Competencies
for Applied Epidemiologists
in Governmental Public
Health Agencies
Centers for Disease Control and Prevention
Council of State and Territorial Epidemiologists
Or
Applied Epidemiology Competencies
(AECs)
for short!
Overview
 Background
 Goals and Rationale
 Methods
 Organization of the Competencies
 Validation of the Competencies
 Applied Epidemiology Competencies
 Uses and Dissemination
Background
Definition of Epidemiology
 Epidemiology is “the study of the distribution
and determinants of health-related states and
events in specific populations, and the
application of this study to control of health
problems.”*
 Epidemiology is one of the core sciences of
public health
*Last JM. A Dictionary of Epidemiology. 4th edition. New York: Oxford
University Press, 2001:62.
Definition of Epidemiologist
 A person who investigates the occurrence of
disease, injury or other health-related
conditions or events in populations to
describe the distribution of disease or risk
factors for disease occurrence for the
purpose of population-based prevention and
control.
— CSTE Workforce Summit, January 2004
Definition of Competency
 A competency is an action-oriented statement
that delineates essential knowledge, skills,
and abilities in the performance of work
responsibilities.
 A competencies is describable and
observable.
— Center for Public Health Practice, Rollins School of Public Health, 2002
Problem
 Insufficient number of public health epidemiologists
 “Epidemiologists” without adequate training
 Lack of clear career ladders for epidemiologists
 Independent, uncoordinated efforts to define the field
 National efforts focused only on academic epidemiology
Goals and Rationale
Goals and Objectives
of the AECs
 Goal to improve the practice of epidemiology in public
health agencies.
 Objectives to create a comprehensive list of
competencies that:
 Define the discipline of applied epidemiology; and
 Describe what knowledge, skills, and abilities four
levels of practicing epidemiologists working in
government public health agencies should have to
accomplish required tasks.
Rationale
for Competency Development
 Standardization of skill levels for hiring
 Method to evaluate, reward, and promote workers
 Road map for training existing workforce
 Guidelines for academia
 Improved ability to define the field
 Utility for future certification processes
Methods
Competency Development
Method
 Reviewed existing competencies/framework
 Expert Panel—cross-cutting representation
 Subgroups:
 Leadership group
 Review panel
 Consultant/editor
 Assessment and validation
 Summer 2005—Tier 2 Competencies
 Early 2006—Tier 1, 2, 3a and 3b Competencies
 Quantitative and qualitative comments
Four Tiers of Practice
 Tier 1—entry level or basic
 Tier 2—mid-level
 Tier 3a—supervisory
 Tier 3b—senior scientist
Differentiating Between Tiers
Example: Surveillance Evaluation
 Tier 1 (entry-level or basic epidemiologist):
 Support evaluation of surveillance systems
 Tier 2 (mid-level epidemiologist/team leader):
 Conduct evaluation of surveillance systems
 Tier 3 (senior-level epidemiologist):
 a. Supervisor/Manager—Ensure evaluation
of surveillance systems
 b. Senior Scientist (PhD)—Design and conduct
evaluation of surveillance systems
Organization
of the Competencies
Competency Framework
for Public Health Professionals
1.
Assessment and Analysis
2.
Basic Public Health Sciences
3.
Communication
4.
Community Dimensions of Practice
5.
Cultural Competency
6.
Financial and Operational Planning and Management
7.
Leadership and Systems Thinking
8.
Policy Development/Program Planning
Source: Council on Linkages between Academia and Public
Health Practice
Competency Construct
I. Skill Domain Area
1. Competency A
 Subcompetency
 Sub-subcompetency/learning objective
 Sub-subcompetency/learning objective
 Subcompetency
 Subcompetency
2. Competency B
 Subcompetency
 Subcompetency
Skill Domain 1:
Assessment and Analysis
Tier 2 Competencies
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Identify public health problems
Conduct surveillance
Investigate acute and chronic conditions
Apply good ethical/legal principles to study design and data
collection, dissemination, and use
Manage data
Analyze data
Summarize results, and draw conclusions
Recommend evidence-based interventions and control measures
Evaluate programs
Skill Domain1:
Assessment and Analysis
Tier 2 Competencies
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Identify public health problems
Conduct surveillance
Investigate acute and chronic conditions
Apply good ethical/legal principles to study design and data
collection, dissemination, and use
Manage data
Analyze data
Summarize results and draw conclusions
Recommend evidence-based interventions and control measures
Evaluate programs
Example: Assessment and Analysis
Tier 2 Subcompetencies
 Conduct surveillance
 Design surveillance for particular public health
problem
 Identify surveillance data needs
 Implement new or revise existing surveillance
system
 Identify key findings
 Conduct evaluation of surveillance systems
Example: Assessment and Analysis
Tier 2 Subcompetencies
 Conduct surveillance
 Design surveillance for particular public health
problem
 Identify surveillance data needs
 Implement new or revise existing surveillance
system
 Identify key findings
 Conduct evaluation of surveillance systems
Example: Assessment and Analysis
Tier 2 Sub-subcompetencies
 Identify surveillance data needs
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Create case definition
Describe sources, quality and limitations of surveillance data
Define data elements to be collected or reported
Identify mechanisms to transfer data from source to public
health agency
Define timeliness required for data collection
Determine frequency of reporting
Describe potential uses of data to inform surveillance system
design
Define functional requirements of supporting information
system
Validation
of the Competencies
Validation Process
 2005: Web survey for Tier 2 only
 76%–98% of respondents supported
competencies
 2006: Web survey of complete competency set, Tiers
1–3
 Three states targeted for >75% participation
 80% of respondents self-identified as Tier 1 and 2
 75% worked in state or local agencies
 Review panel reviewed comments and
recommended appropriate changes
Limitations
to Validation Process
 Surveys not systematic
 Respondents self-reported tier level and other
identifying data, thus room for bias
 Questions asked about only the major
competencies in each skill domain
 No subcompetency or sub-subcompetencies
evaluated in survey
Does Everyone
Have to Be Competent
in ALL Competencies?
Yes and No
(it depends)
an epidemiologist’s favorite answer!
Does Everyone
Have to Be Competent
in ALL Competencies?
 Mastery of the competencies develops
over a continuum of applied
epidemiology practice, not a single point
in an individual’s career
 Infectious disease, chronic disease,
maternal and child health, and
environmental epidemiology may
emphasize different competency areas
Applied Epidemiology
Competencies
…It’s about time!
Competency Skill Domains
1.
2.
3.
4.
5.
6.
Assessment and Analysis
Basic Public Health Sciences
Communication
Community Dimensions of Practice
Cultural Competency
Financial and Operational Planning and
Management
7. Leadership and Systems Thinking
8. Policy Development
1: Assessment and Analysis
Tier 2 Competencies
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Identify public health problems
Conduct surveillance
Investigate acute and chronic conditions
Apply good ethical/legal principles to study design and data
collection, dissemination, and use
Manage data
Analyze data
Summarize results, and draw conclusions
Recommend evidence-based interventions and control measures
Evaluate programs
2: Basic Public Health Sciences
Tier 2 Competencies
 Use knowledge of causes of disease to guide
epidemiologic practice
 Use laboratory resources to support epidemiologic
activities
 Apply principles of informatics, including data collection,
processing, and analysis, in support of epidemiologic
investigations
3: Communication
Tier 2 Competencies
 Prepare written and oral reports and presentations that
communicate necessary information to professional
audiences, policy makers, and the general public
 Demonstrate the basic principles of risk communication
 Incorporate interpersonal skills in communication with
agency personnel, colleagues, and the public
 Use effective communication technologies
4: Community Dimensions
of Practice
Tier 2 Competencies
 Provide epidemiologic input into epidemiologic studies,
public health programs, and community public health
planning processes at the state, local, or tribal level
 Participate in development of community partnerships
to support epidemiologic investigations
5: Cultural Competency
Tier 2 Competencies
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Describe population by various parameters
Establish relationships with groups of special concern
Design surveillance systems to include underrepresented groups
Conduct investigations using languages and approaches tailored to
population
 Use standard population categories or subcategories when
performing data analysis
 Use knowledge of specific sociocultural factors in the population to
interpret findings
 Recommend public health actions that would be relevant to the
affected community
6: Financial and Operational
Planning and Management
Tier 2 Competencies
 Conduct epidemiologic activities within the financial and
operational plan of the agency
 Assist in developing fiscally sound budget
 Implement operational and financial plans
 Assist in preparing proposals for extramural funding
 Use management skills
 Use skills that foster collaborations, strong partnerships, and team
building to accomplish epidemiology program objectives
7: Leadership
and Systems Thinking
Tier 2 Competencies
 Support epidemiologic perspective in agency strategic planning
process
 Promote organization’s vision
 Use performance measures to evaluate and improve program
 Promote ethical conduct
 Promote workforce development
 Prepare for emergency response
8: Policy Development
Tier 2 Competencies
 Bring epidemiologic perspective in development and
analysis of public health policies
Uses and Dissemination
Intended Uses
of the Competencies
 Practitioners
Assess current skills
Create career development plans
Plan specific training and educational
activities
Intended Uses of the
Competencies
 Employers
 Create career ladders for employees
 Develop position descriptions and job qualifications
 Develop training plans for employees
 Assess epidemiologic capacity of an organization
 Educators
 Design education programs that meet needs of
public health agencies
 Incorporate critical elements of epidemiologic
practice into existing coursework
Dissemination
 Oral presentations at meetings
 Downloadable documents:
 CSTE website: www.cste.org/competencies.asp
 CDC website: www.cdc.gov/od/owcd/cdd/aec/
 Quick reference fact sheets
 One-page executive summary and complete preface document
 Fact sheets for each tier
Dissemination
 Online competency toolkit for users
 PowerPoint presentations
 Interactive quiz
 Engage users in the field of epidemiology
 Introduce users to the AECs
 Epidemiology position descriptions
 Training resource guide
 AEC brochure
 Evaluation checklists
Dissemination
 Special Issue of Public Health Reports: CompetencyBased Epidemiologic Training in Public Health Practice
 March/April 2008
 Commentaries on the need for competencies and their uses
 Development of the AECs
 Competency-based applied epidemiology training
 Innovative partnerships between academia and practice
 Evaluation of epidemiology training programs
Dissemination
 Public Health Literature
Editorial: Professional Competencies for Applied
Epidemiologists: A Roadmap to a More Effective
Epidemiologic Workforce
by Guthrie S. Birkhead, MD and Denise Koo, MD, MPH
Journal of Public Health Management & Practice
November/December 2006
Volume 12 Number 6
Pages 501 - 504
Online Resources:
 www.cdc.gov/od/owcd/cdd/aec/
 www.cste.org/competencies.asp
 Complete competency documents
 One page competency summaries by tier
 Competency toolkit
 Competency self-assessment
 Summary of training resources
 Competency PowerPoint slide sets
 Sample position descriptions
 Publications related to competencies
 Contents of the toolkit also available from CSTE:
770-458-3811
The Driving Force of the AECs:
Leadership Group
Conveners:
Denise Koo, MD, MPH—Centers for Disease Control and Prevention
Matt Boulton, MD, MPH—University of Michigan School of Public Health
and CSTE
Co-Chairs:
Gus Birkhead, MD, MPH—New York State Department of Health and
CSTE
Kathy Miner, PhD, MPH, CHES—Rollins School of Public Health, Emory
University
Consultant and Editor:
Jac Davies, MPH—CSTE Consultant and Editor, formerly with Washington
State Department of Health
The Driving Force of the AECs:
Expert Panelists
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Kaye Bender, RN, PhD, FAAN—University of Mississippi Medical Center School of Nursing
Roger H. Bernier, PhD, MPH—Centers for Disease Control and Prevention
Mike Crutcher, MD, MPH—Oklahoma State Dept Health
Richard Dicker, MD, MSc—Centers for Disease Control and Prevention
Gail Hansen, DVM, MPH—Kansas Department of Health and Environment
Richard Hopkins, MD, MSPH—Centers for Disease Control and Prevention
Sara Huston, PhD—North Carolina Division of Public Health
Miriam Link-Mullison, MS, RD—Jackson County Health Department
Hal Morgenstern, PhD—University of Michigan School of Public Health
Lloyd Novick, MD, MPH—Onondaga County (New York) Department of Health
Len Paulozzi, MD, MPH—Centers for Disease Control and Prevention
William M. Sappenfield, MD, MPH—Centers for Disease Control and Prevention
Greg Steele, DrPH, MPH—Indiana University School of Medicine
Lou Turner, DrPH, MPH—North Carolina State Laboratory of Public Health
Mark E. White, MD—Centers for Disease Control and Prevention
The Driving Force of the AECs:
Review and Other Panelists
 Review Panelists:
 James Gale, MD, MS—University of Washington
 Kristine Gebbie, DrPH, RN,—Columbia School of Nursing
 Maureen Lichtveld, MD, MPH—Centers for Disease Control
and Prevention
 Kristine Moore, MD, MPH—University of Minnesota
 Art Reingold, MD—University of California at Berkeley
 CSTE National Office Staff:
 Pat McConnon, MPH, Executive Director
 LaKesha Robinson, MPH
 Jennifer Lemmings, MPH
Partner Organizations
 American Public Health Association (APHA)
 Association of Schools of Public Health (ASPH)
 Association of State and Territorial Health Officials
(ASTHO)
 National Association of County and City Health Officials
(NACCHO)
For more information
 Contact CSTE: 770-458-3811
 Visit the following websites:
www.cste.org
www.cdc.gov/od/owcd/cdd/aec/
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Competency slideset for epidemiology professionals