Abstract
The Healthy People 2020 initiative outlines the U.S. Department of Health’s vision for improving the health of all Americans and recognizes the ability of community colleges to aid in accomplishing this vision by providing cost-effective, comprehensive public health education. Developing a 2-year degree program in public health is not without its challenges, including ensuring that the curriculum is broad enough in scope to serve as a foundation for students’ continuing in their education and content-rich enough to train them adequately to enter the workforce with the associate degree. Here, we present the efforts to meet these challenges in the establishment of an associate of applied science degree in public health. We review the development of both the public health core curriculum and the courses designed to meet the learning outcomes of that curriculum. We present an example of an articulation agreement with a 4-year university and lay-out potential future directions of the associate program.
In its Healthy People 2020 initiative, the U.S. Department of Health and Human Services outlined its vision for improving the health and quality of life of all Americans. Explicit in the program’s mission is an “increase [in] public awareness and determinants of health, disease, and disability . . .” with a goal to “create . . . environments that promote good health for all” (U.S. Department of Health & Human Services, 2015). The ability to meet the goals of Healthy People 2020 relies on the existence of a well-trained and educated public health workforce.
The training of public health professionals has traditionally been the purview of graduate schools (Kirkwood & Riegelman, 2011). More recently, undergraduate institutions have begun to respond to student interest in the field by offering baccalaureate degrees in public health and related disciplines (Peterson, Albertine, Plepys, & Calhoun, 2013). The burgeoning field of public health education has not gone unnoticed by the U.S. Department of Health and Human Services or by the American Association of Community Colleges, both of which realize the significant role that community colleges can play in providing opportunities to students. For instance, the American Association of Community Colleges reports that more than 45% of U.S. college undergraduates are enrolled in courses at one of the nation’s more than 1,100 community colleges (American Association of Community Colleges, 2015), and Healthy People 2020 recognized the ability of community colleges to provide cost-effective and comprehensive public health education. Indeed, Public Health Infrastructure Objective PHI 6.1 sets to increase the proportion of 2-year colleges that offer public health or related associate degrees (U.S. Department of Health & Human Services, 2015).
Community colleges are uniquely poised to offer public health education in a way that satisfies the vision of the Healthy People 2020 program. That is, community colleges provide quality education to diverse student populations in an open-access environment with strong ties to the local communities they serve. Additionally, community colleges offer affordable education to traditional and nontraditional students alike in a manner that allows reciprocal movement of students into the workforce and professionals into the classroom (Kirkwood & Riegelman, 2011).
Despite the advantages of community colleges for students, development of an associate degree program in public health is not without its challenges. First, the close relationship between the community college and the broader community must be considered. Stakeholders in the associate degree program must provide insight into their expectations of program graduates. The role of the public health workforce needs to be clarified, and the broader community must be familiarized with the public health mission.
Second, the 2-year degree must provide students with an education that is both broad enough in scope to serve as a foundation for continuing in their education and content-rich enough to train them adequately to enter the workforce. The Institute of Medicine’s Global Forum on Innovation in Health Professional Education recommends that such a program complement the traditional public health core knowledge base with an infusion of interprofessional education and practice (Institute of Medicine, 2013). The task is to combine core curriculum education with experiential learning and a capstone experience within the confines of the 2-year degree.
Here, we present the efforts to meet these challenges in the establishment of an associate of applied science degree program in public health at Northampton Community College, Bethlehem, Pennsylvania. We review the development of both the public health core curriculum and the courses designed to meet the learning outcomes of that curriculum. We present an example of an articulation agreement with a 4-year university and lay out potential future directions of this program.
Curriculum Development
Northampton Community College (NCC) launched its Public Health program in the fall 2014 semester with 17 enrolled students; development of the program had clearly begun sometime well before that date. The framework for the program drew heavily on the “critical component elements” of undergraduate degrees in public health (Wykoff, Petersen, & Weist, 2013) as well as on the notion that community college graduates have a strong general education background (e.g., Staley & Trinkle, 2011). Using the “elements” as a guide, core threads of competency began to emerge as the central courses of the program were considered. The core threads that were initially chosen for incorporation into program courses included the following: health education, assessment, intervention, evaluation, data collection, health communication, diversity, cultural competency, social determinants of health, and advocacy.
As the central program courses were being envisioned, community stakeholders and representatives from local public health agencies were invited to participate in framing the program as members of an advisory board. Specifically, advisory board members were asked to review the core threads of competency relative to a program prototype and to evaluate the program prototype relative to course sequence, academic content, and curricular rigor. The board members were prompted to emphasize in their review the expectations they would have of graduates entering the workforce.
While advisory board response to the program prototype was overall favorable, it became apparent that different stakeholders had very different expectations of NCC’s graduates. For example, some board members representing the local medical community suggested that the program contain separate, specific courses on oral health, mental health, women’s health, pharmacology, and/or environmental health. Other board members were broader in the scope of their expectations but asked that the courses within the program incorporate clinical skills, such as collection and monitoring of vital signs, medication reconciliation, medication compliance, diet and nutrition recommendations, and an understanding of the primary care system in order to prevent hospital readmissions. These advisors seemed to prefer a program that would emphasize a more individual and biomedical approach to human health rather than the traditional population health approach of most public health programs.
Despite the differences in their specific priorities, advisory board members did agree on the fundamental skills and knowledge base that they wanted to see in program graduates. Board members emphasized the importance of training in the following: written and oral health communication, working with diverse patients, understanding health disparities and social determinants of health, theories of health behavior change, proper advocacy for patients, management of chronic disease, health across the lifespan, the interpretation of data, the importance of collaboration, and health education. These concepts aligned well with the core threads that had been identified, and the suggestions evolved into the program learning outcomes for the new major (Table 1). The advisory board members also agreed on the importance of a capstone experience that cross-cut aspects of the curriculum, as reflected in the program narrative for the major as it appears in NCC’s catalogue (Table 2).
Public Health Learning Outcomes.
Program Narrative.
Course Development
Expansion of the core threads into the program learning outcomes and the consensus among stakeholders for the need of a capstone experience created an ideal top-down scenario for developing the course structure for the major. That is, the notion was to use the newly devised program outcomes as a guide for adopting certain existing courses into the major and for designing appropriate new courses rather than to craft the program learning outcomes from a mosaic of already existing courses. In this way, we were able to utilize some of the College’s existing course offerings to satisfy certain program and general education outcomes while developing new courses specific to public health. To satisfy the new program learning outcomes, a total of eight courses were developed to span the four semesters in which students would be expected to enroll to complete the Associate of Applied Science degree (Table 3).
Course Descriptions and Program Learning Outcomes Covered.
The courses that were designed initially were consistent with those prescribed by the Association for Prevention Teaching and Research and the Association of American Colleges and Universities for 2-year public health degrees (Riegelman, Albertine, Persily, Kaelin, & Cashman, 2008). These courses, including Introduction to Public Health, Introduction to Epidemiology, and Introduction to Global Health, were intended to anchor the public health curriculum, providing students with a solid foundation on which to build their studies. Five additional courses were then developed to expand the content of the introductory courses and to introduce and/or reinforce concepts and skills that were considered vital for graduates of a 2-year public health program. In this way, each of the program learning outcomes was addressed in multiple courses with emphasis on applied outcomes occurring late in the major (Table 3).
An important consideration in designing the new courses within the major was the sequence in which the courses would be offered to students (Table 4). That is, we wanted each course not only to stand on its own but also to relate to previous and subsequent courses. The intention was that the relationship among courses would be explicitly bolstered where possible by cross-course projects. For example, students in Introduction to Epidemiology could design and administer a campus climate survey that related to that course’s learning outcomes. The results of the survey would steer health promotion projects that students would later develop in Community Health Practice and Public Health Education Communication in Semester 4.
Suggested Course Sequence.
Another vital component of individual course design and course sequence was the inclusion of interprofessional educational experiences; teaching students to recognize the benefits of teamwork and to be effective team members is crucial in the public health field (e.g., Suiter, Davidson, McCaw, & Fenelon, 2015). The World Health Organization recognizes the importance of interprofessional training in creating a practice-ready workforce prepared to respond to local health needs. While NCC’s Public Health program is in its formative years, interdisciplinary learning experiences are being emphasized throughout the curriculum. For example, students enrolled in statistics courses are being sought to guide data analysis for Introduction to Epidemiology students. Likewise, students in NCC’s Radio-TV major are being enlisted to help Public Health Education Communication students with the development and production of their media projects. Such relationships, akin to modified learning communities, benefit all students involved and prepare public health students to apply their coursework to practice.
During the fourth semester of study, public health majors will have the opportunity to broaden their health perspectives and gain experience in applying the knowledge and skills they acquired through the program’s capstone course, Public Health Field Experience. Throughout this course, students will work with different public health professionals to observe team-based and interprofessional care, to participate in public health decisions and actions, and to reflect on the material they learned throughout the major. Students will meet weekly in this seminar-format class that emphasizes sharing, comparing, and contrasting the different public health infrastructures and approaches they will observe during their field experiences.
Articulation Agreements
The associate of applied science program was designed to provide a broad first- and second-year course of study in public health to serve as a foundation for transfer into 4-year college and university health programs. Currently, a program-to-program articulation agreement is in place between East Stroudsburg University of Pennsylvania (ESU) and NCC that will allow students who complete the AAS in Public Health to move as juniors into a BS in Public Health major. ESU and NCC have had a long-standing relationship, and ESU accepts more NCC transfer students than any other 4-year college or university. Therefore, we considered it paramount that a credit-for-credit transfer opportunity with ESU be developed for our public health graduates. A number of other local colleges and universities are in the process of reviewing the AAS curriculum; initial feedback is favorable, and we anticipate similar articulation agreements.
Future Directions
As the program builds on its solid framework of common threads, interprofessional experiences, and seamless articulation, we envision opportunities to offer online or hybrid versions of core public health courses. Such online courses will broaden the reach of the program by providing students with flexible course offerings. The addition of a Community Public Health Specialized Diploma or Certificate under this umbrella of programs will also be explored to allow stackable credentialing to individuals already employed in health care or individuals who already possess undergraduate degrees.
Additionally, we realize that public health is not limited by distance; the human population is a global population, and population health is a global issue. Success in the public health field relies on an appreciation of and respect for the social and cultural differences inherent in each population. Younes and Asay (2003) propose that “as educators, we are obliged to provide experiences that expose our students to the diversity of the world.” To address the need of global awareness and diversity in public health, NCC has begun to develop a relationship with institutions in Denmark that NCC students will use as short-term international study experiences. Site visits and initial partnership design meetings were conducted in March 2015. The idea is that the international program will involve numerous workshops with both public and private public health organizations and educators. A key component of the collaboration will involve peer-to-peer instruction between NCC students and Danish public health students, combined student field trips, and reciprocal lectures of visiting faculty. The goal is to offer this opportunity to students in the program as early as March 2016.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.