A Public Health Discussion Series in an Advanced Pharmacy Practice Experience - American Journal of Pharmaceutical Education

Objectives. To develop and integrate a student-centered, active-learning public health discussion series into an existing advanced pharmacy practice experience (APPE) to enhance knowledge and encourage integration of public health activities into students' future careers.

Design. Students participated in 3 hour-long discussions to define and identify the scope of public health and to examine public health initiatives outside of and within health care.

Assessment. Improvement in the ability to accurately define public health was observed after students participated in the discussion series compared to baseline. Post-discussion definitions were more broad and accurate. Unsolicited comments about the discussion series documented in post-APPE reflections described students' initial lack of knowledge, improved knowledge base, and improved interest in participating in public health initiatives.

Conclusions. Time devoted to public health discussions during an APPE can substantially impact student pharmacists' knowledge base and interest in public health. Additionally, this active-learning technique aids in meeting the Accreditation Council for Pharmacy Education (ACPE) public health standards.

Keywords: public health, student pharmacists, experiential education, advanced pharmacy practice experience, active learning

INTRODUCTION

Pharmacies are easily accessible to patients because they are centrally located within communities, have extended hours of operation, and lack the need for appointments for service.1 Pharmacists not only dispense prescriptions but also provide recommendations about nonprescription preparations, disease states, drug interactions, and behavioral modifications, among other services. To prepare students for this type of career, colleges and schools of pharmacy educate about health screenings, immunizations, pain management, and general health, as well as pharmacotherapy. Because of their strong knowledge base and position within communities, pharmacists are ideal to develop and implement public health initiatives, but are often overlooked in this capacity. Unfortunately, only a handful of colleges and schools of pharmacy offer joint doctor of pharmacy (PharmD)/master of public health (MPH) programs; other student pharmacists receive limited public health education.1

Integrating pharmacists into areas of public health has become increasingly recognized among academic institutions. The most recent standards and guidelines from the Accreditation Council for Pharmacy Education (ACPE) has incorporated an additional guideline requiring colleges and schools of pharmacy to ensure that graduates are competent to 'promote the availability of effective health and disease prevention services and health policy through the ability to apply population-specific data, quality improvement strategies, informatics, and research processes to identify and solve public health problems and to help develop health policy.'2 While student pharmacists are exposed to disease state prevention services, outside of a dual PharmD/MPH program or required course in public health, they likely receive minimal exposure to the concept of public health.1 For this reason, many may not know what public health encompasses, defined as early as 1920 by CEA Winslow as 'the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts. . ..'3 Later in 1988, the Institute of Medicine of the National Academy of Sciences called public health 'what we as a society do to assure the conditions in which people can be healthy.'4 In contrast to medicine, public health activities focus on preventing disease and promoting health for the entire community.5

The importance of public health, the need to increase pharmacists' public health activities, and the overall lack of public health education among colleges and schools of pharmacy,1 including the author's home institution, stimulated the development of a discussion series for integration into an advanced pharmacy practice experience (APPE). These purposeful discussions for PharmD students were formatted using a student-centered, active-learning approach. The goal was to build baseline knowledge in public health and stimulate thoughts about integrating various aspects of public health into their future careers. This commentary outlines the discussion series activities occurring during a fourth-year student pharmacists' ambulatory care APPE. To the author's knowledge, this is the first manuscript describing such a design concept for teaching public health.

DESIGN

The public health discussions were integrated into a rural medicine ambulatory care APPE where students saw patients 5 half-days per week in a Black Belt County in a rural area of Alabama. The clinic in the study was a privately owned family medicine practice operated by a single physician, nurse practitioner, and 2 registered nurses, caring for approximately 50 patients daily. Clinic duties included providing disease-focused pharmaceutical care for diabetes, hypertension, dyslipidemia, and tobacco cessation, as well as maintaining a medication-assistance program for low-income individuals. The clinic was an experiential education site for pharmacy students and residents, medical students and residents, and nurse practitioner students.

On the first day of each 5-week education experience, the preceptor of the rural medicine ambulatory care APPE met with assigned student pharmacists for approximately 1� hours. During this orientation session, various aspects of the APPE schedule were addressed, including the inclusion of 3 public health discussions. The students were assigned the task of investigating 'public health' and identifying an accurate definition using any available resources over the following 2 to 3 days. After that time, the group reconvened for the first public health discussion.

The first discussion period, which lasted approximately 1 hour, began with the preceptor asking, based on your investigation, what is public health?' As the students described what they had learned, the preceptor transcribed students' concepts about public health onto a large white board. During this hour, the preceptor helped the students identify several general core concepts about public health which were derived from a number of reputable public health resources (Table 1).6-8 These were addressed in no specific order, but rather mentioned as the conversation lent itself to each idea.

At the conclusion of this 1-hour session, students were assigned the task of identifying 2 peer-reviewed journal articles related to public health that interested them. One article was to discuss a non-medically related aspect of public health, while the second article was to cover a medically-related public health focus. Two additional hour-long appointments were scheduled for later in the APPE to discuss these articles. Students were required to e-mail their selected articles 3 days before the discussion dates so that sufficient time was provided for everyone to review the literature. Students and preceptors were expected to read all selected articles and participate in each discussion. Each student presented 1 article during each of the following 2 hour-long public health discussion sessions. During the second discussion period, articles not directly related to medical aspects of public health were presented; articles pertaining to medical aspects of public health were discussed during the third discussion period (Table 2).

After students described the selected articles, they were asked to explain how the articles related to public health. Students were encouraged to form their own opinions concerning the public health initiative, standard, or policy. They explained their thought process, identified positive and negative attributes to the public health concept at hand, and considered alterations that could provide new direction or improvements on the current status. Towards the conclusion of the third discussion session, students were asked to brainstorm on activities they could incorporate into their postgraduate lives to impact their local, state, or national communities' health. Students were encouraged to think beyond the walls of a pharmacy and consider both realistic initiatives as well as larger endeavors.

Upon completing the public health discussion series, the students were expected to complete accurately the following: explain the differences between public health and medical care; categorize various initiatives as populationbased versus individual-focused; recognize the importance of non-medically related, as well as medically focused initiatives; describe how public health initiatives affect aspects of daily life; illustrate how culture can change the effectiveness of a public health initiative; critique current public health initiatives in terms of benefits and limitations; and propose a public health initiative in which to participate following graduation. Evaluation of this discussion series initiative received IRB approval through exempt procedures.

EVAUATION AND ASSESSMENT

During orientation on the first day of the APPE, students were provided a 3 by 5 index card and 5 minutes to handwrite 1 or 2 sentences defining in their own words the term 'public health' without using any resources. Prior to the initiation of the APPE students received no indication that they would be expected to define or specifically investigate public health. Then each student was asked to read aloud their definition. By spontaneously defining 'public health,' students' baseline knowledge of the field was ascertained. Students also dated and wrote their names on the index cards for matching purposes on the final day of the APPE. The index cards were retained by the preceptor until that time. At the conclusion of the 5-week APPE, the index cards were returned to the students and they were asked to redefine 'public health' in their own words on the back of the card.

Most students included the terms 'wellbeing' and/or 'health care' in their initial definition of public health. Others believed it impacted only rural residents, lowincome individuals, or underprivileged patients. A few students simply wrote 'I don't know.' Overall, their initial definitions were limited in either size or scope of services. The post-discussion session definitions of public health were often more broad in scope, focused on prevention, and noted to impact a population, which could be a single community or the entire globe, rather than one individual.When encouraged to develop public health concepts for initiation following graduation, many students mentioned implementation of immunization services or initiating disease state classes held at their community retail pharmacy. Others considered running for public office or joining the state department of public health.

As part of the 5-week APPE included in the course syllabus and discussed during orientation, students were asked to draft a 2-page paper reflecting on the APPE experience as a whole. They were in no way directed to comment specifically on the public health discussion series, although many did. Within these pages, several common themes about public health recurred among the students' reflections. Often they mentioned their initial lack of knowledge, improved knowledge base, and future intentions to incorporate some aspect of public health into their careers following graduation. One student wrote:

I have always heard the term 'public health,' but never really knew what it was. . .it is not looking at patients individually, but looking at the community as 'the patient.' By doing this, you find problems throughout the community and [can] attempt to find ways to alleviate the problems. . . After discussing the articles, she [the preceptor] challenged us to brainstorm ways to fix the presented problems. While some of my ideas were farfetched, some were things that really could be accomplished and that excited me.

Additionally, students often mentioned how they never considered the importance of culture when designing initiatives or considered non-medically related activities to relate also to public health. Students often noted amazement that public health impacts most aspects of daily living.

By comparing the pre- and post- definitions and reviewing students' unsolicited comments in their APPE reflections, much was learned about their achievement of the expected learning outcome objectives. The improvement in definitions showed that most students gained knowledge about public health and better grasped the differences between medical care and public health, including differences between population-based and individually focused initiatives by completing the discussion series. By correctly identifying articles to discuss, the students demonstrated the ability to recognize the differences between non-medically and medically related initiatives. Their perceived importance of these initiatives, as well as their application of how culture and public health impact many aspects of life, became evident through reading their unsolicited comments. When discussing the journal articles, students were able to critically evaluate the public health initiatives and frequently had considered recommendations for improvement. Last, after completing the discussion series, students demonstrated interest in participating in public health and provided methods to become involved following graduation. Based on this information, it appears that students effectively achieved the learning outcome objectives.

A checklist was developed to verify coverage of and document duration of time spent on each of the general core concepts about public health during the initial discussion. The checklist was completed retrospectively immediately after each initial student-centered discussion. During this hour-long meeting, all core concepts were addressed 83% of the time. At least 4 of the 5 concepts were addressed 100% of the time. The most commonly skipped topics related to the functions of local, state, and national public health services (83% completion rate) followed by the importance of culture (91% completion rate). Table 1 also summarizes the average amount of time spent discussing each core concept.

The initial and second discussion periods consistently utilized the allocated 60 minutes. However, the third discussion session usually did not have sufficient time. This was likely due to addressing the medically related journal articles in addition to students' considerations for integrating public health into their careers following graduation. The discussion series could benefit from adding a fourth discussion session devoted solely to student/pharmacist engagement in public health. The students may further benefit from developing a list of possibilities between the third and fourth discussions outside of class. This would provide time for students to brainstormindividually before openly discussing in a group. Due to the minimal time allocated to the discussion series, and the self-reported increase in student interest, this appears to have been an effective and reasonable method of introducing pharmacy students to the concept of public health.

DISCUSSION

Establishing a PharmD/MPH dual degree, developing a required public health course, or APPE devoted solely to public health would likely be more effective options to enhance pharmacy students' knowledge about public health. These methods, however, are not always feasible. Incorporating this student-centered active-learning approach within one APPE was an easier way to impact pharmacy student knowledge about and attitudes towards public health. Comparing the pre- and post-discussion series definitions of public health with the voluntary comments made in student reflections demonstrated that minimal time devoted during an APPE can substantially impact a student pharmacist's knowledge base and interest in public health.

Furthermore, progression through this active-learning process helped achieve the ACPE competence measure concerning public health.2 Specifically, each of the 5 general core concepts used to direct student learning during the first discussion session directly supported 1 or more of the Center for the Advancement of Pharmaceutical Education (CAPE) listed public health terminal educational outcomes.9 Finally, the articles selected and presented during the second and third discussion periods (Table 2) helped demonstrate specific examples of health policy and effective quality disease prevention services to students.

While participation in the discussion series did not offer direct hands-on public health activities, it provided a framework for identifying public health initiatives, understanding the importance of applying populationspecific data when designing, implementing, and assessing such initiatives, and promoted the value to society of participating in public health activities. Students were therefore more likely to correlate various aspects of pharmaceutical care as public health initiatives and, as noted in several of the students' reflective comments, decided to participate in various public health initiatives in the future. If every student pharmacist participated in a similar discussion group during one APPE, not only would this help align pharmacy school curriculum with ACPE and CAPE measures, but the overall profession's interest and activity in public health initiatives might also increase.

An assessment comparing post-graduation public health activities of discussion series participants to nonparticipants would be an interesting element to evaluate further this active-learning technique. If implemented on a larger scale across several APPEs, this aspect of assessment may be expanded. Integration into all APPEs may not be feasible due to the inability to coordinate schedules; however, it is possible to add these discussion series into several APPEs. The Harrison School of Pharmacy houses APPE students in 6 different regions across Alabama. Point-to-point and multi-point meetings occur virtually via Polycom (Polycom Inc., Pleasanton, CA) video conferencing systems for teaching responsibilities and committee engagements. This technology could be used to connect sites across the state simultaneously to facilitate discussion among multiple student groups at one time. It would not be necessary to limit the discussion series only to rural or ambulatory care APPEs, as public health initiatives occur on all levels of the health system. It would be important, however, to gain a commitment from each preceptor for their students to attend every session within the APPE block.

An additional area for future consideration may be broadening the discussion series to include students from other disciplines. As patients benefit from multidisciplinary practice sites, so may students benefit from an interdisciplinary discussion forum. Many of the APPE regions across Alabama are connected with schools of other health care disciplines, residency programs, and hospitals. Therefore, it would be reasonable to encourage students and residents from other health care arenas to participate, further enhancing the discussion series as a whole.

SUMMARY

Public health is significant to the maintenance of general health in America. Although identified as a required component in the education of pharmacy students, few colleges and schools currently incorporate extensive training in this area.1 Addition of only 3 public health discussions during a singleAPPE positively impacted knowledge and attitudes of fourth-year student pharmacists. Following completion of the discussion series, students had a better idea of the breadth of public health and reported interest in pursuing public health activities following graduation.

[Reference]

REFERENCES

1. American Public Health Association. Policy 200614: the role of the pharmacists in public health. http://www.apha.org/advocacy/policy/ policysearch/default.htm?id51338. Accessed May 27, 2010.

2. Accreditation Council for Pharmacy Education, Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. 2006;18-19. http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf. Accessed May 27, 2010.

3. Winslow CEA. The Untilled Fields of Public Health. Sci. 1920;51(1306):23-33.

4. Committee for the Study of the Future of Public Health. The Future of Public Health. Washington, DC: National Academies Press;1988:1.

5. Association of Schools of Public Health. www.asph.org. Accessed May 27, 2010.

6. World Health Organization. www.who.int/en/. Accessed May 27, 2010.

7. U.S. Department of Health and Human Services. www.hhs.gov. Accessed May 27, 2010.

8. Alabama Department of Public Health. www.adph.org. Accessed May 27, 2010.

9. American Association of Colleges of Pharmacy, Center for the Advancement of Pharmaceutical Education, Educational Outcomes 2004. http://www.aacp.org/resources/education/Documents/CAPE2004.pdf. Accessed May 27, 2010.

[Author Affiliation]

Heather P. Whitley, PharmD(a,b)

aAuburn University Harrison School of Pharmacy

bThe University of Alabama School of Medicine

Submitted January 6, 2010; accepted March 20, 2010; published August 10, 2010.

Introduction to Health Care Delivery: A Primer for Pharmacists - American Journal of Pharmaceutical Education

ROBERT L. MCCARTHY AND KENNETH W. SCHAFER-- MEYER. Introduction to Health Care Delivery: A Primer for Pharmacists, Second Edition. Gaithersburg, AM: Aspen Publishers, Inc., 2000. xvii + 599 pp., 22 figs., 32 tbls. $51.00.

The second edition of this text continues to provide an excellent overview of the United States health care system from the pharmacist's perspective. Several important changes were made since the first edition was published in 1998. First, many of the book's references have been updated and are quite current. Second, nearly every chapter begins with a pharmacy case study that is referred to within that chapter. Pharmacy students who may not always understand how management, public policy, world economics, etc. impact their own practice can easily grasp the situation in the case, then reflect how the chapter's topic may affect the practice of pharmacy. Third, this edition includes six new chapters and is arranged somewhat differently than the first edition. This text is divided into three major topic areas that take the reader through a brief historical review through numerous public policy changes in the 19th and 20th centuries to the current economic systems in health care today.

Part I, entitled, 'Social Aspects of Health Care Delivery,' consists of seven chapters. This section contains discussions of the history of health care in America, other health care professions involved in interdisciplinary care, the pharmacy profession, the patient, public health, drug use and the pharmaceutical sector, and health care ethics. This section gives the reader an excellent idea of how medical care evolved in the United States and how the ethical practice of pharmacy and use of medications fits into total patient care. Two new chapters in Part I are devoted to 'The Pharmacist' which includes a discussion on pharmaceutical care and 'The Patient' which describes the patient as a consumer of health care as well as presenting different patient care models.

Seven chapters make up Part II, 'Organizational Aspects of Health Care Delivery.' This portion of the text contains information about hospitals, ambulatory care, long-term care, mental health services, home care, health care informatics, and international health care. The new chapter in this section concerns how health care informatics provide insight into use of the internet, computer based patient data, automation, and computer aided monitoring devices.

Part III, 'Economic Aspects of Health Care Delivery,' consists of eight chapters that ranges from a review of basic economics to the description of financing for various populations in the U.S. health care system. Topics include basic economic principles, unique aspects of health economics, pharmacoeconomics, private health insurance, Medicare, Medicaid, managed health care, and health care reform. New topics for this edition involve economics and how economics in the health care system follow basic economic principles with an ethical twist. The four basic methodologies of pharmacoeconomics are described with an excellent definition of terminology for the beginning student. The last chapter, entitled, 'Health Care Reform,' discusses past and current financing of the U.S. health care system as well as what the future might hold.

Like the first edition, the second edition offers the student considering a career in pharmacy or another health related field an excellent overview of the practice of pharmacy in the U.S. health care system. Where we were in the past, what pharmacists currently accomplish, and what the profession hopes to build for the future are all described. Further, the senior pharmacy student will profit from a better understand of how pharmacy practice, economics, and general health intertwine in a health care system with many viewpoints and many players. I would continue to recommend this book as an addition to pharmacy libraries of all students and suggest it for incorporation in courses for pharmacy administration and introduction to pharmacy practice.

[Author Affiliation]

Introduction to Health Care Delivery: A Primer for Pharmacists (3rd Edition) - American Journal of Pharmaceutical Education

McCARTHY RL, SCHAFERMEYER KW (Editors). Introduction to Health Care Delivery: A Primer for Pharmacists (3rd Edition). Sudbury, Massachussetts: Jones and Bartlett; 2004. 725 pp, $69.95 (paperback), ISBN 0-7637-3281-8.

Introduction to Health Care Delivery: A Primer for Pharmacists (3rd edition) is the latest revision of the McCarthy and Schafermeyer text covering multiple facets of the United States health care system. The book is divided into 3 major sections containing a total of 23 chapters. The first section of the text contains 7 chapters providing an overview of social aspects of health care delivery. These chapters cover historical and policy perspectives on US health care delivery, health care professionals and interdisciplinary care, pharmacists and the pharmacy profession, the patient, public health, drug use and the pharmaceutical sector, and health care ethics. The second section of the book addresses organizational aspects of health care delivery. It contains 8 chapters, covering hospitals, ambulatory care, long-term care, mental health services delivery, home care, informatics in health care, international health care delivery and pharmaceutical services, and government involvement in health care. The third section covers economic aspects of health care delivery. The 8 chapters contained therein cover economic principles affecting health care, health economics, pharmacoeconomics, private health insurance, Medicare, Medicaid, managed care, and health care reform.

This text would serve as an excellent complement to its nearest competitor, Fincham and Wertheimer's Pharmacy and the US Health Care System (2nd edition). The McCarthy and Schafermeyer textbook generally provides a 'big picture' of the health care delivery system, and thus, may be of interest for persons who are not pharmacy students or practitioners. This is in contrast to the Fincham and Wertheimer book, in which more chapters focus on pharmacists, pharmacy practice, and pharmaceuticals. For example, Pharmacy and the US Health Care System (2nd edition) devotes whole chapters to the pharmaceutical industry, pharmacy organizations, and drug distribution systems, while Introduction to Health Care Delivery: A Primer for Pharmacists (3rd edition) does not. However, the McCarthy and Schafermeyer text provides chapters on international health care and pharmaceutical services, public health, and health care ethics-topics that are not treated in depth in the Fincham and Wertheimer book.

Introduction to Health Care Delivery: A Primer for Pharmacists (3rd edition) retains many of the strengths of the 2nd edition. Each chapter is clearly written, logically organized, and well referenced. Every chapter begins with a scenario that provides a context for the concepts to be discussed, as well as several questions designed to aid understanding. The new edition also has several improvements. Nearly all chapters have been updated and many have been expanded. For example, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is now discussed in the chapter on Medicare, and a section covering pharmacist education and training now supplements the chapter on health informatics. Learning objectives have been added to each chapter and a list of key topics and terms now appears at the end of each chapter. Finally, a completely new chapter on the role of federal and state government in health care has been added.

A major strength of Introduction to Health Care Delivery: A Primer for Pharmacists (3rd edition) is its considerable breadth. The book does a good job covering most major components of the US health care delivery system and the pharmacist's diverse roles in healthcare delivery within a single volume. As such, I would recommend this text to students considering a career in pharmacy, persons teaching an introductory course in the US healthcare delivery system or pharmacy practice, and perhaps to practitioners who wish to increase their knowledge of the health care delivery system in the United States. A weakness of the book is that the level of exposition is generally introductory. As such, it would probably not be appropriate for graduate courses in social and administrative pharmacy or as a reference for advanced researchers and scholars.

In summary, Introduction to Health Care Delivery: A Primer for Pharmacists (3rd edition) provides a comprehensive and up-to-date view of most of the important aspect of the US healthcare system. This book would make a very nice edition to libraries in colleges of pharmacy and academic health centers, and will also be of considerable value to students, both prospective and current, and those teaching courses in this area.

[Author Affiliation]

Reviewed By: Richard R. Cline, PhD

College of Pharmacy, University of Minnesota

[Author Affiliation]

Emerging careers come into focus.(EMERGING CAREERS) - Techniques

When career and technical education (CTE) began, known then as vocational technical education, only those with the most vivid imaginations and creative minds could envision it as it is today. Many of today's jobs didn't even exist when the baby boomers entered the workforce. Over the decades, CTE has maintained its commitment to preparing a skilled workforce, but those skills have changed remarkably. The founders of CTE would be amazed at some of the careers that have emerged over the years.

In the 1960s, the age of space exploration marked advances in science and technology and, as a result, career fields began evolving, as the space-age technology transferred into other industries. In the late 70s, Steve Wozniak designed the first Apple computer, and in 1981, IBM sold its first personal computer. A whole new world of careers began emerging as a result of the rapid growth in information technology. Today, the changes seem to be coming at a lightning-fast speed, and new legislation and regulations as well as new business practices and changing demographics can also result in specialized areas of occupation, but CTE continues working to keep pace.

On the National Association of Colleges and Employers JobWeb.com site, Sharon Jones, career counselor at the University of North Carolina, describes an emerging occupation as 'one that has been recognized in small numbers, but continues to grow.' Among the emerging careers she identifies are some expected ones, such as nurse anesthetists, health informatics specialists, security engineers, and clinical genomics analysts. There are also some unusual ones. Have you heard of creative perfumers who evaluate odors and create fragrances? How about human terrain analysts? Jones describes them as professionals who conduct primary research with local leaders in a country and translate conversations and documents from that country. Patent analysts are also on the list. They help local companies determine how new concepts or products are unique and marketable.

Last year, a CareerBuilder.com article listed seven emerging jobs. They were home stager, health informatics technician, simulation developer, green jobs, emergency management, career counselor and patient advocate. The article also noted that developments in technology, health care, environmentalism and globalization, as well as current economic trends, are helping certain careers to surface.

Technology Trends

One of the main driving forces bringing new career fields into the forefront is technology. A recent Career Vision article noted that three of the emerging industries are biotechnology, nanotechnology and geospatial technology. In recent years, CTE has been tracking the technology and adjusting its offerings accordingly. For example, nanotechnology programs have been increasing at community and technical schools over the past five years. One of those is North Seattle Community College, which became the first college in its state to offer an associate of applied science degree in nanotechnology. The multidisciplinary program exposes students to clean room procedures, including an understanding and maintenance of nano/micro fabrication and characterization equipment.

In 2005, Wisconsin's Chippewa Valley Technical College was one of several technical colleges that partnered with the University of Wisconsin to create the state's first nanoscience technology degree. Recognizing the impending growth in the field, the partnership aimed to attract nanotechnology industries to the area, including nanoparticle manufacturing, micro-fabrication and the medical device industry. Chippewa Valley also partnered with Minnesota's Dakota County Technical College (DCTC) to develop the program's curriculum. DCTC's other partners include more than 25 corporations that serve on advisory committees and provide guest lecturers arid laboratory tours. In addition to internships at some of those companies, DCTC's program includes a capstone experience at the University of Minnesota with lectures and experience in the university's nanofabrication lab, materials characterization lab and the nanoparticles/biotechnology labs.

According to the National Nanotechnology Initiative, the worldwide workforce necessary to support the field of nanotechnology is estimated to be 2 million by 2015, and the National Science Foundation estimates a need of four to five technicians for every Ph.D. scientist or engineer. CTE clearly has a role to play in fulfilling that need.

Geospatial technology is one of the other emerging industries often cited; geospatial information systems (GIS) programs are being created or are evolving from other programs such as surveying and mapping. In 2008, Southern Maine Community College received a three-year grant from the National Science Foundation for a project called 'A Collaborative Model for Geospatial Technology Education in a Rural Region.' The goal was to meet the growing need for workers skilled in the field. Other colleges involved in the project include the University of Maine, Kennebec Valley Community College, the University of Southern Maine and Washington County Community College.

Penta Career Center in Ohio also has a GIS program that uses STARS, a certification program for technical schools, colleges and universities, as well as high schools. Indicative of the emergence of this industry is the fact that the National SkillsUSA Championships now include a geospatial technology competition.

The Seeds of New Careers

While many of these industries are exploring new frontiers, they are also reshaping traditional areas of CTE. Biotechnology is now infused into agriculture education, and new careers are becoming part of the landscape. One of the careers on the CareerOneStop site is precision agriculture technician. The description says that these technicians apply geospatial technologies to agricultural production and management activities such as pest scouting, site-specific pesticide application, yield mapping and variable-rate irrigation. Computers and GPS are now used to develop maps and remote sensing images (or analysis of the topography and data on soil, fertilizer, pests or weather.

One of the schools offering a precision agriculture application technician certificate is Minnesota West Community and Technical College. Among the courses in the 26-credit program are Principles of Agronomy. Introduction to Soil Science, Custom Application, Weed Control, and Corn and Soybean Production. There is also a GIS/GPS course.

Health care and energy are two more fields in which careers are evolving. In 2010, the Community College of Allegheny County announced the results of a study it had commissioned to identify emerging careers in the Greater Pittsburgh area. The three industries identified as having the most potential growth and economic impact were health care and life sciences; energy; and financial services and insurance--with energy and health care having the most positive employment outlook.

The technological changes in health care have certainly been revolutionary, and new careers continue to emerge in the field. Programs, such as the one at St. Phillip's College--one of the Alamo Community Colleges in Texas--are preparing technicians to install, repair, maintain and operate biomedical equipment. In Oklahoma, Canadian Valley Technology Center was chosen as one of the initial sites to launch a biomedical sciences program in 2007, and the program has continued to grow.

As part of its Allied Health Division, Jefferson Community and Technical College (JCTC) in Kentucky offers a volumetric medical imaging (VMI) program. The program's Web site describes VMI as the next generation of medical imaging and offers this explanation of its application: The data obtained from computerized tomography (CT) or magnetic resonance imaging (MRI) traditionally consists of a 2D 'slice' through the body, but with advancing technology, the number of slices obtained per patient has increased to the point that physicians have an overwhelming amount of information to review. To manage the amount of data, software has been developed to combine the set of 2D slices into one comprehensive 3D volume that accurately represents the internal anatomy. The VMI program builds upon previously acquired skills, since admission into the program requires that a student must have already completed an associate degree in radiology technology or CAD.

Green careers are often cited as an emerging area, and they also can build upon previous programs. This past June, Gateway Technical College and the University of Wisconsin-Parkside announced an agreement that provides pathways for associate degree graduates in two Gateway programs to transfer their credits to UW-Parkside and work toward a four-year degree. The two programs are Civil Engineering Technology-Freshwater Resources and Air Conditioning Heating and Refrigeration Technology with an emphasis in geoexchange technology. Geoexchange technology uses the renewable energy just below the earth's surface for heating or cooling buildings and for domestic hot water.

In announcing the agreement, Gateway President Bryan Albrecht noted that educational partnerships such as this one were meeting community needs, and he added, 'The University of Wisconsin-Parkside is a very important educational partner. Together, we can offer improved options for our students in these emerging green career areas.'

New Energy, New Careers

In the fall of 2009, Minnesota West was one of nine Minnesota State Colleges and Universities to launch a new energy technical specialist degree that prepares students to work in either the renewable energy held or traditional energy industries. It is largely funded with a three-year $1 million High Growth Job Training Initiative grant from the U.S. Department of Labor. The new two-year degree program, along with the specialized energy certificates, complements Minnesota West's offerings in biofuels technology and wind energy technology. Besides the energy technical specialist degree, students may also earn a certificate in one of four specialties: ethanol production, biodiesel production, wand turbine maintenance and solar energy assessment.

In announcing the new program, Chancellor James McCormick stated, 'This innovative approach enables our colleges and universities to meet a critical need of Minnesota's traditional and emerging energy industries. Traditional energy employers have an aging workforce, while renewable energy producers are struggling to find workers with appropriate technical skills. These new opportunities for students will advance one of our strategic directions, which is to enhance the state's economic competitiveness. '

In 2010, Cincinnati State Technical and Community College announced that it was adding at least two innovative new programs to its offerings. One is a new major that will be part of its power systems engineering technology program centering on 'Smart Grid' technology, which involves the way households, businesses and lactones use electric power. Larry Feist, chairman of the Energy Efficiency and Renewable Energy Major at Cincinnati State says that the Smart Grid major is designed to capitalize on both the short-term demand for technicians to install new generations of electric and gas meters, and on the longer-range need for specialists who will be able to maintain the new systems and work on the distribution and transmission aspects of the electrical grid.

According to a news release issued by Cincinnati State, Duke Energy was among the 100 utilities that received federal stimulus funds to accelerate the installation of 'smart' electric meters in homes and businesses, and Mark Wyatt, Duke Energy's vice president of smart grid and energy systems, had this to say about the new program: 'Smart, digital technology is changing the free of the energy industry in much the same way wireless changed the telephone business. Having a major devoted to understanding how this technology integrates with today's grid is an important first step in preparing tomorrow's energy professionals.'

The second new program being launched this fall at Cincinnati State is the associate degree program in stormwater management. Ann Gunkel, chair of the institution's Environmental Engineering Technology program, notes that the federal Clean Water Act is making stormwater management, a priority throughout the nation. Students in the program will take core courses within the environmental engineering technologies curriculum, in addition to specialty courses such as environmental mapping, watershed management and stormwater management.

During hard storms--and this year has been one that has seen severe storms in many parts of the country--untreated sewage can flow into waterways through relief valves. So stormwater management is becoming a priority in reducing these dangerous overflows. As Academic Vice President Monica Posey explains, 'Cincinnati State has worked closely with our partners in industry and local government to design a major that will serve an emerging need in the workplace.'

Emerging Pathways

Minnesota West is also helping to bring education in renewable energy to the high school level in its state. This past summer at its Granite Falls Campus, six math, science and agriculture teachers from Southwest Minnesota high schools completed the second part of the renewable energy training that they began last summer. According to Minnesota West, the focus of the program was to expose the participants to a wide range of emerging and existing renewable energy fields, strengthen the science and math backgrounds of the participants, provide insights on how the emerging energy topics relate to the math and science currently being taught, and help integrate the new material into their high school curriculum so that it can help meet state standards.

North Seattle Community College is also connecting with secondary education by playing a leadership role in developing a seamless nanotechnology education program from the K-12 level through the baccalaureate degree. High school students in Minnesota also have the opportunity to be exposed to nanotcchnology as a possible career through a four-day program offered by Dakota County Technical College. In the NanoScience Class, students learn about how nanoscience is changing the world and get to perform experiments and use instruments such as atomic force and scanning tunneling microscopes. They also go to the University of Minnesota to tour the Nanofabrication Center clean room and the Characterization Facility to gain even more exposure and hands-on experience.

In Oklahoma, students begin the two-year biomedical sciences program, at the Canadian Valley Technology Center as high school juniors, and according to instructor Erin Crosby, about 80 percent go on to college.

Through Gateway Technical College's agreement with UW-Parkside, students graduating from the freshwater resources program or the geoexchange program can transfer into UW-Parkside to earn a bachelor's degree in geosciences-soil and water sciences.

CTE to Meet the Emerging Needs

As new technologies and innovative ideas continue to appear on the horizon, even those already in the workforce will need to update their education and training. CTE will have to be ready for them--but it's a challenge we have faced before, and we have always risen to it. So as new careers continue to emerge, CTE will be there to meet them.

TEMPLE UNIVERSITY'S HEALTH INFORMATION PROFESSIONS PROGRAM AIMS TO CLOSE UNEMPLOYMENT GAP - US Fed News Service, Including US State News

PHILADELPHIA, Pa., March 7 -- Temple University issued the following news release:

A new Temple program is providing a pathway to jobs in one of the nation's fastest-growing employment areas.

Funded by a $1.6 million grant from the U.

S. Department of Health and Human Services' Administration for Children and Families, Temple's Health Information Professions (HIP) Career Pathways Initiative offers qualified low-income residents free training leading to certification for positions in medical accounts and electronic health records.

The U.

S. Department of Labor has classified health information professions as an emerging job market. With Philadelphia's unemployment nearly at 2 percent above the national average, the program is designed to help more city residents find work.

'We want to empower low-income people with the opportunity to get into a rapidly growing field where they'll be able to earn their own self-sustaining wages,' said Shirley Moy, interim director of the Center for Social Policy and Community Development (CSPCD), which is coordinating the program.

The center also offers supplemental help during participation in the Career Pathways Initiative, including childcare services, adult literacy services and case management. Non-credit certification takes about 18 weeks, but the program also offers assistance with scholarships and tuition help to eligible students who enroll in credit-bearing programs leading to an associate's or bachelor's degree in health information management or master's degree in health informatics. Upon completion of the program, CSPCD will assist with job placement.

'We understand that success doesn't mean simply completing the training program,' said Moy. 'To that end, we're offering supportive services to break down some of the barriers that impede access to achievement - things like transportation, childcare issues and lack of social supports.'

The inaugural class of the HIP Career Pathways Initiative recently completed their orientation at Temple's Main Campus, and several participants lauded the program's support system.

'This program is beyond what any technical school offers in terms of support,' said participant Naeemah Felder, a single parent to four girls. 'This is a much better opportunity, both in terms of time and the level of assistance you receive.'

If participants are interested in continuing their education after completion of the program, they have the opportunity to earn a bachelor's degree through Temple's Department of Health Information Management, one of only two degree programs in the Philadelphia region certified by the Commission on Accreditation for Health Informatics and Information Management Education.

'We're all here, from different backgrounds, and we all want to succeed, but not having a job makes it difficult to afford quality training,' said Felder. 'This program gives people who want to work the boost they need to get their foot in the door.'

For more information about the HIP Career Pathways Program at the Center for Social Policy and Community Development, contact Mansura Karim at 215-204-7491 or mkarim@temple.edu. For any query with respect to this article or any other content requirement, please contact Editor at htsyndication@hindustantimes.com

COMPUTER SCIENCE PROFESSOR RECEIVES NSF CAREER AWARD - US Fed News Service, Including US State News

CHARLOTTE, N.C., July 21 -- The University of North Carolina-Charlotte issued the following press release:

Computer science professor Tiffany Barnes is studying how to use artificial intelligence to transform education. Her efforts have resulted in a prestigious National Science Foundation (NSF) Career Award.

Barnes, an assistant professor in the Department of Computer Science in UNC Charlotte's College of Computing and Informatics, will receive $646,982 during the next five years to support her research, 'Educational Data Mining for Student Support in Interactive Learning Environments.'

'I am honored and delighted to receive the NSF Career Award to advance my research in developing software to make education better for students learning in science, technology, engineering and mathematics,' said Barnes. 'This award will enable us to engage more graduate and undergraduate students in computer science research that has a direct benefit on society.'

Creating intelligent learning technologies from data has unique potential to transform the American educational system, by building a low-cost way to adapt learning environments to individual students, while advancing research on human learning, Barnes said.

The goal of her project is to create technology for a new generation of data-driven intelligent tutors, enabling the rapid creation of individualized instruction to support learning in science, technology, engineering and mathematics (STEM) fields. It has the potential to develop individualized learning support for a broad audience, from children to adults, including students who are traditionally underrepresented in STEM fields, Barnes said.

'This is exciting news for Dr. Barnes, as well as the college and the University as a whole,' said Yi Deng, dean of the College of Computing and Informatics. 'This prestigious award is yet another reflection upon the exemplary faculty and cutting-edge research of the college.'

The NSF Career Award is the foundation's most prestigious honor in support of junior faculty who exemplify the role of teacher-scholars through outstanding research, excellent education and the integration of their education and research programs within the mission of their organization.

About The College of Computing and Informatics

The College of Computing and Informatics provides academic programs in computer science, software and information systems, information technology, and bioinformatics. It is also the home to leading research centers and institutes, including the Center for Digital Identity and Cyber Defense Research, the Bioinformatics Research Center, the Charlotte Visualization Center, the Diversity in Information Technology Institute, the eBusiness Technology Institute, and the Software Solutions Lab.

About UNC Charlotte

A public research university, UNC Charlotte is the fourth largest campus among the 17 institutions of the University of North Carolina system. It is the largest institution of higher education in the Charlotte region, offering doctoral, master's and bachelor's programs. Fall 2008 enrollment was 23,300 students, including nearly 5,000 graduate students.

About National Science Foundation

The National Science Foundation (NSF) is an independent federal agency created by Congress in 1950 'to promote the progress of science; to advance the national health, prosperity, and welfare; to secure the national defense...' With an annual budget of about $6.06 billion, the NSF is the funding source for approximately 20 percent of all federally-supported basic research conducted by America's colleges and universities. In many fields, such as mathematics, computer science and the social sciences, NSF is the major source of federal funding.For more information please contact: Sarabjit Jagirdar, Email:- htsyndication@hindustantimes.com.

The changing health information service (HIS) work environment.(Editorial) - Health Information Management Journal

The papers in this issue of HIMJ all have something important to say about the changing work environment of Health Information Managers (HIMs). The first three papers examine the HIS work environment from the point of view of managing HIM careers, the quality of the work HIMs perform, and how technology impacts upon the way they do their work. Sandra Leggat's paper focuses on performance management for HIMs with a view to improving outcomes for both staff and organisations through the implementation of transformational leadership. Jude Michel, Hong Son Nghiem and Terri Jackson discuss the contribution HIMs can make towards minimising hospital-acquired complications; and Aziz Jamal, Kirsten McKenzie and Michele Clark have reviewed the published literature on the impact of health information technology on the quality of medical care. The research articles are followed by Helen Cooper's reflective and insightful commentary on the changing roles of HIMs from an educational perspective, where she suggests that rather than viewing changes in the HIS work environment as radical change--out with the old and in with the new--it can be better understood as a continuous process of small, and sometimes not so small, incremental changes, where the basic core elements of the HIM profession are constantly expanding and adapting to changes occurring both within and outside of the profession.

This Issue also contains practical case study examples that demonstrate how such change occurs: Ronit Peled and Jerry Schenirer outline the development of a strategic planning process to enable a regional project to succeed, while Julia Wilkins demonstrates the role that health information management has played in the Royal Flying Doctor Service and how her HIM role has been successfully expanded to meet the organisational goals of the RFDS. Expanding the role of HIMs, particularly in the area of technology, is further highlighted by two professional practice papers. Sari McKinnon shows how the expansion of the role of health informatics in her personal journey as a HIM has enabled her to take her career forward in Singapore, while Michele Bramley and her colleagues from NEHTA highlight the important role of the terminology analyst in integrating new technologies into the HIS work environment. All of these papers highlight different aspects of the changing HIS work environment and I would like to thank Michael Strachan, the guest editor for this Issue, for soliciting papers that represent such a broad range of career perspectives on this important topic.

Finally, the Issue concludes with the professional profiles of two very experienced HIMs, whose amazing careers have spanned many years, and which eloquently demonstrate the changing nature of health information management across time. Marianne Carter has recently retired, but her extraordinary career as a HIM spanned almost 40 years and bears testament to the changing nature of the HIS work environment and to the vitally important interactive role that HIMs play in driving change themselves. Carmel Cheney launched her career working on the Agent Orange Study 28 years ago and now works as a HIM consultant, with many career steps in between. It seems fitting to conclude this Issue, with its focus on the changing HIS work environment, with profiles of HIMs whose careers are a testament to the theme. In this respect, I would like to include Cassandra Jordan (the Journal's state liaison officer [SLO] for NSW) in the discussion1 Cassandra's career as a HIM, both in Australia and overseas, also covers the full gamete of change that has impacted on the profession since the mid-seventies from manual records and manual typewriters through to modern-day technology and methods. Cassandra is HIM for two Sydney-based hospitals as well as convener of the HIMAA (NSW Branch) Private Hospital Special Interest Group. As the Journal's SLO (NSW), Cassandra has inspired many HIMs to write up case studies of interesting projects or professional profiles for publication in the Journal. In tracking the careers of HIMs such as Marianne Carter, Carmel Cheney and Cassandra Jordan across time we see not only the great variety that a HIM career can offer but also how the professional careers of individual HIMs constantly evolve and expand as part of a never-ending process of change. The essential core elements of health information management are always there but the way in which they manifest changes. These profiles are examples of how the HIMs who embody and enable our profession keep it alive and relevant across time and workplace.

References

Bramley, M. (2009). NEHTA terminology analysts. Health Information Management Journal 38(3): 59-63.

Carter, M. (2009). Marianne Carter: A varied HIM career in retrospect. (Professional profile). Health Information Management Journal 38(3): 64-68.

Cheney, C. (2009). Carmel Cheney: Health information management consultant. (Professional profile). Health Information Management Journal 38(3): 69-71.

Cooper, H. (2009). Changing roles of Health Information Managers: an education perspective. Health Information Management Journal 38(3): 38-42.

Jamal, A., McKenzie, K. and Clark, M. (2009). The impact of health information technology on the quality of medical and health care: a systematic review. Health Information Management Journal 38(3): 26-37.

Jordan, C. (2009). Cassandra Jordan: NSW State Liaison Officer, HIMJ. Health Information Management Journal 38(2): 67-69.

Leggat, S. (2009). A guide to performance management for the Health Information Manager. Health Information Management Journal 38(3): 11-17.

McKinnon, S. (2009). Enterprise architecture in the Information Services Division, Ministry of Health Holdings, Singapore. Health Information Management Journal 38(3): 56-58.

Michel, J., Nghiem, H.S. and Jackson, T. (2009). Using ICD-10-AM codes to characterise hospital-acquired complications. Health Information Management Journal 38(3): 18-25.

Peled, R. and Schenirer, J. (2009). Healthcare strategic planning as part of national and regional development in the Israeli Galilee: a case study of the planning process. Health Information Management Journal 38(3): 43-50.

Strachan, M. (2009). Managing change proactively within the current HIM professional domain. (Guest Editorial). Health Information Management Journal 38(3): 7-10.

Wilkins, J. (2009). The Royal Flying Doctor Service flies to new heights: the journey of health information management. Health Information Management Journal 38(3): 51-55.

Barbara Postle

Editor

Health Information Management Journal

email: himj@himaa.org.au

Health Information Management

School of Public Health

Curtin University

GPO Box U1987

Perth WA 6845

AUSTRALIA

Tel: + 61 8 9266-7363

Fax: + 61 8 9266-2958

email: B.Postle@curtin.edu.au

Health Information Manager

South Perth Hospital

76 South Terrace

South Perth WA 6151

AUSTRALIA

Tel: +61 8 9367-0251

Fax: +61 8 9474-2541

email: Barbara@sph.org.au