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A study published
recently in the Annals of Epidemiology finds that training in the
field has changed very little over the past several decades to
meet changing social realities. The next generation of
epidemiologists will be ill-prepared to meet these challenges
unless current training is expanded to teach new skill sets,
according to the authors.
Entitled “Charting
a future for epidemiologic training”, the literature and interview
study was conducted by multiple senior epidemiologists from a
wide-ranging set of work environments led by a core team of
Washington University’s Ross Brownson, the University of
Southern California’s Jonathan Samet, and Saint Louis
University’s Laura Yarber.
Why The Failure
Asked why the pace
of training has not kept up, Brownson told the Monitor “humans are
creatures of habit. In part, this explains why epidemiologic
training has not changed substantially over the past few decades.
There
is also a gap between the competencies needed for epidemiologic
research
versus
those needed for public health practice. If more epidemiologists
spend time working in practice or policy settings, it is likely
that we will find new ways of bridging this gap.”
Boston University’s Sandro Galea, a
co-author of the report, offered another perspective on the
failure to keep pace. He said, “Changes in formal disciplinary
institutions take time. We have faculty who are trained, think,
and practice their field a certain way and training in a new way
requires conceptual shifts that are not easy to grasp and
implement.”
He
went on to add, “I think every generation has a difficult time
meeting the needs of the upcoming generation. This is a
particularly acute concern in epidemiology because the field’s
needs are changing so quickly. But I am confident the field will
rise to the challenge; the article aims to be one small part of
that effort.”
12 New
Realities
The report
identifies twelve macro trends in science and society which the
authors believe are responsible for the opportunities and
challenges being presented to epidemiologists. The authors offer
recommendations for how to reform or expand education in
epidemiology to better prepare epidemiologists to achieve their
primary goals of advancing population health and remaining vital
and credible scientists.
The drivers were
identified through interviews with fifteen experienced
epidemiologists from academia and government service, several with
experience in public health practice settings. These trends are
the following:
1. The increased scope and ability to link
multiple, large, static and streamed data sets—the trend towards
“Big Data”
2. The increased
number of channels and sources of information—the trend towards
greater access to information, often conflicting information (see
cartoon this issue).
3. The multiple
requirements of the Affordable Care Act and the increased desire
to reward value and not just volume in health care— the trend
towards getting more evidence to support health activities.
4. New social
realities such as an increasingly aging population, and diversity
in ethnicity and sexual orientation –the likely demand for
research and practice in new topic areas or greater priority on
existing areas such as health disparities.
5. Increased
interaction between countries or globalization and the increased
transmission of infectious diseases—the likely need for better
control methods and the increased opportunity for epidemiologists
to collaborate internationally.
6. Increased
genome-based research and our ability to characterize and track
patients in greater detail –the likely need for epidemiologists to
learn more about biomedical and data sciences and to work with
others as a team member.
7. A greater focus
on public accountability for the use of public funds in
research—the likely needs for more data sharing, rapid exchange of
information, the use of more participatory approaches, and more
ethical behavior.
8. The increased demand for privacy and regulation of access to
private data –the need for epidemiologists to better understand
the limits on data and participate in balancing individual privacy
and broader social needs for information.
9. A greater focus
on the broad social factors that affect population health—the need
to motivate action against the causes of the causes.
10. A greater
focus on applying what is learned in research—the need to actually
use findings that can improve health.
11. The growing
focus on transdisciplinary approaches to complex problems—the
trend towards team science and keeping or making epidemiologists
critical members of these teams.
12. The record low
success rates for research grants—the likely need to find new
approaches to funding large epidemiologic studies and for
epidemiologists to play an active role in educating persons who
control the purse strings, i.e., make the case for epidemiology.
Points for
Discussion
In presenting these findings, the authors call for
41 broader actions to be taken by epidemiologists as a group. They
present these not as recommendations at this stage but rather as
points for starting a discussion of what needs to be done by the
field. They also present 62 competencies which are types of
knowledge or skills which should be acquired by individuals.
These requirements will vary depending on the work setting, and
level of the graduate degree in question.
Actions for the Field
Examples of the
actions for the field and of the competencies called for are
presented in the two lists accompanying this article.
According to
Brownson, “strategic
planning can help an organization or profession become more
effective and a core principle of strategic planning is the
careful consideration of future opportunities. Within our set of
macro-level trends, there are multiple opportunities to make our
profession more relevant, responsive, and forward-thinking.”
For
example, “epidemiologists…need more training and experience in the
so-called “soft-skills” such as communication and problem solving
that crosses disciplines. Related to this concept of
transdisciplinary problem solving or “team science” we now have a
body of literature showing how to build and implement effective
teams.”
Overarching
Recommendations
While presenting these findings and discussion
points, the authors are more definitive about a few reforms they
think are called for by the data. First of all, they identify a
need for lifelong learning by epidemiologists. They note that such
teaching “…has received too little attention to date and…should be
addressed by professional organizations and academic institutions
in partnership with other key stakeholders.”
In addition to
changes in the classroom, the authors call for more focus on
one-to-one mentoring in both research and practice settings.
In conclusion, the
authors state “…the next generation of epidemiologists will need a
set of skills that goes beyond the training currently being
delivered. We should seek out innovative and creative ways of
delivering epidemiologic training to keep pace with these trends…
and extend the venues in which training occurs.”
The issues raised
by this report should be of interest to a large number of our
readers who are in a position to comment both on the adequacy or
inadequacy of past and current training and the needs for the
future.
We invite readers to comment and help spark a discussion of the
issues. Your comments will be added online following the article
and will be part of any discussion thread which emerges. A full
accounting of the published article can be found at Annals of
Epidemiology 25 (2015) 458-465.
The co-authors are Ross Brownson, Jonathan Samet, Gilbert
Chavez (Ca Dept of Health), Megan Davies (NC Dept of
Health and Human Services), Sandro Galea (Boston
University), Robert Hiatt (Univ of Ca San Francisco),
Carlton Hornung (University of Louisville), Muin Khoury
(CDC & NIH), Denise Koo (CDC), Vickie Mays (UCLA),
Patrick Remington (Univ of Wisconsin), and Laura Yarber.
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Examples Of Actions Which Need To Be Taken By The Field Of
Epidemiology
Some of the actions called for include:
1) Develop guidelines for reporting epidemiologic
research results based on secondary analysis and/or Big Data.
2) Integrate training more fully with communication
and marketing disciplines.
3) Study populations within health care systems.
4) Improve the capacity of epidemiologists to
conduct research which is competent for the culture they operate
in.
5) Develop and enhance cross-national partnerships
6) Apply epidemiology to research dissemination and
implementation as topic areas.
7) Work with those building clinical data
“enterprise warehouses” to anticipate privacy and consent issues.
8.) Develop the capacity to translate science into
action in different venues, especially in the form of policy
action.
9) Develop new courses on translational science
10) Encourage funding and career recognition for
team science
11) Better link epidemiology with public health
practice and health care systems.
A full
accounting of the published article can be found at Annals of
Epidemiology 25 (2015) 458-465 or at this link :
https://tinyurl.com/q6hmr8k
Examples Of Competencies Which Need To Be Acquired By Individual
Epidemiologists
Some of the newer competencies called for by the
authors include:
1) Use and interpret findings from data exploration
tools and other analytics
2) Demonstrate skills to effectively communicate
findings to multiple audiences.
3) Demonstrate skills in using contextual data to
assess quality of health care processes and outcomes.
4) Demonstrate capacity to handle data in at least
one unfamiliar foreign context.
5) Understand how to validate a surrogate marker
and apply the principles of causal inference to “omic” tools
6) Apply new metrics to measure the effectiveness
of epidemiology on population health and health care decision
making.
7) Demonstrate skills in using the electronic
health records to improve access to clinical data for
epidemiologic research.
8) Demonstrate the ability to assess the strengths
and weaknesses of the systems approach to public health problems.
9) Describe the role of epidemiology and
epidemiologists in the translation of knowledge into practice.
A full
accounting of the published article can be found at Annals of
Epidemiology 25 (2015) 458-465 or at this link :
https://tinyurl.com/q6hmr8k |