Competency-based education in Public Health, a model of employing Hybrid-PBL educational method in building core Public Health competencies at the undergraduate medical education.

1. Competency-Based Education in Public Health
A provisional non-tested model
Tarek Tawfik Amin
Professor
Public Health and Community Medicine
Faculty of Medicine, Cairo University.
amin55@myway.com
3/20/2014 Competency-based learning 1Public Health

2. 3/20/2014 Public Health Competency-based learning 2
Objective:
To provide a provisional problem-based educational
model aiming at enhancing the core Public Health
competencies of undergraduate medical students.
The objective of this presentation is:

3. 3/20/2014 Public Health Competency-based learning 3
Introduction:
oPublic health response to new threats,
oGlobalization of complex health-related challenges *,
oRadical new professional approaches empowering individuals and
communities to promote health and prevent disease,
oPublic health professionals prepared to react quickly and
competently **.
* - Sharma K, Zodpey S; Gaidhane A; Syed ZQ; Kumar R; Morgan A. Designing the Framework for Competency-Based Master of Public Health Programs in India. J P u b l i c H e a l t h M a n a g e
m e n t P r a c t i c e , 2013, 19(1), 30–39
-** Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424 DOI 10.1007/s10389-009-
0256-7.
***- An Environmental Scan of Best Practices in Public Health Undergraduate Medical Education REPORT 1: Peer-Reviewed Literature Scan MARCH 2009. Prepared by the Nevis Consulting
Group for the Association of Faculties of Medicine of Canada (AFMC) Public Health Task Group.
Public Health Competencies: ***
 Competency: capacity to act effectively in a specific situation, mobilize
knowledge
and put knowledge into action.
 Not only knowledge („know-how‟), includes the skills and attitudes
(„show-how‟).

4. 3/20/2014 Public Health Competency-based learning 4
The process [development of competency-based
curriculum] *
Identification of public health competencies
Specifications:
-Competencies to be covered
-Competencies to be enhanced
-Methods
-Evaluation and assessment
Mapping of competencies and
learning objectives
Gap analysis for the current status
Future planning and review
* - Building the Public Health Workforce for the 21 Century. A Pan-Canadian Framework for Public Health Human Resources Planning. 2005.

5. Cancer screening in undergraduate medical curriculum
as a model to enhance core Public Health
Competencies.
3/20/2014 Public Health Competency-based learning 5
The topic:

6. Proposed Core competencies and competencies statements*
3/20/2014 Public Health Competency-based learning 6
* CDC, WHO, CanMED and others. ,
Competencies
statements
Core Public Health competency domains
Principles
of
Epidemio
logy
Basic
Biostatisti
cs
Social
and
behavior
al
sciences
Health
care
system,
policy, and
planning
Environ
mental
health
Crosscu
tting
domains
3- Demonstrate critical
appraisal of different
screening modalities
√ √ √
4-Identify principles and
limitations of screening
tests
√ √ √
5-Identify risk factors for
non-communicable
diseases, implications for
their prevention and
control.
√ √

7. 3/20/2014 Public Health Competency-based learning 7
Proposed Core competencies and competencies statements (cont.)
Competencies
statements
Core Public Health competency domains
Principle
s of
Epidemi
ology
Basic
Biostatisti
cs
Social and
behavioral
sciences
Health
care
system,
policy, and
planning
Environ
mental
health
Crosscut
ting
domains
8-Demonstrate
competence in
identifying, obtaining,
and critically reviewing
literature form
different sources
√ √
9-Identify the
behavioral
determinants for health
behavior change
√

8. 3/20/2014 Public Health Competency-based learning 8
Proposed Core competencies and competencies statements
Competencies
statements
Core Public Health competency domains
Principle
s of
Epidemi
ology
Basic
Biostatisti
cs
Social and
behavioral
sciences
Health care
system,
policy, and
planning
Environ
mental
health
Crosscut
ting
domains
13-Produce/deliver
oral/written health
education message of
his/her own choice
√ √
14-Demonstrate ability
to think critically
√ √

9. Proposed Educational
methods
3/20/2014 Public Health Competency-based learning 9
Method/strategy
 Hybrid.
 Medical students: Undergraduate, 2nd-3rd year.
 Pre-requites: basic science, cancer biology.
 Duration: 2 weeks
 Weeks:1st lecture, problem case, discussion sessions, self
learning,
2nd week: discussions, presentation, self reflection,
self learning.
 Field contact: primary health care facility
 Facilitators: Public Health faculty.

10. 3/20/2014 Public Health 10
The PBL case: Breast cancer screening
Problem
Scenario
Identify Facts
Formulate and analyze problem
Generate
Hypotheses
ID Knowledge
Deficiencies
Apply new
knowledge
Self-Directed
Learning
Evaluation
Abstraction
Identify main ideas/keywords
Identify key questions
Writing of learning
objectives
The figure from - COMPETENCY-TO-CURRICULUM TOOLKIT: Developing Curricula For Public Health Workers, Center for Health
Policy Columbia University School of Nursing and Association of Teachers of Preventive Medicine (2004). - Caitlin Ryan Problem Based
Learning Medical Science II (2009).

11. 3/20/2014 Public Health Competency-based learning 11
The process: The three Cs of PBL process *.
Contextual
1. Students are presented with a problem
2. PBL discussion, clarify the facts, define
problem, brainstorm, identify learning needs .
3. Independent study (library, databases, experts )
Collaborative
4. Sharing information, peer teaching and collaborative
working
Constructive
5. Present solution to the problem
6. Review what learned , engage in self, peer and
tutor review of process and reflections on contribution
1- Retention;
2- Integrated knowledge;
3- lifelong learning;
4- Early exposure;
5- Student-staff liaison;
6- Overall motivation.
Advantages
**
* Hartling L, Spooner C, Tjosvold L, and Oswald A: Problem-based learning in pre-clinical medical education: 22 years of outcome research. Med.Teacher 2010, 32:28-35.
** Miller SK. Comparison of student outcomes following problem-based learning instruction versus traditional lecture learning in a graduate pharmacology course. J Am Acad Nurse Pract 2003;15:550-6.

12. - Mrs. C is a rural Egyptian housewife aged 52 years, with technical
diploma education, and has 4 children. She showed up to the
primary care physician complaining of lump in her left breast.
Examination revealed a mass measuring 2 cm at the upper right
quadrant of her left breast and the axilla was free. Mrs. C is diabetic
with previous history of lumpectomy of a benign lesion from her
right breast at the age of 39. She loss her period three years back,
and mentioned the intake of hormonal contraception for 10 years.
Mrs. C was so anxious about her condition as she mentioned the
death of her mother with breast cancer at the age of 49 years plus
she heard from a T.V show that breast cancer is a familial condition.
3/20/2014 Public Health Competency-based learning 12
The problem case: Relevancy to public health, Interest of the
involved students, and Accessibility to search. *
* - Loureiro I, Sherriff N, John Davies JK. Developing public health competencies through building a problem-based learning project. J Public Health (2009) 17:417–424

13. 3/20/2014 Public Health Competency-based learning 13
Relevant learning questions: Examples
1. What are the common risk factors for breast
cancer?
2. Does breast cancer can be prevented?
3. What are the available screening tests?
4. How effective are these tests?
5. Do these tests of value in reducing mortality?
6. Are women in rural areas receiving equal
services as urban?

14. 3/20/2014 Public Health Competency-based learning 14
Relevant sources and documents
Textbook:
- Breast Cancer Epidemiology Li, Christopher (Ed.) 2010, XIII, 417p. 19
illus. Springer.
- Cancer Epidemiology: Principles and Methods IARC Nonserial Publication.
Edited by I. Dos Santos Silva. 999; 425 pages. ISBN 92 832 0405
Open resources:
-http://www.cdc.gov/cancer/breast/index.htm
- http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/
- http://www.who.int/cancer/detection/variouscancer/en/
-http://www.who.int/cancer/nccp/en/
Documents:
- National breast cancer screening guidelines / Egyptian cancer registry
- Facilitator‟s case-book/guidelines
- Student‟s guidelines notes and case portfolio.
Availability of subject‟s experts: Epidemiologist, Oncologist, Primary physician, Health education
consultant.

15. 3/20/2014 Public Health 15
Learning Objectives: examples
1) Identify the different genetic/behavioral/environmental risk
and protective factor for breast cancer
2) Recognize and communicate the recommended case-wise
guidelines for breast cancer screening
3) Criticize the efficiency of different breast cancer screening
methods.
4) Apply and interpret the basic epidemiological terms in
describing the risk (Odds, relative risk).
5) Define the potential factors influence health disparity in
Egypt especially the socio-economic and geography.
An:
Analysis
K: Knowledge Ap:
Application
C:
Comprehension
Cognitive domains
Bloom’s *
Taxonomy
Ev:
Evaluation
A
p
C
A
n
K
E
v
* Bloom BS, Englehart MD, Furst EJ, Hill WH, Krathwohl DR. Tax- onomy of educational objectives: handbook I: cognitive domain. New York: David McKay; 1956.

16. 3/20/2014 Public Health 16
Competency-based education [Methods and
assessment plan]:Skill stage
(Dreyfus)*
Objectives Bloom’s
Taxonomy
Teaching
methods
Assessment
method
New learner
(awareness
stage)
- Identify the different risk and
protective factors
- Assess barriers and promoters
for screening
- Define potential factors
influence health disparity
Knowledge
and
comprehensi
on
Orientatio
n lecture
self
learning
Case study
Written test
(pre-post)
Discussion
sessions
participation
Advanced
learner
(proficiency
stage)
- Recognize and communicate the
recommended case wise-
guidelines for screening
Application
Analysis
Case
scenario
Discussion
Field
Observation
Self
reflection
Presentation
s
Experienced
learner
(mastery
stage)
- Value the risk for cancer based
on patient’s risk factors
background.
Synthesis
Evaluation
Case study
Self
learning
Field
Observation
checklist
Written test* Dreyfus HL, Dreyfus SE. Mind over machine: the power of human intuition and experience in the era of the computer. Oxford: Basil Blackwell; 1986.

17. 3/20/2014 Public Health Competency-based learning 17
Competency mapping: Examples
Learning Objectives
Competencies
3 4 5 8 9 13 14
-Identify the different risk and protective
factor for breast cancer
K
C
C K
- Define the potential factors influence
health disparity.
K A
p
- Recognize and communicate the
recommended case wise-guidelines for
screening
Ap A
n
- Criticize the different methods used in
screening.
Ev A
p
- Apply and interpret the basic
epidemiological terms in describing the
risk (Odds, relative risk).
An A
p
K= Knowledge, C=Comprehension, An=Application,
An=Analysis, Ev= Evaluation

18. Current status
More competencies
Modifications
Future plan
3/20/2014 Public Health Competency-based learning 18
Gap Analysis of the model:

19. 3/20/2014 Public Health Competency-based learning 19
Thank you

20. - Czabanowska , Moust JHC, Peter Schröder-Bäck P, Roebertsen H. Problem-based
Learning Revisited, introduction of Active and Self-directed Learning to reduce fatigue
among students. Journal of University Teaching & Learning Practice. 9(1), 2012.
Available at:http://ro.uow.edu.au/jutlp/vol9/iss1/6.
- Czabanowska K, Smith T, Ko KD , Sumskas L, Otok R, Bjegovic-Mikanovic V,
Brand H. In search for a public health leadership competency framework to support
leadership curriculum–a consensus study. European Journal of Public Health, 2013, 1–
6. doi:10.1093/eurpub/ckt158.
- Sharma K, Zodpey S; Gaidhane A; Syed ZQ; Kumar R; Morgan A. Designing the
Framework for Competency-Based Master of Public Health Programs in India. J P u b l
i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(1), 30–39
- Brownie S, Thomas J, Bahnisch M . Exploring the Literature: Competency-based
Education and Training & Competency-Based Career Frameworks. Report by the
National Health Workforce Planning & Research Collaboration. Faculty of Health
Sciences and University of Queensland Centre for Clinical Research, University of
Queensland, Australia October 2011.
- Loureiro I, Sherriff N, John Davies JK. Developing public health competencies
through building a problem-based learning project. J Public Health (2009) 17:417–424
DOI 10.1007/s10389-009-0256-7.
- An Environmental Scan of Best Practices in Public Health Undergraduate Medical
Education REPORT 1: Peer-Reviewed Literature Scan MARCH 2009. Prepared by
the Nevis Consulting Group for the Association of Faculties of Medicine of Canada
(AFMC) Public Health Task Group.3/20/2014 Public Health Competency-based learning 20
References

21. - Kristine M. Gebbie, KM; Weist EM; McElligott JE; Biesiadecki LA; Gotsch AR; Keck W
et al. Implications of Preparedness and Response Core Competencies for Public Health. J P u
b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 19(3), 224–230.
- Mainor A; Leeman J, MDiv; Sommers J, Heiser C; Gonzales C; Farris RP et al . A
Systematic Approach to Evaluating Public Health Training: The Obesity Prevention in
Public Health Course. J P u b l i c H e a l t h M a n a g e m e n t P r a c t i c e , 2013, 00(00),
1–7
- Building the Public Health Workforce for the 21 Century. A Pan-Canadian Framework for
Public Health Human Resources Planning. 2005.
- Competencies and Learning Objectives. a technical assistance document. Accreditation
Criteria for Schools of Public Health, June 2011, and Accreditation Criteria for Public
Health Programs, June 2011, for the accreditation criteria.
- Cultural Competence Education for Students in Medicine and Public Health Report of an
Expert Panel. Joint Expert Panel Convened by the Association of American Medical
Colleges and the Association of Schools of Public Health. July 2012.
- Public Health Education and Training in the Context of an Enlarging Europe. A guide
towards a more effective, comparable and mobile work force across Europe. 2009.
- Hai-chao LI and Chen W. Reform direction of medical education in China: implementing
“competency-based” medical education. Chinese Medical Journal 2013;126 (17).
- Hou SI. Integrating Problem-based Learning with Community-engaged Learning in
Teaching Program Development and Implementation. Universal Journal of Educational
Research 2(1): 1-9, 2014 http://www.hrpub.org DOI: 10.13189/ujer.2014.020101.
- Hoover CR, Wong CC, Azzam A. From primary care to public health: using problem-based
learning and the ecological model to teach public health to first year medical students. J
Community Medicine, 2011, DOI 10.1007/s10900-011-9495-y.3/20/2014 Public Health Competency-based learning 21
References

22. - Jabbari H, Bakhshian F,Alizadeh M, Alikhah H, Behzad MN. Lecture-based Versus
Problem-Based Learning Methods in Public Health Course for Medical Students. Res
Dev Med Educ, 2012, 1(2), 31-35.
- Calhoun JG, Rowney R, Eng E, Yael Hoffman Y. Competency Mapping and Analysis
for Public Health Preparedness Training Initiatives. Public Health Reports, 2005 Suppl
1 (120), 91-99.
- COMPETENCY-TO-CURRICULUM TOOLKIT: Developing Curricula For Public
Health Workers, Center for Health Policy Columbia University School of Nursing and
Association of Teachers of Preventive Medicine (2004).
- Caitlin Ryan Problem Based Learning Medical Science II (2009).
- Miller SK. Comparison of student outcomes following problem-based learning
instruction versus traditional lecture learning in a graduate pharmacology course. J Am
Acad Nurse Pract 2003;15:550-6.
Public Health Association of Canada (2007) Core competencies for public health in
Canada. PHAC, Ottawa. (www.phac-aspc.gc.ca/core_competencies).
- Hartling L, Spooner C, Tjosvold L, and Oswald A: Problem-based learning in pre-
clinical medical education: 22 years of outcome research. Med.Teacher 2010, 32:28-35.
Bloom BS, Englehart MD, Furst EJ, Hill WH, Krathwohl DR. Tax- onomy of
educational objectives: handbook I: cognitive domain. New York: David McKay; 1956.
3/20/2014 Public Health Competency-based learning 22
References

23. Details of the learning Questions,
Objectives, Competencies and
Mapping.
3/20/2014 Public Health 23

24. Proposed Core competencies and core public
health domains
3/20/2014 Public Health Competency-based learning 24
CDC, WHO, CanMED and others. ,
Competencies
statements
Core Public Health competency domains
Principles of
Epidemiology
Basic
Biostatistics
Social and
behavioral
sciences
Health care
system, policy,
and planning
Environmen
tal health
Crosscutting
domains
1-Apply the basic terminology and
definitions of epidemiology
√
2-Describe a public health problem
in person, time and place.
√ √
3-Critical appraisal of different
screening modalities
√ √ √
4-Identify principles and
limitations of screening programs
√ √ √
5-Identify risk factors for non-
communicable diseases,
implications for their prevention
and control.
√ √ √
6-Define health issues form social
perspectives
√ √
7-Describe health care disparities
in relation to geographical, social
and economical factors
√ √

25. Proposed Core competencies and core public
health domains
3/20/2014 Public Health Competency-based learning 25
Competencies
statements
Core Public Health competency domains
Principles of
Epidemiology
Basic
Biostatistics
Social and
behavioral
sciences
Health care
system, policy,
and planning
Environmen
tal health
Crosscutt
ing
domains
8-Demonstrate competence
in identifying, obtaining, and
critically reviewing literature
form different sources
√ √
9-Identify the behavioral
determinants for health
behavior change
√
10-Describe the interaction
of physical and social
environment and health
√

26. Proposed Core competencies and core public
health domains
3/20/2014 Public Health Competency-based learning 26
Competencies statements
Core Public Health competency domains
Principles of
Epidemiology
Basic
Biostatistics
Social and
behavioral
sciences
Health care
system, policy,
and planning
Environment
al health
Crosscutting
domains
11-Demonstrate leadership
skills , and team building skills
√
12-Demonstrate interpersonal
communication skills
(problem solving, listening,
conflict resolution and
decision)
√
13-Produce/deliver
oral/written health education
message of his/her own
choice
√ √
14-Demonstrate ability to
think critically
√ √ √

27. 3/20/2014 Public Health Competency-based learning 27
Relevant learning questions
1. What are the common risk factors for breast cancer?
2. Does breast cancer can be prevented?
3. What are the available screening tests for breast
cancer?
4. How effective are these tests?
5. Do these tests of value in reducing mortality from
Breast cancer?
6. What are the barriers to women getting these
recommended screening tests?
7. What factors promote the uptake of screening?
8. How we are going to increase women’s awareness
about breast cancer screening?
9. Are women in rural areas receiving equal health care
services as urban?
10. Are the current policies-programs for breast cancer

28. By the end of this case, undergraduate medical students should be
able to:
3/20/2014 Public Health 28
Intended learning outcomes (ILO)
1) Recall the epidemiological features and risk factors responsible for the
development of non-communicable disease with especial reference to cancer.
2) Identify the different genetic/behavioral/environmental risk and protective
factor for breast cancer
3) Define the basic pillars for screening tests namely
sensitivity/specificity/predictive values
4) Recognize and communicate the recommended case wise-guidelines for breast
cancer screening
5) Criticize the different methods used in screening in terms of false
positive/negative, labeling, lead time effect ect.,
6) Apply and interpret the basic epidemiological terms in describing the risk (Odds,
relative risk).
7) Value the risk for breast cancer on individual case based on patient‟s risk factors
background.
8) Assess the potential barriers and promoters for breast cancer screening in Egypt
especially in rural areas
9) Define the potential factors influence the health disparity among Egyptian
K
An:
Analysis
K:Knowledge Ap: ApplicationC: Comprehension
Cognitive
domains
Bloom’s
Taxonomy
Ev: Evaluation
Ap
C
C
An
K
Ev
Ev
C
C

29. 3/20/2014 Public Health 29
Competency-based learning and assessment plan
Skill stage
(Dreyfus)*
Objectives Bloom
Taxonomy
Teaching
methods
Assessment
method
New learner
(awareness stage)
1. Recall the epidemiological features and risk factors
responsible for the development of non-communicable
disease with especial reference to cancer.
2. Identify the different
genetic/behavioral/environmental risk and protective
factor for breast cancer
3. Define the basic pillars for screening tests namely
sensitivity/specificity/predictive values
8. Assess the potential barriers and promoters for breast
cancer screening in Egypt especially in rural areas
9. Define the potential factors influence the health
disparity among Egyptian population especially the
socio-economic and geography.
10. Define the responsibility of primary care in assessing,
guiding and educating individuals with risk factors.
Knowledge and
comprehension
Orientation lecture
Readings/self
learning
Case studies
Written test (pre-post)
Discussion sessions
Advancer learner
(proficiency stage)
4- Recognize and communicate the recommended case wise-
guidelines for breast cancer screening
5- Criticize the different methods used in screening in terms
of false positive/negative, labeling, lead time effect ect.
Application
Analysis
Simulated case
scenario
Role play
Searching /synopsis
Observation
Self reflection
Presentations
Experienced learner
(mastery stage)
6- Apply and interpret the basic epidemiological terms in
describing the risk (Odds, relative risk).
7- Value the risk for breast cancer on individual case based
on patient’s risk factors background.
Synthesis
Evaluation
Case study Observation checklist
Simulated case

30. 3/20/2014 Public Health 30
Competency mapping :K= Knowledge, C=Comprehension, An=Application, An=Analysis, Ev= Evaluation
Learning Objectives Competencies
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1-Recall the epidemiological features and risk
factors responsible for the development of non-
communicable disease with especial reference to
cancer.
K
C
K K
C
K K
2-Identify the different
genetic/behavioral/environmental risk and
protective factor for breast cancer
K
C
A
p
3-Define the basic pillars for screening tests namely
sensitivity/specificity/predictive values
A
p
An Ap
8-Assess the potential barriers and promoters for
breast cancer screening in Egypt especially in rural
areas
K KC Ev Ap K
9-Define the potential factors influence the health
disparity among Egyptian population especially
the socio-economic and geography.
K
C
K
C
10-Define the responsibility of primary care in
assessing, guiding and educating individuals
with risk factors.
K C Ap
4-Recognize and communicate the recommended
case wise-guidelines for breast cancer screening
Ap An
5-Criticize the different methods used in screening
in terms of false positive/negative, labeling, lead
time effect ect.
K
C
C
6-Apply and interpret the basic epidemiological Ap