TRAINING OUTBREAK INVESTIGATORS WHAT MATTERS Dr Kerri Viney

TRAINING OUTBREAK INVESTIGATORS: WHAT MATTERS? Dr Kerri Viney, Research School of Population Health, Australian National University Dr Stephanie Davis, Dr Alex Rosewell, Dr Stephanie Williams, Dr Amelie Dyda, Mr Owen Forbes and Dr Philippa Binns CAPHIA teaching and learning forum: Tuesday 16 July, 2019

WHAT THIS TALK WILL COVER • A brief overview of Field Epidemiology Training Programs • The rationale for our study • Our methods and results • Unanswered questions and the implications of this work Image: Courtesy Dr Erin Walsh, Australian National University

FIELD EPIDEMIOLOGY TRAINING PROGRAMS • Around since the 1950 s • Based on the US Epidemic Intelligence Service • ‘Learning by doing’ and ‘learning through service’ • Pivotal component of strengthening surveillance and response • Workforce development for the future • Contributions while trainees are in the program Slide courtesy of Dr Stephanie Davis, Australian National University

THE MAE PROGRAM (1) • Australia’s Field Epidemiology Training Program (FETP) • Run by the National Centre for Epidemiology and Population Health at the Australian National University since 1991 • 22 month degree • 20 months in field placement • 4 projects written up as a thesis • Oral exam • Awarded degree of Master of Philosophy in Applied Epidemiology Slide courtesy of Dr Stephanie Davis, ANU 4

Master of Philosophy in Applied Epidemiology (22 month Postgraduate Research Degree) (Postgraduate Research Degree) Field Placement Course block 1 Course block 2 Thesis Course block 3 Oral Exam At ANU, Canberra, Australia Outbreak investigation 6 units Public health surveillance 6 units Data anaylsis analysis 6 units Research design and methods Issues in applied epidemiology 6 units Slide courtesy of Dr Stephanie Davis, Australian National University

THE MAE PROGRAM (2) • ~ 260 graduates - 17% are Aboriginal or Torres Strait Islander • 2019 cohort biggest yet! - 19 placements (Aust. and region) • Now running the ASEAN-Australia Health Security Fellowship • Placements in Laos, Cambodia, Vietnam and Myanmar • TEPHINET accredited in 2018 *Information on Australia’s FETP is available here: https: //rsph. anu. edu. au/study/master-degrees/master-philosophy-applied-epidemiology 6 Slide courtesy of Dr Stephanie Davis, Australian National University

2 COMPONENTS TO THIS PROJECT Component 1: The role of mentorship in FETPs Component 2: Key components of learning outbreak investigation How can we improve field epidemiology training in the Asia-Pacific? Slide courtesy of Dr Stephanie Davis, Australian National University

BACKGROUND • Many countries in Asia-Pacific have an FET/P • All use workplace based training model • All require outbreak response as key component • Differing models of teaching, training and supervision • Little known about how to optimise trainee learning • Help requested from MAE for developing resources for trainee supervision and curriculum • Same questions we had been asking… 9

AIMS FOR COMPONENT 2 • To improve training within the Australian FETP, the MAE Program • To identify what experienced public health practitioners considered to be key components in producing competent outbreak investigators Image courtesy: Dr Erin Walsh, Australian National University

METHODS • Semi structured interviews with a purposive sample of 10 Australian experts in the field of communicable disease control • Interviews topics included the qualities of good outbreak investigators and trainees; the qualities of good supervisors; and activities to support trainees • Interview recordings were transcribed analysed using a deductive content analysis approach

THE FOCUS OF OUR QUESTIONING 1. What qualities make for a good outbreak investigator? 2. What activities help trainees become good outbreak investigators? 3. What supervisory structures best support trainees to become good outbreak investigators?

QUALITIES OF A GOOD TRAINEE Personal traits • Curiosity • Persistence • Attention to detail Soft skills • Skilled communicators • All types of communication

“QUOTES” “. . . mainly their creativity and persistence are the key criteria, regardless of their background really. Some of the best investigators haven’t had content knowledge at first but they've learnt very rapidly” (Participant 1) I have witnessed a bit of competitiveness in some students that does not fit well. . . you really need someone who's good at teamwork (Participant 3) “. . under pressure. . . if they don't have exceedingly good interpersonal skills…that can be a major detractor” (Participant 7)

QUALITIES OF A GOOD SUPERVISOR Personal traits • Flexibility • Availability Behaviours • Skilled communicators • Team players • Invested in people, facilitate networking Knowledge and experience • Knowledge about outbreaks and disease control • Experience in investigating outbreaks • Interdisciplinary knowledge

“QUOTES” “…supervisors should…. . make a student feel that they're valued and that you're investing in them. . . it's a two-way street” (Participant 8) “The best ones are those that take an active role in mentoring their trainee” (Participant 4)

BEST ACTIVITIES TO SUPPORT TRAINEES CLASSROOM BASED ACTIVITIES FOR PREPARATION PRACTICAL OUTBREAK EXPERIENCE WITH APPROPRIATE SUPERVISION DEBRIEFING AND REFLECTION ON THE EXPERIENCE WHILE WRITING IT UP Slide courtesy: Dr Tambri Housen, Australian National University

SUPERVISORY STRUCTURES • Appeared to be less important overall (compared to qualities and activities) • However, the following were important: • Recruitment process • Model of supervision • Context of the placement and organisation Image courtesy: Dr Erin Walsh, Australian National University

OUTBREAK INVESTIGATION IS A COMPLEX SKILL Team work Knowledge of pathogens Data analysis Questionnaire design Personal qualities Emphasised, but not in our curriculum Communication Study design Slide courtesy of Dr Stephanie Davis, Australian National University

IMPLICATIONS • Selection of trainees – emphasis on soft skills in interviews • Curriculum revisions – “soft skills” • Supervisor training • Developing relationships • Better guidance on supervising in the field? Slide courtesy of Dr Stephanie Davis, Australian National University

Congratulations - you have a competent investigator! UNANSWERED QUESTIONS • Are exceptional outbreak investigators born or made? • Are exceptional supervisors born or made? • How does trainee learning in the field occur and how can we optimise this? Slide courtesy of Dr Stephanie Davis, Australian National University

CONCLUSIONS • This project offers insights for improvement in the education of trainees in the MAE Program • The perceived importance of soft skills is important given the MAE Program curriculum’s current focus on quantitative methods • This study adds further weight to the importance of field based experience in achieving competence in outbreak investigation Acknowledgements: The Integrated Systems for Epidemic Response Centre of Research Excellence • Additional examination of how this learning occurs and how better to support it is worthwhile The ten participants Cameron Moffatt