Public Health Curriculum Research Articles

Beyond accreditation: unraveling the narrative of public health through a critical race praxis lens.

Recognizing and addressing health inequities among minority populations are pivotal to public health. Further, public health strives to understand the complexities between race and health without limiting discussions around race as a trivial variable. This commitment toward equity demonstrates considerable similarities to Critical Race Theory (CRT) which led to the creation of the Public Health Critical Race (PHCR) Praxis to instill CRT within public health. However, the literature on how public health education incorporates critical race studies remains limited. The goal of this study was to examine how public health curriculum currently aligns with the PHCR praxis and meets public health's goal of health equity. This qualitative study employed document analysis to evaluate academic syllabi from CEPH-accredited MPH programs. Stratified random sampling was applied across two sampling pools, Schools of Public Health (SPH), and Public Health Programs (PHP). Course overviews, course objectives, course curricular information, and course policies were identified and extracted from each syllabus for analysis. A total of 53 syllabi were obtained from a final sample of nine public universities and one private. Through inductive and directed content analysis, a priori themes of Structural Determinism, Voice, Critical Approaches, Ordinariness of Racism, Social Construction of Knowledge, Intersectionality, Disciplinary Self-Critique, Primacy of Racialization, Race as a Social Construct, Race Consciousness, and their respective categories arose as salient. Two new themes, Antiracism Practices and Culture of Inclusivity, were also present. This study is the first to explore public health education's current curricular practices concerning CRT and antiracist praxes. The results confirm the interwoven nature of public health education with critical race studies, as all principles of PHCR praxis were present. However, the prevalence of these principles varied, suggesting gaps in the alignment of public health curricula and CRT. It is essential that public health educators ensure that the foundational competencies students are expected to display align with public health's goal of health equity. This work can equip MPH programs and public health educators with the ability to revise or bolster their current curricular and instructional efforts to support the pursuit of health, racial equity, and social justice.

Public health resilience and recovery in Ukraine: Academic partnerships to improve population health

Abstract Background Strengthening the public health workforce is among top priorities for the transformation of Ukraine’s public health system. As part of the USAID Public Health System Recovery and Resilience Activity, an Academic Partnership Collaborative brought together three Ukrainian universities (National University Kyiv-Mohyla Academy, I. Horbachevsky Ternopil National Medical University, Sumy State University), two American universities (Temple University and Drexel University), and the All-Ukrainian Association of Public Health Specialists (UPHA) to enhance the competencies of public health graduates in Ukraine. Objectives The collaborative focuses on strengthening the Ukrainian universities’ public health curricula and the teaching and research competencies of the Ukrainian faculty, making the curricular changes in Ukraine better aligned with US and European academic standards. The university partners are collaborating with the newly established UPHA in building partnerships with peer organizations in the US (American Public Health Association) and Europe (EuPHA) and sharing advancements in public health education with the broader community of public health practitioners in Ukraine to enhance their competencies to improve population health and align with European systems of public health. Results We have established linkages among all partners via an initial meeting in Uzhhorod, Ukraine in April 2024. We anticipate results by November 2024 to include curriculum review recommendations, coaching on prioritized topics for the Ukrainian partners, faculty development plans, and the establishment of continuing professional development programs in collaboration with UPHA. Conclusions Through this partnership, selected Ukrainian universities will have an enhanced and sustainable capacity to train the public health workforce and will become leading examples for other public health programs to simulate and collaborate with beyond the project. Key messages • Ukraine’s resilience and recovery relies upon the strength of the current and future public health workforce; mechanisms for building public health training are essential to a healthy population. • A collaborative process of strategic activities among American and Ukrainian universities and professional associations can be effective in building a resilient public health system in Ukraine.

Enhancing Interprofessional Skills with SKY Campus: A Pilot Study on Mental Well-being at UCD

Abstract Background Public health professionals and students face increasing mental health challenges. Sudarshan Kriya Yoga (SKY), known for its mental health benefits such as stress reduction and improved emotional regulation, offers a promising strategy for enhancing well-being in public health education. Objectives To evaluate the immediate effects of a three-day participatory SKY workshop on mental well-being of Master of Public Health students at University College Dublin, Ireland. Methods A non-randomized, controlled pilot study will involve MPH students at UCD. Participants, aged 18 and above, enrolled in the MPH programme, will provide informed consent to attend a three-day SKY workshop in September 2024. The workshop, delivered by certified trainers, includes three sessions of three hours each. Standardised and validated Patient-Reported Outcome Measures (PROMs) such as the Perceived Stress Scale (PSS-10) and WHO-Five Well-being Index (WHO-5) will be used to assess perceived stress and mental wellbeing at baseline and immediately after the workshop. Results Based on previous literature, it is hypothesized that participants will show a significant reduction in perceived stress and improvement in mental wellbeing scores. Data will be analysed using descriptive statistics and Wilcoxon signed-rank tests to evaluate changes in PROM scores. Conclusions This pilot study aims to provide preliminary evidence on the effectiveness of SKY in improving mental wellbeing among public health students. Successful outcomes could support integrating SKY into the public health curriculum, promoting its adoption across other institutions, and enhancing the professional skills development of future public health professionals. This component is proposed in the ASPHER core curriculum programme for public health as an important cross curricular subject area Key messages • Integrating SKY Campus workshops into public health education enhances interprofessional skills and mental well-being, offering a holistic approach to professional development in global health. • This study uses standard PROMs to assess the SKY workshop’s impact, aiming for significant improvements in stress and mental well-being to shape global public health curricula.

Support mechanisms and obstacles for developing public health practitioners’ core competences

Abstract Community health needs assessment is one of the central activities for local governments in Estonia, specifically under the health promotion strategic planning, and this includes developing health and well-being profiles for evidence-based public health promotion. For effective implementation of the profile, sufficiently trained public health practitioners are needed. Therefore, analysis of the needs of the additional study programmes according to the core competences of professional standard for health promotion was carried out among public health practitioners and the leaders of local governments. The study was based on the 19 semi-structured interviews carried out in 2022-2023 with leaders (10) and public health practitioners (9) in Estonian local governments. Based on the local government’s size, status of the health and well-being profile and the employment and educational background of the public health practitioner three sub-groups were developed. The collected data was analysed using qualitative content analysis with focus on support mechanisms and obstacles of core competences of public health practitioners. The respondents indicated the need for training on communication (leadership and advocacy) and analytical skills (evaluation and research). Core competence training is however limited by resources (time, energy, motivation, funding), employer expectations (overload at work) and working full-time. Training is supported by personal motivation (e.g., wish to stay competent, understanding the need for training), employer support (including flexible work arrangements), and curriculum support (funding is covered). The results indicate there is a need for flexible education as the need for developing and maintaining core competences emerges in practical work. The results can be used for developing the public health curriculum, to assess and provide training for public health practitioners to better meet the needs of the labor market in the future. Key messages • Local government employees performing health promotion tasks feel the need to upgrade various core competences: e.g., communication, management, data analysis and assessment. • In health promotion, there is a growing need for flexible education, which creates challenges for higher educational institutions to meet the needs of the labor market.

Lowering the Stakes: Quasi-Experimental, Mixed-Methods Evaluation of a Restructured Grading Approach in a Graduate Public Health Research Methods Course

In schools and programs of public health, active learning and restructured feedback strategies may improve student learning and course performance compared to traditional lecture-based formats and grading systems. To promote student engagement and active learning, we implemented the team-based learning (TBL) model and a restructured grading approach based on principles of “ungrading” in the required behavioral research methods course of a master’s level public health curriculum. We conducted a quasi-experimental, mixed-methods evaluation of the implementation of restructured grading approach (two sections, n = 46) compared to the traditional grading approach (two sections, n = 34). For the restructured grading sections, numeric grades were removed for weekly team quizzes and team assignments. We administered and analyzed pre- and post-course surveys to compare perceived mastery of course learning objectives, intrinsic motivation, and perceptions of grading and instructor feedback by grading approach. Additionally, we compared course grades and final paper grades by grading approach and conducted two focus groups (one for each approach). The results indicate that students’ learning, satisfaction, and perceptions of the course were mainly equivalent across grading approaches. Students in the restructured grading sections demonstrated a few modestly improved outcomes compared to their peers in the traditional grading courses. Students in the restructured grading sections had slightly higher mean course grades, reported greater increase in confidence to critically evaluate research designs, and found team quizzes to be more helpful. Removing grades for team quizzes and assignments supported student learning and reduced student stress.

Inclusivity and decolonisation of the post-graduate public health curriculum: Reflections from a student-led approach

The future of successful public health practice requires public health students to be educated within a decolonised curriculum that challenges the historical biases and inequalities that are deeply embedded within global public health and society. In this commentary, we reflect on what it can mean and why it's important to decolonise and diversify a public health curriculum. We describe how we used a student-led approach to begin this process, and share recommendations that are applicable to national and international curricula.

Strategies for Preparing Future Public Health Leaders: Learning from Trailblazing Women in Health Education

Many female health education pioneers made seminal contributions to public health and social justice, yet these examples are not well documented in textbooks or integrated into public health curricula as pedagogical learning opportunities. Providing biographies and lessons learned from the past leaders within undergraduate health education curricula can help develop students’ skills as future leaders and address gender inequities in the field. Gender inequities in higher education as well as many public health practice settings result in lower salaries, slower career advancement opportunities, fewer supervisory positions, increased work-life conflicts, and heavier workloads. Developing women’s competencies in leadership and professionalism early in their careers is critical to meeting public health challenges such as COVID-19. We present four female health education trailblazers from different historical eras and various workforce sectors who exemplify leadership attributes (i.e., courage/risk taking, vision, advocacy, mentorship) and can be highlighted as a part of future health education curriculum. Innovative methods and approaches are provided for integrating these leadership lessons into undergraduate public health courses, in alignment with the HESPA II 2020 competencies. Learning from the past to inform the future is critical to inspiring and shaping the careers of emerging health educators.

Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multiyear Study.

Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multiyear, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school. The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules. Across 3 cohorts, 405 of 420 (96.4%) students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty ( P < .001), more positive attitudes toward public health broadly ( P < .001), and increased knowledge of public health content ( P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules. Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students' knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.

The Urgent Need for Disaster Education as a Core Competency in Accredited Schools and Colleges of Public Health by the Council on Education for Public Health.

Public Health is essential to disaster preparedness, mitigation, response, and recovery. This has never been more evident than during the COVID-19 pandemic when public health was the disaster response lead. However, students are graduating from accredited schools and colleges of public health with limited or no education in disaster management. This is a crisis unto itself, and it is incumbent upon The Council on Education for Public Health (CEPH) to take immediate action. Public health preparedness should be recognized as a core element in public health curricula, and practical experiences, such as drills and simulations, are necessary to equip students with the confidence and competencies needed in high-stress situations. The need for such preparedness education extends beyond the COVID-19 pandemic. It is a crucial step for creating a resilient and competent public health workforce capable of safeguarding community health in the face of complex and emerging challenges.

PUBLIC HEALTH CURRICULUM: DEMENTIA CAREGIVING AS A PUBLIC HEALTH CHALLENGE AND OPPORTUNITY

Abstract A new, free, one-hour, interactive, online module, Dementia Caregiving as a Public Health Challenge and Opportunity, is designed for public health students, educators and professionals. This course approaches caregiving for people with Alzheimer’s disease and other dementias from a population-based perspective , while remembering that these are the individual stories and lives of millions of people today. Dementia caregiving is a public health priority because of its prevalence; its profound influence on individuals, families, communities, and healthcare systems; and its disproportionate effects on subgroups of individuals. A number of public health actions can help to address the population effects of dementia caregiving. There remains a gap in public health curricula that features dementia and dementia caregiving, and this module represents an educational innovation to introduce key concepts in dementia caregiving for students and others. This module defines dementia caregiving, specifies why dementia caregiving is a public health issue, and reviews evidence-based programs for assisting dementia caregivers. Public health examples and case studies are used to support and assess learner understanding. This module was developed for the Alzheimer’s Association by the Emory Centers for Public Health Training and Technical Assistance with support from the Building our Largest Dementia Infrastructure (BOLD) Public Health Center of Excellence on Dementia Caregiving, and represents a novel strategy to elevate dementia caregiving as a matter of public health concern.

Evaluation of a Remote Youth Health Advocate Training Program During the COVID-19 Pandemic

Abstract: Background: Since 2016, Changing Health through Advocacy &amp; eMPloyment In Our NeighborhoodS (CHAMPIONS) has utilized in-person programming to engage high school students from underserved Chicago communities in health advocacy education and exposure to health professional careers. Objective: Describe outcomes after CHAMPIONS' shift from in-person to remote programming during the corona-virus disease 2019 (COVID-19) pandemic. Methods: The Summer 2020 remote program consisted of four main activities: 1) didactic public health curriculum, 2) phone calls to COVID-19 patients, 3) COVID-19 community health projects, and 4) health professional speaker series. Program evaluation consisted of pre-/post-program surveys and focus groups. Results: Participants were very satisfied with CHAMPIONS and reported increased healthy habits, self-efficacy, and knowledge. "First-hand experiences" increased equivalently or more for the remote compared to in-person cohorts. Conclusions: The remote CHAMPIONS program maximized positive effects for participants. Strengths and lessons learned may be used in future enrichment programs to improve accessibility and exposure for underserved students.

Making Community Connections for Minority Outreach in Alzheimer’s Disease

AbstractBackgroundRecognizing the gap in communication that exists between minority populations and Alzheimer’s disease (AD)research community, education and outreach are a critical step in the effort to understand and address disparities. African‐Americans (AA) and Hispanics, are significantly more likely to have Alzheimer’s disease and related dementia (ADRD) as compared to non‐Hispanic Whites. In addition to biological risk, widespread and significant misperceptions about aging process, diagnosis and clinical management influence the way in which AD/ADRD is recognized and subsequently treated in minority populationsMethodAn Alzheimer’s’ Community Engagement ‐Empower Minorities (ACE‐EM) center is proposed as an addition to existing research programs at Delaware State University (DSU). As a Historically‐Black university DSU is uniquely positioned to coordinate Alzheimer’s outreach programs in minority communities of interest. Organizations with strong ties to minority populations improve intervention effectiveness and increase impact. ACE‐EM plans to foster education and training of DSU students under the guiding framework of the Alzheimer’s disease Public Health Curriculum to develop community trusted dementia advocates – an investment for a competent future public health workforce. We recognize the importance of having conversations with family and community members about aging, AD/ADRD and how we can work together to reduce the risks of Alzheimer’s disease for future generations as outlined in the CDC Healthy Brain Initiative Road Map (2018‐2023).ResultCenter will provide a hub for scientific and community exchange for research dissemination specific to cognitive health and AD/ADRD among minorities and 2) engage community members, their families, and partners through culturally targeted and linguistically appropriate education, training, and measurements. Preliminary targeted outreach efforts and data collection in process.ConclusionTo build empowered communities with increased awareness and understanding of cognitive health, through a range of community‐informed and community‐engaged dissemination activities.

More Diverse and Equal: Insights on Moving From "Real-Life" to "Remote" Practicum Experiences and Career Development From Undergraduate Global Public Health Students During COVID-19.

A key facet to typical undergraduate or graduate global public health programs is an applied practice experience (a practicum) that culminates in shared results and public presentations (e.g., research posters, conference and working papers, needs assessments). Requirements vary by program but may be between 80 and 200 hours of experiential learning. While not required by all undergraduate programs in global public health, a practicum occurs as part of a semester of coursework or internship experience after students have declared the major/minor or have completed an expected number of courses. Some students report that the practicum experience, while essential to their career development and future opportunities, presents certain challenges in terms of access. Practicum opportunities can be rife with assumptions that social networks, privilege, and implicit bias affect and even predict the ability to secure an effective, doable, and career-advantageous project. In 2020, the COVID-19 pandemic meant that much of the applied and experiential aspects of a practicum were necessarily shifted from "realworld" experiences to virtual and "remote" contexts. This article highlights insights from students enrolled in undergraduate global public health programs who were planning "real-life", more "traditional" practicum experiences, and had to necessarily move to "remote" and online engagement. These cases suggest that participation in virtual fieldsites is seen as legitimate, fulfilling for students and stakeholders, and can increase diversity, equity, and inclusion in the public health curricula; fostering best practices in career development.

Empowering Older Adults in Underserved Communities—An Innovative Approach to Increase Public Health Capacity for Fall Prevention

Although evidence-based programs have been effective for fall prevention in many communities, older adults living in underserved areas cannot access these services due to the shortage of providers and trainers. In this cross-sectional study, a multi-agency approach was adopted for integrating an evidence-based program, A Matter of Balance (AMOB), into the public health curriculum at a rurally placed university. We assessed student learning as well as the community benefits of fall prevention among those who participated in the AMOB program. Eighty-four percent of the students reported intentions of using AMOB training in their future careers. The average of the items for the effectiveness of “Classroom Training” and “Community Training” provided by the students (n = 25) ranged from 3.52 to 4.32 and 3.48 to 4.36, on a Likert scale (1 = Strongly Disagree to 5 = Strongly Agree), respectively. Older adults who participated in the fall prevention community workshops showed increased confidence in reducing falls, protecting themselves from falling, and becoming steadier on their feet after the training (p &lt; 0.05). Our study demonstrates the value of integrating evidence-based programs such as AMOB in a university curriculum to address rural health disparities related to falls.

A Call for a Transformative Public Health Training: The Necessity of Abolition.

The societal distrust of public health alongside the complex, intersecting, and large public health crises of today and our future requires a transformation of the education of the next generation of public health leaders. The field of public health's goals of health equity for all cannot be advanced until our field interrogates and resists the prison industrial complex (PIC), which maintains White supremacy and (re)produces health inequities. As current and former public health students, we propose incorporating abolition of the PIC as a political vision, structural and power analysis, and organizing strategy into the public health curriculum. We highlight gaps in the public health curriculum and the existing similarities between stated goals of abolition and public health. We propose calls to action for individuals, faculty, and schools of public health to interrogate the carceral nature of public health and work toward contributing to the positive project of an abolitionist future.

Teach, Learn, Do, Repeat: Service Learning Curriculum that Drives Public Health Education while Improving Community Health Outcomes.

The integration of service learning into public health curriculum allows students to apply and ultimately better understand often abstract but important theoretical concepts. We provide lessons learned and practical advice on how to plan and implement an experiential learning project over a two-semester period for upper level undergraduate public health students. Through application of program planning pedagogy, students obtained real-world experience while simultaneously improving mental health for college students. We also discuss how experiential curriculum also provides faculty the opportunity to engage with community stakeholders and organizations to build sustainable partnerships that positively impact students and the community at large.

Initiating decolonization: from The Last Straw! to Whāriki

The board game, The Last Straw!, is part of the Aotearoa (New Zealand) public health and medical curriculum at the University of Otago. An engaging and effective teaching tool about the social determinants of health, the game falls short by being silent about Indigenous experiences. A project is underway to adapt The Last Straw! for play following an Indigenous framework, kaupapa Māori (Māori (Indigenous people of Aotearoa) approach). The game board is being redesigned as Whāriki, a woven mat. The mat represents a metaphor for life as strands of thread are woven throughout the lifecourse, and the thread characteristics impact the strength and qualities of the mat. This brief commentary outlines the first stage of adapting this resource, illustrating decolonizing the public health and medical curriculum in a way that honours and embeds te ao Māori (the Māori worldview), making them visible and intentional.

Using Supplemental Instruction through the EMPOWER Program to Increase Diversity in STEM Fields

The underrepresentation of women and racial minorities in science, technology, engineering and math (STEM) fields is of national concern. Despite recent increases, females continue to be underrepresented in math, physical science, and engineering related fields compared to their male counterparts. There is also evidence showing a troubling inequity trend in enrollment of most graduate and all post graduate degrees in STEM fields. These factors ultimately impact the workforce with women less likely than men with similar degrees to actually be employed in these fields, constituting 23% of the science and engineering labor force and only 10 % of employed physicists. Well-structured interventions are needed to support African American women in overcoming barriers to increase their representation in STEM. What is Needed to Make a Difference? Extracurricular instruction in the form of supplemental educational programming is needed to identify, engage and retain African American female students to ensure their level of post-secondary education STEM success and beyond. The R25 Summer Research Education Program is designed to support education activities that complement and or enhance the training of a workforce to meet the nation’s biomedical, behavioral, and clinical research needs. Methods: The Engaging Multidisciplinary Professional Opportunities for Women in Environmental Research (EMPOWER) program was created to address the diversity in STEM. This summer research experience program was developed to educate high school science teachers in tandem with outstanding African American and Hispanic women from metro Atlanta high schools in the research approaches and competencies required for a deeper understanding of how to measure and assess environmental exposures, including air and water in the urban environment and link them to health effects. Results/Discussion: Students and teachers participated in a four-week summer program. The primary objectives of EMPOWER were two-fold including:1) Enhance teaching capacity within the sciences and assist in the development of public and environmental health curriculum along with in class activities intended to promote interest in STEM. 2) Provide African-American and LatinX women opportunities to engage in faculty lead research projects, obtain hands-on training in tandem with professional and soft skill development. EMPOWER’s major contribution will be to continue to enhance STEM education in high schools leading to higher quality post-secondary opportunities and greater workforce diversity. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Comparing Individual Versus Team Decision-Making Using Simulated Exercises in a Master of Public Health Program

In line with the complex modern health care system and the increasing importance of interprofessional teams, a powerful strategy to facilitate the acquisition of essential teamwork skills and expose students to complex decision-making processes is learning in teams. The purpose of our study was to obtain empirical evidence of superior decision-making by teams versus individuals in two simulated decision-making exercises conducted 4 months apart. We collected quantitative data from three cohorts of Master of Public Health students to determine if teams make better decisions than individuals (“team effect”) between September and January. Students completed simulated emergency survival exercises requiring them to make correct decisions individually and then as teams. Decision quality was determined by comparison to survival experts’ decisions. We calculated the “team effect” as the gain or loss of mean individual versus group scores across 10 learning teams per cohort for fall and winter exercises. All three cohorts had a consistently small average team effect in September and a much larger team effect in January. Our study showed consistent improvements in decision-making after students had worked in teams for 4 months. Overall, this study demonstrates the potential benefit of incorporating team learning into a public health curriculum and the importance of strategies to teach teamwork in health education. Using simulation in health education and promoting team learning activities can help prepare students for interprofessional collaboration, a part of the demanding public health landscape. These results might help convince students of the benefits of teamwork, facilitate collaborative decision-making, and enhance the learning experience.

Assessing climate and health curriculum in graduate public health education in the United States.

Climate change has been identified as both a challenge and an opportunity for public health. The onus to prepare the next generation of public health practitioners lies heavily on schools and programs of public health. This article (i) assesses the status of climate change and health curricula in accredited schools of public health in the United States and (ii) proposes strategies to better train professionals so they are more informed and prepared to mitigate, manage, and respond to the health impacts of climate change. Course offerings and syllabi listed in online course catalogs from 90 nationally accredited schools of public health were evaluated with the purpose of identifying the extent of climate change education in graduate programs. Only 44 public health institutions were found to offer a climate change related course at the graduate level of education. Of the 103 courses identified, approximately 50% (n = 46) are focused on this climate change and health. These courses cover a wide array of topics with an emphasis on conveying fundamental concepts. In-depth assessment revealed a need for integrating learning opportunities that build practical skills useful in a hands-on public health practice environment. This assessment indicates the limited availability of climate-health course offerings available to graduate students in accredited schools. The findings are used to propose an educational framework to integrate climate change into public health curricula. The proposed framework, while rooted in existing directives, adopts a tiered approach that can be readily applied by institutions training the next generation of public health leaders.