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

21 Table 9. Relationships of the first cycle or 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 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 define the modern public health concept, key terms and activity trends. Knowledge of methods for identifying public health problems. Ability to apply biomedical indicators of the health status when evaluating the health of the public and its separate groups. Ability to propose methods and means for reducing health risks. Ability to identify environmental factors affecting health. Ability to choose their study methods and evaluate health risks. Ability to justify the potential effect of environmental factors on health. Ability to propose methods of management of effects of the environment on health. Ability to prepare a disease and trauma prevention programme. Ability to apply organisational, legal, economic, technical, social and public health measures that help to preserve, enhance and control public health. Ability to define the principles of health policy and law. Ability to apply health policy, legal and professional ethics documents to the public health system. Ability to justify the effectiveness of preventive programmes. Ability for effective cooperation with health care specialists and specialists of other sectors. Ability to provide public health services to different groups of the public by involving the community in the health enhancement process. Ability to carry out research in the public health sphere and provide a scientific justification for the relevance of the selected problem. Dublin Descriptors Element A, B A, B A, B, C A, B B, C A, B, C B, C, D B, C, D B, D E 20

22 Table 10. Relationships of the second cycle or Master subject-specific competences and learning outcomes No Subject Specific Competence Determination of public health problems Assessment of population health Assessment of the environmental impact on the health of society and individual groups of society and envisaging its management methods 4. Health care surveillance 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 Learining outcomes Ability to identify and justify public health priorities and causes of problems, choose the most effective solution methods and justify health care needs. Ability to evaluate health of the population, its separate groups and the environment, and factors affecting it. Ability to plan and carry out independent research of public health and/or the health system. Ability to prepare action plans for improving the health of the population. Ability to identify the essential environmental risk factors that affect public health. Ability to characterise the health of the population affected by environmental factors. Ability to organise and implement the assessment and management of effects of the environment on health. Ability to communicate with other authorities in preparing plans for how to reduce the negative impact of environmental factors on the health of the public or its separate groups. Ability to carry out science based research of effects of the environment on public health. Ability to carry out expert analysis of public health safety. Ability to organise, implement and evaluate the supervision and prevention of diseases and traumas in public health. Ability to prepare and implement targeted health programmes. Ability to organise and implement the epidemiological supervision and management of diseases and traumas. Ability to evaluate the effectiveness of public health safety. Ability to contribute to health policy making and implementation, and justify proposals on health policy issues. Ability to organise and carry out the monitoring, audit, risk management and quality assurance of the progress in implementing preventive programmes. Ability to cooperate with other organisations that have an influence on public health, its supervision, the public health science and training. Ability to work with the community and non-governmental organisations. Ability to draw up health enhancement programmes, propose preventive measurers for diseases and traumas and evaluate their effectiveness. Ability to promote the involvement of the community and other social partners in the public health enhancement activities. Ability to organise the application of public health practice based on evidence. Ability to implement scientifically justified interventions. Dublin Descriptors Element B, C B, C B, C, D,E B, C, D B, C, D C, D, E B, C, D B, C, D C, D, E B, C, E 21

23 4. GENERIC COMPETENCES OF THE STUDY FIELD The authors of the Tuning (Tuning Educational Structures in Europe) Project define the generic competences as a combination of instrumental, interpersonal and systemic competences which allow the human to control his or her professional life actively. Generic competences help to adapt to the ever changing world effectively and, where necessary, acquire those professional competences that are need for a specific job. The high level of generic competences gives the opportunity for integrating in the labour market smoothly, gaining new experience more quickly and changing the specialisation or the nature of work performed. During the above mentioned public health professional activity research both the employers and the graduates could express their opinion about the list of the generic competences provided to them and sort those competences according to their importance. The respondents rated the competences on a scale of 1 to 4. The importance of separate generic competences of Bachelors and Masters who completed the public health degree programmes differs. Tables 11 to 13 give the mean of the assessment of the employers opinions about the importance of generic competences for the professional activity of public health specialists (1 not at all important, 2 nor important, 3 important, 4 very important). Table 11. Instrumental generic competences: employers assessment Professional bachelor Mean Bachelor Mean Master Mean Subject area knowledge and understanding of the profession 3,73 Subject area knowledge and understanding of the profession 3,81 Ability to solve problems 3,59 Ability to solve problems 3,77 Oral and written ability to communicate in the native language Ability to make decisions 3,55 Information and communication technologies using skills Ability to think in the abstract, analyse and systemise information Ability to communicate in the foreign language 3,59 Ability to make decisions 3,72 3,54 3,50 3,50 Ability to think in the abstract, analyse and systemise information Oral and written ability to communicate in the native language Information and communication technologies using skills Capacity for organization and planning 3,68 3,68 Ability to think in the abstract, analyse and systemise information Subject area knowledge and understanding of the profession Information and communication technologies using skills Oral and written ability to communicate in the native language Ability to make decisions 3,74 3,71 3,68 3,66 3,63 3,66 Ability to solve problems 3,58 3,55 Capacity for organization and planning 3,50 Summarising the information contained in Table 11, it can be maintained that the employers define the same combinations of instrumental generic competences regardless of the graduate s qualification degree, but they position the priorities of choice in a slightly different way. 22

24 Table 12. Interpersonal generic competences: employers assessment Professional bachelor Mean Bachelor Mean Master Mean Ability to communicate with experts in other fields Teamwork 3,59 Interpersonal skills 3,50 Social commitment and citizenship 3,64 Interpersonal skills 3,79 Teamwork, to ability work in an interdisciplinary team Ability to communicate with experts in other fields 3,74 3,68 3,50 Ethical commitment 3,53 Teamwork, ethical commitment Ability to communicate with people who are not experts of the employees professional field Critical and self-critical abilities Appreciation of diversity and multiculturality 3,53 3,47 3,39 3,13 Concern for safety 3,41 Critical and self-critical abilities 3,49 Ability to work in an international context 2,89 Summarising the information presented in Table 12, it can be stated that the employers define interpersonal generic competences quite differently, depending on the qualification degrees awarded to the graduates. Table 13. Systemic generic competences: employers assessment Professional bachelor Mean Bachelor Mean Master Mean Ability to assess and maintain the work quality Ability to work autonomously Capacity for applying knowledge in practice Capacity to adapt to new situations 3,77 3,68 3,68 3,59 Capacity for applying knowledge in practice Ability to assess and maintain the work quality Ability to work autonomously Tenacity and decisiveness when carrying out set tasks and fulfilling obligations 3,83 3,77 3,72 3,68 Ability to learn 3,50 Ability to learn 3,64 Tenacity and decisiveness when carrying out set tasks and fulfilling obligations 3,50 Capacity to adapt to new situations 3,60 Capacity for applying knowledge in practice Ability to learn, ability to assess and maintain the work quality Ability to work autonomously, tenacity and decisiveness when carrying out set tasks and fulfilling obligations Capacity to adapt to new situations Capacity for generating new ideas Ability of project development and management 3,79 3,71 3,66 3,55 3,47 3,29 The competences are best determined during the practical activity. A professional field of public health specialists is very broad, therefore the significance of generic competences relates to a specific work place of a public health bachelor degree graduate and a master degree graduate. 23

25 5. METHODOLOGICAL RECOMMENDATIONS OF DETERMINATION OF GENERIC COMPETENCES Definition of generic competences in respect of a public health specialist is an important task of each committee of a degree programme. Creation of a professional image of a future specialist should involve not only the study programme committee members but also all concerned shareholders, i.e. social partners (employers, representatives of public professional associations), graduates, academic community (teachers, students), developers of the health policy. The shareholders expectations may be clarified during the surveys by means of the interview methods and questionnaires. Representatives of the groups concerned may be included in a study programme committee. The recommendations of the cycle for determining subject-specific competences are shown in Fig. 2. PROFESSIONAL FIELD ANALYSIS Groups concerned participating in the analysis: employers; graduates; health policy developers; academic community: teachers, students. RESULTS OF PROFESSIONAL FIELD ANALYSIS The expectations of the groups concerned are associated with the professional activity of a public health specialist. STUDY PROGRAMME COMMITTEE S ACTIVITY Formulation, discussing, grouping, generalization and clarification of subject specific competences of a public health specialist. Fig. 2. Cycle of determining subject-specific competences The shareholders concerned participating in the professional field analysis may provide the slightly different information which is required for programme developers seeking to define generic competences. For example: heads of institutions, employees, who are designated as employers, will assess and provide generic competences necessary for a modern public health specialist depending on a represented area of the activity. Their approach will reflect an analysis of the situation existing in the public health area and analysis of effective legal acts; 24

26 assessment of the graduates approach will be based on the comparison of competences acquired during the studies and competences required in the actual working environment; public health is an area of public administration when public institutions implement the state policy within this area. An inquiry of politicians who form public health will allow establishing the priorities of this activity at the state level and will allow defining subject specific competences essential for implementation of said priorities. the members of an academic community, i.e. teachers, will assess the development of subject specific competences of a public health specialist on the basis of scientific evidence based practice, by means of modelling situations, i.e. in what ways public health may develop when the needs of a society are changing. The approach of students learning under the public health degree programmes will allow to evaluate the structure of the degree programmes taught, the adequacy of student workload for the learning outcomes and assessment methods, and the appropriateness of the learning environment for achieving subject-specific and generic competences. The degree programme committee members will be responsible for assessing, grouping and generalizing the collected information. A possibility to consult the shareholders on a constant basis shall be provided in order to ensure effective feedback so that professional expectations are properly reflected in the specialists subject specific competences. 25

27 6. STUDENT WORKLOAD AND ITS CALCULATION The description of the public health degree programme competences and learning outcomes upon evaluation of a study cycle. The degree programme committee and teachers working in a particular degree programme, having evaluated the aforementioned circumstances, group modules or study subjects and plan the student s workload. Workload indicates the time the student needs to complete all learning activities (such as lectures, seminars, projects, practical work, self-study and examinations) required to achieve the expected learning outcomes 17. Student workload is calculated in credits (also called ECTS credits). Credit is a measure of student workload based on the time necessary to complete a given teaching/learning unit 18. Calculating student workload is a collegiate activity (of the degree programme panel and teachers involved in the programme) which determines the successful implementation of the degree programme. Calculating student workload creates prerequisites for a critical review of the degree programme and the evaluation its feasibility and viability 19. The learning outcomes are also the basis for choosing an appropriate teaching/learning activity and evaluating the workload necessary for its performance. There is no doubt that student workload, the teaching methodology and learning outcomes are interrelated. The main conditions that need to be taken into account when planning workload are as follows: 1. The beginning of workload planning: the optimum list of competences. 2. A scope of a degree programme. The scope of the first cycle in colleges and universities may range from 180 to 240 credits. The scope of the master degree programme may range from 90 to 120 credits. 3. A form of studies. The one-year scope of full-time studies may range from 45 to 60 credits. The one-year scope of part-time studies does not exceed 45 credits and the general duration of such studies is only one time and a half longer than full-time studies applying a standard of 60 credits. 4. The duration of a study semester. The usual scope of a study semester is not more than 30 credits. 5. A credit volume. Usually one credit corresponds to academic hours of the student s workload. 6. Selection of a degree programme structure (module or subject). For example, a modular system creates presumptions to combine related disciplines, avoid repetitiveness of topics, use time designated for studying more efficiently by means of an optimal balance of the student s workload. 7. The learning environment that provides conditions for the learners autonomous studies. This includes material resources (library stock, scientific periodicals and information technologies), teachers experience and institutional culture. A study intensive learning environment allows planning student workload and pursuing learning outcomes more effectively. 8. Internal self-assessment of a higher education establishment. Quality indicators, for example: student assessment, programme completion results and dropping out, allows evaluating the academic activity and relate it as an indirect indicator with student workload. 17 ECTS user s guide Europos švietimo struktūrų suderinimas. Universitetų indėlis į Bolonijos procesą. Įvadas. Švietimo mainų paramos fondas. slideshare.net/smpf/tuning-europos-vietimo-struktr-derm-europoje Bulajeva T., Jakubė A., Lepaitė D., Teresevičienė M., Zuzevičiūtė V. Studijų programų atnaujinimas: kompetencijų plėtotės ir studijų siekinių vertinimo metodika. Vilnius,

28 9. Validation of subject specific competences, learning outcomes, scope of a subject/module by means of credits, study methods and assessment methods. 10. Planning of student contact hours, private study and assessment. The determination of workload should not be based on contact hours alone (i.e. the time a student is engaged face to face with the academic staff). The workload embraces all learning activities needed to achieve the learning outcomes. This includes the time spent on private studies and mandatory practice and intended to prepare for assessment, as well as the time needed for assessment itself. A special attention should be paid to planning of autonomous studies by properly selecting tasks, clearly and structurally defining an objective of task execution, tasks, and duration of a task to be executed. 11. Effective feedback. At the end of a semester, student workload may be assessed on the basis of the results of a student and teacher survey. 12. Systemic approach. All participants of the study process must critically and systematically evaluate their contribution in terms of achievement of learning outcomes. 13. One of the reference points is a comparison of student workload with the workload of an average worker. It should be noted that the determination of workload is often hypothetical and verified by experience, because it is affected by internal factors (motivation, level and quality of previous knowledge and health condition), as well as by external factors (complexity of the course unit/ module, quality of teaching, the learning environment, resources, and social factors such as the family, work, and living conditions). The planned student workload must be reasonable, reliable and safe

29 7. RECOMMENDATIONS FOR THE SCOPE OF A COURSE UNIT/MODULE IN CREDITS. RECOMMENDATIONS FOR THE MODULAR AND COURSE UNIT BASED STRUCTURE OF A DEGREE PROGRAMME The structure of a degree programme can be course unit based or modular. The degree programme panel must decide which structure will be more effective for achieving the learning outcomes. The scope of a degree programme in credits is the same irrespective of the chosen structure. A modular study system is characteristic of flexibility and autonomy. This system encourages teachers cooperation, discussions and general research. The student has flexible opportunities to choose certain modules individually which are necessary for the acquisition of subject-specific and generic competences. The main distinctive feature of a modular degree programme is that the defined minimum size of a module in credits (e.g. 5) must be divisible by 60 credits (the scope of one study year). The number five could be the most appropriate multiple. As studies are customised according to students requests, it is easier to replace one module with another one, for example: one module of 10 credits may be replaced with two modules of 5 credits each. This facilitates the transfer of credits gained during mobile studies. A course unit based degree programme highlights the individuality of the teacher but provides fewer opportunities for cooperation of the staff. The main provision, which shall be followed when choosing a degree programme structure, planning a subject/module scope in credits, is the integrity of a degree programme, i.e. the consistent movement from simple to more complicated topics, a gradual progress increase when fostering competences expressed in learning outcomes. A place, significance and volume of each subject or module in a degree programme shall correlate with an express image of a future public health specialist profession the successful expression of which is subject to fostering subject specific and generic competences. The degree programme committee and teachers shall agree collegially. A systemic attitude towards the national public health system, subjects comprising this system and definition of the purpose of the system allows associating public health specialists, who completed different study cycles, and the competences essential for expression of their professional role. In drawing up a degree programme, it is important to achieve that the reliable relationship between competences developed, learning outcomes, course unit/module outcomes and their scope in credits, study methods and methods of assessment is clear and consistent. A matrix can be used to evaluate this circumstance, which reveals that the successful implementation of learning outcomes lacks time, material resources, etc. There may be an opposite case where, with more credits planned for separate course units or modules than necessary for achieving the intended learning outcomes, student workload increases and the path towards the learning outcomes becomes longer and more complicated. The learning outcomes of some disciplines can be linked with several learning outcomes of a degree programme, while the learning outcomes of other disciplines can be related to almost all learning outcomes of the degree programme 21. This example may be useful for teachers and students because it directly shows the relationship between separate disciplines, learning outcomes and competences of a degree programme. The matrix of relationships of a degree programme is given in Table Bulajeva T., Jakubė A., Lepaitė D., Teresevičienė M., Zuzevičiūtė V., op. cit. 28

30 Table 14. Matrix of relationships of a degree programme Degree programme... Competences Course units Degree programme level learning outcomes GUIDELINES OF COMPETENCE DEVELOPMENT IN THE STUDY FIELD OF PUBLIC HEALTH Module / course unit 1 Module / course unit 2 Module / course unit 3 Competence 1 Learning outcome(s) X X X Competence 2 Learning outcome(s) X X X... Module / course unit N Competence 3 Learning outcome(s) X X Competence 4 Learning outcome(s) X X... Competence N Learning outcome(s) X X The matrix of the relationships between competences, learning outcomes and disciplines of a degree programme allows to provide a systemic evaluation of the rationale, consistency, planning and validity of the development of the degree programme. This matrix is highly informative, with a view of updating the degree programmes that are being implemented, through optimising the structure and content of the programme. In order to provide a more accurate definition of the learning outcomes of a module or course unit, the authors propose using B. Bloom s and SOLO taxonomies. 29

31 8. RECOMMENDATIONS FOR TEACHING, LEARNING AND ASSESSMENT METHODS This section discusses the relationship between the teaching and learning methods (or the study methods) and competences of the public health study field. Separate units (disciplines, modules) can have several study and assessment methods. Each teaching or learning method has different features and is used for different purposes. The choice of teaching and learning methods depends on the specific character of the content of studies, teachers qualifications, traditions and norms of the higher education establishment, as well as on intended learning outcomes. The assessment methods for studies and students are inseparably related with competences of a degree programme and learning outcomes of a discipline, which makes the degree programme consistent and transparent. To highlight these relationships, the authors propose this Table Table 15. Relationship between competences, learning outcomes of a degree programme and discipline, and methods of studies and assessment Competences Learning outcomes of a degree programme Discipline which provides prerequisites for achieving the learning outcomes Methods of studies Methods of assessment of learning outcomes The table shows that the entire study process is related to and dependent on the fostered competences the essential components of which are the following: knowledge and comprehension, knowing how to behave, knowing how to be. The previously discussed competences of the public health study field are developed in the Professional Bachelor, Bachelor and Master study cycles. However, their position according to importance and the level of achievement differs. As it was mentioned before, 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. Public health specialists must work actively in the sphere of determinants that have the greatest impact on individual and public health, in particular in the sphere of environmental factors and lifestyles, analyse the functioning of the health care system and its effect on public health, and evaluate the availability and quality of health care services provided. This description also reflects a broad and versatile range of the activities of a public health specialist, is significant in formulating an innovative approach to teaching and learning methods and implies a study process oriented towards the student and the student s self-learning. 22 Bulajeva T., Jakubė A., Lepaitė D., Teresevičienė M., Zuzevičiūtė V., op. cit. 30

32 In addition to traditional study methods (lecture, seminar, laboratory work), problem studies, project work, e-learning, virtual studies, etc. can be used 23. Lecture. A traditional teaching method or lecture can be used to convey basic knowledge, which can vary both in form and function. With respect to time spent, a lecture is a very effective study method which requires delivering (learning) theoretical material of a large scope. Most often a lecture is understood as a teaching/learning environment where the teacher talks to a group of students and the interaction during contact hours is most often one-directional from the teacher to the student. In practice, lectures can be very formal and totally informal. Audiences can be very large, including several hundred students, and very small. During the lecture the teacher may apply different methods depending on the goal and learning outcomes. The lecture may be of a reviewtype so that the students may familiarize with the essential points of a specific area. Also the teacher may explain one essential and complicated point in detail. The lecture may be conducted in a form of mutual communication when the students, having familiarized with the topic to be discussed via the Intranet in advance, participate in a broader presentation of the topic during the lecture when both the teacher and the students provide interesting examples. Traditionally the theoretical material discussed during the lectures is understood through examples and their applicability to solving the problems during the seminars and laboratory works. Workshops may be related to the lecture topics. During workshops a variety of methods may be used. The aim of the workshops is to provide a possibility to learn autonomously and apply in practice acquired theoretical knowledge. The teachers may provide various material (documents, slides, pictures, etc.) and ask students to divide into small groups which would discuss, distinguish the main outlines, main principles, prepare reports, oral presentations, which would be generally discussed in a plenary session. Seminars. Some authors recommend to have a limited number of students participating in seminars (from 3-4 to 30-40). The context of the seminar is less formal than that of the lecture. An essential condition is the discussion encouraged during the seminars. Seminars may be organized so that each student gets a task and prepares the presentation on a certain specific point of a generally discussed problem. Other students are invited to observe and ask questions. During some seminars the problem is presented by the teacher and the students are encouraged to ask questions and participate in the discussion. This is assessed. Work in a group. One of the key forms of the active learning method is work in groups, since it provides an opportunity to involve everyone. Group-work may be applied when implementing problematic or task-based teaching. In this case the group or group members form tasks individually or approach the problems, and the teacher participates as an observer. The said tasks are performed and problems are solved between the group meetings. In this case the students manage themselves and consult the teacher on a regular basis. E-learning. It most often performs the role of an additional study method, usually for the purpose of disseminating the material of lectures and seminars among students. Literature searches. This methods is used to prepare for seminars and write essays and final theses. Case studies. Case studies help synthesize acquired knowledge, this means information collection and individual or group presentation in a form of the qualitative research in order to foster a holistic conception of certain conditions or a situation. It is also used in order to understand an impact of environmental factors on health and to determine health problems of various people groups; debate, discussion, oral presentation and group-work methods may be used. Besides, in this case an ability of critical, creative and analytical thinking will be fostered as well as ability to find and use various sources, become a member of a team. This promotes autonomy and increases motivation for studies. 23 Universities Contribution to the Bologna Process. An introduction. 2nd Edition,

33 For example, with respect to the development of the competence cooperation with health care specialists and specialists of other fields, seminars and experience-based empirical teaching may be applied, which involve the use of play elements (role-play) and audiovisual material that shows interaction and allows observing human communication. Professional partnership skills can be developed through multidisciplinary projects and joint health and social programmes. Professional independence and responsibility are developed by documenting the process of public health supervision. Ethical principles related to the understanding of legislation are shaped when preparing reports, criticising them or consulting with a teacher. Students can be offered various ethical scenarios that are discussed and evaluated by students themselves. The competence under consideration, which is very important for self-development abilities and awareness, can be developed by the method of autonomous studies when analysing various incidents, problems and experience and providing feedback. As mentioned before, assessment forms a coherent whole with the teaching/learning methods in developing subject-specific and generic competences and does not represent only a summary of a study period. At the beginning of each course unit, the students must be introduced not only to the learning outcomes of that unit with respect to generic and subject-specific competences, but also to their assessment system (with particular attention paid to assessment criteria and sources that provide evidence of the competences) 24. In view of the fact that the ECTS methodology places an emphasis on student-oriented studies where the student becomes an active participant of the study process, creating an assessment system must give the student an opportunity for self-assessment and feedback on the student s achievements and progress in the discipline that is being studied. Different assessment methods can be applied to public health studies. The study method selection depends on many factors which should be considered by a teacher developing his/her own assessment system: a size of a students group; aims of assessment whether it is formative or summative assessment; learning outcomes of a subject; object of assessment (what is assessed knowledge, comprehension, generic or specific competences). In order to thoroughly examine all fostered competences one assessment method is not enough. It is necessary to use more and various assessment methods which allow examining the learning level of all learners and its correspondence with the learning outcomes. It should be noted that the subject assessment system would be incomplete if the assessment models and methods had not be integrated into the whole. Assessment measures the learning outcomes, which are articulated with the help of the SOLO or B. Bloom s taxonomy. Various assessment methods and tasks are proposed for assessing different levels of cognition. An oral or written survey or test may be applied to assess the learning outcomes at the knowledge level, while a case study, project activity, review of information sources, etc. are suitable for measuring the achievement of learning outcomes at a higher level (analysis, synthesis). For example, in developing the competence of population health evaluation, the first cycle Bachelor degree programme will have to provide for assessment methods that will allow to determine whether the student has the ability to apply health indicators to evaluate the health of the public and its separate groups. Students of the Master degree programme will have to demonstrate their ability to evaluate the health of the public and its separate groups and the factors affecting it, and the appropriately selected instrument of evaluation will allow measuring the level of achievement of a separate element of a competence. When developing the assessment system of a particular subject and assessment tools, it is possible to associate the competences to be fostered (extracting them into assessed competence 24 Bulajeva T., Jakubė A., Lepaitė D., Teresevičienė M., Zuzevičiūtė V., op. cit. 32

34 elements) with the assessment methods and assessment tasks. The assignments which allow a student to show acquired knowledge, its understanding, theoretical and practical abilities and values at the utmost should be selected for assessment. To assess knowledge and understanding the authors recommend to use the SOLO taxonomy which describes the students learning outcomes in a hierarchical manner. When developing the subject assessment system, it is necessary to remember that the same competences may be fostered in degree programmes of different cycles, and the assessment system is intended to help assess the compliance of the competence level with the requirements of an awarded degree. The authors of a degree programme must take into account the guidelines for a degree/cycle, the level of which is determined by the above-mentioned elements of the Dublin descriptors and which is expressed as a list of learning outcomes, i.e. each generic and subject-specific competence becomes part of the guidelines for a degree programme if the level to be attained is expressed as specific learning outcomes. Subject specific competences are associated with the study content, reflect the degree programme specificity and comprise the basis of a profession. The basis of generic competences consists of transferred abilities which are essential for all students who want to successfully complete their studies and acquire a qualification which would allow to find a job easily and remain on a labour market afterwards, would help to study further and improve, undertake ethical commitment, be an active member of society and meaningfully participate in various activities. It has been noticed that the correlations between teaching (learning) methods and generic competences exist. For example, instrumental competences may be assessed during oral presentation in a work group. Thus the study methods during the study process become assessment methods in respect of generic competences provided that a student himself/herself actively participates in assessment of generic competences. Such assessment methods as self-analysis, peer assessment, praise and similar non-cumulative assessment methods are more appropriate to assess the development of generic competences. With respect to the summative assessment system, the authors propose to assign a certain portion of the score for the presentation of the task rather than be limited to the assessment of the content alone. 33

35 Literature Law on Public Health of the Republic of Lithuania. Official Gazette, 2002, No Resolution No 600 of the Government of the Republic of Lithuania of 19 June 2006 amending Resolution No 941 of the Government of the Republic of Lithuania of 27 July 2001 approving the Lithuanian National Public Health Strategy. Official Gazette, 2006, No Resolution 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 establishments, and the list of qualification degrees. Official Gazette, 2009, No Order No v-1035/isak-2680 of the Minister of Health and of the Minister of Education and Science of the Republic of Lithuania of 30 December approving the guidelines for the procedure for health care in school. Official Gazette, 2005, No Order No V-918 of the Minister of Health of the Republic of Lithuania of 15 November 2007 approving the list of compulsory positions for municipal public health units and the qualification requirements for such positions. Official Gazette, 2007, No Order No V-58 of the Minister of Health of the Republic of Lithuania of 3 February 2009 approving the procedure for health care at pre-school education establishments and the recommendations for children s health care at pre-school education establishments. Official Gazette, 2009, No Order No ISAK-276 of the Minister of Education and Science of the Republic of Lithuania of 27 February 2007 approving the regulations for the study fields. Official Gazette, 2007, No Order No V-501 of the Minister of Education and Science of the Republic of Lithuania of 9 April 2010 approving the guidelines for the 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 the general requirements of the Master s degree programmes. Official Gazette, 2010, No 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. strategy_wp_lt.pdf Beresnevičiūtė V Profesinio lauko tyrimas. Seminar of ECTS 18 November 2010, Vilnius. project experts, Bulajeva T., Jakubė A., Lepaitė D., Teresevičienė M., Zuzevičiūtė V Studijų programų atnaujinimas: kompetencijų plėtotės ir studijų siekinių vertinimo metodika. Vilnius, ECTS user s guide guide_lt.pdf 34

36 Essential Public Health Services. National Public Health Performance Standards Program. CDC. Europos švietimo struktūrų suderinimas. Universitetų indėlis į Bolonijos procesą. Įvadas. Švietimo mainų paramos fondas. Kalėdienė R., Petrauskienė J., Rimpela A Šiuolaikinio visuomenės sveikatos mokslo teorija ir praktika. Šviesa. Oxford Textbook of Public Health V Ed. by Detels R., Beaglehole R., Lansang M. A., Gulliford M. Oxford University Press. Poviliūnas A Nuo profesinės veiklos tyrimų prie profesinės veiklos lauko tyrimų. Seminar of ECTS project experts, 18 November 2010, Vilnius. rezultatai Turnock B. J Public Health: Career Choices That Make a Difference. Jones and Bartlett Publishers. Turnock B. J Public Health: What It Is and How It Works. 4th Edition. Jones and Bartlett Publishers. Universities Contribution to the Bologna Process. An Introduction nd Edition. 35

37 Annexes A n n e x 1. Comparison of the importance of subject-specific competences according to the study cycles Professional Bachelor Bachelor Master Subject Specific Abilities and Skills Mean Standard Deviation Subject Specific Abilities and Skills Mean Standard Deviation Subject Specific Abilities and Skills Mean Standard Deviation Apply principles of professional ethics 3,5 0,51 Use information technologies in the context of public health 3,66 0,52 Use information technologies in the context of public health 3,63 0,54 Cooperate with health care colleagues and specialists of other sectors 3,32 0,78 Cooperate with health care colleagues and specialists of other sectors 3,64 0,49 Cooperate with health care colleagues and specialists of other sectors 3,5 0,56 Use information technologies in the context of public health 3,32 0,72 Apply principles of professional ethics 3,57 0,58 Promote healthy lifestyle, foster public health 3,42 0,64 Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 3,23 0,75 Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity 3,53 0,58 Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 3,39 0,75 Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 3,09 1,02 Promote healthy lifestyle, foster public health 3,47 0,75 Apply principles of professional ethics 3,39 0,64 Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity 3 1,07 Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 3,43 0,58 Assess public health indicators 3,37 0,85 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 2,91 1,02 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 3,4 0,5 Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety 3,34 0,78 36

38 Plan, carry out and assess research of citizens, environmental health or health system 2,86 1,04 Suggest, develop and implement prevention programs, assess their efficiency 3,36 0,74 Suggest, develop and implement prevention programs, assess their efficiency 3,34 0,88 Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety 2,82 1,01 Assess public health indicators 3,35 0,74 Carry out prevention, forecast and control of noncontagious and contagious diseases 3,34 0,81 Promote healthy lifestyle, foster public health 2,82 0,73 Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety 3,32 0,52 Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity 3,26 0,69 Control modern laboratory equipment of health research and diagnostics, assess research results 2,73 1,28 Control compliance with the requirements of hygiene and work safety recommendations 3,32 0,81 Control compliance with the requirements of hygiene and work safety recommendations 3,18 0,8 Suggest, develop and implement prevention programs, assess their efficiency 2,73 0,94 Assess and analyse an impact of public, community and family health on social development of a society 3,26 0,68 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 3,16 0,92 Carry out prevention, forecast and control of noncontagious and contagious diseases 2,73 0,96 Form, coordinate, implement, assess and represent national and international health policy 3,26 0,77 Plan, carry out and assess research of citizens, environmental health or health system 3,11 0,91 37

39 Control compliance with the requirements of hygiene and work safety recommendations 2,68 1,25 Plan, carry out and assess research of citizens, environmental health or health system 3,21 0,81 Form, coordinate, implement, assess and represent national and international health policy 3,08 0,91 Form, coordinate, implement, assess and represent national and international health policy 2,64 1,14 Carry out prevention, forecast and control of noncontagious and contagious diseases 3,11 1,01 Assess and analyse an impact of public, community and family health on social development of a society 2,82 0,98 Evaluate the quality, planning and management of the health care system 2,64 1,05 Evaluate the quality, planning and management of the health care system 3,02 0,92 Evaluate the quality, planning and management of the health care system 2,7 1,02 Assess public health indicators 2,59 1,01 Control modern laboratory equipment of health research and diagnostics, assess research results 2,6 1,06 Control modern laboratory equipment of health research and diagnostics, assess research results 2,53 1,13 Assess and analyse an impact of public, community and family health on social development of a society 2,55 0,96 Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 2,19 1,15 Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 2,18 1,16 38

40 A n n e x 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 Professional Bachelor Bachelor Master Subject Specific Abilities and Skills Mean Standard Deviation Subject Specific Abilities and Skills Mean Standard Deviation Subject Specific Abilities and Skills Mean Standard Deviation Use information technologies in the context of public health 3,27 0,7 Use information technologies in the context of public health 3,47 0,69 Promote healthy lifestyle, foster public health 3,45 0,65 Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 3,05 0,72 Apply principles of professional ethics 3,21 0,78 Use information technologies in the context of public health 3,45 0,55 Cooperate with health care colleagues and specialists of other sectors 3,05 1,05 Promote healthy lifestyle, foster public health 3,17 0,84 Apply principles of professional ethics 3,26 0,79 Apply principles of professional ethics 2,95 0,9 Cooperate with health care colleagues and specialists of other sectors 3 0,72 Suggest, develop and implement prevention programs, assess their efficiency 3,13 0,88 Promote healthy lifestyle, foster public health 2,91 0,92 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 2,98 0,77 Cooperate with health care colleagues and specialists of other sectors 3,13 0,66 Plan, carry out and assess research of citizens, environmental health or health system 2,77 1,11 Suggest, develop and implement prevention programs, assess their efficiency 2,96 0,93 Plan, carry out and assess research of citizens, environmental health or health system 3 0,77 Assess public health indicators 2,73 1,24 Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity 2,96 0,81 Assess public health indicators 3 0,9 39

41 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 2,68 0,99 Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety 2,91 0,83 Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety 2,97 0,79 Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity 2,68 0,84 Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 2,91 0,69 Assess and analyse an impact of public, community and family health on social development of a society 2,92 0,82 Identify, distinguish and analyse needs of public and personal health, problems and determining factors, carry out public health safety 2,64 1 Assess and analyse an impact of public, community and family health on social development of a society 2,89 0,79 Apply knowledge on the public health care system, health protection policy, health system legal acts in a professional activity 2,92 0,78 Control compliance with the requirements of hygiene and work safety recommendations 2,55 1,01 Plan, carry out and assess research of citizens, environmental health or health system 2,85 0,88 Form, coordinate, implement, assess and represent national and international health policy 2,87 0,84 Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 2,5 1,14 Assess public health indicators 2,79 0,91 Apply in practice scientific and evidence-based public health principles, skills, methods and knowledge 2,87 0,96 Evaluate the quality, planning and management of the health care system 2,5 1,01 Control compliance with the requirements of hygiene and work safety recommendations 2,77 0,91 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 2,84 0,86 Carry out prevention, forecast and control of noncontagious and contagious diseases 2,5 0,96 Form, coordinate, implement, assess and represent national and international health policy 2,7 0,75 Control compliance with the requirements of hygiene and work safety recommendations 2,74 0,72 40

42 Suggest, develop and implement prevention programs, assess their efficiency 2,41 1,05 Carry out prevention, forecast and control of noncontagious and contagious diseases 2,68 0,89 Carry out prevention, forecast and control of noncontagious and contagious diseases 2,71 0,77 Assess and analyse an impact of public, community and family health on social development of a society 2,36 0,9 Evaluate the quality, planning and management of the health care system 2,55 0,8 Evaluate the quality, planning and management of the health care system 2,63 0,94 Control modern laboratory equipment of health research and diagnostics, assess research results 2,36 1,22 Control modern laboratory equipment of health research and diagnostics, assess research results 2,19 0,97 Control modern laboratory equipment of health research and diagnostics, assess research results 2,26 1 Form, coordinate, implement, assess and represent national and international health policy 2,36 1,05 Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 2,02 1,17 Take, accept and label specimens, prepare samples for research, assess specimen and sample reliability for analysis 2,

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