School of Public Health: External Review Report

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1 School of Public Health: External Review Report Prepared by: Kristan J. Aronson, Queen s University Craig R. Janes, University of Waterloo Beth Virnig, University of Minnesota Robert Tyler, University of Saskatchewan March 24, 2015 (Final External Review Report)

2 EXECUTIVE SUMARY We recognize that the School of Public Health at the University of Saskatchewan has been through a turbulent time. A difficult leadership transition coupled with rapid growth in student numbers without commensurate growth in the faculty complement has compromised its charter mission and vision. Nevertheless, it is important to acknowledge at the outset many of the accomplishments and achievements made over the eight years since its inception: The School was able to establish a successful MPH program. Numbers have grown substantially since its launch, and the School was able to achieve accreditation for the MPH program from the Agency for Public Health Education Association (APHEA) in This accreditation recognizes clearly that the program has met, despite growing pains, an international standard for public health education. The School has been able to launch a MSc/PhD program in Epidemiology, and in Vaccinology and Immunotherapeutics, and participates in a collaborative MSc/PhD program in Biostatistics. Selected faculty members (both those appointed to the school and joint appointments) have established successful individual research programs. Several faculty members are committed to and demonstrate excellence and innovation in teaching. These are important accomplishments and should provide a good foundation for the School as it moves into the next phase of its development. However, several serious issues and problems were identified in this review. There appears to have been a shift in mission and vision over time that has led to conflict among faculty and between units. Partly this shift may rest on the decision by SPH leadership early on to focus heavily on MPH growth at the cost of other programs and development of a coherent research focus. This has led to a troubled history of collaboration with key UofS partners, especially the College of Medicine, in particular the Department of Community Health and Epidemiology, but also including a number of research centres (VIDO, CCHSA, SPHERU, IPHRC), the School of Public Policy, and the School of Environment. Engagement with the public health system of the province and local community was also noted to be weak: the School has not stepped into the position of public health leadership that was envisioned in its charter mission and vision. In terms of governance the School has been troubled from the beginning. Initially meant to be a unit with a large faculty complement, comprised in part by a significant number of primary joint appointments, the School, for a variety of reasons, has not achieved the critical mass necessary to meet its principle research and educational objectives. This may in part stem from the early development of the School when the resources and incentives available were insufficient to attract and retain the support of key stakeholders. The School was never able to engage constructively with the Department of Community Health and Epidemiology, its most obvious (and needed) partner. Leadership difficulties, perceived lack of consultation with rank and file faculty, and flawed decision making processes have become barriers to building a cohesive, collegial and positive community within the School. Lacking effective partnerships either within the University or in the external community, and having failed to engage constructively with Community Health and Epidemiology, without significant School of Public Health: External Review Report Page 2 of 21

3 organizational and structural changes the School is in our view unsustainable. The focus on the MPH degree as the principal means of School growth and development was possibly misplaced, and has led to the atrophy of graduate research programs as well as the attenuation of collaborative programs that would have better linked the School to other programs and research units. The rapid growth of the MPH and the pressures on faculty that this entailed may in large part be responsible for the unremarkable research profile of the School. While some faculty have established strong research careers, in general the research profile of the School is modest and unfocussed; this will compromise further growth and development of the School. The School never embraced the research leadership that might have been provided by the two Chairs it was allocated the Centennial Chair and the Canada Research Chair in Environmental Health. We observed with concern that some faculty may not be well positioned to secure tenure. In order to address these problems we recommend that the School, along with its University and community partners and the upper administration, engage in a period of conversation and reflection about the future of the School. We identify a number of specific recommendations in the text of this document. In general these recommendations may be summarized as follows: School faculty and leadership, and their internal and external partners, need to reflect on, clarify and/or rethink the mission and vision of the School, resolving the conflicts or divergences that may have arisen since The relationship between the School and the Department of Community Health and Epidemiology must be resolved. There is no plausible future option for the School that does not include integration with that Department. The Department of Community Health and Epidemiology cannot be allowed to remain on the sidelines of this discussion, and must take some leadership responsibility going forward. Identify and engage leadership who can begin to repair some of the distrust and bad feelings that now characterize relationships between the School and other partner units. Welldesigned and substantive democratic and consultative processes are clearly needed. Assertively engage partners both external and internal to the University. Rethink the strategic enrollment plan of the School, identifying means for balancing enrollment in the MPH and research degrees in the context of the available faculty complement. Develop and reward effective research partnerships that link School faculty with researchers in other units. Develop means for providing research mentorship for faculty and ensure that faculty time for research is protected. While CEPH accreditation should remain a goal, it can only be realistically pursued if all of the above issues are dealt with first. School of Public Health: External Review Report Page 3 of 21

4 TABLE OF CONTENTS 1. Introduction Mission and Vision of the School of Public Health Organizational Structure and Governance Academic and Educational Activities Research Activities Partnerships Conclusions and Overarching Recommendations School of Public Health: External Review Report Page 4 of 21

5 1. INTRODUCTION The site visit was conducted on January 28 and 29. The School did not prepare a self-study document in preparation for the visit nor were we provided with an updated document reflecting the current mission and vision of the School. We relied in our analysis on an overview (positioning paper) document from 2015 provided to us; the three planning cycle reports for ; several reports and data tables from the accreditation self-study report prepared for the European-based Agency for Public Health Education Association (APHEA); and some written notes and documents provided to us by individual faculty from the SPH and CHE. We met with several stakeholders in oneon-one and small group meetings. These stakeholders included: Ernie Barber, Interim Provost; Nazeem Muhajarine, Interim Executive Director for the SPH; George Mutwiri, Assistant Executive Director and MPH Program Director for the SPH; Suresh Tikoo, Graduate Chair, V&I Program Director for the SPH; Michael Atkinson, former Provost and current Executive Director of the Graduate School of Public Policy; Adam Baxter-Jones, Dean of the College of Graduate Studies and Research; Bruce Reeder, Professor in the Department of Community Health & Epidemiology; Preston Smith, Dean of the College of Medicine; and (by phone) Robert Buckingham, Professor and former Executive Director of the SPH. We also had group meetings with: SPH staff; external partners from the local public health community; SPH faculty members; UofS Health Science Deans/Leaders; and representatives from the Collaborative MSc and PhD Program in Biostatistics and the PhD Program in Epidemiology (which included representatives from the Vaccinology and Immunotherapeutics program and current department heads of Community Health & Epidemiology, and Mathematics and Statistics), and a group of graduate students. School of Public Health: External Review Report Page 5 of 21

6 2. MISSION AND VISION The charter vision of the School of Public Health (SPH) developed in 2007 focused on creating a center of excellence in interdisciplinary public health research and education in areas of identified strength in the University. These areas centered on veterinary public health, agricultural and rural public health, Aboriginal people s health, and socio-behavioral health. As part of a University commitment to interdisciplinary and collaborative models of graduate education, the School was to be built on a framework of existing centers of academic excellence present in several Schools, Colleges, and research institutes, with additional new investment in faculty appointments, including a Canada Research Chair and a Centennial Chair. The School was to focus on outreach to and engagement with the local and provincial public health community, building on some successful relationships already developed by the Department of Community Health and Epidemiology (CHE) within the College of Medicine. One of the principal objectives of the new School was to attain accreditation from the U.S.-based Council on Education for Public Health (CEPH), a key milestone that was intended to signal the quality and national/international standing of the School. In the overview paper provided to us, an updated vision for the School from December 2014 is expressed quite simply as a commitment to becoming a preeminent center of learning, bringing together innovative thinkers from multiple disciplines to solve public and population health problems. This newer vision also articulates values of respect and integrity, collaboration among disciplines, environmental stewardship, social justice, and sustainability. Several aspirational objectives follow; these focus somewhat more on gaining international recognition than the original vision, in addition to continuing local engagements. Consistent through all the documents is a strong emphasis on interdisciplinarity. We found that that many key stakeholders who were active in the founding of the School continue to endorse in broad strokes the original mission and vision. We agree that the University is particularly well positioned to develop programs in veterinary public health (OneHealth) initiatives, rural and agricultural public health, and Aboriginal peoples health. However, there did not seem to be a clear consensus in the School that the founding mission and vision remained fully relevant, especially in terms of whether or how the School might engage with and advance these broader initiatives, either within the University, or with partners in the wider provincial or national public health community. In part this lack of clarity may be related to the enormous stresses experienced by faculty as a result of rapid growth of the training program, insufficient faculty to meet the training obligations, and a difficult leadership transition. These stresses have understandably turned the focus of the School inward as faculty struggle to maintain their individual teaching and research responsibilities. Some evidence was provided that suggested that leadership who shaped the direction of the School after 2007 may have pursued a somewhat different set of objectives for the School than initially envisioned, shifting from a programmatic focus on the local and provincial public health community to one less focused on local partners and situated more in terms of international public health priorities (though we were not provided with a cogent, written formulation of this vision). For School of Public Health: External Review Report Page 6 of 21

7 example, SPH faculty expressed a conflict between those within the School wishing to be international in scope and those who wanted a smaller, more local, community-based School that would primarily serve the needs of the province and health region. It is not clear to us whether this apparent discordance in scope is widely perceived, nor is it clear that emphasis on one orientation necessarily precludes the other. However, we found that the lack of consensus among key stakeholders as to a clear current mission and vision, when coupled with other pressures and stresses on a too-small faculty complement, has contributed to failures to meet the ambitious School objectives identified in the founding proposal. These have attenuated or precluded the development of necessary partnerships internal to the University, and have compromised ties to the local public health community. It is unlikely, however, that differences in opinion about the appropriate mission and vision fully explain all of the conflicts and problems that have emerged since the founding of the School in Our discussions with key stakeholders and review of prior reports pointed to the following ongoing issues related to a lack of a coherent mission and vision for building the School: Relationships with the College of Medicine, in particular the Department of Community Health and Epidemiology, broke down early in the development of the School. This clearly hamstrung the development of a fully functional School with expertise in all of the core areas of public health. The University now has two largely non-cooperating public health academic units. This is not sustainable. Issues of whether an independent School could be trusted to meet Medical School accreditation needs was repeatedly raised. The extent to which the needs of the Medical School drive the structure of public health entities needs to be addressed at the highest level of University leadership. As we document in more detail in the Partnerships section below, the School was unable to, or chose not to, establish strong collaborative relationships with key University partners in other health sciences units and research centers. Failure to fully establish collaborative relationships within the University extends as well to key external bodies. The School has not been well engaged with the provincial public health system nor with community partners outside of meeting needs for MPH student practicum placements. As a consequence, the School has not yet been able to engage in or foster much applied public health research. Although we acknowledge that it takes time to build such relationships, efforts in this domain have been inadequate. Positive achievements were also noted. The School was able to launch a sizeable MPH program, which after some early problems, appears to have stabilized under recent new leadership. Thesisbased programs have also been established: the collaborative program in biostatistics and the vaccinology and immunotherapeutics program are potential successes. An online MPH program has been launched, although numbers are to date smaller than anticipated. Accreditation of the MPH program by the Europe based accrediting agency (APHEA) is an important accomplishment. Some individual faculty members have been able to establish or maintain successful research programs. Because CEPH accreditation was considered from the beginning to be an important objective of the School of Public Health: External Review Report Page 7 of 21

8 School, and central to its mission and vision, it deserves a special note of explanation and analysis. CEPH accredits public health education in two ways: First, it accredits individual public health programs, primarily the MPH degree, but also the DrPH and a growing number of baccalaureate programs; academic research degrees (MSc/PhD) may be included under a program s accreditation umbrella (or unit of accreditation). Program accreditation at this level does not require establishment of an independent School. Secondly, CEPH accredits structurally independent Schools of public health (similar in structure to Colleges or Faculties). Here the standard is much higher in terms of the size of the faculty complement and the range of specializations; e.g., a minimum of five faculty in each of the five pillars of public health (epidemiology, biostatistics, environmental health, health management & administration, and social-behavioral health sciences). This second model requires much greater investment on the part of the institution and accreditation criteria are much less flexible. To date in Canada, only the University of Alberta has achieved accreditation as a School. Simon Fraser University and the University of Montreal have their specific programs accredited (at Simon Fraser University all degrees are included under the accreditation umbrella: BA, BSc, MSc and PhD degrees in Health Science, as well as the MPH). All CEPH accredited Schools and Programs are invited to join the Association of Schools and Programs of Public Health, which is the major public health education association in North America. At present, CEPH requires that any independent institution of public health that is identified by the nomenclature of college or school adhere to the more stringent requirements, although these criteria are currently under review by CEPH s governing body. 1 Thus, in order to be accredited by CEPH, the School of Public Health would need to remain independent of other units (particularly the Medical School), would need to build a sizeable complement of faculty, multiple MPH streams and a PhD in at least three streams. Thus the School would not only need a considerable investment of new resources, it would require that the Department of Community Health and Epidemiology join the School, along with several other faculty from partner units. It does not appear to us that the University at the time of the creation of the School provided the necessary resources, nor did it evidence the political will to make this happen. At least in terms of CEPH accreditation, the School s aspiration appeared doomed from the beginning. Thus, although the vision and mission point clearly to establishment of an independent School, requisite resources to do this in a way that would meet the standards of accreditation were not provided at any point in the School s development. Recommendations Mission and Vision 1) It is our opinion that the School needs to undertake a period of reflection on its educational and research mission, ideally with its natural allies and partners within the University and community, in order to reinvigorate its mission and vision and to produce an updated and realistic agenda and action plan, supported by clear University resource commitments, for meeting the renewed set of objectives that will no doubt emerge. 1 CEPH is in the midst of changing its criteria for accreditation, and based on conversations with CEPH on February 13, 2015 (Janes had a telephone call with Kristin Varol at CEPH about a number of unrelated topics, but the UofS came up in the conversation), it is possible that the School versus Program distinction may be considerably blurred or erased altogether. This decision will be made by mid-year. If the distinction is reformulated, it may provide an opportunity for the School to renew its progress toward CEPH accreditation as an independent unit.. School of Public Health: External Review Report Page 8 of 21

9 2) Accreditation should remain a goal, but consideration needs to be given to whether the goal of an independent, accredited School of Public Health is attainable in the currently constrained resource environment of the UofS. Other options, including integration with CHE under a current Dean, should be explored. School of Public Health: External Review Report Page 9 of 21

10 3. ORGANIZATIONAL STRUCTURE AND GOVERNANCE At its inception the School of Public Health was to be organized under a collaborative, interdisciplinary model of governance: the School would have some primary appointments but would also be expected to bring into the School through a mechanism of joint and associate appointments faculty from other units. The School was to be led by an Executive Director who reports to the Provost and sits on the Council of Health Science Deans. Ideally, leadership of the School would have been established with a Dean at the helm, and some problems may have arisen initially through a perceived lack of equivalence of an Executive Director at the Decanal level. Further, it is clear from our discussions (although written documents remain ambiguous on this point) that many, if not most, of the faculty of Community Health and Epidemiology within the Department of Medicine were expected to join the School, along with smaller numbers from most of the other health sciences units. Without clear incentives for doing so, coupled with the perhaps natural territoriality of Deans and Department Heads, building such a collaborative unit is complex. It requires skillful leadership, a great deal of persuasion, and, at the end of the day, some strategic influence of Provost-level administration to make such things happen. Beyond a smile and a handshake, it is clear that for the School to have gotten off to a good start, some major realignment and reallocation of resources would have been required at the outset. This did not happen: the School was never able to acquire the human and financial resources needed to meet its objectives. At present, Community Health and Epidemiology, a key player in the development scenario, does not appear to be engaged with the School. We consider this to be an unacceptable and unsustainable state of affairs that must be corrected if the University is to maintain its commitment to an independent and interdisciplinary School of Public Health. It is not efficient use of resources for the University to maintain two separate public health programs. The Dean of Medicine, who was not at the UofS when the School was founded, needs to support this integration and should be assured that regardless of departmental/school configuration, the School of Medicine accreditation and training needs will be met. The contentious departure of the previous Executive Director led to the unpopular (from the perspective of the School) appointment of an interim ED, which has eroded the legitimacy of the role. Coupled with rapid, almost uncontrolled, growth of the MPH program, which requires considerable investment of administrative resources, it is clear to us that the current organizational and leadership structure of the School is inadequate to manage and support either teaching or research activities. School faculty seemed adrift, struggling to meet heavy teaching and supervisory responsibilities and often electing to delay establishing research careers in the absence of available time, good mentorship and organizational clarity. We worry that the research careers of new faculty will continue to be sacrificed in such an environment. And, as several reports, the survey results provided, and our meeting with students suggest, students have also suffered. However, we hasten to acknowledge that the MPH program has improved greatly under the administration of the interim Executive Director and Associate Executive Director. School of Public Health: External Review Report Page 10 of 21

11 Faculty morale is low. Some were quite angry with the state of affairs that they found themselves in, many were concerned about the future of their careers and the School, and a clear desire for effective leadership was expressed to us on several occasions. Indicative, perhaps, of an as yet unor poorly-developed management and organizational structure, concerns were expressed about getting credit for things credit for students (in the collaborative programs), credit for research grant income if the PI is in another unit, etc. Finally, many of the faculty in the School felt that they were rarely consulted regarding decisions that affected them, including the appointment of the current interim Executive Director. We were also informed of a search for an epidemiologist that, despite reported consensus decision at the School level, was declared failed at the Provost level without apparent consultation with the School. Because this information came to us in a letter after the site visit was completed, we are not sure whether this information is accurate or complete or whether it was under the guidance of past or current leadership; nevertheless, this speaks to low faculty morale and perceptions of ineffective governance and poor consultation processes. Despite the poor state of faculty morale, staff morale generally seemed good. They were generally positive about faculty and students, though they also worried about the poor relationship between the School faculty and the interim ED. This, of course, is a major concern. However, the staff are clearly hard working and dedicated, and carry a great deal of the administrative burden, especially for the MPH program. The size of the staff complement appears insufficient to meet School objectives if both teaching and research support are to be part of their responsibilities. As a final note, we did not undertake a careful analysis of financial resources in the School. We understand that a new activity-based and transparent budget model will be phased in shortly. What figures we had available suggested that the School will be adequately resourced for its educational activities, and shows some room for expansion. Interestingly, we were informed by some that the School has surplus resources, and that in the past some available funding for graduate students from the graduate school had been foregone. In light of complaints about insufficient faculty resources, the appearance of surplus or unused funds is paradoxical. We are not sure whether this is an outcome of poor financial management in the School, or a reluctance by upper administration to invest further resources in the School in the context of its publically visible problems and conflicts. Recommendations Organizational Structure and Governance 1. Clearly some decisions need to be made regarding the relationship between the SPH and CHE. There are a number of options for doing this, which we articulate with some specificity in the final section of this report. Regardless of which option is chosen, a focus on effective leadership and the development of a consultative model of governance, respectful of democratic decision-making processes, is essential at this time. There is a considerable level of bad feeling and distrust that has affected faculty morale, and likely their productivity. The politics underlying the SPH are long standing and appear to continually re-infect new faculty. It is likely that trust will need to be established well before any significant structural changes can be implemented. It will also be important that senior academic leadership commit to actively supporting whichever future option is selected. School of Public Health: External Review Report Page 11 of 21

12 4. ACADEMIC AND EDUCATIONAL ACTIVITIES The School of Public Health currently offers a professional (generalist) MPH degree, MSc & PhD degrees in Vaccinology and Immunotherapeutics and a PhD in Epidemiology, and it collaborates with CHE and Mathematics and Statistics to offer a MSc and PhD in biostatistics. Although not necessarily obvious from the inception documents, the primary focus of the SPH as it developed became the rapid growth of the MPH. The leadership of the School pursued an approach where students were seen as the principal mechanism by which the faculty complement would grow, and once the faculty grew, research-based (thesis) programs could be developed. We noted, however, that this particular strategy was not articulated in the framing proposal for the School, nor was it clear that the successful development of the School depended solely on the rapid roll-out of a large MPH program. Some of the key stakeholders consulted suggested that this shift in strategy may be one of the points where the later mission and vision diverged from the original charter, leading to some of the challenges identified above. With the information provided to us it was not possible for us to fully judge the quality of educational programs nor their educational/knowledge outcomes. However, we did note that the School was able to achieve accreditation for the MPH program from the European APHEA. The selfstudy and subsequent accreditation report suggest that the MPH program meets international standards for quality, scope and breadth of the curriculum. Although APHEA noted growing pains, their site visit report was overall positive. Many of these growing pains were evident in the survey responses provided to us (the survey was administered for purposes of this review). There were quite a few complaints by students and alumni about the quality of the program, coherence of the curriculum, availability of courses, teaching, difficulties obtaining practicum placements, and general faculty support. Other than what we were able to glean from the survey of alumni, no data were provided on what MPH graduates did after completion of this degree. The survey responses did indicate that the program was generally helpful in providing the skills that graduates needed for their current job. We did hear from a sampling of MPH students and stakeholders concerns that the program grew more rapidly than the local public health market was able to sustain. The thesis-based research programs are quite small at this point. We met with a few students from these programs in a group context. No clear message regarding program quality emerged from these discussions (the MPH students were more vocal). Some expressed satisfaction, largely based we believe on the quality of mentorship they received, or were receiving, from their faculty supervisors. Some indicated that the focus on the rapid scale-up of the MPH led to the neglect of the research based programs. Despite some of the difficulties flagged by students and in the survey, our meeting with students suggested that many positive changes have occurred over the past year or so, improving things for current students, especially in the MPH program. The current MPH director was reported to have done a good job in dealing with many of the program s growing pains, and currently enrolled School of Public Health: External Review Report Page 12 of 21

13 students generally expressed satisfaction with the program. Faculty representatives generally felt that the quality of the collaborative biostatistics program was high, though they felt that the program could be better organized, and collaboration could be enhanced. However, all felt the program got off to a great start and was providing excellent research skills to graduates. We believe this collaborative approach might be an effective model for other programs. Conversely, we found that the School-based program in Epidemiology is struggling. Program representatives indicated that there were not enough faculty, and in one case a faculty hire in epidemiology was scuttled at the Provost level. Shortages of funding across all of the programs was noted as a particular problem, though in at least one report, $30,000 in funding allocated by the University to SPH students was left on the table. Several faculty noted the failure of the School to develop and offer a thesis-based MPH option with the MPH program. School faculty blamed upper administration for stalling or blocking this degree. Others outside the School faulted the School and its leadership. Regardless of who or what is to blame, the rationale for offering such a degree was not clear to us. Some additional strategic thinking about this and the other research programs is clearly in order, though we acknowledge that this will depend on other decisions, especially the future of the School and the size of the faculty complement. Finally, and very much a concern both for the future of the research-based programs and for the research profile of the School more generally (as we indicate below), two Chair positions originally allocated to the SPH a Centennial Research Chair and a Canada Research Chair were lost. We were told that the Centennial Research Chair left due to lack of support from SPH leadership, and that the Canada Research Chair was lost because it was never filled. Insofar as these Chair positions would have provided critical research leadership for the School and its thesis-based programs, this is a clear problem and area of weakness in the School. Students expressed concerns that international students need more cultural/social support and a more gradual orientation to their new homeland and public health system prior to starting a heavy course load. Concern was also expressed regarding lack of communication to students regarding standards of academic integrity, written policies with regard to procedures/guidelines for each degree, milestones/deadlines and appeals procedures. We believe that the School may have enrolled more international students than they had the resources to support. We suggest that the School may wish to rethink international student enrollment targets, or bring international student enrollments in line with those in the University as a whole. As we discuss above, accreditation by the Council on Education for Public Health (CEPH) was highly valued by the leadership and faculty of the SPH, and was part of the original SPH vision. This was the rationale for the extremely rapid increase in student enrollment in the MPH program, with the logic expressed that additional faculty hires would be offered by central administration to support the large student body, and the number and disciplinary mix of faculty would then grow to meet the accreditation standard (five faculty in each of the five core disciplines of socio-behavioral sciences, epidemiology, biostatistics, health policy/leadership, and environmental health). Accreditation remains an objective for faculty, but with its current complement of faculty the SPH cannot meet the School of Public Health: External Review Report Page 13 of 21

14 CEPH standard. Because of the very rapid growth and current large number of students, the SPH has struggled to meet stated educational objectives, even without consideration of accreditation. We believe that there are clearly not enough people to undertake the current teaching load and management/operations of the School s educational programs, even with the participation of faculty from other units. Teaching loads appear to be high, with significant effects on faculty research productivity. Recommendations Academic and Educational Activities 1. Some rethinking of the enrollment strategies in the School are needed, specifically an analysis of target MPH enrollments in the context of the current faculty complement and the desire to build out the research programs. A realignment of priorities to balance the professional and research degrees is clearly in order. Student enrolment should be capped at a level that maintains high quality educational programming. With regard to the MPH, consider linking enrolment to needs in the public health community to avoid flooding the market," and remember that enrollment targets should reflect capacity for both classroom training, applied projects and advising. The School should consider capping the percentage of international students at 35% (the same as at the graduate level at the UofS as a whole), unless more resources are devoted to cultural orientation, more transition time is allowed prior to starting courses, and more consideration is given to job placement for international students postgraduation. 2. Students are very concerned about academic integrity; the School and faculty should be as well. Modules related to plagiarism, etc., might be incorporated into foundational curricula for all SPH programs. Violations of academic policies should be dealt with promptly, and in accordance with University procedures. 3. The collaborative model that appears to be successful in relation to the biostatistics program might also serve as an organizing mechanism for other programs, and will also foster collaborative partnerships that the School has not yet been able to foster. 4. Although a thesis-based MPH degree was articulated as a key objective by many stakeholders, the rationale for offering this degree vis-à-vis other available research-based masters degrees was not clear. This goal should be reconsidered in light of the other strategic planning that needs to be done to sustain public health education at the UofS more generally. 5. We endorse the objective of accreditation by CEPH, if that remains a value for the SPH. However, consideration should be given to accreditation of the MPH program instead of the entire School, though this will depend on revisions to CEPH criteria. Mapping course content onto competencies expounded by CEPH and other agencies would be an excellent practice. Also, it is important to note that meeting quality standards in public health does not mean standardization; in fact, the SPH might work on a process that has the goal of identifying School of Public Health: External Review Report Page 14 of 21

15 three or four niches that reflect clear strengths. We note that this was in fact part of the original vision for the School. 6. Student funding should be a priority, and a closer relationship with Graduate Studies is required to maintain high admission and academic standards as well as access to funding. School of Public Health: External Review Report Page 15 of 21

16 5. RESEARCH ACTIVITIES The possibility of interdisciplinary faculty collaborations and synergies was repeatedly noted as a primary motivation for the founding of the School. This work would seem to be first manifested in the arenas of research and scholarship. However, in spite of this initial promise, research has largely failed to deliver on its potential. Throughout documents and meetings, it was clear that research was not a priority in decisions around faculty hiring, promoting growth, or internal or external collaborations. While the strategy of focusing on teaching first and research second, using student demand to secure faculty positions, might seem reasonable, it is also clear how it can backfire. Lacking a strong research presence, the strongest researchers are lost to stronger institutions (e.g., the Centennial Chair). Finally, it appears that teaching overloads have led to faculty paying too little attention to their research and, ultimately, to underdeveloped curriculum vitae that will make tenure cases challenging in some situations. Finally, there is little infrastructure around securing external funding, building collaborations, or research resources. In short, the overall research profile of the School has not been well developed. Funding levels are low, with modest tri-council funding noted (six current tri-council awards to current primary faculty in the School, most of this to those in the Vaccinology program/vido). The publication record of primary faculty is also quite modest. The research agenda appeared to us to be unfocussed. The CRC in Environmental Health that was allocated at the inception of the School was not filled, and the Centennial Research Chair was vacated when the incumbent left and there has been no replacement. Ineffectually managed growth of the MPH program appears to have been achieved at the expense of thesis-based research programs that might have helped foster a stronger research program, particularly in partnership with faculty in other units. Recommendations Research Activities 1) Encourage SPH faculty to partner with established researchers across the University to increase the size, scope and quality of the research portfolio. 2) Develop multidisciplinary, cross-unit mentoring plans for all tenure-track faculty. These mentoring teams should provide advice and guidance about research focus and strategies, grant seeking, publications, etc. Mentors should be drawn from the broad network of centers, departments and schools discussed below in the partnerships section. 3) Develop minimum research and teaching levels for all tenured and tenure-track faculty in this unit. There were signs that some senior faculty were almost completely focused on externally funded research and did virtually no teaching in the program, and some junior faculty had the opposite profile. While, on average, all faculty teach and do research, this model is unsustainable and unfair. School of Public Health: External Review Report Page 16 of 21

17 4) Ensure that all faculty hires on tenure-track appointments include evaluation of research potential as well as teaching potential, and that a realistic teaching and research plan, including start-up funds, be included in the request for position approval. Search committees should reflect the diversity of potential partner departments. 5) The UofS should identify strategies to promote and reward cross-college collaboration in the area of research. School of Public Health: External Review Report Page 17 of 21

18 6. PARTNERSHIPS Partnerships are essential to the success of a School of Public Health. The interdisciplinary nature of public health leads naturally to collaboration with, and contributions from, several departments, schools/colleges and faculties across the University, and with external agencies at all levels of government, as well as non-governmental organizations with sympathetic missions. The University of Saskatchewan sits at the hub of an expansive network of institutions, agencies and organizations whose purpose and focus contributes directly to or is complementary with the mission and goals of the SPH. As mentioned earlier, the original vision of the SPH focused on excellence in interdisciplinary public health research and education in areas of identified strength in the University such as veterinary public health, agricultural and rural public health, Aboriginal peoples health, and socio-behavioral health. Existing centers in several schools, colleges and research institutes would provide foundational strength for the SPH, an explicit manifestation of the University of Saskatchewan s commitment to interdisciplinary and collaborative models of research and graduate education. Further, the original intent was that the School would have strong partnerships through outreach and engagement with the local and provincial public health community, building on successful relationships already developed by the Department of Community Health and Epidemiology within the College of Medicine. Indeed, the public health system provincially and nationally should be viewed as key partners in advising the SPH on needs and priorities for education and research programs, and likewise the SPH faculty and graduating students could be of great assistance to the provincial and national public health system by producing evidence and translating evidence into practice through many avenues such as surveillance, analyzing trends, health promotion, intervention research, commissioned research, expert reviews/advice, providing surge capacity, etc. Research groups with SPH faculty at the helm are: MERCURi Research Group, Population Health Data Laboratory, and VIDO/InterVac. Other well-funded research centres at the University that have clear public health mandates have more tenuous or no relationships with the SPH such as CCHSA, SPHERU, IPHRC, Saskatchewan Cancer Control, Saskatoon HIV/AIDs, etc. There are some positive relationships across schools/faculties apparent for some OneHealth initiatives with the Western College of Veterinary Medicine, such as the Integrated Training Program in Infectious Diseases, Food Safety and Public Policy (ITraP), an interdisciplinary, international training initiative with the goal of reducing the medical, economic and social impacts of outbreaks for people, industries and the public sector. While there is great potential for education and research partnerships with other health sciences units (Kinesiology, Nursing, Public Policy, and Environment and Sustainability), these relationships have not been fostered to their level of potential. There was no evidence presented to us that the SPH has been consistently engaged with the provincial public health system. A few community partners are engaged through hosting MPH practicum students. The positive cross-fertilization that could occur between the practice of public health locally and the SPH, for both public health education and research missions, is not apparent at this time. School of Public Health: External Review Report Page 18 of 21

19 Mutual benefits from strong partnerships would greatly bolster the ability of the SPH to achieve its mission. Articulation of key principles, objectives and implementation steps through affiliation agreements would be ideal. These partnerships between the SPH, both internal and external to the University, ultimately will improve the health of populations though public health education, research, and practice. Recommendations Partnerships 1. The School needs to be much more assertive in developing and engaging with partners both internal and external to the University. Such partnerships were a particularly important strategic element of the original proposal to develop the School, and will be absolutely critical to its long-term success. 2. Increase outreach and mutual interactions with Aboriginal communities for all aspects of mission including service and research, and to encourage Aboriginal students to apply to graduate school. 3. Develop and foster close ties with the public health system in Saskatchewan and Canada. School of Public Health: External Review Report Page 19 of 21

20 7. CONCLUSIONS & OVERARCHING RECOMMENDATIONS Our main conclusion is that the University cannot sustain two separate public health units if the initial mission and vision for a School of Public Health are to be met. Nearly all of the difficulties and challenges identified in this report derive from this finding. We urge the University and its key community stakeholders to engage in a dialogue about how to integrate Community Health and Epidemiology and the School of Public Health, but in a way that does not attenuate or preclude partnerships and links to other units on campus. There are a number of models for doing this, and the appropriate solution must emerge from a careful consideration of the local context and an intentional, facilitated rapprochement between affected units, allowing sufficient time for reflection and input. However, ultimately all involved will have to put aside their personal concerns and histories and commit to supporting the plan that is selected. No faculty, unit or school can have the luxury of sitting back and waiting to see how things unfold before deciding whether to participate. This is particularly true of the Department of Community Health and Epidemiology. This strategy of waiting to see how things unfold may, in part, have led to the current situation and cannot be allowed to recur. The following four options, some suggested to us by key stakeholders, are worthy of consideration: 1) Integrate Community Health and Epidemiology into the School of Public Health, recognizing faculty interests/needs as well as the accreditation requirements of the College of Medicine. We understand that given a history of past conflicts and past and current reluctance of the Dean of Medicine to relinquish the Department of Community Health and Epidemiology, not to mention the tendency for faculty to be highly risk-averse in contemplating any such change, this may prove to be a difficult option, and would take both time and highly effective and skilled leadership. An advantage to this model is that it better positions the School for CEPH School-level accreditation, national recognition, and, if handled skillfully, presents a better model of interdisciplinary collaboration than any other of the options. If this option is chosen, proper incentives for all concerned will need to be provided. This must be seen as a win-win scenario. Providing growth funds to the School, prioritizing and incentivizing, through salary and other benefits, position transfers from CHE to the SPH, and ensuring that the College of Medicine maintains sufficient resources to staff its community medicine programs will require significant and thoughtful investment by the upper administration. 2) The School of Public Health could be merged into the Department of Community Health and Epidemiology within the College of Medicine. This option would clearly relinquish the objective of an independent School, and would also conceptually envelop public health within the College of Medicine. A long history of development of public health, especially in the U.S., suggests that this may not be an effective way to build a comprehensive program that addresses all elements of public health. Medicine is by its very nature dedicated to clinical research and education. Public health within medicine is often consigned to teaching undergraduate courses and research that has a clinical relevance (i.e., health services research), thus failing to be comprehensive in scope or vision. The Dean of the Medical School repeatedly noted that he was in favor of this plan and used the physical therapy program as an example of his ability to manage non-medical units within the school. This School of Public Health: External Review Report Page 20 of 21

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