Edited by: Michal Grivna, United Arab Emirates University, United Arab Emirates
Reviewed by: Laura Rudkin, University of Texas Medical Branch, USA; Jason Scott Turner, Saint Louis University, USA
Specialty section: This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The goal of any public health education at the Masters level is to transmit knowledge and skills to meet current and future public health challenges. We suggest an innovative multi-modal approach to public health education using a case-based pedagogy combined with competency-based curriculum and a team-based approach to foster truly experiential learning. We describe each pedagogical approach in connection to the relevance of optimal methods for training public health professionals. Western University’s Schulich Interfaculty Masters of Public Health (MPH) program (ON, Canada) provides a unique interprofessional education through case-based learning and competency-based curriculum. This Masters program has attracted applicants from around the world to learn in a supportive interprofessional environment and to foster them as they become learners and leaders in public health changes. To our knowledge, we are the first condensed MPH program using integrated case-based pedagogy as our main pedagogical approach.
Health professional education is in a constant state of change in order to meet the demands of a very complex work force. Training of health professionals has shifted focus to be more about skills and competencies (i.e., “what can you do”), rather than about specific information (i.e., “what do you know”). The impact of changes in training goals has dictated the need for transformations in how programs conceive, organize, and provide education to meet current and future health challenges.
Public health is an interdisciplinary field that requires health professionals working in it to be proficient in a myriad of skills and competencies not only for their own profession but also of other professions with whom they work. Postgraduate programs specific to public health provide the required establishment for training a competent workforce and avoid gaps in knowledge and skills. There exists a growing need for high quality postgraduate public health educational programs, as well as rigorous continuing education specific to public health.
The Council for Education in Public Health (CEPH) defines public health as, “enhancing health in human populations, through organized community effort” (
Since the 1970s, emphasis upon collaboration among health-care professions has been increasing, and in order to facilitate this way of working, interprofessional education (IPE) has been introduced (
In an effort to expand and innovate in public health education, our program faculty has carefully considered both the context of learning as well as the transmission of information to meet current and future public health challenges. Western University, located in Ontario, Canada is home to 30,000 students and 12 faculties and schools. Western’s Schulich Interfaculty Program in Public Health is housed within the Schulich School of Medicine and Dentistry. The program trains a maximum of 60 students in an intensive 1-year course-based professional Masters of Public Health (MPH) program. This innovative case-based program has attracted applications from around the globe. Our case-based, competency-based program was built for the increasingly interdependent demands of an ever-changing global health system.
Western’s goal was to create a unique and focused program grounded in transformative learning. The goal of this paper is to present an overview of current practices in public health education at the Masters level. We will explore how both the case-based approach and competency-based education models prepare students for the complexities of real-world decision-making. We believe our approach is both an innovative and essential approach to teaching in the complex area of public health.
Public health by definition is interdisciplinary and, as such, the objectives of our MPH program are diverse. Our program not only imparts solid technical skills and promotes critical thinking through competency-based curriculum but also embolden our students to be conscientious interdisciplinary professionals through an IPE lens. Our students take 49.5 credits in a condensed 1-year program, resulting in a very intensive learning experience. Each course has its own learning objectives, which align with our program competencies (discussed below). Our program’s mission is “to produce transformative knowledge, professionals and leaders that work to create healthy and sustainable communities both locally and globally. To this end, we foster professional education, public outreach and scholarship to support practitioners, leaders and change agents in moving societies toward more sustainably healthy futures”.
While there is no one best, agreed-upon, approach to interprofessional teaching, research has shown specific pedagogic approaches to be better suited for interprofessional learning. These include problem-based learning (PBL) (
Principles of effective instruction emphasize incorporating a thoughtful collaboration among students as a technique to increase levels of engagement ( Case-based pedagogy Team-based learning Competency-focused curriculum
We have created a program whereby each component builds on and off the others and is inter-related and iterative. We believe our approach to education provides our students with the necessary skills and tools to succeed in the fast paced, dynamic, and complex work environment of public health.
The case method of learning, which we have adapted from business management education, requires students to take an active role in their learning. This learning-by-doing involves the exploration of complex and often ill-defined real-world public health issues. Students simulate the experience faced by actual decision-makers using imperfect information in a swiftly changing environment. Cases are our main educational material. Students are often provided with supplementary or additional readings (journal articles, text book chapters) as well; however, one of our internal outcome measures is that 60% of course teaching is case-based/experiential learning (see Table
| Lecture based | Experiential learning | |
|---|---|---|
| Terms and labels | Lecture method Didactic (lecturing) “Student” |
Discussion teaching; active learning; case method learning; problem-based learning; advanced seminar; simulations “Learner” |
| View of learning | Learning-as-product; can be precisely measured Learning ends with last lecture Learning is information |
Learning-as-process: cannot be precisely measured Learning is life-long skill Learning is experience |
| Student preparedness, attendance and participation | Varies; can be entirely optional |
Preparation, attendance, and participation essential to learning |
| Responsibilities | Professor has major responsibility for teaching, which is transferring information |
Learners have major responsibility for learning, both for themselves and contributing to the learning of their colleagues, in both individual and group settings |
| Optimized for | Small details Memorization Un-integrated bits of information Facts: “right answers” A “canon” of core concepts Short-term recognition Knowing “about” Certainty |
Large, broad concepts Application Synthesized, integrated knowledge Ideas: “alternative approaches” Skills and competencies Long-term understanding Knowing “how to” Uncertainty |
| Rate of “information transfer” | High: many “facts per hour” | Low – few “facts per hour” |
| Faculty resources | Fewer faculty resources required |
Substantial faculty resources required |
| Role of theory | Theory as end in itself |
Theory informs practice; practice informs theory |
| Role of professor | Professor is most important teacher Professor is “expert instructor” Professor teaches students |
Learners become their own best professors Professor is “expert facilitator” Professor learns from students |
| Time allotted for questions and discussion | Varies from none to quite interactive; often spontaneous |
Extensive, designed into each session |
| Visual aids | Slides prepared by professor |
Words and diagrams drawn on board by professor and/or learners |
| Adaptability to emerging “news” | Less flexible/structured (because lecture topics and slides are pre-set) |
Flexible/adaptable (i.e., can be a story from that morning’s news) |
| Order in which concepts are covered in a particular session | Often, largely predictable |
Sometimes, largely unpredictable |
| When learning ends | Right around the final exam, when forgetting begins |
Learning never ends if one has a learning need and the tools to locate knowledge |
There is no consensus on the definition of case-based learning (CBL). One definition includes viewing CBL in terms of its goal: “to prepare students for clinical practice, through the use of authentic clinical cases” (
Case method learning is a three-stage process that builds on each subsequent step. It starts with individual case preparation, followed by a small group discussion, concluding with a large group discussion. Many disciplines use variations of experiential learning, including medicine, law, business, education, and engineering, as it challenges students to confront real-world situations. Case-based teaching has been proven to be superior to conventional didactic teaching in developing students’ decision-making and critical thinking skills (
Problem-based learning is, “any learning environment in which the problem drives the learning” (
There is a paucity of teaching cases in public health. Case-based pedagogy is predominantly composed of business cases, while existing health-related cases tend to be based on the US and, therefore, do not reflect the reality of Canadian health systems. Case repositories (e.g., Harvard Publishing, Ivey Publishing, European Case Clearinghouse, etc.) have few teaching cases that can be used in a health program. This created an opportunity for our program to develop
A pedagogy that emphasizes collegiality is an essential piece of public health education, fostering free thought to ensure a complete and mutual learning experience (
Our teams have five to six students; group sizes between three and six students are optimal for collaborative learning (
We conceive team-based learning as a collaborative process where our students work together, drawing from discipline-specific perspectives to address a mutual problem. We argue, as do others (
Researchers have outlined competency outcomes specific to IPE, such as communication, conflict resolution, problem solving, coping with uncertainty and ambiguity, group reflection practices, willingness to work together, mutual respect, and openness to trust in competencies of self and others (
The core competencies outlined by the PHAC, and the Council of Education for Public Health were used as a guide in developing the 19 core competencies for students in our MPH program. Our MPH Program covers 19 competencies: competencies 1–8 include, for example knowledge of health systems and critically appraising the literature; these reflect the core areas of public health. Competencies 9–19 reflect our Program’s concentration and include designing a program evaluation and formulating effective health communication. See Table
| Demonstrate knowledge of the systems in which public health functions, including current public health challenges ( |
| Recognize how the determinants of health (biological, social, cultural, economic, and physical) influence the health and well-being of specific population groups ( |
| Perform a community needs assessment taking into account the unique social, environmental, economic, historical, and cultural characteristics of the community ( |
| Establish observable relationships between the present level of environmental stresses and human health ( |
| Critically appraise the literature to understand patterns of health and ill health, establish causal associations, and recommend courses of actions ( |
| Demonstrate a professional appreciation of the ethical, legal, and social issues in public health policy and practice ( |
| Identify participatory relationships to foster community collaboration ( |
| Develop and implement a sustainable plan to address public health challenge(s) ( |
| Recognize and apply effective leadership practices in the public health context |
| Promote leadership development by incorporating learning from self-reflection into professional development and public health practice |
| Formulate, for Aboriginal and other communities at risk, culturally relevant and appropriate strategies when planning, implementing, adapting, and evaluating public health programs and policies |
| Discuss the legal framework of public health practice including legislative authority, rights, obligations and risks, at the federal, provincial, and municipal levels |
| Optimize organizational performance by applying systems thinking |
| Design appropriate program evaluations for public health interventions |
| Critically assess research designs that are appropriate for public health practice |
| Write a basic research proposal for application in public health practice |
There are two unique features to the success of our pedagogy:
our dynamic learning environment our focused faculty and staff
Our program is housed within the Western Centre for Public Health and Family Medicine. Our dedicated space for students includes a large teaching classroom and 10 smaller learning team rooms. The learning environment extends beyond the classroom into our community and across national and international borders. Through our “Brown Bag Seminar Series,” we bring the world into our classroom, allowing the students to hear from and interact and network with practitioners from the field (such as current and past Chief Public Health Officers of Canada, Medical Officers of Health from provincial health units, WHO officials, NGO, and community health organization personnel). Our students then “go into the field” through practicum and community-engaged learning, providing the opportunity for learners to synthesize and integrate knowledge gained from coursework (
The faculty of the MPH Program reflect the interlinked curriculum that they teach with expertise in anthropology, biostatistics, epidemiology, environmental sciences, family medicine, “big data,” health economics, health policy and law, health promotion, health services and implementation research, and management. As a new program, we identified and recruited interested (and deeply committed) faculty from across the different schools and departments at Western to the MPH program. This dual (and in some cases, triple) departmental appointment structure facilitates an interdisciplinary cross-talk and collaboration that would otherwise not have existed.
Student learning is also supported through our devoted program staff. A highlight is dedicated and individualized career counseling for our students both during the program and after graduation.
The success of our MPH program is showcased throughout our circular innovations and national and international attention. The MPH program welcomed the first cohort of students in Fall 2013; the third cohort will graduate in August 2016. Applications have nearly tripled in the 3 years since the program started. The uniqueness of the program has enticed future public health leaders from Canada and the world. The level of interest increased the likelihood of an increased application pool (
Almost all our graduates have been employed or admitted to other degree programs after graduation (including some who receive offers before they graduate), and anecdotal evidence suggests that employers (and students) highly value the case and team method of learning.
As a program, we have undergone rigorous evaluations in order to be a credible candidate for CEPH accreditation. The decision will be announced in the fall months of 2016.
Western has taken the lead in designing a novel case-based MPH program. We would like to not only share our experiences of the case method of learning in public health but also learn from other schools and programs doing the same. We would like to catalyze new initiatives and develop new interdisciplinary collaborations among public health educators and professionals, and this paper is a step in that regard.
Teaching using cases requires a different instructional skill set. Faculty must guide and manage class discussions and ensure that the learning objectives are met through this approach. We have sponsored our faculty to attend case teaching workshops, and our faculty are rapidly gaining experience in this approach through their own experience.
We also observed a lack of consensus on which public health topics are best taught by using cases. While topics such as leadership or program evaluation easily lend themselves to the case-based approach, the purely technical foundations of topics such as biostatistics and epidemiology do not. Our experience is that, although we can aim for 60% of our curriculum being taught using cases, there will, of course, exist wide variation between courses.
Students (and employers) acknowledge the benefit of working in teams after graduation. However, incorporating this pillar of public health into an intensive 1-year curriculum can be challenging due to resource and time constraints, and each year there are teams that struggle. Faculty advisors invest time and energy guiding teams into developing strategies for working together. Despite the challenges, feedback from well-functioning teams indicates that this has been an excellent mechanism for building and fostering cross-cultural learning and understanding.
As the MPH program grows, we are focusing our efforts on promoting the writing of public health cases, by reaching out to other schools/programs, public health practitioners, and researchers. Simultaneously, more thought has to be given to understanding what the appropriate teaching skills are for case method learning. How do we foster them? What effective facilitation skills are required? How do we use cases to sequentially present the mounting complexity of the core concepts of public health as the students move forward in their classes?
Last, but certainly not least, we need to build an evidence base to demonstrate the effectiveness of this format. What are the ideal methods of student and program evaluation of this format? The paradigm of transformative learning is underpinned by the sequential progression of the student from acquiring knowledge, to mastering the skills, and, finally, embodying the values of public health. How can we assess each step of this progression in a case-based education format?
We believe our program is a success story. We have navigated the muddy and sometimes-torrential waters of public health education and come up with a unique and innovative approach that is producing graduates who go on to improved careers. Our global focus has inculcated a learning environment rich in experience and challenges. Our CBL team approach ensures our curriculum is relevant, current, and engaging. Case method learning is aligned with competency-driven instruction. Our competencies hold our students (and faculty) to a high standard, ensuring they will thrive in the complex challenges of public health. Ensuring high quality competency-based IPE leads to improved health-care delivery (
All authors contributed to the ideas and conceptualization of the manuscript. SS drafted the first version of the manuscript. All authors edited and approved the final manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.