EditorialProfessional Competencies for AppliedEpidemiologists: A Roadmap to a More EffectiveEpidemiologic Workforce

Guthrie S. Birkhead and Denise Koo� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

The most valuable asset for any public health agency is awell-trained and competent workforce. In recent years,this recognition has prompted multiple public healthorganizations in the United States to define the expectedcompetencies for public health workers. (Competen-cies are action-oriented statements that delineate the es-sential knowledge, skills, and abilities required for theperformance of work responsibilities.1) For example, asa critical foundational effort, the Council on LinkagesBetween Academia and Public Health Practice (COL)developed competencies for all public health workerson the basis of eight domains of public health practice.2

The Association of Schools of Public Health has recentlydeveloped competencies for graduating master of pub-lic health (MPH) students, which might become the ba-sis of professional credentialing in the future.3 Othercompetencies for public health professionals have alsobeen developed (eg, for public health preparedness, in-formatics, and public health law), but only a limitednumber are discipline-specific.4

Epidemiology is one of the core disciplines of pub-lic health. This is particularly true for applied publichealth practice in governmental agencies. From pub-lic health surveillance, to investigation of public healthproblems, and to evaluation of public health interven-tions, epidemiologists are vital members of the publichealth team, helping ensure that public health actionsand programs are evidence-based and effective. How-ever, as with other sectors of public health, the field ofepidemiology has been under stress in recent years. Acombination of the impending retirement of a substan-tial portion of the epidemiologic workforce who weretrained and began to work in the 1960s, 70s, and 80s, theincreasing limitations on public health resources at alllevels of government and the increasing expectations

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and demands on public health in the areas of emerg-ing infectious diseases, biologic and chemical terrorismpreparedness, chronic disease prevention and control,to name a few, has led to shortages in the number oftrained epidemiologists working in these settings.5–8

The Council of State and Territorial Epidemiologists(CSTE), the professional organization representing epi-demiologists at the state, and recently at the large cityand county level, has documented (with the support ofthe Centers for Disease Control and Prevention [CDC])specific gaps in the number of practicing epidemiol-ogists during the last decade.8 A 2004 CSTE surveyof state epidemiologists determined that 29 percent ofepidemiologists had no formal training or academiccoursework in epidemiology. This survey also indi-cated a need for continuing education in multiple areas(eg, design of epidemiologic studies, data management,

The findings and conclusions in this editorial are those of the authors and do notnecessarily represent the views of the Centers for Disease Control and Prevention.

The authors acknowledge the invaluable work of Jac Davies, the primary authorof the AEC documents. We also thank Kathleen Miner, cochair of the workgroup,for her guidance regarding workforce and instructional competencies. We alsothank Jennifer Lemmings, LaKesha Robinson, and Patrick McConnon of CSTE fortheir expert assistance and support in carrying out this work. Finally, we thankthe members of the workgroup for their sustained effort, expert input, patience,and good humor in bringing the AECs to fruition.

Corresponding author: Guthrie S. Birkhead, MD, New York State Departmentof Health, Room 1417, Corning Tower, Empire State Plaza, Albany, NY 12237(e-mail: gsb02@health.state.ny.us).

� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

Guthrie S. Birkhead, MD, is Director, Center for Community Health and AIDS Institute,

New York State Department of Health, Albany; Associate Professor of Epidemiology,

School of Public Health, University at Albany, Albany; Workforce Lead, Council

of State and Territorial Epidemiologists; and Cochair, Centers for Disease Control

and Prevention (CDC)/CSTE Applied Epidemiology Competencies Workgroup, Atlanta.

Denise Koo, MD, is Director, Career Development Division, Office of Workforce and

Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia,

and Convener, CDC/CSTE Applied Epidemiology Competencies Workgroup.

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TABLE 1 ● Intended uses of applied epidemiologycompetencies∗� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �

The Applied Epidemiology Competencies, developed by the Centers for

Disease Control and Prevention and the Council of State and Territorial

Epidemiologists, define the discipline of applied epidemiology as

practiced in government agencies. The intended uses vary by category of

user and include the following:

• Practitioners

◦ Assessing current skills

◦ Creating career development plans

◦ Planning specific training and educational needs

• Employers

◦ Creating career ladders for employees

◦ Developing position descriptions and job qualifications

◦ Developing training plans for employees

◦ Assessing epidemiologic capacity of an organization

• Educators

◦ Designing education programs that meet the needs of public health

agencies

◦ Incorporating critical elements of epidemiologic practice into

existing coursework

∗From Council of State and Territorial Epidemiologists.

evaluation of public health interventions, and leader-ship and management).

To train, recruit, and retain the next generation ofpracticing epidemiologists at the federal, state, and lo-cal levels, defining what the skills and competencies ofsuch workers is essential. Recognizing this need, theCSTE and the CDC have partnered to develop a set ofcompetencies that define the practice of applied epi-demiology in governmental settings. This statement ofcompetencies serves different purposes (Table 1). First,competencies help define the discipline of applied epi-demiology for current and future practitioners alike.Second, they help guide development of curricula forboth primary and continuing education in public healthso that the needs of the applied epidemiology practicesetting are met. Finally, they assist the leadership in gov-ernmental public health agencies to better understandthe role of epidemiologists and to better enable them tocreate employment opportunities that will attract andretain them.

The Applied Epidemiology Competencies (AECs)were developed by an interdisciplinary workgroupconsisting of representatives from federal, state, andlocal public health agencies, from national professionalorganizations, and from schools of public health. Dur-ing fall 2004–spring 2006, the group met three timesin person and multiple times in different combinationsby telephone and other electronic means. Their work re-sulted in a set of competencies for applied public healthepidemiology that are available on the CSTE Internetsite.9

The AECs were developed within the framework ofthe Core Competencies for Public Health Professionalsdeveloped by the COL and, thus, are consistent withthe competencies that are expected of all workers inpublic health practice. In addition, the workgroup de-cided early in its deliberations that it should developcompetency statements for epidemiologists spanningthe career ladder from master’s degree–prepared epi-demiologists within 2 years of starting practice, to epi-demiologists with master’s degrees and more than2 years of practice or doctoral-level training, to senior-level epidemiologists who have taken either a man-agement track or a more purely scientific track in theircareers.

The entry- or basic-level tier also includes competen-cies for workers without formal training in epidemiol-ogy but who fill epidemiologic functions, particularlyin local health departments (eg, public health nurses orsanitarians who do epidemiologic case or outbreak in-vestigations), at least in as much as they execute suchfunctions. Midlevel epidemiologists often are given re-sponsibility for specific program areas (eg, operating asurveillance system or leading an investigative team).The highest tier of competencies recognizes that epi-demiologists often advance in their agencies to man-agement and leadership functions, yet maintain theirepidemiologic approach in their new positions. Certainepidemiologists, particularly those working in largestate health departments or the federal government, areable to maintain an exclusively scientific focus in theirwork, but nevertheless continue to work in an appliedsetting and have special roles in developing new ap-plied epidemiology techniques and ensuring the com-petency of lower tier epidemiologists. Thus, readingacross the tiers, the competencies describe a career lad-der from entry-level workers who should apply basicepidemiologic principles in their work but still requireoversight and direction, to higher tier workers who de-sign and direct public health programs according toepidemiologic principles, to the highest tier who in-corporate epidemiology into leadership, decision mak-ing, innovation, and advocacy for epidemiology in theagency.

On the basis of the COL competencies that all publichealth workers should possess, the AECs cover broadtopics beyond pure analytic epidemiologic methodsand an appreciation for basic biology and medicalscience to include the other COL domains of policydevelopment and program planning, communicationskills, cultural competency skills, community dimen-sions of public health practice, financial planningand management skills, and leadership and systemsthinking. Although the COL has provided generalworkforce competencies in each of these areas, theAEC document makes them more specific to the task

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of the epidemiologist at all levels of government. Forexample, cultural competency for the epidemiologistrequires that the design of survey instruments uselanguage understandable by diverse populations toyield useful information. Moreover, communicationwith the media should acknowledge the limitations ofthe epidemiologic studies being presented.

Each domain in the AECs contains multipleworkforce competency statements that are furtheramplified in subcompetency and, in certain cases,sub-subcompetency statements, following the MACHmodel in which more general workforce compe-tencies are broken down into multiple instructionalcompetencies.10 The AECs, then, form a comprehensiveset of competencies spanning applied epidemiologypractice. During the course of seeking broad input intothe competencies, the following question was oftenheard, “Can any epidemiologist be competent in allthese areas?” The workgroup acknowledges that everyepidemiologist cannot be equally competent in allareas. Different disciplines within epidemiology (eg,infectious disease, chronic disease, or maternal-childhealth) will emphasize different analytic competen-cies. Different positions within different governmentalagencies might have different needs and respon-sibilities. Perhaps the AECs can best be describedas “aspirational” because they define the breadthof the discipline for practitioners, educators, andemployers.

As previously mentioned, broad input was soughton two preliminary drafts of the AEC document.In addition to having broad representation on theworkgroup itself, the drafts were placed on the In-ternet for open comment. Comments were solicitedthrough professional society newsletters and often onthe Internet/intranet sites of 18 national professionalorganizations in addition to the CSTE and the CDC,including the American College of Epidemiology, theAmerican College of Preventive Medicine, the Asso-ciation of the Schools of Public Health, the AmericanPublic Health Association, the Association of State andTerritorial Health Officials (ASTHO) and its subjectmatter affiliates, the National Association of Countyand City Health Officers, the Public Health Foun-dation, and the Society for Epidemiologic Research.Notices to readers were also published in the Morbidityand Mortality Weekly Report (MMWR).11,12 Presentationswere made at the annual meetings of American PublicHealth Association, Association of State and TerritorialHealth Officials, and the CSTE, and at the SecondNorth American Congress of Epidemiology. In all,approximately 400 respondents provided commentsand input in each of two waves of postings of the draftAECs. The majority were epidemiologists in practice,although a limited number were from academia. The

process confirmed the basic soundness and validity ofboth the process and the product: comments were gen-erally positive and confirmed that the AECs describewhat practicing applied epidemiologists do, or shoulddo, in their jobs on a regular basis. In addition, excellentrecommendations from these comment periods wereincorporated into the document.

The workgroup recognizes, despite the positivereception of the competencies to date and the post-ing of the final document on the CSTE Internet site(http://www.cste.org), that the real proof of their valuewill be evidenced by their use in guiding educationand improving the capacity of the applied epidemi-ology workforce. The CSTE will continue to assessthe state-level workforce through periodic surveys.The CDC is planning to use the competencies as thebasis for its Epidemic Intelligence Service, PreventiveMedicine Residency, as well as other epidemiologicworkforce training activities. These competenciesshould also provide impetus for additional partner-ships between academia and practice. Developmentof methods to assess achievement of these com-petencies will be a critical next step. To encouragethoughtful consideration and use of the competen-cies, a special issue of Public Health Reports has beenannounced, with a focus on competency-based epi-demiologic training programs in public health practice(http://www.asph.org/press/fridayletter/press.cfm?fl.index=1423#Art4010). Even so, the full impact ofthe competencies will be felt only over a period ofyears as curricula, job descriptions, and career tracksare developed by practitioners and educators at alllevels. For them, we hope the AECs provide a trueguide for improving the epidemiologic workforce. Theworkgroup invites you to review the competenciesand use them in your practice.

REFERENCES

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2. Public Health Foundation. Council on Linkages BetweenAcademia and Public Health Practice. April 11, 2001. Availableat: http://www.phf.org/competencies.htm. Accessed May31, 2006.

3. Association of Schools of Public Health. ASPH EducationCommittee. Master’s Degree in Public Health Core CompetencyDevelopment Project, Version 2.3. August 11, 2006. Available at:http://www.asph.org/userfiles/Version2.3.pdf. AccessedSeptember 4, 2006.

4. Association of Schools of Public Health. Competency Re-sources. July 18, 2006. Available at: http://www.asph.org/document.cfm?page=935. Accessed September 6, 2006.

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6. Association of State and Territorial Health Officials. StatePublic Health Employee Worker Shortage Report: A Civil ServiceRecruitment and Retention Crisis. Washington, DC: Associationof State and Territorial Health Officials; 2004. Available at:http://www.astho.org/pubs/Workforce-Survey-Report-2.pdf. Accessed May 31, 2006.

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8. Council of State and Territorial Epidemiologists. 2004 Na-tional Assessment of Epidemiologic Capacity: Findings and Rec-

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9. Council of State and Territorial Epidemiologists. CDC/CSTEdevelopment of applied epidemiology competencies. Avail-able at: http://www.cste.org/competencies.asp.

10. Miner KR, Childres WK, Alperin M, Cioffi J, Hunt N. TheMACH Model: from competencies to instruction and per-formance of the public health workforce. Public Health Rep.2005;120(suppl 1):9–15.

11. Centers for Disease Control and Prevention. Notice to read-ers: draft of applied epidemiology competencies. Morb MortalWkly Rep MMWR. 2006;55(6):158.

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