Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey.

Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19. Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress. Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying. (Am J Public Health. 2023;113(6):689-699. https://doi.org/10.2105/AJPH.2023.307273).

MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework.

INTRODUCTION: MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). PURPOSE: This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. ASSESSMENT: Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. CONCLUSION: Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

Community Health Outside the Exam Room: Extracurricular Learning to Augment Nurse Practitioner Student Practice Readiness.

BACKGROUND: The curricular requirements of nurse practitioner (NP) programs are well established. NP students' clinical practicums provide a context for the extracurricular acquisition of administrative, operational, and systems-focused NP skills. PROBLEM: Acquisition of extracurricular NP skills is variable and highly dependent on a student's clinical placements. The COVID-19 pandemic exacerbated this variability by limiting students' access to traditional clinical rotations. APPROACH: With our practice partners, we inventoried the behaviors that are associated with new graduate NP readiness for practice in community health centers. We then developed an extracurricular seminar series to develop these behaviors. Each seminar in the series was presented by a preceptor. OUTCOMES: Students reported gains in their perceived readiness to practice. The casual format and preceptor presenters were highly valued by students. CONCLUSIONS: NP educators should consider leveraging academic-practice partnerships to standardize students' acquisition of administrative, operational, and systems-focused NP competencies.

Key factors influencing public health students and curricula in India: Recommendations from a mixed methods analysis.

BACKGROUND: Building on a distinguished history of community medicine training, public health programs have been expanding in India in recent years. The COVID-19 pandemic has brought additional attention to the importance of public health programs and the need for a strong workforce. This paper aims to assess the current capacity for public health education and training in India and provide recommendations for improved approaches to meet current and future public health needs. METHODS: We conducted a desk review of public health training programs via extensive internet searches, literature reviews, and expert faculty consultations. Among those programs, we purposively selected faculty members to participate in in-depth interviews. We developed summary statistics based on the desk review. For qualitative analysis, we utilized a combination of deductive and inductive coding to identify key themes and systematically reviewed the strengths and weaknesses of each theme. RESULTS: The desk review captured 59 institutions offering public health training across India. The majority of training programs were graduate level degrees including Master of Public Health and Master of Science degrees. Key factors impacting these programs included collaborations, mentorship, curriculum standardization, tuition and funding, and student demand for public health education and careers. Collaborations and mentorship were highly valued but varied in quality across institutions. Curricula lacked standardization but also contained substantial flexibility and innovation as a result. Public sector programs were perceived to be affordable though fees and stipends varied across institutions. Further development of career opportunities in public health is needed. CONCLUSION: Public health education and training in India have a strong foothold. There are numerous opportunities for continued expansion and strengthening of this field, to support a robust multi-disciplinary public health workforce that will contribute towards achieving the sustainable development goals.

National Institute of Public Health/School of Public Health of Mexico: contributions to social equity and knowledge-based public policies.

The School of Public Health of Mexico (ESPM, in Spanish), was founded on March 23, 1922, several years after the creation of the first schools of public health in the United States of America (USA), such as Johns Hopkins in 1916 and those of Harvard, Yale, and Columbia, among others. The Escuela de Salubridad, as the ESPM was initially called, was the first of its kind in Latin America and the fifth in the world; thus, it was responsible for providing the first public health degrees in Mexico to medical health officers and other higher education diplomas in the fields of hygiene and public health. Several years after its own founding, in 1987, the ESPM co-founded the National Institute of Public Health (INSP, in Spanish) which to date continues to be the organization in which the ESPM is housed. Since the ESPM merged with the INSP, research and human resources training have been considered necessary processes for initiating and strengthening structural change in the field of health at the national and regional levels. As part of its centennial, the ESPM is committed to the continued expansion of its future perspective through the restructuring of its academic programs; this is a process in which the instilling of values, a unified curriculum based on public health, a flexible educational model and social commitment are fundamental. Key words: Public Health, Public Health School of Mexico, social equity and education.

Five deficits to tackle by the future public health education.

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Towards a unified curriculum system based on a public health holistic approach. Renovation of the academic programs at the School of Public Health of Mexico.

Public health training cannot be practiced in isolation, but rather within the framework of substantive conceptual visions, the organizational structure and teaching culture in a broad sense. The School of Public Health of Mexico (ESPM), in the mist of its 100th anniversary, is implementing an educational restructure with the guidance of conceptual and ethical principles. The restructure of the academic pro-grams will follow a constructivist pedagogical model, based on renewed institutional practices that integrates research, teaching and community outreach, making for truly transfor-mative learning. The new design of the whole structure of its academic programs has the objetive of making them flexible, less technical-based but more practical, and a within an uni-fied curricular system that articulates and allows continuity between master's degrees and doctorates programs. In the new structure, the curriculum will have a common core for all the academic programs, emerging from the study of the essential bases of public health, human rights, including gender and social perspectives, principles of global health, ethics of public health practice, environmental and animal health inferences and community outreach in the form of social retribution. The Institute's research groups will be the functional units for investigation and teaching, thus students will be integrated into these at an early stage, under the guidance of a tutor. In this context, the requirements for a comprehensive, unifying and at the same time flexible cur-riculum will support training of Public Health with a holistic approach. The current programs were analyzed including the review of their courses, regarding the pertinence of their contents and proposed competencies. We present herein a description of these observations, and propose a new com-mon core (conceptual-operative) with compulsory courses as the base for all programs. The participation of all academic bodies in reviewing the proposed new common core, as well as the syllabus and courses, identified those that are essential in each program's study concentration area, is indicated.

Student reflections on an interdisciplinary pandemics course utilising systems thinking.

ISSUE ADDRESSED: The complexity and uncertainty of the COVID-19 pandemic highlights the need to change training of public health professionals in higher education by shifting from siloed specialisations to interdisciplinary collaboration. At the end of 2020 and 2021, public health professionals collaboratively designed and delivered, a week-long intensive course-Public Health in Pandemics. The aim of this research study was to understand whether the use of systems thinking in the design and delivery of the course enabled students to grasp the interdisciplinary nature of contemporary health promotion and public health practice. RESEARCH METHODS: Two focus group interviews (n = 5 and 3/47) and a course opinion survey (n = 11/47) were utilised to gather information from students regarding experiences and perceptions of course design and delivery, and to determine if students felt better able to understand the complex nature of pandemics and pandemic responses. MAJOR FINDINGS: Students provided positive feedback on the course and believed that the course design and delivery assisted in understanding the complex nature of health problems and the ways in which health promotion and public health practitioners need to work across sectors with diverse disciplines for pandemic responses. CONCLUSIONS: The use of an integrated interdisciplinary approach to course design and delivery enabled students used systems thinking to understand the complexity in preparing for and responding to a pandemic. This approach may have utility in preparing an agile, iterative and adaptive health promotion and public health workforce more capable of facing the challenges and complexity in public health.

Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study.

The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.

A school of public health responds to the pandemic: A case study from Washington D.C.

The emergence of COVID-19 immediately affected higher education, and the closure of campuses at the start of the pandemic in March of 2020 forced educational institutions to quickly adapt to changing circumstances. Schools of public health faced challenges not only of shifting to remote learning and work environments, but also uniquely redirecting public health research and service efforts toward COVID-19. This paper offers a case study of how the Milken Institute School of Public Health at the George Washington University (GWSPH), the only school of public health in the nation's capital, initially adapted to the COVID-19 pandemic. Using a modified version of the Public Health Preparedness and Response Core Competency Model created by the Association of Schools and Programs of Public Health and the Centers for Disease Control and Prevention, we analyze how GWSPH worked in three areas-research, education, service/operations. We reviewed this initial response across four domains: model leadership; communication and management of information; planning and improving practice; and protecting worker (and student) health and safety. The adaptation of the model and the analysis of GWSPH's initial response to the pandemic can be useful to other schools of public health and health sciences in the United States and beyond, in preparing for all hazards. We hope that such analysis also informs the current concerns of schools such as return to in-person education as well as planning for future public health crises.

Public health in undergraduate nursing education and workforce readiness.

Student engagement with the community is a cornerstone of undergraduate nursing education in Canada. Working with community from perspectives of social justice, health equity, advocacy, and political action are essential for workforce readiness. We suggest that the erosion of public health theory and clinical courses in baccalaureate nursing programs undermines the potential capability of nurses to address the intersectionality of the social determinants of health. The impact of the COVID-19 pandemic on populations further demonstrates inequities, particularly among marginalized populations. Public health nursing education supports students' understanding about the health impacts of social injustice, how systemic racism is embedded in colonial and Eurocentric structures, and practices of superiority and privileges.We, as a national group of public health nursing educators, set out to investigate how existing guidelines and competencies support public health in undergraduate education across Canada. Results from a national questionnaire of educators, and of PHN leaders on new graduate practice readiness are presented. Questionnaire responses confirm an erosion of PHN theory and practice in baccalaureate nursing education (BNE) curricula. The results of the questionnaires combined with evidence of PHN since the global pandemic provide educators and practitioners more insight to inform future directions to respond to workforce readiness.

Advancing Leadership Training to Address Health Equity and Respond to Public Health Emergencies.

CONTEXT: In 2015, Impactivo developed the Advancing Leadership in Times of Crisis (ALTC) program for the Region 2 Public Health Training Center under a subaward from the Health Resources and Services Administration. Puerto Rico's (PR) government had defaulted on its debt, and public health officials needed tools to face the fiscal crisis. The ALTC has since been adapted for PR's public health emergencies, including the Zika epidemic, category 5 hurricanes, earthquakes, and the Covid-19 pandemic. PROGRAM: The program incorporates Ron Heifetz's work on Adaptive Leadership and Marshall Ganz's work on community organizing to address the Centers for Disease Control and Prevention's Essential Public Health Services (EPHS) and health equity. The ALTC is a contextualized and modularized training program that has been provided in different modalities in person and online. IMPLEMENTATION: The Spanish language program has been carried out with 4 cohorts (totaling 82 graduates). Participants were 80% women and 100% Hispanic, empowering underrepresented groups to achieve change. EVALUATION: In the immediate postprogram survey, more than 90% strongly agree that their understanding of the subject matter improved, that they were able to identify actions that apply to their work, and that they were confident in their ability to apply it. Follow-up surveys after the COVID-19 pandemic found that 89% of respondents continue to work in public health, 25% were promoted, and 49% felt confident to train others. Participants also reported that ALTC helped them increase their public health tools (91%), expand their network (84%), and strengthen knowledge about the EPHS (90%). DISCUSSION: Evidence supports that ALTC is a promising training program to increase leadership skills and EPHS competencies that can be adapted to address contextual health equity and public health emergencies. Future research should explore the expansion of ALTC to other contexts and its impact on population health and health equity.

Crisis leadership: a case for inclusion in accredited Master of Public Health program curricula.

OBJECTIVES: To evaluate the exposure to crisis leadership theory already present in Council on Education for Public Health (CEPH) accredited Master of Public Health (MPH) programs in the United States and provide a compelling case for its future inclusion. STUDY DESIGN: This was a narrative review. METHODS: We compiled a comprehensive list of 179 CEPH schools that offered an MPH program. During January through March 2021, we examined 179 websites for the core courses and elective courses offered in the MPH degree program to determine if any courses covered the topics of leadership, crisis leadership, or crisis management in either the course title or description. RESULTS: Leadership courses were available in only 55.31% of CEPH-accredited schools. Only a single program (0.56%) offers a crisis leadership course. CONCLUSIONS: The current global COVID-19 pandemic and reality of climate-induced disasters have brought crises to the forefront for health systems. Successful leadership for the future requires public health leaders to have training in crisis leadership. The evaluation and revision of public health curricula must focus on leadership competency development to prepare graduates to lead complex multiple crisis events and system shocks simultaneously.

Epidemic Intelligence Service Alumni in Public Health Leadership Roles.

Since 1951, the Epidemic Intelligence Service (EIS) of the U.S. Centers for Disease Control and Prevention (CDC) has trained physicians, nurses, scientists, veterinarians, and other allied health professionals in applied epidemiology. To understand the program's effect on graduates' leadership outcomes, we examined the EIS alumni representation in five select leadership positions. These positions were staffed by 353 individuals, of which 185 (52%) were EIS alumni. Among 12 CDC directors, four (33%) were EIS alumni. EIS alumni accounted for 29 (58%) of the 50 CDC center directors, 61 (35%) of the 175 state epidemiologists, 27 (56%) of the 48 Field Epidemiology Training Program resident advisors, and 70 (90%) of the 78 Career Epidemiology Field Officers. Of the 185 EIS alumni in leadership positions, 136 (74%) were physicians, 22 (12%) were scientists, 21 (11%) were veterinarians, 6 (3%) were nurses, and 94 (51%) were assigned to a state or local health department. Among the 61 EIS alumni who served as state epidemiologists, 40 (66%) of them were assigned to a state or local health department during EIS. Our evaluation suggests that epidemiology training programs can serve as a vital resource for the public health workforce, particularly given the capacity strains brought to light by the COVID-19 pandemic.