Undergraduate Environmental Health Education: Preparing for the Future.

Introduction

The National Environmental Health Science and Protection Accreditation Council (EHAC) received a contract from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services to conduct a two-day workshop for educators who teach in undergraduate environmental health programs. Funding for the contract was provided via interagency agreements with HRSA by the Agency for Toxic Substances and Disease Registry (ATSDR) and the National Center for Environmental Health (NCEH).

The workshop was held in Las Vegas, Nevada, on June 25-26, 1998. Its goals were to improve the levels of knowledge, skills, and motivation among environmental health faculty, to make environmental health education more responsive to the needs of a diversified environmental health workforce, and to strengthen academic and practical experiences for the current and future environmental health workforce. This was the first time that representatives from the majority of undergraduate environmental health programs met to address issues related to these goals.

A workshop-planning committee was assembled from a list of faculty at EHAC-accredited and nonaccredited programs who had indicated a willingness to serve. The committee selected 50 faculty to receive travel and per diem funding to attend and participate in the workshop. Those invited were chosen from among 62 undergraduate faculty who responded to an EHAC survey that asked respondents to indicate their areas of professional interest and willingness to attend and participate in the workshop.

The planning committee identified six focus areas for discussion prior to and during the workshop. The focus areas addressed topics specified in the contract and issues deemed to be important to all undergraduate programs. Members of the planning committee volunteered to serve as group leaders for the focus groups listed below:

* Continuing Education, Distance Learning, and Technological Advances;

* Women, Gender, Diversity, and International Environmental Health Issues;

* Core Curriculum Areas and Practice Competency;

* Internship and Job Placement of Graduates;

* Linkages with Agencies and Associations; and

* An Association of Undergraduate Programs.

Six to eight attendees were assigned to each focus group according to experience and stated interests in the topics. To develop the topics and prepare for discussion, the planning committee and each focus group held conference calls prior to the workshop.

During the workshop, each focus group was allotted two hours for discussion of its assigned topic. The format was determined by each focus group, but generally involved an overview in which all attendees participated, small break-out group sessions to address specific issues, and a wrap-up session, again involving all attendees.

Three individuals, considered by the planning committee to be leaders in the environmental health profession, were invited to present papers during the workshop. Larry Gordon, of the University of New Mexico, presented the keynote address, providing a summary of major findings and recommendations from previous HRSA-sponsored workshops dealing with environmental health education. Jack Hatlen, of the University of Washington, provided a historical review of undergraduate environmental health accreditation in the United States. Norman Parkinson, of Kings College in London, England, described the training of environmental health professionals and academic program accreditation in the United Kingdom. This background information provided the foundation for subsequent discussions.

Attendees discussed each of the focus topics in terms of needs, opportunities, and courses of action. The major findings from these discussions are presented below. These findings constitute valuable insights into the state of undergraduate environmental health education from the viewpoint of faculty who attended the workshop.

Continuing Education, Distance Learning, and Technology

The general consensus was that environmental health professionals need continuing-education offerings that allow them to upgrade their skills and competencies and provide for certification and recertification in their fields. It was agreed that distance learning, including Internet courses, is a promising means of making these opportunities accessible. Faculty must, however, be supported in their efforts to develop continuing-education and distance-learning courses. College and university administrators must recognize the value of these programs to institutions and compensate faculty accordingly. Institutions should be encouraged to provide release time, travel, technological training, and salary incentives to ensure the success of these efforts. In addition, development of these courses should be given weight in faculty tenure and promotion evaluations. Allocation of time for training is particularly important for enhancing faculty competency in the formats and technologies they need to deliver quality conti nuing education and distance learning.

Quality control of course content and outcome assessment must be a significant part of early attempts to initiate collaborative continuing-education and distance-learning courses. EHAC should form a committee of faculty and practitioners to monitor the quality of continuing-education and distance-learning programs. Faculty should develop an appropriate outcome assessment instrument to evaluate quality EHAC or an association might act as a repository for policies on these programs. A sharing of progress, successes, and failures among institutions would increase quality. Opinions from industry, consultant firms, and agencies should be solicited in a systematic fashion to provide feedback on the effectiveness of programs and courses.

Colleges and universities should collaborate on the development of grants and funding sources to improve the quality of these programs. Collaborations need to include universities, agencies, professional groups, industries, and grassroots groups. Surveys of faculty and professionals will help identify experts on different topics. If collaboration among university programs is to occur, turf issues on matters related to ownership of courses and credit hours must be avoided. This will require that the intellectual-property concerns of university administrators be addressed.

Women, Gender, Diversity, and International Environmental Health

This workgroup divided itself into four subgroups, each of which discussed one of four related topics: environmental justice, educational curricula, international issues, and minority recruitment of students and faculty.

Overall, the workgroup concluded that reasonable expectations in each of the topic areas currently are not being met. The workgroup also felt, however, that concerted efforts to remove barriers to achieving such expectations could be successful. For example, the subgroup on environmental justice found that environmental policies, planning, and land use frequently do not incorporate full parity or equality for minority populations. To reach parity, the issues of poverty economics, and minority health--as these affect and are affected by environmental integrity--must be incorporated as priorities within the field of environmental health proper.

With respect to educational curricula in environmental health, the workgroup felt that vigorous efforts must be taken to incorporate topics related to women, gender, diversity, ethics, and international environmental health into the scope and function of environmental health within the United States and elsewhere. Such topics include population control (including the debate concerning overconsumption versus overpopulation as a cause of environmental degradation); violence against women and children; occupational hazards that differentially affect women and children; intergenerational equity; and the effects on environmental integrity of certain manufacturing and marketing decisions made by multinational business corporations. Among the strategies suggested for incorporating these topics into environmental health curricula were the following:

* use of local examples,

* use of broad-based or well-documented global examples,

* guest lectures,

* field trips,

* studies and internships in international locations, and

* development of new courses.

The subgroup on international environmental health recommended the integration of international perspectives into all environmental health curricula through modification of existing course content and through internship and research opportunities. Several of the subgroup's overall concerns regarding the internationalization of curricula focused on the lack of an international perspective--or even of awareness of differences within the United States--in environmental health priorities among some students and faculty. In addition, it was the subgroup's assessment that environmental health professionals often are placed into settings in which they are required to work internationally but are ill prepared to do so effectively and with an appropriate cultural perspective.

The minority recruitment subgroup concluded that recruitment of students and faculty of color is fundamentally an issue of professional and social ethics and equity. Thus, the subgroup emphasized the need to encourage a sustained, universal commitment to equity and diversity among all environmental health professionals.

Core Curriculum Areas and Practice Competency

EHAC's standards for environmental health science and protection have been developed largely on the basis of discussion among environmental professionals, a majority of whom are academics. The appropriateness of these guidelines has not been formally evaluated. Instead, there has been a reliance on a sense of general satisfaction with the accreditation process among faculty and program directors of the accredited programs. EHAC has recognized a need to obtain more assurance of the relevance of its standards and to develop mechanisms for regular evaluation and improvement. Similarly, a need has been identified to help nonaccredited programs access reliable data in making their curricular decisions, a process perhaps made more difficult by a lack of a national association composed of similar academic programs facing common problems.

Participants were generally satisfied with the EHAC Accreditation Guidelines, although individuals expressed some dissatisfaction with discrete elements. No area was consistently seen as deficient across groups or even among several individuals within a group. Some discussion centered on the lack of rationale presented for the guidelines. Specific references were made to the following potential problems:

* a lack of explicit rationale for the requirement of in-depth instruction in no fewer than four technical areas;

* a need to streamline the standards and institutional self-study requirements;

* substantial and perhaps excessive flexibility being allowed to programs, although the need to retain flexibility also was expressed;

* an overlap between the core and technical area specifications; and

* a lack of validated competency (outcome) requirements (although it should be noted that some academic programs use the NEHA Registered Environmental Health Specialist/Registered Sanitarian (REHS/RS) examination as a measure of competency outcomes among their graduates).

Undergraduate programs in industrial hygiene and safety often closely resemble environmental health programs. The accreditation standards used by the American Board of Engineering Technology (ABET) for these disciplines were discussed to determine applicability to environmental health. The discussions consistently rejected ABET standards as appropriate for adoption by EHAC, although some discussions identified ABET and similar standards as potentially useful peripheral sources of information. EHAC guidelines were seen as appropriate to a broader field than that addressed by ABET standards. Moreover, ABET was seen as overly prescriptive, with EHAC guidelines viewed as reflecting a more helpful philosophy of allowing variation within a broader construct of appropriate academic requirements.

EHAC developed a survey to obtain information about the performance of accredited-program graduates and the suitability of their educational experiences to their professional and personal education objectives. The survey has been administered on a trial basis to graduates from two accredited programs and their supervisors. In examining preliminary data, as well as the survey instrument, the workgroup reached the consensus that this approach provided a potentially valuable source of information. Concern was expressed, however, about the potential for misapplication of data. To realize a full, national utility, surveying of graduates and their supervisors would have to encompass a large number of the accredited programs.

An important finding from this workshop is that no major problems with current EHAC curricular guidelines were identified. Although discomfort with discrete elements of the standards was expressed, there was no uniformity of opinion about revisions, additions, or deletions.

Consensus was strong that it would be helpful in evaluating curricular issues for there to be meetings of appropriate individuals representing diverse backgrounds related to undergraduate programs in environmental health. Concern was expressed that without proper representation, information would not be useful. Consensus also was strong in identifying the potential value of information from program graduates and their supervisors--while recognizing the potential for misuse of these types of data.

Internship and Job Placement of Graduates

Field experience or internship is considered an essential component in the academic preparation of environmental health undergraduates. A survey conducted by EHAC indicated that 100 percent of EHAC-accredited programs require internship experiences, as do 70 percent of non-EHAC-accredited programs. The average number of clock hours required by both accredited programs (average 350 hours) and nonaccredited programs (average 295 hours) greatly exceeds the minimum of 180 clock hours required by EHAC accreditation guidelines. Topics discussed during the workshop included

* legal issues associated with internships,

* problems associated with evaluation and monitoring of student performance,

* problems associated with site development, and

* issues related to job placement of graduates.

Liability and contract issues are a major concern for faculty with respect to the development and maintenance of appropriate internship sites. There was general agreement that legal and contract issues are similar for all programs but that it may be difficult to develop a "generic" contract because of the differences among program requirements and university policies. It was recommended that faculty consult with the university or college attorney or risk manager on matters relating to contracts with internship sites, student health and accident insurance, malpractice insurance, and workers' compensation, if applicable.

Many issues were identified as potential barriers to proper evaluation of student performance in internship placements. To prevent or minimize the barriers, it was recommended that faculty visit internship sites regularly and discuss student progress with internship supervisors. In addition, it was suggested that students be required to prepare weekly reports of activities that should be submitted to faculty for review and evaluation.

A key to a successful internship program is the development of appropriate internship sites and the maintenance of existing sites. It was recognized that there are several barriers to establishing and maintaining sites:

* lack of recognition by college or university administrators of the critical importance of internships to a successful academic program,

* lack of understanding by administrators of the amount of time required to develop and maintain appropriate sites, and

* lack of compensation for faculty for activities related to internship programs.

In addition, a careful review and evaluation of potential internship sites may be impossible when the number of students needing an internship experience exceeds the supply of approved or available sites.

It was suggested that faculty establish and maintain contact with agencies and industries that can provide students with internship opportunities. Furthermore, programs should use alumni to identify potential sites, and faculty should use the HRSA document Designing Environmental Internships: A Guide for Successful Experiences as an aid in developing and maintaining successful internship programs, [*] Finally, it was noted that some students have been successful in locating suitable internships via the Internet and that Internet technology may be a useful tool in the establishment of site exchanges between programs.

There was general agreement that faculty have some responsibility to aid students in preparing for job interviews and for identifying suitable employment opportunities. Several strategies were discussed, including the provision of career counseling for students, with resume writing, mock job interviews, and instruction in how to use other career-planning services offered by institutions.

Linkages with Agencies and Associations

Although the concept of linkages was touched upon by many of the focus groups, the importance of partnerships in meeting the future demands of undergraduate environmental health education warranted a separate session dedicated to the topic. The issues discussed during this session focused on the following needs:

* to acquire additional resources, especially funding, for academic environmental health programs;

* to enhance public and employer recognition of the field of environmental health;

* to train and recruit more faculty with practical experience; and

* to attract students earlier in their academic pursuits and expand the partnership base.

Participants felt that the most significant need is an increase in funding for undergraduate environmental health programs, commensurate with funding for graduate public health education. They felt that additional monies could be used to hire faculty and that these new hires would translate into more educators with practical experience and therefore better training of students. In addition, greater funding could improve infrastructure, which would mean additional laboratory and student workspace, as well as more advanced equipment and instrumentation.

Participants agreed that funding for undergraduate environmental health education has been limited by a lack of recognition that environmental health is a distinct discipline, that undergraduate environmental health programs play an important role in producing competent practitioners, and that these practitioners provide a significant service in protecting public health. Because environmental health programs often are not autonomous and fall under the umbrella of other departments (e.g., public health, health science, biology), they sometimes lack identity and are confused with other disciplines such as environmental programs in science, biology and management. To compound this confusion, many other academic fields are using the buzzword "environment" to attract students. Even when the environmental health profession is recognized, it is often perceived as low paying and unglamorous.

There was a general consensus that the field of environmental health needs to be better defined, and that this definition should clearly distinguish the field from other environment-related disciplines. At the same time, the new definition should not only focus on community health, but should also accommodate the increased importance of occupational, ecological, and global health issues. Once the definition of environmental health has been updated, marketing and recruitment resources should be developed. Marketing strategies should highlight the success of environmental health graduates in the job market and capitalize on increased public awareness of environmental health concerns (e.g., Escherichia coli O157:H7) These promotional materials would be the tools of an organized and professional campaign to increase the visibility of the environmental health field. The effort should target universities and colleges, K-12 public schools, industry, government, and the general public, and it should call upon the he lp of successful alumni. An increase in recognition would give environmental health advocates more influence and leverage to improve the status of the field in private, public, and academic circles.

Participants concurred that in order to more adequately address undergraduate environmental health education needs, academics must solidify linkages with traditional partners (e.g., county health departments) and establish new linkages at the local, regional, and national levels in the government, community, and private sectors. Partnerships with a diversity of groups could increase internship opportunities, job placement of graduates, joint research, and funding opportunities. Perhaps most important, undergraduate environmental health programs should establish partnerships with one another and work collectively toward a common goal.

All participants were in agreement that undergraduate environmental health programs--their professors, students, and alumni--need to organize and become active in seeking additional resources and support for the field of environmental health. Participants felt that the most effective way to pursue these opportunities is establish an association for academic environmental health programs.

An Association of Undergraduate Programs

An association could provide a mechanism for coordinating and mobilizing the efforts of college and university programs in educating environmental health practitioners. The absence of an association of this type was the motivating force behind the formation of this focus group. Acknowledging the fact that good environmental health education is not limited to EHAC-accredited programs, this group made a concerted effort to identify and solicit the participation of all institutions that offer degrees in environmental health. It was hoped that this mix of institutions could come together to form a strong professional organization.

In reviewing the results of the workshop, unanimity was expressed in two areas. These two areas were the need for an association and the purpose or mission of the association. A large majority--88 percent--felt that membership should be tied strongly to accreditation. Two-thirds felt that the organization should be limited to environmental health programs. A smaller majority--60 percent--wanted an organization that would be independent of EHAC.

The final action was appointment of a committee charged with developing a financially sound organization that would be as inclusive as possible but retain the professional integrity needed in a professional organization.

The Association for Environmental Health Academic Programs was formally established during NEHAs Annual Educational Conference on July 5, 1999, and its formation was a direct result of recommendations developed during the faculty workshop.

Summary

Attendees indicated that the workshop was beneficial and that the opportunity to communicate with faculty representing 23 programs accredited by EHAC and nine programs not accredited by EHAC was extremely useful. There was general agreement on a number of points:

* There is a need for undergraduate environmental health programs to collaborate on matters related to distance learning.

* Topics related to women, gender, diversity, ethics, and international environmental health should be incorporated into the environmental health curriculum.

* There are no major problems with current EHAC curricular guidelines, but the guidelines should be evaluated on a regular basis.

* Field experience or internship is an essential component in the academic preparation of undergraduate environmental health students.

* There is a significant need for increased funding for undergraduate environmental health programs.

* There is a need to increase the visibility and recognition of environmental health programs.

* There is a need to solidify ties with traditional partners and to establish new linkages at the local, regional, and national levels in the government, community, and private sector.

* It is essential that undergraduate faculty communicate with each other on matters relating to the preparation of environmental health practitioners.

* There is a need for an association of undergraduate academic programs to provide leadership and a focal point for identification and resolution of issues common to all.

The establishment of an association was viewed as the most practical and effective way to address these issues and to pursue related opportunities.

(*.) Designing Environmental Internships: A Guide for Successful Experiences (1996), Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Health Resources & Services Administration.