The CDC s Epidemic Intelligence Service Program from 1951 2008 How Many Veterinarians are Accepted Annually

1. The CDC�s Epidemic Intelligence Service Program from 1951�2008 � How Many Veterinarians are Accepted Annually?� Kris Bisgard, DVM, MPH, Diplo. ACVPM Supervisor, EIS Field Assignments Branch Career Development Division Office of Workforce and Career Development

2. Office of Workforce and Career Development, CDC Ensure a competent and sustainable workforce Ensure competent and sustainable leadership Ensure the use of best practices in workforce and career development

3. Epidemic Intelligence Service1951� Two-year post-graduate program of service and on-the-job training Physicians, doctoral-degree (PhD), nurses, dentists, statisticians, veterinarians Majority of EIS graduates continue working in public health

4. Required EIS Coursework

5. EIS learning structure: Competency domains and  Core Activities of Learning (CALs)

6. Epidemic Intelligence ServiceOWCD Desired Outcomes Individual-level goals Public health practitioners who can use epidemiology as a tool Competent, consequential epidemiologists Program goals Balance of EIS Officers Service to partners Future leaders Alignment with CDC�s strategic imperatives, public health needs Improved Improve public health

7. Veterinarians in Public Health Zoonotic and infectious diseases Environmental health Chronic diseases Population-based medicine Problem-solving

8. Objective Describe Veterinarians in EIS

9. Epidemic Intelligence Service1951�2008 3117 EIS Officers 246 (8%) Veterinarians

10. Number of Veterinarians in EISby Decade, 1951�2008

11. Proportion of Veterinarians in EISby Decade, 1951�2008 (n=246)

13. Number of Female Veterinarians in EISby Decade*, 1990�2008

14. From 2002 to 2008, 13 (22%) of 58 veterinary EIS Officers were male and 45 (78%) were female.From 2002 to 2008, 13 (22%) of 58 veterinary EIS Officers were male and 45 (78%) were female.

15. Rate of Veterinarians Accepted for EIS1997�1999 and 2000�2002 1997�1999 72 (8%) of 870 applicants 26 (36%) of 72 veterinarians accepted 2000�2002 49 (6%) of 843 15 (31%) of 49 veterinarians accepted

16. EIS Applicants, by Year, 2005�2007

17. Rate of Acceptance for EIS, 2007 69 (38%) of 182 U.S. Citizen/Perm. Resident 12 (10%) of 124 non-U.S. Citizen 48 (27%) of 181 Physicians 31 (31%) of 100 PhDs 5 (23%) of 22 Veterinarians 55 (32%) of 172* Female 26 (23%) of 113* Male *Sex for 21 applicants not identifiable from application

18. 2008 EIS Class (n=80) 30 (38%) physicians 39 (49%) PhDs and others 52 (74%) of 70 in Public Health Service 56 (70%) female 11 (13%) veterinarians

19. 2008 Veterinary EIS Class (n=11) 11 (100%) female 10 (91%) have additional graduate degree 1 (9%) USDA assignee 1 (9%) USAF assignee 7 (64%) at headquarters and 4 (38%) at field 6 (67%) of 9 in Public Health Service

20. Summary 1951�2008, 246 (8%) of 3117 EIS Officers were veterinarians 1970�1989 proportion veterinarians lowest 2000�2008, 64 (9%) veterinarians of 723 EIS Officers Number of EIS applicants increased Proportion of female EIS veterinarians increased

21. Recommendations Encourage veterinarians with advanced training to apply to EIS Encourage veterinarians to join the Public Health Service Encourage CDC to accept =12% veterinarians in each EIS class

22. Acknowledgments Marguerite Pappaionou, et al. Veterinarians in Public Health: The Epidemic Intelligence Service of the Centers for Disease Control and Prevention, 1951�2002. JVME 2003; 30(4):383� 91. Dr. Pappaionou�s current affiliation: Executive Director, Association of the American Veterinary Medical Colleges Jennifer G. Wright, Anthrax Vaccine Research Program, NCIRD, CDC Douglas Hamilton, Director, EIS Program, CDC

23. �If you don�t know where you�re going, any road will get you there.� --Lewis Carroll

24. Match Rate by CIO, 2007 ClassOffered >6 Positions*includes Prematched Assignments

25. Match Rate by CIO, 2006 ClassOffered Positions >6*includes Prematched Assignments

26. Proportion of Veterinary EISOs by Sex, 2002�2008 The following four slides summarize and compare key findings in race reporting in Montana from 2000, shown by the blue bar, to 2006, shown by the orange bar. As demonstrated in the previous table, this slide compares the proportion of gonorrhea case reports by reported race in 2000 and 2006. The proportion of case reports among whites increased from 28% to 48% of cases. In contrast, case reports among AI/AN decreased from 38% to 20% of all cases. The proportion of cases reported race unknown remained fairly high, decreasing only slightly from 29% to 26% of all case reports.The following four slides summarize and compare key findings in race reporting in Montana from 2000, shown by the blue bar, to 2006, shown by the orange bar. As demonstrated in the previous table, this slide compares the proportion of gonorrhea case reports by reported race in 2000 and 2006. The proportion of case reports among whites increased from 28% to 48% of cases. In contrast, case reports among AI/AN decreased from 38% to 20% of all cases. The proportion of cases reported race unknown remained fairly high, decreasing only slightly from 29% to 26% of all case reports.

27. Number of Veterinarians in EISby Decade, 1951�2008

28. Improved Health Impact Results Workforce needs are anticipated and filled through strategic recruitment Skills and competency of the health workforce are improved and sustained Competent health and leadership cadre are in place when and where needed Practices of health organizations and systems are improved

29. Program Issues Clarity of overall goals for program? For individual EISOs? Current expected (measurable) outcomes? Evidence base for our approach? Consistency with educational standards? Responsiveness to changes in public health practice? Desired, measurable outcomes?

30. Individual-level Issues What can EIS graduates do? What should our graduates be able to do? How do we determine this? What are competencies for an applied epidemiologist? What are required qualifications for our EIS candidates?

31. Competency Domains Essential for EIS Analytic Assessment Basic Public Health Sciences Communication Community Dimensions of Practice Cultural Competency Leadership and Systems Thinking Policy Development/Program Planning

32. Analytic/AssessmentCompetencies Essential for EIS Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply ethical/legal principles to study design, data collection, dissemination, and use Manage data Analyze data Summarize results/draw conclusions Recommend evidence-based interventions and control measures

33. Basic Public Health Sciences Competencies Essential for EIS Use knowledge of causes of disease to guide epidemiologic practice Apply principles of informatics, including data collection, processing, and analysis, in support of epidemiologic practice

34. Communication Competencies Essential for EIS Prepare written/oral reports and presentations that communicate necessary information Demonstrate basic principles of risk communication Incorporate interpersonal skills in communication with agency personnel, colleagues, and public Use effective communication technologies

35. Community Dimensions of Practice Competencies Essential for EIS Provide epidemiologic input into studies, public health programs, and community public health planning processes Participate in development of community partnerships to support investigations

36. Cultural Competency Competencies Essential for EIS Describe population 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 population to interpret findings Recommend public health actions that would be meaningful to the affected community

37. Leadership and Systems Thinking Competencies Essential for EIS Promote ethical conduct in epidemiologic practice Prepare for emergency response

38. Policy Development Competencies Essential for EIS Bring epidemiologic perspective in development and analysis of public health policies

39. Self-Reported Improvement in Epidemiologic Competence At end of EIS training 2002 Class: 92% 2003 Class: 95% 2004 Class: 93% 2005 Class: 91%

40. Educational Standards (adapted from Accreditation Council for Graduate Medical Education) Stage 1: Apprenticeship Stage 2: Program = Multiple learners and mentors Stage 3: Formal learning activities Stage 4: Educational outcomes Quality of graduates� competence to practice, based on scientifically valid, consensus-based measures Stage 5: Quality of public health practice

41. Rationale for Development of Competencies for Applied Epidemiologists (AECs) Definition of needed skills for hiring Method to evaluate, reward, promote workers Roadmap for training existing workforce Guidelines for academia Improved ability to define the field Utility for any certification process

42. Methods Review existing competencies/framework Convene expert Panel�crosscutting representation Subgroups: Leadership group Review panel Consultant/editor Obtain directed feedback (informatics) Conduct validation surveys�practice, academia Summer 2005�tier 2 only (n= 380) Early 2006�all tiers (n= 420) Quantitative, qualitative comments

43. Competency Framework for Public Health Professionals Analytic Assessment Basic Public Health Sciences Communication Community Dimensions of Practice Cultural Competency Financial Planning and Management Leadership and Systems Thinking Policy Development/Program Planning Source: Council on Linkages between Academia and Public Health Practice

44. Development Process Conducted 3 in-person meetings of expert panel (Oct 04, Mar 05, May 06), multiple conference calls Presented at CSTE (Jun 05), APHA (Dec 05) Used web-based surveys to obtain expert panel�s and other practitioner/academic input Recognized that COL competencies apply to all public health professionals, including epis Focused on crafting language to reflect unique aspects of epidemiologic practice Recognized that proficiency will differ depending on level of experience and job expectations

46. Skill Domain 1: Analytic/AssessmentTier 2 Competencies Identify public health problems Conduct surveillance Investigate acute and chronic conditions Apply ethical/legal principles to study design, data collection, dissemination, and use Manage data Analyze data Summarize results/draw conclusions Recommend evidence-based interventions and control measures Evaluate programs

47. Example: Analytic/AssessmentTier 2 Sub-Competencies Conduct surveillance Design surveillance for particular public health issue Identify surveillance data needs Implement new or revise existing surveillance system Identify key findings Conduct evaluation of surveillance systems

48. Example: Analytic/Assessment Tier 2 Sub-Sub-Competencies Identify surveillance data needs 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

49. Differentiating Between Tiers Example: Surveillance Tier 1 (entry level or basic): Support evaluation of surveillance systems Tier 2 (mid-level epidemiologist/team leader): Conduct evaluation of surveillance systems Tier 3 (senior level): Supervisor/Manager -- Assure evaluation of surveillance systems Senior Scientist (PhD) -- Design and conduct evaluation of surveillance systems

50. Four Tiers of Practice Tier 1: Recent MPH graduate/MA epidemiology or Bachelors degree only with some epidemiology experience Tier 2: MPH or MA epidemiology with 2+ years experience Doctoral epidemiologist Non-epidemiology professional degree plus epidemiology training Tier 3A: (supervisory, management) Tier 2 with additional experience Tier 3B: (senior scientist, researcher) Tier 2 with additional experience Nonepi prof degree include RN, MD/DO, DDS/DMD, DVM, PhD, RSNonepi prof degree include RN, MD/DO, DDS/DMD, DVM, PhD, RS

51. Alignment of the  EIS Program  with Essential CDC/CSTE Applied Epidemiology Competencies Richard Hoffman, MD* Denise Koo, MD EIS Conference

52. CIO Match Rate, 2006 ClassOffered Positions < 6

53. CIO Match Rate, 2007 ClassOffered Positions < 6

54. CAL Completion Rates(Source: EISO Exit Survey)

55. Essential Applied Epidemiology Competencies for all EIS Officers

56. Mapping the EIS competencies to the Essential AECs

57. Mapping the CALs to the Essential AECs

58. Survey of EIS Supervisors:Methods

59. Survey of EIS Supervisors:Participants

60. Results of Survey of EIS Supervisors (n=21):Essential AECs with Insufficient Priority or Opportunity

61. Survey of EIS Supervisors:Results

62. Possible ways to evaluate competence in the essential AECs

63. EIS course work that is applicable to the Essential AECs

64. AECs for which there is EIS course work but not necessarily on-the-job training

65. Possible ways to modify the EIS program

66. We would like to acknowledge and thank:

67. Thank you for your participation!!