TO: Graduate Curriculum Committee
FROM: Suzanne Lea, PhD, Department of Public Health, BSOM
DATE: February 11, 2014
RE: Reply to external reviewers for Request to Establish a PhD Degree Program in Epidemiology
The Request to Establish a PhD Degree Program in Epidemiology (RAE, Appendix C) was sent from the
Graduate School to two external reviewers on January 21, 2014. Each reviewer was a chair or higher rank
in a department of epidemiology at an accredited school of public health or program. Below is the
content of the reviewers and the reply from the Department of Public Health.
Reply to External Reviewers:
Reviewer 1:
Thank you for the opportunity to review your proposed doctoral program. I found your
request for a new degree to be very informative. I would like to address several areas in the proposed
program. My comments will be targeted and a bit brief as I am typing this with a finger injury. If you
need any expansion on my comments, I will be happy to speak by phone.
Clearly there is a strong need for this type of program, and I believe it will serve both the students' and
state needs very well. There certainly was an excellent justification in terms of future employment
opportunities. Geographically, you are well situated to offering this program. I also believe that you
are not duplicating existing resources.
The overall quality of the program appears sound. One of the struggles of a new program is its ability
to address a wide breath of issues while remaining sufficiently focused. I think in the future you
might want to include a course on infectious disease epidemiology, as this is a common issue in health
departments.
Reply: Infectious disease epidemiology at the master’s level was not
listed in the doctoral curriculum. However the reviewer was quite
correct about the absence of Infectious Disease curriculum at the
doctoral level, so a methods in transmission has been a dded in Table 2.
The statistical education seems quite adequate. You might want to add an additional epidemiological
methods course, perhaps with a focus on study design. We have found our students benefit by
instruction in analyzing and presenting the results of research studies.
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Overall the admission standards seem good although we have found that students who have practical
experience in the field are stronger candidates. This may be of even greater importance given the focus
of your program on public health practice. You may consider also requesting a writing sample so you
can evaluate the applicants' past work in the area of public health.
Reply: The admissions documentation include a writing a sample.
Also if your students have an MPH in a field other than epidemiology, they would likely need greater
introductory material so you may consider potential differences between those with an MPH in
epidemiology and those in other fields.
Reply: A statement under admissions criteria includes clarification that MPH graduates without a
degree in epidemiology may be required to take MPH-level epidemiology courses. This is not an
unusual request, based on other programs.
You have utilized existing faculty from a number of departments quite effectively. I did not have time to
review the faculty so I do not feel able to fully address their credentials.
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The greatest issue that I struggled with was the request for a PhD program (as opposed to a DrPH)
when one of your major foci was in public health practice and the other in clinical epidemiology. I
appreciate your comments that "a PhD degree is more suited than a DrPH because professional in
public health departments are engaging more as investigators and collaborators in population
health research", but the program will need to clearly define the research emphasis within the
proposed program.
Reply: The program focus has been clarified on page 15 to read below.
The ECU PhD degree will be an academic doctoral degree. The primary differences are in areas of
emphasis in the epidemiology curriculum: public health practice and clinical health data systems. The first
focus area fills an employment gap in epidemiology training that exists now and is anticipated to become
larger as data systems become more integrated, requiring advanced skills in public health informatics. For
example, population health data from public health processes, that are fundamentally clinical encounters,
are largely scattered across public health service sectors. CDC has been at the forefront of health
information technology since the late 1990s integrating messaging standards and the electronic capture of
data through the Public Health Information Network (PHIN). An epidemiology PhD degree instead of a
DrPH degree is suited for this purpose, because professionals in public health departments, and those
engaged in accessing and interpreting community-based public health systems data, are engaging more
as investigators and collaborators in population health research, particularly in pursuit of federal grants.
The second focal area is research involving clinical data systems. Hospital or clinic-based data systems may
incorporate the use of electronic health records (EHR) for secondary data analysis of etiologic questions
that have population health consequences, particularly where biological samples may be stored (for
example, tumor blocks). In addition, students should have a grounding in the design and conduct of
clinical trials, as this may be a real and immediate employment opportunity, working with research
implementation of interventions to test new therapies or devices. Vidant Medical Center has enormous
potential for expanding their clinical trials portfolio and innovations in biomarker discovery. Epidemiology
training in this focal area will cover the design, conduct, implementation, and analysis of intervention
studies. Another opportunity with clinical data relates to gathering information about the effectiveness of
a new treatment, particularly under real world conditions (as present in the EHR) where the patient may
not be compliant or have several comorbid conditions (Note: randomized clinical trials typically aim to
remove patient variation (except for treatment effects) out of the process.). The unifying theme that
students in our program will be attracted to is the population health framework of health disparities.
Students may be interested in investigations of disease etiology related to multi-level risk factors and
disease predictors, including primary data collection, which is the foundation of academic epidemiology
training. Epidemiology skills may also be applied to quality improvement questions. We absolutely want
our CH-SPH colleagues to view the ECU PhD degree as credible, producing well-trained academic
researchers
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Epidemiology is by definition a research field so I believe that your focus areas in some ways expand
the traditional role considered for epidemiologists and can contribute greatly to the field. I wish
you the greatest success in your program and hope that my review was of some help. Please feel
free to contact me if you have any further questions.
Reviewer 2:
Eastern Carolina University (ECU) is proposing to start a doctor of philosophy (PhD) program in
epidemiology in 2015 that is focused on, “1) minority, underserved, and rural populations, and 2)
collaborate in interdisciplinary teams to develop evidence-based solutions that translate into improved
population health”. The program will be housed in the Department of Public Health (DOP), Brody School
of Medicine (BSOM). DOP currently offers a master’s in public health (MPH) program.
Justification: Two niche areas are identified where there is a shortage of epidemiologists. These are 1)
within health departments, and 2) among clinical researchers. The PhD graduates will be trained with a
focus on these two areas. The health departments conduct programs that are designed to improve health
at a population level. Epidemiologists can play an important role particularly in program evaluation, and
surveillance systems. Both these areas are influenced by increased use of electronic medical records.
Clinicians and basic scientists are conducting research at ECU hospitals, clinics and laboratories and need
epidemiologists to be part of the research team. The program objectives have been developed around
these two areas. There is a clear need for the program with the stated objectives that is adequately
justified. The physical facilities seem adequate.
Overall Quality of Program: The need for the program is justified, and the PhD program is designed the
program to meet the need. There are deliberate efforts to collaborate, and not compete, with other
players in the area such as University of North Carolina at Charlotte and Chapel Hill, the local health
departments, researchers with ongoing studies, and the departments of psychology and biostatistics. This
demonstrates an efficient and strategic use of resources. The program also has some challenges.
1) Curriculum: The proposed new courses for the doctoral curriculum include those in basic
epidemiology, evaluation, data management, and electronic health records. This set of proposed
coursework is aligned with the public health focus of the program. The other main goal of the
program is to train individuals to support clinical research, but there are not any core courses that
cover clinical epidemiology or comparative effectiveness research. Including these topics, instead
of environmental epidemiology for instance, may align the coursework more closely with overall
program objectives.
REPLY: Tables 1 and 2 have been revised to reflect more method coursework in epidemiology.
Environmental epidemiology has been removed. The version external reviews received did not
have a version which included clinical trials methods and coursework.
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2) Likewise, one of the stated aims of the program is to address disparities. Including some
coursework on topics such as community based participatory research or other methods aimed at
addressing health disparities may be beneficial.
Reply: Community base participatory research is a conceptual approach and epidemiologic
methods may be useful depending on the community research preference. This topic has been
added to the Topics in Public Health and Epidemiology course, MPH 7031, which was added to
table 1.
3) Though methods in psychology and epidemiology overlap, the emphasis varies. While it is hard to
determine the content of the courses from course numbers and titles, it may be that courses
taught by epidemiology or biostatistics faculty instead of the two psychology courses more closely
meet the needs of students in epidemiology.
Reply: Health psychology statistics courses were removed.
4) Student research: The proposal for student research is to collaborate with clinical faculty
conducting research. I assume this would mostly consist of clinical research. The plan to extend
research collaboration to include health systems research could be fleshed out in more detail.
Reply:
Page 15 has been edited:
The ECU PhD degree will be an academic doctoral degree. The primary differences are in areas
of emphasis in the epidemiology curriculum: public health practice and clinical health data
systems. The first focus area fills an employment gap in epidemiology training that exists now and
is anticipated to become larger as data systems become more integrated, requiring advanced
skills in public health informatics. For example, population health data from public health
processes, that are fundamentally clinical encounters, are largely scattered across public health
service sectors. CDC has been at the forefront of health information technology since the late
1990s integrating messaging standards and the electronic capture of data through the Public
Health Information Network (PHIN). An epidemiology PhD degree instead of a DrPH degree is
suited for this purpose, because professionals in public health departments, and those engaged in
accessing and interpreting community-based public health systems data, are engaging more as
investigators and collaborators in population health research, particularly in pursuit of federal
grants.
The second focal area is research involving clinical data systems. Hospital or clinic-based data
systems may incorporate the use of electronic health records (EHR) for secondary data analysis of
etiologic questions that have population health consequences, particularly where biological
samples may be stored (for example, tumor blocks). In addition, students should have a grounding
in the design and conduct of clinical trials, as this may be a real and immediate employment
opportunity, working with research implementation of interventions to test new therapies or
devices. Vidant Medical Center has enormous potential for expanding their clinical trials portfolio
5
and innovations in biomarker discovery. Epidemiology training in this focal area will cover the
design, conduct, implementation, and analysis of intervention studies. Another opportunity with
clinical data relates to gathering information about the effectiveness of a new treatment,
particularly under real world conditions (as present in the EHR) where the patient may not be
compliant or have several comorbid conditions (Note: randomized clinical trials typically aim to
remove patient variation (except for treatment effects) out of the process.). The unifying theme
that students in our program will be attracted to is the population health framework of health
disparities. Students may be interested in investigations of disease etiology related to multi-level
risk factors and disease predictors, including primary data collection, which is the foundation of
academic epidemiology training. Epidemiology skills may also be applied to quality improvement
questions. We absolutely want our CH-SPH colleagues to view the ECU PhD degree as credible,
producing well-trained academic researchers
5) The role of the faculty teaching the core epidemiology course in student dissertations could be
clarified. The core courses are mostly directed at population level research while the student
research plan seems mostly at clinical research.
Reply: The reviewer misunderstood this comment, so it better explained on page 24. The teaching
requirement, 6 credits, includes developing or updating course content and providing instruction
in the classroom for a master’s level course supervised by a professor. The concept behind the
teaching requirement is that many PhD epidemiology graduates are excellent researchers, but
may have not had much experience as an epidemiology intstructor.
Readiness of the current faculty: ECU has faculty with expertise in the core disciplines to undertake this
program. The current faculty members are teaching in the MPH program and have a set of courses to
build from. This is a good starting point. The plan is to hire two more individuals for the PhD program. This
is a good idea because the resources needed for the PhD program will be in addition to continuing with
the existing MPH training. The collaboration with UNC Chapel Hill for student electives is innovative and a
good use of resources.
Summary: The proposal to start a PhD program in epidemiology has clearly defined objectives that meets
community needs, and efficiently uses existing resources. The existing MPH program is a good starting
point for the program. The curriculum can be aligned to more closely meet the overall program goals.
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