GUIDELINES OF COMPETENCE DEVELOPMENT IN THE STUDY FIELD OF PUBLIC HEALTH

Transcription

1 GUIDELINES OF COMPETENCE DEVELOPMENT IN THE STUDY FIELD OF PUBLIC HEALTH

2 Development of the Concept of the European Credit Transfer and Accumulation System (ECTS) at the National Level: Harmonization of the Credit and Implementation of the Learning Outcomes Based Study Programme Design VP1-2.2-ŠMM-08-V Žymantė Jankauskienė, Rita Liepuonienė, Rimantas Stukas, Genė Šurkienė, Kęstutis Žagminas, Birutė Gostevičienė, Erika Kubilienė, Jurgita Matuizienė, Algimantas Urbelis GUIDELINES OF COMPETENCE DEVELOPMENT IN THE STUDY FIELD OF PUBLIC HEALTH Vilnius 2012

3 Žymantė Jankauskienė Rita Liepuonienė Rimantas Stukas Genė Šurkienė Kęstutis Žagminas Birutė Gostevičienė Erika Kubilienė Jurgita Matuizienė Algimantas Urbelis GUIDELINES OF COMPETENCE DEVELOPMENT IN THE STUDY FIELD OF PUBLIC HEALTH Vilniaus universitetas, 2012 ISBN

4 TABLE OF CONTENTS Table Of Contents Introduction BRIEF PRESENTATION OF THE STUDY FIELD DETERMINATION AND POSSIBILITIES OF STANDARD PROGRAMME GUIDELINES FOR THE PUBLIC HEALTH STUDY FIELD TYPICAL FIELD OF PROFESSIONAL ACTIVITY AFTER COMPLETION OF PUBLIC HEALTH DEGREE PROGRAMMES GENERIC COMPETENCES OF THE STUDY FIELD METHODOLOGICAL RECOMMENDATIONS OF DETERMINATION OF GENERIC COMPETENCES STUDENT WORKLOAD AND ITS CALCULATION RECOMMENDATIONS FOR THE SCOPE OF A COURSE UNIT/MODULE IN CREDITS. RECOMMENDATIONS FOR THE MODULAR AND COURSE UNIT BASED STRUCTURE OF A DEGREE PROGRAMME RECOMMENDATIONS FOR TEACHING, LEARNING AND ASSESSMENT METHODS.30 Literature...34 Annexes...36 Annex 1. Comparison of the importance of subject-specific competences according to the study cycles...36 Annex 2. Comparison of the assessment of the level of subject-specific competences demonstrated by the employee at the beginning of work according to the study cycles...39

5 Introduction Guidelines of competence development in the study field of public health (hereinafter the Guidelines ) was prepared for Vilnius University to implement the national project Development of the Concept of the European Credit Transfer and Accumulation System (ECTS) at the National Level: Harmonisation of Credits and Implementation of the Learning Outcomes Based Study Programme Design (No VP1-2.2-ŠMM-08-V ) in One of the key conditions for assuring the quality of studies is the commitment of a higher education establishment to prepare and implement modern study programmes. Programmes oriented towards the public, market and individual are competence based programmes that must reflect requirements of more complicated and constantly improving professional activities intended for a future professional. The reference point for reports on the preparation of new study programmes must be the present-day and future labour market requirements based on research of the development of an appropriate profession. The content of study programmes should comply with the latest achievements of science, art and technology, and the national and European Union strategic development guidelines. The content and methods of implementation of study programmes must provide conditions for employment and the development of citizenship and be recognised by the academic community. These requirements must serve as the basis for the articulation of subject-specific and generic competences and the planning of learning outcomes that ensure the development of such competences during the study process. A higher education establishment should train free, responsible, professional, competent and creative members of the public who have the ability for critical thinking and teamwork and are ethical. Imparting knowledge and developing students competences is not sufficient. It is necessary to nurture the principles of an individual with higher education and his or her approach to the development of society, technologies and the whole world. More attention must be devoted to the development of generic competences, understanding their importance for increasing the graduate s employment opportunities as well as for the harmonious evolvement and professional development of the personality. These Guidelines will contribute to the preparation and updating of competence based programmes of the public health study field. The Gudelines give a detailed survey of the standard professional activity upon completion of programmes of the public health study field, presents the subject-specific and generic competences and gives recommendations for the scope of a module / course unit in credits, the calculation of workload and the modular and course unit based structure of the study programme. 4

6 1. BRIEF PRESENTATION OF THE STUDY FIELD Public health is the science of preventing disease, prolonging life and promoting physical and mental health through the organized efforts of society, taking care of the environment protection by controlling infectious diseases and teaching individual hygiene 1. Public health specialists, upon carrying out health monitoring and promoting a healthy lifestyle, consider prevention of diseases rather than their treatment as the main priority. Public health focuses on population issues rather than on the personal health issues. The problems of public health and challenges to health are subject to change depending on a varying physical, social and economic environment 2. In the process of globalization the spread of health threats becomes a universal object of public health in terms of the science and practice, therefore the analysed problems of public health are definitely to be considered in the global context of health 3. The policy of public health has been formed in Lithuania for a long time. At the beginning classic epidemiological-hygiene research was sufficient in order to resolve the most problematic issues in this area. However, a concept of public health has significantly changed both globally and in Lithuania. The new policy of public health is based not only on the activity of managers of the national, regional or local levels but also on involvement of individuals, community, nongovernmental organizations and private sector in improvement of public health 4. Today the mission of the new public health is to achieve a desired condition of citizens health through organized efforts of institutions and a society as well as eliminate the health unbalance 5. A condition of modern public health is determined by the people s lifestyle, environment, inheritance and health care system 6. Information accumulated at the international level shows that the public health specialists are not able to solve the problems of public health single-handedly. To solve these problems it is necessary to involve a community and other social and economic structures which determine health 7. However, a crucial role subject to the solution of said problems most often falls to the graduates of the biomedicine area public health field degree programme. By its resolution the Government of the Republic of Lithuania has approved the List of study areas and fields based on which studies are organised at higher education establishments. Public health is listed in the group of the medicine and health study fields of the area of the biomedical sciences (Table 1). 1 Kalėdienė R., Petrauskienė J., Rimpela A. Šiuolaikinio visuomenės sveikatos mokslo teorija ir praktika. Šviesa, Turnock B. J. Public Health: What It Is and How It Works. 4th ed. Jones and Bartlett Publishers, Ibid. 4 Oxford Textbook of Public Health. V Ed. by Detels R., Beaglehole R., Lansang M. A., Gulliford M. Oxford University Press, Essential Public Health Services. National Public Health Performance Standards Program. CDC. essentialservices.html 6 Decision No 1350/2007/EC of the European Parliament and of the Council of 23 October 2007 establishing a second programme of Community action in the field of health ( ). Official Journal of the European Union, 2007, L 301, p Commission of the European Communities. Together for Health: A Strategic Approach for the EU COM(2007) 630 final. ec.europa.eu/health/ph_overview/documents/strategy_wp_lt.pdf 5

7 Table 1. The groups of study fields and the study fields of the biomedical sciences study area 8 Study area Group of study fields Study field A300 Medicine A400 Dentistry A500 Professional Oral Hygiene A600 Public Health Biomedical Sciences Medicine and Health B200 Pharmacy B300 Rehabilitation B400 Nutrition B700 Nursing B800 Medical Technology B900 Medicine and Health The public health specialists follow the health strategy the implementation principles of which are based on assurance of ethical health values, assurance of health as the most important indicator of well being, integration of the health issues into all areas of the state politics; the said strategy professionally approaches today s largest challenges, i.e. citizens ageing, threats to health and new technologies 9. Public health specialists must work actively in the areas of environmental factors and lifestyles, i.e. determinants that have the greatest effect on individual and public health, analyse the functioning of the health care system and its influence on the health of the population, and assess the availability and quality of health care services provided. The public health specialists not by chance focus on epidemiological research of the impact of environmental and social factors on health and life quality of various groups of citizens, analyse the impact of social factors, safe environment, health care model on public health, and make decisions for the benefit of health. The global processes of urbanisation, the increasing imbalances of health and the quality of life, the growing number of environmental risk factors, the spread of chronic non-infectious diseases and the acceleration of globalisation processes make constant adjustments in the professional areas of a public health specialist, where successful operation requires subjectspecific and generic competences (knowledge, abilities and principles) necessary for identifying public health problems, evaluating the health of the population and foreseeing management methods, carrying out the supervision of public health, health policy making, implementation and evaluation, and organising and implementing health education. In search for new methods to solve public health problems, evidence-based practice needs to be applied. 8 Source: Order No 1749 of the Government of the Republic of Lithuania of 23 December 2009 approving the List of study areas and fields based on which studies are organised at higher education establishment, and the List of qualification degrees. Official Gazette, 2009, No The Lithuanian National Public Health Strategy for (Official Gazette, 2006, No ). 6

8 2. DETERMINATION AND POSSIBILITIES OF STANDARD PROGRAMME GUIDELINES FOR THE PUBLIC HEALTH STUDY FIELD The first cycle study programmes of the public health field in Lithuania are implemented by universities and colleges and second- and third-cycle studies are organised at universities. Presenting guidelines for a typical study programme implemented in this study field is not that simple, since the programme content is influenced by the broad based public health content defined in Section 1. The potential activities of a public health specialist range from the effect on the behaviour and lifestyle of member of the public to the participation in health policy making and attempts to ensure the provision established in the Constitution of the Republic of Lithuania, i.e. the inherent right of every citizen to health. The professional activity of a public health specialist presented in greater detail in the following sections is not homogeneous. Although this field is mostly related to the medicine and the group of health fields of the biomedical science studies, the preparation of the guidelines for a standard study programme must also evaluate and reflect the relationships with the social study fields of the social sciences area (psychology, sociology, social work and anthropology) and the education and training study fields (pedagogy, educology, andragogy, etc.). The guidelines for the public health study field can highlight the unique character of the programme without doubt, focusing on a certain specific public health service that places emphasis on the individual s self-development, the possibilities for health management and influence on lifestyles, the evaluation of the health of members of the community, prevention of diseases and traumas, epidemiological surveillance, monitoring, public information, education and training. Subject-specific and generic competences of a public health specialist are developed by employing a holistic and systemic approach based on the partnership of members of the public and the sustainable societal development strategy. The continuous monitoring of the changing health needs of members of the public, the social and economic situation of the country and globalisation trends in the future will determine the emergence of interdisciplinary study programmes not only in the second but also in the first cycle of studies. The development of subject-specific and generic competences of a public health specialist and the articulation of learning outcomes are closely related with the cycles and the system of qualification levels of the Republic of Lithuania based on competences necessary for an individual s activities that is established by the guidelines for the Lithuanian qualifications framework and the international documents of the Bologna process (Dublin descriptors, 2005). The scope of the first cycle college degree programme upon completion of which professional bachelor degree or professional bachelor degree and professional qualification are awarded shall comprise not less than 180 and not more than 210 credits. The scope of the first cycle university degree programme upon completion of which bachelor degree is awarded shall comprise not less than 210 and not more than 240 credits 10. The scope of the second cycle master degree programme shall comprise not less than 90 and not more than 120 credits 11. When developing a description of a certain cycle degree programme which provides a degree it is necessary to formulate competences to be fostered and design learning outcomes. Learning outcomes are formulated with account of the cycles and the complexity, independence, instability and the limits of responsibility of the activities of the future professional. The application of these criteria is based on the descriptions of qualification levels and the results of the professional activity research. 10 Order No V-501 of the Minister of Education and Science of the Republic of Lithuania of 9 April 2010 approving the guidelines for general requirements of degree-awarding first-cycle and integrated study programmes. Official Gazette, 2010, No Order No V-826 of the Minister of Education and Science of the Republic of Lithuania of 3 June 2010 approving the guidelines for general requirements of the Master s study programme. Official Gazette, 2010, No

9 First cycle degree programmes are intended for developing the general learning calibre, imparting the theoretical background of the study field and building professional skills necessary for independent work and professional activity, and professional values. The Professional Bachelor degree programmes in public health are predominantly focused on the preparation for practical activities. The graduates will have the ability to carry out diagnostic tests on humans and the environment in the European Union health care sector. The public health bachelor university degree programmes are more centred on universal general education, theoretical preparation and professional abilities of the highest level. Therefore, the public health Bachelor degree programme is oriented towards carrying out public health safety control intended for the assessment of the compliance of the economic and commercial activities with the requirements of regulatory acts on public health safety and for the application of administrative sanctions 12. Public health specialists who were awarded a master degree must obtain good skills of scientific research work during the studies, since namely they, having integrated into public health scientific research and practical work space, will have a positive impact on the state public health policy in terms of their decisions. The experience of the European countries (Finland, Sweden, the Netherlands) proved that the public health reforms are implemented more successfully when a sufficient amount of attention is paid to the scientific grounding of a problem approach and solution, when efficiency of implemented preventive strategies and implemented structural changes of public health care are subject to a continuous scientific assessment. A scientific activity provides a scientific basis when planning the programmes of health promotion and disease prevention as well as enhancing organizational models of the health care systems. A public health specialist has to refer to the scientific experience during his practical activity when implementing his/her generic and specific competences, demonstrating obtained skills and abilities. An obvious demand of the scientific work experience of a public health specialist becomes apparent when working in tertiary level structures of the Ministry of Health. As for said structures, the problems are solved on the scientific basis, decisions are made on the basis of scientifically proven arguments, a continuous cooperation with the respective structures of the European Union is carried out The Law of the Republic of Lithuania on Public Health. Official Gazette, 2002, No Commission of the European Communities. Together for Health: A Strategic Approach for the EU

10 3. TYPICAL FIELD OF PROFESSIONAL ACTIVITY AFTER COMPLETION OF PUBLIC HEALTH DEGREE PROGRAMMES The field of professional activity must involve the implementation of the main public health principles of the World Health Organization (WHO) and the objectives of the National Health Concept of Lithuania, the Lithuanian Health Programme and the Lithuanian National Public Health Strategy. The practical public health area is multi-sectoral, therefore a field of professional activity inevitably becomes multi-sectoral as well. The following three core functions of public health may be distinguished: assessment, health policy development and assurance, which are implemented through the essential public health services 14 : 1. Assessment of community health, epidemiological supervision and monitoring of diseases and traumas. 2. Determination of the community health problems and dangers for health, analysis of possible causes (analysis of disease outbreaks, epidemiological analyses of infectious and non-infectious diseases, traumatism, environmental dangers and other threats to health). 3. Raising awareness, education and encouragement to take prevention measures. 4. Mobilization of community partnership in order to determine health problems and solutions. 5. Policy development in order to maintain individual and public efforts due to participation in health protection planning. 6. Assurance of the healthy environment through development and implementation of the provisions of legal acts. 7. Determination of demands of personal health care services in order to ensure availability of health care services. 8. Planning of human resources of public and personal health care and assurance of professional improvement. 9. Assessment of efficiency, availability and quality of provision of personal and public health services carrying out constant monitoring of public health programmes. 10. Search for new scientifically based methods of solution of health problems. The said public health services are provided in the professional activity of a public health specialist. The graduates, having completed the public health degree programmes, may work in public health centres, municipal bureaux of public health, State Food and Veterinary Service, State Labour Inspectorate, State Non Food Products Inspectorate, Consumer Rights Protection Service, social care institutions, childhood education facilities, municipal doctors service, health care institutions, diagnostics departments of public health centres, personal health care institutions, forensic medicine centres and other institutions which carry out diagnostics research of people and environment. With a view to assuring the quality of public health services, it is necessary to check the social needs of the specialists professional and academic qualification. The most significant element here becomes the competences which help select knowledge, skills and values required for provision of a certain service 15. Professional activity research is becoming one of the key elements in defining the professional portrait of a future specialist Essential Public Health Services. National Public Health Performance Standards Program. CDC. html 15 Poviliūnas A. Nuo profesinės veiklos tyrimų prie profesinės veiklos lauko tyrimų. Seminar of ECTS Project Experts, 18 November 2010, Vilnius Beresnevičiūtė V. Profesinio lauko tyrimas. Seminar of ECTS Project Experts, 18 November 2010, Vilnius. rezultatai 9

11 A survey of employers and graduates was carried out in The purpose of the survey was to find out the opinion of employers and graduates about the abilities and skills necessary to provide the essential public health services. A direct interview method was used, when the inquirers were questioning the respondents and filled out the questionnaires, and an interview method was used by means of modern technologies, i.e. the inquiry via the internet. First of all an arrival of an interviewer to a company/institution where the respondent works was discussed and only in case of a disagreement or at the respondent s request, an electronic link to the questionnaire was sent. The companies/institutions, where the employees having acquired bachelor or master degree of public health in higher education institutions not earlier than 5 years ago, were selected for the inquiry (i.e. graduates of public health degree programmes of ). When selecting the respondents the following sources served as the basis: universities and colleges, science institutes, the Ministry of Health, State Public Health Care Service, the Ministry of Social Security and Labour, the Ministry of Education and Science, public search data bases. The public health specialists were looked for in the Lithuanian State Health Centres, bureaux, municipalities, hygiene centres, State Environmental Health Centre, Centre for Contagious Diseases and AIDS, mental health centres, National Health Insurance Funds, Drug Control Department, State Consumers Rights Protection Service, State Food and Veterinary Service, State Labour Inspectorate, State Non Food Products Inspectorate, etc. Snowball sampling was also used as a selection method. The survey involved 74 managers of the public health specialists or persons who possessed information on generic and subject specific competences of an employee. During the survey 33 public health specialists who finished their public health studies in and were working according to their speciality were questioned. The survey was conducted from 12 July till 6 August in The interview lasted for min. The survey was carried out in 91 companies and institutions. In order to clarify subject specific competences of the public health study field 18 subject specific competences were provided for the survey (Table 2). Table 2. Subject-specific competences used for the professional activity research No Subject Specific competences Assess an impact of a physical and social environment, threats, risk factors subject to public health and health of its separate groups and suggest their control methods Identify, distinguish and analyse public and individual health needs, problems and deciding factors and implement public health safety Assess and analyse an impact of public, community and family health on social development of a society 4. Plan, carry out and assess research of citizens, environmental health or health system 5. Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 6. Control modern laboratory equipment of health research and diagnostics, assess research results 7. Assess public health indicators 8. Form, coordinate, implement, assess, represent national and international health policy 9. Evaluate the quality, planning and management of the health care system 10. Suggest, develop and implement prevention programs, assess their efficiency 10

12 11. Carry out prevention, forecast and control of non-contagious and contagious diseases 12. Control compliance with the requirements of hygiene and work safety recommendations 13. Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 14. Cooperate with health care colleagues and specialists of other sectors 15. Promote healthy lifestyle, foster public health 16. Apply principles of professional ethics 17. Apply knowledge of the public health system, public health policy and regulatory acts on the health system to professional activities 18. Use information technologies in the public health sphere First of all, we will present the results of the employers survey. Table 3 shows the subjectspecific competences which were identified by the employers as very important and important for the professional activities (the degree of approval is expressed as a percentage). Table 3. The employers opinion about competences very important and important for the professional activities Very important subject-specific competences Use information technologies in the context of public health Cooperate with public health colleagues and specialists of other sectors Apply principles of professional ethics 54.2 Pct Important subject-specific competences Pct Assess an impact of a physical and social environment, threats, risk factors subject to public health and health of its separate groups and suggest their control methods Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public Assess and analyse an impact of public, community and family health on social development of a society The employers also assessed the level of the employees subject-specific competences at the beginning of employment (Table 4). Table 4. The employers opinion about the level of the employees subject-specific competences at the beginning of employment Strong level of subject-specific competences Use information technologies in the context of public health Pct 49.5 Apply principles of professional ethics 40.2 Promote healthy lifestyle, foster public health 38.2 Medium level of subject-specific competences Assess and analyse an impact of public, community and family health on social development of a society Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity Assess an impact of a physical and social environment, threats, risk factors subject to public health and health of its separate groups and suggest their control methods Pct

13 The survey also dealt with the employers assessment by relating the importance of subjectspecific competences of the professional activity to the cycle. The distinctive trends are presented in Annex 1. The employers indicated the subject-specific competences they would expect from future public health specialists, depending on the qualification level awarded. The survey investigated subject-specific competences that graduates of higher education establishments had at the beginning of their professional career and how this process was assessed by the employers. Annex 2 contains a comparison of the level of subject-specific competences which the employee had at the beginning of work, according to the cycles. The information presented in Annexes 1 and 2 allows highlighting the employers expectations and define the real situation with subject-specific competencies that public health specialists have at the beginning of their professional career. During the professional activity research, two group discussions were held with public health specialists who in had completed the Professional Bachelor degree programme at the Faculty of Health Care of the University of Applied Sciences and the Master degree programme at the Faculty of Medicine of Vilnius University. The key questions addressed in the discussion with the public health graduates were: preparation for work: to what extent the employee felt prepared for work and how he/she began work; employers expectations with respect to public health graduates: what competences the employers focused on when employing the graduate; what competences the employers require from new employees, and what the employers expect from new employees; skills and knowledge acquired on the job: what knowledge and skills were acquired on the job; in their opinion, would acquiring such knowledge and skills at the college/university have been better; is acquiring such knowledge and skills at the college/university is possible or do these represent specialised competences that can and must be acquired on the job; lacking knowledge and skills: what knowledge and skills they found or are finding lacking when doing their job; proposals for upgrading the health studies: proposals of graduates on how the study programme could be supplemented or upgraded; maybe the course units could be supplemented with new topics, new course units could be added to the degree programmes or maybe the teaching methodology could be modified slightly; in their opinion, what competences should be the focus of attention; discussion of the lists of subject-specific and generic competences: which of these competences are necessary for their work to a greater or lesser extent; do the graduates feel that during the study years they have acquired competences that they have marked as necessary; do they share the employers opinion that the competences included among the top ten are the ones most important for the professional career. The graduates of the public health professional bachelor degree studies, who participated in the group of focus discussions, work in laboratories of various health care institutions including the companies of private sector. They were awarded the professional bachelor degree in the Faculty of Health Care of Vilnius College in All participants of this focus discussion group agreed that theoretical knowledge acquired during the studies was sufficient for the beginning, however they lacked practice and skills of technical work, since each laboratory is subject to the particular specificity and methodology. According to the public health specialists, who participated in the survey, the employers expect them to have work experience and practical work skills prior to hiring them. Most interviewees noticed that a graduate s wish to learn is a great advantage as well as quick information management 12

14 and its appliance, personal characteristics (for example, thoroughness, honesty, responsibility) which may determine employers decision to hire a graduate. Active and interested students of Vilnius College receive proposals during their practical training to stay and work in a company or institution. According to the graduates of the public health studies at the University of Applied Sciences, theoretical and practical knowledge about a specific area of a particular public care establishment is gained on the job. Different working methods and measures are introduced at the work place. The graduates of Vilnius College, having started to work in the specific health care institutions, lacked specific knowledge and skills, which is influenced by dynamically changing work measures. The participants in the discussion gave a favourable assessment of the broad-based degree programme of this education establishment, which provides guidelines for further interest and professional development. When discussing the list of competences of a public health specialist, the participants of the Professional Bachelor discussion group grouped the subject-specific competences necessary at the beginning of the professional career according to their importance (Table 5). Table 5. The opinion of the Professional Bachelors on the importance of subject-specific competences at the beginning of the professional career Very important subject-specific competences Use information technologies in the context of public health Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis Important subject-specific competences Cooperate with health care colleagues and specialists of other sectors Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge Carry out prevention, forecast and control of non-contagious and contagious diseases Suggest, develop and implement prevention programs, assess their efficiency Less important subject-specific competences Control compliance with the requirements of hygiene and work safety recommendations Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity Assess an impact of a physical and social environment, threats, risk factors subject to public health and health of its separate groups and suggest their control methods Operate modern public health test, diagnostic and laboratory equipment, and evaluate test results The outline of the key subject-specific competences identified during the surveys of the employers and graduates of public health programmes differs according to the importance of those competences, since the subject-specific competence identified as most important by the latter, in particular take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis, was characterised by the employers as least important. It is noteworthy that the participants in the discussion group sorted the subject-specific competences with account of the specific nature of their particular workplace. The discussion also dealt with the list of generic competences. The health care graduates of the University of Applied Sciences defined the generic competences important for their work and grouped them according to their importance (Table 6). 13

15 Table 6. The opinion of the Professional Bachelors on the importance of generic competences in the professional career Very important generic competences Ability to solve problems Capacity for applying knowledge in practice Important generic competences Subject area knowledge and understanding of the profession Ability to assess and maintain the work quality Ability to work autonomously Ability to make decisions Ability to learn Ability to communicate in the foreign language Ability to search for, process and analyse information from a variety of sources Information and communication technologies using skills Teamwork Capacity to adapt to new situations Concern for safety Less important generic competences Ability to think in the abstract, analyse and systemise information Oral and written ability to communicate in the native language Tenacity and decisiveness when carrying out set tasks and fulfilling obligations Ability to communicate with people who are not experts of the employees professional field Capacity for organization and planning Critical and self-critical abilities In the opinion of the graduates of Faculty of Health Care of Vilnius College, who participated in the survey, the programme they completed was detailed and broad, and the gained experience depends on the students wish to learn for themselves but not for a diploma. When considering potential offers for enhancement of a study programme, the public health specialists who have a professional bachelor degree define the extension of the duration of the studies, a possibility to continue studies in a master degree programme. The participants state that during three years of study they learn how to study, since a period of three years is too short for acquiring all-round knowledge; a completed degree programme is designated to form basic knowledge. The graduates collect professional knowledge in the labour market, in a specific work place. Also the graduates would prefer continuous professional studies, since they feel a need for further learning. The discussion participants state that they lack a perspective in Lithuania in terms of further professional improvement, professional qualification enhancement and a career. When discussing generic competences of a health care specialist, the public health professional bachelor graduates, who participated in the survey, suggest to focus more on psychological knowledge, skills of a foreign language and leadership skills in a degree programme. The graduates of the public health master degree studies, who participated in the group of focus discussions, work in State Health Centres, Vilnius University, health care institutions and other state institutions. They completed the master degree programme in Faculty of Medicine of Vilnius University in 2005, 2008 and Some of the specialists study for a doctorate s degree. All interviewees of this group started to work as public health specialists during their studies (including the bachelor study cycle). In respondents opinion, the knowledge acquired in Vilnius University was sufficient, they could not have been able to work without this knowledge; however, practical knowledge of a specific particular area is very significant and it is gained at the work place. Upon changing the work place, it is necessary to learn new things. A theoretical preparation depends on public health area in which the specialists work, however, the interviewees consider it as useful and beneficial for their work activity. As for the novelty of a speciality, demand of specialists in the labour market (including specialists of narrow, specific areas, for example, sportsmen s nutrition), young public health specialists, who begin to work, have to create work 14

16 methods, model, implementation mechanisms on their own on the basis of theoretical and practical knowledge acquired in the higher education institution. When discussing employers expectations in respect of the health specialists, first of all the respondents indicated that education and master degree were important factors for the employers. During the discussion it was mentioned that the employers tend to require an employee to have a master degree (for example, a graduate with the bachelor degree is hired upon a condition that he/she will continue the master degree studies), although, in the respondent s opinion, the work may be performed by a person who has the bachelor degree. In other cases, an employer simply expects good understanding of specific work mechanisms of an institution without a special focus on acquired knowledge. The respondents discussed the differences of the study cycles. The bachelor degree is sufficient for a specialist s work when the tasks are specific, procedures are standard and they seldom change. The master degree is required for a scientific work when the work is more autonomous, more creative, perception of relations, explanation of causes are required. When hiring a person the employers considered knowledge of the English language as significant as well as employee s abilities to use certain computer programs at the level of epidemiological knowledge. Teamwork skills and other generic competences are also important for work execution, since subject specific competences alone are not enough in order to successfully work in a team. The respondents indicated that the specialisation, that is both theory and practical knowledge, was acquired on the job in accordance with the specific area of activity of the establishment. Traineeship at the university introduces the students to the specific activity and structure of separate establishments. The discussion group participants gave a positive assessment of the training of health care specialists at the Faculty of Medicine of Vilnius University. In the respondents opinion, the degree programme was overloaded in a positive way, i.e. the degree programme was broad based and many different subjects had to be studied. According to the respondents, a narrow specialisation is not sufficient for a public health specialist who needs broader knowledge. The knowledge of biochemistry, physiology and anatomy acquired during the studies comes among the knowledge most needed for work. Therefore, more attention could be devoted to it at the university. Public health is a broad based science. As a result, a professional in this field cannot be a specialist in a narrow area only. The participants of the discussion stressed that law, management and economics should be taught in the public health degree programme just as biochemistry and other basic disciplines. The graduates of the public health degree programme stated that they acquired sufficient knowledge of management at the Vilnius university and they apply it at work, however, they lack administrative knowledge. Some discussion participants think that knowledge of public health economy is important, the others disagree with it. The emphasis on the importance of one or another discipline depends on the workplace specialisation of the respondents, since public health is a broad and versatile professional activity and embraces more than one social and economic activity sector. In the opinion of the public health specialists engaged in an academic activity, the university has to provide broad education but not specific knowledge. Knowledge required by a particular company does not have to be developed at university. Each work place offers courses during which specific competences required for that particular work place are fostered. While discussing the list of subject specific competences of a public health specialist the participants named the following competences as the most significant: apply in practice scientific and evidence-based public health principles, skills, methods and knowledge; identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety. 15

17 According to the respondents, the most important factor in the work of public health is the health policy which is centred on medicine in Lithuania, health care of one person, which does not correspond with the concept of health as human well being. The following competences were also named as important: assess an impact of a physical and social environment, threats, risk factors subject to public health and health of its separate groups and suggest their control methods; assess public health indicators; suggest, develop and implement prevention programs, assess their efficiency; carry out prevention, forecast and control of non-contagious and contagious diseases; plan, carry out and assess research of citizens, environmental health or health system, promote healthy lifestyle, foster public health. The discussion participants stated that it is not simple to distinguish the significance of one competence or another, since all of them are important. Different competences are of higher priority in each particular work place. For example, public health care is not very important for work at the Vilnius Public Health Centre, since this activity is assigned to the State Labour Inspectorate. Having discussed the list of generic competences of a public health specialist the graduates of the public health master degree programme named the following generic competences as the most significant for their work: capacity for applying knowledge in practice; ability to conduct scientific research; The following competences are also important according to the master degree programme graduates: subject area knowledge and understanding of the profession; ability to work autonomously; teamwork; capacity for analysis and synthesis; ability of project development and management; ability to solve problems; ability to make decisions; capacity for organization and planning; ability to retrieve and analyse information from different sources. An opinion that almost all competences listed in the list of generic competences are important was also expressed. The participants in the discussion found it difficult to make proposals regarding the improvement of the public health degree programme. The respondents stressed that they rated the degree programme positively. The necessary competences are developed to a greater or lesser extent during the study years, and in some cases the number of competences developed exceeds that contained in the list. According to the master degree programme graduates the satisfaction with the studies depends on a person s motivation, i.e. those who wanted to study this particular subject and work in this area are satisfied with the quality of studies. The respondents professional activity and their positions stand for a proof of a sufficient preparation for work. When discussing the programmes of different study cycles, it was difficult for the graduates of the master degree programme to discuss each programme of a study cycle separately. The discussion several times stressed the unclear difference between the Bachelor and Master cycles. The majority were of the opinion that the Master s degree programme was studied automatically as compulsory. In discussing the study opportunities, the Masters in public health identified several opportunities for continuing the studies: upon completing the Bachelor s degree programme, to find employment and, realising the knowledge they lacked, to continue studies in the Master s degree programme or 16

18 to continue the Master s studies immediately after the Bachelor s studies. During discussions the public health master graduates paid attention to the fact that a part of public health services could be provided by a private sector (companies). If the government transferred a part of the public health control area to private management, it would result in a larger competition, according to the discussion participants, which would lead to increased salaries and satisfaction with work. However, in all cases the public health master graduates state that public health is an expensive public service. The public health degree programme and its content have been positively evaluated by the interviewees. Although a large workload was emphasized, it was recognized as necessary and important for a work activity. Upon conducting the survey of academic community, employers and graduates and analysing the results of the professional field research, the subject specific competences of the public health study field were clarified and summarized for the first and second study cycles. The eighteen subject-specific competences used for the professional activity research were combined into ten subject-specific competences that could be the basis for degree programme developers to articulate the learning outcomes (Fig. 1). Table 7 shows the final list of the subject-specific competences. Table 7. Subject-specific competences of a public health specialist No. Subject Specific Competence 1. To identify the public health problems 2. To evaluate health of population 3. To assess environment effect to the health of society, individual groups of society and envisaging its management methods 4. To organize the health care surveillance 5. To perform health care safety 6. To form, implement and evaluate health policy 7. To prepare, implement and evaluate preventive programmes 8. To cooperate with health care specialists and specialists in other sectors/fields 9. To organize and implement health education 10. Engage with research and evidence based practice looking for innovative patterns of solution the public health problems The importance and development of these competences in different cycles are distinguished by relating the subject-specific competences with the five elements defined in the Dublin descriptors: A knowledge and understanding; B application of knowledge and understanding; C decision making; D communication skills; E learning skills. The relationships of the cycles, subject-specific competences, learning outcomes and elements mentioned in the Dublin descriptors are shown in Tables 8 to

19 Assess an impact of a physical and social environment, threats, risk factors subject to public health and health of its separate groups and suggest their control methods To identify the public health problems Identify, define and analyse public and individual health needs, problems and factors determining them, and ensure public health safety To evaluate health of population Assess and analyse an impact of public, community and family health on social development of a society Plan, carry out and assess research of citizens, environmental health or health system Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis Operate modern public health test, diagnostic and laboratory equipment, and evaluate test results To assess environment effect to the health of society, individual groups of society and envisaging its management methods To organize the health care surveillance To perform health care safety Evaluate public health indicators To form, implement and evaluate health policy Form, coordinate, implement, evaluate and represent national and international health policy Evaluate the quality, planning and management of the health care system Propose, prepare and implement preventive programmes and evaluate their effectiveness To prepare, implement and evaluate preventive programmes To cooperate with health care specialists and specialists in other sectors/fields Carry out prevention, forecast and control of noncontagious and contagious diseases To organize and implement health education Control the implementation of hygiene and occupational safety recommendations and requirements Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge praktikoje Engage evidence based practice looking for innovative patterns of solution the public health problems Cooperate with colleagues of the health care system and specialists of other sectors Promote healthy lifestyle, foster public health Apply principles of professional ethics Apply regulatory acts and knowledge of the public health care system and the health policy to professional activities Use information technologies in the context of public health Fig. 1. Distinct and summarised subject-specific competences of the first and second cycles 18

20 Table 8. Relationships of the first cycle or Professional Bachelor subject-specific competences and learning outcomes No. Subject Specific Competence Learining outcomes 1. Determination of public health problems 2. Assessment of population health 3. Assessment of the environmental impact on the health of society and individual groups of society and envisaging its management methods 4. Health care surveillance 5. Implementation of public health safety Formation, implementation and assessment of health policy Management of preventive programmes Cooperation with health care specialists and specialists in other sectors/fields Organization and implementation of health education Engaging evidence based practice looking for innovative patterns of solution the public health problems Ability to evaluate health and health needs of individuals and separate groups of society. Ability to compare laboratory tests results with the standard. Ability to analyse the structure of the organism and the functioning of organs and systems. Ability to define pathological processes of the human organism. Ability to survey effects of the environment on public and individual s health. Ability to prepare a workplace and means for performing laboratory tests. Ability to take and receive samples. Ability to perform or assist with performance of laboratory tests. Ability to discuss factors determining the reliability of test results. Ability to define the hygiene requirements for laboratories. Ability to evaluate conditions of the working environment. Ability to control the quality of laboratory tests at all laboratory test stages. Ability to apply provisions of health legislation and professional ethics documents to the professional activity. Knowledge of preventive programmes carried out in Lithuania. Ability to work in a health care team and cooperate with other sectors. Ability to communicate and convey information within one s competence. Ability to disseminate professional experience and educate the public. Dublin Descriptors Element A, B B, C A A, B, C, D A, B, C B, C, D A D C, D, E D, E 19