Lessons From a Community Driven Experiential Public Health Course

Abstract

Applied practice opportunities are essential in both undergraduate and graduate public health programs, and are emphasized in the 2016 changes to the Council on Education for Public Health (CEPH) accreditation requirements. To generate and implement solutions to challenges our communities face, there is an increased need for public health training that includes both rigorous coursework and experiential learning opportunities. We share here a framework and scaffolding from a class that has provided a supportive structure for public health students to conduct applied practice activities in response to expressed needs of community organizations. Guiding Principles: The practicum is grounded in theories of practice-based learning, community based participatory research, and community engaged research with a vision of preparing students to participate in community knowledge generation partnerships to more effectively address health disparities. Lessons learned: Advance planning creates a foundation for success. Community partner and student interests are aligned; teams share the common goal of promoting sustainable long-term impact through their projects. Students are prepared for success through the development of instrumental tools (e.g., logic models, program impact pathways, and work plans) that guide project development and implementation. Students learn to adapt to evolving partner needs. Students have a unique learning experience that is practice-based. Future work to understand key functions of different course elements will add quantitative metrics to the existing qualitative metrics in the preceptor evaluation, work with other practicum instructors to develop common best practices and will include a qualitative analysis of student reflections.

Keywords

active learning collaborative learning community-based experiential learning experiential action learning

Introduction

Applied practice opportunities are an essential element in both undergraduate and graduate public health programs, and are emphasized in the 2016 changes to the Council on Education for Public Health (CEPH) accreditation requirements (Council on Education for Public Health, 2016). These opportunities allow students to take the public health curriculum into the field of public health practice, applying coursework to complex problems and relationships in learning situations with strong mentoring support (Hernandez et al., 2014). To generate and implement solutions to challenges our communities face, there is an increased need for public health training that includes both rigorous coursework and experiential learning opportunities (Fleckman et al., 2015; Hearne, 2008; Levin & Rutkow, 2011; Upadhyaya et al., 2015). Practice-based teaching and learning are essential to academic institutions and programs that train public health professionals (Atchison et al., 2006). In upholding this commitment, practice-based teaching and experiential learning can help bridge the gap between academic research and public health practice to train professionals who are able to provide public health services to diverse communities (Atchison et al., 2006). Although there has been documentation of such educational and experiential integration in areas of medicine (McCloskey et al., 2011), nursing, and social work (Natland et al., 2016), there is less documentation in public health (Dhavan et al., 2010; Gregorio et al., 2008; House et al., 2014; Villanueva et al., 2011). Given the requirement in CEPH accreditation for applied public health experiences, schools of public health offering master’s degrees in public health (MPHs) have used a range of approaches, including both internship experiences and applied coursework. This paper shares a framework and scaffolding from a class that has provided a supportive structure for public health students to conduct applied practice activities in response to expressed needs of community organizations.

Background

The Practice-based Community Health Research course (PBCHR) at the Yale School of Public Health (YSPH) has prepared hundreds of students for careers in public health practice and research using a unique blend of projects submitted by community organizations and coursework on theory and practice in community engaged research. Using a team-based model, students in their first and second years of MPH coursework are able to assist practice-based community health partner organizations generate the information they need to improve their programs while drawing heavily on the course structures to avoid putting undue strain on community partners.¹

This course is the successor to a mandatory applied practice experience that Yale MPH students took from 1968 to 2001. The history of the course prior to what is described herein was previously published (Hartwig et al., 2004). The current instructor (DLH) began teaching the course in January 2008, first as Community Health Program Planning, and then renamed as Practice-Based Community Health Research in 2015 to more accurately reflect the emphasis on co-generation of knowledge to inform community health practice.

Methods

Guiding Principles

The course is based on Fink’s significant learning approach (Fink, 2003), with learning objectives for both students and teaching assistants (TAs). (1) The overarching student learning objectives are that students will be able to design and implement situationally appropriate applied community health research projects; and (2) that students see themselves as public health leaders and lifetime learners (see Supplemental Materials for learning objectives), while the TA learning objectives are that TAs provide appropriate encouragement, feedback and guidance and will supportively and critically assess student work. The course is open to all MPH students (first and second years) and other students with the permission of the instructor.

The course structure embodies a commitment to community engagement through long-standing relationships with community partners and supports students in completing practice-based community health research projects that promote experiential learning while bridging the divide between research and practice.

The team nature of the course exemplifies the importance of team science in addressing complex public health problems (Cooper, 2018). Intra-group dynamics additionally foster self-directed and peer-based learning, along with experiences in managing collaborative relationship dynamics.

The practicum is grounded in theories of practice-based learning, community based participatory research (Israel et al., 2013) and community engaged research (Kim et al., 2019) with a vision of preparing students to participate in community knowledge generation partnerships to more effectively address health disparities (Sabo et al., 2015). Course readings highlight participatory theory and practice methods, as an essential approach to addressing health disparities. Class sessions emphasize active learning, with group quizzes, reflective inquiry growing out of the readings, role plays, and case studies drawn from previous group experiences.

Community Generation of Projects

The course is taught each spring semester, and the course timeline begins in late summer of the previous calendar year, at the beginning of the academic year. In late July or early August an invitation to submit a proposal (see proposal form in Supplemental Materials) for the upcoming year is distributed widely through the instructor’s contact list (see invitation in Supplemental Materials), as well as by encouraging recipients to share the invitation with their colleagues and networks. The structured (3–4 pages) proposal is due in mid-September, and all proposals are then reviewed by students who have previously taken the course, the course instructor, and a faculty expert on the relevant research area to assess feasibility, clarity of proposed work, and preceptor and organizational capacity to partner with public health students. The review process takes 2 to 4 weeks and organizations are invited to revise their proposals and resubmit by mid-October.

Student Ownership

Project selection

Once the proposals are finalized (usually late October), they are shared electronically with all MPH students. Information sessions are held in early November, and students who participate in the information sessions are added to a temporary course website used to communicate with all interested students. The students are asked to complete an online survey with questions regarding basic demographics, accomplishments in public health practice, both qualitative and quantitative research expertise, oral and written language proficiency, and previous experiences in program management. Students are also asked to indicate their top three project choices. The survey is completed by the Monday before the Thanksgiving break (which begins on Friday), and students receive their project assignment 4 to 5 days later, by the Friday before Thanksgiving. Commitments to the course are due the Monday after Thanksgiving. After students commit, all organizations are notified, and organizations whose projects were not selected are linked to other possible sources of support.

Initial team meetings

Once the teams are established, they are introduced to each other and asked to meet as a group in December prior to the end of the previous semester. Materials for that meeting include reflections on previous group experiences, best practices working in groups, and an individual assessment that encourages self-reflection such as Charles Murray’s “How Thick is Your Bubble” quiz (Murray, 2016) and implicit bias assessments (Implicit, 2011).

Personnel Support

A student assistant coordinates the proposal submission, review, revision process, as well as the sharing of proposals with MPH students and information sessions for students during the fall semester, and then transitions into a lead teaching assistant role in the spring. There is a teaching assistant, faculty expert, and organizational preceptor assigned to each student team. In addition, general support is provided by the course instructor, and guest speakers/consultants including a public health librarian, administrative staff who support project budget development, and staff from the Human Research Protection Program who provide advice on developing protocols for ethical review.

Course Content and Assignments

Students are required to complete a variety of assignments to build the skillsets to engage in practice-based community health research. To prepare students and stimulate assessment and critical thinking, course assignments cover a range of planning tools and substantive assessments. A full description of the assignments is included as Supplemental Table 1. The course is divided into two modules, the first focused on planning and designing the projects, and the second focused on critical issues in community health research.

Module 1. Approaching community health research

Module 1 covers the first 6 weeks of class and focuses on preparing and planning the project. This module includes two 5-hour classes, with a home-cooked meal provided by the instructor, where students have the opportunity to build relationships and work on assignments (logic models, literature reviews, program impact pathways, work plans, ethics review protocols) with the instructor and TAs available to provide support as needed. Readings have focused on tools for program planning and management (Daponte, 2008; Issel, 2008).

Module 2. Issues in community health research and practice

During the second module the teams shift to implementing their projects, with the class sessions providing an opportunity for check-ins, and relevant course content such as communication skills, group dynamics, power and trust in relationships, and topics relevant to community health research partnerships such as capacity building and sustainability, evidence for public health decisions, community based participatory research (CBPR), Systems Thinking, Implementation Science, and other relevant topics, drawing on relevant scientific literature for readings. There are also one or two working sessions during the second half of the class.

Final Products and Outcomes

Final work products include a short individual reflection paper, 2 to 3 page field action report that can be disseminated by the community organization, a final comprehensive report, and a final presentation of the project’s results in a special class session at the end of the semester to which preceptors are invited.

Individual Reflection Papers

In the second module, 3 to 4 weeks before the end of the semester, students are asked to submit 1 to 2 page reflection papers. These are in the first person, and students reflect on the MPH core competencies they have addressed through this course. Student reflections highlight the transformative experience of having the opportunity to understand more deeply the public health needs of the communities they work with and to see their efforts impact the community organizations.

APHA Presentations

All groups are invited to consider submitting an APHA abstract early in the semester. A number of groups have been invited to present posters or oral presentations at APHA over the last 10 years. Students have found the opportunity to be very helpful, both in terms of helping them share the results of their work, and also for them to have a better understanding of where their work sits in the field of public health practice.

Preceptor Evaluations

Preceptor evaluation in the years covered by this manuscript focused primarily on qualitative feedback (see Box 1). Organizational preceptors perceived value in both the partnerships with students and the student work products, noting the impact on their staff of engagement with students, as well as the usefulness of the final reports.

Box 1.

Preceptor Comments

“[C]ommunity agencies like [name] are so darn lucky when chosen to host a team of Yale students (in our case from the YSPH or School of Management) for assistance on research or planning projects. . . .[H]aving student project team members interacting with the agency staff makes for a stimulating, learning-focused environment for everyone. And strategically, these “partnerships” provide appropriate incentive for the agency to invest sufficient resources in and sustain its commitment to the project. It has been our greatest reward to use the outputs of these projects to further our agency’s planning and advocacy work.”

“The Yale students helped design a successful smoking cessation plan for our patients. Three years ago, about a third of our patients were actually assessed for tobacco use. Today, 99% of our patients 13 and over are assessed for tobacco use.”

Course Impacts

In addition to bridging the gap between academic and public health practice, the course also values sustainable community impact and partnership. While impact cannot be measured directly, we can report that partners value the work products. Over the 10 years covered herein (2008–2017), there have been 42 different community partners, and over half have submitted a project proposal for four or more years (Table 1). Key findings and contributions to public health are consistently shared with community partners to help promote continuous development and impact within the populations being served. To encourage further impact students have the opportunity to submit project abstracts to conferences like the American Public Health Association (APHA) Annual Conference and the Connecticut Public Health Association. Returning community organizations and accepted APHA abstracts are evidence of the achievements of the course.

Table 1.

Proposals Submitted and Accepted (2008–2017).

Number of proposals submitted per organization	Community partner	Number of proposals submitted	Proposal accepted (%)	APHA abstracts accepted (%)
6+	Optimus Health Care	6	83	20
	CT AIDS Resource Coalition/AIDS CT	6	50	50
	Jewish Senior Services	6	50	100
6+	Overall	18	61	50
4–5	Community Renewal Team	4	75	0
	Leeway, Inc.	4	50	50
	New London Homeless Hospitality Center	5	60	0
	Planned Parenthood of Southern New England	4	100	75
	Southwestern Area Health Education Center	4	75	100
	Yale New Haven Hospitality	5	80	50
4–5	Overall	26	73	46
2–3	City Seed	2	100	100
	Common Ground High School	3	100	33
	Hill Health Center	2	50	0
	Liberty Community Services (Liberty House)	3	0	NA
	New Haven Board of Education	2	50	0
	VNA	2	50	NA
	Yale AIDS	2	100	0
2–3	Overall	16	62.50	42.90
1	All	26	50	56
All	Overall	86	61.63	48.73

Student enrollment has fluctuated over the 10 years, ranging from 12 to 32 (Figure 1). Figure 1 also shows the diversity of students in the course, coming from four to eight different departments across the years. Intentional outreach to a range of community organizations has led to an increasing diversity in projects, such as projects focused on elder abuse in partnership with Jewish Senior Services (www.jseniors.org) (Kurkurina et al., 2018), a series of projects addressing community health worker usage, funding and regulation in Connecticut in partnership with the Southwestern Area Health Education Center (www.swctahec.org), and several projects focused on community food security in partnership with organizations such as Common Ground High School and Environmental Center (www.commongroundct.org) and City Seed (www.cityseed.org).

Figure 1.

Number and departments/concentrations of Students in the course, 2008 to 2017. Left axis shows the proportion of students from each concentration for each year; right axis shows the total number of students each year.

Lessons Learned

Planning for the course in advance is a key component that creates a foundation for success. As described in the course timeline, community partners, and interested students are engaged early. The instructor connects with community partners to invite submission of project proposals and provides a space for partners to voice their needs, goals, and desired impact. Simultaneously, students are engaged through a series of information sessions where previous projects are showcased. These efforts work together to garner the necessary interest to move forward with accepting project proposals.

Community partner and student interests are matched, and that matching is an important part of the success of projects. Alignment in interests encourages intrinsic motivation and student ability to approach their projects with enthusiasm; partners and students share the common goal of promoting sustainable long-term impact through their projects.

Students are prepared for success through the development of instrumental tools (e.g., logic models, program impact pathways, and work plans) that guide project development and implementation. Regular check-ins with teaching assistants provides much needed mentoring support.

The course continuously aims to maximize the practicum experience by encouraging student feedback and embracing adaptability to evolving public health interests and practices. Thus, students have a learning experience that is uniquely practice-based.

Discussion

In engaging students with practical learning and research, the PBCHR course provides an integrated learning opportunity where students work collaboratively and supportively with faculty advisors, teaching assistants and community preceptors to apply tools and concepts from their coursework. The carefully scaffolded course allows students to engage in applied public health practice in their first year of training. This strengthens their internship experience, and also gives students the opportunity to take additional elective courses based on insights and interests identified during the PBCHR course. Recent MPH graduates reflecting on the value of their public health internships highlighted the importance of having responsibility for a specific project, having multiple opportunities to contribute ideas and innovations, and dedicated mentoring time from both academic and organizational preceptors as the most beneficial elements of the experience (Hernandez et al., 2014).

Through this course students have been able to work with a number of disadvantaged groups, including, for example, people who are homeless, prisoners, people with HIV, people with substance use disorders, uninsured and immigrant communities, and low income individuals and families. The course structure demands individual and group reflection, and through the combination of action and reflection we hope to strengthen students’ abilities to address health disparities.

Community organizations who partner with the PBCHR course often engage more broadly with the Yale School of Public Health, such as by offering internship placements. Community organizations have shared in other contacts the value of working with student teams, valuing the results students generated and the opportunities to draw on expertise and skills not available within their organization (Comeau et al., 2019).

Future work to better understand impacts and key functions of different course elements will add quantitative metrics to the existing qualitative metrics in the preceptor evaluation, and will include a qualitative analysis of student reflections.

Supplemental Material

sj-doc-1-php-10.1177_23733799211056311 – Supplemental material for Lessons From a Community Driven Experiential Public Health Course

Supplemental material, sj-doc-1-php-10.1177_23733799211056311 for Lessons From a Community Driven Experiential Public Health Course by Debbie L. Humphries, Christina Bastida and Mahaya C. Walker in Pedagogy in Health Promotion

Supplemental Material

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Supplemental material, sj-doc-2-php-10.1177_23733799211056311 for Lessons From a Community Driven Experiential Public Health Course by Debbie L. Humphries, Christina Bastida and Mahaya C. Walker in Pedagogy in Health Promotion

Supplemental Material

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Supplemental material, sj-doc-4-php-10.1177_23733799211056311 for Lessons From a Community Driven Experiential Public Health Course by Debbie L. Humphries, Christina Bastida and Mahaya C. Walker in Pedagogy in Health Promotion

Supplemental Material

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Supplemental material, sj-docx-3-php-10.1177_23733799211056311 for Lessons From a Community Driven Experiential Public Health Course by Debbie L. Humphries, Christina Bastida and Mahaya C. Walker in Pedagogy in Health Promotion

Supplemental Material

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Supplemental material, sj-docx-5-php-10.1177_23733799211056311 for Lessons From a Community Driven Experiential Public Health Course by Debbie L. Humphries, Christina Bastida and Mahaya C. Walker in Pedagogy in Health Promotion

Supplemental Material

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Supplemental material, sj-docx-6-php-10.1177_23733799211056311 for Lessons From a Community Driven Experiential Public Health Course by Debbie L. Humphries, Christina Bastida and Mahaya C. Walker in Pedagogy in Health Promotion

Footnotes

Acknowledgements

Teaching assistants have helped to refine and improve the methods and content of this course over the last 10 years. They include: (2008) Meredith Safer, Ligia Gomez; Laura Frye; Patrick Byam; Katharine Brickson; (2009) Nkem Okafor, Elizabeth Jackson; Tim Mercer; Camellia Mortazazadeh; Diana Marie Sanchez; Jorge Cruz; (2010) Aaron Cook, Eliza Little, Laena Orkin; (2011) Whitney Hubbard, Sharon Taylor; (2012) Katie La Monaca, Britton Gibson, Stephanie Platis; (2013) Margaret Lippitt, Neel Iyer, Amelia Reese-Masterson; (2014) Crystal Gibson, Mary D’Alimonte, Ben Clopper; (2015) Jennifer Grasso, Sarah Ali; (2016) Brittany Lange, Colette Matysiak; (2017) Monica Guo, Nicole Collins, Elina Kurkurina.

Author Note

Christina Bastida is now affiliated to Executive Director, HealthForce Partners, Stockton, CA, USA.

Mahaya C. Walker is now affiliated to Senior Research Consultant, Advisory Board, Washington, DC, USA.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Debbie L. Humphries

Supplemental Material

Supplemental material for this article is available online at .

Notes

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