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The most valuable asset for any public health agency is a well-trained and competent workforce. In recent years, this recognition has prompted multiple public health organizations in the United States to define the expected competencies for public health workers. (Competencies are action-oriented statements that delineate the essential knowledge, skills, and abilities required for the performance of work responsibilities.1) For example, as a critical foundational effort, the Council on Linkages Between Academia and Public Health Practice (COL) developed competencies for all public health workers on the basis of eight domains of public health practice.2 The Association of Schools of Public Health has recently developed competencies for graduating master of public health (MPH) students, which might become the basis of professional credentialing in the future.3 Other competencies for public health professionals have also been developed (eg, for public health preparedness, informatics, and public health law), but only a limited number are discipline-specific.4
Epidemiology is one of the core disciplines of public health. This is particularly true for applied public health practice in governmental agencies. From public health surveillance, to investigation of public health problems, and to evaluation of public health interventions, epidemiologists are vital members of the public health team, helping ensure that public health actions and programs are evidence-based and effective. However, as with other sectors of public health, the field of epidemiology has been under stress in recent years. A combination of the impending retirement of a substantial portion of the epidemiologic workforce who were trained and began to work in the 1960s, 70s, and 80s, the increasing limitations on public health resources at all levels of government and the increasing expectations and demands on public health in the areas of emerging infectious diseases, biologic and chemical terrorism preparedness, chronic disease prevention and control, to name a few, has led to shortages in the number of trained epidemiologists working in these settings.5-8
The Council of State and Territorial Epidemiologists (CSTE), the professional organization representing epidemiologists at the state, and recently at the large city and county level, has documented (with the support of the Centers for Disease Control and Prevention [CDC]) specific gaps in the number of practicing epidemiologists during the last decade.8 A 2004 CSTE survey of state epidemiologists determined that 29 percent of epidemiologists had no formal training or academic coursework in epidemiology. This survey also indicated a need for continuing education in multiple areas (eg, design of epidemiologic studies, data management, evaluation of public health interventions, and leadership and management).
To train, recruit, and retain the next generation of practicing epidemiologists at the federal, state, and local levels, defining what the skills and competencies of such workers is essential. Recognizing this need, the CSTE and the CDC have partnered to develop a set of competencies that define the practice of applied epidemiology in governmental settings. This statement of competencies serves different purposes (Table 1). First, competencies help define the discipline of applied epidemiology for current and future practitioners alike. Second, they help guide development of curricula for both primary and continuing education in public health so that the needs of the applied epidemiology practice setting are met. Finally, they assist the leadership in governmental public health agencies to better understand the role of epidemiologists and to better enable them to create employment opportunities that will attract and retain them.
The Applied Epidemiology Competencies (AECs) were developed by an interdisciplinary workgroup consisting of representatives from federal, state, and local public health agencies, from national professional organizations, and from schools of public health. During fall 2004-spring 2006, the group met three times in person and multiple times in different combinations by telephone and other electronic means. Their work resulted in a set of competencies for applied public health epidemiology that are available on the CSTE Internet site.9
The AECs were developed within the framework of the Core Competencies for Public Health Professionals developed by the COL and, thus, are consistent with the competencies that are expected of all workers in public health practice. In addition, the workgroup decided early in its deliberations that it should develop competency statements for epidemiologists spanning the career ladder from master's degree-prepared epidemiologists within 2 years of starting practice, to epidemiologists with master's degrees and more than 2 years of practice or doctoral-level training, to senior-level epidemiologists who have taken either a management track or a more purely scientific track in their careers.
The entry- or basic-level tier also includes competencies for workers without formal training in epidemiology but who fill epidemiologic functions, particularly in local health departments (eg, public health nurses or sanitarians who do epidemiologic case or outbreak investigations), at least in as much as they execute such functions. Midlevel epidemiologists often are given responsibility for specific program areas (eg, operating a surveillance system or leading an investigative team). The highest tier of competencies recognizes that epidemiologists often advance in their agencies to management and leadership functions, yet maintain their epidemiologic approach in their new positions. Certain epidemiologists, particularly those working in large state health departments or the federal government, are able to maintain an exclusively scientific focus in their work, but nevertheless continue to work in an applied setting and have special roles in developing new applied epidemiology techniques and ensuring the competency of lower tier epidemiologists. Thus, reading across the tiers, the competencies describe a career ladder from entry-level workers who should apply basic epidemiologic principles in their work but still require oversight and direction, to higher tier workers who design and direct public health programs according to epidemiologic principles, to the highest tier who incorporate epidemiology into leadership, decision making, innovation, and advocacy for epidemiology in the agency.
On the basis of the COL competencies that all public health workers should possess, the AECs cover broad topics beyond pure analytic epidemiologic methods and an appreciation for basic biology and medical science to include the other COL domains of policy development and program planning, communication skills, cultural competency skills, community dimensions of public health practice, financial planning and management skills, and leadership and systems thinking. Although the COL has provided general workforce competencies in each of these areas, the AEC document makes them more specific to the task of the epidemiologist at all levels of government. For example, cultural competency for the epidemiologist requires that the design of survey instruments use language understandable by diverse populations to yield useful information. Moreover, communication with the media should acknowledge the limitations of the epidemiologic studies being presented.
Each domain in the AECs contains multiple workforce competency statements that are further amplified in subcompetency and, in certain cases, sub-subcompetency statements, following the MACH model in which more general workforce competencies are broken down into multiple instructional competencies.10 The AECs, then, form a comprehensive set of competencies spanning applied epidemiology practice. During the course of seeking broad input into the competencies, the following question was often heard, "Can any epidemiologist be competent in all these areas?" The workgroup acknowledges that every epidemiologist cannot be equally competent in all areas. Different disciplines within epidemiology (eg, infectious disease, chronic disease, or maternal-child health) will emphasize different analytic competencies. Different positions within different governmental agencies might have different needs and responsibilities. Perhaps the AECs can best be described as "aspirational" because they define the breadth of the discipline for practitioners, educators, and employers.
As previously mentioned, broad input was sought on two preliminary drafts of the AEC document. In addition to having broad representation on the workgroup itself, the drafts were placed on the Internet for open comment. Comments were solicited through professional society newsletters and often on the Internet/intranet sites of 18 national professional organizations in addition to the CSTE and the CDC, including the American College of Epidemiology, the American College of Preventive Medicine, the Association of the Schools of Public Health, the American Public Health Association, the Association of State and Territorial Health Officials (ASTHO) and its subject matter affiliates, the National Association of County and City Health Officers, the Public Health Foundation, and the Society for Epidemiologic Research. Notices to readers were also published in the Morbidity and Mortality Weekly Report (MMWR).11,12 Presentations were made at the annual meetings of American Public Health Association, Association of State and Territorial Health Officials, and the CSTE, and at the Second North American Congress of Epidemiology. In all, approximately 400 respondents provided comments and input in each of two waves of postings of the draft AECs. The majority were epidemiologists in practice, although a limited number were from academia. The process confirmed the basic soundness and validity of both the process and the product: comments were generally positive and confirmed that the AECs describe what practicing applied epidemiologists do, or should do, in their jobs on a regular basis. In addition, excellent recommendations from these comment periods were incorporated into the document.
The workgroup recognizes, despite the positive reception of the competencies to date and the posting of the final document on the CSTE Internet site (http://www.cste.org), that the real proof of their value will be evidenced by their use in guiding education and improving the capacity of the applied epidemiology workforce. The CSTE will continue to assess the state-level workforce through periodic surveys. The CDC is planning to use the competencies as the basis for its Epidemic Intelligence Service, Preventive Medicine Residency, as well as other epidemiologic workforce training activities. These competencies should also provide impetus for additional partnerships between academia and practice. Development of methods to assess achievement of these competencies will be a critical next step. To encourage thoughtful consideration and use of the competencies, a special issue of Public Health Reports has been announced, with a focus on competency-based epidemiologic training programs in public health practice (http://www.asph.org/press/fridayletter/press.cfm?fl.index=423#Art4010). Even so, the full impact of the competencies will be felt only over a period of years as curricula, job descriptions, and career tracks are developed by practitioners and educators at all levels. For them, we hope the AECs provide a true guide for improving the epidemiologic workforce. The workgroup invites you to review the competencies and use them in your practice.
1. Nelson JC, Essien JDK, Loudermilk R, Cohen D. The Public Health Competency Handbook: Optimizing Individual & Organization Performance for the Public's Health. Atlanta, Ga: Center for Public Health Practice of the Emory University Rollins School of Public Health; 2002. [Context Link]
2. Public Health Foundation. Council on Linkages Between Academia and Public Health Practice. April 11, 2001. Available at: http://www.phf.org/competencies.htm. Accessed May 31, 2006. [Context Link]
3. Association of Schools of Public Health. ASPH Education Committee. Master's Degree in Public Health Core Competency Development Project, Version 2.3. August 11, 2006. Available at: http://www.asph.org/userfiles/Version2.3.pdf. Accessed September 4, 2006. [Context Link]
4. Association of Schools of Public Health. Competency Resources. July 18, 2006. Available at: http://www.asph.org/document.cfm?page=35. Accessed September 6, 2006. [Context Link]
5. Gebbie KM, Turnock BJ. The public health workforce, 2006: new challenges. Health Aff. 2006;4:923-933. [Context Link]
6. Association of State and Territorial Health Officials. State Public Health Employee Worker Shortage Report: A Civil Service Recruitment and Retention Crisis. Washington, DC: Association of State and Territorial Health Officials; 2004. Available at: http://www.astho.org/pubs/Workforce-Survey-Report-2.pdf. Accessed May 31, 2006. [Context Link]
7. Bureau of Health Professions, Health Resources and Services Administration. Public Health Workforce Study. Rockville, Md: US Department of Health and Human Services, Health Resources and Services Administration; 2005. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/publichealth/default.htm. Accessed May 31, 2006. [Context Link]
8. Council of State and Territorial Epidemiologists. 2004 National Assessment of Epidemiologic Capacity: Findings and Recommendations. Atlanta, Ga: Council of State and Territorial Epidemiologists; 2004. Available at: http://www.cste.org//Assessment/ECA/pdffiles/ECAfinal05.pdf. Accessed May 31, 2006. [Context Link]
9. Council of State and Territorial Epidemiologists. CDC/CSTE development of applied epidemiology competencies. Available at: http://www.cste.org/competencies.asp.[Context Link]
10. Miner KR, Childres WK, Alperin M, Cioffi J, Hunt N. The MACH Model: from competencies to instruction and performance of the public health workforce. Public Health Rep. 2005;120(suppl 1):9-15. [Context Link]
11. Centers for Disease Control and Prevention. Notice to readers: draft of applied epidemiology competencies. Morb Mortal Wkly Rep MMWR. 2006;55(6):158. [Context Link]
12. Centers for Disease Control and Prevention. Notice to readers: applied epidemiology competency development. Morb Mortal Wkly Rep MMWR. 2005;54(30):750. [Context Link]
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