Public Health Seminar : Classics to Contemporary Cases for a New Pedagogy

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.

Keywords

competency-based education public health pedagogy case-based learning

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).

Table 1.

Public Health Seminar Foundational Knowledge and Competencies.

Public health seminar	CEPH alignment (no., knowledge or competency)^a	Link to course activities
Public health history, philosophy, and values	No. 1, Knowledge	Analyses of classic cases that shaped public health, including foundational values illustrated (e.g., public health as data-based with policy-focused solutions, importance of community partnerships), attributes of public health leadership (e.g., political engagement, communication skills), and applications in present day public health, all demonstrated in reflection critiques and class discussion (e.g., Cholera Through Time and Space: Cholera in London, St. Louis, and Abroad)
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	No. 3, Knowledge	In case analyses, recognizing the unique value of knowledge gained from different methods, especially those drawn from academic and practice disciplines outside public health. Reflection critiques must consider how each case is transdisciplinary and class discussion include questions about methods used in the case (e.g., Gun Violence as Public Health Issue)
The critical importance of evidence in advancing public health knowledge and advocating for policies to improve health	No. 6, Knowledge	Evaluation of the types of evidence and strength of evidence used in prioritizing among public health problems and available solutions, as well as the ways evidence is designed and presented to maximize impact. Class discussions, reflection critiques, and final project make connections between cases and parts of the MPH curriculum that emphasize evidence-based practice and policy (e.g., Research Methods, Cross-cutting Themes, Transdisciplinary Problem Solving courses)
The need to clearly interpret and effectively communicate findings from data analyses to different audiences	No. 4, Competency No. 19, Competency	Written communication in weekly reflection critiques, assessed for ability to synthesize perspectives from across case materials, summarize, and interpret cases.Oral communication in small-group discussions and facilitation of student-led cases, assessed in participation grade.Oral and media communication in final video or photo essay, assessed for ability to communicate key aspects of cases in compelling and instructional ways.
The benefits of applying systems thinking to public health problems	No. 22, Competency	Analysis of cases that apply systems thinking to PH, assessed in reflection critique or participation grade through discussion (e.g., The Milk Problem, Climate Change and Health, The Global Sugar Problem)

Council on Education for Public Health (2016).

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.

Table 2.

Public Health Seminar Rubrics.

Assignments (%, total class grade)	Assessment frequency	Grade criteria
Participation (40%)	Assessed at midpoint and endpoint of class (2 times, 100 points each)	Attendance: Perfect attendance, unless excused, to weekly classes and PH Speaker series.Preparation: Evident that the student has completed the assigned reading or other media, and comes prepared with questions and commentary (Extra points awarded when student has completed optional reading or her/his own research on the subject.)Quality of contributions: Student is actively participating in class discussion with thoughtful contributions made. Critical analyses offered as well as connections to the MPH curriculum.Communication skills: Focused, clear, and succinct points articulated. Balanced participation that also facilitates other student contributions.
Reflection critiques (30%)	Submitted before class for each case study (10-12 times, 10 points each)	Timely submission. The reflection critique should be submitted by midnight of the night before class for the classics and emerging/contemporary cases. There will be no reflection critiques assigned for the PH Speaker series.
		Appropriate length. The reflection critique does not exceed the 300 word count, but also takes advantage of this count and is not too short.
		Content. The reflection critique includes some of the following:
		• Introduction: briefly summarize the content of the larger PH case. Should capture the essence of the larger case and the broader principles underlying specific circumstances.
		• Critical analysis: highlight the strengths and weaknesses in the PH case. State and argue your opinions.
		• Make connections to: the MPH curriculum; your past experiences and knowledge of the issue; previous cases; and if classic, make connections to present day public health issues.
		• Integrate new information you have collected or researched on your own.
		• Conclusion: synthesize the main arguments made in the critique.
Final project: video or photo essay (30%)	Assessed as final project at end of class (1 time, 100 points)	Goal: Demonstrate understanding and critical thinking about a public health case and communicate it clearly and concisely through a video or photo essay. For this project you will be evaluated both on content and presentation of the final product. This project may be used as a portfolio product upon completion of the MPH program. Faculty discussion leaders select the best final projects from each section to be included in a showcase event during the spring semester.
		Content: Your final project will focus on one public health case discussed in class or of your own choosing. Topics not covered in class should be approved by the section instructor. As a general guide, your final project should: (1) briefly explain or describe the case in a way that an unfamiliar audience would understand, (2) indicate key public health principles illustrated by the case, and (3) describe any implications of the case for public health more broadly. See instructions below for each project format.
		Option 1: Video
		The video is a short “clip” with or without animation describing the public health case and key principles and implications.
		Length: 90 to 120 seconds
		Format: Videos will be evaluated primarily on content, and to a lesser extent on production quality. Elaborate editing, visual aids, or special effects are not expected though welcomed. Because this is the designated portfolio product for the course, it should be something you are comfortable sharing with others, including prospective employers.
		Presentation Style: Deliver the content in whatever format and platform you prefer. Creative narration and visual images are appreciated. The video should be clear, comprehensible, and compelling.
		Option No. 2: Photo Essay
		A photo essay is a series of images that forms a narrative on a topic of choice. The photos do the “telling” and are supported by short captions of text that provide context for each photo.
		Length: Between 5 and 8 photographs—Images should be photos taken by the student.
		Format: You may wish to upload your images into a PowerPoint presentation, or you may wish to have them printed and displayed in a nondigital format. Photo essays should include a brief introductory paragraph describing the theme of the photo essay. Each photo should have approximately 3 to 4 sentences as a caption below.
		Presentation Style: Students that choose to create a photo essay will display and present their images in a brief (3-5 minutes) presentation on the final day of class. A PowerPoint presentation is appropriate. If the student chooses to use printed photos, they may display them in class.
		Content Score (70 points) _______
		Presentation Score (30 points) _______

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).

Table 3.

Representative Faculty and Student Feedback on Key Pedagogical Elements of Public Health Seminar.

Key pedagogical element	Student feedback
Small group discussion format	“I appreciated the chance to reflect and discuss openly with my fellow students in a more intimate and personal setting. Though there are moments when it feels uncomfortable, it does provide an arena to be vulnerable in assessing your own opinion.”—Student
	“[The small group discussions] challenge students’ beliefs and values—helping them become more well-rounded public health practitioners—by exposing them to various global and contextual perspectives.”—Faculty
	“[Public Health Seminar provided] students the opportunity to take a small class which promotes collegiality and comfort with classmates, and getting to know different faculty. Also, the benefit for faculty is to getting to know the students!”—Faculty
Case-based learning	“Public Health Seminar helps me critically analyze all kinds of public health cases . . . it will continue to contribute to my thinking after the class ends.”—Student
	“Public Health Seminar’s unique format gives it its substance. Some graduate level courses are brief and monothematic. Others are broad but lengthy. Too many involve didactic lectures. Public Health Seminar seems completely different from other courses on the academic market. The course is akin to the speed dating of public health events. The rapid-fire approach not only engages the students with a wide variety of subjects, many of which they may not have considered previously, but it also encourages them to form a quick yet considered opinion.”—Faculty
Integration with MPH curriculum	“Public Health Seminar has enabled me to integrate what I’ve learned from my other classes and how it can be applied in a real world setting.”—Student
	“Public Health Seminar allows students to think about methods for which public health problems can be addressed in the context of concrete examples. For example, they first have to understand what evidence needs to be gathered to determine where a public health problem is occurring (i.e., what are the characteristics of the affected population and how do data collection systems help with defining where the burden of the health problem exists), what do public health practitioners need to know to address the public health issue (what is different about those affected vs. not), and what are the barriers to implementation of a solution and how to you overcome those barriers to implement a solution. Students also need to think about who needs to be involved in identification of the problem and solution to that problem (i.e., who are the stakeholders).”—Faculty
Communication skills	“Many times in their professional careers our students will be asked to present their public health position in a discussion type setting with peers, supervisors, subordinates, sister agencies, political leaders, etc. The seminar allows them to test and perfect their approach in a safe learning environment.”—Faculty
	“Public Health Seminar Students learn how to: utilize evidence to make their point; be civil and courteous to those who disagree; practice articulating public health concepts to several different people in a room who view a problem from various vantage points and levels of public health understanding; and forcefully support their positions without being combative.”—Faculty

Table 4.

Public Health Seminar Case Examples.

Case type	Topic
Classic	Typhoid Mary and Typhoid Fever
	The Milk Problem in St. Louis: Infant Mortality and Food Safety
	Florence Nightingale: Sanitation Mortalities in Crimean War
	Cholera Through Time and Space: Cholera in London, St. Louis, and Abroad
	Eradicating Polio: From Jonas Salk to Mop Up Campaigns
Emerging/contemporary	Climate Change and Health
	Mental Health: Community Trauma and PTSD
	Gun Violence as a Public Health Issue
	Mosquito Borne Diseases: Malaria, Dengue, Zika, and Chikungunya
	The Global Sugar Problem
Student led	Heroin and Opioid Addiction
	Human Trafficking
	Native American Health Disparities
	Future of Healthcare Reform
	Incarceration and Health
Public health speaker series	Making Data More Human
	Health Coverage for Children: Impact of the ACA and Medicaid Expansion
	Engineering Physical Activity Back in to American Communities and Lives
	Natural Disasters and Public Health
	Rethinking Global Suicides

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.

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