• lCI'/F.SD/OO2 ENGLISH ONLY
lIEGIORAL WOIItSKOP ON THE TEACHING OF EPIDEMIOLOGY
Spousored by the WORLD HEALTH OIGAlUZATION lIEGIOlIAL OFFICE FOR THE WESTDlI PACIFIC
Hanila, Philippines 21 October - 3 Nov_bar 1980
REPOIlT
NOT FOR SALE
PUNTED AND DISTRIBUTED BY '1'111!:
IEGIOlIAL OFFICE FOR THE WESTERN PACIFIC OF THE WOJtLD HEALTH ORGAlUZATION
Manila, Philippines April 1981
WHO I VI,- Pl-: J Ll!.j'r--. ',im~ll<i. Phiiino!'r\"
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NOTE
The views expressed in this report are those of the consultants and participants ·in the workshop and do not necessarily reflect the policies df the Organization.
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This report has been prepared by the Western Pacific Regional Office of tbe World Healtb Organization for.. Governments of the Member States in tbe Region and for tbose who participated in the Regional Workshop on the Teaching of Epidemiology which was held in Manila, Philippines, from 21 October to 3 November 1980.·
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I ,
, t CONTENTS 1.
2. 3. 4.
.............................................. OBJECTIVES ................................................. ORGANIZATION .............................................. INTRODUCTION CONTENTS OF THE WORKSHOP 4.1
1 1
1 2
..................................
4.2 4.3 4.4 4.5 4.6
Definitions and discussion on epidemiology and careers in epidemiology ••••••••••••••••••••.••••• Studies in epidemiology ••.••••••••••••••••••••••••••• Training facilities in the Region •••••••.•••••••••••• Curriculum planning: systematic course design ••••••• DevelopDlent of an instructional unit •••...•.•••.....• ' General considerations on teaching ••••••••••••••••••• Evaluation of the curriculum ••••••••.••••••••••••••••
2
S 18 18 19 19 20 5 6
4.7 5. 6.
EVALUATION OF THE WORKSHOP
................................ CONCLUSIONS AND RECOMMENDATIONS ........................... Epidemiological services and career structure •••••••• Teaching of epidemiology •••••••••••••••••••.••••••••• Epidemiological research ••••••••••••••••••••••••••••• The participants •••••••••••••••••••••••••••••••••••••
6.1
6.2 6.3 6.4
21 21
22 23
AlOO!XES AlOO!X 1
LIST OF PARTICIPANTS, CONSULTANTS, TEMPORARY ADVISERS AND SECRETARIAT
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ANNEX 2 AlOO!X 3
.............. AGENDA .......................................... LIST OF DOCUMENTATION ISSUED .................... ........
25 31 41
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ANNEX 4
THE PROFESSIONAL RESEARCH EPIDEMIOLOGIST
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• 1. INTRODUCTION
Dr G. laery, Director, Disease Prevention, and Control, opened the aeeting on behalf of the Regional Director, WHO Regional Office for the Western Pacific. He called attention to the critical lack of epidemiological expertise, which had hampered the development,of epide.io1ogical services and research activities in the Region, and the urgent need for the above situation to be remedied. Following the welcome address by the Regional Director, the participants, in dyads, explained their background and discussed with their partner their expectations from the workshop. While a wide range of experience was apparent, alaoat all the participants were engaged professionally in both teaching and research in the field of epidemiology. There wa. surpri.ing uniformity in expectationa with participant. seeking not only ..... perspective. in teaching, but aho the .haring of experiences with colleague. from different parts of the Region.
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2.
OBJECTIVES
The objective. of the meeting were: (1) (2) (3)
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to arrive at a con.en.us with regard to the working definition and .cope of epideai.o10gy; to de.cribe the roles and functions of an epidemiologist and the career. open to them; to identify pre.ent and future epidemiological manpower need. in research, teaching and training; to identify current probl... in epidemiological re.earch, teaching and training; to discuss how these needs and problem. are being met and other alternative .olutions that can be employed; to consider the systematic approach to ~urricu1um
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(4) (5)
(6)
planning.
3.
ORGANIZATION
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The work. hop _s attended by 22 participants from 12 countries in the Region. (See ADDex 1 for full list of participants and the secretariat.) Dr A.C. Reyes, Workshop Director, chaired all the plenary ses8ion8. Dr I.A. Web.ter was de.ignated overall rapporteur. A rapporteur for .ach day' ••••• ion . .sa1so designated.
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• The meeting consisted of plenary sessions interspersed with group discussions, each group electing its own chairman and rapporteur. The agenda is attached as Annex 2 while a list of documentation issued forms Annex 3. The major headings were: 1. Introduction, 2. Scope of epid~iology and Careers in epidemiology, 3. Studies in epidemiology, and 4. Training in epidemiology. A substantial portion of the workshop was devoted to the systematic approach to curriculum planning. Tbe last day was devoted to the formulation of the summary, conclusions and recommendations.
4.
CONTENTS OF THE WORKSHOP
4.1
Definitions and discussion on epidemiology and careers in epidemiology
The meeting adopted the definitions for epidemiology and epid8llliologist. 4.1.1 Epidemiology THE STUDY OF THE DISTRIBUTION AND DETERMINANTS OF HEALTH AND DISEASE IN HUMAN POPULATIONS TO ENABLE HEALTH SERVICES TO BE PLANNED RATIONALLY, DISEASE SURVEILLANCE TO BE CARRIED OUT, AND PREVENTIVE AND CONTROL PROGRAMMES TO BE IMPLEMENTED AND EVALUATED. 4.1.2 The epidemiologist
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A person who preferably has had formal postgraduate training and experience in- the discipline, and who regards the practice of epidemiology as his or her primary professional task. 4.1.3 4.1.3.1 Roles and responsibilities Research
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The professional epidemiologist is expected to: (a) Lead a research team, train its members and be responsible for the coordination of the different skills needed in a successful progr_e. Identify the problem, select the appropriate research strategy, and develop precise and detailed protocols. Such development will often include a pilot study with pre~te.ting and validation of the proposed methodology. Ensure that the data collection phase of the study is carried out properly, and that the data are processed in such a way as to facilitate analysis and interpretation.
(b)
(c)
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(d)
Provide an interpretationaf ",the ,results .in, the fCt"' hf a report whieh is available to the scientific eonnunity and, where appropriate, as reeommendations to a pol icy'-making body. Be aware of his responsibilities. both to ,the pat'ticular community he is studying and to the wider soeiety. Such reaponlttbil it,y i.plies a concern for the ou'tcomie:~ of hiS' work in the longer term"which may be both benefieial and' possibly deleterious. . Tea,ehing •• , ; j
<e)
4.1.3.2
The professional epidemiologist is expected (a)
to:
Contribute to the teaching of all heal th'Personnei.' By his knowledge of the patterns 'of disease in hili eOllimunity, he should play a'major role in strueturing the prioritiea'of teaching progr_s. His speeific input will consh't in ilttroducing the epidemiological view of health and disease, including the eaU8es and eonsequences of illness ~ The organization of appropriate Held experience' for students is an' integral part of the task. eon~ribute
(b)
Develop relationships with other disciplines, and be prepared to to bl;)th undergraduate and postgraduate C:raining programmes developed within these diseiplines.
4.1. 3.3
Service
The professional epidemiologist is expected to: (a) Advise on appropriate eollection and analysis of data, 80 that health status assessments' snd health serviee plsnnii).g,may be faeilitated • Be coneerned as a consultant, or as an exeeutive, in health
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(b)
surveillance programmes, whieh may eover a very'wide range of di.ease proCesses, or be speeifie to a simple disease. (c) Take part in evaluative or health service research, including cost-effective and cost-benefit analyses. and demand
4.1.4SuPpl~
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In Cermaof' their epidemiological expertise, each country needs a aixture of individuals with varying levels of training and experience. The profe1810nal epidemiologist bas been de,scribedab~e in SOllIe detail, but in additiont:here is a need for, individuals who, while often ellS;a.ged in epidemiologieal work, lack the extensive fOt'1ll&l traini:n& required of the professional epid«miologist. 'Such people include ..edi,cal, <!fl;ic;ers of bealth,pUblic health nurses, research' aS,sis,tants '¥ldhl;)s,pita1. ' administrators. Any asse'ssiaent of tbeneed for epidemiologists must take into account the belief that the performance of all health professionals would be enhanced by an un4erstanding o'f epidemiological principles and concepts. It is believed that there is overall shortage of epi4emiologieal _power throughout' the Region and that this ahortage ia manifest in each of the functions of research, teaching and service.
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• 4.1.5 <a) DeteraiDallu of the need for epidemioloaical manpower Population of a country or region in terms not only of absolute aize. but alao taking into account the diatribution of that population. !be atructure of the health care ayatem, aa deterained by the prevailing political philoaophy and- by the hiatorical development of the ayatem. !be pattern of morbidity and mortality of a particular country aay require greater or le.ser emphaaia on tbe need for trained epid. .iologists. The resources available in aaney, manpower and materiala. It . .at be noted in this context that.' paradoxically, the poorer a country is in terma of resourcea, the greater may be the need for good epid. .iologiats. The training capacity of the country, which in part depends upon the adequacy of the educational syatem at tertiary and aub-tertiary levela. achieve~nt
(b)
(c)
(d)
(e)
4.1.6
Coattrainta preventing (a)
of the optLaal nwabers
Lack of long-term aanpover planning policiea. In part thia ia due to lack of data being available to authorities. Dut of greater iIIporcance may be tbe lack of avarene.. by thoae authoritiea of the nature of the epideaioloaiata' potential contribution. Inadequate recruitment to the discipline. The probl .. here ia ca.,lex. In aeneral the profesaional epid. .iologiat can expect a Ie.. secure career structure, and lower status and monetary reward than his clinical colleaguea. Aa a consequence, it ia more difficult to motivate undergraduates. and the vicious circle ensures that there are inaufficient teachers with teaching progr_. that appear Ie .. attractive than the alternatives presented by clinicians.
(b)
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4.1.7
Po .. ible aolutio08 to the problem <a) Govenaenu should be encouraged to recognize the Uoportance to them of a pool of trained epidemiological manpower. Appropriate action would be to specify a career atructure culminating in full consultant rank. with pay and conditions equivalent to thoae which are usual for clinicians in the particular country. Support could be given to educational establisbaente. support that is earmarked for the development of proar.... s in epidemiology. Finally. governments should be urged to realize the importance of long-term manpower planning. Educational institutions should be urged to evaluate their progr.... s. with particular reference to whether their graduates are receiving enough epidemiological instruction to perform. their •
(b)
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duties in an optimal manner. At departmental level, the epidemiologists should make a determined effort· to relate both to·. clinicians and to government services, making them aware of .the value of the epidemiological contribution. (c)
The World Health Organization has a major role to play in helping. to solve the problem. International workshops and training progr_s are valuable in themselves, but even more, imporJ;.,.t are follow-up recOlllnendations designed to IIIOtivate gove.nmae.nts. and universities. Provision of consultants and grants will, inevitably 'upgrade training programmes, as well as thereeeou;ch·,· and s.ervice components of the epidemiological task. WHO is ideally placed to encourage collaborative studies.
4.2
Studies in epidemiology
Reaearcb h central to tbe epidemiological task. It haa' value in its It is also the foundation of the epidemiologists' 'competence t'o advi.e governments. Research is a necessary prelude to good .training " , . progr_., and such progr_es can only be carried out by units active ,.in ongoing research. For these reasons, five population-based studies carr;ied out in the Region were studied and evaluated. The conclusions reached may be considered under two major headings: own right.
4.2.1
Researcb in the Region
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It ie apparent that within the Region there exists a range of sophisticated epidemiological studies completed, in progress, or at tbe. planning etage. These studies have been well planned, and are appropriate. to the needs of tbe communities in wbicb they sre being carried out. A. limitation in some sreas is a lack of skilled biostatistical·and coaput~ng ataff to support tbe epidemiologist, while in others there are problems' witb computer hardware. Research in the Region would be enhanced by collaborative studies, by the trsining of more support staff, and by an· awareness on the part of granting bodies of the need for long-term funding of epidemiological projects. 4.2.2 Research and training
Research projects are a valuable teaching resource for field work: while they are in progress, and for classroom work after. their completion. It is particularly helpful for students to be involved with work being; carried out in their own community, and the importance of such a 'reality' cannot be overemphasized. By way of contrast, field studies can often· use overseas students on electives, and the result is not only field experience but should abo be the widening of tbe students' perspectives of the world in which he lives. 4.3 Training facilities in the Region
Between January and July 1979, a survey was carried out by Dr A. Reyes of training facilities for epidemiologists in the WIll Western Pacific Region. Six countries offer courses leading to a Master of Public Health Diploma, and two offer courses leading to a Diploma of Public Healtb wii:bin which epidemiology was a required course component. The curriculum. of ~he,
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various Schools of Public Health appeared to be very similar. With regard to undergraduate trainina, all medical schools visited taught epidemiology as part of social and preventive medicine or community medicine; the time provided and the curriculum content v~ried considerably. The training courses provided for other health workers often contained an epid. .iological element, but this was by no means universal. All governments visited agreed on the need for the training of epid. .iologists, but it was rare for epidemiology to be identified as a separete discipline; more usually the need expressed was for the developaent of units concerned with disease control. Most governments adaitted difficulty in recruiting epidemiologists and in general, these posts were relatively unattractive to physicians because of low pay and statUI.
The major obstacles to the development and strengthening of epideaiology included failure by governments to appreciate the potential contribution of epidemiology and failure to support effectively the .chools of public health. Much could be done in terms of u-provement of the curricula in basic courses in epidemiology and disease control offered to .iddle-level personnel. 4.4 Curriculum planning: systematic course design
The content of the curriculum, pertaining to any discipline taulht within an institution, is moulded to s lsrge extent not only by the discipline itself but also by a number of pressures. Theae include national, institutional and profes.ional goals in education, and alao national goals in health and the prevailing professional phil080phy. Tha particular format of the curriculum depends upon the approach of the course design, which aay be subject-oriented, or oriented to a broad or narrow field. In the reaainder of this section, a psrticular method of designing a curriculum to teach epidemiology will be presented in the fOnD of specific successive steps. These 8teps will be illustrated by examples. 4.4.1 Roles and responsibilities
The purpose of any course in epidemiology is to contribute to the profes8ional performance of a variety of health workers. The first task in curriculum design is to identify the eventual product, or the particular categories of health workers to whoa the course is oriented. The.e categories may be described as "professional roles", where a role i. the future position, prOfession or occupation to be assumed by the student after grsduation. Definition of role will need to be accompanied by a description of the setting in which the professional will perfor.. Each role will carry a set of responsibilitie. and a major responsibility can often be divided into sub-responsibilities. Table 1 shows four ex. .pl•• of this process. 4.4.2 Skill., knowledse and attitudes
Granted a responaibility (or a sub-responsibility) in a role deatined to be filled by a produ~t of the course, the next step is to define the ca.ponent skills, knowledge and attitude. the practitioner will need to fulfil that responsibility.
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Table 1.
Four selected roles as examples of the output of an epidemiology course A maior responsibilitv Designing research projects and protocols Sub-responsibilitie'
Role hofessiou1 research epidemiologist General medical practitioner ..
Settin2 University Unit
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Urban, suburban
Diagnosis of his patients' condition
Take a history Conduct physical examination ComaIunicate Integrate and interpret data
Feneral medical practitioner Health inspector
Rural area
Reporting of notifiable diseases To advise and develop a safe water supply
Semi-rural area
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• Table 2.A. Component skills, knowledge and attitudes required for various responsibilities (see Table 1)
PROFESSIONAL EPIDEMIOLOGIST Responsibility Design research projects and protocols. Skills 1. Given a proble., or a proble. area, he will be able to "operationalize" the problem, or to redefine it in such a way that it . .y be stated as an hypothesis or set of hypotheses. Select those methods and techniques which are appropriate to test the hypothesis, tsking into account any constraints that . .y be built into· th@ situation.
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2.
3. 4.
Construct a protocol which is a clear and unambiguous account of the research that is to be done. Test the feasibility of this protocol, including the validation of the methods proposed. Knowledge
1.
A detailed understanding of the health situation in his own area: this will include population structure, morbidity and mortality patterns, trends, social and political system and the organization of health and medical services in his srea. A general knowledge of the above for neighbouring countries and the world; he has the ability to find out. He is familiar with th~ national history of some diseases and is able to find out the known facts on any human disease. He is able to locate and evaluate results and procedures of previous related or similar studies, which have been reported in the scientific literature. From his experience, he can asseS8 the probability that any proposed plan will be accepted by the target population. He ia able to justify all his proposals in terms of money, manpower and time; he is able to identify and debate potential ethical problems. Attitudes
2. 3.
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4.
5.
1. 2. ,..
A critical and scientific approach to all problems; he has an awareness of priorities of health problems in his own area. He is open-minded with an ability to consider other views fairly and,
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if npcpssary, to modify his own. _~_. disciplines.
Itt' 1» vrt'(101n·tJ to work in with profe •• ionals io other _______ =.__._=.._c= ___c_________harmony ___.=______________•_______•____.... ~
clo8~
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Table 2.B.
Component skills, knowledge and attitudes required for various responsibilities
GENERAL MEDICAL PRACTlTIORER (URBAN,SUBURBAN)
Responsibility To cure and care for patients. Sub-responsibility To take an adequate medical history.
Skills 1. 2. 3. 4. Establish a rapport with his patients. Establish a personal profile on each patient, such a profile to include social, occupational and past medical history. Elicit a clear and accurate statement of the patient's perception of the presenting problem. Elicit personal significance of the problem in terms of the patient's family, occupation and other social groups of significance to the patient • Elicit an accurate chronological sequence of the presenting problem and aasociated phenomena. Be able to integrate the data he obtaina in order to state an ordered set of testable hypotheses or differential diagnoses. He is able to continuously modify his hypotheses aa more and more data become available.
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.5.
6.
Knowledge 1. Structure of the community in which he practises; size, age and sex distributions, ethnic,religion, culture and education structure. He will be familiar with local customs and idioms. Patterns of disease in his area together with recent changes such as epidemics.
, 2.
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Knowledge (cont'd) 3. Knowledge of the risk-factors for common disease., the magnitude of relative rilke, and ability to define variationl in teras of the beliefa of hi. community. He will be familiar with the veriable. waye in which illness msy present, and in particular will be aware of local concepts of illne8s and ita causation. He will know the natural history of disease and how it is modified in hi. local coaaaunity; he will know the calendar of local events of iaportance to hia patients. He will be faailiar with local family atructure and the way in which
4.
I
5.
6.
local belief and custom modify occupation, education and affluence. He will be aware of the preeaure of social, legal, political and
economic effecta upon perception., . .nifeltation and .....a.ent of il1nesa. 7. He vil1, through reading and practice, be f ..iliar with the acientific
procesa of hypotheaea generation and testing.
Attitudes 1. 2. 3. He will be genuinely concerned for hi. patient'. well-being.
He will be open-ainded and free of prejudice.
• _I ________. . . .__ • •_._•••••• _. ___ . . . . . . . .
He will appreciate the importance of the knowledge base listed above to his daily work • ~
•••- - . - - -••••••••. . . . . . . . . . . .___ _
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Table 2.C.
Component skills, knowledge and attitudes required for various responsibilities
GENERAL MEDICAL PRACTITIONER (RURAL)
Responsibility To report notifiable diseases promptly and adequately.
Skills 1.
He knows what is a notifiable disease as opposed to what is not. He knows the proper channels to report such disease. It is assumed that he has the ability to accurately diagnose disease.
2.
NB
Knowledge 1. 2.
3. - 4.
He can list notifiable diseases. He is able to diagnose disease. both notifiable and non-notifiable. He is aware of the usual pattern of these diseases in his community. He knows the reporting system.
, 1.
Attitudes He recognizes the importance of correct identification of notifiable disease and of prompt reporting of such disease.
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• Table 2.D. HEALTH INSPECTOR Responsibility To advise and develop a safe water supply. Skills 1. 2. 3, 4. He can identify possible water sources. He can choose a safe, acceptable and adequate water source. Component skills, knowledge and attitudes required for various responsibilities
He can collect and dispatch water samples for laboratory testing. can interpret results.
He
He is able to supervise and assist with installation of the chosen water supply and with its treat1llent. He can advise on pre.ventive me.aures against possible bacterial and chemical contamination. He is able to devise monitoring systems. Knowledge
1. 2. 3.
He knows the range of different water sources and their characteristics.
He knows the pattern of diaeases and, in particular, those which are affected by the nature of the water supply.
He understands simple microbiology and chemistry, aa it affects water supply. He can collect water samples and understands the basis of laboratory tests.
4.
He is familiar with the principles of construction, treatment and maintenance of water supply facilities. He is aware of costs, availability, and government policy on different types of installation. He haa a good background to water supply, which includes not only knowledge of disease and potential sources of pollution, but also the community sociocultural patterns affecting the use of water. Attitudes
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5.
1.
He desires to promote a safe water supply, and is aware of the need of inVOlving the community in the processes involved in supplying safe water. He is aware of the importance of community acceptance of the water he is reaponsible for supplying and desires to satisfy the wishes of the community in this respect.
2.
.
,
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4.4.3
Translation into learning objectives
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Having specified the skills. knowledge and attitudes needed by the student to discharge his responsibility. it is necessary to translate these into learning objectives or competencies. How can one assure that the entry student emerges at the end of the progr_e with "an acceptable level of skill •• knowledge and attitudes? These acceptable levels may be specified. together with a statement as to the conditions under which they will be demonstrated. for various leveh of responsibility: professional. terainal student and entry student. It may help the process to specify inter.ediate competencies. Examples are given below and for each category of health worker. a single skill ha. been selected •
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... Table 3.A. Example of competeneies related to speeific skills
PROFESSIONAL RESEARCH EPIDEMIOLOGIST RespOllsibility Skill
Designs research projects and protocols. Constructs a protocol which ia a clear and un. .biguous stat_ent describing research that is_ to be done. Able to locate and evaluate results and procedures 9f previous related or similar studies which have been reported in the scientific literature. Performance
lCDowledge
ConditiOlls
(a)
Entry student
-----
When given sets of data relating to .arbidity or mortality patterns in the classroom: (b) Terainal student
will describe, analyse and compare these data to the satisfaction of the teacher of the course.
When given a research problem with specified budget to be solved in a specific community: (e) Professional
As an interactive process with his teacher and under his supervision, will construct a clear and unambiguous protocol. Will operationalize the problem, referring back to the requester as necessary. Produce a clear and unambiguous protocol, including methods of validating procedures. The protocol will include a budget. ==_.~
When given a research problem, expressed in vague terms:
__••_. _________.....___••__.=_===-ac ••_.........
............_____.__.._
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Table 3.8.
Ex"ple of competencies related to specific skills URBAN. SUBURBAN
GERERAL MEDICAL PRACTITIONER:
Responsibility Skill
Takes an-adequate lIledical history; Integrates data obtained fro. the history in order to state an ordered set of testable hypotheses or differential diagnoses. Knows the patterns of disease in his community and the risk -factors for ~_n and les8 c _ n diseases. Throughreadill8 and practice. is
r
f . .iliar with the scientific process of hypotheaia generation and testin•• - Attitudf! Conditions (a) Entry student Ia genuinely concerned for his patient's and is" free of prejudice. " well~i~"
------
Performance
1Iben given a new patient in a hoapital aettins: (b)
Will summarise the information he has receivedfrolll the patient concerning the latter's illness.
Ter.inal atudent Will integrate all relevant information and list an ordered set of hypotheais to be tested. These will take into account the epidemiological realities of seribus and common diaeaaes in hia co.lllUnity.
•
iben given a new patient in any clinical aettins:
(c)
Profeaaional Will integrate all relevant information and list an ordered set of hypothesis to be teated. Theae will take into account the epidemiological realities of his caa..mity.
When given a new patient in any clinical setting:
--.--------_.._---_._..---_.._ .._--_..._------- . •
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Table 3.C.
Example of competencies related to specific skill. RURAL
GENERAL MEDICAL PRACTITIONER:
Reaponaibility Skill Knowledle Attitude
Reports notifiable diseases proaptly and adequately. Knows the proper channels to report such diseaae. As above. Recolnizes the importance of notification of notifiable disease. Perfontance
Conditions (a) Entry atudent
~ request in the ~lassroom:
Will lists reasons why certain diseases are notifiable
(b) (c)
Tenainal student Profeaaional
~ receipt of information
that a notifiable disease has !been dispo.ed: ~
will 'fill in proper fonts and forward them to the proper authorities throulh appropriate channels. ___ ••••••• _. ___________•••• __ •• =._cb. ••••••
S.__C_B._._..___..._.__....._ .._ •
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Table 3.D. HEALTH
Example of competencies related to specific skills
INSPECTOR
Responsibility Skill Know~edge
Advises on and develops a safe water supply. Advises and assists with installation of the chosen water supply and with its treatment. Is familiar with the principles of construction, treataent and maintenance of water supply facilities.
Attitude Conditions (a) Entry student
Desires to promote a safe water supply.
-----
Performance
When .given six pluabing tools: (b) Terminal student
Will demonstrate their correct use in • all cases.
Given data concerning a hypothetical community:
Will describe the construction, maintenance and monitoring of the water supply; he will compare and contrast two methods.
(c)
Professional will describe all the possible and appropriate means of constructing, maintaining and monitoring a safe water supply. will write a document giving his choice of methods with reasons for this choice •
Given a real c~unity and a real problea:
•
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4.5
Development of an instructional unit
Ten instructional units were developed by groups and by individuals. One example of these appears in Annex 4. 4.6 4.6.1 General considerations on teaching Field training
Field training is an important part of the learning experience in epidemiology, giving as it doea an opportunity for the student to apply classroom theory to the 'real world'. In this context, it i. worthnotina that the less artificial the field work, the greater the student' a infereat and 1II0tivation. There are certain difficulties and constraints with field work. SOllIe students resist the course, and for this reason, it l118y be preferable for the field work experience to be an elective option; the reasons for such resistance are varied and include a preference for clinical subjects. A hi&h staff/student ratio is required for this activity and it involves hours of preparation in planning. If the area to be studied is far distant from the campus, transport and accommodation become major costs. If a single community is used over the years, it may become resistant to the uae of students and further, the communities usually available for teachina are depre.,ed localities giving the student • biased view of the epidemiologist's work. Nevertheless the concept of field work is important snd much can be done to encourage the student. Above all there is a feeling on the student's part that his work is worthwhile. Sometillles, this occurs naturally and steDIS frOlll a wise choice of cOlllmunity; IIIOre often the student's project l118y be published or presented to a lIIedical meeting. It is important to ensure feedback of the student's work to the agency actually working in the field. One way of giving students experience is through working on part of a staff lIIember's research. It is absolutely essential that the student haa no sense of exploitation, and the conditions under which he i8 working mU8t be clearly explained to hilll. 4.6.2 4.6.2.1 Some comments on the facilitation of learning The teacher • •
While the lecturer obviously needs to be both an expert in his subject and enthusiastic in his desire to communicate, a genuine concern for the student's welfare is of equal importance.- The teacher has the task, often difficult, of creating a non-threatening atmosphere where .he student feels 8ble to adlllit ignorance and ask for help. 4.6.2.2 The subject
The subject needs to be presented in an interesting manner and its relevance to the local community must be apparent. In constructing the case, the teacher needs to develop a logical sequence with moveaent from lower levels to higher and from the easy to the more difficult.
- 19 -
4.6.2.3
The method
The closer the teaching material is to real-life situations, the more successful it is likely to be. It is important that positive reinforcement be provided, so that the learner feels that he is successful at the task. The more the individual student is actively involved in the learning process, the more likely the material will be retained. 4.7 Evaluation of the· curriculum
Evaluation is an integral part of a training course. It should be regarded as an instructional activity whose purpose is to obtain feedback, both for measuring student progress or for progressive course improvement and development. Evaluation begins before the course commences. It should start with manpower training and systematic course design, bearing in mind the future professional responsibilities the students are likely to assume in a given professionl setting. Students enter a training course with certain skills, knowledge and attitudes; some of these will be essential prerequisites. The latter may be examined by a 'prerequisite test', either MCQ or by interview. A 'pre-test' may indicate certain students who could bypass the particular instructional unit, or components thereof. 'Progress tests' are carried out during the course and may consist of MCQs, project reviews or observation checklists; these are helpful to initiate and direct remedial action. The 'post test' has the purpose of determining whether Terminal Student Competence has been obtained. This procedure is greatly facilitated by clear, specific and observable criteria, laid down during the systematic analysis of professional responsibilities. In an instructional unit designed for elective self-learning, with guidance as necessary, the students are evaluated after every task and this may take the form of presentation of the work to the rest of the class. Following such presentation, discussion of the quality of the product takes place or perhaps it is compared with a model result. Any problems can be instantly solved and remedial action initiated.
5.
-
EVALUATION OF THE WORKSHOP
Replies were received from all the 22 participants. Three participants however missed the last day's session because of important commitments in their own institutions. The evaluation questionnaire was prepared in some detail with the expectation that more specific comments could be obtained, thus enabling the organizers to exactly pinpoint any shortcomings. In general the objectives were considered to have been met, since 95% of the replies indicated "fair" to "very well", and 72% of the repliell were under the ''well'' to "very well" categories. The "poor" replies amounted only to 2.3%.
- 20 -
.,
The majority of the participants (94.5%) replied that they had learnt new skills and concepts and 90% stated that these could be applied in their respective institutions or department. Most of the participants (81%) indicated they were able to express their ideas or problems well. The documentation was considered to be about right by 67.5% of the participants while 31.5% of the participants thought there was too .uch. It was suggested that such documents should be distributed well in advance 80 that they could be thoroughly reviewed and studied. With regard to the quality of documentation, 37% gave no replies. Only 57% of the replies were in the "satisfactory" to "very satisfactory" range. Of the replies received, 39% considered that certain documente should be widely distributed. The method of introduction and presentation of the documents was considered "fair" to "extremely satisfactory" by 95% of the replies and "satisf.ctory" to "extremely satisfactory" by 81. 5%. Discussions at the plenary session were graded "fair" to "very .atisfactory" by 91% of the replies and "satisfactory" or better by 79%.
" •
89% of the replies slso rated the group discu8sions to be satisfactory. The field visit to Laguna was considered to be useful. About 50% opf the participants got acquainted with the malaria model and the sUle proportion did not expre8S interest in having the malaria model ae a teaching tool. The meeting was considered to be too long by 45% of the participant., just right by 45% and too short by 10%. The scheduling was satisfactory to 86% of the participant·s: the administrative aspects were rated satisfactory by 95% of the respondents. Almost all respondents (95%) felt that such meetings 8hould be held regularly and their attendance were worthwhile, not only personally but lso to their country and institutions or departments. In general, the workshop may be regarded as-having been a succes ••
6.
OONCLUSIONS AND REOOMHENDATIONS
The workshop filled a clear regional need for coordinated epide.iology teaching and research, which are necessary if national health objectives are to be met. The workshop, appreciating WHO's initiative, has formulated recommendations to maintain the momentum generated by the workshop, so that epidemiological needs over the period to the year 2000 can be met.
- 21 -
6.1
Epi~emiological
services and career structure
The workshop identified the essential role of epidemiologists in implementing the agreed health goals of Kember States, including programme planning and evaluation, tropical and diarrhoeal disease control, the expanded immunization programme and primary health care. Therefore, the workshop: rec~nds that the role of epidemiological work ,should be brought by WHO to the attention of senior health administrators in the Region through a seminar, and during the Regional Committee as a technical presentation or programme review; also that countries should organize national seminars to discuss the role and achieve the balanced development of epidemiology in order to achieve the goals of the health services.
requests national governments to provide a career structure, including adequate full-time epidemiological posts, comparably ra.unerated to clinical specialists, to obtain adequate recruitment and earneBtly requests WHO to support this strongly. Countries should review and establish their manpower needs in epidemiology. It is however clear that present numbers of trained epidemiological workers in the region are grossly inadequate by any standards. welcomes the support by WHO for the development of epidemiological surveillance units and similar services. Every country needs a unit or units with identifiable epidemiological functions and the workshop deplores their inadequate development insom~ countries. Adequate iaboratory backing for epidemiological work is also essential. /
• 6.2
emphasizes the need for health services and academic institutions to solve health problems and improve field teaching, draws attention to the successes that have followed such cooperation, and requests WHO to promote it strongly. leaching of epidemiology
The participants in the workshop were able to redesign part of the curriculum for their present institutions, lesrn new ways to design courses, and to exchange experiences. In order to build on this beginning and ensure a multiplier effect, the workshop: recommends that national workshops for teachers of epidemiology should be organized and that WHO should strongly encourage these. These would raise teaching standards and prepare nationally relevant curricula for fu1l- and part-time epidemiological workers, including the education of undergraduate medical students. strongly recommends that who should give full support to national and international workshops focussing on epidemiological methods, and educational techniques for instruction and evaluation of epidemiological teaching. Since the successful outcome of the present workshops largely resulted from the esrly appointment of a full-time coordinstor, the workshop participants recommend that this practice should be followed in the organizstion of future workshops.
- 22 -
•
recommends that suitable epidemiology courses for medical staff involved in curative work and for allied health workers should be promoted, with evaluation and strong government support. Due recognition should be given to the contribution of allied health personnel. WHO policy on the orientation of education in the health professions, so that they are closely related to cOlBUnity health needs, should be restated at a future Regional Coaaittee meeting. requests WHO to undertake coordination of resources and expertise for the development and dissemination of educational materials for epidemiology teaching in this Region. requests governments to arrange, and WHO to facilitate ahort-tena international exchange visits between teaching staff of inscitutions working in the field of epidemiology. 6.3 Epidemioloaical research
At the workshop, several epidemiological field research workerevere able to aeet for the first time. It is highly desirable to promote the exchange of epidemiological skills and knowledge and also to provide field training opportunities for young workers in view of the shortage of skilled manpower which limits programme development. The workshop therefore: '-proposee the foriaation of a regional association of epidemiol08ist. to aeet annually and requests WHO, the International. Epidemiological Association and national governments to facilitate this. The regional association should prepare a list of priority problem. needing epidemiological research. WHO should stress the advantages of a comprehensive epidemiological approach to priority problema and develop it in varied situations along with the regional association. requests WHO to cause a list of field research projects in the Region to be prepared. The resources and potential of each project for research training should be indicated. Suitable operational control projects and field training areas should aho be included. in view of the diversity within the Region, encouraaesWHO to promote international collaborative studies in comparative epidemiology. A code of ethics to guide field research in huaan cOIIIIIIUnities would be helpful. reguests training means of training WHO to promote postgraduate epidemiological research in academic institutions and suitable field projects by research training fellowships and also residential workshops.
•
.,
- 23/24 -
6.4
The participants
To forward the aims of better epidemiological teaching, research and aervice, the workahep participants resolved, on returning to their home institutions, to explain what took place at the meeting to their colleagues to i!ple.ent what they.have learned at the workshop to act as a focal point in explaining to other health workers of their country the needs .nd approaches in epidemiology teaching to exchanae draft research protocols as a means of both raising atandards and encouraging collaboration and to assist actively in implementing the recommendations. Therefore, the workshop: earnestly requests the Deans and staff of the institutions represented to support them in this, warmly thanks WHO for its initiative in calling the meeting, and reguests WHO to distribute the meeting report videly to potentially interested institutions and to place the conclusions and recommendations before the Regional eo..ittee •
• •
- 25 -
ANNEX 1
LIST OF PARTICIPANTS CONSULTANTS, TEItPORARY ADVISERS AND SECRETARIAT 1.
PARTICIPANTS
AlJSTRALIA
Professor Ian W. Webster Professor of Community Meeds University of New South Wales P.O. Box 1, Kensington N. S.W. 2033 Australia Dr ·David Christie First Assistant in Clinical Epidemiology Department of Community Health University of Melbourne 243 Grattan Street Melbourne 3053 Australia
CHINA, PEOPLE'S REPUBLIC OF
Professor Lian Zhi-hao Vice Dean, School of Public Health Department of Epidemiology Beijing Medical College Beijing People's Republic of China Professor Gai Bao-huang Professor in Epidemiology Epidemiology Faculty Sichuan Medical College Sichuan People's Republic of China Dr Yuan Hong-chang Department Head Department of Epidemiology Shanghai First Medical College Shanghai People's Republic of China
•
- 26 Annex 1
•
CHINA, PEOPLE'S REPUBLIC OF (cont'd)
Dr He Shangpu Vice Director Department of Epidemiology Wuhan Medical College People's Republic of China Dr Vadram Sadhu Senior Tutor in Social and Preventive Medicine Fiji School of Medicine Suva Fiji Dr Masumi Minowa Chief, Chronic Infectious Disease Section Department of Epidemiology Institute of Public Health Tokyo Japan •
PIJI
JAPAN
"
Dr Kohichi Soga Deputy Director Office of Councillor for Science and Technology Minister's Secretariat Ministry of Health and Welfare Tokyo Japan
MALAySIA
Dr R. Mariappan Head, Division of Epidemiology Public Health Institute Kuala Lumpur Malaysia Dr Nooriah bte Mohamed Salleh Lecturer in Depart.ent of Community Health Faculty of Medicine Universiti Kebangsaan Jalan Raja Muda Kuala Lumpur Malaysia
• •
NEW ZEALAIm
Dr Robert Beaglehole Senior Lecturer in Epidemiology University of Auckland Auckland New Zealand
- 27 -
Annex I
NEW ZEALAND (cont'd)
Professor D.C.G. Skegg Professor of Preventive and Social Medicine University of Otago Dunedin New Zealand Dr K. Gee Lecturer in Epidemiology Faculty of Medicine University of Papua New Guinea Port Moresby Papua New Guinea Dr Arsenio Jimenez Assistant Professor and Chairman Department of Community Health University of the Philippines Pedro Gil Street Manila Dr Angelita C. Camacho Assistant Professor I Department of Community Health Institute of Public Health University 6f the Philippines Pedro Gil Street Manila
PAPUA NEW GUINEA
PHILIPPINES
KOREA, REPUBLIC OF
•
Dr Joung-Soon Kim Professor Department of Epidemiology Seoul National University Seoul Republic of Korea Dr. Sam-Sob Choi
Professor of Preventive Medicine College of Medicine Ewha Womana University Seoul .Republic of Korea SINGAPORE Dr Tommy Goh Ewe Hock Senior Lecturer Department of Social Medicine and Public Health Faculty of Medicine University of Singapore Singapore 0316 Republic of Singapore
- 28 -
Annex I HOIIG KOIIG Dr J.W.L. Kleevens Reader, Head of the Department of Community Medicine University of Hong Kong Hong Kong Dr Le Xuan l'hong Lecturer Hanoi Medical High School Ministry of Health Hanoi Socialist Republic of Viet ... Dr Pham Van Long Lecturer Faculty of Medicine Hanoi Socialist Republic of Viet 118m
VIET IIAM, SOCIALIST REPUBLIC OF
·
,
2.
COIISULTANTS
Dr Arturo C. Reyes (Workshop Director) 1450 Calumpang Street Dasmariftas Village Makati Metro Manila Dr Itsu&o Shigematsu Director Department o·f Epidemiology The Institute of Public Health 6-1, Shirokanedsi 4-chome Minato-ku Tokyo Japan 108 Professor David Bradley Ross Institute of Tropical Hygiene London School of Hygiene and Tropical Medicine Keppel St. (Gower St.) London WClE 7HT England • •
•
•
Annex 1
3.
TEMPOJIARY ADVISERS
Dr Eddy I.C. Lo... i.caDt Director- of He.lth Epideaiology Unit Ministry of Health Mal.,.~
kuala ~ur
•
,
kuala p.pur Mal·Y81a
Dr Aj •• t Kaur Gill Head of eo..unity Health Divi.ion lnetitute for "-dic.l Re ••• rch
Dr Coraeon P. Goneal•• Dir.ctor _ .ational Teacher Tr.ining Center Univ.r.ity of the Philippiae. 8,.t•• 547 Pedro Gil Street Eraita Manil.
4.
SECRETARIAT
,
Dr G. Cuboni Medic.l Offic.r Epidetniological Surveill.nce S.rvice. Project l'Vrt Hare.by P.pua Me" Guinea Dr G•.1. LavoiJ'pi.rr. Medic.l Offic.r Food Aid Proar_. NHO Headqu.rt.r. Geneva
Dr R. Lindner Regional Advi.er in eo..unicable Di •••••• WHO Regional Offic. for tb. we.t.rn Pacific Manil. Dr
R. Harrow Medical Officer WHO Speci.l l'rogr_ on Trainina .nd Re ••• rch on Tropical Di ••••e. WHO Headquarter. Geneva
- 30 -
Annex I Dr T. Olakowsk i Medical Officer/Team Leader Intercountry project on Epidemiological Surveillance and Disease Control in the South Pacific Suva
Fiji
Dr 1. D. Riley Medical Officer Intercountry project on Acute Respiratory Infections Goroka Pap~a New Guinea •
•
- 31 -
AGENDA Activity Day I, 'lunday, 21 October 0130 Regbtration Rapporteur of the day; Dr I. Webater 1.
In-Charae
0900
Introduction
Plenary aeaaion; - Welcome address - Orientation 0945
Regional Director Dr A.C. Reye~e
In Dyads; during snacks interview partner re peraonal data and expe~t.ti~. Plenary sen ion; - Introduction of partner's personal data and expectation
1030
1%15
Lunch break 2. Scope of and careers in epidemiology
1330
2.1
Definition and scope of epidemiology Roles and functions of .pidemiologbu
Dr Morrow
2.2 1430
Dr Lavoirpiern
Group discussion: - Definition of epideaiology, functions of epidemiologist.
1515
Coffee break
-32 -
Annex 2 Time 1530 1630 Activity Plenary session: Group reports Steering Committee meeting In-Charge Group rapporteurs - ,.'
Day 2, Wedneaday, 22 October Rapporteur of the day: 0800 Dr A. Jimenez
Plenary session: Summary of expectation and objectives of workshop Dr Webster Dr Morrow Dr La
, •
0830 0900 0945 1000
2.3
Careers in epidemiology
2.4 Manpower and training needs in epidemiology Coffee break Group discussion: Manpower and training needs Lunch break Plenary session: Group reports
1200
1315
Group rapporteurs
3. 1400 1415 1500
Studies in epidemiology Dr Morrow
Plenary session: 3.1 Population epidemiology 3.2 Schistosomiasis
Dr Call1&cho
Coffee break Plenary session: 3.3 Diarrhoea Steering Committee meeting Dr Gill
1515 \600
- JJ •
Anne" 2 Activity Day 3, 'naur.day. 23 October Rapporteur of the day: 0800 Drll. Beaglehole . Dr Ililey Dr 1.0
In-Charge
Plenary ses.ionl 3.4 Acute respiratory dieea.e. 3.5 Evaluation of control progr_ Coffee break ITAI-ITAI diseale and cadaium pollution Group discussions: Evaluation of above studies: Group Group Group Group Group
0845 0930 0945.
Dr Shige.. tsu
1030
1 - Diarrhoea 2 - Acute respiratory di .... e. 3 - Schisto.a.iasis 4 - Iv.l~tion of control prolr..... 5 - lTAI-ITAI di....e
l200 1445 1500 1600
Lunch break . Coffee break .Plenary .e.sion: Group reports Steering Codaittee .eating Group rapporteur.
Day 4, 'riday. 24 October 4.
Traininl in epideaiology Dr Il. Mariappan
Ilspporteur of the day: 4.1 0830
Field training
Departure, WHO Manila Arrival at Bay, Laguna Plenary se.sion: 4.1 Field training Dr A. C. Reyes
0930 0945
•
-I - 34 -
Annex 2
Ti_ 1000
Activity - The comprehensive community health programme, Health Science Center, University of tbe Pbilippines (CCHP/HSC-UP) - Student presentation - Open forU1D Lunch break Field visit to: Bo. Sto. Domingo Bo. Maaasaya Return to Manila
In-Charge Dr S. Gasmen, D~rector,
CCHP
1020
lloo 1300
• •
1400
1600
Day 5, saturday, 25 October Rapporteur of the day: 0800 Dr J.S. Kim
Plenary aession: 4.2 4.3 Revi.ew of training needa Dr Reyes and problems in Epidemiology Curriculum planning Approaches to curriculum Dr C.P. Gonzales planning: the systematic course des i 1ft •
0815
0845
4.3.1
0930 0945
Coffee break Group discussion Professional responsibilities of selected epidemiological health workers
1100
Plenary session: Group reports Group rapporteur. Su..ary list of responsibilities I I
1215
Lunch break APTBRMOON PREE
•
•
- 35 -
Day 6, No_ay, 27 October Rapporteur of the day~
Tiu -
Activity
Dr D.C.G. Skega
0800
Plenary 8eaaion: Review of last week's se.sion Dr Christie
0815
• 0945
Analysis of profeaaional responaibilitie. with eaphaai. on field activity (skills, knowledge and attitude.) Coffee break Plenary sesaion: ror.ulation of learning objective.
Dr Gonadea
1000
Dr Gonzalea
1100 Analyze relponsibilitiea identified for co.ponent akills, knowledge and attitude. (at various levelsr Tranalate these into learning objectives
1215 1330 1500
Lunch break Group discussions (cont'd.) Coffee break Group discu8aio.n8 (cont 'd.) Steering c~ittee
1515 1600
..eting A. Thoaaa (optional)
Siwulation esercises on the epideaiology and control of _laria
•
- 36 -
Annex 2 Activity In-Charse
Day 7 •. Tue.day. 28 October Rapporteur of the day: Dr J. Kleevens
0800
Plenary session: Croup report8 on learning objectives for various levels of epidemiological workers Croup rapporteurs •
1000 1015
Coffee break Plenary 8es8ion: Croup reporting (cont'd.)
1200 1330
Lunch break Croup discussion: 4.3.2 Sharing of peak experiences in teaching-Iellrning activities
1415
Plenary session: Croup reporting Group rapporteur. •
1500
Coffee break Plenary session: Saae lellrning principles culled from experiences Dr Gonzales
1515
Summary of replies to Dr GonzlIles questionnaire on tell ching methods employed in epidemiology 1600 Steering committee meeting Simulation exercises on the epidemiology and control of _larill
- .37 -
Annex 2 Activity Day 8, Wednesday, 29 October Rapporteur of the day:. Dr A. eaaacho In-Qlarge
.
,-
0800
Plenary aession: 4.3.3 Teaching method. in epidemiology I.sues in the teaching of field epidemiology Dr Shis_tsu Dr Bradley
•
1000 1015
Coffee break Plenary se.ssion:
4.3.4
Principles of evaluation scoring and reporting procedures Group/individual work
Dr Lo
Dr Lavoirpierre
1100
4.3.5
Develop a learning unit to include strategy of teachiag and instructional material and an overall evaluation for field studies (with media support)
1200 1330
Lunch break Group/individual work (cont'd.) Coffee break Group/individual work (cont'd.) Steering committee meeting Simulation exercises on the epidemiology and control of malaria A. Thoma. (optional)
1500 1515 1600
- 38 -
• Annex 2
Activity Day 9, 'lhuraday, 30 October 0800 1600
Group/individual work (cont'd.) Steeri1l8 ca.aittee . .etilll
Day 10, Friday, 31 October Rapporteur of the day: 0800
Dr It. Gee
•
Group/individual work (cont'd.) •
1000 1015 1200
Coffee break Submit completed learni1l8 units Lunch break Plenary session: ca..ents on the learning units subllitted
1400
1500 1515 .
Coffee brealt Plenary sea8ion: Comments (cont'd.) Finalization of respective curricula and instructional unita •
1600
Steeri1l8 committee meeting
Day 11, MOnday, 3 November 5. S_ry, cOnclusiona and recommendations Dr
Rapporteur of the day:
T.B.H, Goh
0800
Plenary8esaion: Review of past ses8ions and other needa and problems Dr D.atristie • •
1000.
Coffee break
- 39/40 -
Annex 2 Activity 1015 Group discussion: Solution8 and rec_ndations with 8pecific 8uggestiona for L.pl.-entation by: 1.
In-Charge
2.
International 1.1 WHO 1.2 Bilateral National Teaching inatitutions Gove~nts
1200 1330
Lunch break Plenary 8eaaion: Group reports on p08.ible rec_adations
1400 1500 1530
Approval of final report Evaluation of workshop Closing eer~ny
Clo8ing address
Regional Director
•
•
- 41 •
ANNEX 3
IMrOIlMATION BULLETIN NO. 4
LIST OF DOCUM!NTATION ISSUED Iafor.ation Bulleti.a 1. !
Bulletin No. I Bulletin No. 2 BuUetin No. 3 Bulletin No. 4 -
Inforaation about workshop (content., objectivea, site, duration and date, etc.) List of participants, consultants, te.porary. adviser. and secretariat • Detailed objectives List of documentation i •• ued
2. 3. 4.
•
Wol'kiaa paperl WPR/ISD/80.1 WPil/IO/80.2 WPR/ISD/80.3 WPl/ISD/80.4 WPR/ISD/80.S Wl'R/ISD/80.6 Handout. Agenda item 2.1 Agenda item 2.2 •
-
Agenda Epidemiological Manpower and Training Need. by Dr Eddy Lo Evaluation of Control Progr..... by Dr Eddy Lo Itai-Itai Disea.e and C8d.iu. Pollution by Dr I. SbigeDatau Taaching of Epidemiology by Dr I. Sbigeaatsu Issue. in the Teaching of Field Epideaiology by Professor D. Bradley
-
Agenda itea 2.2.A
Agenda itea 2.3.A Agenda item 2.4 Agenda itea 3.1 Agenda itea 3.2 .-
The Concept of Epidemiology (E50/78.3) (Handout No.1) Functions of an Epidemiologist (180/79.2) (Handout No.2) Specific educational objectivea (E50/78.l) (Handout No.8) . The Need for Epidemiologiats (Handout No. 2.3) Questionnai~e No. 2 C8reers in Epidemiology Ipideaiological Manpower and Training Needs (wn/BSO/80.2) Definition. andelasaHicationa of Population-based Studiea: The Advantages and Li.itationa of lach·Type Quantitative Aspects of the Epideaiology of !. japenicum Infection in a Rural C~nity of Luzon, Ph11ippines Report on the Workshop on Population Epidemiology of Schistosoma Japonicum Infections Held in Manila and Iroain, Soraogon, Philippines
•
•
- 42 Annex 3
Agenda item 3.3 Agenda item 3.4 Agenda item 3.5 Agenda item 3.6 Agenda item 4.2 Agenda item Agenda item Agenda .i.tem Agenda item Agenda item 4.3.1 4.3.1A 4.3.18 4.3.3 4.3.3A -
Agenda item 4.3.38 Agenda item 4.3.4 Agenda item 4.3.5 Agenda item 4.3.3c -
Population-based Study of Diarrhoea in Malaysia Goroka ARI Unit: An Introduction to the Asaro Valley Study Evaluation of Control Programmes (WPR/ESD/80.3) Itai-Itai Disease and Cadmium Pollution (WPR/ESD/80.4) A Mathematical Model for the Allocation of Cancer Control Programme Assignment Report, 29 January - 30 July 1979 by Arturo C. Reyes, WHO Consultant (ICP/ESD/OO2) Model of Curriculum Planning Introduction to Behavioural Objectives Curriculum Development Teaching Method. in Epidemiology (WPR/ESD/80.5) Issues in the Teaching of Field Epidemiology (WPll/ESD/80.6) Summary of replies to questionnaires received The evaluation process - A model for classroom teachers Example of a Model of Course Design for a Unit of Instruction Instructional Functions and Methods
• •
Guidelines for Group Discussions (GD) Group reports Agenda Agenda Agenda Agenda Agenda Agenda Item Item Item Item Item Item 2.2 (GP) 2.4 3 4.1 4.3.1 4.3.2
Other documentation received A Field Guide on Epidemiological Methods in the Tropics (Draft) by Professor w.o. Phoon Dr K. Saga's (Japan) paper Dr D. Christie's (Australia) paper Dr J.W.L. Kleevens'(Hong Kong) paper
• •
- 43 -
•
'lU PROnSSIOMAl. RESEARCH EPIDElUOLOGlST
He4esigns research projects and protocols
c:o.ne title:
• Short courae in designing research projects and protocols (aa part of an MPH course) To enable the MPH studeat to be coapetent in deaipiag a reBearch protocol for an epitlelai.oiogical Btuely
at
'J 'rtf-:.
Iteclical graduates 1oIIbo are UDdertaking an HPII coarse and who have caapleted basic·epide.ioIOCY ... biostatistics in the MPH course. The total student intake will be 6-12 per course. In the institution providing ~he MPH course and the situation in which tbe project is to be illlll_ted. 40 hours over 20 days (officially)
Seui.:
"SOUR.S: ,. .. w 1: Hateri.ala: F...... s:
I full-ti.e Epideaiologist (+ secretarial ..-istaace) supporting staff as the unit provides
Past aodels of protocol. (see pp. 49/50)
Deterained by tbe facilities for tbe KPH course Determined by the in8titutiOlla' facilities, etc. (MPB course)
•
Itole: Settis:
Professional Epideaiologist University and/or ...earch Institute See first docu.ent. aesponsibility 3
.. .,....ibility; Skills:
This unit only covers
1. 2. 3.
4.
Befine8 the identified problem to be studied FOmillales stady objectives Selects methods and techniques to achieve the 8tudy object he. Write a protocol
•
• - 44 -
Itn_ledle of: (Skill 1) 1.
2. (Skill 2) (Skill 3) 3. 4.
5.
(Skill 3) (Skill 4)
6.
7.
(Skill 4) Attitudes:
8.
The updated information about the epidemiology of the "problem", its relative iaportanee and the setting in whieh it is to be studied Results and proeedures of previous similar studies in his own and other eountriea SysteDS of logie reasoning Different methods and teehniques and their validity, ine1uding _thods applied in other seienees, e.g. biology and behavioural seienees Potential ethieal problems Costs, manpower, tu.e and faeilities required and available to earry out the study General prineiples of protoeol drafting (models) proeedures in relation to handling protoeols and timing. This ineludes justifieation of all proposed aetivities. MethQds of evaluation of protoeols
• t
1.
Related to skill 1
He should have a eritieal and seientifie approaeh in dealing with problems He must appreeiate the relative importanee of health problems he diseovered and eonsiders the priorities of other interested groups (non-epidemiologists, non-medieal) 2. Related to 2 •
He should be thorough (e.g. preeise, persistent and eonsistent) He should also be speeifie 3. Related to 3
He should be open minded: prepared to aeeept other views and wherever neeessary to eompromise (be flexible) Be Ihould aeeept to involve a wide range of diseipUnes He Ihould bave respeet for etbieal issues 3. Related to 4 sbould aeeept tbe importanee of a properly and tiaely prepared protoeol and He should have a preparedness to re-a.seas and re-write his protoeol. He jI
11
• I I
•
I
,
- 4S -
Annex 4
a)
Profe•• ional cQ!petency PerfoZlD8nce When given all epideaiological reaearch probl_ in a field ..ttiog He designs an appropriate
research protocol which can be iapl_nted dficielltly. to
provide data which will anewer the questiolla raiaed. b) Teninal nudest cp!IPetellCY Given a practical and etraightfoT1l'.rd epid. .iololical -field probl_ c)
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He will deaign an appropriate reaearch protocol which can be impleaented efficiently .to the satisfaction of the teacher.
Entry student coapetency Having succes.fully completed the baaic epid_iololY and bioatatistica of the MPH course Plell of t ••chiDi atratelY yo.peteacr Inatructional activiti.s - Provide students with information about the course progr.... and contents including assesament - Delineate and discuss the expectation. of teachers and students
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He will be able to sol .. siaple statistical and epid_ioloai~al problems.
( IIltroduction)
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Students will ·formulate etudy objectives (Skill 2)
- Provide information on well and poorly designed projects_ to enable the studant to comment on each a. to their relative aerits - Provide reading material on principlu of thi! fobDuladon of hypotheses and of objectives - Provide data from epidemiological projects for students to foraulate specifi~ Objectives a. an exercise with asses_nt
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Selecte aethode (and techniquea) to achieve the atudy objectives (Skill 3)
- Have students review epideaiological study methods for the study of the project specified
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Annex 4
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Have students justify their selection of methode and have students agree on the methods to be used in the study and each write up an outline for comments by the teacher
- For their selected projects have the students review available techniques appropriate to the research objectives - Having reviewed techniques, have students assess the reliability and validity and have the students liat the advantages and disadvantages of techniques and decide on the onea to be used Refines the identified proble.a to be studied (skill 1) .~,
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,t- Group discussion on refining coaaunity health proble.. - Given examples of studies of c_nity healda probl... , the student will review and comment of how these probl...· . .y have been refined for study - Given a comaunity health problem for which a protocol is to be designed, the student will di.sect and translate the problem so that the different coaponents can be studied.
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Writes a protocol, etc. (Skill 4)
1) Have students review protocols of other epidemiological projects, list the items contained in them and comment on the aerits in a group discussion 2) From the list of items for the protocol, determine those items which are essential to their study in a group discussion ,
3) Given the list of essential components of a protocol, desigb s protocol for.at for their selected project
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Annex 4
4) The student will submit his prepared protocol to another group of students acting as if they are the funding body fOT evaluation for funding. S) Using the pupa red format, . the
the student will obtain an evaluation of the protocol from the teacher and other persons. 6) The student will pre-test parts
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or all of the protocol by simulation exercises or in the field. 7) Given the comments and findings
of (4), (S) and (6), the student will revise and finalize the protocol.
7.
Partial syllabus Instructional activities Day I 1-2 hrs Assignment next se.sion and evaluation
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Introduction and overview of the Given handouts on community course. (Lecture) Pre-test: health problems students have ascertain whether student have read thes.e in order to refine prepared protocol before. Include them queationa on students' expectations Class exercise: Teacher leads discussion on community health probl. .s and presentation of students findings on their given probleas Clas. pre.entation: Students finding. of the comparisons of studies and discus. ions Discussion based on student's reading: Lecture/stmaary on the principles of hypotheses and objectives formulation Group discussion of individual student presentation on selected and set problems Handouts on project examples and reading list on ·formulation of hypotheses/objectivity student to select a study 'project for further study (in consultation with teacher) and refine. Teacher to ensure that.different methods are represented in the class Handout of epidemiological data, students to prepare specific research objectives Handouts on methods and techniques student prepare
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Day 2
2hrs Day 3 2hra Day 4 2 hrs
Day S 2 hrs &
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Day 6 2hra Day 7 2 hrs
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Date Day 8 2hn Day 9 2hn
In8tructional activities Review by teacher of epidemiological methods and techniques and role playing, audiovisual pre8entation and data analysis
Assignment next session and evaluation
Individual work on project Day 10 inCluding design questionnaires, whole for.s and dummy tables day Day 11 whole day Day 12 2 hrs Day 13 2hn Day 14 In group discussions present methods and techniques to the group for their own projects Design the study protocol for Have students review protocols of other epidemiological projects their selected project and list iteas contsined in them in group discussion from the list of it ... of the protocol determine those items essential to their study in group discussion. Have 8tudents present their protocols to the group of students acting as funding agency Individual protocol evaluation by teacher/expert Students to individually pretest, revise and redraft the protocol Have students present their final protocol to teacher and clas ... tes (celebration) P1aa of evaluation Day 1 Pre-test to ascertain knowledge and skills TWo aspect8: past experience level of knowledge (pre-requisite test) By classroom di8cu8sion (observation) and questioonaire Ob8ervation of 8tudents' presentation with i . .edi8te feedback Have protocol evaluated by teacher/expert
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Day 15 2hra Day 16 Day 17 Day 18 Day 19 Day 20
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Day 2 Day 3
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Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 12 Day 13 Day 14 Day 15 Day 16
Same as for Day 2 and 3 Class test: examples, MCQ with immediate feedback
Same as for Day 2 and 3 Observation of student performance with immediate feedback Same as Day 2 and 3
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Student's evaluation of colleague's protocols according to established guidelines Asseaaaent of student's protocols by teacher/expert with immediate feedback
Day 17 ) Day 18 ) Self assessment of protocols Day 19 ) Day 20 Final assessment (of students) (i) student's protocol (H) overall (in-course) performance Poat-teat and course evaluation
Day?
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Materials needed Apart from pencils, paper, and access to library facilities: Examples of protocols, including questionnaire, records, duamy tables, good examples, bad examples Examples of data describing community health problema Reference material: formulating hypotheses, specific objectives
Handouts on methods and techniques including tests of reliability, validity and other aspects of problems of measurements.