Improving Undergraduate Epidemiology Education: An Example Using Instructional Teams

"We adjusted for race": now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020-2021

Race is a social construct, commonly used in epidemiologic research to adjust for confounding. However, adjustment of race may mask racial disparities, thereby perpetuating structural racism. We conducted a systematic review of articles published in Epidemiology and American Journal of Epidemiology between 2020 and 2021 to (1) understand how race, ethnicity, and similar social constructs were operationalized, used, and reported; and (2) characterize good and poor practices of utilization and reporting of race data on the basis of the extent to which they reveal or mask systemic racism. Original research articles were considered for full review and data extraction if race data were used in the study analysis. We extracted how race was categorized, used-as a descriptor, confounder, or for effect measure modification (EMM)-and reported if the authors discussed racial disparities and systemic bias-related mechanisms responsible for perpetuating the disparities. Of the 561 articles, 299 had race data available and 192 (34.2%) used race data in analyses. Among the 160 US-based studies, 81 different racial categorizations were used. Race was most often used as a confounder (52%), followed by effect measure modifier (33%), and descriptive variable (12%). Fewer than 1 in 4 articles (22.9%) exhibited good practices (EMM along with discussing disparities and mechanisms), 63.5% of the articles exhibited poor practices (confounding only or not discussing mechanisms), and 13.5% were considered neither poor nor good practices. We discuss implications and provide 13 recommendations for operationalization, utilization, and reporting of race in epidemiologic and public health research.

An effectiveness evaluation of a community-based course for medical students: a randomized controlled trial in the teaching of epidemiology

BACKGROUND

Epidemiology is considered to be the fundamental science of public health and plays an important role in clinical competence and professional development. The objective of this study is to evaluate the effectiveness of a short-term course for the teaching of epidemiology, which was designed as a community-based class for medical students.

METHOD

This course was designed according to Kern's six-step approach to curriculum development. A total of 75 undergraduates were recruited. Forty-one students were assigned to an experimental group engaged in theoretical teaching and practical courses, while 34 students were assigned to the control group only taking theoretical courses. All participants were asked to complete a pre- and post-course survey and to take a test after completing the course. The scores between the experimental and control groups were compared using the Wilcoxon test.

RESULT

The experimental group showed significantly higher self-assessment scores in course understanding (p = 0.0126) and clinical practice skills (p = 0.0005) after completing the course, while no significant difference was observed in the control group. In addition, students in the experimental group reported significantly higher interest (p = 0.0015), stronger learning motivation (p = 0.0113) and a better mastery of epidemiology (p = 0.0167) after completing the course than those in the control group. However, test scores (p = 0.0859) and pass rates (p = 0.1755) demonstrated no statistical significance between the two groups.

CONCLUSION

The short-term practical course in epidemiology exerted significantly positive effects on the improvement of student learning enthusiasm, course understanding and clinical practice skills. These findings provide new ideas and statistical evidence for the development of epidemiological instruction. Future studies should explore how to more widely and optimally apply community-based courses to the teaching of epidemiology.

Population health assessment project: An innovative strategy for teaching principles of epidemiology

Public health nurses (PHNs) use principles of epidemiology in their work with communities; however, teaching these concepts at the baccalaureate level can be challenging. To reinforce the epidemiologic concepts taught in the classroom, two nursing faculty in our baccalaureate nursing program developed a population health project that allows students to explore concepts of epidemiology within the context of a population health concern. This article describes how the project provides students with a realistic opportunity to research the health issue. As a part of the project, students collect and analyze data about the health concern at the county, state, and national level. The project also requires students to identify local agencies who provide services for people who are impacted by the health issue and describe their role and function within the community. Furthermore, students discuss the roles and responsibilities of nurses in managing the population health concern under investigation. In doing so, students recognize how epidemiology informs population level nursing care. If nursing students understand epidemiological concepts, they will be better prepared to educate the communities they serve after graduation when a population health crisis, such as the recent COVID-19 pandemic, occurs.

Invited Commentary: Epidemiologic Methods as Applied to Epidemiology Education-Goals and Expectations to Advance and Diversify the Field

In their accompanying article, Brown and Cox (Am J Epidemiol. 2021;190(2):305-312) offer strategies for improving introductory epidemiology instruction in large undergraduate classes using a team-based instructional approach. Effective epidemiology instruction can increase the quality and effectiveness of teaching and learning in our discipline. Recent work has suggested that epidemiology education can also be targeted as a mechanism to fuel equity and progress in the field. In this commentary, I contextualize Brown and Cox's article within the literature on epidemiology instruction for undergraduates. I also explore the status of methods for measuring teaching and learning effectiveness in our field. I revisit what makes epidemiology a unique science and connect this with instructional strategies that have the potential to capitalize on these features. Lastly, I consider whether our field can improve in developing methods of measuring the effectiveness of epidemiology instruction for achieving these aims. Ultimately, as I suggest, increasing the rigor of methods for evaluating epidemiology instruction will serve to diversify, enhance, and advance our discipline.