Understanding epidemiologists who serve as preceptors

Annals of Epidemiology 28 (2018) 258e263

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Brief communication

Understanding epidemiologists who serve as preceptors Jessica Arrazola, DrPH, MPH, CHES a, *, Gulzar Shah, PhD, Mstat, MS a, Jeff Jones, PhD, MA a, Jingjing Yin, PhD, MA b, Elizabeth Harper, DrPH, MPH c a

Department of Health Policy, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro c Association of State and Territorial Health Officials, Arlington, VA b

a r t i c l e i n f o

a b s t r a c t

Article history: Received 3 November 2017 Accepted 29 January 2018 Available online 16 February 2018

Purpose: This study describes factors associated with epidemiologists from state health departments (HDs) who served as preceptors. Methods: We used the 2014 Public Health Workforce Interests and Needs Survey, a national survey of state health agency workers, and selected those who identify their role in the organization as an epidemiologist and a state HD employee for analysis. Variables related to recruitment and retention were studied, and predictor variables were assessed. We applied statistical analysis of complex sampling design based on weights generated by the distribution of the epidemiologists. Logistic regression was used to determine factors that are significant predictors of preceptorship. Results: Significant factors of increased preceptorship included being black (adjusted odds ratios [AOR] ¼ 3.98, 95% confidence interval [CI], 2.01e7.88), being a team leader (AOR ¼ 2.09, 95% CI, 1.07 e4.05), a supervisor (AOR ¼ 2.75, 95% CI, 1.25e6.08), or a manager (AOR ¼ 2.70, 95% CI, 1.15e6.34), and collaborating with academia (AOR ¼ 3.11, 95% CI, 1.82e5.34). Conclusions: State HDs and academic institutions should collaborate to offer applied epidemiology practicum opportunities to (1) increase job satisfaction among applied epidemiologists and (2) prepare the incoming workforce to work in applied epidemiology. © 2018 Elsevier Inc. All rights reserved.

Keywords: Preceptorship Practicum Epidemiology Workforce development Public health

Introduction Practicums are applied student learning experiences that are supervised by a preceptor. All schools and programs of public health accredited by the Council on Education for Public Health require a practicum component for all graduate students [4]. The practicum is an opportunity for the student to practice the skills they have learned in the classroom in practice-based setting. While “field placement programs benefit students, employers, and academic institutions, they can be difficult to establish, manage, sustain, and evaluate” [17]. Academic institutions facilitating practicum experiences rely on community partnerships with

All authors have participated in conception and design or analysis and interpretation of the data; drafting the article or revising it critically for important intellectual content; and approval of the final version. * Corresponding author. Department of Health Policy, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460. E-mail address: [email protected] (J. Arrazola). https://doi.org/10.1016/j.annepidem.2018.01.013 1047-2797/© 2018 Elsevier Inc. All rights reserved.

willing working professionals to serve as preceptors for the students. The role of the preceptor is to provide supervision and mentorship for the student. The preceptor is expected to “monitor the implementation of practicum projects, model effective public health practices, and provide important feedback to faculty and students” [20]. Accredited Schools of Public Health are required to offer an epidemiology concentration [4], yet collaborations between these institutions and potential employers of their students tend to be low [18]. In 2014, only 27% of state workers indicated they had worked with the academic community [7], while 12% of the state public health workforce participated in a successful collaboration in the past year [18]. Practicum opportunities are also limited by the availability of staff to serve as preceptors [3]. Approximately 18% of epidemiologists intend to leave the workforce in the next 5 years, which may exacerbate the existing demands and pressures on the workforce [11]. While the number of epidemiology trainees is increasing, the capacity for applied epidemiology practicum opportunities necessary to prepare a student for employment may be insufficient [11].

J. Arrazola et al. / Annals of Epidemiology 28 (2018) 258e263

The applied learning experience that practicums offer is essential for graduates to be qualified for entry-level positions. Practicums rooted in competencies, such as the Applied Epidemiology Competencies, have the potential to improve the capacity of the current workforce in performance of the 10 Essential Public Health Services [1,16]. Epidemiology field training programs that incorporate mentoring and competency-based frameworks can produce highly capable epidemiologists [6]. Lack of relevant competencies can make the graduates less “competitive for employment in the current and future job market” [2]. Epidemiology field placements are key to strengthening health systems [23]. Students are able to observe the agency's organization, processes, people, and culture through their practicum experience [5]. In addition, practicums provide exposure to public health practice that may guide the student's chosen career path. The purpose of this study is to identify predictors of applied epidemiology graduate preceptorships and other associated factors such as years of experience, race, and academic partnerships. A better understanding of who serves as a preceptor offers a novel perspective and foundation for enhancing the applied epidemiology workforce pipeline.

Material and methods This research uses a cross-sectional survey of public health employees, the 2014 Public Health Workforce Interests and Needs Survey (PH WINS), led by the Association of State and Territorial Health Officers and the de Beaumont Foundation. The PH WINS used a complex sampling design (described in [14,19]), with a total of 19,171 completed surveys, of which 10,246 were completed by the state central office. This was the first national assessment of the state agency level public health workforce. This study uses data from a subset of the sample limited to those who self-identify their role in the organization as an epidemiologist and a state health department (HD) employee (n ¼ 681). The Georgia Southern University Institutional Review Board determined this research was “exempt” from a full review (H16362). Preceptorship is the dependent variable of interest for this study and was self-reported by participants indicating “yes” or “no” to supervising a student experience in the last year. Other relevant measures included race, age, gender, supervisory level, annual salary, educational attainment, years in current position, years in the agency, years in public health practice, collaborate with academia, and overall job satisfaction. The original sample was designed to be nationally representative of the state health agency workforce. Because the analyses for this study were limited to state health agency epidemiology workforce, we generated new weights using poststratification, for this sample to be representative of epidemiologists at all state health agencies. The denominators for weight calculations were derived from the state enumeration data compiled through the Council of State and Territorial Epidemiologists' 2013 Epidemiology Capacity Assessment. Descriptive analyses (PROC SURVEYFREQ) were performed, and logistic regression (PROC SURVEYLOGISTIC) was used to determine factors that are significant predictors of preceptorship. The analysis was conducted using SAS Studio, version 3.6 (SAS Studio, Cary, NC).

Results Among epidemiologists, 26% serve as preceptors (n ¼ 174). The subgroup analysis of preceptors (Table 1) shows that 45% are below

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the age of 40 years and almost 73% are female. Most are white (66%). Preceptors hold positions across all supervisory levels: nonsupervisor (33%), team leader (19%), supervisor (32%), and management (16%). Over 58% earn less than $75,000 annually. Nearly 61% hold bachelor's and master's degrees, whereas 29% hold bachelor's, master's, and doctorate degrees. Approximately 56% of preceptors have been in their current position for 5 years or less, 56% have been at their agency for 10 years or less, and 62% have more than 10 years of experience in public health practice. Nearly 72% collaborate with academia. Almost 89% of preceptors strongly agree or agree they have overall job satisfaction. Table 2 describes the distribution of preceptorships and academic partnerships. In 2013, over 26% of epidemiologists served as a preceptor. Nearly 79% reported that the benefit of hosting the practicum outweighed or equaled the work required to host the practicum. Furthermore, 52% of epidemiologists collaborated with members of the academic community (faculty/staff/students) on public health practices issues. Almost 92% of those that collaborate with the academic community identify the value of the academic partnership to be somewhat or very helpful. The unadjusted odds ratios (Table 3) indicate that higher odds of serving as preceptors were associated with increased age, black (vs. white), supervisor or manager (vs. nonsupervisor), higher annual salary, higher educational attainment, more years in current position, more years in agency, more years in public health practice, experience collaborating with academia, and higher overall job satisfaction (Table 3). Adjusted odds ratios are reported in Table 3, to statistically control for confounders, while assessing the association of each independent variable in the model with the dependent variable preceptorship. After controlling for other independent variables in the model (e.g., age, gender, race, supervisory level, annual salary, educational attainment, years in current position, years in the agency, years in public health practice, collaborating with academia, and overall job satisfaction), few factors were significant in predicting preceptorship. The odds of being a black preceptor were significantly higher (adjusted odds ratio: 3.98; confidence interval [CI]: 2.01e7.88) than the adjusted odds of being a white preceptor. Compared to the adjusted odds of a preceptor being a nonsupervisor, the adjusted odds of being a team leader were 2.09 (CI: 1.07e4.05), a supervisor were 2.75 (CI: 1.25e6.08), or a manager were 2.70 (CI: 1.15e6.34). The adjusted odds of a preceptor collaborating with academia were 3.11 (CI: 1.82, 5.34), compared with preceptors not collaborating with academia.

Discussion This large-scale retrospective study examines the factors associated with odds of serving as preceptors among applied epidemiologists. This study found that one in every four epidemiologists serve as preceptors. Epidemiologists who serve as preceptors (plan, supervise, and evaluate a student experience) overwhelmingly believed the benefits from the preceptorship outweighed or equaled the work required to host the practicum. Principles of Rational Choice Theorydindividuals are rational decision-makers based on perceived costs and benefits [13]dwould suggest that findings about net value of preceptorship might motivate some of the remaining 74% of epidemiologists who do not currently serve as preceptors. The data suggest epidemiologists who serve as preceptors sort into two types: first, the most experienced epidemiologistsdprofessionals 56e65 years in age, earning $85,000

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J. Arrazola et al. / Annals of Epidemiology 28 (2018) 258e263

Table 1 Percent distribution of characteristics of epidemiologists who served as preceptors, responding to the PH WINS assessment, United States, 2014 Variable

Unweighted N

Age 30 y or below 31e35 y 36e40 y 41e45 y 46e50 y 51e55 y 56e60 y Over 60 y Gender Female Male Race White Black Hispanic Asian OR AI/AN OR NHOPI OR 2þ races Supervisory level Nonsupervisor Team leader Supervisor Management Annual salary Less than $45,000 $45,000.01e$55,000 $55,000.01e$65,000 $65,000.01e$75,000 $75,000.01e$85,000 $85,000.01e$95,000 $95,000.01e$105,000 More than $105,000 Educational attainment Bachelor's Bachelor's Master's Bachelor's Master's Doctorate Bachelor's Doctorate Years in current position 0e5 y 6e10 y 11e15 y Over 15 y Years in the agency 0e5 y 6e10 y 11e15 y 16e20 y 21 or more years Years in public health practice 0e5 y 6e10 y 11e15 y 16e20 y 21 or more years Collaborate with academia No Yes Overall job satisfaction Strongly disagree/disagree Neither agree nor disagree Agree Strongly agree Subject area Infectious disease General epidemiology and surveillance Maternal and child health Chronic disease Environmental health Behavioral health and injury Other

167 17 22 32 23 18 19 16 20 171 124 47 167 114 21 13 19 174 61 30 58 25 161 11 24 25 30 22 20 13 16 174 7 102 55 10 170 90 47 20 13 170 46 43 41 21 19 173 24 35 46 24 44 174 52 122 174 14 7 74 79 163 53 39 16 10 12 6 27

Weighted percent*

95% confidence limits for weighted percent

10.5 14.6 19.9 11.5 10.8 7.7 11.4 13.6

4.7e16.1 8.8e20.4 12.9e26.9 6.8e16.2 5.6e16.0 4.0e11.4 4.7e18.1 7.3e20.0

72.6 27.4

65.2e80.1 19.9e34.8

67.5 13.7 9.0 9.8

59.4e75.6 8.3e19.0 2.8e15.2 5.1e14.6

33.2 19.3 31.8 15.8

25.3e41.1 12.3e26.2 24.1e39.5 8.8e22.8

6.1 19.7 14.9 17.8 12.1 13.7 7.4 8.4

2.3e9.9 11.4e28.0 9.1e20.6 11.0e24.5 7.1e17.2 7.6e19.9 3.2e11.6 3.9e12.9

4.2 60.6 29.2 5.9

1.0e7.4 52.6e68.7 21.9e36.45 2.0e9.8

55.8 23.9 10.2 12.1

45.0e62.6 17.2e30.6 5.4e15.0 4.8e19.4

31.1 24.8 21.1 11.5 11.5

22.8e39.5 17.2e32.3 14.6e27.6 6.2e16.8 5.7e27.3

15.3 22.4 24.2 12.2 25.9

9.0e21.5 15.2e29.6 16.8e31.7 7.0e17.4 18.4e33.5

28.3 71.8

20.9e35.6 64.4e79.1

7.1 4.1 41.6 47.2

3.0e11.2 0.9e7.4 33.3e49.9 38.8e55.7

29.0 23.4 13.4 5.2 10.3 2.4 16.3

24.1e36.6 15.7e31.1 6.5e20.2 1.8e8.6 4.2e16.4 0.4e4.4 9.9e22.7

AI/AN ¼ American Indian/Alaska Native; NHOPI ¼ Native Hawaiian or Pacific Islander. * Percentages may not total to 100 due to rounding. Association of State and Territorial Health Officials. Public Health Workforce Interests and Needs Survey, 2014. Available from: http://www.astho.org/phwins/.

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Table 2 Number and percent of epidemiology preceptors regarding practicums and academic partnerships responding to the PH WINS assessment, United States, 2014 Variable

Unweighted N

Perceived preceptorship value The work required to host the practicum outweighed the benefit a lot The work required to host the practicum outweighed the benefit a little The work required to host the practicum was equal to the benefit The benefit to the department outweighed the work required to host the practicum a little The benefit to the department outweighed the work required to host the practicum a lot Participate in academic partnerships No Yes Value of academic partnerships Not helpful Somewhat helpful Very helpful

172 10 24 64 27 47 174 52 122 122 6 46 70

Weighted percent*

Weighted percent 95% confidence limits

7.3 14.1 36.5 17.4 24.7

3.83e10.81 8.51e19.62 28.8e44.1 10.47e24.41 17.38e32.05

28.3 71.8

20.92e35.58 64.42e79.08

5.4 39.6 55.1

0.88e9.85 29.30e49.80 45.09e65.09

* Percentages may not total to 100 due to rounding. Association of State and Territorial Health Officials. Public Health Workforce Interests and Needs Survey, 2014. Available from: http://www.astho.org/phwins/.

or more, with 11 years or more experience in public health; second, younger epidemiologists (ages 31e40) who are new to an agency (5 years or less) and who are in supervisory roles are more likely to serve as preceptors. We conjecture that novice epidemiologists may be open to helping other students as preceptors but are not in a position to serve as a preceptor. The less frequent preceptor service among mid-career epidemiologists may be tied to job responsibilities and/or life course events that our present study does not identify. This research illustrates blacks are more likely to serve as a preceptor than whites. Current epidemiology preceptors are racially more diverse than all epidemiologists, but the applied epidemiology workforce remains less racially diverse than the general population [10,27]. An increase in preceptors overall could increase the diversity of the workforce pipeline. Collaboration with an academic institution increases the likelihood of an epidemiologist serving as a preceptor. This finding illustrates the value of developing and maintaining linkages between educators and practitioners as vital to student learning opportunities and aligns with the Public Health Accreditation Board's Standard 8.1 to develop future public health workers [22]. It suggests shared value and interdependency in the preceptorship and arrangements for academic institutions and HDs. Such shared sense of value might explain why the majority (55%) of Council on Education for Public Healtheaccredited schools and programs of public health indicated participating in an academic HD [8]. Practicum partnerships benefit the health agency and the academic institution. Academic institutions are able to provide students with a variety of applied learning experiences to satisfy their practicum requirement. Health agencies can benefit greatly from hosting practicum students through additional short-term skilled staff, innovative perspectives, and project assistance [5]. Despite the value of preceptorship to epidemiologists, staff may find it difficult to serve as a preceptor in addition to completing their regular duties, especially in an understaffed environment or a lowresource environment [25]. Public health employees can also benefit from serving as preceptors because a successful preceptorship experience may increase a preceptor's job satisfaction [12,21,26,28] and expand the participants' network and social capital, fostering long-term professional growth and satisfaction among the preceptor and student [9]. These factors may lead to increased retention of preceptors within HDs [24]. Several recommendations flow from our findings. Academic institutions and HDs can intentionally collaborate by formalizing partnerships facilitating student practicum experiences, inviting

leaders to participate on an advisory board, and provide training to prospective preceptors that may lead to an increased readiness and willingness to serve as preceptors. In addition, HDs can establish standing policies to engage students as opportunities arise to provide surge capacity during public health emergencies, hiring freezes, and outbreak investigations. In view of the changing public health workforce [15], the supply of preceptors should be addressed in consideration of planned retirements and turnover. HD leadership should encourage junior staff to become preceptors as a means for professional growth and to prevent a disruption to the availability of student training experiences.

Limitations The findings should be interpreted in view of several limitations. Only 37 of the 50 states participated in the 2014 PH WINS. Despite reweighting the data to provide national estimates of the applied epidemiology workforce, omission of key states may have imposed limitations to generalizability. Selection bias may have occurred among respondents who practice epidemiology but did not identify it as their primary area of focus (e.g., nurses, biostatisticians, informaticians, or sanitarians); these respondents were excluded from analysis. Finally, the self-reported data were not independently verified.

Conclusions This study is the first to describe value of preceptorship and factors associated with it among applied epidemiologists. The findings show that applied epidemiology preceptors overwhelmingly indicated a high value of preceptorship. Odds of epidemiologists serving as preceptors significantly varied by characteristics such as race, collaboration with academic institutions, and served in leadership, supervisory, or managerial positions. HDs and academic institutions can collaborate to provide preceptorship experiences, ultimately to build workforce capacity and to foster individual and organizational relationships. Furthermore, additional student experiences may provide an increasingly qualified workforce to be recruited and hired in public health agencies. As a large proportion of epidemiologists do not currently serve as preceptors, HD leadership should encourage staff to become preceptors as an opportunity for their own professional growth.

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Table 3 Logistic regression* of factors associated with epidemiology preceptors from the PH WINS assessment, United States, 2014 Variable

Age 30 y or below (Ref) 31e35 y 36e40 y 41e45 y 46e50 y 51e55 y 56e60 y 61e65 y Over 65 y Gender Female (Ref) Male Race White (Ref) Black Hispanic Asian OR AI/AN OR NHOPI OR 2þ races Supervisory level Nonsupervisor (Ref) Team leader Supervisor Management Annual salary Less than $45,000 (Ref) $45,000.01e$55,000 $55,000.01e$65,000 $65,000.01e$75,000 $75,000.01e$85,000 $85,000.01e$95,000 $95,000.01e$105,000 More than $105,000 Educational attainment Bachelor's (Ref) Bachelor's Master's Bachelor's Master's Doctorate Bachelor's Doctorate Years in current position 0e5 y (Ref) 6e10 y 11e15 y Over 15 y Years in the agency 0e5 y (Ref) 6e10 y 11e15 y 16e20 y 21 or above Years in public health practice 0e5 y (Ref) 6e10 y 11e15 y 16e20 y 21 or above Collaborate with academia No (Ref) Yes Overall job satisfaction Strongly disagree/disagree (Ref) Neither agree nor disagree Agree Strongly agree

Acknowledgments

Odds ratio

Adjusted odds ratio

OR (95% CI)

AOR (95% CI)

This analysis would not have been possible without the data provided by ASTHO and the de Beaumont Foundation. Funding source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

2.14 2.83 1.85 2.23 2.50 3.08 4.11 1.28

1.95 1.50 0.80 0.62 0.93 1.17 1.51 0.41

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(0.97e4.70) (1.31e6.15) (0.84e4.07) (0.95e5.23) (1.04e6.04) (1.24e7.65) (1.61e10.46) (0.32e5.20)

(0.58e6.57) (0.41e5.52) (0.22e2.90) (0.13e2.87) (0.22e3.89) (0.26e5.24) (0.30e7.48) (0.03e5.26)

1.17 (0.75e1.80)

0.72 (0.44e1.17)

2.87 (1.50e5.46) 2.26 (0.93e5.47) 0.78 (0.42e1.43)

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1.25 (0.51e3.09) 2.67 (1.03e6.89) 1.43 (0.45e4.59)

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1.24 (0.79e1.95) 1.08 (0.57e2.05) 2.32 (1.05e5.12)

1.46 (0.74e2.86) 2.01 (0.83e4.88) 2.12 (0.64e7.06)

1.56 1.60 2.15 1.41

(0.92e2.64) (0.92e2.78) (1.06e4.36) (0.68e2.91)

0.75 0.62 0.65 0.24

(0.34e1.67) (0.21e1.83) (0.13e3.24) (0.05e1.19)

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