Teaching core Epidemiology & Biostatistics: A qualitative review of approaches. Glenda Lawrence. Public Health and Community Medicine

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1 Teaching core Epidemiology & Biostatistics: A qualitative review of approaches Public Health and Community Medicine Glenda Lawrence

2 Background Epi & Biostats are foundational competencies in PH All MPH (& UG) graduates require core knowledge & skills National competency frameworks & professional registration Questions re: how to improve teaching practice What is the minimum that all MPH graduates should know? What factors influence curriculum design? How is competency best assessed? What are the main challenges in teaching epi & biostats? What approaches work to enhance student engagement?

3 Aim Explore these questions using qualitative methods Review of information obtained from university websites Australia, US, Europe, UK Review of PH competency frameworks Australia, US, Canada, Europe, UK Qualitative interviews with experienced academics who teach core epi and/or biostats in MPH programs UK, US

4 Methods Qualitative interviews convenience sample 8 Universities 4 UK (Russell Group) 2 teach combined epi & biostats 4 US (top 10 SPH) 2 teach combined epi & biostats Mix of fully F2F, blended, fully online; or separate F2F and online Ethics approval - all data de-identified (incl institution) approach to identified senior academics (+ snowball to identify other academics teaching intro level) Data analysed themes

5 Interviews Interviewed 27 people (1 via Skype) Mix of 1-3 people interviewed per session Semi-structured Entry requirements, number of students, mode(s) of delivery Curriculum and influences in design / review of curriculum Approaches to delivery / innovations to enhance engagement Methods of assessment Challenges Perception of student understanding of epi & stats linkage (Development and sharing of resources activities, exam qs)

6 Results Number of students per class ranged Increasingly diverse student population Universities moving away from focus on medical graduates to broaden entry requirements Changing teaching approaches Increasing use of online / blended teaching Increased combining of epi & biostats teaching Level of integration varies some are 2 parallel streams within a single unit, including separate exam Qs Majority of MPH programs comprise up to 1/3 thesis

7 Curriculum Design Range of factors considered Requirements of PH registration exams (UK, US) MPH accreditation requirements (US) Competency frameworks ASPHER, UK, US Canvassing/surveying government PH staff (UK) Staff views / experience Due to diversity of students and their needs All students do basic level; PH trainees also do advanced Some streaming in the US to start at a different level and progress to advanced concepts quickly (e.g. Quantitative or Epi streams)

8 Curriculum basic / core level Epidemiology All taught measures of disease freq & association, study design, error & bias, confounding, critical appraisal, screening, causation (greater emphasis in US introduced earlier) +/- outbreak and surveillance (taught in other PH courses) Biostatistics more varied All taught descriptive & inferential statistics; simple linear regression, sample size calculation Some extended to principals of multiple linear & logistic regression Differences in view of whether students should be able to hand calculate or only use software (correctly) & interpret output Should non-parametric methods be taught as core? Predominantly use STATA or SPSS for analysis

9 Teaching When taught fully F2F: Number of contact hours varied a lot 2 hrs/wk for 8 wks (Epi only) to 8 hrs/wk for 10 wks (combined) Weekly Lecture(s) plus lab & tutorial Blended - used to deliver short lectures plus online discussion forums & quizzes with feedback Online recorded lectures; wikis for group critical appraisal; synchronous weekly interactive tutorials

10 Innovation More online teaching Blended delivery, wikis, quizzes MOOC style online delivery Engagement - examples Current PH/epi real world stories/debates, YouTube videos etc RCT using a James Cook U Bandaid removal and pain score study Use of games in statistics Using real data for analysis and learning activities Move to teaching epi and biostats together Of the 4 identified as separate, 3 now moving to teaching together to enhance student understanding of the link between epi & biostats.

11 Assessment Formative and summative Exams Predominantly closed book (with some formulas provided) MCQ, short answer, some calculation Rarely required to do critical appraisal % of the total mark Home work assignments include critical appraisal Online quizzes with feedback provided Group projects data gathering & analysis; or critical appraisal via wiki

12 Challenges Diversity of student ability and confidence More challenging when students are in the same class Some students are fearful of epi and stats Increasing expectations by students Need for more opportunities to share teaching experiences and resources with other academics Many welcomed idea of sharing teaching and assessment resources with other academics internationally

13 Limitation Small, non-representative sample of universities Qualitative descriptive study Hasn t answered question of what should be the base level epi and biostats knowledge and skills of all PH graduates

14 Conclusions More common than differences in approach Curriculum design Topics covered Challenges Epi and biostats are core (and key) Opportunity to develop an international community of practice and resource sharing in teaching core epidemiology and biostatistics Important as Global PH competencies are developed and implemented

15 Acknowledgements Thank all participating academics in 8 institutions Lois Meyer (UNSW) SPHCM travel grant

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