Field Epidemiology Training Program Development Handbook
Field Epidemiology Training ProgramDevelopment HandbookU.S. Department of Health and Human ServicesCenters for Disease Control and PreventionCoordinating Office for Global HealthDivision of Global Public Health Capacity Development
On the CDThe enclosed CD contains an electronic copy of this manual and appendices which supplement the text. Theappendices provide useful tools and references to assist in the development of an FETP.Appendices are listed by the appropriate chapter title and then by number. On the CD, click the chapter title link toview all appendices for that chapter.FETP Development HandbookU.S. Centers for Disease Control and PreventionDivision of Global Public Health Capacity Development
Field epidemiology Training programdevelopmenT HandbookDepartment of Health and Human ServicesU.S. Centers for Disease Control and PreventionCoordinating Office for Global HealthDivision of Global Public Health Capacity Development
Atlanta, GA: U.S. Centers for Disease Control and Prevention. 2006.
ContentsCONTENTSFOREWORDVIIABOUT THIS 3.43.53.6INTRODUCTION TO FETPSCompetencies .1A Few Terms .3Partners .3Goal of an FETP.4Key Principles .4Diversity .6READINESS ASSESSMENT7Assess Readiness for an FETP .72.1.1Ministry of Health commitment .72.1.2Physical security.82.1.3Political stability.82.1.4Availability of funding .8Conduct an FETP Planning Assessment .92.2.1Assemble assessment team .92.2.2Identify persons to interview .92.2.3Determine ministry goals and document infrastructure.102.2.4Review and determine burden of disease .102.2.5Document a need for applied epidemiology competencies .102.2.6Identify potential partnerships .112.2.7Establish a career path for graduates.12Develop a Country Plan.12PLANNING15Key Questions.15Develop Program Goals and Objectives .17Develop Workplan and Timeline .17Develop Advisory Committee .19Determine Program Management Locus .203.5.1Program location options .203.5.2Recommendation .213.5.3Discussion .21Determine Program Staffing and Responsibilities .213.6.1Program leadership and management.223.6.2Technical leadership .23i
.6.3Field supervision and mentoring .233.6.4Training development and implementation. 243.6.5Editor . 243.6.6Administrative support.25Define Service Functions of FETP .25Agree on Competencies.26Address Certification of Graduates .273.9.1Certification options.273.9.2Recommendation .28Determine Curriculum Components and Schedule .293.10.1Duration of training program.293.10.2Schedule for training.293.10.3Content and methods .293.10.4Evaluation of trainees.303.10.5Faculty considerations .30Select Trainees and Develop Support Plan .313.11.1Size of an FETP class.313.11.2Qualifications of trainees .313.11.3Trainee positions and support.32Establish Career Structure and Opportunities .32Establish Program Monitoring and Evaluation .333.13.1Monitoring.333.13.2External evaluation . 34Address Budget and Other Administrative Issues .343.14.1Budget . 343.14.2Budget authority.373.14.3Pre-authorized arrangements for travel.373.14.4Provision of suitable office space and services .37IMPLEMENTATION39Recruit and Select Trainees .394.1.1Convene selection committee.394.1.2Develop expectations for incoming trainees. 404.1.3Organize application process. 404.1.4Recruit trainees. 414.1.5Receive applications . 424.1.6Screen applications. 424.1.7Interview applicants. 434.1.8Select trainees . 434.1.9Inform applicants of their status. 43Organize Field Placements .434.2.1Determine field placement strategy . 444.2.2Select field sites . 454.2.3Match trainees to field placement sites . 464.2.4Orient field supervisors. 474.2.5Evaluate field sites. 48Develop Network for Graduates.49
M AND TRAINING51Training Models .51Designing the Curriculum .515.2.1Agree on competencies.535.2.2Review competency-based instructional goals.535.2.3Review goal-based learning objectives . 545.2.4Finalize curriculum . 545.2.5Create instructional plan.555.2.6Create two-year program schedule .595.2.7Create training material development list .605.2.8Define expectations for field activities .60Developing Training .615.3.1Create course syllabus .615.3.2Choose appropriate existing class materials.615.3.3Develop new class materials .615.3.4Develop field study .615.3.5Link didactic course content to field activities.62Delivering Training .635.4.1Manage logistics of training events .635.4.2Coordinate faculty . 645.4.3Conduct orientation for instructors . 645.4.4Conduct effective lectures, case studies, exercises .655.4.5Prepare effective class reviews .665.4.6Support field supervisors .67Evaluating Training .675.5.1Evaluate curriculum and training.675.5.2Level 1: Evaluate learner satisfaction.675.5.3Level 2: Evaluate learning.685.5.4Level 3: Evaluate performance .705.5.5Level 4: Evaluate results .715.5.6Summaries .72ADMINISTRATION73Maintain Funding Sources .736.1.1Identify outside funding sources.736.1.2Establish clear communication with donors . 74Manage Equipment and Supply Needs .74Develop Staff and Field Supervisors .75Manage Program Communications .75SERVICE77Public Health Services .777.1.1Emergency response .777.1.2Surveillance and health information systems .787.1.3Public health assessment .807.1.4Public health interventions .81iii
Contents7.27.388.18.28.37.1.5Involving decision makers in study design .81Communications .827.2.1Communication difficulties .837.2.2Communications products .837.2.3Public health bulletin/report . 847.2.4Clearance for public health bulletin/report. 847.2.5Disseminating reports electronically. 84Integration of Laboratory and Epidemiology Services .85MONITORING AND EVALUATION87Monitoring and Evaluation Cycle for FETPs .88Program Monitoring .888.2.1Using data systems to facilitate monitoring .908.2.2Documents and hard-copy files.908.2.3Reporting and using data .91Program Evaluation.91TABLESTable 1: Levels of Learning.1Table 2: Potential Partnerships.11Table 3: Options for Program Location .20Table 4: Functions of Staff Members .22Table 5: FETP Core Competencies .26Table 6: Options for Certification .27Table 7: Options for Funding Trainees .32Table 8: Options for Field Placement .44Table 9: Options for Matching Trainees to Field Placements .46Table 10: Examples of Different Training Models within FETP .51Table 11: Competencies, Goals, and Objectives .52Table 12: Training Techniques .57Table 13: Training Course Checklist.63Table 14: Actions Necessary to Conduct Surveillance .79Table 15: Levels of a Surveillance System.79Table 16: Current Epidemiology Publications by Country .85FIGURESFigure 1: FETP Logic Model.5Figure 2: FELTP Schedule.59Figure 3: Use of Continuous Monitoring for Program Improvement.89iv
ContentsAPPENDICESThe following appendices are found on the accompanying CD-ROM.Chapter 1: Introduction to FETPsAppendix 1: Partnerships in Field Epidemiology Training and Service, 1975-2001Appendix 2: Table of Field Epidemiology Training ProgramsAppendix 3: Map of Field Epidemiology Training Programs - 2004Appendix 4: Training Programs in Epidemiology and Public Health Interventions Network(TEPHINET) Background and Contact InformationAppendix 5: Field Epidemiology Training Program Logic ModelAppendix 6: Examples of Field Epidemiology Training Program ModelsChapter 2: Readiness AssessmentAppendix 1: Strategic Planning ToolAppendix 2: FELTP Country Plan ExampleChapter 3: PlanningAppendix 1: FELTP Logic Model ExampleAppendix 2: FETP Workplan ExampleAppendix 3: Timeline for Planning and Implementation ExampleAppendix 4: Planning ChecklistAppendix 5: Example of FETP Position DescriptionsAppendix 6: Detailed Budget ExampleAppendix 7: Budget Justification ExampleChapter 4: ImplementationAppendix 1: Battelle ReportAppendix 2: Announcement in WHO Global Leadership Programme ExampleAppendix 3: Application Process Interview Form ExampleAppendix 4: Guideline for Evaluating New Field Sites ExampleAppendix 5: Field Placement Memorandum of Understanding TemplateAppendix 6: Instructions for Completing the Field Placement TemplateAppendix 7: Suggested Mentor/Supervisor Training CurriculumChapter 5: Curriculum and TrainingAppendix 1: FETP Standard CurriculumAppendix 2: Creating Competencies, Instructional Goals, and Learning ObjectivesAppendix 3: Developing Content and Lesson PlansAppendix 4: Trainee Workplan ExampleAppendix 5: Course Syllabus ExampleAppendix 6: Field Exercise ChecklistAppendix 7: Competency Indicators Checklist ExampleAppendix 8: FETP Trainee Satisfaction Evaluation ExampleAppendix 9: Instructor Orientation Meeting ExampleAppendix 10: The Six Questions RuleAppendix 11: Managing Difficult StudentsAppendix 12: Summary of CFETP Mentor/Supervisor Responsibilities for Officer Activitiesv
ContentsAppendix 13: Level 1 Reaction Evaluation Form ExampleAppendix 14: Level 1 Course Evaluation Form ExampleAppendix 15: Post Test ExampleAppendix 16: Trainee Self-Assessment ExampleAppendix 17: Level 3 Evaluation - Analysis of Scientific Quality ExampleAppendix 18: Performance Evaluation Form ExampleAppendix 19: Level 3 Evaluation - Interview ExampleAppendix 20: Evaluation Summary Spreadsheet ExampleChapter 6: AdministrationNo appendices at this time.Chapter 7: ServiceAppendix 1: CDC Updated Guidelines for Evaluating Public Health Surveillance SystemsAppendix 2: Health Information System Inventory and FlowchartAppendix 3: Rapid Surveillance Assessment ToolAppendix 4: Technical Guidelines for Integrated Disease Surveillance and Response in the AfricanRegionAppendix 5: IMRAD Model: Why Do Chickens Cross the Road?Appendix 6: Involving FETP in a Public Health Bulletin: New or ExistingAppendix 7: Planning Guide for Publishing a Public Health Bulletin/ReportAppendix 8: Example of Author Guidelines - WHO BulletinAppendix 9: Laboratory Evaluation and Improvement StrategiesAppendix 10: Framework for Program Evaluation in Public Health (MMWR)Chapter 8: Monitoring and EvaluationAppendix 1: Proposed Program IndicatorsAppendix 2: Sample Program Evaluation Summaryvi
ForewordFOREWORDIt is a pleasure to introduce this new version of the Field Epidemiology TrainingProgram (FETP) Development Handbook. Designed for public health professionalswho want to implement or strengthen their FETPs, the handbook delineates thekey factors that contribute to a sound and effective applied epidemiology trainingprogram.For purposes of this handbook, the term FETP will refer to all public healthtraining programs that share FETP core competencies and service goals, includingPublic Health Schools Without Walls, Field Epidemiology and Laboratory TrainingPrograms, and other similar capacity development programs.FETPs are competency-based training and service programs in applied epidemiologyand public health that build public health systems capacity in the countries wherethey are implemented, by recruiting promising young health workers and buildingtheir competencies through on-the-job mentorship and training. The trainees workin active public health teams that are tackling the most serious and acute problems oftheir populations, leading to improvements in program implementation even as thetrainees are learning. For example, in 2004, the first introductory course of the Kenyaprogram was interrupted when the Ministry of Health (MOH) requested that staffand trainees investigate a large epidemic of aflatoxicosis. Because the trainees quicklyproduced data on the size and scope of the outbreak, as well as evidence suggestingthat poisoning was caused by eating moldy maize, the MOH was able to advocatefor emergency food shipments to the affected areas and destruction of contaminatedfood, which led to a quick decline in cases. Next, the trainees worked with expertsand communities to determine culturally appropriate ways for villagers to safely storemaize.FETPs provide service and strengthen capacity in public health systems in manyways. For example, FETPs Strengthen response to acute problems such as outbreaks and natural and manmade disasters, Strengthen the scientific basis for program and policy decisions to prevent andcontrol diseases and conditions, the key to public health impact, Strengthen surveillance systems through evaluations, managing ongoing or newsurveillance systems, and training of local health staff, Strengthen the communication of epidemiologic information by contributingto the national epidemiology bulletin, publishing journal articles, and presentingsurveillance data to decision makers. An epidemiology or public health bulletinis an important method of communicating epidemiologic information amonghealth workers, public health professionals, and other key partners. In some cases,the FETP has taken full responsibility for publishing the bulletin.The FETP model has been applied successfully in countries throughout the world.In recent years, large countries, such as China and India, have begun programs.Also, the Central Asian countries and the Central American countries have bandedtogether to develop regional programs. FETPs and allied programs of the world havevii
Forewordpartnered together in a network alliance, Training Programs in Epidemiology andPublic Health Interventions Network (TEPHINET). It is our hope that TEPHINETmembers and partners, including CDC and the World Health Organization, canwork together to help foster new and existing programs around the world and buildthe capacity to improve public health systems.Patricia M. Simone, DirectorDivision of Global Public Health Capacity DevelopmentCoordinating Office for Global HealthCenters for Disease Control and Prevention
ABOUT THIS HANDBOOKAUDIENCEThis handbook is intended for persons who Plan, develop, and implement field epidemiology training programs (FETPs), Manage existing FETPs, and Evaluate FETPs.These persons include resident advisors appointed by CDC and their host country counterparts,program managers, and country directors. University or MOH counterparts, field coordinators, andfield supervisors may also find value in this handbook.PURPOSEIn addition to providing information to our previously described audience, this handbook shouldalso be of assistance to persons who wish to advocate for an FETP and for persons developingcompetency-based epidemiology training programs that do not fully meet the definition of an FETP.Each section of this handbook will guide you through the process covered in that section, and wehave included various tools and references to help with this on the enclosed CD-ROM.ORGANIZATIONThe handbook is organized into the following chapters:1. Introduction to FETPs5. Curriculum and Training2. Readiness Assessment6. Administration3. Planning7. Service4. Implementation8. Monitoring and EvaluationThe enclosed CD-ROM contains an electronic copy of this manual and appendices whichsupplement the text. The appendices provide useful tools and references to assist with thedevelopment of an FETP. Appendices are listed by the appropriate chapter title and then by number.On the CD-ROM, click on the chapter title link to view all appendices for that chapter.SYMBOLS USEDBelow is a list of symbols used throughout the handbook.This symbol refers to theCD-ROM which contains moreinformation.VThis symbol refers to lists ofquestions that may be useful.This symbol appears at the startof each chapter and delineates thecontent of the chapter. This symbol points to tips that maybe useful.iv
ERXW WKLV DQGERRNCOMMONLY USED ACRONYMSBelow is a list of acronyms used throughout this WRATEPHINETUNDPUNICEFUSAIDWHOCenters for Disease Control and PreventionCoordinating Office for Global HealthContinuous quality improvementEpidemic Intelligence ServiceEpidemic Information ExchangeField Epidemiology and Laboratory Training ProgramField Epidemiology Training ProgramMinistry of HealthMaster of Public HealthNon-Governmental OrganizationPublic Health Schools Without WallsResident advisorTraining Programs in Epidemiology and Public Health Interventions NetworkUnited Nations Development ProgrammeUnited Nations Children’s FundUnited States Agency for International DevelopmentWorld Health OrganizationACKNOWLEDGEMENTSThank you to everyone for their dedication, time, and efforts in creating this handbook.DevelopmentThe following participated in writing, revising, and developing tools and templates for the FETPDevelopment Handbook.Elliott ChurchillHoang DangEric GogstadSuzanne ElbonRubina ImtiazBassam JarrarDonna JonesDouglas KlauckeEdmund MaesJames MendleinPeter NsubugaEunice RosnerJennifer ScharffNadine SunderlandDenise TraicoffHenry WalkeMark WhiteContent ReviewWe would like to thank the following people from country Field Epidemiology Training Programswho provided feedback.Yvan Hutin (India)Augusto Lopez (Central America) George W. Pariyo (Uganda)E. Rutebenberwo (Uganda) Fred Wurapa (Ghana)We would like to thank Pascale Krumm for graphic design and formatting of the handbook.We would also like to thank those who worked on the development of previous versions of theFETP Handbook: Martha Alexander, Sharon McDonnell, Mohamed Patel, Helen Perry, and DianeSpeight.v
1INTRODUCTION TO FETPS7KLV FKDSWHU GHVFULEHV Characteristics of FETP programsCompetenciesCommon terms used throughout the manualPartners of FETP programsThe goal of an FETPKey principles of FETPsThe diversity found in F
appendices provide useful tools and references to assist in the development of an FETP. Appendices are listed by the appropriate chapter title and then by number. On the CD, click the chapter title link to view all appendices for that chapter. FETP Development Handbook U.S. Centers for Disease Control and Prevention
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Introduction to Epidemiology and Genetic Epidemiology. Major goals in Epidemiology To obtain an unbiased & precise estimate of the true effect of an exposure or intervention on outcome in the population at risk To use this knowledge to prevent and treat disease.
Key words Epidemiology: , Familial aggregation, Genetic dominance, Genetic epidemi ology, Heritability, Popperian philosophy, Sampling, Shared environment, Twins. INTRODUCTION What is genetic epidemiology? Epidemiology has been defined as the "study of the distribution and determinants of health-related states and events in populations" [32].
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Principles of EPIDEMIOLOGY Second Edition An Introduction to Applied Epidemiology and Biostatistics 12/92 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention (CDC) Epidemiology Program Office Pub
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