Undergraduate public health education: is there an ideal curriculum?

Abstract

This commentary speaks to the need to design a curriculum that best meets the needs of students who are enrolled in Bachelor of Science in Public Health (BSPH) degree programs. The past 10 years has witnessed a dramatic growth in the number and size of these programs. While several of these degrees are housed within schools and colleges of public health, many are located in colleges of arts and science, allied health, medicine, and many other academic homes. It is difficult to determine the actual number of BSPH programs (or similar type degrees but with different names) due to a lack of national accrediting standard. The number of students in these programs varies widely with as few as 25 to as many as 600. In addition to stand-alone BSPH degrees, there are a number of what is known in the field as three plus two programs where a student spends 3 years completing their undergraduate courses and then an additional 2 years of study that completes both their BS degree in addition to their Master of Public Health (MPH). The point here is that there is a significant demand for the BSPH degree on the part of students and universities are more than happy to meet that demand. A legitimate question that we have is what career or education paths do students pursue once they complete their BSPH degrees. Evidence suggests that the largest fraction of BSPH students use the degree as pre-professional preparation for entry into advanced clinical training including medicine, nursing, physical therapy, physician assistant, pharmacy, and other specialty areas. Given the implementation of the Affordable Care Act and the movement toward population health, it is critical that future clinicians know and can potentially apply core public health principles into their practices. A second path for BSPH graduates is into MPH degree programs. Once the spark is ignited during their undergraduate education, students see that they can make a profound difference in public health practice but know that the MPH is the degree of choice for a large number of employers. In our companion commentary (“Undergraduate Public Health, Lessons Learned from Undergraduate Health Administration Education”), we ask whether courses taken in the BSPH degree might have the capacity to either transfer into the MPH or perhaps students should be waived out of one or more of the core courses and instead be allowed to take additional electives. If this practice were to become commonplace, prospective MPH students might see an opportunity to better tailor their graduate education. In addition to preparation for clinical education or entry into an MPH program, current BSPH students sometimes move directly into Public Health related jobs at the entry level where they obtain important work experience before advancing to an MPH degree. There are also students who upon graduation go into a whole variety of other education or work related opportunities including Peace Corps or Teach for America. Given the four paths that BSPH graduates can potentially take, it is important to clearly understand where students go once they depart our programs and how our curricula can add value to the career options for graduates. Toward that end, does it make sense to craft a single unified BSPH curriculum that provides a rigorous preparation in public health and at the same time is flexible enough to accommodate the multiple career paths of graduates? Although various frameworks have been proposed (AAC&U, ASPPH, and CEPH), no model has been developed in sufficient detail to consider the challenges of implementing a truly well-articulated program. Do we as a field wish to develop a BSPH curriculum that mirrors the current CEPH requirement for accredited MPH degrees with a required core and multiple program tracks? If this is the option selected, what differentiates the BSPH from the MPH? As noted in our companion commentary, graduates from AUPHA certified undergraduate health administration programs compete successfully for entry level management jobs with graduates from CAHME accredited MHA programs. Regardless of how we design our BSPH curriculum, programs need to keep in mind what is in the best interest of their students. As programs think about either designing a BSPH curriculum de novo or modifying an existing curriculum, there are four important elements to keep in mind: