Competencies Competencies for Applied Epidemiologists for Applied Epidemiologists

in Governmental Public in Governmental Public Health AgenciesHealth Agencies

Centers for Disease Control and Prevention

Council of State and Territorial Epidemiologists

OrOrApplied Epidemiology Competencies Applied Epidemiology Competencies

(AECs)(AECs) for short! for short!

Overview

Background Goals and Rationale Methods Organization of the Competencies Validation of the Competencies Applied Epidemiology Competencies Uses and Dissemination

Background

Definition of Epidemiology

Epidemiology is “the study of the distribution and determinants of health-related states and events in specific populations, and the application of this study to control of health problems.”*

Epidemiology is one of the core sciences of public health

*Last JM. A Dictionary of Epidemiology. 4th edition. New York: Oxford University Press, 2001:62.

Definition of Epidemiologist

A person who investigates the occurrence of disease, injury or other health-related conditions or events in populations to describe the distribution of disease or risk factors for disease occurrence for the purpose of population-based prevention and control. — CSTE Workforce Summit, January 2004

Definition of Competency

A competency is an action-oriented statement that delineates essential knowledge, skills, and abilities in the performance of work responsibilities.

A competencies is describable and observable.

— Center for Public Health Practice, Rollins School of Public Health, 2002

Problem

Insufficient number of public health epidemiologists

“Epidemiologists” without adequate training

Lack of clear career ladders for epidemiologists

Independent, uncoordinated efforts to define the field

National efforts focused only on academic epidemiology

Goals and Rationale

Goals and Objectives of the AECs Goal to improve the practice of epidemiology in public

health agencies.

Objectives to create a comprehensive list of competencies that: Define the discipline of applied epidemiology; and Describe what knowledge, skills, and abilities four

levels of practicing epidemiologists working in government public health agencies should have to accomplish required tasks.

Rationale for Competency Development

Standardization of skill levels for hiring

Method to evaluate, reward, and promote workers

Road map for training existing workforce

Guidelines for academia

Improved ability to define the field

Utility for future certification processes

Methods

Competency Development Method Reviewed existing competencies/framework

Expert Panel—cross-cutting representation Subgroups:

Leadership group

Review panel

Consultant/editor

Assessment and validation Summer 2005—Tier 2 Competencies

Early 2006—Tier 1, 2, 3a and 3b Competencies

Quantitative and qualitative comments

Four Tiers of Practice

Tier 1—entry level or basicTier 2—mid-levelTier 3a—supervisoryTier 3b—senior scientist

Differentiating Between Tiers Example: Surveillance Evaluation Tier 1 (entry-level or basic epidemiologist):

Support evaluation of surveillance systems

Tier 2 (mid-level epidemiologist/team leader):

Conduct evaluation of surveillance systems

Tier 3 (senior-level epidemiologist):

a. Supervisor/Manager—Ensure evaluation

of surveillance systems b. Senior Scientist (PhD)—Design and conduct

evaluation of surveillance systems

Organization of the Competencies

Competency Framework for Public Health Professionals

1. Assessment and Analysis

2. Basic Public Health Sciences

3. Communication

4. Community Dimensions of Practice

5. Cultural Competency

6. Financial and Operational Planning and Management

7. Leadership and Systems Thinking

8. Policy Development/Program Planning

Source: Council on Linkages between Academia and Public Health Practice

Competency Construct

I. Skill Domain Area 1. Competency A

Subcompetency Sub-subcompetency/learning objective Sub-subcompetency/learning objective

Subcompetency Subcompetency

2. Competency B Subcompetency Subcompetency

Skill Domain 1: Assessment and AnalysisTier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply good ethical/legal principles to study design and data

collection, dissemination, and use Manage data Analyze data Summarize results, and draw conclusions Recommend evidence-based interventions and control measures Evaluate programs

Skill Domain1:Assessment and AnalysisTier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply good ethical/legal principles to study design and data

collection, dissemination, and use Manage data Analyze data Summarize results and draw conclusions Recommend evidence-based interventions and control measures Evaluate programs

Example: Assessment and Analysis

Tier 2 Subcompetencies Conduct surveillance

Design surveillance for particular public health problem

Identify surveillance data needs Implement new or revise existing surveillance

system Identify key findingsConduct evaluation of surveillance systems

Example: Assessment and AnalysisTier 2 Subcompetencies

Conduct surveillanceDesign surveillance for particular public health

problem Identify surveillance data needs Implement new or revise existing surveillance

system Identify key findingsConduct evaluation of surveillance systems

Example: Assessment and Analysis Tier 2 Sub-subcompetencies

Identify surveillance data needs Create case definition Describe sources, quality and limitations of surveillance data Define data elements to be collected or reported Identify mechanisms to transfer data from source to public

health agency Define timeliness required for data collection Determine frequency of reporting Describe potential uses of data to inform surveillance system

design Define functional requirements of supporting information

system

Validation of the Competencies

Validation Process 2005: Web survey for Tier 2 only

76%–98% of respondents supported competencies 2006: Web survey of complete competency set, Tiers 1–3

Three states targeted for >75% participation 80% of respondents self-identified as Tier 1 and 2 75% worked in state or local agencies

Review panel reviewed comments and recommended appropriate changes

Limitations to Validation Process Surveys not systematic Respondents self-reported tier level and other

identifying data, thus room for bias Questions asked about only the major

competencies in each skill domain No subcompetency or sub-subcompetencies

evaluated in survey

Does Everyone Have to Be Competent in ALL Competencies?

Yes and No

(it depends)

an epidemiologist’s favorite answer!

Does Everyone Have to Be Competent in ALL Competencies?

Mastery of the competencies develops over a continuum of applied epidemiology practice, not a single point in an individual’s career

Infectious disease, chronic disease, maternal and child health, and environmental epidemiology may emphasize different competency areas

Applied Epidemiology Competencies

…It’s about time!

Competency Skill Domains

1. Assessment and Analysis

2. Basic Public Health Sciences

3. Communication

4. Community Dimensions of Practice

5. Cultural Competency

6. Financial and Operational Planning and Management

7. Leadership and Systems Thinking

8. Policy Development

1: Assessment and AnalysisTier 2 Competencies

Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply good ethical/legal principles to study design and data

collection, dissemination, and use Manage data Analyze data Summarize results, and draw conclusions Recommend evidence-based interventions and control measures Evaluate programs

2: Basic Public Health SciencesTier 2 Competencies

Use knowledge of causes of disease to guide epidemiologic practice

Use laboratory resources to support epidemiologic activities

Apply principles of informatics, including data collection, processing, and analysis, in support of epidemiologic investigations

3: CommunicationTier 2 Competencies

Prepare written and oral reports and presentations that communicate necessary information to professional audiences, policy makers, and the general public

Demonstrate the basic principles of risk communication Incorporate interpersonal skills in communication with

agency personnel, colleagues, and the public Use effective communication technologies

4: Community Dimensions of PracticeTier 2 Competencies

Provide epidemiologic input into epidemiologic studies, public health programs, and community public health planning processes at the state, local, or tribal level

Participate in development of community partnerships to support epidemiologic investigations

5: Cultural CompetencyTier 2 Competencies

Describe population by various parameters Establish relationships with groups of special concern Design surveillance systems to include underrepresented groups Conduct investigations using languages and approaches tailored to

population Use standard population categories or subcategories when

performing data analysis Use knowledge of specific sociocultural factors in the population to

interpret findings Recommend public health actions that would be relevant to the

affected community

6: Financial and Operational Planning and Management Tier 2 Competencies Conduct epidemiologic activities within the financial and

operational plan of the agency Assist in developing fiscally sound budget Implement operational and financial plans Assist in preparing proposals for extramural funding Use management skills Use skills that foster collaborations, strong partnerships, and team

building to accomplish epidemiology program objectives

7: Leadership and Systems ThinkingTier 2 Competencies Support epidemiologic perspective in agency strategic planning

process

Promote organization’s vision

Use performance measures to evaluate and improve program

Promote ethical conduct

Promote workforce development

Prepare for emergency response

8: Policy Development Tier 2 Competencies

Bring epidemiologic perspective in development and analysis of public health policies

Uses and Dissemination

Intended Uses of the Competencies Practitioners

Assess current skills Create career development plans Plan specific training and educational

activities

Intended Uses of the Competencies Employers

Create career ladders for employees Develop position descriptions and job qualifications Develop training plans for employees Assess epidemiologic capacity of an organization

Educators Design education programs that meet needs of

public health agencies Incorporate critical elements of epidemiologic

practice into existing coursework

Dissemination Oral presentations at meetings

Downloadable documents: CSTE website: www.cste.org/competencies.asp

CDC website: www.cdc.gov/od/owcd/cdd/aec/

Quick reference fact sheets One-page executive summary and complete preface document

Fact sheets for each tier

Dissemination Online competency toolkit for users

PowerPoint presentations

Interactive quiz

Engage users in the field of epidemiology

Introduce users to the AECs

Epidemiology position descriptions

Training resource guide

AEC brochure

Evaluation checklists

Dissemination

Special Issue of Public Health Reports: Competency-Based Epidemiologic Training in Public Health Practice March/April 2008

Commentaries on the need for competencies and their uses

Development of the AECs

Competency-based applied epidemiology training

Innovative partnerships between academia and practice

Evaluation of epidemiology training programs

Dissemination

Public Health Literature

Editorial: Professional Competencies for Applied Epidemiologists: A Roadmap to a More Effective Epidemiologic Workforce

by Guthrie S. Birkhead, MD and Denise Koo, MD, MPH

Journal of Public Health Management & PracticeNovember/December 2006  Volume 12 Number 6 Pages 501 - 504

Online Resources:

www.cdc.gov/od/owcd/cdd/aec/ www.cste.org/competencies.asp

Complete competency documents One page competency summaries by tier Competency toolkit

Competency self-assessment Summary of training resources Competency PowerPoint slide sets Sample position descriptions Publications related to competencies

Contents of the toolkit also available from CSTE:770-458-3811

The Driving Force of the AECs:Leadership Group

Conveners:Denise Koo, MD, MPH—Centers for Disease Control and PreventionMatt Boulton, MD, MPH—University of Michigan School of Public Health

and CSTE

Co-Chairs:Gus Birkhead, MD, MPH—New York State Department of Health and CSTEKathy Miner, PhD, MPH, CHES—Rollins School of Public Health, Emory

University

Consultant and Editor:Jac Davies, MPH—CSTE Consultant and Editor, formerly with Washington

State Department of Health

The Driving Force of the AECs:Expert Panelists Kaye Bender, RN, PhD, FAAN—University of Mississippi Medical Center School of Nursing Roger H. Bernier, PhD, MPH—Centers for Disease Control and Prevention Mike Crutcher, MD, MPH—Oklahoma State Dept Health Richard Dicker, MD, MSc—Centers for Disease Control and Prevention Gail Hansen, DVM, MPH—Kansas Department of Health and Environment Richard Hopkins, MD, MSPH—Centers for Disease Control and Prevention Sara Huston, PhD—North Carolina Division of Public Health Miriam Link-Mullison, MS, RD—Jackson County Health Department Hal Morgenstern, PhD—University of Michigan School of Public Health Lloyd Novick, MD, MPH—Onondaga County (New York) Department of Health Len Paulozzi, MD, MPH—Centers for Disease Control and Prevention William M. Sappenfield, MD, MPH—Centers for Disease Control and Prevention Greg Steele, DrPH, MPH—Indiana University School of Medicine Lou Turner, DrPH, MPH—North Carolina State Laboratory of Public Health Mark E. White, MD—Centers for Disease Control and Prevention

The Driving Force of the AECs:Review and Other Panelists

Review Panelists: James Gale, MD, MS—University of Washington Kristine Gebbie, DrPH, RN,—Columbia School of Nursing Maureen Lichtveld, MD, MPH—Centers for Disease Control

and Prevention Kristine Moore, MD, MPH—University of Minnesota Art Reingold, MD—University of California at Berkeley

CSTE National Office Staff: Pat McConnon, MPH, Executive Director LaKesha Robinson, MPH Jennifer Lemmings, MPH

Partner Organizations

American Public Health Association (APHA) Association of Schools of Public Health (ASPH) Association of State and Territorial Health Officials

(ASTHO) National Association of County and City Health Officials

(NACCHO)

For more information

Contact CSTE: 770-458-3811 Visit the following websites:

www.cste.org www.cdc.gov/od/owcd/cdd/aec/