Abstract
This best practice article explains a Public Health Seminar course that represents an innovative approach to public health pedagogy with demonstrated learning impacts. Reflecting many of the new Council on Education for Public Health competencies, this required course introduces incoming MPH students to the field of public health using a series of classic and contemporary cases, critically analyzed in a small group discussion format. Other modalities include succinct weekly written reflection critiques, rotating faculty discussion leaders, and a final project using various media platforms to communicate case narratives. Key pedagogical elements support students’ knowledge and skill acquisition: (1) small group discussion format, (2) case-based learning, (3) integration across MPH curriculum, and (4) communication skill building. The Public Health Seminar course offers the opportunity to motivate students early in a program, engaging them in relevant issues and providing insight into the importance of their MPH learning and public health professional practice.
Introduction
Beyond being an acclaimed nurse and widely read author, Florence Nightingale (1820-1910) was a public health leader. Her systematic observations, data analyses, and use of infographics convinced Queen Victoria of England to change policy and improve the British health care system. Ms. Nightingale demonstrated that sanitary conditions in hospitals were responsible for more deaths than those occurring at the frontline of the Crimean War, laying the groundwork for the subfield of nosocomial infections.
This classic public health case, among the Delta Omega classics, is one of several used in a graduate level Public Health Seminar course (Delta Omega Honorary Society in Public Health, 2017). It brings to life core principles of public health, many of which have been codified into the new foundational knowledge and competencies for MPH education.
Public health history, philosophy and values
The essential roles of qualitative and quantitative methods in assessing population health and understanding the wide range of factors that influence the health of a population
The critical importance of evidence in advancing public health knowledge and advocating for policies to improve health
The need to clearly interpret and effectively communicate findings from data analyses to different audiences
The benefits of applying systems thinking to public health problems (Council on Education for Public Health, 2016).
Public Health Seminar is organized around critical analysis of such cases. Required for all MPH students entering our program, at a medium-size private university in the United States, the course yields positive outcomes and reflects many of the new Council on Education for Public Health (CEPH) competencies. Here, we describe the course, present its key elements, theoretical underpinnings, and share lessons for adapting the course for use in other programs and institutions.
Course Description
Objectives
Public Health Seminar was developed by a small group of faculty and introduced into our curriculum in fall 2014. Its original intent was to introduce incoming MPH students to the field of public health in a concrete and engaging way, integrating key curriculum components using a small-group discussion format. Since its inception, the course has been refined to include other objectives such as critical analysis and problem-solving skills, synthesis, and application of public health theories and methods, communication through various media platforms, and facilitating group discussion. Course elements and associated assessments again align with CEPH Foundational Knowledge and Competencies (Table 1).
Public Health Seminar Foundational Knowledge and Competencies.
Content
The course focuses on two types of public health cases: (1) classics illustrating foundational insights into public health and themes that transcend time and (2) emerging or contemporary cases affecting public health in today’s world. Classics include those widely known in the field such as John Snow Cholera or Typhoid Mary and also others unique to the local context of the Brown School at Washington University in St. Louis, and the City of St. Louis. For example, The Milk Problem case dates from the early 1900s during which two Brown School students conducted an influential mixed-methods study to show widespread contamination of milk from the region (Moore, Weiss, & Mangold, 1911). Ahead of their time, as is true for other individuals featured in the classics, they used epidemiology, structured observations, and laboratory analyses to prove their hypotheses and guide food safety regulations in the region. The relevance of the classics to current public health issues and practice may be highlighted but often becomes apparent in student understanding.
Emerging or contemporary cases are more responsive to current local, national, and global public health situations. Students tend to gravitate more readily to these cases given their salience in current public discourse. We include contemporary cases that may be “thematic” such as vaccine noncompliance or gun violence, as well as “episodic” cases such as the Ebola outbreak or lead contamination in the drinking water of Flint, Michigan (United States) (Dorfman, Wallack, & Woodruff, 2005). For both the classics and the contemporary cases, students receive a set of materials that provide context and commentary on the situation. These materials typically include short-form videos, podcasts, or articles from the popular press. During class, students engage in discussion, planned learning activities, and/or problem and solution analyses with the faculty discussion leaders. In addition to the faculty-led discussions, students lead a group discussion on a public health case of collective interest twice per semester.
A final component of the course is analyses of the Public Health Speaker Series sponsored by the MPH program. Speakers, six per academic year, include leaders from local, state, national, and international public health agencies, and have addressed timely public health issues (e.g., Medicaid expansion, suicide, e-cigarettes, physical activity, and the built environment) and innovative methods (e.g., data visualization, social movements). Speakers also provide students with insights into different public health career paths.
Modalities
Public Health Seminar is a yearlong course required of all newly matriculating MPH students. Students earn one-credit hour in fall semester and another in spring. The course meets once a week for an hour in a small group discussion format, with 10 to 12 students per section. Typically, there are 6 to 8 sections depending on the number of incoming MPH students. Sections are offered at two time periods, Tuesday (4:15 p.m.-5:15 p.m.) and Wednesday (12:15 p.m.-1:15 p.m.), intentionally selected to follow the Public Health Speaker series (Tuesdays, 12 p.m.). Students register for a section based on time preference, availability, faculty discussion leader, among other reasons. Generally, this approach results in a reasonable distribution and preferred mix of students from different backgrounds and specializations within the program. There have been instances when a group of students in one section from first semester want to remain together and will register for the same section in second semester, suggesting some success in the cooperative learning element discussed below.
A course master develops the cases, discussion outlines, and assignments, and coordinates the logistics and course website with the support of a teaching assistant. Faculty discussion leaders lead a section of the course, share tactics and exercise ideas, and occasionally develop new cases. Faculty discussion leaders switch to different sections of the course mid-way through the semester to provide students with exposure to different faculty members throughout the first year of the program. There are usually a comparable number of faculty discussion leaders to number of sections (6-8 per semester), though some faculty members may lead two sections. Most are full-time faculty again intended to increase interaction with MPH students. Occasionally, adjunct or doctoral students serve as discussion leaders.
Three elements comprise course grades: participation (40% of students’ grade); reflection critiques (30%); and final video or photo essay project (30%; seeTable 2). The participation grade (out of 100 points) is assigned twice during the semester, mid-term and the end of the semester. Reflection critique grades (out of 10 points) are given each week of the assignment, and the final video or photo essay project grade (out of 100 points) is given at the close of the semester.
Public Health Seminar Rubrics.
Participation includes attendance in class and the Public Health Speaker Series but more important is the level and quality of engagement in class discussions. Twice each semester half of the students from each section select their own case, identify readings, and facilitate the class discussion. These “student led” cases provide opportunities for students to take ownership over course material, and develop skills in leading and facilitating group discussion. Students receive a participation grade with feedback at midsemester and again, at the end of the course.
For each classic and contemporary/emerging case, students submit a brief reflection critique (300-word maximum). These written assignments must succinctly summarize and critically analyze the case. Students are expected to apply concepts from the MPH curriculum, make connections to other cases, integrate relevant insights from other sources including personal experience, and—where appropriate—state and defend their own opinions about the case. The reflection critique prepares students for class discussion, critical thinking, and concise written communication. Students receive written feedback and a score for each critique. This rapid-cycle feedback received early in their MPH studies accelerates the establishment of normative expectations for the program.
For the final project, each student chooses one case discussed that semester and creates a short video (90-120 seconds) or photo essay telling the story in an accessible, informative manner appropriate for an audience of nonpublic health professionals. These final projects are evaluated on both content (70%) and presentation (30%). Content grades are based on how well students convey the essence of a case, the core principles of public health illustrated, and broader implications of the case. Presentation grades consider organization, production quality, and delivery. Faculty discussion leaders identify the best projects, which are featured in a spring semester Red Carpet and Video Showcase event, and archived as models that are shared with students in successive years of the course.
Key Pedagogical Elements of Public Health Seminar: Evidence-Based Principles of Learning
Certain elements of Public Health Seminar, supported by evidence and theories of learning and pedagogy, were intentionally included during course planning and further refined based on course evaluation and feedback.
Small Group Discussion Format
“Student active engaged learning” and “student learning conversations” are considered the highest order of instructional practice (Ambrose, Bridges, DiPietro, Lovett, & Norman, 2010; Valentine, 2005). We designed the course with this modality and have received uniformly positive feedback on the small group discussion format. Students regard it as a “comfortable and safe environment” to explore and express ideas around public health issues. The learning environment (social, emotional, and intellectual climate), supported by this format, is central to the course design.
International students (from outside the United States), in particular, both gain and contribute richly in the small group discussion format. There is the opportunity to practice spoken English in a less intimidating environment, and offer comparative perspectives for how cases might be applied in their home countries or other international contexts.
The cooperative learning approach draws on social interdependence and cognitive development theories, and contrasts with competitive, individualism approaches (Johnson, Johnson, & Smith, 1998). It posits the utility of informal student collaboration to solve problems in a naturally created learning situation. Cooperative learning models interprofessional practice competency and the value of solving public health problems with a team of individuals bringing different perspectives (Council on Education for Public Health, 2016). One review of 305 studies reporting outcomes associated with cooperative learning instruction in higher education showed positive results in terms of academic success, quality of relationships, and psychological adjustment (Johnson et al., 1998). Their consistent findings for creativity in problem solving and higher level reasoning, as well as the social learning and skills acquired, in our view, are especially important for the MPH student.
Case-Based Learning
The second key element of the course, case analysis, builds on its value in preparing students for future public health practice. The related problem-based learning method has a long history across many disciplines and clear evidence for its success. One meta-analysis showed evidence for the method building knowledge structure around concept comprehension and application (Gijbels, Dochy, Van den Bossche, & Seger, 2005). Authors describe how theories converge around problem-based learning for its capacity to strengthen metacognitive functions that “operate on an organized domain-specific knowledge base” (Gijbels et al., 2005). During small group discussions faculty deepen this active-learning method by posing questions around problem and solution analyses and facilitating in-class activities like debates, role plays, prioritization and ranking exercises, interpretation of infographics, epidemiology exercises, etc.).
We include a mix of public health cases in the course to expose students to topics that are either unique in our curriculum or in complement to topics covered in other courses. The emerging and contemporary cases span local to global problems, enabling students to be informed and conversant on relevant issues of the day (Mansilla & Jackson, 2014). Classic cases demonstrate the vital importance of learning from history and often persistence or recurrence of problems into the present. Consistent themes emerge among the cases such as the importance of leadership and champions, the critical role of surveillance data and other information acquisition, the importance of policy solutions for lasting impact, and the need for effective communication to enhance understanding of and gain support for public health problems and improvements.
Recent attention has been directed at instruction that recognizes dispositional learning and intelligence, though to a lesser degree in postsecondary education (Perkins, Tishman, Ritchhart, Donis & Andrade, 2000). The concept states that learning derives not only from intellectual capabilities, but also in how people are disposed to use or invest these capacities. Cognition may be channeled or mediated by such traits as curiosity, motivation, or particular interests and passions. The inclusion of different cases in Public Health Seminar allows for differences in dispositional learning and instruction on the part of faculty discussion leaders.
Integration With MPH Curriculum
Public Health Seminar was designed with curriculum integration as a primary objective. Students’ ability to achieve this aim increases as they progress through the program. In Public Health Seminar, students are supported to identify and apply concepts from our foundations core areas of biostatistics, epidemiology, environmental health sciences, policy, and health behavior, but as well, from the other program pillars of transdisciplinary problem solving, evidence-based public health, ethics, and health disparities (Lawlor, Kreuter, Sebert Kuhlmann, McBride, 2015). Evidence from the field of educational neuroscience underlines the importance of active information retrieval to consolidate learning (Karpicke & Roediger, 2008). This transdisciplinary element is effective at highlighting the importance of transdisciplinary practice and systems thinking, a prerequisite to confronting complex public health problems of the 21th century (Begg, Galea, Bayer, Walker, & Fried, 2014; Institute of Medicine Committee on Educating Public Health Professionals, 2003).
The Global Sugar Problem is one example case among many where analysis requires perspectives ranging from the biology of diabetes to societal commercial and policy forces that might influence food and beverage access. Students consider the weighting of these factors and leverage points for public health solutions.
Another contribution of Public Health Seminar to integration is the shared history it creates among faculty and students. Other courses across the curriculum can invoke cases covered as examples to reinforce concepts or methods. Regardless of the specialization, students receive a common, integrated experience that can guide and focus studies moving forward in the program.
Communication Skills
New CEPH competencies for MPH education emphasize the importance of communication that is audience-appropriate in both content and strategies (Council on Education for Public Health, 2016). Public Health Seminar was designed to help students develop three specific communication skills: (1) active listening to understand the perspectives of others; (2) distilling complex cases and phenomena to their essence in order to communicate clearly and concisely in writing, when formulating questions, in response to other’s questions, and in formal presentations; and (3) using engaging formats to convey public health information to diverse audiences. These skills were practiced and evaluated throughout the course in written assignments (reflection critiques), visual presentations (videos and photo essays), interpersonal communication (class discussion), and group facilitation (planning and leading class sessions).
Conclusions
In the 3 years of offering the Public Health Seminar, it has been well received by students and faculty, as evidenced by consistently high scores and qualitative feedback received on course evaluations (Table 3). The small discussion format, case-based learning, integrative curriculum approach, and emphasis on communication competencies surface as successful elements in the course. We recognize some areas for improvement moving forward, some addressed and others ongoing. For example, more global case content and comparative global health analyses has been added in response to both increasing numbers of international students and globalization trends. The inclusion of student-led topics and discussions occurred last year in response to student requests for greater participation in the selection of cases. Student-selected topics have varied widely and provide faculty and the MPH Program with excellent information about the types of public health challenges that captivate student interests (Table 4).
Representative Faculty and Student Feedback on Key Pedagogical Elements of Public Health Seminar.
Public Health Seminar Case Examples.
Note. PTSD = posttraumatic stress disorder; ACA = Affordable Care Act.
Other ongoing challenges in the course include format and length of the course and standardized grading across various faculty discussion leaders. We have observed waning student interest in the spring semester of Public Health Seminar as students advance in the MPH program. This may be due to case analysis fatigue or a readiness to specialize in specific areas of public health. We are considering other content and skill-building areas or reducing the course to one semester. Finally, students value the rotating professor modality, but have remarked on the challenge of responding to different grading styles. We addressed this through more detailed rubrics and periodic meetings with discussion leaders, while also emphasizing to students the importance of learning to adapt to different instruction or “supervision” styles as a public health practice skill.
Overall, positive feedback has established Public Health Seminar’s presence in our curriculum. The course provides students an entry point into the field of public health and an opportunity to synthesize learnings across the curriculum. Students tackle public health problems dominating the headlines or prominent in the public sphere, making the curriculum much more timely and relevant. Each student receives prolonged, meaningful interactions with leading faculty in a small group setting, also enabling valuable student-to-student interactions. We perceive its advantages in the new era of CEPH competencies to reinforce evidence-based approaches, public health leadership, communication, and systems thinking.
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.