Public Health Education at the University of California, Davis: Past, Present, and Future Programs

Transcription

1 Public-Health Training for Veterinarians Public Health Education at the University of California, Davis: Past, Present, and Future Programs David W. Hird g K.C. Kent Lloyd g Stephen A. McCurdy g Marc B. Schenker g John J. Troidl g Philip H. Kass ABSTRACT This article reviews the history of public-health education at the University of California, Davis, from the inception of the Master of Preventive Veterinary Medicine Program in the School of Veterinary Medicine through the creation of the Master of Public Health Program offered jointly by the Schools of Medicine and Veterinary Medicine. The long history of collaborative teaching and research between the schools, as well as the university s close proximity to and relationship with numerous university-affiliated and state public-health agencies, has created remarkable opportunities for novel and creative public-health education. The university is already anticipating the approval of a School of Public Health on its campus, which will create even more educational opportunities in both human and veterinary public-health disciplines. Given the projected shortfall of veterinarians entering such fields, the opportunity of a novel Doctor of Public Health degree program specifically suited to the needs of veterinary medicine is also discussed as a means of addressing this shortage. Key words: public health, veterinary public health, veterinary medical education, epidemiology, DrPH INTRODUCTION The University of California, Davis (UC Davis), has a tradition of public-health education that dates back more than 40 years. What began with a degree program for graduate veterinarians has now become a multifaceted and profoundly interdisciplinary approach to studying health and disease in animal and human populations. This article describes the degree programs that currently exist in public-health-related fields and the goals that we hope to accomplish with ambitious new initiatives on our campus that are nearing the final stages of the University of California s system-wide approval process. THE MASTER OF PREVENTIVE VETERINARY MEDICINE DEGREE PROGRAM The Master of Preventive Veterinary Medicine (MPVM) is a professional degree program in population health and applied epidemiology administered by the School of Veterinary Medicine (SVM). More than 850 veterinarians and other health professionals from more than 75 countries have received the MPVM degree since the first class graduated in Graduates are prepared to work in a wide range of arenas government, academia, and private industry and in a similarly wide range of settings, including human public health and population health in livestock, laboratory animals, companion animals, and aquatic species. Depending on a student s background, the program takes between one and two years to complete. University fees for the one-year program in the 2007/2008 academic year were $11,357 for California residents and $26,345 for non-residents. The program consists of 28 quarter-units of required coursework, 12 or more quarter-units of elective coursework, and a 10-quarter-unit project. Required coursework includes 12 units in statistics (basic statistics and probability, regression and analysis of variance, and multivariable statistics) and eight units in epidemiology (courses in introductory epidemiology, epidemiologic study design, and applied epidemiologic problem solving), information management (especially microcomputer-based spreadsheets and database managers), planning and reporting applied research projects, and policy and risk communication. Elective courses allow students to choose an area of emphasis in population health, food safety, public health and zoonoses, wildlife disease and ecology, ecosystem health, or international health. The required project is a written and oral report of an applied epidemiologic study. The intent is to develop skills in the design and conduct of field research and data analysis. The study must represent a careful, systematic, and creative investigation involving an epidemiologic topic to uncover facts or principles or to develop an educational or disease-control program. Research projects have focused on health and diseases of livestock, poultry, wildlife, and companion animals; zoonoses and public health; and food safety. Approximately one-third of MPVM projects are subsequently published in peer-reviewed journals. There are currently no distancelearning components for the MPVM program, although this option is under study. The MPVM is also offered in conjunction with residency programs leading to board certification. Residents in Dairy Production Medicine and Herd Health and Reproduction spend their second of three years in the MPVM program. Residents in companion-animal shelter JVME 35(2) ß 2008 AAVMC 219

2 medicine and behavior can also include the MPVM in their program. The international health emphasis integrates a one-year MPVM degree with a two-year assignment through the US Peace Corps Master s International program. This integration allows veterinarians to apply knowledge and skills gained from the MPVM program to their Peace Corps assignment, which permits them, in turn, to generate data used for the MPVM project. At the inception of the MPVM program, veterinary medicine was the predominant focus of its classroom examples and scenarios, and students in classes (with the exception of statistics) were predominantly veterinarians. Later, new university programs in epidemiology (MS and PhD) and public health (MPH) were created; many core MPVM epidemiology and statistics classes were incorporated into these programs, and veterinarians then shared the same classroom with physicians and doctoral students in epidemiology, international nutrition, and comparative pathology. Human-oriented epidemiology and publichealth faculty have now become course co-leaders and teachers, enriching students experiences through expanded comparative and integrative learning. THE MASTER OF PUBLIC HEALTH DEGREE PROGRAM Approximately a decade ago faculty and public health professionals at UC Davis, the California Department of Health Services (since reorganized and renamed the California Department of Public Health, or CDPH), and regional county health departments recognized a growing need for public-health education and professionals to serve California s Central Valley and northern California. These areas were experiencing rapid growth and had large rural populations with significant unmet public-health needs. Existing programs in epidemiology and occupational/ environmental health were also growing to address the needs of the public-health community, particularly the CDPH. These imperatives led to the genesis of the MPH program at UC Davis. Many factors facilitated planning and argued for making UC Davis a center of public-health education. First, UC Davis faculty have a global reputation for research in public health and its respective disciplines, especially epidemiology, biostatistics, and environmental and occupational health. These strengths exist across the campus but are especially centered in the Schools of Medicine and Veterinary Medicine. Second, according to the National Center for Zoonotic, Vector-Borne, and Enteric Diseases at the Centers for Disease Control and Prevention (CDC), the majority of emerging infectious diseases and human pathogens are of animal origin, including severe acute respiratory syndrome (SARS), avian influenza, West Nile virus, and pathogens potentially arising from bioterrorism. Third, UC Davis, located at the northern end of California s Central Valley, is near the state capital and the headquarters of the CDPH. There is a long history of collaboration between UC Davis and CDPH, involving cancer, nutrition, infectious diseases, reproductive health, and environmental/occupational health, and many CDPH personnel hold volunteer faculty appointments at UC Davis. The outcome of this planning process was the establishment of an MPH program at UC Davis to focus on practical public-health education, emphasizing the intersection of the public-health needs of the Central Valley and rural California and the expertise of UC Davis faculty. Jointly administered by the Schools of Medicine and Veterinary Medicine, the program enjoys the strong involvement of the practicing public-health community in both teaching and leadership roles. In addition, the program adds a considerable practical focus through partnerships with local, state, and federal governmental agencies, especially the CDPH (the largest health department in the United States, with preeminent programs in tobacco control, preventive medicine, chronic diseases, maternal and child health, and infectious diseases). UC Davis also draws upon campus units already focused on public health, including the Western Center for Agricultural Safety and Health, the Western Institute for Food Safety and Security, the Center for Occupational and Environmental Health, the Center for Advanced Studies in Nutrition and Social Marketing, the Center for Health Services Research in Primary Care, the MIND Institute for study of neurodevelopmental disorders, and the UC Davis Genome Center. The UC Davis MPH program admitted its first class in the summer of Admission was initially limited to clinical health professionals (chiefly those holding MD, DVM, DO, DDS, PharmD, RN, NP, and PA degrees) and students concurrently enrolled in an educational program leading to a clinical health professional degree (e.g., MD and DVM). The original MPH program had a 48-quarter-unit curriculum designed for completion in one year. Because of the recent change to a 56-quarter-unit curriculum mandated by the Council for Education on Public Health (CEPH), the program is no longer represented as a one-year curriculum. While it is possible to complete 56 quarter-units in one year, doing so is difficult and, in many cases, inadvisable. Therefore, applicants are urged to plan for at least one or two additional quarters in a second year. University fees for the one-year program in the 2007/2008 academic year were $15,557 for California residents and $28,096 for nonresidents. The curriculum requires courses in the basic public-health disciplines: epidemiology (4 units), biostatistics (8 units), social and behavioral sciences (3 units), environmental health science (3 units), health services and administration (3 units), and public-health informatics (1 unit). Students choose at least three elective courses from either traditional areas of emphasis (e.g., environmental health, epidemiology, general public health, nutrition) or two non-traditional areas: human and zoonotic infectious diseases and veterinary public health (VPH). Although California presently has four accredited schools of public health and seven other universities that also offer MPH degrees, UC Davis is uniquely poised to offer coursework in the latter two areas through close collaboration between the Schools of Medicine and Veterinary Medicine. A weekly seminar, taught jointly by full-time faculty at UC Davis and from the public-health practice community, addresses current issues in public health. The seminar allows students to identify potential projects for their public-health practicum experiences. The practicum is an eight-quarter-unit practical public-health experience, most commonly undertaken with 220 JVME 35(2) ß 2008 AAVMC

3 the local or state health department, that consists of approximately 240 hours over two or more academic quarters and includes a written and an oral report. The option of offering all core coursework through distance learning is being actively explored. The program s Introduction to Public Health three-quarter-unit course is currently taught both in the classroom and online; the cost of the latter is $950. The MPH program has reached two important milestones since its beginnings. In June 2005 it received national accreditation from the CEPH. The program s enrollment, initially restricted to health science professionals, has now expanded to include students with non-professional degrees, approximately doubling the class size to the midtwenties and allowing the university to serve the large and enthusiastic population of potential public-health students whose highest degree is the baccalaureate. In addition, the University of California has recognized the state s need for at least one new school of public health, which appears likely to be situated at UC Davis. With this will come the resources to allow substantial expansion of the MPH class size and to add doctoral programs in the basic disciplines of public health. The existing and planned infrastructure including faculty, students, community public-health professionals, and the people of California gives credence to the promise of a bright future for public health at UC Davis. THE PROPOSED UC DAVIS SCHOOL OF PUBLIC HEALTH The past few years have seen dramatically increased national attention to the field of public health, as a result of very visible tragedies such as the terrorist attacks of September 11, 2001, and Hurricane Katrina; epidemics such as SARS, West Nile virus, and avian influenza; and awareness of new chronic disease epidemics such as obesity. Public health is recognized as the major driving force behind the reduction in disease and the increase in life expectancy over the first half of the twentieth century, but attention and resources for public-health interventions have decreased in recent decades as resources have been directed toward our medical care systems. The epidemics and tragedies noted above, as well as the failure of medical care systems to further reduce the disease burden from many intractable global health problems such as malaria, tuberculosis, and traumatic injuries, have resulted in a renewed focus on public health. In April 2005, the University of California wide Health Sciences Committee issued its report Health Sciences Education: Workforce Needs and Enrollment Planning. 1 This document identifies a critical need for additional training in public health at the University of California and was a core justification for the planning of a new School of Public Health at UC Davis that envisions continued integration of teaching, research, and public-health efforts (the proposal has been approved by the UC Davis Academic Senate and is currently under review by the University of California Office of the President). UC Davis has a tradition of integrating its public-health training via joint courses for MPVM, MPH, and epidemiology (MS and PhD) degrees. This integration pools the insights of human- and veterinary-oriented public-health and epidemiology students into the impact of animals on human health and the public-health interventions necessary to address zoonotic diseases. Such interactions may be relevant to infectious disease, reproductive health, cancer, allergic and respiratory diseases, mental health, and many other health outcomes. Many research collaborations exist between the UC Davis SVM and public-health researchers in the UC Davis School of Medicine and in other colleges. One such area is zoonotic diseases, in particular those carried by insect vectors. Most of the global epidemics of the past few decades have originated in animal populations or have been disseminated by animal vectors. Research programs in the SVM, including the Center for Vectorborne Diseases, the Center for Comparative Medicine, and the California National Primate Research Center, are a foundation of excellence in publichealth research whose investigators will work closely with those from the new School of Public Health. An important source of collaboration since its creation in 1980 is the UC Davis Center for Occupational and Environmental Health, which supports faculty in both medical and veterinary schools. There is a long tradition of multidisciplinary collaboration on the health effects of occupational and environmental air pollution. Investigators at the SVM have focused on animal exposure studies and pathologic changes of airborne toxicants, while medical and public-health researchers have conducted clinical and population-based studies of environmental/occupational respiratory diseases. Another area of collaboration is the study of non-respiratory environmental/occupational toxicants on human health. Scientists have addressed the effects of pesticides and other chemicals on human health; the SVM s expertise in toxicology provides an important and complementary expertise to researchers in the Public Health Sciences Department of the School of Medicine who focus on occupational health hazards using clinical and populationbased approaches. RECONSIDERING THE FUTURE ROLE OF VETERINARY MEDICAL EDUCATION IN PUBLIC HEALTH AT UC DAVIS A premise of veterinary medicine is that the health of animals, of the environment, of the food supply, and of the (human) public are inexorably linked. Within public health, the fundamental principle of veterinary medicine s role is to confront those pathogens transmitted from animals to humans and responsible for zoonotic diseases. In addition, many common non-zoonotic diseases and illnesses in human societies, such as diabetes and obesity, also occur frequently in dog and cat populations. For these and many other reasons, public health is emerging as a major component of veterinary medical education as the need for highly skilled and knowledgeable veterinary professionals grows. The Bureau of Labor Statistics expects that there will be 28,000 job openings in the veterinary medical profession by 2012 thanks to growth and net replacements, a turnover of nearly 38%. Unfortunately, the demand will vastly exceed the supply. According to the National Research Council, there are insufficient (veterinary medical) graduates to meet the needs in a number of major and distinct fields of JVME 35(2) ß 2008 AAVMC 221

4 veterinary medicine dealing with various species of foodanimals, rural practice (mixed domestic animals), ecosystem health (including wildlife disease and conservation biology), public health, the many dimensions of the food system, and biomedical science. Too few veterinary students are choosing to specialize in basic biomedical science or pathology... 2 This is evident at the UC Davis SVM: in 1991 almost 60% of MS and PhD students held DVM degrees, but by 2005 this figure had dropped to 30%. The Veterinary Public Health Workforce Expansion Act, 3, 4 currently before both houses of Congress, seeks to remedy this shortfall and reverse the decline in the VPH workforce by providing infrastructure and resources specifically to increase the number of trained veterinarians in public health and related research. It is incontrovertible that the majority of students who become veterinarians do not obtain the requisite postdoctoral training necessary to become researchers. This is partially a result of diminishing interest in research careers among veterinary medical students, thanks to their lack of exposure to role models in basic science and hands-on research. Probably no less important, however, is the reality of what such a commitment entails: additional time in school, mounting educational debt, and inadequate funding for tuition and living costs. Even the Veterinary Public Health Workforce Expansion Act makes explicit note of this problem: The Nation s veterinary medical colleges do not have the capacity to satisfy the current and future demand for veterinarians and veterinary expertise that is vital to maintain public health preparedness. 3 Clearly, a cultural change is in order if the profession is to alter its course. That there are students who want to pursue graduate academic degrees (MS, PhD) is likewise beyond dispute. In the 2005/2006 academic year at UC Davis, more than 850 students received such degrees, compared to 124 who received DVM degrees. It is an unfortunate reality, therefore, that most students enter veterinary medical school with the sole intention of becoming practitioners and that most graduate feeling exactly the same way. Likewise, if graduating veterinarians do seek post-doctoral education, it is far more likely to be in a clinical specialty than in a graduate academic program. It would be naïve to believe that faculty can have a substantial influence on this outcome either by trying to change the mind-set of students or by using proactive methods (e.g., targeted admissions). SVM faculty at UC Davis have long recognized the pressing national need for veterinarians to fill the role of publichealth professionals in the years to come and to manage diseases in animal populations that can have profound health and economic consequences in animal and human populations alike. But is it truly necessary for VPH practitioners to be trained to be clinical practitioners as well? Would it in fact be possible to create an entirely new paradigm within a school or college of veterinary medicine, or in partnership with another entity, offering a public-health degree with a veterinary track allowing students to. acquire broad knowledge of VPH practice, research, and theory;. analyze issues and problems in VPH using critical evaluation, applied research methodology, and statistical methods;. understand VPH policies and practices through the study of how programs are implemented in institutions and society; and. develop a vision and philosophy for professional leadership in VPH? With the imminent arrival of a School of Public Health at UC Davis, the triumvirate of this school with the SVM and the School of Medicine may be able to accomplish what a single school cannot. The precedent for such a paradigm, in fact, already exists and is employed in schools of public health around the United States: the Doctor of Public Health (DrPH) degree program. Although most students who obtain a DrPH degree are interested in pubic health in human populations, they are not physicians and hence are not licensed to practice medicine. The DrPH is thus an advanced medical degree for students who do not want to go to medical school and practice clinical medicine. It is past time for veterinary medicine to recognize a similar alternative to the DVM degree. Unlike the PhD, but like the DVM and the MD, the DrPH is a professional degree, its training program and dissertation focusing on public-health practice and designed for those intending to work as public-health professionals. This program is ideally suited for students who are interested in a career in the allied health sciences but do not want to matriculate into veterinary or medical school, as well as for those who are interested in animal-related careers but do not want to become clinicians. To help mitigate the costs of a postgraduate education, entrance into the program could occur prior to completion of the BS degree (as is true of the UC Davis SVM) and need not be restricted to California residents, although prior experience and evidence of leadership potential in public-health science, management, policy, practice, and so on would be required. So as to not devalue the importance of a classical medical education, one possible vision for students entering the program with focused veterinary medical interests could include a curriculum similar to the first two years of veterinary medical school (basic and pre-clinical sciences), providing a life sciences foundation for the degree:. Cell and tissue and function. Cellular mechanisms of disease, injury, repair, and healing. Organ-system form, function, and disease. Infectious disease. The -ologies. Ecosystem health. Critical thinking and reasoning. Ethics and jurisprudence Threaded through the first two years (as well as subsequent years) would be a DrPH seminar, which would provide face-to-face exposure to scientists working in veterinary and human public health for the purpose of evolving the sophistication of our DrPH students in understanding the 222 JVME 35(2) ß 2008 AAVMC

5 research agenda and scientific trajectory of top scientists in the field of public health. In their third year, students would diverge away from the clinical competency courses that their DVM counterparts would take and, instead, toward veterinary and human public-health courses:. Epidemiology. Food safety. Food-animal medicine. Foreign animal disease. Zoonotic disease. Public health. Biostatistics. Veterinary medicine electives. Food-animal in-house and ambulatory medicine. Concomitant advanced coursework leading to joint MPVM or MPH degree Students would take additional electives during this year, facilitating deeper exploration of one or more of these core areas and constituting a minor in a core public-health area. All students would take a required course in Public Health Leadership and an additional course in either verbal or mathematical communication. The DrPH seminar would continue in the third year, with an emphasis on publichealth practice. Potentially, our DrPH students would share seminar speakers with the MPH Seminar Series, with its current focus on public-health practice. In the final year of the DrPH program, students would be placed in a Leadership Practicum/Residency, providing the opportunity to take their training to the next level in preparation for assuming leadership positions following graduation. The residency program requires a strong mentor match with each student for the purpose of engaging in a predetermined Public Health Practice Project or an Applied Public Health Research Project. The Public Health Practice Project would culminate in an in-depth paper summarizing and analyzing all phases of the project, from identification of the problem or opportunity to resolution and evaluative follow-up, and the Applied Public Health Research Project would culminate in a dissertation. During this final year the DrPH seminar could be conducted online, enabling students to undertake residency experiences beyond the immediate UC Davis region. The emphasis of the final-year seminar would be on participation in a series of Public Health Leadership Case Studies developed by the faculty and public-health practitioners for the purpose of exploring solutions to real-world public-health leadership challenges and opportunities for leadership intervention or contribution by DrPH-prepared professionals. The success of such a degree program in helping to address the nation s deepening deficit of veterinarians pursuing careers in public health is predicated on a key assumption: that there are more students without clinical training who would like a VPH career than there are veterinary medical students who are getting clinical training and want VPH careers. Although DrPH graduates would technically not be veterinarians, and thus would not be eligible for licensure, they could partner with veterinarians in ways for which there are already established precedents. For example, DrPH graduates, physician assistants, and family nurse practitioners already work together in complementary ways in public health. A final consideration in the decision to implement a DrPH degree program is the ubiquitous problem of diversity in veterinary medicine. The veterinary medical profession has historically had difficulty in making itself more diverse (except with respect to gender), and current demographic changes in California are outpacing those within our SVM. Public health as a profession, on the other hand, is a much more diverse field (e.g., approximately one-third of the student body at the nearby UC Berkeley School of Public Health are people of color). It is plausible that a DrPH program in VPH, because of its natural interface with human public health, could attract a diversity of students that veterinary medicine cannot. CONCLUSION Reconsideration of public-health practitioners objectives and national interests (food safety, public health, biosecurity) will inevitably lead prescient and forward-thinking veterinary schools/colleges to offer an alternative professional degree pathway to help redress the shortage of veterinary medical public-health professionals. REFERENCES 1 Universitywide Health Sciences Committee, University of California. University of California Health Sciences Education: Workforce Needs and Enrollment Planning < UC%20binder_final_9.1.pdf>. Accessed 03/31/08. Office of Health Affairs, University of California, National Research Council. Animal Health at the Crossroads: Preventing, Detecting, and Diagnosing Animal Diseases. Washington, DC: National Academies Press, 2005 p Veterinary Public Health Workforce Expansion Act 2007 < s >. Accessed 03/31/08. Senate Bill 746, 110th Congress. 4 Veterinary Public Health Workforce Expansion Act 2007 < h >. Accessed 03/31/08. House Bill 1232, 110th Congress. AUTHOR INFORMATION David W. Hird, DVM, MPVM, PhD, is Professor of Epidemiology in the Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA USA. K.C. Kent Lloyd, DVM, PhD, is Professor and Associate Dean for Research and Graduate Education Programs, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California, Davis, CA USA. JVME 35(2) ß 2008 AAVMC 223

6 Stephen A. McCurdy, MD, MPH, is Professor of Epidemiology in the Department of Public Health Sciences, School of Medicine, University of California, Davis, CA USA. Marc B. Schenker, MD, MPH, is Professor of Epidemiology in the Department of Public Health Sciences, School of Medicine, University of California, Davis, CA USA. John J. Troidl, PhD, MBA, is Academic Administrator in the Department of Public Health Sciences, School of Medicine, University of California, Davis, CA USA. Philip H. Kass, DVM, MPVM, MS, PhD, is Professor of Epidemiology in the Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA USA. Address correspondence to Dr. Philip Kass, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA USA. 224 JVME 35(2) ß 2008 AAVMC