Becoming a Professional

Abstract

Cultivating professionalism among students is a key goal of the Master of Public Health (MPH) practicum. Achieving this goal, however, can be pedagogically challenging. We provide guidance on implementing and using an online student discussion board as a vehicle for promoting professional development, based on our experience overseeing the MPH internship (practicum) at a large urban university school of public health. Our approach is derived from the professional development literature identifying active reflection on practice experiences as a critical means of facilitating the process of developing mastery and proficiency. We have found that an online discussion board provides a supportive environment for discussing numerous professional challenges encountered in the internship and sharing strategies for addressing these challenges. Our experience suggests that online discussion boards are a useful tool to help MPH students develop their professional skillset, conduct, and values.

Keywords

discussion boards professional development critical reflection public health pedagogy

The goal of Master of Public Health (MPH) education is to provide students with a broad range of skills needed to serve as competent public health professionals. Traditionally, most public health schools and programs have focused on necessary training in technical competencies. Less attention is given to helping students develop the skills and qualities comprising professionalism, which are also critical to career success. Employers place a premium on staff that can demonstrate a number of professional practice skills including problem solving, teamwork, leadership, and the ability to quickly integrate into the organization, and they note the need to incorporate more management and communication skills in public health education (Association of Schools and Programs of Public Health, 2013b). Public health employees report feeling unprepared in a number of important areas related to professional skills, including program management, communication, and responding to dynamic situations (Sellers et al., 2015). Many MPH faculty are familiar with the complaint of the professionals who hire our students that while our graduates are technically proficient, they fall short on the skills needed to function effectively in an organization.

How can public health programs address this gap in professional development training? As a required element of MPH training, the practicum provides all MPH students with the opportunity to work in “real world” settings and develop professional practice skills and professionalism. The experiential aspect of the practicum compels students to learn how to respond to everyday challenges in public health work and sets the course for their professional conduct and expression. The purpose of this coaching article is to share our experiences as public health faculty in using an online discussion board as a means of promoting professionalism among MPH students engaged in their practicum.

Harnessing the Potential of the Practicum to Promote Professionalism

Our approach evolved as we observed the benefits of asking MPH students engaged in their practicum to discuss challenges they were confronting and how they resolved them. Students often responded with thoughtful statements about learning to be effective in areas such as communication and understanding an organization’s culture and operations. This prompted us to take a closer look at reflection as a pedagogical tool. There is a sizable literature discussing how development of professionalism requires reflection, involving a process of mindful attention to how one assesses and responds to situations that pose new challenges and entail complex solutions (Ginsburg et al., 2000; Rogers, 2001). Reflection is particularly useful in experiential learning to help foster creative problem solving and professional progression (Regehr & Mylopoulos, 2008). Reflecting on real-life situations encountered during professional training helps adult learners think about their experiences and critically analyze how to improve performance (Dunfee, Rindflesch, Driscoll, Hollman, & Plack, 2008). Methods for stimulating reflection include use of structured exercises, typically involving journals, guided questionnaires, diaries, essays, or portfolios (Alley, Jackson, & Shakya, 2015; Pagano & Roselle, 2009; Rogers, 2001; Sasnett & Ross, 2012; Wallman, Lindblad, Gustavsson, & Ring, 2009; Wozniak, 2012). These pedagogical strategies facilitate students’ active engagement in critically assessing their professional capacities and practices, supporting ongoing professional development.

Online discussion boards are a particularly useful format for facilitating the process of professional reflection. Discussion boards offer a forum for students to work through professional development issues in a self-directed, problem-solving–oriented manner and help develop a community of practice among students (Yang, 2009). Electronic discussion boards have been used successfully in clinically oriented health sciences professional training programs to help students connect classroom knowledge to practice (e.g., developing research questions and analyzing data) and support higher-order thinking (Dunfee et al., 2008; Evans, Yeung, Markoulakis, & Guilcher, 2014). Participation in discussion boards can be a means of promoting debate and in-depth discussion among students (Resnik, 2005). An online discussion board is a useful tool for stimulating student-centered active learning (Hudson, 2014; Teikmanis & Armstrong, 2001) and facilitates peer-to-peer interaction among students (Linjawi, Walmsley, & Hill, 2012; Martyn, 2005).

Incorporating Professional Development and Reflection Into Our Curriculum

We decided to employ an online discussion board in our public health internship (practicum) course as a means of promoting student reflection by providing a semistructured format for students to examine their practice experiences and share problem-solving insights with each other. The discussion board was one of several vehicles for prompting reflection on professional development among the internship students.

At our school of public health in a large private university, students in two MPH concentrations with a health promotion focus enroll in a one-semester 3-credit internship seminar course concomitant with their internship fieldwork. During the 2014-2015 academic year, as new faculty for the course, we reviewed the existing seminar curriculum and decided to redesign it in order to have greater focus on professional development issues and provide students with structured reflection opportunities. This comprised inviting guest speakers to discuss the realities of working in public health; progress reports, which included required reflection on the student’s internship experiences for topics such as how teams function, fitting into the organizational culture, perceptions of how organizations operate, and challenges encountered and solutions employed; a final report, which also included structured reflection sections; and required participation in the online discussion board. Students receive direct feedback on their performance from their preceptors, who are asked to assess the student’s professional development as well as technical skills in formal midpoint and final evaluations; these evaluations are shared with course instructors and the student. The evaluations include open-ended questions on assessing the quality of the student’s work and professional behavior, observed professional strengths, and areas for improvement. We also include close-ended questions to rate the student’s communication skills and various behaviors and attributes related to professionalism, for example, working on teams, taking initiative, working independently, following through on assigned work, accepting ideas and suggestions of others, punctuality, and dependability.

Implementing an Online Discussion Board

We find the discussion board to be an accessible and relatively simple mechanism to execute. It worked well in our class sizes, ranging from 4 to 17 students. Based on our experiences, we recommend the following guidelines:

Use available online course management systems. Postings are made using the discussion forum function of the university’s electronic course management platform, which is functionally similar to Blackboard. Postings and discussion threads appear in the course site and can easily be followed by students and the instructors.

Make the discussion board a required element of the practicum/internship. Our course syllabus instructs students to post at least three separate items for discussion on the course discussion board and respond to at least three items posted by other students. There is no minimum or limit to the number of students who can respond to a particular posting. Due dates are given for new postings and responses to other postings, spread throughout the semester. Each posting is worth a certain number of points toward the final grade in the course. We originally asked for four postings but found that students were finding it hard to come up with fresh topics and thoughts by the end of the semester. We found it more useful to allocate only a few days between original postings and responses in order to keep the students engaged and the discussion active.

Allow flexibility in discussion focus, with some direction from instructors. Students can be given freedom to decide on discussion topics to ensure that their issues and voices are given full expression. We note in the syllabus that postings should focus on problems, challenges, tips, and lessons learned encountered in the internship. Students can base items on issues they raised in their progress reports or broach new topics. No further guidance regarding topics was provided, but we expect that as recurring themes are noted across semesters, we may suggest a few specific subjects. While we did not encounter any problems with inappropriate, insensitive, or confidential postings, providing some basic ground rules for participation would likely be useful in the future.

Use the discussion board to monitor issues confronted in the internship. The discussion board also enables faculty to keep an eye on problems and offer advice to both individual students and the whole class when appropriate. We used the discussion forum to identify common issues, highlighting them in our own postings. While we did not respond to every posting or discussion thread, we added advice or encouragement when a topic seemed to capture the attention of a number of students. In addition, we communicated directly with individual students in response to a posting when faculty advisement seemed warranted. We also selected common discussion board topics for further discussion during internship seminar meetings. We note the potential of discussion boards as an approach that enables faculty to be more directly engaged in guiding students’ professional development during the practicum.

Assessing Discussion Boards

Faculty may find it useful to compile and examine discussion topics as part of an experiential learning assessment approach both for the course and educational program. A discussion board provides valuable documentation of student professional development unavailable through typical assignments or direct observation at the internship sites. We present below our method for compiling information from the discussion and findings from this assessment.

Method

We examined postings from several semesters (fall 2014, with five students enrolled, and spring 2014, with 24 students enrolled across two sections and a total of 259 postings). We reviewed the discussion board entries independently and sorted them into themes based on consensus. We tallied the number of entries related to a particular theme, including initial postings and responses.

Summary of Findings

Our assessment helped us identify a number of themes, which can be used proactively in future semesters to help students address key issues confronted through the internship. The themes tended to coalesce around several general areas: (a) mastering professional behaviors, (b) technical skills development, and (c) transitioning from internship to career. Across all areas, the discussions usually focused on identifying particular challenges encountered in the internship and sharing advice and strategies for dealing with these challenges. Under these themes, related specific topics discussed most frequently (in at least 20 postings) included, as shown in Table 1: being well-organized and learning to balance multiple demands of school, internship, and job (28 postings); how to work on teams and interact with coworkers (25); requests for assistance with specific technical skills and sharing of related resources (56); how to wrap things up at the end of the internship (21); advice for the job search and career planning (37); and reflections on the practice and value of public health (22). Other popular topics mentioned in at least 10 postings included time management (13); being flexible, for example, learning to deal with project implementation delays (14); learning to work proactively and independently yet ask for guidance when needed (17); gaining confidence in the work and feeling comfortable speaking up (10); development of such professional qualities as maintaining a positive attitude, diplomacy, and leadership (12); and developing and applying skills learned in the classroom or new skills needed for the internship (17).

Table 1.

Student Discussion Board Entries.

Themes and related topics	Number of entries	Examples
Mastering professional behaviors
Being well-organized: Learning to balance multiple demands	28	“As an intern the best way is to communicate with your preceptor about the busy schedule you have and that you’re trying to balance everything with the internship . . . if you communicate this earlier on, hopefully it’ll prevent any miscommunications and provide a less stressful work environment.”
Being well-organized: Learning to balance multiple demands		“I agree with your recommendations, keeping track of tasks throughout the day is really helpful. Since I wrote my post about being given too much work and feeling overwhelmed, I have started meeting with my leads more often. I include all of them in emails when I’m assigned a new task/project so that they can communicate with each other as well. This showed them the amount of work I was being assigned, due dates, and how I was progressing with each. As a result a better schedule is slowly coming together . . .”
Being well-organized: Time management	13	“So far for me, I’ve been trying to be as organized as I can by writing out all my due dates on an excel sheet, color coding, etc. It definitely helped me prioritize what I needed to get done week by week”
Being well-organized: Time management		“My calendar has been the most handy for me to keep track of all my to dos and I think that prioritizing them on what needs to be done has been the most helpful . . . time management is of the essence when balancing everything and I’ve been working on that too and trying to make it a lifelong habit.”
Being flexible	14	“I think I underestimated how long certain projects would take and did not account for other things to pop up. What about revising/making a new plan for what you want to accomplish for the remainder of the semester? Maybe sitting down with your preceptor to plan out the remainder of the internship? I think I am going to take my advice and do that too!”
		“I had a similar problem when I worked at (agency) as a Research Assistant. Higher management was lacking when I started, and only got worse from there. For a good amount of time, there was no one occupying 6 management positions above me. It was not only frustrating because of the lack of support, but it also created an ambiguity of roles since I had to take on a lot of responsibilities that weren’t necessarily mine. I think the key is to be flexible.”
Learning to work independently and proactively	17	“Ask for training sessions if you are at a place and you aren’t familiar with something. My first day I just struggled through something, however getting over the nervousness of just starting I now ask my preceptor for mini training sessions when I’m assigned something I’ve never done before.”
Learning to work independently and proactively		“I do sometimes feel like I should be more proactive when it comes to the work that I am doing. . . . Thankfully this week, it wasn’t a pressing concern, as we were in the process of organizing and conducting a training workshop for providers, but there were definitely moments when I wondered if I could have perhaps started something on my own without waiting for someone to hand over work to me.”
Learning to speak up, gaining confidence	10	“. . . I realized after a couple of days that by asking questions about the project or offering suggestions that you think could benefit their program can really pay off. For example, I was able to provide a different perspective last week when we were deciding how to analyze a new data set.”
Learning to speak up, gaining confidence		“I too have learned that a benefit of working hard and being responsive and effective in my work has given me the opportunity to feel confident in my ability to speak up and be honest when I think our priorities should go in a different direction or that I’m going to need more time or assistance from others in getting something done. When I haven’t spoken up, I’ve found myself scrambling to get something done in time and isolated from potential help from other team members.”
Working on teams, interacting with coworkers	25	“I am finding it challenging to devote only the two intended days a week to internship work. The projects I am working on may be worked on by others at different times, and may require my response or input, meaning I am trying to manage expectations about the time I have devoted to each project each week, while also trying not to hold up someone else’s progress.”
Working on teams, interacting with coworkers		“I think when you are defending your work/vision acknowledge what the other people have to say, validate it by saying something positive and then redirect to where you want to be or where you saw the project going. Generally avoid loaded negative words like ‘ugly.’ . . . I’m not saying censor yourself too much or be silent but express your frustrations calmly and directly.”
Acclimating to the organizational culture and environment	7	“. . . It’s been very valuable to learn about the inner workings of a small nonprofit. For example, the roles of staff members tend to be very flexible, which is an aspect of the job that drew most of the employees to this organization. Unfortunately, It seems like our board is somewhat inactive, and a bit disconnected from the office staff, which has led to some sticky situations in terms of financial support and decision making.”
Acclimating to the organizational culture and environment		“There are many projects that are simultaneously being worked on in the program, which I am sure is overwhelming for my preceptor and others in the (organization) but . . . I am very much so a Type A person, and the lack of organization and structure is making me a little anxious. Any advice on how to adjust to this new environment would be greatly appreciated.”
Development of specific professional qualities	12	“I think the most important quality I’ve learned so far is confidence. . . . Another quality I learned is positivity.”
		“My internship also encourages everyone to be curious—to take a new perspective on an issue or question and to look out for new opportunities or research targets. This experience has definitely made me more aware of how conscious one needs to be sometimes in order to stay curious.”
		“I’ve taken on more of a leadership role in my internship recently and it has definitely helped me learn diplomacy.”
Ethical issues	4	“. . . I too have felt at times that the greater public health interests are being compromised for program efficiency and time/money constraints”
Technical skills development
Requests and suggestions for technical assistance, sharing resources	56	“I do not have extensive experience in IRB approval writing and was wondering if anyone had any advice, tips, or resources that they have used.”
		“Here’s a link to the CDC’s guide for conducting focus groups.”
		“When I submitted an abstract for the 2015 APHA conference, I found a lot of resources on the APHA website that provided me with a framework to help me write my abstract.”
Learning/applying skills	17	“. . . I have applied my biostatistics information when trying to understand all the background literature. They would mention type I and II error in regards to their studies, or the level of significance to a particular study population which allows me to put things in perspective.”
Learning/applying skills		“Should I talk to my supervisor and ask to keep doing things I’m better at, instead of conducting recruitment so that I can be more effective and efficient for the study program? Or should I push myself forward a little bit and practice my skills on recruiting?”
Transition from internship to career
Wrapping up at end of internship	21	“I’ve found I’ve finally hit my stride and am more productive at my internship than in the early weeks, but suddenly we’re quite close to the end! . . . A couple of my projects are very personal to me and I’ve put a lot of work into them and would love to see them finished, but I’m nervous I’ll have to leave them behind for someone else to wrap up the details. Is anyone else experiencing this?”
Wrapping up at end of internship		“I am having a similar conversation with my preceptors this week regarding wrapping up projects and possibly continuing work on others. If you feel like you have a good relationship with your preceptor and she values your work, I would shoot her an email and proactively schedule a meeting with some bullet points you would like to discuss, i.e., suggest a specific meeting day/time or send a calendar invite and outline your agenda . . .”
Job search and career planning	37	“Through searching and reviewing job descriptions, I’ve noticed how some job positions such as Program Manager, Research Associate, etc. are tied to the different classes that we took thus far (i.e., Program Evaluation, Research Methods, etc.). Since we took a semester-long class to just get an overview of the topic and not exactly experts yet, I’m not sure how to prove our knowledge and expertise when the jobs also require years of experience under our belt.”
Job search and career planning		“I would advise you not to sell yourself short. I would think carefully about the experience you’ve gotten through the program, as well as any transferrable skills you’ve received from other jobs you’ve had, or even volunteer work you’ve done. Growth and experience can come from many different sources, and while you may have other knowledge or experience that is equally valuable in this position, and you should sell them on that.”
Understanding how public health works in practice, value of public health	22	“I’m starting to realize that implementing a program is not an easy matter and requires a lot of time, effort, and management. Since I will be coordinating/collaborating with a few volunteers that sign up each week to assist with me, it requires good communication from both ends and also the need to be flexible.”
		“Our classes have made me aware of the important role that community-based participation plays in public health and it is exciting to see these concepts playing out in our work.”
		“Over the course of the internship I have also learned a lot about communication. There needs to be effective communication between an employee/intern and leadership/coworkers as miscommunication can cause issues that could have otherwise been avoided. . . . This internship has validated all of the reasons why I want a career in public health.”

Note. APHA = American Public Health Association; CDC = Centers for Disease Control and Prevention; IRB = institutional review board.

In general, postings made early in the internship tended to focus on time management, balancing competing time demands, and learning how to best function in the organizational environment. Later entries involved discussion of postgraduation plans and reflections on what was learned in the internship. The discussion threads revealed students’ struggles and resolutions as they learned how to be flexible, take initiative, deal with ambiguity, and respond to other challenges presented by the real world of public health practice. Sample student entries for each topic are presented in Table 1.

Examples of Student Interaction

As noted above, we required each student to respond to a minimum number of postings by other students to help foster a learning community. The following is an example of an exchange between students:

Student A:

. . . I am in my third week and it’s hard to say no even though I’m exhausted by the end of the day. I work with three program leads and keep getting projects and other assignments to work on simultaneously with due dates that are days apart. . . . It’s hard as a new intern to say no when you’re still getting used to the surroundings and understanding people’s roles. . . . Any words of advice?

Student B:

I have been having similar issues at my internship and feeling quite overwhelmed as well. I finally sent out an email to my supervisors telling them politely how I prefer to work and a suggested, realistic timeline for all of my projects. They all agreed with my timelines and now my projects are much more spaced out. Perhaps just taking a little authority or control where you can, may establish some parameters? I hope this helps!

Examples of Peer Support

As suggested by the above, the tone of the exchanges was very supportive, with words of encouragement. When responding to postings by their peers, students always provided empathy and often gave specific advice for how to deal with issues raised. Students appeared to find it reassuring that others were experiencing similar issues, for example, “I am really relating to the posts this week . . .” Comments contributed to a sense of sharing and motivation, for example, “I hope everyone has been having a positive experience at their internship and that you feel just as proud about and inspired by the work you are doing.”

Summary

Online discussion boards can be a useful tool to help MPH students address a range of professional development issues. Discussion boards provide a platform for encouraging students to raise issues they are confronting in the practicum in real-time and in a supportive, nonjudgmental setting. They serve as a vehicle for helping students engage with each other and develop their peer networks. The breadth of the discussions exposes students to a range of professional issues in real-world contexts and helps students with limited public health work experience better understand the public health workplace and its expectations.

Future Directions

Next steps in advancing use of online discussion boards in MPH education include evaluating the outcomes of participation. Evaluation of experiential learning is an emerging topic in the clinical health professions, with little attention to date in public health. Assessing the contribution of active reflection on practice-based experiences to the process of developing public health competencies and professionalism presents many challenges in terms of methods, measures, and standards (Koole et al., 2011; Leijen, Valtna, Leijen, & Pedaste, 2012). One promising approach is the use of assessment rubrics to establish expectations in defined content areas and provide scoring metrics for discussion board participation (Greenberg, 2015; Phillippi, Schorn, & Moore-Davis, 2015). Assessment rubrics also could facilitate comparison of student entries with preceptor observations in related areas, both for individual students and for cohorts of students. Employing qualitative techniques, as we did, is a valuable approach for examining the substance and meaning of discussion board comments and conversations. Public health education would benefit from future evaluations designed to examine the impact of online discussion boards on such issues as improvements in specific professional competencies, student performance in the internships, and peer-to-peer networking.

Online discussion boards have the potential to enable students to reflect on experiential learning, develop technical and problem-solving skills, and cultivate professionalism. These critical outcomes parallel the taxonomy for competency-based education recommended by the Association of Schools and Programs in Public Health, which comprises cognitive (knowledge), psychomotor (skills), and affective (attitudes) domains (Association of Schools and Programs of Public Health, 2013a). Discussion boards are a useful and easy to implement tool for providing MPH students engaged in their practicum with structured opportunities for professional reflection and development.

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.

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