Cherry, Robert A. MD; Davis, Tom
In January 2006, the Pennsylvania State University (Penn State) unveiled the first courses in its new master of homeland security (MHS) degree in public health preparedness, the nation's first advanced degree program sponsored by a medical school to broadly train homeland security professionals in the field of public health preparedness. This milestone capped an effort that had begun less than three years before, in May 2003. The realization of this goal required the combined resources and expertise of the Pennsylvania Department of Public Health (PA-DOH), the Pennsylvania National Guard, and a number of academic units at Penn State: the college of medicine, the graduate school, the college of agricultural sciences, the college of earth and mineral sciences, the college of liberal arts, and the World Campus, a part of Penn State Outreach, the nation's largest educational outreach organization. The creation of this flexible and loosely connected strategic partnership was a pioneering effort within one of the nation's premier universities—a large, distributed, highly structured institution with approximately 80,000 students, 38,000 faculty and staff, and an annual operating budget of $3 billion.1
The three-year journey that culminated in the creation of the MHS program had begun with a simple question: do we need advanced education in the field for homeland security? With the acknowledgment that public health preparedness was an emerging professional field, coupled with a growing national need for tertiary education to support that field, a multidisciplinary team from several sectors was mobilized to investigate and meet that need. In retracing the steps in the development of the program, we begin with a review of the backdrop against which the need for advanced education in the field of homeland security arose, and into which the network of strategic alliances to develop Penn State's degree program was woven.
The Growing National Need
In November 2002, 22 government agencies with 169,000 employees were integrated into a single federal Department of Homeland Security (DHS).2 This thrust a growing number of federal professionals into viewing homeland security as their full-time career. Furthermore, the need for education and training for an increasing number of homeland security professionals at the state and local level was emerging as a critical priority. According to a 2004 Association of State and Territorial Health Officials report, “The most difficult challenge state and local public health agencies face in developing the capacity to respond to terrorist events, emerging infectious diseases, and other public health threats and emergencies is assuring a qualified workforce is available to carry out these functions.”3 In all, individuals from a variety of backgrounds—public and private; civilian and military; federal, state, and local—suddenly found a need to enhance their knowledge and skills, develop leadership potential, and advance their careers in this burgeoning field.
For its part, the federal DHS identified the building of coalitions and partnerships as one of the guiding principles in its own strategic plan, specifically identifying academia as one of the partners it sought to engage with across traditional boundaries.4 Against this backdrop, academia has found itself uniquely positioned to leverage its strengths in developing a cadre of leaders in homeland security, to influence the debate surrounding counterterrorism and homeland security, and to foster a better informed and prepared citizenry. Because homeland security and public health preparedness are broadly encompassing concepts, it is not surprising that an advanced degree program in public health preparedness has emerged as a multidisciplinary program led by professionals with a wide array of expertise.
For this growing number of homeland security professionals, there continues to be no clear professional development path. Nevertheless, there has been a proliferation of emergency-management programs in higher education. In 1997, only two emergency-management programs existed in the United States. By 2005, that number had climbed to 120.5 Of the 32 master degree programs offered by U.S. institutions at that time, the most common offering was a master in public administration with a concentration in emergency management.
Schools of dentistry,6 nursing,7–9 public health,10 and veterinary medicine11 have introduced educational preparedness instruction into their curricula as well. In 2003, the Association of American Medical Colleges (AAMC) laid the groundwork for bioterrorism education in U.S. medical schools. The AAMC issued a report recommending that bioterrorism education be integrated into medical school curricula throughout the entire four years.12 Several medical schools have already reported their experiences in developing and implementing specific course work in this area.13–15 However, before 2006, there were no advanced degree programs in public health preparedness or homeland security offered by any U.S. medical school.
An Emerging Professional Discipline
Before we proceeded with developing the MHS program at Penn State, we needed to be certain that the field of homeland security actually represented a relatively new, emerging professional discipline. There are six key attributes, in our opinion, that define a profession:
▪ The profession must have a well-defined fund of knowledge in a specific area.
▪ The profession creates training programs that are designed to develop a specific set of skills related to the discipline.
▪ The profession provides expert teaching and mentoring to individuals new to the field.
▪ The profession seeks to expand the knowledge base of the profession through scientific research.
▪ The profession is associated with scientific journals that advance knowledge in the field.
▪ There is a professional organization and/or society that promotes a set of educational and training standards that validates the profession and creates the foundation for expertise and/or competency in the field.
On the basis of the above criteria, it seemed that the specialty of public health preparedness was starting to take as a profession in the early part of this decade. It is the emergence of a unique body of knowledge and set of skills that forms the foundation of a profession. Professions cannot thrive and expect to have meaning and purpose unless there are leaders who seek to improve the profession by expanding the knowledge base through scientific research. Ultimately, research adds legitimacy to the field and distinguishes it as a discipline. Leaders in the field of homeland security must therefore have a firm grasp of the basic principles of scientific research, as well as the intellect to critically evaluate research studies in their field of interest. To this end, academia was well positioned to fill this void.
Foundations of the MHS Program: A Network of Strategic Partnerships
Throughout the degree-program-development process, the program architects consciously developed and maintained strategic alliances, both internally at the university and externally with relevant government and military entities. Creating this loose network of strategic partnerships not only provided the flexibility to adapt quickly to the evolving higher education environment around homeland security, but it also proved to be the only way to move the degree program from conception to realization in a time frame that made sense. By leveraging partners' core competencies, a project team was able to aggregate and align the best of each member's contributions to ensure that program development was congruent with evolving concepts in federal and state disaster planning.
The project team, created and headed by the team leader (or future program chair), found itself in a dynamic state of evolution. Throughout this process, however, the college of medicine remained well positioned to be the sponsoring academic unit for this highly interdisciplinary program. The project team was ultimately responsible for accomplishing the following objectives: (1) identifying and recruiting experts within the university who had a scholarly record of accomplishment in the area of homeland security, (2) coordinating the efforts of a diverse group of participating academic units, (3) seeking out and securing external funding sources for the proposed program, (4) obtaining advice and guidance on the process and procedure for proposing a new graduate degree program, and (5) drafting and developing program and course proposals, in collaboration with both internal and external consultants, that met Penn State's academic standards for graduate education.
External relationships were rapidly forged and integrated into the operations of the project team. This thread of collaboration and partnership was woven throughout the various phases of development. Consultation was obtained on curricular goals and objectives through representatives of the Pennsylvania National Guard, the Pennsylvania Office of Public Health Preparedness, the university council on graduate education, and selected members of Penn State faculty. Many of these individuals, in turn, provided experienced military and civilian contacts for additional advice and supports. After program approval was obtained from the university trustees, the project team was replaced by an advisory board, headed by the program chair, that consisted both of external stakeholders and internal members of the university, including program faculty. The advisory board expanded upon the external network of partnerships through formal relationships and memberships with two key national organizations: the Homeland Security Defense/ Educational Consortium (HSDEC) and the National Academic Consortium for Homeland Security.
The 10-Step Process to Program Development
The Penn State College of Medicine developed a vision for the MHS program by addressing several key issues in a precise and logical order. Ultimately, a 10-step process emerged.
Step 1: Know who you are
First and foremost, faculty and staff in the college of medicine asked a fundamental question regarding practitioners of public health preparedness: who are they, both as a group and as a profession? There were two reasons for asking this question. First, the question reflects the fact that the long-term viability and strength of this emerging professional discipline will not be defined exclusively by what these practitioners do, but primarily by who they are as leaders and how they fulfill their obligations to the field and to those whom they serve. Second, a full and thorough understanding of the field allows one to compare and contrast the profession with the sponsoring institution's core competencies. All of this requires a critical examination of the sponsoring institution's own traditional, threefold educational mission, values, and guiding principles. In the case of the college of medicine, we determined that the educational, research, and patient-care mission was in line with those seeking a career in public health preparedness.
Step 2: Know what you want to do
Once we had decided that our strategic mission, core values, and guiding principles were compatible with those in the field of public health preparedness, we then asked ourselves what we were trying to accomplish. Obviously the ultimate goal was to create a new educational program in homeland security, but the deeper issue had to do with whether to establish a general program around the broad field of homeland security or whether to focus on a specific discipline within that broad field. In this case, we decided to focus on public health preparedness because it was in line with our core competencies as well as our educational mission.
Step 3: Understand your target audience
Next, the project team moved to considering who would make up the target audience for the new program. Understanding the knowledge, skills, and abilities that students would be bringing to the program was essential for later decisions around course subject matter. The project team quickly embraced the fact that people working in this emerging professional field have many diverse educational backgrounds and experiences. We therefore concluded that a large portion of prospective students would likely include nonscience, postbaccalaureate graduates, and would likely be made up of practitioners from diverse backgrounds: federal, state, and local public health officials; public affairs administrators; emergency-management professionals; health care professionals; first responders; criminal justice and law enforcement personnel; military staff; and members of corporate security. With respect to the college of medicine's educational, research, and patient-care mission, this diversity of educational backgrounds and professional experience among students is an element that medical schools are accustomed to and have longed embraced.
The demographic profile of the initial student body did indeed reflect the diversity we anticipated. The initial class of 36 students was composed of 21 men (58%) and 15 women (42%). There were 17 students between the ages of 25 to 44 years old and an equal number between the ages of 45 and 64. A total of 34 students were employed (94%), and 13 identified themselves as working in a health-related field. The majority of students (29) were from the Northeast or the Great Lakes area, with an additional student from Florida, two from Colorado, three from California, and one military officer based in Turkey. List 1 and Figure 1 provide more details about the inaugural class.
Step 4: What's in a name?
Having gone through self-reflection, narrowed our focus, and explored the target audience for the program, we then approached the intriguing question of what to call the new program. Again, we stayed grounded in the threefold mission of the college of medicine. From the standpoint of the medical school, incorporating the term homeland security into the degree title and the phrase public health preparedness into the program title reinforced the program's alignment with our organizational mission. This was also consistent with the organization of homeland security within the government of our home state, starting within the Pennsylvania Office of Homeland Security.
Accordingly, the college of medicine proposed that the degree title be master of homeland security. Continuing with the parallel, PA-DOH features an Office of Public Health Preparedness that “coordinates and supports PA-DOH efforts to prepare for, protect against, respond to, and recover from all acts of bioterrorism and other public health emergencies that affect the civilian population …, serves as liaison with the Office of Homeland Security and [the Pennsylvania Emergency Management Agency] PEMA …, [and] represents DOH to other federal agencies and [the] private sector.”16 Therefore, the proposed MHS degree would be conferred to those completing the newly proposed graduate program, titled Public Health Preparedness. In all, the decision about what to call the evolving graduate degree program ensured consistency with corresponding government organizational structures and had the further benefit of aligning with the growing number of undergraduate programs with the same name.17
Step 5: Define your educational goals
With the program beginning to take on an identity, we turned our attention to perhaps the core issue of the effort: what competencies did we want to develop among program participants? This decision was particularly difficult to tease out because there was no well-defined professional discipline associated with homeland security. At the time, there were no professional organizations, societies, or officially recognized journals to turn to for assistance. Federal and state government agencies were also struggling to define a clear set of strategic priorities. In addition, there were no colleges or universities with experience in developing an advanced academic program of this kind. Against that backdrop, the multidisciplinary project team consulted with internal and external partners to ultimately select the following core areas of focus:
▪ public health preparedness,
▪ epidemiologic evaluation,
▪ disaster communication,
▪ agricultural biosecurity,
▪ disaster psychology, and
▪ critical infrastructure protection.
Only recently has there been literature on developing a set of core educational competencies to teach terrorism and disaster preparedness to health professions students.18 List 2 provides information on the program's current course offerings and content. Information is also available from the program's Web site (http://www.worldcampus.psu.edu/MasterinHomelandSecurity.shtml).
Step 6: Recruit internal and external partners
With the program competencies identified, the project team shifted to identifying faculty, authors, practitioners, and others with significant expertise in these competencies to develop and instruct the courses to support them. Again, because homeland security is not an established professional discipline, the challenge was seeking out lead faculty from multiple disciplines for each of the specific competencies. The vision assumed that, with lead faculty members in place to oversee each competency, those individuals would in turn oversee the development of relevant course work and instruction by recruiting internal and external experts with specific expertise in that area.
Each of these subgroups would then coalesce around a common theme and develop a set of graduate-level course goals, objectives, materials, activities, and assessments. Because we had found early on that no single individual possessed a complete set of skills and knowledge around all of the competencies, we reached out to a diverse group of faculty in trauma and emergency medicine, epidemiology, psychology, communications, agricultural sciences, geosciences, political science, and criminal justice. In all, eight different academic departments, from six different colleges, in three separate Penn State campus locations, were recruited to collaborate on course development and instruction. In many cases, the lead faculty members also brought in external consultants with “real-world experience” to assist in curriculum development, including members of the Pennsylvania National Guards and members of disaster medical assistance teams.
In all, this multidisciplinary recruiting effort represented the cultivation of a loose, decentralized network of strategic alliances that would come together to create value for the program. To that end, the project team established a working relationship with the Office of Public Health Preparedness in Pennsylvania. For its part, the program chair for the new degree now serves on the state's Advisory Committee for Preparedness, and in return, several individuals from PA-DOH have been tapped to participate in the new degree program's advisory board. Beyond state government, the project team has also reached out to the HSDEC to discuss standardizing educational goals and curriculum on a national level.
Step 7: Decide how to deliver the content
The next, and perhaps least intuitive, step involved determining how to deliver the degree program. A key challenge for the development team, the instructors, and the potential audience involved was geographical. With PA-DOH located in Harrisburg, Penn State's College of Medicine located in Hershey, the graduate school and World Campus administration located at University Park, instructors located throughout the state, and potential students located across the country, the challenge was to make the program accessible and attractive to the practicing professional in the field. This required another measure of creativity. After thorough discussion and exploration, the program team arrived at a decision that would not have been possible even 10 short years ago: the program would be offered entirely online. Two key factors drove the decision to do this. First, it was felt that offering the program as a traditional, entirely residential program—at the opposite end of the spectrum—would make it far less attractive to the target audience that had been identified in step three above, namely, the practicing professional already working in the field. Second, a middle-of-the-road approach combining some residential and some online components, a so-called blended learning approach, might be cumbersome and expensive, and therefore become a potential barrier in attracting the most talented pool of applicants already working in the field.
The use of distance education to earn advanced degrees for health care professionals was already possible. For many, online degrees have become increasingly more attractive and convenient as a means to educational advancement.19 There are now master of public health degrees in health services administration,20 public health nutrition,21 and public health leadership22 that can be obtained through distance learning. In addition, online learning programs leading to a master degree are also available in nursing,23 primary health care,24 rehabilitation counseling,25 and health care education,26 as well as public health.27
The decision to pursue a distance education format was particularly attractive because of the success and experience of Penn State's World Campus, the primary academic outreach arm for the university. The World Campus has partnered with a number of academic units within Penn State to deliver 13 undergraduate and nine graduate degree programs. All of them are offered through an online, distance education format. The World Campus provides a full range of student services, including financial aid information, academic advising, and technical support. An instructional design and development team is in place to assist faculty members with creating and formatting course content for Internet use. The World Campus also has divisions of academic affairs, marketing communications, and program planning and management. This preexisting and well-established structure allowed us to focus more heavily on the academic development of the program.
Step 8: Identify sources of funding
There was a recognized need for funding to support course development, instructional design, teaching, and marketing of the new program. Even before submission of the program and course proposals to the graduate council and the university trustees, we sought internal commitment from the schools and academic departments that were involved. Penn State's World Campus agreed to provide financial support for the program. The commitment followed extensive Athat there would be a population of professionals interested in pursuing such a degree. In addition, the government has a history of providing university grant support to develop bioterrorism educational programs to train health care personnel.28,29 The Pennsylvania Office of Public Health Preparedness was also interested in providing financial support for our degree program in return for the project team's expertise in developing a set of educational programs for the state.
Step 9: Ensure academic rigor
In examining the question of academic rigor, the core issue was how to deliver a high-quality program at a distance to individuals of varying educational backgrounds. In exploring this question, the first step was to establish whether the program would be a degree in graduate education or a professional program, because there is a distinct difference between the two. Graduate education implies that there is an educational foundation that has been established at the undergraduate level. Because it is still an emerging discipline, public health preparedness suffers from a paucity of relevant undergraduate academic experiences. Accordingly, we elected to create a professional degree that is consistent with meeting the needs of individuals who have working experience in the field but desire formal academic training to enhance their knowledge and abilities, to discover new methods and concepts through research, and to provide leadership to their field.
In addition, we needed to be confident that the distance education environment met the academic standards of graduate study at Penn State and that the program was a learning experience equivalent to residential instruction. Even in a virtual environment, academic success requires that students feel part of a broader academic community regardless of their physical locations. We also provided access to online and print library resources so that students were able to identify and locate articles, books, media, and other materials required for their studies. We learned over time that the use of distance learning for higher education30,31 and to advance bioterrorism education32 was showing promise. Moreover, there was ample experience within the university to support the effectiveness and quality of distance education. The project team therefore proceeded to use experienced instructional designers within the university to assist the faculty with course development.
Finally, an organizational structure was put into place to ensure academic rigor and program quality. Selected faculty members were appointed to a committee on admissions and academic affairs. This committee reports to the advisory board and is responsible for maintaining academic standards and enhancing the overall teaching effectiveness of the program. The committee not only coordinates the admissions process, but responds to and makes recommendations regarding faculty and student concerns. A program team was also formed, consisting of a program manager and representatives from students' services, instructional design, marketing, and client development. This team also reports to the advisory board and assists the program chair in meeting objectives and benchmarks related to educational goals, cost-effectiveness, and program access.
Step 10: Providing leadership and vision
Finally, throughout each of these steps in the process, clear communication and consistency in presenting the program's vision remained paramount. This proved essential for securing buy-in and for building and strengthening the network of strategic partners that would construct the program, a network rooted in Penn State's rich ties to national security research and education. Without strong multidisciplinary leadership, we would not have been able to achieve critical milestones in the program's development (see Figure 2).
The path that led to the development of an MSH in public health preparedness at the Penn State College of Medicine took just under three years to traverse. From the initial step of establishing the vision for the program, to gaining buy-in across disciplines, sectors, and administrative areas in a large, distributed, and highly structured institution, to cultivating a multidisciplinary program-development team and enlisting strategic partners to bring the vision to life, the story of the MHS in public health preparedness is one of collaboration. The resulting degree program serves as a timely case study in the type of collaboration required to adapt flexibly and quickly to the evolving homeland security environment in the United States. In this respect, its greatest value lies in leveraging the competencies of a network of partners and strategic alliances to meet the educational objectives of homeland security professionals while strengthening higher education's role in shaping this emerging professional discipline.
There were many individuals who participated in or supported the project team and who were thereby instrumental in the creation and development of this degree program. The authors wish to acknowledge a select group of these individuals who demonstrated enormous dedication, commitment, and passion to this extraordinary effort: Jay Moskowitz, associate vice president for health sciences research, College of Medicine; Mike Verderame, associate dean for graduate studies, College of Medicine; Regina Vasilatos-Younken, senior associate dean of the graduate school; Craig Meyers, professor of microbiology and immunology, College of Medicine; Kevin P. Furlong, professor of geosciences, College of Earth and Mineral Sciences; Jim Holliman, professor of emergency medicine, College of Medicine; Gretchen A. Kuldau, assistant professor of plant pathology, College of Agricultural Sciences; Kevin R. Murphy, professor and chair of psychology, College of Liberal Arts; Roxanne Parrott, professor of communication arts and sciences and health policy administration, College of Liberal Arts; Zhengmin Qian, assistant professor of health evaluation sciences; Peter Rubba, director of academic affairs, Penn State World Campus; Peter Forster, associate director, Academic Programs, Penn State World Campus; Norman “Tut” Bailey, senior marketing associate, Penn State World Campus; Col. Xavier Stewart, director, Military Support to Civil Authorities, Pennsylvania National Guard; Alice Grofebert, former workforce preparedness manager, Pennsylvania Office of Public Health Preparedness; and Guillermo J. Pierluisi, MD, MPH, Center of Operational Medicine, Medical College of Georgia.
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