Shaping applied epidemiology workforce training to strengthen emergency response: a global survey of applied epidemiologists, 2019-2020.

BACKGROUND: Rapid and effective emergency response to address health security relies on a competent and suitably trained local and international workforce. The COVID-19 pandemic has highlighted that the health security workforce needs to be well equipped to tackle current and future challenges. In this study, we explored whether training in applied epidemiology was meeting the current needs of the applied epidemiology workforce. METHOD: We conducted a cross-sectional online survey that was available in English and French. We used purposive and snowballing sampling techniques to identify potential survey respondents. An online social media advertisement campaign was used to disseminate a REDCap survey link between October 2019 and February 2020 through field epidemiology networks. Survey questions included demographic details of participants, along with their technical background, level of formal education, topics studied during epidemiology training, and years of experience as an epidemiologist. We used Pearson Chi-squared (Chi2) to test the difference between categorical variables, and content analysis to evaluate responses to open-ended questions. RESULTS: In total, 282 people responded to the survey. Participants had a range of formal public health and epidemiology training backgrounds. Respondents applied epidemiology experience spanned almost 30 years, across 64 countries. Overall, 74% (n = 210) were alumni of Field Epidemiology Training Programs (FETP). Basic outbreak and surveillance training was well reported by respondents, however training in specialised techniques related to emergency response, communication, and leadership was less common. FETP graduates reported higher levels of formal training in all survey topics. CONCLUSION: It is critical for the health security workforce to be well-trained and equipped with skills needed to ensure a rapid and effective response to acute public health events. Leadership, communication, interpersonal skills, and specialist training in emergency response are lacking in current training models. Our study has demonstrated that applied epidemiology workforce training must evolve to remain relevant to current and future public health challenges.

Lessons Learned From an Intensive Writing Training Course for Applied Epidemiologists.

Although writing is a valued public health competency, authors face a multitude of barriers (eg, lack of time, lack of mentorship, lack of appropriate instruction) to publication. Few writing courses for applied public health professionals have been documented. In 2017 and 2018, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention partnered to implement a Morbidity and Mortality Weekly Report Intensive Writing Training course to improve the quality of submissions from applied epidemiologists working at health departments. The course included 3 webinars, expert mentorship from experienced authors, and a 2-day in-person session. As of April 2020, 39 epidemiologists had participated in the course. Twenty-four (62%) of the 39 epidemiologists had submitted manuscripts, 17 (71%) of which were published. The program's evaluation demonstrates the value of mentorship and peer feedback during the publishing process, the importance of case study exercises, and the need to address structural challenges (eg, competing work responsibilities or supervisor support) in the work environment.

Perspectives on the Future of Epidemiology: A Framework for Training.

Over the past century, the field of epidemiology has evolved and adapted to changing public health needs. Challenges include newly emerging public health concerns across broad and diverse content areas, new methods, and vast data sources. We recognize the need to engage and educate the next generation of epidemiologists and prepare them to tackle these issues of the 21st century. In this commentary, we suggest a skeleton framework upon which departments of epidemiology should build their curriculum. We propose domains that include applied epidemiology, biological and social determinants of health, communication, creativity and ability to collaborate and lead, statistical methods, and study design. We believe all students should gain skills across these domains to tackle the challenges posed to us. The aim is to train smart thinkers, not technicians, to embrace challenges and move the expanding field of epidemiology forward.

Occupational Stress among Field Epidemiologists in Field Epidemiology Training Programs from the Public Health Sector.

Despite the high-demand work environment for field epidemiologists in field epidemiology training programs, little is known about their occupational stress. To identify occupational stress and its related factors, the occupational stress among trainees in field epidemiology training programs in Southeast Asia and Western Pacific regions from 2016 to 2018 was examined using six subscales: Role Overload, Role Insufficiency, Role Ambiguity, Role Boundary, Responsibility, and Physical Environment. Furthermore, the data on the year of training and type of training program as well as the level of burnout, which affects stress-coping strategies, were collected. Fisher's exact tests and logistic regression models were used to examine associations between occupational stress, burnout, the number of years of training, and the type of training program. Sixty-two trainees participated, and there were no significant associations between burnout, the year of training, and type of training program. A burden of occupational stress in Role Overload and Physical Environment was reported by 56% and 53% of respondents, respectively. The trainees affiliated with a university program were less likely to have a burden of occupational stress in Responsibility and Physical Environment. It is concerning that more than half of trainees in the programs experienced occupational stress in Role Overload and Physical Environment. Additional efforts to design improved training programs to reduce occupational stress are warranted.

Recruiting epidemiologists: A developmental perspective on expanding epidemiology exposure for adolescents.

Adolescents are at a unique developmental stage that is well-primed for epidemiology instruction. Although a handful of pioneers have focused on expanding epidemiology instruction to teen audiences, there are still no systematic efforts in the United States to attain this goal. In this paper I posit that epidemiologists and other public health professionals are critical to this effort. Epidemiologists from public health agencies, academia and non-profit organizations can engage in partnerships with schools, such as by offering internships and pairing graduate students/mentees with teachers and adolescent learners. Through these efforts, we can leverage teens' natural interests in risk taking, health and wellness, and community change to learn population-level thinking. I posit that these measures can encourage widespread exposure to epidemiology principles, and also enhance the future of public health disciplines.

Training the Twenty-First Century Cancer Epidemiologist.

To assess and advance training of twenty-first century cancer epidemiologists, the National Cancer Institute (NCI) sought to obtain a snapshot of the cancer epidemiology training landscape by conducting a survey across academic institutions and cancer centers, focusing on four key training areas driving current cancer epidemiology research ("drivers"): (1) collaboration, (2) novel methods/technologies, (3) multilevel analysis, and (4) knowledge integration. Complementary to the survey, we conducted a portfolio analysis of active NCI-funded training grants. In the present report, we provide our findings from this effort and contribute to the on-going conversation regarding the training of next-generation cancer epidemiologists. Analyses and insights gained from conversations with leaders/educators across 24 academic institutions/cancer centers and the portfolio analysis of training grants echoed contemporaneous conversation that cancer epidemiology training must adapt to meet the needs of the changing research environment. Currently, with the exception of novel methods/technologies, cancer epidemiology trainees receive the majority of their training in collaboration, multilevel approaches, and knowledge integration/translation either informally, ad hoc, or not at all; exposure to these identified drivers varied considerably by institution, mentor, and other external as well as internal factors.

InterPreT cancer survival: A dynamic web interactive prediction cancer survival tool for health-care professionals and cancer epidemiologists.

BACKGROUND: There are a variety of ways for quantifying cancer survival with each measure having advantages and disadvantages. Distinguishing these measures and how they should be interpreted has led to confusion among scientists, the media, health care professionals and patients. This motivates the development of tools to facilitate communication and interpretation of these statistics. METHODS: "InterPreT Cancer Survival" is a newly developed, publicly available, online interactive cancer survival tool targeted towards health-care professionals and epidemiologists (http://interpret.le.ac.uk). It focuses on the correct interpretation of commonly reported cancer survival measures facilitated through the use of dynamic interactive graphics. Statistics presented are based on parameter estimates obtained from flexible parametric relative survival models using large population-based English registry data containing information on survival across 6 cancer sites; Breast, Colon, Rectum, Stomach, Melanoma and Lung. RESULTS: Through interactivity, the tool improves understanding of various measures and how survival or mortality may vary by age and sex. Routine measures of cancer survival are reported, however, individualised estimates using crude probabilities are advocated, which is more appropriate for patients or health care professionals. The results are presented in various interactive formats facilitating understanding of individual risk and differences between various measures. CONCLUSIONS: "InterPreT Cancer Survival" is presented as an educational tool which engages the user through interactive features to improve the understanding of commonly reported cancer survival statistics. The tool has received positive feedback from a Cancer Research UK patient sounding board and there are further plans to incorporate more disease characteristics, e.g. stage.

[Perceptions about their own old age from the perspective of a group of epidemiologists in training]. / Percepciones de un grupo de epidemiólogos en formación acerca de su propia vejez.

OBJECTIVE: Exploring, from the perspective of a group of epidemiologists in training, the perceptions about their own old age. MATERIAL AND METHODS: Exploratory, qualitative-descriptive study, in which ethnographic tools were applied: observation, field diary and group interview (GF). RESULTADOS: Explored from the perspective of a group of epidemiologists in training. The group agreed that to plan to reach a functional and decent old is important, despite the current unfavorable and adverse conditions, recognizing that not all will reach there, and it is less common for young people to think and plan their own old age, and even less work with and for the elderly. The meaning of aging most often mentioned by the group contain the word "phase", in which concept and care reflect the high standards desired individually. It became clear, that nursing homes for old age people are necessary, but the services provided are differentiated since "the economy determines the care for the elderly". CONCLUSION: Reflecting on the perception of old age itself, for the group of epidemiologists in training, helped visualize their concerns, fears, expectations, and to reflect on their responsibilities and possibilities in providing scientific evidence to plan and make sound decisions for a dignified old age and aging of the population from Nariño.

OBJETIVO: Explorar desde la mirada de un grupo de epidemiólogos en formación, las percepciones sobre su propia vejez. MATERIAL Y MÉTODOS: Estudio exploratorio, cualitativo - descriptivo, en el cual se hizo aplicación de herramientas etnográficas: observación, diario de campo y entrevista grupal (GF). RESULTADOS: El grupo consensuo que programarse para llegar a una vejez funcional y digna es importante, a pesar de las desfavorables y adversas condiciones actuales, reconociendo que no todos lograrán llegar a ella, y que es menos común en los jóvenes pensar y planear su propia vejez, y menos trabajar con y para los viejos. Los significados sobre vejez más frecuentemente referidos por el grupo contienen la palabra "etapa", en cuyo concepto y cuidados se reflejan los altos estándares deseados a nivel individual. Se puso de manifiesto que los hogares para ancianos son necesarios, pero que los servicios prestados son diferenciados pues "la economía determina la atención para el anciano". CONCLUSIÓN: La reflexión acerca de la percepción de la propia vejez, para el grupo de epidemiólogos en formación, ayudó a visualizar sus inquietudes, miedos, expectativas y a reflexionar acerca de su responsabilidad y posibilidades en el aporte de evidencia científica que permita planear y tomar decisiones acertadas para un envejecimiento y vejez dignas de la población nariñense.

Examining state health agency epidemiologists and their training needs.

PURPOSE: Despite increases in formal education, changing trends affecting epidemiologic practice prompted concerns over whether epidemiologists had sufficient training. METHODS: This study sought to explain factors that predicted low self-reported proficiency levels among daily important work tasks of state health agencies' epidemiologists. The number of knowledge gaps, instances where epidemiologists identified a work-related task both as 'very' important in their daily work and felt they were "unable to perform" or performed at a "beginner" level, was studied, and predictor variables were assessed. A total of 681 epidemiologists responded to the 2014 Public Health Workforce Interests and Needs Survey, a national survey of state health agency workers; epidemiologists represented 7% of all respondents. RESULTS: Epidemiologists at state health agencies worked mostly in communicable disease (31%) or general surveillance (26%). Epidemiologists reported eight key daily work-related activities with an average of three training gaps. Factors that decreased the likelihood of epidemiologists' low proficiency in performing key activities were the presence of internal trainings (adjusted odds ratio = 0.69, 95% confidence interval, 0.49-0.99) and length of time working in public health (adjusted odds ratio = 0.95, 95% confidence interval, 0.93-0.98). CONCLUSION: Although formal education of epidemiologists is on the rise, state health agencies' epidemiologists feel unprepared to tackle one-third of their important daily tasks.

The use of specialty training to retain doctors in Malawi: A discrete choice experiment.

Emigration has contributed to a shortage of doctors in many sub-Saharan African countries. Specialty training is highly valued by doctors and a potential tool for retention. Yet not all types of training may be valued equally. In the first study to examine preferences for postgraduate training in depth, we carried out a discrete choice experiment as part of a cross-sectional survey of all Malawian doctors within seven years of graduation and not yet in specialty training. Over August 2012 to March 2013, 148 doctors took part out of 153 eligible in Malawi. Despite evidence that specialty training is highly sought after, Malawian junior doctors would not accept all types of training. Doctors preferred timely training outside of Malawi in core specialties (internal medicine, general surgery, paediatrics, obstetrics & gynaecology). Specialty preferences are particularly strong, with most junior doctors requiring nearly double their monthly salary to accept training all in Malawi and over six-fold to accept training in ophthalmology (representing a bundle of unpopular but priority specialties). In contrast, the location of work before training did not significantly influence most doctors' choices when guaranteed specialty training. Using a latent class model, we identified four subgroups of junior doctors with distinct preferences. Policy simulations showed that these preferences could be leveraged by policymakers to improve retention in exchange for guaranteed specialty training, however incentivising the uptake of training in priority specialties will only be effective in those with more flexible preferences. These results indicate that indiscriminate expansion of postgraduate training to slow emigration of doctors from sub-Saharan African countries may not be effective unless doctors' preferences are taken into account.

Commentary: the role of epidemiologists in funding biomedical education and research.

Melissa Perry served as the president of the American College of Epidemiology from September 2014 to September 2015. This is a written version of her Presidential Address at the 2015 Annual Meeting. Her speech was inspired by a 2014 Wall Street Journal commentary by Dr. Ferric Fang of the Washington University School of Medicine and Dr. Arturo Casadevall of the Albert Einstein College of Medicine of Yeshiva University. They likened the process of submitting a research proposal to the National Institutes of Health to playing the Powerball lottery. In her speech, Dr. Perry argued for the urgent need for epidemiology researchers to reach out to policymakers and the public in support of our field to ensure the continuation of research projects that can help improve the health of citizens everywhere.