PRINCIPLES OF POPULATION MEDICINE AND EPIDEMIOLOGY

PRINCIPLES OF POPULATION MEDICINE AND EPIDEMIOLOGY POP HLTH 717

I.

COURSE OVERVIEW AND OBJECTIVES

The goal of this course is to provide students with a basic understanding of the principles of population medicine, with particular emphasis in epidemiology. Through lectures, small group discussions, plenary discussions, and individual web-based instruction, students will learn about epidemiologic methods relating to both the conduct and the interpretation of clinical and public health research. The principles of population-based prevention, population-based screening, community health assessment and intervention, health disparities, quality of health care, health systems, and global health will also be covered. Small group discussion and plenary discussion of exercises will constitute about half of the contacthours for the course. While the exercises will be used to illustrate methodological issues, they will be also used as a means to present students with currently relevant topics in clinical research, population research, and public health practice. This course will provide a foundation for the population health curriculum in subsequent years of the medical student training. It will also prepare students for the understanding of methodological principles underlying evidence-based medicine and methods in clinical and population-based research. Specific Objectives: By the end of the course, the students will understand the following: 

Broad definition of ―health‖ and ―health determinants‖ both at the individual and at the population level.



Principles of epidemiology as a basic science for medical research, evidence-based clinical practice, and public health practice.



Main study designs, methods, statistical inference, and basic methodological terminology in clinical and epidemiologic research.



Difference and complementary nature of individual-based and population-based strategies for prevention.



Basic strategies to identify and address community health needs and health disparities, both locally and globally.



Basic methodological issues in the evaluation of health care quality.



Basic features of the US health care and public health systems and how do they compare with systems in other countries.

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II.

COURSE DATES / LOCATION

Dates:

August 18 – December 13, 2011 (see detailed calendar pages 7-11)

Hours:

Between 8:00 am and 12:00 noon (see calendar)

Lectures:

HSLC Rooms 1306,1325, 1335, and G5/119 CSC (see schedule)

Small group discussions:

HSLC Rooms 2272, 2276, 2280, 2284, 2288

Course website:

Learn@UW (logon using your UW ID and password) Will include all course materials contained in this book, recommended readings, additional readings, and lecture webcast materials.

III.

ORGANIZATION AND COURSE REQUIREMENTS

This is a 3-credit course, with a total of 62 instructional contact hours. Contact hours will occur in different hours of the morning and days of the week as reflected in the enclosed course schedule. In addition, successful completion of the course will require that the students work outside these scheduled contact hours, both individually (e.g., reading exercises and additional recommended readings) and in groups (e.g., completing small group assignments). A detailed list of the 29 lectures, 3 plenary discussions, and 24 sessions of small group discussions is included at the end of this syllabus. Lectures Lectures will typically last for about 50 minutes. Lectures are informal, and questions regarding further clarification of concepts that might be of general interest can be asked at any time. More specific one-on-one questions can be asked to individual instructors present at the small group discussion sections or during TA office hours (see page 5). Attendance at lectures will not be monitored but is highly recommended. Lectures will be captured and made available at the course website for review after the lecture. Review of the lecture handout and recommended readings prior to each lecture is highly recommended. Small Group Discussions Students will be randomly assigned to one of five rooms, each containing five tables. Attendance at small group discussion sessions is required and will be monitored (see Grading section below). Small group discussions will focus on solving nine written exercises. Exercises are based on published articles or other supporting materials; questions are provided as a guide to the discussion. Exercises vary in length and span through 2 to 4 sessions each (see schedule and calendar on pages 7-11): 2

1. Outbreak Investigation (2 sessions) 2. Design and Analytical Issues in Randomized Trials (3 sessions) 3. Study Design and Interpretation: Sleep Apnea and Hypertension (4 sessions) 4. Screening and Cost-Effectiveness (3 sessions) 5. Assessing the Health of a Community (3 sessions) 6. Programs for Community Health Improvement (2 sessions) 7. Health Care Systems: US and International Comparisons (3 sessions) 8. Evaluating Health Care Quality (2 sessions) 9. Global Environmental Health (2 sessions) In general, small group discussion sessions will last 50-60 minutes; for the last session of each exercise, 1.5 hours has been allocated so that there is enough time for each table to complete their work and to get ready for a plenary discussion in each room. The last 45 minutes to 1 hour of the last session for each exercise (marked with an ‗*‘ in the schedule and calendar, pp. 7-11) will be devoted to a plenary discussion of the exercise in each of the small group rooms. While the faculty discussion leader(s) will moderate these general discussions, students will be randomly selected and invited to lead the presentation of different sections of the exercise. Exercises‘ text and supporting materials are included in this course book and are also available at the course website. Students are expected to read each exercise prior to the first session; it is also strongly recommended that, when applicable, calculations are carried out prior to the small group sessions. During the small group discussion sessions, each group (table) is expected to discuss the exercises among themselves and with faculty facilitators present at each of the rooms. Because some exercises require calculations, students will need access to a pocket calculator or a laptop/PDA with calculator software. Readings There is one required reading for this course, Rose, Geoffrey. Sick Individuals and Sick Populations. Int J Epidemiol 2001 Jun;30(3):427-32; discussion 433-4 which is printed in your course book and can be found at Learn@UW. There is no required textbook for this course. The following texts, however, have useful sections for some of the topics covered in the lectures and exercises in this course. 

Gordis L: Epidemiology (4th edition). Philadelphia, PA: Elsevier, 2009.



Fletcher RW and Fletcher SW. Clinical Epidemiology. The Essentials (4th Edition). Baltimore, MD: Lippincott Williams & Wilkins, 2005.



Turnock BJ: Public Health. What It Is and How It Works (4th edition). Sudbury, MD: Jones and Bartlett Publishers, 2009.

For many of the lectures, sections from one or more of these textbooks will be listed as recommended readings. Additional recommended or additional readings for lectures and exercises will include journal articles and chapters from other books.

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Grading Students will be evaluated using a Pass/Fail Grading system based on: - Two multiple choice Mid-Term Exams (40% Total, 20% each). These exams will occur during the integrating weeks (September 26-30 and November 7-11). - Final Exam (35%): a multiple choice exam that will take place on December 13 in 1306 HSLC. - Quizzes (15%): There will be short online quizzes given throughout the semester worth a total of 15% of the final grade. - Class and small group discussion participation (10%). The final course grade of "pass" or "fail" will be determined based on the above weights. Students receiving an average of 80% or greater will receive a "pass‖ and those receiving a score less than 80% will receive a "fail." This historical cutoff may change somewhat under extenuating circumstances, e.g., be lowered somewhat due to unexpectedly difficult exams. Students receiving a "fail" grade will be required to re-take the entire course the next time it is offered. As policy, there will be no opportunities for re-examination or extra work to improve a course grade. Important note: Unexcused absences in a small group discussion session will result with points being deducted from your course grade. Participation accounts for 10% of your total grade in this course. As attendance in the small group discussions is mandatory, missing a discussion section will adversely affect your grade. In general, you will lose 10% of your participation grade (1% of total grade) for each small group session with an unexcused absence. If you have any difficulty that prevents you from attending a small group discussion session, email the teaching assistant, Dr. Allen Bateman ([email protected]), before the discussion session to schedule a make-up session. Excuses for absences after the missed small group session will not be approved. Make-up sessions are held during office hours on the Tuesday/Thursday that is closest to the actual lab date.

Important note about contacting course instructors For issues related to course schedule, attendance, and quizzes, please contact Dr. Allen Bateman ([email protected]). Except under extenuating circumstances, the course director and course codirector much prefer that students contact them right after lectures or during small group discussions rather than by email if they have a need to speak directly with either of them (or by appointment—see next page).

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IV.

COURSE FACULTY

Course Director:

F. Javier Nieto, MD, PhD, MPH Chair of the Department of Population Health Sciences Professor of Population Health Sciences and Family Medicine Room 707C WARF Building, 265-5242, [email protected] Office hours by appointment: Patty Grubb ([email protected], 265-0516)

Course Co-Director: Patrick L. Remington, MD, MPH Associate Dean for Public Health Professor of Population Health Sciences Room 4263 Health Sciences Learning Center, 263-1745, [email protected] Office hours by appointment: Patty Grubb ([email protected], 265-0516)

Teaching Assistant:

Allen Bateman, PhD Master of Public Health candidate, Department of Population Health Sciences [email protected] Office hours: Mondays and Wednesdays, 12:00 noon-1:00 pm, 4262 HSLC

Lecturers (subject to change):

James Conway, MD FAAP Associate Professor Department of Pediatrics

Jonathan Patz, MD, MPH Professor Department of Population Health Sciences and Institute for Environmental Studies

Tom DeLeire, MD Associate Professor Department of Population Health Sciences

Patrick Remington, MD, MPH Associate Dean, School of Medicine and Public Health and Professor, Dept of Population Health Sciences

Norman Fost, MD, MPH Professor Department of Pediatrics and History of Medicine and Bioethics

Stephanie Robert, PhD Professor School of Social Work

F. Javier Nieto, MD, MPH, PhD Professor and Chair Department of Population Health Sciences

Maureen Smith, MD, PhD Associate Professor Department of Population Health Sciences

Thomas Oliver, PhD, MHA Professor Department of Population Health Sciences

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Small Group Discussion Faculty (subject to change): Below is a list of faculty and staff members from the Departments of Population Health Sciences (PHS), Medicine, Family Medicine, Pediatrics, Ophthalmology, the Wisconsin Division of Public Health, and the La Follette School of Public Affairs who will facilitate the small group discussion sessions. Leonelo Bautista, MD, DrPH Associate Professor, PHS

Ana Martinez-Donate, PhD Assistant Professor, PHS

Randy Brown, MD, PhD Assistant Professor, Family Medicine

Kristin J. Meyers, PhD, MPH Assistant Scientist, Opththalmology and Visual Sciences

Bridget Booske, PhD Senior Scientist, PHS

Lauren Mueenuddin, MS Honorary Fellow, PHS

Shobhira Chheda, MD Associate Professor (CHS), Pediatrics

Paul Peppard, PhD Assistant Professor, PHS

James H. Conway, MD, FAAP Associate Professor, Pediatrics

F. Javier Nieto, MD, PhD Professor, PHS and Family Medicine

Karen Cruickshanks, PhD Professor, PHS, Ophthalmology and Visual Sciences

Jonathan Patz, MD, MPH Professor, PHS, Institute for Environmental Health Beth Potter, MD Associate Professor (CHS), Family Medicine

David M. Deci, MD Associate Professor, Family Medicine Maureen Durkin, PhD, DrPH Professor, PHS

Patrick Remington, MD, MPH Associate Dean of the School of Medicine and Public Health and Professor, PHS

Mark Edgar, PhD Senior Outreach Specialist, PHS

Adnan Said, MD Associate Professor (CHS), Medicine

Corinne Engelman, PhD, MSPH Assistant Professor, PHS

Ajay Sethi, PhD Assistant Professor, PHS

John Frohna, MD Professor (CHS), Pediatrics

Amy Trentham-Dietz, PhD Associate Professor, PHS

Ronald Gangnon, PhD Associate Professor, PHS and Biostatistics

David Vanness, PhD Assistant Professor, PHS

Cindy Haq, MD Professor (CHS), Family Medicine

Mark Werner, PhD Wisconsin Division of Public Health Adjunct Assistant Professor, PHS

Marty Kanarek, PhD Professor, PHS

Whitney Witt, PhD Assistant Professor, PHS

Kristen Malecki, PhD, MPH Assistant Scientist, PHS

Barbara Wolfe, PhD La Follette School of Public Affairs Professor, PHS and Economics

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Principles of Population Medicine and Epidemiology (Pop Health 717) Course Schedule Fall 2011

DATE Aug 18 Thu

Aug 23 Tue

TIME

LECTURE

1:00-1:50

(1) Introduction: Understanding the Determinants of Health

2:00-2:50 8:10-9:00

HSLC ROOM 1306 1306

(2) Epidemiology and the Natural History of Disease

PLENARY DISCUSSION OR SMALL GROUP EXERCISE1

LECTURER Faculty Nieto

Screening for Lung Cancer (Plenary Discussion)

1306

Nieto Remington

9:00-10:00

(1) Outbreak Investigation

Faculty facilitators

Aug 24 Wed

8:00-9:30

(1) Outbreak Investigation*


Aug 25 Thu

9:10-10:00

(3) The Experimental Paradigm

1306

Remington

Aug 30 Tue

8:10-9:00

(4) Measuring and Comparing Risk (1)

1306

Nieto

Aug 31 Wed

8:10-9:00

(5) Measuring and Comparing Risk (2)

1306

Nieto

8:10-9:00

(6) Intro to Biostatistics Concepts (1)

1306

Nieto

Sept 1 Thu

Sept 2 Fri Sept 7 Wed

9:00-10:00 8:10-9:00

(2) Randomized Control Trials (7) Intro to Biostatistics Concepts (2)

1335

Faculty facilitators Nieto

9:00-10:00

(2) Randomized Control Trials

Faculty Facilitators

8:30-10:00

(2) Randomized Control Trials*


7

Sept 8 Thu

Sept 12 Mon Sept 15 Thu Sept 20 Tues

Sept 22 Thu Sept 23 Fri

8:10-9:00

(8) Study Designs: Case Series, Cohort

1306

9:00-10:00

Nieto (3) Observational Study Designs

8:10-9:00

(9) Study Designs: Case-Control

G5/119 CSC

9:10-10:00

(10) Issues of Interpretation-Bias

1306

9:00-10:00

Faculty facilitators Nieto Remington

(3) Observational Study Designs


8:10-9:00

(11) Issues of Interpretation – Confounding

1306

Remington

9:10-10:00

(12) Addressing Issues of Interpretation

1325

Remington

8:00-9:00

(3) Observational Study Designs


9:00-10:00

(3) Observational Study Designs*


9:30-10:20

Review (HSLC 1325)

Nieto

Block 1 Exams and Integration Week (Sept 26-30) Sept 26 Mon

1:00-2:30

Oct 4 Tue

9:10-10:00

(13) Synthesizing and Interpreting Scientific Evidence

1306

Nieto

Oct 5 Wed

9:10-10:00

(14) Evaluating Diagnostic Tests (1)

1306

Nieto

8:10-9:00

(15) Evaluating Diagnostic Tests (2)

1306

Nieto

Oct 11 Tue

Block 1 Exam (room TBD)

9:00-10:00

(4) Screening

8


Oct 12 Wed

9:00-10:00

Oct 13 Thu

9:10-10:00

Oct 14 Fri

8:30-10:00

Oct 17 Mon

9:10-10:00

(17) Ethical Issues in Population Screening

1306

Fost

Oct 18 Tue

9:10-10:00

(18) Individual and Population Prevention

1306

Nieto

Oct 19 Wed

9:00-10:00

Oct 20 Thu

10:10-11:00

(19) The Public Health System

1306

Remington

Oct 24 Mon

9:10-10:00

(20) Community Health Assessment

1306

Remington

Oct 25 Tue

8:30-9:30



Oct 27 Thu

8:30-10:00

(5) Community Health Assessment*


Oct 28 Fri

9:10-10:00

Nov 1 Tue

9:00-10:00 8:10-9:00

(4) Screening (16) Cost Effectiveness Analysis

1306

DeLeire (4) Screening*


(21) Public Health Interventions

1306

(22) Closing the Gap

1306

9


Faculty facilitators Remington

(6) Programs for Community Health Improvement*

9:00-10:30


Remington (6) Programs for Community Health Improvement

Nov 3 Thu



Block 2 Exams and Integration Week (Nov 7-11) Nov 4 Fri

11:10-12:00

Review (HSLC 1325)

Nov 7 Mon

10:00-11:30

Block 2 Exam (room TBD)

Nov 15 Tue

9:10-10:00

Nov 16 Wed

9:00-10:00 8:10-9:00

(23) Health Care Systems (1)

1306

Oliver (7) Evaluating Health Systems

(24) Health Care Systems (2)

Nieto, Remington

1306

Faculty facilitators Oliver

Nov 17 Thu 9:00-10:00

(7) Evaluating Health Systems


Nov 18 Fri

8:30-10:00

(7) Evaluating Health Systems*


Tue Nov 22

9:10-10:00

Wed Nov 23

9:00-10:00

Tue Nov 29

9:10-10:00

Wed Nov 30

8:30-10:00

Thu Dec 1

9:10-10:00

Fri Dec 2

8:30-10:00

(25) Quality in Healthcare Systems

1306

Smith (8) Evaluating Health Care Quality

(26) Research and Quality Improvement

1306

Smith (8) Evaluating Health Care Quality*

(27) Addressing Health Disparities

1306 1306

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Faculty facilitators Robert

Unnatural Causes (Plenary Discussion)

Remington

Dec 5 Mon

9:10-10:00

Dec 6 Tue

9:00-10:00

Dec 7 Wed

9:10-10:00

Dec 8 Thu

8:30-10:00

Dec 9 Fri

9:00-10:30

Dec 12 Mon

1:00-150

Dec 13 Tue

12:00-1:30

(28) Environmental Health: Place Matters

1306

Patz (9) Global Environmental Health

(29) Global Health

1306

Conway (9) Global Environmental Health*

Panel Discussion

1306 Review (HSLC 1306) Block 3 Exam

Location: cluster rooms (HSLC 2272, 2276, 2280, 2284, 2288) unless otherwise indicated in ―HSLC Room‖ column. * Indicates general discussion of the exercise. 1

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Faculty facilitators Faculty facilitators Remington