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A New Approach to Teaching Veterinary Public Health at the Ohio State University

Correspondence: Address correspondence to Dr. Thomas E. Wittum, Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: wittum.1{at}osu.edu.

	ABSTRACT

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
Public-health practitioners with expertise in the area of veterinary public health are expected to understand the prevention and control of zoonotic infectious diseases in both human and animal populations. This focus on multiple species is what makes the veterinary public health (VPH) official unique. The development of a new VPH specialization within the existing Master of Public Health (MPH) degree program at the Ohio State University represents a significant new collaboration between the College of Veterinary Medicine and the College of Public Health. The main objective of the VPH specialization is to educate and train professionals to provide them with the skills, knowledge, and resources necessary to protect and improve human health using a One Medicine approach. The program targets a population of students who will likely enter the professional veterinary medicine curriculum but have one year available to enhance their preparatory training in health sciences before beginning the program. A core series of VPH courses was initiated to complement the existing MPH course requirements. The program has been successful in attracting students from the primary target population, but it has also attracted students wanting the MPH as a terminal degree and veterinarians returning to school to expand their career options.

Key Words: public health • educational approaches • veterinary public health

	NATIONAL NEED

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
Zoonotic infectious diseases such as avian influenza, bovine spongiform encephalopathy (BSE), and severe acute respiratory syndrome (SARS) threaten to produce global epidemics.¹ Food-borne zoonotic pathogens such as Campylobacter and Salmonella enterica regularly contaminate our food supply.² Other zoonotic pathogens that produce diseases such as anthrax, tularemia, and plague are potential agents of bioterrorism.³ Outdoor activities can place us at risk of zoonotic diseases such as West Nile virus and leptospirosis,⁴ and direct interaction or contact with animals can result in life-threatening zoonotic diseases such as rabies or infection with Escherichia coli O157:H7.⁵ In addition, animal populations can have important impacts on the environment that may indirectly threaten public health.⁶ In the absence of appropriate prevention and control efforts, zoonotic diseases pose considerable risk to public health.

Public-health practitioners with expertise in the area of veterinary public health (VPH) are expected to have the training and ability to address the public-health risks attributable to zoonotic infectious diseases. In particular, they are expected to understand the prevention and control of zoonotic infectious diseases in both human and animal populations. This zoonotic focus, together with an understanding of the physiological differences between multiple species, is what makes the veterinary public-health official unique. Clinically oriented training and experience resulting from Doctor of Veterinary Medicine (DVM) degree programs is an excellent complement to VPH training, as it enables a complete understanding of the role of morphological and pathophysiological factors in the respective animal species. However, public-health officials who are not veterinarians but have specialized training in VPH may also be needed to meet the future demands of the profession.

Despite the demand for a public-health workforce with knowledge and training in VPH, there is an increasing shortage of veterinarians, as well as other public-health professionals, working in this area. According to a recent report by the Association of American Veterinary Medical Colleges, by 2012 there will be a critical shortage of professionals working in VPH.⁷ The new VPH training program initiated by the Ohio State University (OSU) will help address this workforce deficiency using a One Medicine approach.⁸

	LOCAL NEED

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
OSU's new VPH program originally grew from the need of students who wanted to enter the OSU DVM program. In 2006, there were nearly 1,000 applicants for the 140 available positions at OSU. Each year, a subset of applicants are not accepted but have very similar academic qualifications to those who are accepted into the DVM program. Many of these students intend to take steps to improve their application portfolio and then reapply to the DVM program the following year. Often such students will be admitted into and will successfully complete the DVM program upon repeat application. This leaves them with at least a one-year gap between completing an undergraduate degree and beginning the professional veterinary curriculum. Many students wish to use this year to obtain additional training in a health sciences field, both in preparation for veterinary school and for the benefit of their professional careers. They want to enter a program with the following characteristics:

• The program should be oriented toward the health sciences.
  
• The program should be beneficial to their veterinary school application.
  
• The program should help to prepare them for veterinary school and complement the veterinary school curriculum.
  
• The program should provide career opportunities if the student does not obtain the DVM degree, or broader career options if the DVM is obtained.
  
• The course requirements for the program can be completed in approximately one year.
  

We developed a novel VPH program that directly targets this population of students by addressing these specific needs. In effect, the result is a dual-degree program requiring five years for the student to complete both MPH and DVM degrees.

	PHILOSOPHY

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
Our philosophy is that students should receive a broad-based public-health education, but with special emphasis on the topics of infectious-disease epidemiology, zoonotic diseases, and biostatistics. In addition, enough flexibility should be provided to allow the student to specialize in an area of interest. Our intention is to produce a graduate with the following specific characteristics:

• A broad knowledge of the epidemiology and recognition of local and foreign zoonotic and food-borne diseases, including newly emerging and re-emerging infectious diseases.
  
• The ability to use that knowledge to design epidemiological and field studies to assess prevalence, distribution, and risk factors for such diseases, as well as to design appropriate surveillance programs.
  
• The ability to coordinate data collection and epidemiological database management, including quality control of data, and to tabulate and analyze epidemiological data using standard and complex statistical methods.
  
• The ability to plan, initiate, and conduct both case and outbreak investigations of zoonotic diseases; knowledge of the methods used to identify, collect, and preserve the appropriate human, animal, arthropod, and environmental specimens for laboratory analysis; and will the necessary training to recognize the proper diagnostic tests and to understand the appropriate interpretation of test results.
  
• Knowledge of basic bio-security and emergency-response principles, including personal protective equipment and incident command-post systems, as well as first-response, recovery, and management strategies related to zoonotic disease outbreaks of natural or man-made origin.
  
• A broad knowledge of US food-animal industries and a thorough understanding of food-safety issues, including the ability to establish and evaluate Hazard Analysis Critical Control Points (HACCP) systems, standard operating procedures, and other preventive and surveillance programs to assure the safety of the nation's food supply.
  
• A broad knowledge base to understand the impact that human and animal interactions have on the environment and the capability to design and execute intervention strategies to protect environmental health.
  

We decided that we could best accomplish these teaching goals by integrating our new content into the current MPH degree program offered by the OSU College of Public Health (CPH).

	COLLABORATION AND INTEGRATION

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
The School of Public Health, recently renamed the College of Public Health (CPH), at the Ohio State University was founded in 1995 through a merger of the existing Department of Preventive Medicine and the Division of Health Services Management and Policy in the College of Medicine. The first MPH degree was awarded by OSU in 1992, through the accredited degree program in community health/preventive community medicine that existed prior to the establishment of the School of Public Health. Thus, the public-health program at OSU can be considered a young one relative to many other programs in the United States. The OSU CPH continues to be the only accredited school of public health in Ohio.

The strong support of the CPH for the development of a VPH specialization was critical to the initiation of the program. We decided to integrate our program into the existing MPH program so that our graduates could receive the degree widely recognized as the foundation for a career in public health. We developed a new field of specialization within the MPH program and developed specific degree requirements for the specialization. The Veterinary Public Health specialization is certified on the graduate's transcript in order to recognize his or her specialized training. The new MPH-VPH program thus took advantage of existing courses, experienced public-health faculty members, and available administrative support for its initiation.

A key to the successful implementation of our program is that, under the current OSU budgeting system, tuition dollars from individual students track back to the colleges in direct proportion to individual student enrollment hours within each college. Thus, under this system, both the degree-awarding unit (CPH) and the unit administering the specialization (CVM) can benefit in proportion to their contributions.

The MPH-VPH academic requirements are overseen by a steering committee made up of CVM faculty members. This committee provides oversight for all requirements for the VPH specialization and ensures that all VPH students meet the academic requirements for admission to the program and for graduation. Students enrolled in the MPH-VPH program are assigned a faculty advisor within the CVM, based on their area of interest and upon approval of the steering committee. Key CVM faculty members who play an important teaching and administrative role in the VPH program have joint faculty appointments in the CPH to facilitate interaction. Some of these joint-appointed faculty members have also taken an active role in advising and working with MPH students specializing in epidemiology and other fields outside the VPH specialization.

	APPROACH AND APPLICATION

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
In order to receive the MPH degree, regardless of specialization area, all students must take courses in five core areas of public health as required for accreditation by the Council on Education for Public Health: epidemiology, biostatistics, environmental health, health behavior and health promotion, and health services management and policy. The core courses offered within the CPH are presented in Table 1. In addition to these core courses, requirements for the VPH specialization include courses in zoonotic diseases, food safety and food-borne diseases, and bio-security and environmental health, in addition to courses in biostatistics, also described in Table 1. MPH-VPH students must work with their faculty advisors to identify a set of elective courses appropriate to their specific area of interest. Finally, they must complete a relevant public-health practice placement and an appropriate culminating experience.

The first in our series of VPH courses is titled Zoonoses and Diseases Common to Animals and Humans. This course is intended to develop an understanding of the basic epidemiology of common and important zoonotic diseases. The course emphasizes the understanding and application of preventive and control strategies specific to these zoonoses. The importance of safeguarding animal and public health from zoonotic diseases is emphasized throughout the course, which is presented in two major sections. The aim of the first section is for the student to develop an understanding of important concepts in infectious animal diseases, including the definitions and categories of zoonoses, causation and disease association, individual and herd immunity concepts, diagnostic techniques, and other related topics. The second section is a comprehensive review of the most common zoonotic diseases. For each disease, the students learn the etiological agent, epidemiology, most common manifestations of the disease in humans and animals, diagnostic procedures, and preventive and control measures.

The second course is titled Food-Borne Diseases, Food Animal Production Systems, and Food Safety. This course is presented in three sequential blocks of information. In the first section, students receive an overview of the food chain for common food products of animal origin, with special emphasis on pre-harvest food-safety issues. Students gain an understanding of how food products from animal sources (milk, meat, eggs, and seafood) move from the farm to the table and at which critical points zoonotic food-borne pathogens and other health risks are most likely to enter the food chain. In the second section of the course, the most common food-borne bacterial and viral diseases are described in detail, with special emphasis on their epidemiology and transmission; specific preventive and control measures for each disease are described and discussed. Finally, the third block of the course presents food-safety-related issues such as antimicrobial resistance, hazard analysis, good management practices, meat inspection and the HACCP system, and peri- and post-harvest food-safety training.

The final course in the VPH series is titled Biosecurity, Preparedness, and Environmental Health. This course provides an overview of bio-security issues related to veterinary public health, including surveillance, bioterrorism, preparedness, and management of zoonotic disease outbreaks. In addition, common environmental health issues related to human and animal interactions and their importance to public health are discussed. Other topics covered in this course include veterinary public-health regulations and governmental issues, air and water quality, carcass disposal, agricultural waste management, and the noninfectious consequences of animal and human interactions.

In addition to this core series of VPH courses, our students have the opportunity to select three or more elective courses relevant to their specific area of interest. Students use these elective courses to track informally into specialty areas of VPH, including infectious diseases, veterinary epidemiology, food safety, and emergency preparedness and bio-security. All elective courses must be approved by the MPH-VPH steering committee as relevant to the program; however, the diverse nature of veterinary public health offers students broad opportunities to focus their academic programs by choosing elective courses from the offerings of multiple colleges.

A significant requirement for the MPH-VPH degree is that the student must complete a VPH field practice-placement experience. The practice placement requires that the student gain at least 120 hours’ experience in a public-health practice setting. The purpose of the practice placement is to give students a significant opportunity to apply knowledge and skills from the classroom toward the achievement of specific public-health goals in a field setting. This is accomplished under the direct supervision of a public-health practitioner, serving as preceptor, and of a sponsoring faculty member, usually the student's faculty advisor. We have worked closely with local, state, and federal public-health agencies to identify practice-placement opportunities for our students. Agencies that have sponsored our students for this experience include the Columbus (Ohio) Health Department, the Ohio Department of Health, the Ohio Department of Agriculture's Consumer Analytical Laboratory and Animal Disease Diagnostic Laboratory, and the Centers for Disease Control and Prevention.

The final requirement for the MPH-VPH degree is the completion of a public-health culminating experience, which is intended to allow the student to explore a VPH topic in depth to generate a useful and meaningful final product. The culminating experience can take the form of an applied research project, an integrative writing project, a grant proposal, or a traditional thesis. Examples of MPH-VPH students’ culminating experiences are presented in Table 2.

	STUDENT POPULATION

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

More than half the students accepted into our program have been representative of the original population of students we targeted when we developed the program. These students intend to enter the DVM program and have a high acceptance rate into that program while working toward the MPH-VPH degree. To date, 39 MPH-VPH students have applied to a professional veterinary medicine program, and 31 (79%) have been accepted. One student has also been accepted into a professional medicine (MD) program.

In addition to the students from our original target population, we have also had a significant number of applicants with undergraduate degrees who are interested in earning an MPH with a specialization in VPH as a terminal degree. Some of these students come directly from completion of an undergraduate degree program, while others are returning to school for an advanced degree to enhance their career options. We have also had many applications from veterinarians in both public and private practice who want to obtain public-health credentials to enhance their careers or to allow for a change in career direction. Surprisingly, we have also attracted students with other professional degrees, including both nurses and lawyers, who wish to obtain advanced public-health training with a focus on infectious disease.

To date we have accepted and enrolled five veterinarians into our MPH-VPH program. Because the academic background of veterinarians is very different from that of our original target population of students, various adjustments to the program were required to accommodate those with DVM training. The veterinarians generally enroll in more specialized elective courses to take advantage of their previous experience and training in the health sciences. In addition to all the basic MPH-VPH course requirements, veterinarians in the program are provided with supplementary support opportunities in their preparation for the board examination of the American College of Veterinary Preventive Medicine (ACVPM). These support opportunities include preparatory classes, educational materials, organized discussion and study groups, and ready access to multiple ACVPM board-certified veterinarians on the faculty of the CVM. The option to leave the program with both the MPH degree and ACVPM board certification is attractive to many veterinarians and ideal for military veterinarians, who will return to active duty with public-health-oriented duty assignments.

In addition to these students seeking the specialization in veterinary public health, the VPH courses have proven popular with MPH students in other specializations, especially epidemiology and environmental health sciences. Some PhD students in the CPH have also enrolled in these courses, suggesting that there is substantial interest in VPH among a much broader audience of students.

	OUTCOME MEASURES

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
To date, nine of the 17 students from our first (2005) cohort have completed the MPH degree, with six others expected to complete the MPH-VPH program while working toward the DVM degree. In total, 16 students have graduated from our program, and a large number are in the final stages of completing their program. Only two students have dropped out of the program and are not expected to complete their degrees.

We are still too early in the program, however, to assess its success by any measure other than the number of applicants, which has been far higher than we originally anticipated. We intend to measure the success of the program over time using a variety of available metrics, including the success rate of MPH-VPH students who apply for admission to the DVM program and the performance of those students once in the DVM curriculum. Successful placement of our graduates in public-health careers will be another measure of our success. The success of veterinarians enrolled in the program at obtaining diplomate status in the American College of Veterinary Preventive Medicine will also be a metric of success. Finally, the impact of our students and graduates on local and national public-health agencies will be an important indicator of the success of the program.

While the success of the degree program itself is somewhat difficult to measure at this early stage, many benefits have accrued to the participants from our collaborative efforts. Productive research relationships have been expanded, the visibility of public health on campus and in the community has been enhanced, and discussions have begun on a variety of potential joint efforts between the CVM and the CPH. Perhaps the best indicator of the broader benefit of this type of relationship has been the awarding of a multi-million dollar Targeted Investment in Excellence competitive grant from the university to these colleges to support teaching and research in the area of public-health preparedness, specifically recognizing the importance of the collaboration between colleges.

	FUTURE DIRECTION

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 
Our program is still in an early stage of development, so we are not yet ready to significantly expand or modify it. We are still at the stage of ensuring that we have adequate numbers of elective courses, practice-placement opportunities, and culminating experiences to accommodate the needs of our current students. However, we have already begun the planning process for future development of the program. We wish to expand the delivery of course material to students in remote locations via the Internet. In addition, we plan to offer expanded course opportunities to accommodate the diversity of students beyond our initial target population. Finally, in order to meet current demands and to maintain our success in the program, it is essential that we recruit additional existing and new faculty members with interest and expertise in areas of veterinary public health to mentor and teach our students.

	ACKNOWLEDGMENTS

 
The authors gratefully acknowledge the contributions and support of Drs. Kent Hoblet, Glen Hoffsis, John Hubble, Stan Lemeshow, and Tom Rosol. Their leadership, encouragement, and commitment to student education have provided the foundation for our success.

	Footnotes

 
AUTHOR INFORMATION

Armando E. Hoet, DVM, PhD, Dipl. ACVPM, is an Assistant Professor and Coordinator of the OSU Veterinary Public Health MPH program, Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: hoet.1{at}osu.edu.

Robert J. Caswell, PhD, is Associate Professor of Health Services Management and Policy and Associate Dean for Academic Affairs, College of Public Health, The Ohio State University, 1841 Millikin Road, Columbus, OH 43210 USA. E-mail: rcaswell{at}cph.osu.edu.

Fred J. DeGraves, DVM, PhD, is Assistant Professor of Veterinary Public Health, Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: degraves.1{at}osu.edu.

Paivi J. Rajala-Schultz, DVM, PhD, is Associate Professor of Veterinary Epidemiology, Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: rajala-schultz.1{at}osu.edu.

Wondwossen A. Gebreyes, DVM, PhD, Dipl. ACVPM, is Associate Professor of Veterinary Epidemiology, Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: gebreyes.1{at}osu.edu.

William J.A. Saville, DVM, PhD, Dipl. ACVIM, is Professor of Veterinary Epidemiology and Chair of the Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: saville.4{at}osu.edu.

Thomas E. Wittum, PhD, is Professor of Veterinary Epidemiology, Department of Veterinary Preventive Medicine, The Ohio State University, 1920 Coffey Road, Columbus, OH 43210 USA. E-mail: wittum.1{at}osu.edu.

	REFERENCES

TOP ABSTRACT NATIONAL NEED LOCAL NEED PHILOSOPHY COLLABORATION AND INTEGRATION APPROACH AND APPLICATION STUDENT POPULATION OUTCOME MEASURES FUTURE DIRECTION REFERENCES

 

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