Health Professionals for a New Century
The future of public-health education was the topic of the day for public-health researchers, educators, and practitioners from around the nation in “The Second Century Symposium: Transforming Public Health Education,” held November 1 at the Harvard School of Public Health (HSPH). In a wide-ranging discussion, four panels tackled themes ranging from the transformative potential of online technologies, to the changing nature of professional education, to the unique challenges facing the field of public health itself.
HSPH dean Julio Frenk set the stage by offering an overview of his school’s three-year-long centennial curricular review. Advances in cognitive science combined with technological developments have spurred what he called a “deep reflection on the future of higher education.” The school as a result will shift toward an “open architecture” of learning, he announced, characterized by modular units structured around core competencies; it will also employ “blended” approaches that mix online and on-site learning for what Frenk called “informative, formative, and transformative” goals. Redesigned degree programs will train students more specifically for careers as either researchers or practitioners; in particular, a new Dr.P.H. degree for public-health leadership begins accepting applications this fall. Educational innovation features prominently in HSPH’s recently launched $450-million capital campaign, unveiled in late October on the occasion of the school’s centennial, and has already drawn significant philanthropic support.
The first panel, “The Digital Revolution and the Science of Education,” considered the influence of technology on the practice and nature of higher education. HSPH produced one of the first EdX online courses, “Health in Numbers,” a course in epidemiology and biostatistics that drew 55,000 registrants. Sukon Kanchanaraksa, director of the Center for Teaching and Learning at the Johns Hopkins Bloomberg School of Public Health, addressed the issue of accreditation; the next step for MOOCs, he said, would be for students to have their accomplishments recognized.
Yet in his morning presentation, Frenk was already looking beyond these massive open online courses, or MOOCS, to what he called small private online classes, or SPOCs. These smaller courses would use online modules as part of a “flipped classroom” approach, in which students learn course material on their own time and engage in discussions in class. “We’re already post-MOOC,” affirmed panelist Robert Lue, Menschel faculty director at Harvard’s Bok Center for Teaching and Learning. He argued that digital advances offer an opportunity to rethink the mission of education: “Online transforms the in-person.”
New technologies allow educators to personalize education and tailor reinforcement for maximum retention, said Rishi Desai, a medical educator at the online nonprofit educational platform Khan Academy. He compared current online educational approaches to advertising billboards: though they reach many people, the message is the same for everyone. “What Khan Academy is trying to do is push [online learning] toward what we have on our phones: personalized marketing that really targets you.”
But later panelists seemed to argue that even these new technologies would not serve the many demands of professional education. The panel on “Reinventing the Classroom, Campus, and Community for Learning and Teaching” presented professional education as a series of apprenticeships focused on three objectives: knowing, doing, and being. The third apprenticeship, focusing on character, ethics, and the identity of the profession, is “distinctly third,” though often decisive in future success, said William Sullivan, senior scholar at Wabash College’s Center for Inquiry in the Liberal Arts and founding director of the Educating Tomorrow’s Lawyers project at the University of Denver.
Sullivan argued that in moving beyond content and competencies, professional education would require pedagogical innovations. He suggested a role for simulations and programs analogous to medical residencies, echoing the focus on mental presence set forth by fellow panelist Erin Driver-Linn, director of the Harvard Initiative for Learning and Teaching. Similarly, David Garvin, Christenson professor of business administration at Harvard Business School (HBS), offered lessons from HBS’s use of the case method, “in essence, a flipped classroom approach.” “Engagement goes up,” he said, when students have read the case in advance and can have interesting discussions. Denise Koo ’84, director of the division of scientific education and professional development at the Centers for Disease Control and Prevention, related her own memorable experience of studying an actual disease outbreak during her M.P.H. studies. “I was totally hooked,” she said.
But even in a self-professedly data-driven field, the difficulty of evaluating factors like ethics and professionalism was readily apparent in a later panel, “Assessing Learning for Action and Input.” Nancy Kane, HSPH associate dean for case-based teaching and learning, pointed out that didactic and case-based teaching methods have different goals. “I don’t think my school, with its diversity of programs, is ready to have a single kind of assessment tool,” she said.
Hobbs professor of cognition and education Howard Gardner took her concerns a step further, urging HSPH to take the “right-hanging fruit” rather than the “low-hanging fruit” and to “share the confusion” inherent in education rather than devising simple metrics. “The danger of the low-hanging fruit,” he said, “is that you look at what’s easiest to assess rather than what you really value.” (See this report on Gardner’s recent book, The App Generation: How Today’s Youth Navigate Identity, Intimacy, and Imagination in a Digital World.)
The final panel, “Public Health Education Unbound: Transforming the Field,” brought these reflections to bear on the field of public health in particular. Sue Goldie, Lee professor of public health and director of the Harvard Global Health Institute, argued that the skills required for teaching and learning—communication, introspection, and self-reflection, in particular—are essential to an interdisciplinary field like public health. “With creativity,” she said, “we can create teaching and learning spaces that…enrich the whole being of our profession.” University provost Alan Garber pointed out that current pedagogical innovations like MOOCs are bound to change; all of higher education, he said, is in a period of “great experimentation.”
The result was a day that produced more questions than answers. The HSPH curricular reform has emphasized a shift from a knowledge-based to a competency-focused curriculum, but panelists repeatedly argued for the importance of elusive factors like professional values. Many of the suggested pedagogical innovations for active engagement—simulations, field learning, and the case method, for instance—are already being piloted at HSPH and other Harvard schools, but panelists like Koo articulated the need to balance “willy-nilly” learning-by-doing approaches with more structured reflection.
One thing was certain: “We need to convene again,” said closing speaker Lincoln Chen, M.D. ’68, president of the China Medical Board. “And this time, it shouldn’t be another hundred years.”