Health Education Research, Vol. 14, No. 5, 581-582,
October 1999
© 1999 Oxford University Press
Editorial |
Graduate training in health education: integrating classroom and community
Associate Professor, Social and Behavioral Sciences
Deputy Director, Center for Injury Research and Policy, Johns Hopkins University School of Public Health
The articles by Helitzer and Wallerstein (Helitzer and Wallerstein, 1999
), and Quinn (Quinn, 1999) provide compelling and informative discussions of curricula to achieve a better integration of the `ivory tower' and the `real world'. Both examples are grounded in health education competencies and skills that have widespread support in the field (AAHE, 1998; Auld et al., 1998). Any academic program seeking to enrich the practice component of its training program will find these articles extremely helpful. Specific competencies to be achieved and the methods to achieve them are well described, as are the potential concerns such as community reactions and availability of resources to support this labor-intensive teaching approach. Although their model approaches may not fit in all academic settings or degree programs without some modification, the underlying concepts of the benefits of learning by doing, applying theory and creating community partnerships certainly should. The utility of the approaches presented in these two articles can be examined from the perspectives of the students, the academic institutions and the communities involved.
With regard to students, the practicum approach being advocated could be an example of what Green notes is reflective of health education practice at the end of the century, `...new forms of old ideas, new wine in old bottles' (Green, 1999). It has been known for some time that adult learners differ from child learners, in particular in their life experiences, as well as their need for a problem-solving orientation, and self-study and personal inquiry opportunities in their educational programs (Draves, 1984). As Helitzer and Wallerstein (Helitzer and Wallerstein, 1999) point out, learning about theories only in the classroom fails to give students the opportunity to apply them in the field, which is precisely the skill they will be expected to have upon graduation. Because students are still learning, however, it is essential that appropriate supervision be provided to protect and encourage the educational process in the field setting.
Academic training programs have evolved over time. Training that once depended exclusively on professorial lectures now often includes bringing practitioners into the classroom to share real world examples of the content (e.g. theories and principles) being taught. Giving students `hands on' practical experience is also offered in many programs, either at the end of their classroom experience, or as Helitzer and Wallerstein (Helitzer and Wallerstein, 1999), and Quinn (Quinn, 1999) recommend, integrated throughout the academic training program. Where on this continuum practical training falls for a given degree program and academic institution will depend on many things, such as the specific degree program and the institutional setting. For example, at the Johns Hopkins School of Public Health, the general MPH degree has a year-long integrating experience and the specialist MHS degree in health education has a 6-month full-time internship. For practica that are to be incorporated throughout the academic year, opportunities may be constrained by the need to be within a reasonable proximity to the institution. Thus, at a national level, there must be flexibility in how competencies in the application of theories and principles to practice can be achieved in different institutional settings. However, increasingly available and sophisticated distance-learning technologies can expand options for students to apply textbook learning to personally relevant public health problems in settings around the world.
An emphasis in curricula on applied problem solving in community settings is wholly consistent with the evolution of health promotion, which according to Green (Green, 1999):
...has sought in the fourth quarter of this century to shift the locus of initiative for health, and control over its determinants, from medical institutions and professionals back to individuals, families, schools, and work sites. But it has done so in a context of growing community, social and technological support for shared responsibility for health.
This notion of shared responsibility suggests that the next generation of public health professionals and health education specialists must have the requisite skills to work effectively with the varied constituencies who shape a community's health and quality of life. These skills can best be acquired by applying theories and principles learned in the classroom in community settings under the supervision of faculty and the expert guidance of field preceptors. Finally, academic researchers need to become fully engaged in this partnership process. Student practica offer the added potential benefit of advancing the science of community health promotion if we see them as opportunities to learn about the research needs of practitioners and to pursue collaborative research initiatives.
As important as community-based interventions are in the field of health education, we should remind ourselves of the diversity of settings in which our graduates work. For example, they may be in settings that demand special expertise in program evaluation, qualitative methods, marketing preventive services or a whole host of other specific skills that are part of health education practice. The changing landscape of public health and health education, especially in its relationship to medicine (Lasker, 1997; Gielen et al., 1998; Merrill et al., 1998), suggests that we maintain flexibility in our practica curricula. Students should have the opportunity to meet the required competencies in different ways, depending on their backgrounds, interests and career goals. This could require a substantial commitment of faculty resources to develop and maintain the necessary partnerships with a wide array of organizations. Such an investment seems clearly warranted given the substantial contribution to public health that graduate prepared health educators can and should be making in the next century.
References
American Association for Health Education, National Commission for Health Education Credentialing, Inc. (1999) Society for Public Health Education. A Competency Based Framework for Graduate-Level Health Educators. AAHE, Reston, VA.
Auld, M. E., Gielen, A. and McDonald, E. (1998) Strengthening graduate professional preparation in health education for the 21st century. Health Education and Behavior, 25, 413–417.
Draves, W. A. (1984) How to Teach Adults. The Learning Resources Network (LERN), Manhattan, KS, pp. 10–11.
Gielen, A., McDonald, E. and Auld, M. E. (1998) Health Education in the 21st Century: A White Paper. Health Resources and Services Administration, Rockville, MD.
Green, L. W. (1999) Health education's contributions to public health in the twentieth century: a glimpse through health promotions' rear-view mirror. Annual Review of Public Health, 20, 67–88.[Web of Science][Medline]
Helitzer, D. and Wallerstein, N. (1999) A proposal for a graduate curriculum integrating theory and practice in public health. Health Education Research, 14, 697–706.
Lasker, R. D. and the Committee on Medicine and Public Health (1997) Medicine and Public Health: The Power of Collaboration. The New York Academy of Medicine, New York.
Merrill, R., Chen, D. W., Gielen, A. C., McDonald, E., Auld, M. E., Mulrooney, S. J. and Sampson, N. H. (1998) The future health education workforce. Journal of Health Education, 29(5), S-59–S-64.
Quinn, S. C. (1999) Teaching community diagnosis: integrating community experience with meeting graduate standards for health educators. Health Education Research, 14, 685–696.
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