‘Enlightened change agents with leadership skills’: A scoping review of competency-based curricula in public health PhD education

Abstract

There is growing momentum for PhD curricula to move away from traditional apprenticeship models and to adopt competency-based education models. The objectives of this study were to identify key drivers for adopting competency-based curricula during PhD training and to articulate key competencies to be developed as part of the curriculum for PhD public health training. Relevant peer-reviewed and grey literature published between 2002–2022 was included. Data were extracted using Microsoft Excel and the findings were grouped descriptively. 22 records were included, with the USA showing the most progress regarding competency integration. Key drivers for adopting competency-based curricula include meeting emerging challenges in the public health field and preparing graduates for a labour market beyond the academic route. Communication and leadership skills have emerged as key competencies that require further development. PhD education must be underpinned by clearly defined competencies relevant to the public health context and supporting graduates move to the next phase of their careers.

Keywords:

• curriculum review
• PhD training
• competency-based
• health policy research
• health service research
• public health
• population health research
• scoping review

1. Introduction

Educators, funders, and employers, including those within the realm of public health, are increasingly expected to be competency based (Verderame et al., 2018). As such graduates are expected to demonstrate specific skills by the end of training programmes (Frank et al., 2010). Traditionally, PhD training has focused on research projects and dissertation completion, with piecemeal training undertaken as needed for these purposes. However, changes including greater publication expectations (Van Rooij et al., 2021), specific requirements regarding researcher conduct (Roland, 2007), and increasingly diverse postdoctoral career trajectories (Germain-Alamartine et al., 2021), require changes to the PhD training orientation as graduates need to be prepared for 21^st century requirements.

There are also specific considerations for public health PhD training warranting a review of existing curricula. Public health encapsulates population health research, health policy research and health services research. Increasingly frequent public health emergencies such as Ebola and Zika outbreaks (Wilder-Smith & Osman, 2020) have highlighted the need for public health researchers to engage with community groups and provide trustworthy, comprehensible advice regarding disease prevention and health protection (Gilmore et al., 2020). While 20th century public health priorities focused on issues such as sanitation and vaccination (Fielding, 1999), new and potentially more complex issues are arising for 21st century graduates, including the health complexities associated with aging populations, multimorbidity and antimicrobial resistance (Briggs et al., 2020), as well as climate change and bioterrorism (Radosavijevic, 2011). Such challenges require growing involvement of public health graduates at the grassroot community levels, as well as higher level political entities (Institute of Medicine, 2003). Indeed, the COVID-19 pandemic highlighted the importance of highly trained public health researchers who can conduct and communicate high-quality and impactful research, which addresses large scale population healthcare issues, informing healthcare policy and delivery of healthcare services. This includes cultivating a high-skilled public health research community which can inform and implement transformation in policy and practice. As such, it is timely to review existing PhD curricula in public health. Educational scholarship within public health is a nascent but burgeoning area of interest. This review will contribute to and extend what is known about competency-based education in PhD public health curricula.

1.1. Review question

How is competency-based education represented curricula for PhD training programmes in public health?

1.1.1. Aims

To identify:

1. What are the drivers for competency-based PhD curricula in public health?

2. How is competency-based education integrated into PhD curricula in public health?

1.2. Methods

A scoping review maps main concepts relating to a broad-based and under-researched question, incorporating literature from peer-reviewed and grey literature (Maggio et al., 2021). As such the aim of scoping reviews is description as opposed to qualitative or quantitative synthesis informed by critical evidence appraisal (Peters et al., 2021). A scoping review was deemed most appropriate for this research question, as the key aim was to identify key characteristics of PhD curricula in public health, which is an area with limited research to date (Munn et al., 2018). A preliminary search revealed some peer-reviewed and grey literature in the field, confirming that there is existing research that meets the inclusion criteria for the review; no current or underway scoping reviews were identified.

This scoping review will be conducted in accordance with the Joanna Briggs Institute’s methodology for scoping reviews (Peters et al., 2020) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews (Tricco et al., 2018) (Appendix A). The review protocol was registered with the OSF pre-print server and is awaiting approval.

1.3. Eligibility criteria

The population, concept, and context framework was used to develop eligibility criteria (Pollock et al., 2023), which are outlined in the table below.

Table

Inclusion criteria	Exclusion criteria
Curricula relating to population health research, health policy research, and health service research	Curricula relating to fields other than public health and research that does not focus on curriculum
PhD programs	undergraduate, master’s, and non-PhD postgraduate programs
English language publications	Non-English language publications as time and human resources did not allow access to translation services (Peters et al., 2020)
Publications between 2002 and 2022.	Research prior to 2002 is less likely to reflect issues pertinent to the current curricula. Moreover, PhD education has increased exponentially over the last two decades (Kulo & Cestone, 2022). Therefore, it is reasonable to extrapolate that most of the literature has been published over the past 20 years. A preliminary keyword search had been undertaken by the first and third author and this confirmed that the ten-year limiter was appropriate
All geographical regions were eligible for inclusion	None

1.4. Search strategy

A search string was developed with the support of a specialist librarian (see Appendix B). This search string was adapted as required to search three relevant databases: MEDLINE, CINAHL, and ERIC. The reference lists of all the included sources of evidence were screened for additional studies. Database searches were augmented with searches of relevant body webpages, such as government and non-profit Organisations, to ensure the identification of relevant grey literature (see Appendix B).

1.5. Source of evidence selection

All relevant and accessible peer-reviewed and grey literature were included. It was important to include grey literature, as national bodies may have published relevant documents, given the public health focus, for example, the Department of Health. Titles and abstracts were screened by the first author based on the inclusion criteria. Peters et al. (2020) recommend two reviewers complete screening. This was not feasible in this case due to limited author availability. To mitigate for this an initial set of 10 title and abstracts was reviewed by the first and third authors to ensure inclusion criteria were fit for purpose. Subsequently, the full texts of the selected citations were assessed in detail the inclusion criteria by the first author. Reasons for exclusion of sources of evidence in the full text that did not meet the inclusion criteria were recorded. Search results were uploaded to the Rayyan reference management software, and duplicates were removed. The results of the search and the study inclusion process are reported in the PRISMA flow diagram (Figure 1). 22 publications were included in the scoping review.

Figure 1. Preferred reporting items for systematic reviews and meta-analyses flow diagram.

1.6. Data extraction

Data from each study were charted using the bespoke data extraction tool developed for this review, including specific details about the concept, context, study methods, and key findings relevant to the review question (Appendix C). As this was a scoping review, a critical appraisal of the included studies was not required (Munn et al., 2018)

1.7. Data analysis and presentation

Extracted data was analysed to develop codes relevant to the research question by highlighting relevant text. Codes were then organised into categories and labelled to describe the underpinning information (Appendix D). This approach was used to summarize and explain the findings in relation to the objectives of the scoping review. Given the mapping focus of this review, this type of descriptive analytical approach was appropriate (Sargeant & O’Connor, 2020). A more interpretive approach such as thematic analysis was beyond the scope of this scoping review (Peters et al., 2020)

1.8. Results

22 records were included in this review. Six studies were based on empirical research, including five quantitative survey studies (Hiney et al., 2011; Hlaing et al., 2020; Kinnard Campbell, 2014; McKinney et al., 2019; Sherman et al., 2016) and one qualitative study (Park et al., 2021). Two records represented document reviews (Hlaing, 2019; Lee et al., 2013), while another two reported stakeholder consultations (Burgess et al., 2018; Lee & Samet, 2003). Twelve records were commentaries or editorials (Cody et al., 2002; Debate et al., 2015; Declercq et al., 2008; Dodds et al., 2010; Gebbie et al., 2008; Keating et al., 2022; Koblinsky et al., 2015; Lenihan et al., 2015; Ndejjo et al., 2022; Otok et al., 2017; Paradis et al., 2017; Trauth et al., 2011). Eighteen records were from North America (USA and Canada). Two records referred to European regions and one report was based Africa. A summary of key findings from each study can be found in Appendix E, which form the basis of the analysis below.

1.8.1. What are the drivers for competency based-education in PhD curricula in public health?

Overall, the key findings from this review confirm that PhD curricula in public health are working to adopt and implement competency-based curricula, an area that is better established in master’s programmes (Hlaing et al., 2020). Public health is not a static field, and new areas that require consideration will continue to arise. In recent years, these include bioterrorism (Lee & Samet, 2003) and climate change (Keating et al., 2022). As such, curricula and competencies must continue to evolve (Burgess et al., 2018). Moreover, the career trajectories of public health graduates have been changing. The traditional academic track is becoming less the norm, and programmes need to prepare graduates to work in diverse settings (Park et al., 2021).

There is growing awareness that public health graduates need not only to have strong research skills but also cross-cutting capabilities in areas such as leadership, project management and communication (Ndejjo et al., 2022; Sherman et al., 2016). The importance of leadership competence for graduates of public health PhD programs was reflected in this review, with the authors identifying leadership as an important competency for a range of reasons. These include the ability to take on leadership roles within industries and large organisations (Park et al., 2021). There is also a need for public health graduates to be able to not only act as leaders within the field of public health, but also when working with interdisciplinary groups, and PhD training should equip graduates for this (Dodds et al., 2010). Public health graduates are also expected to be leaders in addressing emerging and evolving complex issues and challenges, such as climate change (Keating et al., 2022). Communication is also increasingly being recognised as a key skill required by public health graduates. As such, curricula must be responsive to evolving public health needs and prepare graduates to respond to such needs.

1.8.2. How is competency-based education integrated in PhD education in public health?

In response to the changing needs of public health graduates and growing requirements for competency-based education, the Association of Schools of Public Health (ASPH,2009) in the USA published a set of seven core doctoral education competencies in 2009. These were advocacy, communication, community and cultural orientation, critical analysis, leadership, management, professionalism, and ethics. PhD programs began adopting these as part of their curricula in the early 2010s (Trauth et al., 2011) and faculty are becoming more cognisant of these competencies. For example, Kinnard Campbell (2014) reported that almost 70% of directors of public health PhD programs in the USA were familiar with relevant competency frameworks, and the vast majority of those not familiar with competences planned to address this. Graduate feedback also supports this change, with Koblinsky et al. (2015), who reported on a series of studies illustrating that graduates felt unprepared for workforce entry upon PhD completion, especially for non-academic roles. However, geographical discrepancies were evident. Recall the representation of the reports included in this review, with over 80% coming from North America. Otok et al. (2017) reports that Europe has lagged behind other regions in this respect and recommend continent wide “network thinking” to address this issue. Similarly, Ndejjo et al. (2022) assert that African countries need to enhance PhD training in areas of knowledge translation and problem solving to ensure graduates are “enlightened change agents with leadership skills” (p. 4)

In terms of how universities have adapted curricula to incorporate competency frameworks, several different routes have been taken. At the University of South Florida College of Public Health, faculty members have clustered related ASPH competencies for teaching purposes (Debate et al., 2015). For example, advocacy, leadership, and community engagement formed a single cluster. Within each cluster, three levels of learning are specified: benchmark (knowledge or comprehension), milestone (apply or analyse), and capstone (evaluate or create), and evaluation is informed by detailed competency rubrics. When revising the Doctor of Public Health program at the Graduate School of Public Health (University of Pittsburgh), the faculty also deliberately incorporated ASPH competencies into the curriculum. They identified two competencies that had particular resonance for their programme and that they developed in greater depth, namely critical analysis and community/cultural orientation (Trauth et al., 2011). Other programs that did not formally adopt ASPH competencies were influenced by these and other frameworks, such as the Council on Education for Public Health Master of Public Health competencies (Park et al., 2021) and the Institute of Medicine report on workforce and educational issues related to health services research (Gebbie et al., 2008). Although competency adoption represents significant progress, it does not address the issue of educating students to attain competencies.

Leadership is a competency area that provides an illustrative example of how PhD programs in public health have developed new teaching methods to reflect competency-based education. Gebbie et al. (2008) pointed out that as a discrete competency, leadership requires specific training in as much as any other specialist area, perhaps more so as it is a less embedded and familiar task within public health curricula (Declercq et al., 2008). At the University of Illinois Chicago, the School of Public Health leadership has become a core competency, with six leadership-related competencies guiding the curriculum (Lenihan et al., 2015). Dodds et al. (2010) report on a targeted leadership program at the University of North Carolina at Chapel Hill. Each year 20–30 students were invited to participate in a program consisting of six workshops and an annual conference. Practically, a range of tools can be used to support educators in developing specific curricular areas. For example, the Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model underpinned the development and implementation of a climate change course with a leadership focus as part of an applied epidemiology course for Doctor of Nursing Practice students (Keating et al., 2022). Paradis et al. (2017) also highlighted the importance of self-evaluation and determination of learning needs.

Another public health teaching challenge that can emerge in the training of students with a biomedical or clinical background is guiding their transition from an individualized patient-centred approach to a population- or community-centred approach (Lee et al., 2013). However, the recruitment and training of a diverse range of students is key for a robust and agile public health workforce. McKinney et al. (2019) outlined how transformative learning principles were used to address this issue, using disorienting dilemmas, self-examination of values and feelings, critical assessment of sociocultural assumptions, and recognition of the shared experience of discontent and transformative processes.

2. Discussion

The findings of this review help clarify the key features of pedagogically robust PhD curricula in public health and how they can be integrated into education programs, with a view to optimally preparing graduates for the 21st century workforce.

As with any change process, it is important to clarify why curriculum changes are needed in the field of PhD public health education. Traditionally, PhD programs have been apprenticeship based, with key priorities being thesis completion and preparation for employment within academia (Verderame et al., 2018). However, there are increasingly fewer opportunities for graduates to follow the traditional academic-researcher route (Larson et al., 2014), with burgeoning opportunities for roles outside the higher education sector, such as within industries and public bodies (Hnatkova et al., 2022). For graduates to gain employment and be successful in these environments, particular skills and competencies are required, which can be developed during doctoral training (Hnatkova et al., 2022). Therefore, preparation for the labour market is a key driver for updating doctoral curricula (Lachmann et al., 2020).

However, geographical differences were identified during the review, with North American higher education institutions demonstrating more advanced development and integration of doctoral competencies than their European and African counterparts. The Association of Schools of Public Health in the European Region (ASPHER) represents several European Schools of Public Health. In 2013, the ASPHER published a document entitled “Recommendations for PhD programmes in public health: A report from the ASPHER Working Group on Doctoral Programmes and Research Capacities” (Association of Schools of Public Health, 2013). The aim of this study was to provide practical guidelines for Schools of Public Health setting up PhD programs. This document does not focus on specific program outcomes or competencies, as it is oriented towards operational matters. However, the authors acknowledge that PhD programs would benefit from a similar competency approach developed for master’s students in public health. Master’s in public health programmes have largely moved to competency-based education with a focus on developing the skills needed for workforce entry (Meredith et al., 2022) In collaboration with the ASPHER, the World Health Organisation has recently published a set of workforce competencies for the public health field, recognising that a robust public health workforce is needed to prevent disease, prolong life, and protect and promote health (World Health Organisation, 2020). As such, there are foundations from which public health program providers can develop doctoral competencies. They can also consult those referenced in the findings of this review, such as ASPH competencies. The ASPHER also provides a forum for developing competencies at the European level and building on network-level knowledge referred to by Otok et al. (2017). To ensure that public health PhD graduates globally have comparable skills and opportunities as their North American peers, a further reason is to undertake curriculum development and review.

The findings of this review highlight that in terms of curriculum content, research skills need to be matched by transferable skills, such as communication and leadership skills, for public health graduates. Recent history has provided compelling reasons to ensure that public health graduates are skilled in these areas. Communication was key during the COVID-19 pandemic, public health experts needed to gain widespread compliance with public health measures, while also being able to address misinformation and disinformation (Bin Naeem & Kamel Boulos, 2021). This highlights the need for public health graduates to be equipped with topics and research expertise. They need to have the skills to communicate information effectively and correct misinformation to a non-public health audience (Lavazza & Farina, 2020). Additionally, leadership has emerged as a key competency for PhD public health graduates. Indeed, it is important that student leadership education incorporates sequential skill development so that graduates can lead and effect change regardless of whether they have formal leadership positions or not (Lachance & Oxendine, 2015).

In this review, different approaches to developing these competencies are reported. Most of these appear to be derived from available faculty interests and experience. However, Buckley et al. (2009) strongly asserted that teaching designed to achieve these types of meta-competencies needs to be carefully designed and sequenced if teaching is to be effective. Therefore, in addition to topic experts, pedagogical experts also play a valuable role in ensuring that curricula are optimally designed to achieve intended outcomes (Burrell et al., 2015). This could include bespoke training and support for programmes and academic staff as they develop competency-based curricula, as many may not have experience in curriculum development (Echols et al., 2018).

A limitation of this review is that, by adopting a scoping review approach, the emphasis is on reporting on the breadth of data, as opposed to depth, as might be found in a systematic review (Tricco et al., 2016). While efforts were made to ensure comprehensive database searching, resource constraints limited the number of databases which were included. While no geographical areas were excluded the ability to only include English language publications may have limited geographical representation, with a positive skew towards North America. It would be beneficial to augment this review with work focused on sourcing further information from Europe and Africa and seeking information from regions such as Asia, Australia and New Zealand which were not represented in this review. Additionally, the records were not critically appraised. As such, the level of confidence in data-forming findings is unclear. This review presents a snapshot of the current situation, which can provide guidance for developing competency-based PhD curricula.

3. Conclusions

This review identified key drivers for competency-based curricula in public health doctoral education that are locally and globally relevant. In addition to research and topic expertise, graduates require leadership and communication skills. As fewer graduates remain in academia, transferable skills are becoming increasingly valuable. Even in the context of academia, emerging public health challenges mean that graduates need these skills more than ever before. Competency-based education is no longer an option. However, educators can use a range of approaches and methodologies to integrate competencies and ensure that student learning is meaningful in the context of specific programs. An overarching aim of PhD training is for graduates to be the enlightened leaders needed for public health.

Educators can use many approaches to integrate competencies into their public health curricula. The underpinning requirement is that doctoral education is based on clearly defined competencies relevant to the public health context and supporting graduates move to the next phase of their careers and become “enlightened change agents with leadership skills” (Ndejjo et al., 2022, p. 4).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by the Health Research Board [SPHeRE/2022/1].

Appendix A:

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist

Table

SECTION	ITEM	PRISMA-ScR CHECKLIST ITEM	REPORTED ON PAGE #
TITLE
Title	1	Identify the report as a scoping review.	1
ABSTRACT
Structured summary	2	Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.	1
INTRODUCTION
Rationale	3	Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.	2–3
Objectives	4	Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.	3
METHODS
Protocol and registration	5	Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.	4
Eligibility criteria	6	Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.	4–5
Information sources*	7	Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.	5
Search	8	Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated.	5; Appendix B
Selection of sources of evidence†	9	State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.	5
Data charting process‡	10	Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.	7
Data items	11	List and define all variables for which data were sought and any assumptions and simplifications made.	7
Critical appraisal of individual sources of evidence§	12	If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).	6
Synthesis of results	13	Describe the methods of handling and summarizing the data that were charted.	7
RESULTS
Selection of sources of evidence	14	Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.	5–6
Characteristics of sources of evidence	15	For each source of evidence, present characteristics for which data were charted and provide the citations.	7–8
Critical appraisal within sources of evidence	16	If done, present data on critical appraisal of included sources of evidence (see item 12).	7
Results of individual sources of evidence	17	For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.	Appendix C
Synthesis of results	18	Summarize and/or present the charting results as they relate to the review questions and objectives.	7–11
DISCUSSION
Summary of evidence	19	Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.	11–14
Limitations	20	Discuss the limitations of the scoping review process.	14
Conclusions	21	Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.	15
FUNDING
Funding	22	Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.

JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

*Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites.

†A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to studies only. This is not confusing with information sources (see the first footnote).

‡The frameworks by Arksey and O’Malley (6), Levac et al. (7), and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting.

§The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of “risk of bias” (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document).

From: Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473. doi: 10.7326/M18-0850

Appendix B:

Example Search from CINAHL Plus with Full Text

Table

#	Query	Limiters/Expanders	Last Run Via	Results
S14	S10 AND S11 AND S12	Limiters—Published Date: 20020101–20221231 Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	263
S13	S10 AND S11 AND S12	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	280
S12	S4 OR S5 OR S6 OR S9	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	1,141,862
S11	S3 OR S8	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	16,949
S10	S2 OR S7	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	61,358
S9	“population health” or “public health” or “health services”	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	419,829
S8	Doctoral or PhD or doctorate or doctorant	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	16,949
S7	curriculum OR curricula OR curricular OR “PhD program*”	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	59,486
S6	(MH “Adolescent Health Services”) OR (MH “Health Services for Persons with Disabilities”) OR (MH “Health Services for Older Persons”) OR (MH “Mental Health Services”) OR (MH “Hospital Programs”)	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	52,451
S5	(MH “Epidemiology+”)	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	792,732
S4	(MH “Population Health Management”)	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	130
S3	(MH “Education, Doctoral”)	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	2,488
S2	(MH “Integrated Curriculum”) OR (MH “Course Evaluation”)	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	3,784
S1	(Curriculum OR curricula OR curricular OR “PhD programme*”) AND (Doctoral or PhD or doctorate or doctorant) AND (“population health” or “public health” or “health services”)	Expanders—Apply equivalent subjects Search modes—Boolean/Phrase	Interface—EBSCOhost Research Databases Search Screen—Advanced Search Database—CINAHL Plus with Full Text	140

Grey literature sourcing

Table

Ireland	International
Health Research Board	The London School of Hygiene & Tropical Medicine
Irish Research Council	University of Auckland School of Population Health
Science Federation of Ireland	Advanced Care Research Centre
Department of Health	Population Health Sciences Bristol Medical School
Department of Public Health, Health Service of Ireland	National Institute of Health
Department of Business, Enterprise and Innovation	UK Health Security Agency
Health Information Quality Authority	UK Office for Health Improvement and Disparities
eHealth and Disruptive Technologies (formerly Office of the Chief Information Officer), Health Service of Ireland	Institute of Health Equity in UK
Royal College of Physicians of Ireland	University of Helsinki Doctoral Programme in Population Health
Health and Social Care Professionals	School of Health and Related Research in Sheffield University
School of Population Health, Royal College of Surgeons in Ireland	London School of Economics Health Research
School of Public Health, University College Cork	INEQ—Helsinki Inequality Initiative
Irish College of General Practitioners	European Observatory in Health Systems and Policies
Infectious Diseases Society of Ireland	World Health Organisation Europe
Institute of Public Health	Public Health European Commission
Centre for Health Policy and Management, Trinity College Dublin
Irish College of General Practitioners
Infectious Diseases Society of Ireland
Institute of Public Health in Ireland
Irish Platform for Patient Organisations, Science and Industry
Health Research Charities in Ireland
Mental Health Ireland
Disability Federation of Ireland

Appendix C:

Data Extraction

Table

Title	Authors	Year	Region	Study methods	Concept	Context	Key features of doctoral curriculum
Aligning a departmental DRPH program with the new ASPH competencies	Trauth JM, Documét PI, Hawk M, Blais NA.	2011	USA	Commentary/Editorial	The process of aligning departmental DrPH program with the new ASPH competencies, the challenges encountered, and expectations for professionals trained in the program	The Department of Behavioural & Community Health Sciences (BCHS) at the University of Pittsburgh Graduate School of Public Health (GSPH) has had a departmentally based DrPH program for many years. In the past several years, there has also been an increasing demand for a PhD program. As a result of a change in BCHS leadership in 2007 and the development of a strategic plan for the department, work began in 2008 on restructuring the doctoral program. The restructuring involved simultaneously creating a PhD in the Social and Behavioural Sciences and making major modifications to the existing DrPH degree in keeping with the emerging ASPH competencies.	Revised doctor of public health program is aligned with the Association of Schools of Public Health competencies, there is more in-depth coursework in two of the competency areas—critical analysis and community/cultural orientation—than in other areas. The focus on these two competencies is a reflection of our faculty orientation and expertise as well as the need to develop a solid grounding in theory and analytical methods for a doctoral degree. Seven courses fall into the critical analysis domain, including two evaluation courses that provide a foundation for our graduates to conduct evaluation research on the effectiveness of evidence-based programs in Organisations that they will lead.
Future directions of Doctor of Public Health education in the United States: a qualitative study	Chulwoo, Park and Migliaccio, Gene and Edberg, Mark and Frehywot, Seble and Johnson, Geralyn and Park, Chulwoo	2021	USA	Literature review; Qualitative interviews	The Doctor of Public Health (DrPH) degree is an advanced and terminal professional degree that prepares the future workforce to engage in public health research, teaching, practice, and leadership. The purpose of the present research was to discuss the desirable future direction and optimal education strategies for the Dr PH degree in the United States.	A total of 28 Council on Education for Public Health (CEPH)-accredited DrPH programs in the United States was identified through the Association of Schools and Programs of Public Health (ASPPH) Academic Program Finder. Then, a qualitative analysis was conducted to obtain perspectives from a total of 20 DrPH program directors through in-depth interviews	All of the DrPH curriculums have been restructured with various components: a better reflection of CEPH competencies; addressing the real public health issues in the twenty-first century; making a clear distinction from Master of Public Health (MPH) and PhD programs; teaching more research-related skills; providing more diverse coursework; and developing a leadership course, practicum, and qualifying examination for moving on to all but dissertation stage; and providing better guidance for dissertation development; Four participants highlighted that DrPH programs should focus on leadership. A DrPH program does not necessarily steer students into an academic route; rather, it should steer them into a leadership path in which they are incorporated into large Organisations. DrPH pro-grams should be recognised for preparing public health leaders by teaching them solid leadership skills, analytical thinking skills, and advanced applied skills; Although all 20 participants mentioned throughout the interviews that the DrPH is a professional degree, two highlighted that DrPH programs should still focus on methodology to train students in the research skills that translate into public health practice.
Integrating health services research into nursing doctoral programs: the evolution of nursing research	Cody, M. and Beck, C. and Courtney, R. and Shue, V. M.	2002	USA	Commentary/Editorial	To increase HSR capacity, nurse researchers need to become educated in HSR; This article describes HSR, outlines methods for incorporating HSR into doctoral curricula	• Doctoral programs outside nursing. • Integration of HSR within nursing doctoral pro-grams. • Postdoctoral education.	Educators faced with adding a track or integrating HSR into the curriculum may find it helpful to organize the curriculum around the seven areas of HSR outlined in the IOM’s 1995 report. These are: • Organisation and financing of health services. • Access to health care. • Quality of care. • Clinical evaluation and outcomes research. • Informatics and clinical decision making. • Practitioner, patient, and consumer behaviour. • Health professions workforce. The authors propose two additional HSR curriculum areas—health policy formulation and analyses; and health care model and service innovation. See table for additional areas of study suggested.
Our Practice Is Our Passion: Development and Delivery of a 21st-Century Doctor of Public Health Program	DeBate, Rita D. and Petersen, Donna J. and Wathington, Deanna and Wolfe-Quintero, Kate	2015	USA	Commentary/Editorial	The Dr PH Core Competency Model outlined seven competency domains essential to advanced Dr PH training: leadership, advocacy, communication, management, community and cultural orientation, professionalism and ethics, and critical analysis.	An innovative DrPH program of study at the University of South Florida (USF) College of Public Health that incorporates 21st-century advanced public health competencies with an outcome- and competency-based curricular model delivered in a hybrid format in collaboration with local and national public health professionals.	The 90-credit hour DrPH program of study at USF comprises three curricular clusters: (1) advocacy, leadership, and community engagement; (2) management and ethics; and (3) evidence-informed public health. Each of these has associated content domains and competencies that address three levels of learning: benchmark (knowledge or comprehension), milestone (apply or analyse), and capstone (evaluate or create); specific course may be designated as addressing a specific competency (e.g., evidence-informed public health contributes to the following competency: apply theoretical and evidence-informed perspectives from multiple disciplines in the design and implementation of programs, policies, and systems). However, earning a passing grade in the course does not necessarily equate with meeting the competency, because the final grade may be influenced by a variety of assessments (e.g., attendance, class participation, knowledge exams, and so on). Guidelines for implementing competency-focused or -based programs include aligning degree-based competencies (e.g., DrPH core competencies) with workplace skill requirements, a system of reliable assessments using competency-based rubrics based on learning objectives versus traditional assessment of grades earned for completion of course work, and incorporating adult- and student-centred learning methods; Each DrPH competency is assessed by specific evaluation rubrics that evaluate the fulfilment of learning objectives associated with each benchmark, milestone, and capstone competency; Dr PH students who encounter professional or personal life events that hinder completion of the degree can earn certificates as evidence of competency and mastery of advanced public health skills.
The changing pattern of doctoral education in public health from 1985 to 2006 and the challenge of doctoral training for practice and leadership	Declercq, Eugene and Caldwell, Karen and Hobbs, Suzanne Havala and Guyer, Bernard	2008	USA	Commentary/Editorial	The challenge for schools of public health is to seriously address the question of how much of what we offer in a DrPH program is the result of the needs of the field and how much is a repackaging of our research training.	The number of DrPH programs was relatively stable between 1985 and 2000, and causes of this pattern are unclear. From 2002 to 2006 however, the number of Dr PH students increased by 40%, and the growth in the number of DrPH programs suggests this increase is likely to continue. This growth also comes at a time, when the number of DrPH graduates has increased rapidly.	Although there is clearly demand for doctoral education in public health, schools of public health now must determine the content of their doctoral curriculum. For those seeking a PhD in a research field (epidemiology, biostatistics, health services, and environmental sciences accounted for 71 % of all PhD students), the development of highly skilled researchers is a difficult but fairly straight forward process. In a sense, this is what faculty do best, mentor students to become future public health faculty. The DrPH programs that emphasise training in leadership and practice face a different challenge.
The UNC-CH Leadership Training Consortium: building the capacity to develop interdisciplinary MCH leaders	Dodds, J. and Vann, W. and Lee, J. and Rosenberg, A. and Rounds, K. and Roth, M. and Wells, M. and Evens, E. and Margolis, L.	2010	USA	Commentary/Editorial	This article describes the UNC-CH MCH Leadership Consortium, a collaboration among five MCHB-funded training programs, and delineates the evolution of the leadership curriculum developed by the Consortium to cultivate interdisciplinary MCH leaders	The Maternal and Child Health consortium meets monthly. Its primary task to date has been to create a leadership curriculum for 20–30 master’s, doctoral, and post-doctoral trainees to understand how to leverage personal leadership styles to make groups more effective, develop conflict/facilitation skills, and identify and enhance family-centred and culturally competent Organisations. What began as an effort merely to understand shared interests around leadership development has evolved into an elaborate curriculum to address many MCH leadership competencies	the key activity is the design and implementation of a curriculum for leadership development—the Interdisciplinary Leadership Development Program (ILDP). The Consortium began the process of developing the ILDP during the 2000–01 academic year and the first cohort of trainees (referred to as leadership fellows) entered the program for the 2001–2002 academic year. Each of the UNCCH MCHB-supported training programs selects participants to become ILDP fellows, for a total of approximately 25–30 each year. In the early years, the fellows met for only three workshops during the academic year, but over time the curriculum has evolved to include six workshops and participation in the annual UNC Minority Health Conference, as our training programs responded to the leadership competencies articulated for the field of MCH [6,7].
Education for the public health profession: a new look at the Roemer Proposal	Gebbie, K. M. and Potter, M. A. and Quill, B. and Tilson, H.	2008	USA	Commentary/Editorial	Public health is a vital and vibrant evidence-based profession, the impact of which influences life and death matters for millions of people every day. As such, the leadership of the profession should require of itself no less scholarly credentials than the leadership of other major healing professions, and should require specialty training specific to the field of public health at the doctoral level.	Reconsideration of the Roemer proposal, we have blended our combined 100-plus years of public health practice and current close association with public health work force development activities with the deliberations of the Institute of Medicine (IOM) committee on public health education. We have updated the Roemer proposal and presented it as one way in which the field of public health could reorganize itself to ensure competent leadership, and an SPH could restructure to fully prepare public health professionals for the 21st century.	Many of the present DrPH degree programs follow the five-year model of study proposed in the 1980s by Roemer. Since historically a fairly high percentage of public health school students possess doctoral degree (typically the MD), they might perceive that a DrPH is an unnecessary investment of time and expense. Furthermore, the typical DrPH model tends to deemphasize the intensive practical experience that would set it apart from other clinical and scientific doctoral degrees. The authors invite schools to consider the possibility of asserting that the DrPH should be the entry-level professional practice degree, with a curriculum to match. For a student entering with at least a bachelor of arts or bachelor of science degree with basic sciences (social and physical) and numeracy skills, the curriculum might look something like the sequence of courses and experience outlined in the Figure. The sequence begins with a semester of primarily classroom education designed to ground the individual in the conceptual models essential to modern public health practice: an ecologic model of health and basic human biology, including genomics. The three sub-sequent semesters match each classroom experience with practice relevant to what is being learned, such as a series of environmental health program experiences matched to coursework on interpretation of environmental laboratory data, risk assessment and management, communication, regulation, and emergency response. The student would be expected to be actively engaged in practice and to move to more responsible levels of work. For the course(s) on policy, law, and management, the field assignment(s) would be as a junior manager under the guidance of an assigned mentor. The final year of practice could be in one of the specialized areas of public health, though that would not be necessary. The demonstration of readiness to be granted the DrPH would be documentation of a project or series of projects that demonstrate competency in all core public health professional domains.
Competencies acquired in epidemiology doctoral programs	Hlaing, WayWay M.	2019	USA	Document review	Although clear competency sets are outlined for the MPH and DrPH graduates, competencies pertaining specifically to research/science-focused (PhD/ScD) degrees in epidemiology are presently not defined by the Association of Schools and Programs of Public Health (ASPPH)	Through the Council on Education for Public Health database, institutions conferring doctoral (PhD, ScD, DrPH) degrees in epidemiology were identified. The competencies listed on the corresponding institutions’ websites were extracted and summarized.	The list of 11 common competencies from PhD and DrPH programmes: 1. Recognise potential ethical issues and address/implement the concepts of ethical conduct of research in epidemiologic studies. 2. Design epidemiologic studies applying sound methodology and strategies to assess the threats to validity of results. 3. Develop, validate, and implement data collection methods and tools needed for performing epidemiology investigations. 4. Apply quantitative and reasoning skills and content-area knowledge to analyse data from epidemiological studies systematically. 5. Use the application of statistical methods that are critical to epidemiologic inquiry; manage, manipulate, and analyse data using statistical software packages; interpret data appropriately. 6. Identify major public health problems, their general pathophysiology, descriptive epidemiology, and associated risk factors. 7. Critically evaluate scientific literature and synthesize the outcomes across studies, balancing limitations and contributions of each study. 8. Articulate research questions that advance scientific knowledge; originate, design, and develop new inquiries worthy of research support. 9. Present data at academic and professional meetings and submit scientific articles for publication in high-impact peer-reviewed journals. 10. Convey epidemiologic concepts to students and peers; effectively communicate epidemiologic information to scientists, policy makers, and the public. 11. Conduct an advanced original research project and demonstrate mastery of the topic area.
A Snapshot of Doctoral Training in Epidemiology: Positioning Us for the Future	Hlaing, WayWay M. and Schmidt, Renae D. and Ahn, Soyeon and Samet, Jonathan M. and Brownson, Ross C.	2020	USA; Canada	Quantitative—Survey	Collect information on doctoral-level competencies in general epidemiology (doctoral) degree programs and other pertinent information from accredited programs in the United States and Canada.	Although epidemiology core competencies are established by the Association of Schools and Programs of Public Health for masters-level trainees, no equivalent currently exists for the doctoral level.	11 competencies were deemed very or extremely important and were rated as such by > 85% of participants: items no. 6 (Competency to formulate sound research questions and key hypotheses for a specific research problem or scenario), 7 (Competency to appraise pertinent literature critically (i.e., methodological quality of research) to identify the current status of evidence and meaningful gaps in extant knowledge on the topic of interest), 8 (Competency to design a study by applying sound research methodology, including strategies aimed at minimizing biases and confounding effects), 9 (Competency to select an appropriate study design (basic to advanced) for a specific problem, as well as to articulate scientific and practical strengths and limitations of different designs), 11 (Competency to determine the appropriate sample size), 14 (Competency to apply advanced statistical methods when analysing study data), 15 (Competency to use computer software for data entry, database management, data analysis, and displaying/visualizing study results), 16 (Competency to interpret measures e.g., frequency, disease burden, association, public health impact and results from epidemiologic studies and draw appropriate inferences), 17 (Competency to communicate, verbally and in writing, research findings to scientists) 19 (Competency to address ethical issues that can arise in the different stages—sample selection, design, measurements, data analysis, interpretation and communication of result—of epidemiologic research) 23 (Competency to demonstrate mastery of a substantive area of epidemiologic research relating to the students’ dissertation research).
							Only 52.7% of the respondents felt that the competency to describe an effective surveillance system was very or extremely important. Approximately 30% of the respondents did not consider primary data collection competency as very or extremely important. Competency to communicate findings to non-scientists was rated as very or extremely important by 72.3%of survey respondents, whereas all respondents felt that both “competency to communicate findings to scientists” and “competency to interpret epidemiologic studies and results” were very or extremely important. Interestingly, approximately 25% of respondents believed that competency to convey concepts to new learners (i.e., teaching) was unimportant or slightly important or chose neutral as their response. Approximately 10% of respondents were neutral regarding competency to address ethical issues in epidemiologic research; Emerging topic—related or noncore competencies results compiled to determine if 9 competencies are currently assessed in the participant’s program. More than 80% of the programs currently emphasize the competency to (1) develop and write grant proposals, and (2) assess evidence for causality on the basis of different causal inference concepts (e.g., directed acyclic graphs). More than 50% of the programs are currently assessing 3 important noncore competencies:
							competency to (1) work in a multidisciplinary team, (2) identify funding sources, and (3) ensure that epidemiology is closely linked with the upstream social determinants of health. Other competencies relating to big data, omics technologies, implementation science, and use of current and future communication technologies such as social media are not commonly assessed; Participants were given the opportunity to indicate 1 competency that was currently lacking in their program. Although only 39 of 55 people responded to this question, some participants indicated more than 1 competency. The most frequently cited topics were big data, omics technologies, primary data collection methods, and preparing primary data for use by others.
Integrating Climate Change in the Curriculum: Using Instructional Design Methods to Create an Educational Innovation for Nurse Practitioners in a Doctor of Nursing Practice Program	Keating, Stacen A. and Vetter, Mary Jo and Klar, Robin Toft and Wright, Fay	2022	USA	Commentary/Editorial	The impact of the COVID-19 pandemic and the Nurses Climate Challenge’s notable messaging about the importance of including climate change in epidemiology and the nursing curriculum highlighted a gap in the clinical applied epidemiology course content. In response, faculty developed an innovative educational module that integrated climate change as a critical content area, emphasizing the DNP leadership role in responding to the health impact of climate-related issues. The climate change module was delivered to a class of 28 DNP students enrolled in the clinical applied epidemiology course in the fall of 2020.	The professional competencies for doctor of nursing practice (DNP) education include population health, clinical prevention, and health promotion. Aligned with these competencies, the curriculum at a large metropolitan college of nursing (CON) includes a clinical applied epidemiology course. This course is delivered during the first semester of the postmaster’s DNP curriculum. Students are either on the bachelor of science to DNP track or the post-master’s DNP track. Typically, students are early-to mid-career professionals working as registered nurses, nurse practitioners, or midwives	The Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model guided the conceptualization and integration of climate change content into an innovative module within the clinical applied epidemiology course. Faculty designed and developed educational materials that described the impact of climate change on health in a single module for DNP students. The module, titled Environmental Considerations for Clinical Decision Makers, included asynchronous and synchronous learning activities. Planned Content for Module on Environment/Climate Change: Learning objectives 1. Discuss various environmental factors (air, land, water, and climate change) that have the potential to impact the health of populations. 2. Identify the role of the clinical decision maker (DNP) to access epidemiologic data within his or her agency as it relates to environmental health factors and clinical decision making. Assigned pre-readings (read before class). Post-module activity in the learning management system, post an electronic narrative response to the following prompts: What exposures do you feel are the most significant towards developing chronic health conditions in (a) your clinical population and (b) the larger public health environment
Program Evaluation: Use of Core Competencies in College and Universities with Community/Public Health Programs in Master’s and Doctorate Curriculums	Kinnard Campbell, Diane	2014	USA	Quantitative—Survey	Evaluate colleges and universities that have adopted, incorporated and indicated an intent to develop, utilize and implement public health core competencies into future curricula	Nelworth et al. (2014), stressed a need for mapping public health core competencies into work-force training as the goals of public training has progressed from a focus on knowledge transfer to development of skills or competencies. It was further indicated by Nelworth et.al, that mapping competencies to training would have the potential for enhancing the value of public health training during resource-constrained times by directly linking training content to the desired skills. The questionnaire was developed and used to assess the degree of knowledge of current Deans and Directors of Public/Community Health Nursing programs. Their knowledge level was measured on a set of practices that corresponded to the community/public health competencies, the Healthy People Curriculum Taskforce Presentation established by ACHNE, and the IOM’s re-port of the “Future of the Public’s Health in the 21st Century”	An overall pattern emerged revealing that many of the faculty subjects were familiar with public health core competencies. An estimated sixty-seven percent of the respondents were familiar with the core competencies (M = 49.5, SD = 23.54). Of the respondents who were not familiar 93.8%had plans to become familiar (M = 50.5, SD = 61.87) with public health core competencies. The findings also revealed the need for increasing publications and federal support to complement the findings of the Institute of Medicine’s report to improve the future of the public’s health. The findings also disclose the need for increased federal support for PHN education (Issel et al., 2006). The federal government through the Bureau of Health Professions in HRSA recognises the importance of addressing not only the importance of workforce development but educational advances (Issel et al., 2006)
Preparing Future Faculty and Professionals for Public Health Careers	Koblinsky, Sally A. and Hrapczynski, Katie M. and Clark, Jane E.	2015	USA	Commentary/Editorial	An important goal of doctoral education is to prepare graduates for the challenges of academic and professional careers. Yet research from multiple disciplines, including public health, has indicated that many PhD graduates feel ill equipped for the demands of academic and other postgraduate positions	In 2003, the Department of Family Science in the University of Maryland’s School of Public Health launched a “Preparing Future Faculty” (PFF) program to enrich the professional development of its doctoral students. The department offers PhD programs in both maternal and child health and family science. The department modelled its program after the successful national PFF initiative of the Council of Graduate Schools and the Association of American Colleges and Universities	Foundational Seminars Teaching seminars: Developing a syllabus and learning outcomes, Instructional technology, Curricular innovations for active learning, Culturally-competent instruction, Managing the classroom environment, Online learning and blended courses, Assessing student learning, Creating a teaching portfolio, Scholarship of teaching and learning. Research seminars: Navigating the institutional review board, Preparing research presentation, Writing for publication, Grant-writing skills, Community-based research and program evaluation, Preparing seed, foundation, and federal grants, Analysing state health policies. Service seminars: Roles of chairs, deans, and administrators, Faculty governance, including student attendance at faculty meetings, Academic committees: types, workloads, Professional and campus service, Service opportunities and expectations in non-academic jobs. Work—life seminars: Work—life policies, Work—life resources: child care, elder care, resource and referral services, Strategies for balancing work and family life. Exploration and Job Search Career and job search seminars and activities: Career mapping, Creating a competitive vita or resume, Constructing compelling cover letters, Networking and information interview, Conducting an effective job search, Interviewing strategies for academic and non-academic positions, Mock interviews, Negotiating first contract and start-up package, Understanding the promotion and tenure process at colleges and universities, Successful performance reviews in positions outside, academia Site visits and career panels: Visits to diverse academic institutions, Visits to government and non-profit agencies, Career panels with doctoral alumni and area professionals. Independent and Mentored Experiences: Preparation for teaching through teaching assistantship and course observation, Faculty-mentored, independent instructor experiences, Faculty-mentored research projects, Research presentations at professional conferences, Submission of articles for publication in refereed journals, Student leadership of subprojects on faculty grant projects, Internships with research and health services agencies, mentored by faculty or agency professionals. Year 1: Enrolment in PFFP course, Foundational seminars, Career exploration and job search activities, Teaching or research assistantship. Year 2: Enrolment in PFFP course, Foundational seminars, Career exploration and job search activities, Teaching or research assistantship, Faculty-mentored research project,
							Journal article submission (required), Research presentations at national meeting. Years 3 and 4: Optional enrolment in PFFP course, Attendance at seminars and site visits of interest, Independent, mentored teaching experience, Research presentations at national meeting, Journal article submissions, Internships mentored by faculty or external supervisors. PFFP is evaluated through student teaching evaluations and anonymous student, alumni, and faculty surveys addressing PFFP program outcomes. Data on doctoral alumni employment have also been collected every 5 years. Qualitative Findings: PFFP fosters a strong sense of academic community, enhancing faculty—student interaction, faculty guidance, peer support, and degree completion, Multiple mentoring relationships enable students to develop skills in teaching, research, and management of work—life challenges from faculty other than their dissertation chairs or course instructors and from professionals working outside academe, Learning about positions in diverse academic institutions and the government, non-profit, and private sectors boosts knowledge about job requirements and expectations of diverse careers and provides valuable contacts for future job seeking, Preparation for future employment, including structured, independent teaching and research experiences increases students’ confidence and ability to tackle the job market and frequently helps them to improve their salaries, benefits, and start-up packages. Quantitative Evaluations: An initial evaluation of PFFP involving 19 students assessed the value of PFFP activities in preparing students for academic and non-academic careers. On 4-point scale students rated every activity between 3 (helpful) and 4 (very helpful). Highest ratings (>3.5) were awarded to career mapping, teaching mentors, informal student-faculty discussions about teaching, research mentors, campus and professional service opportunities, site visits to academic institutions and government and non-profit agencies, and job interviewing skills and practice
Expected ethical competencies of public health professionals and graduate curricula in accredited schools of public health in North America	Lee, Lisa M. and Wright, Brandy and Semaan, Salaam	2013	USA; Canada	Document review	The purpose of this assessment was to assess the expected ethical competencies of public health professionals as reflected in published codes and competencies, review current ethics instruction at schools of public health (SPH), and recommend ways to bridge the gap between what is expected and what is currently taught in graduate level courses	Public health’s population focus presents unique ethics considerations that differ from those reflected in biomedicine and clinical care. Interactions between health care providers and patients emphasize the clinician’s obligation to the patient and the patient’s autonomy. Emphasis on the individual presents a challenge to public health professionals whose “patient” is the community or population	Half of schools (n = 23) required an ethics course for graduation (master’s or doctoral level), 21 did not, and 2 had no information. Sixteen of 23 required courses were 3-credit courses. Course content varied from 1 ethics topic to many topics addressing multiple ethics domains. We determined that 8 principles from the Code of Ethics fit into the ethics domains we defined, 3 of which mapped to more than 1 domain. In addition, we identified 9ASPH MPH competencies and 9 ASPH DrPH competencies related to ethics (5 of which mapped to more than 1 domain), as well as 5 of the CDC and CSTE competencies (2 of which mapped to more than 1 domain), and 16 of the PHF COL competencies that fit into the ethics domains, 1 of which mapped to more than 1 domain
ACE forum report: the making of an epidemiologist—necessary components for doctoral education and training	Lee, N. L. and Samet, J. M. and Lee, Nora L. and Samet, Jonathan M.	2003	USA	Report	The 2002 meeting of the American College of Epidemiology included an open forum on doctoral education and training in epidemiology. Discussion groups, facilitated by selected senior epidemiologists, recommended changes that would better prepare future epidemiologists to meet new challenges in public health and to build successful careers.	The future of the public’s health depends in part upon the impact that public health professionals, including epidemiologists, will have on health problems. The rising concern about bioterrorism has led to questions about the adequacy of the public health infrastructure of the United States and initiatives to enhance the level of preparedness for bioterrorism and other threats. The preparation of public health professionals has also been brought to the fore front by a recent report from the Institute of Medicine (IOM) of the National Academies	Mentoring: The forum participants agreed that training in mentoring should be offered and encouraged, and the panel suggested that mentoring activities should be institutionalized by adding them to the faculty responsibilities of research, teaching, and service. Primary Data Collection: This group addressed the topic of primary data collection, beginning with the question: How much field experience should be required? The participants recognised that gathering data allows the trainee to experience the inherent difficulties of doing so, to recognise potential sources of bias in their data, and to understand issues of data quality. Without an experience in primary data collection, students will not understand how problems arise in data collection, how they are recognised, and how they are addressed. The group proposed that this sometimes-humbling experience is an essential element of doctoral training. Media: As part of doctoral programs, media training that emphasises communications practice should be provided, with ample opportunities for students to apply their new skills. For example, students could participate in mock interviews with journalists, or complete an exercise in condensing their complicated research into a 5-minute presentation in lay language.
The University of Illinois at Chicago School of Public Health Doctor of Public Health program: an innovative approach to doctoral-level practice leadership development	Lenihan, Patrick and Welter, Christina and Brandt-Rauf, Paul and Neuberger, Babette and Pinsker, Eve and Petros, Michael and Risley, Kristine	2015	USA	Commentary/Editorial	Leadership continues to be stressed for addressing the public health challenges of today, but the emphasis is more on driving change and collaboration at the community level and across sectors and less on establishing the authority of public health agencies to carry outcome functions. But a recent Robert Wood Johnson Foundation report noted that lack of leadership skills was a “huge barrier” to cross-sector collaboration.	Recognising the need for a more comprehensive and rigorous approach to leadership development, a consensus has emerged that the focus of the Doctor of Public Health (DrPH) degree should be leadership in public health practice and an array of competencies has been put forth by Association of Schools and Programs of Public Health for how this focus should be implemented	In 2005, the UIC-SPH revised its longstanding DrPH program to adopt a practice leadership focus within a competency framework. Six competencies: 1. Gain in-depth understanding of core areas of public health practice, research, and theory including the legal basis for public health, public health as a system, and the ecological model, 2. Analyse issues and problems using needs or resource assessments, critical evaluation, applied research methodology, and statistical methods. 3. Synthesize information from multiple sources to develop strategies for addressing problems in an area of emphasis that contributes to the evidence base of practice and public health scholarship 4. Demonstrate leadership in designing and implementing policies, strategies, and interventions. 5. Assess communication strategies and use communication skills across diverse audiences to inform or influence program and policy decisions 6. Demonstrate a vision and philosophy for leadership that includes systems thinking and ethical principles) guide a highly structured curriculum, consisting of nine core courses and a focused area of emphasis leading to the completion of a portfolio and a dissertation. The UIC competencies, though consistent with those developed later by Association of Schools and Programs of Public Health, provide a distinctive emphasis for the UIC-SPH program
Transformative Learning in an Online Doctor of Nursing Practice Population Health Course	McKinney, Selina Hunt and Herman, JoAnne and Nkwonta, Chigozie A.	2019	USA	Qualitative—survey	the conceptual transition from individual care to population health is challenging for many learners. Students often hold strong beliefs about individual determinants and personal responsibility for health, while underestimating influences of education, neighbourhood, home, zip code, ethnicity, and others (Fawcett & Ellenbecker, 2015). These beliefs insulate them from confronting their own mental models. To expand their perspectives on the concept of health, we created an online course using transformative learning (TL) principles	The purpose of this article is to describe the integration of transformative learning (TL) principles into an online DNP population health course and report on student learning outcomes.	TL uses strategies to encourage students’ self-examination of their beliefs and assumptions. These beliefs create barriers to acceptance of population concepts, especially social determinants of health. TL phases included: (a) disorienting dilemmas, (b) self-examination of values and feelings of fear, anger, guilt, or shame, (c) critical assessment of sociocultural assumptions, (d) recognition that one’s discontent and the transformative process are shared and that others have negotiated a similar change, and (e) exploration of options to gain concordance with new perspectives. TL disorienting dilemmas were created through provocative, real-life patient stories through videos and articles about disparities in care, differential exposure to health insults, disparate life opportunities, and health outcomes. Students chose a population of practice interest and wrote iterative analyses of that population’s health determinants based on the weekly learning topics. Investigators identified eight TL themes from students’ survey responses. Five of the themes were the first five themes of Mezirow’s TL learning concepts. The three emergent themes were Trust, Concordance, and System Analysis
Positioning Africa’s public health doctoral students to lead societal transformation and development	Ndejjo et al. (2022). Positioning Africa’s public health doctoral students to lead societal transformation and development. BMJ Global Health, 7, e007996.	2022	Africa	Commentary/Editorial	With the need to increase PhD graduates across all fields in Africa including in Science, Technology, Engineering and Mathematics, 4 opportunities should be availed for graduates to make a significant contribution to addressing public health and development problems.	Several public health training institutions and funding agencies are making efforts to expand PhD training in Africa. The Consortium for Advanced Research Training in Africa has developed and implemented a collaborative structured PhD training programme in population and public health to bridge existing competency gaps with significant success. However, substantial gaps remain and the programme focuses on those in academia. This article discusses how Africa’s public health doctoral students can be better positioned for the African and global marketplace across different career pathways and lead societal transformation and development on the continent	Public health is a multidisciplinary and interdisciplinary field that requires transferable skills which if well harnessed can position a PhD graduate for career success. Public Health PhD graduates could capitalise on their cross-disciplinary capacity by ensuring that they also have cross-cutting skills. These include project management skills such as in planning activities, scheduling and chairing meetings and conference calls and taking minutes, in addition to grants and scientific writing, evidence synthesis and data analysis. Also useful are communication skills such as using graphics and other tools to create high-quality presentations or illustrations that convey complex information in simple ways for both scientific and lay audiences, teaching and facilitation, advocacy, interpersonal, leadership and teamwork skills. These are critical for any post-PhD career. Public health PhD training, while focusing on teaching knowledge generation, can assist graduates in developing these additional skills and students should invest some time to acquire them for personal and professional development. PhD training can and must equip recipients with knowledge, skills, and competencies to advance specialty areas through conducting original research. Through doctoral training, students can also be equipped with several transferable skills that are applicable in a wide range of careers. With the evolution of the career landscape and developmental needs of Africa, these skills become useful in preparing students for a wide variety of career pathways. the PhD academic curricula should prepare students for a broad range of career pathways through building critical practical skills in addition to discipline-specific knowledge.34–36 This entails rethinking the curricula to explore important and emerging realities such as information, communication and technology, a switch from problem description to innovations and solution-based orientation, and emphasis on knowledge translation beyond scientific publications. Moreover, beyond being experts with knowledge and skills or professionals with ethical values, universities should train PhD students to be enlightened change agents with leadership skills. On completion, trainees are expected to generate new knowledge to advance health or other fields and this requires highly skilled and educationally prepared PhDs
Public health educational comprehensiveness: The strategic rationale in establishing networks among schools of public health	Otok, Robert and Czabanowska, Katarzyna and Foldspang, Anders	2017	Europe	Commentary/Editorial	Considering the overwhelming health gap, also in our part of the world, caused by poor social conditions, as also demonstrated by Marmot in this issue of the Journal [1,2], there is in public health a huge need for professional competences in sociology and other behavioural sciences and their interaction with, for example, epidemiology, biostatistics, qualitative methods and health promotion and disease prevention.	it is a relevant question for leads and staff of schools and university departments of public health, how well the need for providing public health students with such competences is actually met.	In the European Region, we generally have focussed on meeting the needs of education at the bachelor and master’s levels, without quite an identical strength of consideration at the PhD level and, furthermore, public health specialization on a bachelor and master’s basis. Between-country networking can be further extended geographically, and it seems that similar considerations—on network collaboration among national and regional European schools and departments of public health—should be discussed also in other parts of Europe. Such a “network thinking” aiming at strengthening the basis for comprehensive, interdisciplinary, dynamic and coherent public health education and training could constitute a massive shift towards achieving excellence, knowledge brokering and the exchange of experience concerning best practice in public health. networking between schools of public health is a relevant theme to be considered at public health conferences at various levels—global, European, regional and national.
The University Public Health Partnership for Public Health Research Training in Quebec, Canada	Paradis, Gilles and Hamelin, Anne-Marie and Malowany, Maureen and Levy, Joseph and Rossignol, Michel and Bergeron, Pierre and Kishchuk, Natalie	2017	Canada	Commentary/Editorial	Highly trained public health researchers are needed who are able to study the upstream determinants of health and the complex pathways through which various determinants influence population health. Training must prepare future researchers to work in multidisciplinary settings and teams and to communicate effectively with stakeholders from different sectors of society	We created the Quebec Transdisciplinary Research Training Program in Public Health Interventions: Promotion, Prevention and Public Policy (the 4P Program) in 2003.I t was one of several initiatives of the Quebec Population Health Research Network to build research capacity	The second pillar was a curriculum complementary to university curricula that promoted a transdisciplinary approach to conducting population health intervention research. The curriculum comprised 16 domains () addressed in monthly day-long, in-person seminars for all trainees and mentors to discuss key aspects and emerging issues of public and population health research. The entire curriculum was covered over two years. This seminar series included theoretical and practical elements and promoted the acquisition of core competencies, including: 1. foundational knowledge of public health, 2. transdisciplinary research in public health, 3. intervention research ethics, 4. development of research net-works and partnerships, 5. knowledge translation, and 6. research career management. To ensure that our fellows acquired these competencies, we adopted a pedagogical approach on the basis of self-evaluation of needs, establishment of personal learning objectives, and formal learning contracts specifying the respective responsibilities of fellows
Doctor of Public Health Education and Training: Where Are We Now?	Sherman, Barry R. and Hoen, Rebecca and Lee, Joel M. and Declercq, Eugene R.	2017	USA	Quantitative—Survey	The prescribed competencies for DrPH graduates—developed in 2009 by the Association of Schools and Programs of Public Health (ASPPH)—are advocacy, communication, community and cultural orientation, critical analysis, leadership, management, professionalism and ethics, and policy analysis and development. In 2014, an expert panel appointed by ASPPH published Framing the Future: DrPH for the 21st Century, which presented a vision for the DrPH graduate as ‘‘a transformative leader with expertise in evidence-based public health practice and research who is able to convene diverse partners and communicate to effect change across a range of sectors and settings.	We conducted a survey to further describe the evolution of DrPH programs by examining the range of curricula and teaching models that have emerged since the survey con-ducted by Lee et al in 2009. Our data provide the latest complete information on DrPH preparation and can help to lay the groundwork for future conversations about criteria and standards for DrPH education and training	Curriculum: The total number of semester credit hours of course work beyond the master’s level varied widely (range, 36–70). Sixteen institutions did not allow transfer of credits toward the DrPH degree from previous MPH or master of science. degrees. Twenty-one respondents said the DrPH curricula directly addressed the DrPH core competencies of ASPPH. The most frequently mentioned required courses for degree completion included epidemiology, biostatistics, research methods, DrPH seminar, leadership, and management. Twenty-one institutions offered at least 1 seminar for DrPH students only. The proportion of total credit hours dedicated to DrPH required courses (not electives) varied widely, from none to > 80%.
Update on the Health Services Research Doctoral Core Competencies	Burgess JF, Menachemi N, Maciejewski ML.	2018	USA	Consultation	To formally represent the substantive training provided in HSR doctoral programs and to clearly distinguish HSR training from other postgraduate opportunities for students and employers, a list of core competencies was first developed in a 2005 Agency for Healthcare Research and Quality (AHRQ)—funded conference. An update to the HSR competencies was deemed appropriate because HSR as actively practiced today has evolved to account for important changes in health policy, care delivery models, and data sources that prompt new research questions	In preparation for the November 2016 conference on the HSR Workforce, the lead author (JB) was tasked with developing a white paper on updated HSR competencies where he presented the unpublished V2 competencies to conference participants for discussion and feedback. To develop the white paper, the lead author reviewed V1 core competencies originally developed in 2005 (that were published in 2009) and the V2 competencies that were developed for the 2008 conference. Conference participants included academic, governmental, and private sector stakeholders of health services researchers, including educators, students, and employers. Additional feedback was solicited from doctoral program directors and other HSR workforce experts that participated in Academy Health’s HSR Learning Consortium. This feedback led to modest revisions by the lead author, which were then presented (by NM) at Academy Health’s June 2017 Annual Research Meeting in New Orleans. Additional feedback was received from session participants including two invited discussants.	The original 14 core competencies outlined in V1 were reduced to 11 competencies in V2, which were retained with edits in V2.1 (1. Acquire knowledge of the context of health and health care systems, institutions, actors, and environments. 2. Apply or develop theoretical and conceptual models and skills relevant to health services research. 3.Propose important research questions informed by structured evidence assessment, stakeholder positions, pertinent theoretical and conceptual models, and new data; and formulate solutions to health problems, practice, and policy. 4. Use or develop a conceptual model to specify study constructs for a health services research questions and develop variables that reliably and validly measure these constructs. 5. Recognise the strengths and weaknesses of study designs to appropriately address specific health services research questions. 6. Sample and collect primary health and health care data and/or assemble and manage existing data from public and private sources. 7. Execute and document procedures that ensure the reproducibility of the science, the responsible use of resources, and the ethical treatment of research subjects. 8. Demonstrate proficiency in the appropriate application of analytical techniques to evaluate HSR questions. 9. Work collaboratively in teams within disciplines, across disciplines, and/or with stakeholders. 10. Effectively communicate the process, findings, and implications of health services research through multiple modalities with stakeholders. 11. Knowledge translation to policy and practice). The number of competencies were reduced because one competency (Apply in-depth disciplinary knowledge and skills relevant to HSR) was subsumed under others; one new competency merged two separate competencies about primary and secondary data collection; and one additional new competency merged two competencies regarding ethical and protocolized conduct of research. The current V2.1 competencies include ethical conduct of research, conceptual models, the development of research questions, study designs, data measurement and collection methods, statistical methods for analysing data, professional collaboration, and knowledge dissemination.
Review of Population Health Research and Health Services Research in Ireland	Hiney, M., Curran, B. & Clarke, P.		Ireland	Quantitative—Survey	This review of PHR and HSR in Ireland was undertaken with four objectives in mind: 1. To establish a baseline description of current research capacity and activity in PHR and HSR in Ireland 2. To assess the outputs and impacts of current PHR and HSR in Ireland. 3. To map the strengths and weaknesses in PHR and HSR in Ireland as it is currently configured and identify deficits that will require attention over the coming years 4. To provide underpinning evidence for the development of an action plan for capacity and infrastructure development and for rational research investment in PHR and HSR.	This review was carried out in the context of the national health strategy, Quality and fairness: A health system for you (DoHC, 2001), which aims to deliver a healthier population and a world-class health system’, and in response to national momentum to make Irish research world class and to use the knowledge generated by that research for economic and social progress. This impetus is articulated clearly in the Government’s 2008 strategy for economic recovery and growth Building Ireland’s Smart Economy: a Framework for Sustainable Economic Renewal, which recognises the crucial importance of health research to Ireland in enhancing health and social wellbeing, developing better quality health services, generating employment opportunities, and establishing Ireland as an international location for innovative health research and commercialisation.	The skills and competencies survey achieved an overall response rate of 69 per cent (330 respondents), of whom approx. 2/3 of respondents were female and 1/3 were male. However, the gender split was not even across disciplines and tended to break along stereotypical lines. Male respondents outnumbered females in medicine, commerce, chemical sciences, mathematics and statistics, computer science, dentistry, politics and environmental sciences. On the other hand, female respondents outnumbered males in all other disciplines and in particular nursing, social sciences, biological and health sciences, humanities and therapies. 3.3.1 Early-stage training in PHR and HSR Training provision through PhD graduate programmes, undertaken through academic departments creates a multidisciplinary environment for students and there has been considerable progress in this regard in Ireland, with PhD programmes and graduate schools being funded by a number of agencies. The HRB PhD Scholars Programme was the first of its kind in Ireland and provides a good model for this approach to training. The PhD Scholars Programme in HSR supports annual cohorts of five to seven high-quality students from a wide variety of disciplines, who are trained on four-year programmes with interweaved, individualised research training and skills-development opportunities. Projects are located in various centres within the collaborating institutions (RCSI, TCD and UCC) and include ten weeks of specialist rotations in health-related data-collection agencies, relevant taught modules and a placement at an overseas agency. Both the HRB and more recently Molecular Medicine Ireland have provided support (HRB Clinical Training Fellowship and MMI
							Clinical Scientist Fellowship) for newly qualified doctors who are willing to step out of their clinical training in order to complete a PhD. The National SpR/SR Academic Fellowship Programme (NSAFP) provides an example of an innovative and integrated approach to early-stage training of clinicians in a professional setting. This programme replaced the HRB Clinical Training Fellowship, and is run in partnership with the HSE, the Forum of Irish Postgraduate Medical Training Bodies and the university academic medical departments. The programme is targeted specifically at those doctors about to enter specialist training programmes but who have as an ultimate career goal a leading clinician scientist role. Successful candidates draw up a personalised training plan that will result in receipt of both a PhD and Certification of Completion of their clinical training on completion of the overall programme. Postgraduate training also enables targeted capacity-building in emerging areas important to PHR and HSR that is currently underdeveloped in Ireland. Examples include health economics and epidemiology. The HRB has developed opportunities for strengthening international exchange and mutual learning in these areas through its participation in the Ireland-Northern Ireland-National Cancer Institute Consortium 15, through which it has offered Epidemiology Fellowships, Cancer Prevention Fellowships, and Health Economics Fellowships, in addition to summer schools in cancer prevention and control for scientists and health professionals.

Appendix D:

Coding and Categorisation

Coding

Table

critical analysis

community/cultural orientation

real public health issues in the twenty-first century;

teaching more research-related skills

diverse coursework

leadership course

leadership

leadership path

preparing public health leaders by teaching them solid leadership skills, analytical thinking skills, and advanced applied skills

methodology to train students in the research skills that translate into public health practice.

Organisation and financing of health services

Access to health care

Quality of care

Clinical evaluation and outcomes research

Informatics and clinical decision making

Practitioner, patient, and consumer behaviour

Health professions workforce

health policy formulation and analyses

health care model and service innovation.

advocacy, leadership, and community engagement

management and ethics

evidence-informed public health

benchmark (knowledge or comprehension), milestone (apply or analyse), and capstone (evaluate or create)

highly skilled researchers is a difficult but fairly straight forward process.

mentor students to become future public health faculty

training in leadership and practice face a different challenge.

Interdisciplinary Leadership Development Program

the conceptual models essential to modern public health practice match each classroom experience with practice relevant

ethical issues

Design epidemiologic studies

data collection methods

quantitative and reasoning skills

statistical methods

major public health problems

Critically evaluate scientific literature

Articulate research questions

Present data at academic and professional meetings

Convey epidemiologic concepts

advanced original research project

formulate sound research questions

to appraise pertinent literature critically

design a study

select an appropriate study design

determine the appropriate sample size

apply advanced statistical methods

computer software

interpret measures

communicate

ethical issues

Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model guided the conceptualization and integration of climate change content

asynchronous and synchronous learning activities.

Many of the faculty subjects were familiar with public health core competencies. Of the respondents who were not familiar, 93.8% had plans to become familiar with public health core competencies.

Foundational seminars (teaching seminars, research seminars, service seminars, work-life seminars);

Exploration and Job Search (Career and job search seminars and activities, site visits and career panels);

Independent and mentored Experiences

Mentoring

Primary Data Collection

Media

Understanding of core areas of public health practice, research, and theory.

Analyse issues and problems

Synthesize information

leadership in designing and implementing policies, strategies, and interventions.

communication strategies Demonstrate a vision and philosophy for leadership that includes systems thinking and ethical principles

Students’ beliefs and assumptions create barriers to acceptance of population concepts, especially social determinants of health. disorienting dilemmas

self-examination of values and feelings of fear, anger, guilt, or shame,

critical assessment of sociocultural assumptions

recognition that one’s discontent and the transformative process are shared and that others have negotiated a similar change,

exploration of options to gain concordance with new perspectives.

cross-disciplinary capacity by ensuring that they also have cross-cutting skills, e.g. project management skills

communication skills

transferable skills

Beyond being experts with knowledge and skills or professionals with ethical values, universities should train PhD students to be enlightened change agents with leadership skills.

Network collabour ation—“network thinking”

transdisciplinary approach to conducting population health intervention research.

Monthly day-long, in-person seminars for all trainees and mentors to discuss key aspects and emerging issues of public and population health research.

Seminar series included theoretical and practical elements and promoted the acquisition of core competencies/; foundational knowledge of public health, transdisciplinary research in public health, intervention research ethics, development of research networks and partnerships, knowledge translation, research career management. pedagogical approach on the basis of self-evaluation of needs, establishment of personal learning objectives, and formal learning contracts specifying the respective responsibilities of fellows

most frequently mentioned required courses for degree completion included epidemiology, biostatistics, research methods, DrPH seminar, leadership, and management.

11 competencies: 1. Acquire knowledge of the context of health and health care systems, institutions, actors, and environments. 2. Apply or develop theoretical and conceptual models and skills relevant to health services research. 3. Propose important research questions informed by structured evidence assessment, stakeholder positions, pertinent theoretical and conceptual models, and new data; and formulate solutions to health problems, practice, and policy.4. Use or develop a conceptual model to specify study constructs for a health services research questions and develop variables that reliably and validly measure these constructs.5. Recognise the strengths and weaknesses of study designs to appropriately address specific health services research questions. 6. Sample and collect primary health and health care data and/or assemble and manage existing data from public and private sources. 7. Execute and document procedures that ensure the reproducibility of the science, the responsible use of resources, and the ethical treatment of research subjects. 8. Demonstrate proficiency in the appropriate application of analytical techniques to evaluate HSR questions. 9. Work collaboratively in teams within disciplines, across disciplines, and/or with stakeholders. 10. Effectively communicate the process, findings, and implications of health services research through multiple modalities with stakeholders. 11 Knowledge translation to policy and practice.

Code aggregation and category development

Table

leadership course	communication strategies	Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model guided the conceptualization and integration of climate change content	cross-disciplinary capacity by ensuring that they also have cross-cutting skills, e.g., project management skills
Leadership	Convey epidemiologic concepts	asynchronous and synchronous learning activities.	Beyond being experts with knowledge and skills or professionals with ethical values, universities should train PhD students to be enlightened change agents
leadership path	communicate	Foundational seminars (teaching seminars, research seminars, service seminars, work-life seminars);	transferable skills
preparing public health leaders by teaching them solid leadership skills, analytical thinking skills, and advanced applied skills	communication skills	Monthly day-long, in-person seminars for all trainees and mentors to discuss key aspects and emerging issues of public and population health research.	real public health issues in the twenty-first century;
advocacy, leadership, and community engagement	Effectively communicate the process, findings, and implications of health services research through multiple modalities with stakeholders.	Seminar series included theoretical and practical elements and promoted the acquisition of core competencies/; foundational knowledge of public health, transdisciplinary research in public health, intervention research ethics, development of research networks and partnerships, knowledge translation, research career management. pedagogical approach on the basis of self-evaluation of needs, establishment of personal learning objectives, and formal learning contracts specifying the respective responsibilities of fellows	methodology to train students in the research skills that translate into public health practice.
training in leadership and practice face a different challenge.	Present data at academic and professional meetings	disorienting dilemmas	evidence-informed public health
Interdisciplinary Leadership Development Program		exploration of options to gain concordance with new perspectives.	the conceptual models essential to modern public health practice match each classroom experience with practice relevant
leadership in designing and implementing policies, strategies, and interventions.		self-examination of values and feelings of fear, anger, guilt, or shame,
Demonstrate a vision and philosophy for leadership that includes systems thinking and ethical principles		critical assessment of sociocultural assumptions
most frequently mentioned required courses for degree completion included epidemiology, biostatistics, research methods, DrPH seminar, leadership, and management.
enlightened change agents with leadership skills.

Analytical Memo

• Curriculums needs to be responsive to evolving PHPHSR needs so that graduates are prepared for reality

• Academic track becoming less the norm—need to prepare graduates for working in different settings

• Ability to adopt leadership roles key

• Globally efforts to develop and implement clear doctoral outcomes—this is better established in Masters of Public Health—may reflect history of doctoral programmes where dissertation was sole focus, now moves towards structured and competency focused programmes

• Pedagogical approaches of actual teaching—transformative learning, self-evaluation and determination of learning needs

Appendix E:

Summary of key findings per study

Table

Authors	Concept	Context	Key public health PhD curriculum features
(1) Burgess et al. (2018)	To formally represent the substantive training provided in HSR doctoral programs and to clearly distinguish HSR training from other postgraduate opportunities for students and employers, a list of core competencies was developed in a 2005 Agency for Healthcare Research and Quality (AHRQ)—funded conference.	At the November 2016 conference on the HSR Workforce, participants provided feedback on a white paper updating HSR competencies Additional feedback was solicited from doctoral program directors and other HSR workforce experts.	The original 14 core competencies outlined in V1 were reduced to 11 competencies: 1. Acquire knowledge of the context of health and health care systems, institutions, actors, and environments. 2. Apply or develop theoretical and conceptual models and skills relevant to health services research. 3. Propose important research questions informed by structured evidence assessment, stakeholder positions, pertinent theoretical and conceptual models, and new data; and formulate solutions to health problems, practice, and policy. 4. Use or develop a conceptual model to specify study constructs for a health services research questions and develop variables that reliably and validly measure these constructs. 5. Recognise the strengths and weaknesses of study designs to appropriately address specific health services research questions. 6. Sample and collect primary health and health care data and/or assemble and manage existing data from public and private sources. 7. Execute and document procedures that ensure the reproducibility of the science, the responsible use of resources, and the ethical treatment of research subjects. 8. Demonstrate proficiency in the appropriate application of analytical techniques to evaluate HSR questions. 9. Work collaboratively in teams within disciplines, across disciplines, and/or with stakeholders. 10. Effectively communicate the process, findings, and implications of health services research through multiple modalities with stakeholders. 11 Knowledge translation to policy and practice.
(2) Cody et al. (2002)	To increase HSR capacity, nurse researchers need to become educated in HSR	Doctoral programs within and without nursing	Educators faced with adding a track or integrating HSR into the curriculum may find it helpful to organize the curriculum around the seven areas of HSR outlined in the IOM’s 1995 report: • Organisation and financing of health services. • Access to health care. • Quality of care. • Clinical evaluation and outcomes research. • Informatics and clinical decision making. • Practitioner, patient, and consumer behaviour. • Health professions workforce. The authors propose two additional HSR curriculum areas—health policy formulation and analyses; and health care model and service innovation.
(3) Debate et al. (2015)	The DrPH Core Competency Model outlined seven competency domains essential to advanced DrPH training: leadership, advocacy, communication, management, community and cultural orientation, professionalism and ethics, and critical analysis.	Incorporation of advanced public health competencies with an outcomes- and competency-based curricular model at the University of South Florida (USF) College of Public Health	The 90-credit hour DrPH program of study at USF comprises three curricular clusters: (1) advocacy, leadership, and community engagement; (2) management and ethics; and (3) evidence-informed public health. Each of these has associated content domains and competencies that address three levels of learning: benchmark (knowledge or comprehension), milestone (apply or analyse), and capstone (evaluate or create); specific course may be designated as addressing a specific competency (e.g., evidence-informed public health contributes to the following competency: apply theoretical and evidence-informed perspectives from multiple disciplines in the design and implementation of programs, policies, and systems). Each DrPH competency is assessed by specific evaluation rubrics that evaluate the fulfilment of learning objectives associated with each benchmark, milestone, and capstone competency; DrPH students who encounter professional or personal life events that hinder completion of the degree can earn certificates as evidence of competency and mastery of advanced public health skills.
(4) Declercq et al. (2008)	The challenge for schools of public health is to seriously address the question of how much of what we offer in a DrPH program is the result of the needs of the field and how much is a repackaging of our research training.	From 2002 to 2006 however, the number of DrPH students increased by 40%, and the growth in the number of DrPH programs suggests this increase is likely to continue.	Although there is clearly demand for doctoral education in public health, schools of public health now must determine the content of their doctoral curriculum. For those seeking a PhD in a research field (epidemiology, biostatistics, health services, and environmental sciences accounted for 71 % of all PhD students), the development of highly skilled researchers is a difficult but fairly straight forward process. In a sense, this is what faculty do best, mentor students to become future public health faculty. The DrPH programs that emphasize training in leadership and practice face a different challenge.
(5) Dodds et al. (2010)	The UNC-CH MCH Leadership Consortium, a collaboration among five MCHB-funded training programs, delineates the evolution of the leadership curriculum developed by the Consortium to cultivate interdisciplinary MCH leaders	The Maternal and Child Health consortiums primary task to date has been to create a leadership curriculum for 20–30 master’s, doctoral, and post-doctoral trainees to understand how to leverage personal leadership styles to make groups more effective, develop conflict/facilitate skills, and identify and enhance family-centred and culturally competent organisations.	The key activity of the consortium is the design and implementation of a curriculum for leadership development—the Interdisciplinary Leadership Development Program (ILDP). Each of the UNCCH MCHB-supported training programs selects participants to become ILDP fellows, for a total of approximately 25–30 each year. In the early years, the fellows met for only three workshops during the academic year, but over time the curriculum has evolved to include six workshops and participation in the annual UNC Minority Health Conference, as our training programs responded to the leadership competencies articulated for the field of MCH
(6) Gebbie et al. (2008)	Public health is a vital and vibrant evidence-based profession, the impact of which influences life and death matters for millions of people every day. As such, the leadership of the profession should require of itself no less scholarly credentials than the leadership of other major healing professions and should require specialty training specific to the field of public health at the doctoral level.	Reconsideration of the Roemer proposal, blended with public health practice and current close association with public health work force development activities with the deliberations of the Institute of Medicine (IOM) committee on public health education.	Many of the present DrPH degree programs follow the five-year model of study proposed in the 1980s by Roemer. For a student entering with at least a Bachelor of Arts or Bachelor of Science degree with basic sciences (social and physical) and numeracy skills, the curriculum might look something like the sequence of courses and experience outlined in the Figure. The sequence begins with a semester of primarily classroom education designed to ground the individual in the conceptual models essential to modern public health practice: an ecologic model of health and basic human biology, including genomics. The three subsequent semesters match each classroom experience with practice relevant to what is being learned, such as a series of environmental health program experiences matched to coursework on interpretation of environmental laboratory data, risk assessment and management, communication, regulation, and emergency response.
(7) Hiney et al. (2011)	This review of PHR and HSR in Ireland was undertaken to establish a baseline description of current research capacity and activity in PHR and HSR in Ireland, assess the outputs and impacts of current PHR and HSR in Ireland, map the strengths and weaknesses in PHR and HSR in Ireland and provide underpinning evidence for the development of an action plan for capacity and infrastructure development and for rational research investment in PHR and HSR.	This review was carried out in the context of the national health strategy, Quality and fairness: A health system for you (DoHC, 2001), which aims to deliver a healthier population and a world-class health system, and in response to national momentum to make Irish research world class and to use the knowledge generated by that research for economic and social progress.	3.3.1 Early-stage training in PHR and HSR Training provision through PhD graduate programmes, undertaken through academic departments creates a multidisciplinary environment for students and there has been considerable progress in this regard in Ireland, with PhD programmes and graduate schools being funded by a number of agencies. The HRB PhD Scholars Programme was the first of its kind in Ireland and provides a good model for this approach to training. The PhD Scholars Programme in HSR supports annual cohorts of five to seven high-quality students from a wide variety of disciplines, who are trained on four-year programmes with interweaved, individualised research training and skills-development opportunities. Projects are located in various centres within the collaborating institutions (RCSI, TCD and UCC) and include ten weeks of specialist rotations in health-related data-collection agencies, relevant taught modules and a placement at an overseas agency. Postgraduate training also enables targeted capacity-building in emerging areas important to PHR and HSR that is currently underdeveloped in Ireland. Examples include health economics and epidemiology.
(8) Hlaing (2019)	Competencies pertaining specifically to research/science-focused (PhD/ScD) degrees in epidemiology are presently not defined by the Association of Schools and Programs of Public Health (ASPPH)	The competencies listed on the corresponding institutions’ websites of institutions conferring doctoral (PhD, ScD, DrPH) degrees in epidemiology were identified.	11 common competencies from PhD and DrPH programmes identified: 1. Recognise potential ethical issues and address/implement the concepts of ethical conduct of research in epidemiologic studies. 2. Design epidemiologic studies applying sound methodology and strategies to assess the threats to validity of results. 3. Develop, validate, and implement data collection methods and tools needed for performing epidemiology investigations. 4. Apply quantitative and reasoning skills and content-area knowledge to analyse data from epidemiological studies systematically. 5. Use the application of statistical methods that are critical to epidemiologic inquiry; manage, manipulate, and analyse data using statistical software packages; interpret data appropriately. 6. Identify major public health problems, their general pathophysiology, descriptive epidemiology, and associated risk factors. 7. Critically evaluate scientific literature and synthesize the outcomes across studies, balancing limitations, and contributions of each study. 8. Articulate research questions that advance scientific knowledge; originate, design, and develop new inquiries worthy of research support. 9. Present data at academic and professional meetings and submit scientific articles for publication in high-impact peer-reviewed journals. 10. Convey epidemiologic concepts to students and peers; effectively communicate epidemiologic information to scientists, policy makers, and the public. 11. Conduct an advanced original research project and demonstrate mastery of the topic area.
(9) Hlaing et al. (2020)	Collect information on doctoral-level competencies in general epidemiology (doctoral) degree programs and other pertinent information from accredited programs in the United States and Canada.	Although epidemiology core competencies are established by the Association of Schools and Programs of Public Health for masters-level trainees, no equivalent currently exists for the doctoral level.	11 competencies were deemed very or extremely important: 6 (Competency to formulate sound research questions and key hypotheses for a specific research problem or scenario), 7 (Competency to appraise pertinent literature critically (i.e., methodological quality of research) to identify the current status of evidence and meaningful gaps in extant knowledge on the topic of interest), 8 (Competency to design a study by applying sound research methodology, including strategies aimed at minimizing biases and confounding effects), 9 (Competency to select an appropriate study design (basic to advanced) for a specific problem, as well as to articulate scientific and practical strengths and limitations of different designs), 11 (Competency to determine the appropriate sample size), 14 (Competency to apply advanced statistical methods when analysing study data), 15 (Competency to use computer software for data entry, database management, data analysis, and displaying/visualizing study results), 16 (Competency to interpret measures e.g., frequency, disease burden, association, public health impact and results from epidemiologic studies and draw appropriate inferences), 17 (Competency to communicate, verbally and in writing, research findings to scientists) 19 (Competency to address ethical issues that can arise in the different stages—sample selection, design, measurements, data analysis, interpretation and communication of result—of epidemiologic research) 23 (Competency to demonstrate mastery of a substantive area of epidemiologic research relating to the students’ dissertation research).
(10) Keating et al. (2022)	Faculty developed an innovative educational module that integrated climate change as a critical content area, emphasizing the DNP leadership role in responding to the health impact of climate-related issues.	The professional competencies for Doctor of Nursing practice (DNP) education include population health, clinical prevention, and health promotion. Aligned with these competencies, the curriculum at a large metropolitan college of nursing (CON) includes a clinical applied epidemiology course.	The Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model guided the conceptualization and integration of climate change content into an innovative module within the clinical applied epidemiology course. The module, titled Environmental Considerations for Clinical Decision Makers, included asynchronous and synchronous learning activities.
(11) Kinnard Campbell (2014)	Mapping public health core competencies into work-force training as the goals of public training has progressed from a focus on knowledge transfer to development of skills or competencies.	Evaluate colleges and universities that have adopted, incorporated, and indicated an intent to develop, utilize and implement public health core competencies into future curricula.	Many of the faculty subjects were familiar with public health core competencies. Of the respondents who were not familiar, 93.8% had plans to become familiar with public health core competencies.
(12) Koblinsky et al. (2015)	Research from multiple disciplines, including public health, has indicated that many PhD graduates feel ill equipped for the demands of academic and other postgraduate positions	The Department of Family Science in the University of Maryland’s School of Public Health launched a “Preparing Future Faculty” (PFF) program to enrich the professional development of its doctoral students, modelled on the successful national PFF initiative of the Council of Graduate Schools and the Association of American Colleges and Universities.	PFF Course content: Foundational seminars (teaching seminars, research seminars, service seminars, work-life seminars); Exploration and Job Search (Career and job search seminars and activities, site visits and career panels); Independent and mentored Experiences
(13) Lee et al. (2013)	Review current ethics instruction at schools of public health (SPH), and recommend ways to bridge the gap between what is expected and what is currently taught in graduate level courses.	Public health’s population focus presents unique ethics considerations that differ from those reflected in biomedicine and clinical care, as the “patient” is the community or population.	9 ASPH DrPH competencies related to ethics (5 of which mapped to more than 1 domain), as well as 5 of the CDC and CSTE competencies (2 of which mapped to more than 1 domain), and 16 of the PHF COL competencies that fit into the ethics domains, 1 of which mapped to more than 1 domain.
(14) Lee and Samet (2003)	The 2002 meeting of the American College of Epidemiology included an open forum on doctoral education and training in epidemiology, recommending changes that would better prepare future epidemiologists to meet new challenges in public health and to build successful careers.	Concern about bioterrorism has led to questions about the adequacy of the public health infrastructure of the United States and initiatives to enhance the level of preparedness for bioterrorism and other threats. The preparation of public health professionals has also been brought to the forefront by a recent report from the Institute of Medicine (IOM) of the National Academies	Mentoring: The forum participants agreed that training in mentoring should be offered and encouraged. Primary Data Collection: The participants recognised that gathering data allows the trainee to experience the inherent difficulties of doing so, to recognise potential sources of bias in their data, and to understand issues of data quality. Media: As part of doctoral programs, media training that emphasizes communications practice should be provided, with ample opportunities for students to apply their new skills. For example, students could participate in mock interviews with journalists, or complete an exercise in condensing their complicated research into a 5-minute presentation in lay language.
(15) Lenihan et al. (2015)	Leadership continues to be stressed for addressing the public health challenges of today, but a report noted that lack of leadership skills was a “huge barrier” to cross-sector collaboration.	A consensus has emerged that the focus of the Doctor of Public Health (DrPH) degree should be leadership in public health practice and an array of competencies has been put forth by Association of Schools and Programs of Public Health for how this focus should be implemented.	The UIC-SPH revised its longstanding DrPH program to adopt a practice leadership focus within six competencies guiding the curriculum: 1. Gain in-depth understanding of core areas of public health practice, research, and theory including the legal basis for public health, public health as a system, and the ecological model, 2. Analyse issues and problems using needs or resource assessments, critical evaluation, applied research methodology, and statistical methods. 3. Synthesize information from multiple sources to develop strategies for addressing problems in an area of emphasis that contributes to the evidence base of practice and public health scholarship 4. Demonstrate leadership in designing and implementing policies, strategies, and interventions. 5. Assess communication strategies and use communication skills across diverse audiences to inform or influence program and policy decisions 6. Demonstrate a vision and philosophy for leadership that includes systems thinking and ethical principles.
(16) McKinney et al. (2019)	To expand student perspectives on the concept of health, we created an online course using transformative learning (TL) principles to support the conceptual transition from individual care to population health.	The purpose of this article is to describe the integration of transformative learning (TL) principles into an online DNP population health course and report on student learning outcomes.	Students’ beliefs and assumptions create barriers to acceptance of population concepts, especially social determinants of health. TL phases included: (a) disorienting dilemmas, (b) self-examination of values and feelings of fear, anger, guilt, or shame, (c) critical assessment of sociocultural assumptions, (d) recognition that one’s discontent and the transformative process are shared and that others have negotiated a similar change, and (e) exploration of options to gain concordance with new perspectives.
(17) Ndejjo et al. (2022)	With the need to increase PhD graduates across all fields in Africa opportunities should be availed for graduates to make a significant contribution to addressing public health and development problems.	The Consortium for Advanced Research Training in Africa has developed and implemented a collaborative structured PhD training programme in population and public health to bridge existing competency gaps with significant success. As substantial gaps remain this article discusses how Africa’s public health doctoral students can be better positioned for the African and global marketplace across different career pathways and lead societal transformation and development	Public Health PhD graduates could capitalise on their cross-disciplinary capacity by ensuring that they also have cross-cutting skills, e.g., project management skills such as in planning activities, scheduling and chairing meetings and conference calls and taking minutes, in addition to grants and scientific writing, evidence synthesis and data analysis. Also useful are communication skills such as using graphics and other tools to create high-quality presentations or illustrations that convey complex information in simple ways for both scientific and lay audiences, teaching and facilitation, advocacy, interpersonal, leadership and teamwork skills. Through doctoral training, students can also be equipped with several transferable skills that are applicable in a wide range of careers. With the evolution of the career landscape and developmental needs of Africa, these skills become useful in preparing students for a wide variety of career pathways. Beyond being experts with knowledge and skills or professionals with ethical values, universities should train PhD students to be enlightened change agents with leadership skills.
(18) Otok et al. (2017)	In public health a huge need for professional competences in sociology and other behavioural sciences and their interaction with, for example, epidemiology, biostatistics, qualitative methods and health promotion and disease prevention.	It is a relevant question for leads and staff of schools and university departments of public health, how well the need for providing public health students with such competences is actually met.	In Europe, less educational attention has been paid at the PhD level. International networking can be further extended geographically, and it seems that similar considerations—on network collaboration among national and regional European schools and departments of public health—should be discussed also in other parts of Europe. Such a “network thinking” aiming at strengthening the basis for comprehensive, interdisciplinary, dynamic, and coherent public health education and training could constitute a massive shift towards achieving excellence, knowledge brokering and the exchange of experience concerning best practice in public health.
(19) Paradis et al. (2017)	Highly trained public health researchers are needed who are able to study the upstream determinants of health and the complex pathways through which various determinants influence population health. Training must prepare future researchers to work in multidisciplinary settings and teams and to communicate effectively with stakeholders from different sectors of society.	The Quebec Transdisciplinary Research Training Program in Public Health Interventions: Promotion, Prevention and Public Policy (the 4P Program) was one of several initiatives of the Quebec Population Health Research Network to build research capacity.	One key pillar was a curriculum complementary to university curricula that promoted a transdisciplinary approach to conducting population health intervention research. The curriculum comprised 16 domains addressed in monthly day-long, in-person seminars for all trainees and mentors to discuss key aspects and emerging issues of public and population health research. Seminar series included theoretical and practical elements and promoted the acquisition of core competencies, including: 1. foundational knowledge of public health, 2. transdisciplinary research in public health, 3. intervention research ethics, 4. development of research networks and partnerships, 5. knowledge translation, and 6. research career management. To ensure that our fellows acquired these competencies, we adopted a pedagogical approach on the basis of self-evaluation of needs, establishment of personal learning objectives, and formal learning contracts specifying the respective responsibilities of fellows.
(20) Park et al. (2021)	The Doctor of Public Health (DrPH) degree prepares the future workforce to engage in public health research, teaching, practice, and leadership.	A qualitative analysis was conducted to obtain perspectives from a total of 20 Council on Education for Public Health (CEPH)-accredited DrPH program directors through in-depth interviews	All of the DrPH curricula have been restructured with various components: a better reflection of CEPH (masters) competencies; addressing the real public health issues in the twenty-first century; making a clear distinction from Master of Public Health (MPH) and PhD programs; teaching more research-related skills; providing more diverse coursework; and developing a leadership course, practicum, and qualifying examination for moving onto all but dissertation stage; and providing better guidance for dissertation development; Four participants highlighted that DrPH programs should focus on leadership. A DrPH program does not necessarily steer students into an academic route; rather, it should steer them into a leadership path in which they are incorporated into large Organisations. DrPH programs should be recognised for preparing public health leaders by teaching them solid leadership skills, analytical thinking skills, and advanced applied skills; Two participants highlighted that DrPH programs should still focus on methodology to train students in the research skills that translate into public health practice.
(21) Sherman et al. (2016)	An expert panel appointed by ASPPH published “Framing the Future: DrPH for the 21st Century”, which presented a vision for the DrPH graduate as ‘‘a transformative leader with expertise in evidence-based public health practice and research who is able to convene diverse partners and communicate to effect change across a range of sectors and settings.	A survey to further describe the evolution of DrPH programs by examining the range of curricula and teaching models that have emerged since the survey of Lee et al. (2009) to provide the latest complete information on DrPH preparation and can help to lay the groundwork for future conversations about criteria and standards for DrPH education and training.	Twenty-one respondents said the DrPH curricula directly addressed the DrPH core competencies of ASPPH. The most frequently mentioned required courses for degree completion included epidemiology, biostatistics, research methods, DrPH seminar, leadership, and management.
(22) Trauth et al. (2011)	The process of aligning departmental DrPH program with the new ASPH competencies, the challenges encountered, and expectations for professionals trained in the program.	Restructuring of an established DrPH program at the Department of Behavioral & Community Health Sciences (BCHS) at the University of Pittsburgh Graduate School of Public Health (GSPH), involving making major modifications to the existing DrPH degree in keeping with the emerging ASPH competencies.	Revised Doctor of Public Health program is aligned with the Association of Schools of Public Health competencies, there is more in-depth coursework in two of the competency areas—critical analysis and community/cultural orientation—than in other areas.