compiled and reviewed. Similar phrases and words were grouped together using a constant comparative method approach. Where responses did not fit a certain category, a new category was created. Some questions allowed for more than one response, and the top five responses per question (where applicable) were reported below. All analyses were conducted using Stata™ (version 10.0; StataCorp, College Station, TX, USA), and a p value of ≤.05 was regarded as significant.

Results

By the end of the evaluation period, a total of 88 respondents (45% of all participants with an email on file) had successfully completed all demographic, occupational history, and scaled and short-answer programme questions. A total of 115 survey responses were gathered, but 27 respondents were excluded from the analyses due to incomplete answers or non-responses.

Study demographic characteristics and occupational history

A total of 65 (74%) respondents reported holding a job as an ecosystem health professional since their enrolment in Envirovet, while 23 (26%) respondents had not (Table 1). A more racially diverse population was seen among those who practised in ecosystem health compared to those who had not (p = .005) with a greater representation of African and Asian professionals in the ecosystem health group. A statistically significant difference between occupational groups was also observed when comparing those who lived in the USA to those who were internationally based (p = .03) with international respondents being more likely than US respondents to be involved in ecosystem health careers. A total of 77 (88%) respondents indicated they were currently employed at the time of survey administration, with 55 (71%) of them indicating they were practising within the ecosystem health profession. Among those currently employed, the top five reported job titles included Veterinarian (i.e. Resident, Associate Veterinarian, Veterinarian Officer, etc.), Researcher (i.e. Staff Scientist, Postdoctoral Fellow, Research Associate, etc.), Leader and/or Coordinator of an organisation or projects (i.e. Project Coordinator, Consultant, Non-profit CEO, etc.), and Academic Professor.

Table 1.

Study participant demographics categorised by ecosystem health occupational history.

	Worked in ecosystem health, n (%)	Never worked in ecosystem health, n (%)	p value
Respondents	65 (74)	23 (26)	N/A
Gender
Female	38 (58)	19 (83)	.044
Male	27 (42)	4 (17)
Years since Envirovet participation
1–5	27 (41)	12 (52)	.427
6–10	29 (45)	7 (30)
11–15	7 (11)	2 (9)
>16	2 (3)	2 (9)
Ethnicity
Hispanic	7 (11)	3 (13)	.717
Non-Hispanic	58 (89)	20 (87)
Race
Caucasian	39 (60)	22 (96)	.005
African	17 (26)	0 (0)
Asian	7 (11)	1 (4)
No answer	2 (3)	0 (0)
Current location
USA	28 (43)	16 (70)	.029
International	37 (57)	7 (30)
Highest level of degree listed
Doctoral	45 (69)	21 (91)	.135
Masters	16 (25)	2 (9)
Bachelors	4 (6)	0 (0)

Of all respondents, 50% (n = 44) were residing in the USA, and the other 50% (n = 44) were living internationally. In the USA, 20 states were represented and the largest number of respondents currently lived in California (8, 18%), New York (5, 11%), Florida (4, 9%), Wisconsin (3, 7%) and Oregon (3, 7%). The countries with the greatest representation outside of the USA were Canada (9, 21%), Tanzania (5, 11%), Nigeria (4, 9%) and South Africa (4, 9%). Respondents also lived in Brazil (3, 7%), Kenya (3, 7%), United Kingdom (3, 7%), Indonesia (2, 5%), Thailand (2, 5%) and Uganda (2, 5%), with one person (2%) each residing in France, Germany, India, Japan, New Zealand, Panama, and Rwanda.

Scaled programme questions

A total of 78 (89%) respondents indicated that they strongly or somewhat agreed with the statement ‘Envirovet has made a tangible, concrete, real difference in the skill set that I use in my work’, with only 10 (11%) being either neutral or disagreeing with the statement. A smaller subset, 59 (67%), indicated that they agreed with the statement ‘My experience through Envirovet has helped me obtain my desired employment position’, with 7 (8%) disagreeing. As an indication that Envirovet’s impact on participants was through both the acquisition of concrete skills and exposure to academic theory, responses to the statements ‘Envirovet has helped me incorporate principles of ecosystem health in my current position’ (73 [83%] agree, 4 [5%] disagree) and ‘Envirovet taught me skills that I use in my current job’ (77 [88%] agree, three [3%] disagree) were similar. It was also clear that Envirovet taught participants skills that they not only used in the past, but that they continued to use on a regular basis, as 76 (86%) respondents agreed with the statement ‘Envirovet taught me skills that I’ve used in past jobs’ with 72 (82%) of respondents indicating agreement with the statement ‘I apply the skills I learned in the Envirovet programme on a regular basis’. In response to the statement ‘Envirovet influenced my current career path’, 59 (67%) respondents strongly agreed, 14 (16%) somewhat agreed and only 3 (3%) disagreed either strongly or somewhat. An overwhelming 88 (100%) respondents agreed with the statement ‘The content in the Envirovet programme met my expectation’. Similarly, 88 (100%) respondents agreed that they would recommend the Envirovet programme to colleagues given the chance. To offer further insight on the perception of Envirovet’s success from the participants’ standpoint, respondents were asked whether they agreed with the statement ‘I believe Envirovet has done a good job at meeting its intended goal of increasing the numbers and effectiveness of veterinarians in productive ecosystem health research and application terms around the world’: 85 (97%) respondents agreed, while 3 (3%) indicated that they neither agreed nor disagreed with the statement.

When answers to the scaled programme questions were analysed in terms of those who had held a position in the ecosystem health profession compared to those who had never held a job in the ecosystem profession, a variety of responses were seen. In general, a higher proportion of respondents who had practised in the ecosystem health profession agreed favourably with statements regarding their Envirovet participation (Table 2), and statistically significant differences in the responses were observed when comparing the two occupational groups. A larger proportion of participants who practised in ecosystem health were more likely to ‘strongly agree’ with the statements concerning Envirovet’s impact on their overall skill set, current career path and its achievement of the overarching programmatic goal compared to respondents not currently practising in an ecosystem health profession. Statistically significant differences between those respondents who had practised in ecosystem health and those who had not were also seen regarding the statements ‘Envirovet taught me skills that I’ve used in past jobs’ and ‘Envirovet influenced my current career path’. There were no significant differences in responses to the statements: ‘The content in the Envirovet programme met my expectations’ and ‘I would recommend the Envirovet programme to colleagues’.

Table 2.

Scaled question responses by ecosystem health job status.

Question	Strongly Agree,n (%)	Somewhat Agree,n (%)	Neither Agree or Disagree, n (%)	Somewhat Disagree, n (%)	Strongly Disagree, n (%)	Not Applicable or No Answer, n (%)	p value
1. Envirovet has made a tangible, concrete, real difference in the skill set that I use in my work
Worked in ecosystem health	44 (68)	19 (29)	2 (3)	0 (0)	0 (0)	0 (0)	<.001
Never worked in ecosystem health	7 (30)	8 (35)	3 (13)	3 (13)	0 (0)	2 (9)
2. My experience through Envirovet has helped me obtain my desired employment position
Worked in ecosystem health	35 (54)	14 (22)	8 (12)	2 (3)	0 (0)	6 (9)	<.001
Never worked in ecosystem health	2 (9)	8 (35)	6 (26)	1 (4)	4 (17)	2 (9)
3. Envirovet has helped me incorporate principles of ecosystem health in my current position
Worked in ecosystem health	46 (71)	16 (25)	3 (4)	0 (0)	0 (0)	0 (0)	<.001
Never worked in ecosystem health	6 (26)	5 (21)	6 (26)	2 (9)	2 (9)	2 (9)
4. Envirovet taught me skills that I use in my current job
Worked in ecosystem health	45 (69)	18 (28)	2 (3)	0 (0)	0 (0)	0 (0)	<.001
Never worked in ecosystem health	5 (22)	9 (39)	4 (17)	1 (4)	2 (9)	2 (9)
5. Envirovet taught me skills that I have used in past jobs
Worked in ecosystem health	32 (49)	27 (42)	1 (1)	0 (0)	0 (0)	5 (8)	.03
Never worked in ecosystem health	6 (26)	11 (48)	1 (4)	2 (9)	1 (4)	2 (9)
6. I apply the skills I learned in the Envirovet programme on a regular basis
Worked in ecosystem health	36 (55)	24 (37)	5 (8)	0 (0)	0 (0)	0 (0)	<.001
Never worked in ecosystem health	4 (18)	8 (36)	4 (18)	3 (14)	3 (14)	0 (0)
7. Envirovet influenced my current career path
Worked in ecosystem health	48 (74)	10 (15)	6 (9)	0 (0)	0 (0)	1 (2)	.02
Never worked in ecosystem health	11 (48)	4 (17)	5 (22)	2 (9)	1 (4)	0 (0)
8. The content in the Envirovet programme met my expectations
Worked in ecosystem health	59 (91)	6 (9)	0 (0)	0 (0)	0 (0)	0 (0)	.67
Never worked in ecosystem health	22 (96)	1 (4)	0 (0)	0 (0)	0 (0)	0 (0)
9. I would recommend the Envirovet programme to colleagues
Worked in ecosystem health	63 (97)	2 (3)	0 (0)	0 (0)	0 (0)	0 (0)	1.000
Never worked in ecosystem health	23 (100)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
10. I believe Envirovet has done a good job at meeting its intended goal …
Worked in ecosystem health	61 (94)	4 (6)	0 (0)	0 (0)	0 (0)	0 (0)	<.001
Never worked in ecosystem health	14 (61)	6 (26)	3 (13)	0 (0)	0 (0)	0 (0)

Programme impact and improvement short-answer questions

In response to the question ‘What immediate steps/actions did you take as a result of the Envirovet programme?’, 21 (19%) respondents indicated that the programme spurred them to pursue additional experiences within the ecosystem health discipline, whether this was via an internship, research opportunity or something similar. An additional 20 (18%) respondents returned to university for advanced degrees or to receive further education on the topics taught in the programme. A total of 17 (16%) respondents indicated that their thought process and the way that they perceived the environment have changed as a result of the programme; 17 (16%) respondents immediately shared information about the programme and their experiences with others, while 13 (12%) respondents indicated that the career trajectory they were on before enrolment in Envirovet was significantly affected by the programme.

In response to the question ‘What long-term changes, if any, did you make as a result of the Envirovet programme?’, 26 (24%) respondents indicated that the programme had ultimately influenced their overall career choice. A total of 19 (17%) respondents stated that the Envirovet programme had provided them with a greater awareness of relevant issues to the field, such as how a veterinarian can become an ecosystem health professional or how research can drive action. Similar to the top response of influencing overall career choice, 18 (17%) respondents stated that the programme had guided the decisions they had made within their current career (i.e. whether or not to take a job offer, opportunities to do research, etc.) or continued to help guide lifestyle choices regarding environmental issues (i.e. sustainability, recycling, etc.). Additionally, 17 (16%) respondents indicated Envirovet had motivated them to continue their training in order to obtain more knowledge within the ecosystem health field. Finally, 10 (9%) respondents stated that the programme helped them maintain or establish a network of people with similar interests/concerns (i.e. mentors, colleagues, new friends, etc.).

In response to the question ‘What practices/skills did/do you implement in your life as a result of the Envirovet programme specifically?’, a total of 120 skill sets were reported across 88 respondents; 31 (35%) respondents indicated they approached situations, both personally and professionally, with a different perspective due to an increased knowledge about topics centred on One Health, ecosystem health, wildlife health, population health and environmental awareness (i.e. seeing the ‘big picture’ of interconnectedness across health sectors). Additionally, 26 (30%) respondents said there had been an increase in interpersonal skills (e.g. communication, collaboration, problem solving, networking and working with local stakeholders/communities) as a result of Envirovet participation, and 26 (30%) respondents also reported an increase in technical skills because of participation, such as animal immobilisation, necropsies, sampling, handling and diagnostic techniques. In total, 13 (15%) respondents reported they implemented more sustainable practices (e.g. recycling and other conservation measures) after participation followed by 12 (14%) respondents who implemented new research skills learned through the programme, such as epidemiology, statistics and grant writing. Finally, 9 (10%) respondents indicated that they were frequently in the position to educate people about ecosystem health principles and that they used the skills acquired during the time in Envirovet to do this; 3 respondents (3%) indicated no specific concrete skills had been gained.

In response to the question ‘What was the greatest result/impact of your participation in the Envirovet programme?’, 46 (52%) respondents said that the relationships they made with people (i.e. Envirovet instructors, fellow students and local community members) had had the greatest impact on them. In addition, 19 (22%) respondents indicated that their participation in Envirovet provided career guidance or identified new career opportunities; 16 (18%) respondents also indicated that Envirovet made them feel empowered to make change through the knowledge they gained in the programme and 7 (8%) respondents indicate greater self-awareness in their motivations or desires in life.

With respect to programme improvement, we asked ‘What specific assistance would have been helpful to you in implementing skill sets acquired/presented in the Envirovet programme?’. A total of 27 (31%) respondents indicated that no specific additional assistance would have been helpful aside from what was already included. General curriculum suggestions, such as adding a written component, including a final project or learning more about diagnostic testing, were suggested by 18 (21%) respondents. Nine (10%) participants indicated that it would have been helpful to have more information regarding current job/research opportunities available to someone who wanted to stay in the ecosystem health profession. Tools or a mechanism to facilitate continued alumni networking were suggested by 9 (10%) respondents, and 4 (5%) respondents indicated that they would have benefited from an after-programme mentor to help guide them through their newly chosen ecosystem health profession, access to electronic course material, further continuing education opportunities or general networking opportunities within ecosystem health.

Finally, with an eye towards the future of Envirovet, we asked ‘Do you believe that a different type of course (i.e. web-based curriculum or lecture series only) covering the same material would have had the same or similar impact as the current curriculum?’ A resounding ‘no’ was reported in 86 (98%) of responses. Of the two (2%) responses that indicated ‘yes’, all answers focused on using online materials as a supplement to the current programme, not as a replacement.

Discussion

Capacity building through health education has been used as a key approach to addressing shortages of trained and employed workers in different health disciplines globally. This impact evaluation showed that the majority of Envirovet alumni held an ecosystem health position since their time on the programme, and more than half of the respondents indicated they currently held a position in the ecosystem health profession. Survey findings indicated that those in ecosystem health profession were more likely to be racially diverse, living outside the USA and possessing a wider range of highest achieved academic degrees than their counterparts who reported never having been in the ecosystem health profession.

Evaluation revealed that the reach of Envirovet has gone well beyond the participants themselves and has likely impacted the work of local organisations, programmes, and the colleagues of participants. Answers to several questions indicated that Envirovet inspired participants to not only make environmentally conscious lifestyle changes, such as adopting more sustainable practices, but also spurred them to make changes professionally, whether this was through guiding on-the-job decisions, or establishing professional network contacts. For these reasons, the Envirovet Summer Institute appears to have achieved its overarching objective of increasing the number and effectiveness of veterinary and allied health professionals in the ecosystem health discipline, and alumni participation served not only to promote sustainable practices and collaborative processes in the animal health sector, but also to build capacity in regions of the world where an ecosystem health workforce was minimal or non-existent.

Perhaps the greatest impact of Envirovet, however, was on the development of close relationships among colleagues and with others in the field. The greatest majority of respondents indicated that without these important relationships, the programme would not have been as successful. This finding is especially important at a time when many educational and non-educational institutions are adopting web-based learning systems as a tool for teaching and learning activities. Without the support and accountability between students and teachers that comes through consistent, in-person interactions, Envirovet and its One Health framework may not have had the same level of long-lasting beneficial impacts.

Areas for improvement were suggested and mainly centred on adding additional topics to the curriculum (i.e. emerging infectious diseases, health policy/law, etc.) specific to the respondent’s year of participation, expanding components such as career counselling and promoting the idea of after-programme mentors. Having the opportunities to explore beyond the fundamental concepts covered in the Envirovet curriculum in order to individually focus on topics in the niche in which people see themselves practising could foster a greater sense of accomplishment and belonging among participants. This collaborative networking could also increase the likelihood of successful adoption of a career within the ecosystem health profession.

In addition to veterinary medicine, respondents indicated their interests or background lay in public health, epidemiology, conservation medicine, health education or environmental management, showing the potential collaborative network’s truly multidisciplinary representation and likely approach to solving ecosystem health problems. Research papers have highlighted the benefits of bringing together experts across disciplines in order to better understand infectious diseases and patterns of disease emergence, as well as to address future challenges in global health (Atlas, 2013; Atlas et al., 2010; Kakkar and Abbas, 2011; Zinsstag et al., 2012). The need for transdisciplinary research that involves local stakeholders and communities, as seen in Envirovet’s Session III, has also been extensively advocated (Charron, 2012; Conrad et al., 2009). Using specialised health education as a guiding force for increasing the knowledge, skills and capacity of trained workers to practice within the ecosystem health profession may also help to address communication and collaboration shortcomings seen across health sectors.

One limitation of this evaluation was the absence of an external comparison group. In order to more accurately measure the impact of Envirovet in advancing more people towards ecosystem health careers, a control group similar in terms of ecosystem health interest, demographics and background, but without programme exposure, would have been beneficial. Without such a control group, it is difficult to evaluate to what extent the programme itself influenced participants towards an ecosystem health career path, as compared to the initial interests or desires of participants that may have steered them towards participation in Envirovet and an ecosystem health career path anyway.

Limitations exist when attempting to generalise beyond the sample population and its principal demographic characteristics. Furthermore, because the sample population was drawn from alumni with current email addresses on file and only 88 respondents (45% of all participants with an email on file) successfully completed the survey, the potential for selection bias exists. It is also possible that those respondents who were most impacted upon by the programme were also those more likely to respond to the request for information regarding their time in the Summer Institute.

Despite these caveats, it was clear that Envirovet was successful both in its main goal of increasing the perceived effectiveness of professionals in ecosystem health and in accomplishing other identified benefits, such as fostering close relationships among people within the allied disciplines and teaching a new skill set useful in ecosystem health. Through its adoption of the One Health framework, there are now more professionals employed in the field who are better equipped to address emerging infectious diseases at their source. Understanding the demographics of the participant pool, the successful programmatic components and the areas where improvement was needed is an important step in not only refining the One Health approach taken by the programme but also in informing the development of other ecosystem health and One Health training programmes.

Footnotes

Acknowledgements

We thank programme alumni who participated in this survey. We would also like to thank Justin Cox and Christopher Ancheta for their help in the preparation of .

Declaration of conflicting interests

Kirsten VK Gilardi and Val R Beasley serve as directors of the Envirovet programme.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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