COMMENTARY

Innovations in Graduate Public Health Education: The Instituto

Nacional de Salud Publica
During the past 10 years, Laura Magaa Valladares, PhD, and Mauricio Hernndez vila, PhD
the Instituto Nacional de
Salud Publica (National In-
THE ESCUELA DE SALUD workforce and producing evi- institute outside the United States
stitute of Public Health) in
Mexico has meticulously re- Pblica de Mxico (ESPM; School dence through mission-oriented accredited by this council. In
vised its educational model. of Public Health of Mexico) was research. Thus, the INSP assumed 2011 the INSP was reaccredited
This analysis resulted in the founded in 1922 with funding its role in constructing a better and for seven years, meeting all the
transformation of its educa- from the Mexican government. healthier society. criteria.
tional model by tracing a new Since then, the ESPM has had During the past few decades,
path in the pedagogical struc- a major role in training the Mexi- a new wave of health and educa- PEDAGOGICAL
ture and faculty development can public health workforce.1 tional reforms has required, once STRUCTURE AND
to meet current challenges ESPM was originally created to again, public health schools to FACULTY DEVELOPMENT
and students needs.
train personnel, for example, transform and adapt to a new era
The first stage dealt with
medical ofcers, nurses, specialists of modernism, change, and inno- It was a challenge to transition
the national and interna-
in sanitary services, and labora- vation.3 Recently, a dened from a teacher-centered, content-
tional accreditation stan-
dards that came with the tory technicians, to control infec- movement toward competency- based education model to one
21st century. The second tious diseases that were wide- based education has taken place, centered on the students and
stage responded to evidence spread in Mexico. ESPM embraced reshaping educational institutions their competencies. One driving
of cognitive research show- the sanitary movement that aimed around the world. The movement force was the commitment of the
ing that students are better to prevent and control infectious emphasizes active learning, stu- INSP to work for international
prepared when they are en- diseases and improve food safety dent engagement, and more and national accreditations. The
gaged, active, and responsi- in the country. global, exible, and technologi- transformation of our traditional
ble for their own learning. The creation of the ESPM cally oriented curricula.4 The cur- educational model, which was
This transformation was
strengthened the movement that rent health challenges are arising centered on an instructor, devel-
grounded on the use of in-
aimed to combat waste and sewer in a new world: one that is more oped dened curricula to a
formation and communica-
gas; improve water quality, urban complex, unpredictable, and glob- competency-based educational
tion technologies and on
a competency-based educa- health, and food safety; control alized. These challenges require model, which implied a shift from
tional approach that has led alcoholism; and eradicate illnesses professionals who can integrate a teacher-centered to a learner-
the expansion and innova- such as yellow fever, plague, ty- their knowledge and skills with the centered orientation in a short
tion of educational practice. phoid fever, and smallpox. De- ability to work and communicate period.
(Am J Public Health. 2015; cades later, the need arose for well in interdisciplinary and often However, reengineering our
105:S88S91. doi:10.2105/ innovation and change in the international teams. educational programs presented
AJPH.2014.302478) ESPM. Mexico was suffering a se- Bearing in mind this enormous a major challenge, because it in-
vere economic crisis, and research educational challenge, in 2005 volved the complete transforma-
and information was needed for the INSP sought international ac- tion of the classroom experience
effective decision making about creditation from the Council on as well as professor methods and
the future of the Mexican public Education for Public Health and evaluations.5 The challenge was to
health system. moved to the competency-based transform the previous pedagogi-
This need brought about the educational model, transforming cal structurewhich relied exclu-
foundation of the Instituto Nacio- the approach of its educational sively on traditional lecturesinto
nal de Salud Publica (INSP; Na- programs. INSP adopted new ways one that allowed more discussion,
tional Institute of Public Health) in to blend learning and technology. collaboration, and teamwork, with
1987 by merging the ESPM with The principal actors involved in a focus on the learners. The reor-
two newly created research cen- our educational transformation ientation was centered on learn-
ters: one for infectious diseases, were students, alumni, faculty, ing, problem solving, and narrow-
and the other in public health.2 employees, and the community. ing the relation between theory
Since then, the INSP has aimed By 2006 the INSP was accredited and practice.
to improve health and well-being by the Council on Education for We focused on integrating new
by training the public health Public Health, becoming the rst pedagogical tools such as case

S88 | Commentary | Peer Reviewed | Valladares and vila American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
 COMMENTARY

studies, learning-based projects, teaching strategies, adult learning, (DrPH), and every three years the a commercial platform. Before
and collaborative work. INSP has technology in the classroom, and academic body reexamines the 2005 there was only the full-time
been working to increase learner evaluation in a competency-based competencies to guarantee that program. Since then, the virtual
competencies through resolving program. To achieve these goals they are appropriate and relevant. and executive programs have
case studies under the training of we developed a 160-hour di- To respond to the various needs been expanding, and in 2013,
experts and engaging in intellec- ploma course for our faculty. of our students, the MPH is now 50% of the graduates came from
tual tasks specic to a particular The diploma course was well offered in three formats: a full- our full-time programs, 27% from
work setting. Abstract thinking received among the academic time program, an executive ver- the virtual program, and 23%
skills, required in many technical community. Since 2006, about 50 sion offered on weekends, and from the blended executive
jobs today, are learned effectively (30.5%) faculty members com- a program that is completely program.
through a combination of practice plete the diploma course every online. Generally, the MPH full- The online MPH program, like
and explicit teaching in a mean- year, and it is now offered online. time program receives younger the other formats, has good grad-
ingful context. In addition, the INSP organizes students who want to pursue a ca- uation rates: more than 80%,
We realized quickly that one practical teaching workshops reer in public health, whereas the which is higher than is that which
of the main challenges was not twice a year to strengthen faculty executive program is designed to specialized literature in the eld
only training the professors in competencies. Some topics include train public health ofcials work- has shown for general online pro-
new teaching strategies and conceptual maps, rubrics, and so- ing in federal programs in Mexico grams9; this is owing to the suc-
learning-based technology but cial networks for educational pur- City and the surrounding areas. cessful combination of synchro-
also reforming commonly used poses; learning styles; coaching; Students in the executive program nous and asynchronous activities.
teaching materials. In other words, and the use of case studies. With meet on Fridays and Saturdays INSP takes special care to ensure
we had to untrain the faculty from this yearly teacher-training pro- and work online during the week. the commitment and dedication of
teaching their old way so they gram, the faculty members are This blended format has proven to students working at middle and
could incorporate new change and developing the necessary skills to be very effective, as demonstrated higher positions at the State Min-
innovation in the classroom. Pro- teach a competency-based curric- by graduation rates of between istries of Health. In the past three
fessors in public health, as in many ulum.3 87% and 91%which are consis- years, more than 400 students
other elds, tend to rely on tradi- INSP launched the e-portfolio tently higher than are those for the have graduated from the three
tional teaching methods. They are strategy.6 An e-portfolio is a com- other two formatsand by student types of program.
used to giving long lectures with pilation of the work that students and employer satisfaction. In 2008, the INSP offered
little interaction (as they them- have done to reect the way they We designed the online MPH a DrPh program for the rst time.
selves received as students); have learned.7 Assessing progress as a complete virtual program to We designed this innovative pro-
therefore, this is the role in which with an e-portfolio provides evi- serve all Mexican states and Latin gram to train public health leaders
they tend to be most comfortable. dence of students competencies. American countries. The courses in Mexico and Latin America, us-
The adopted paradigm places This strategy supports students are developed on an asynchro- ing a b-learning (blended learning)
the student in the center of the intellectual growth and facilitates nous platform, which allows pro- format. The main goal of the DrPh
educational process. The students their responsibility in their own fessors to manage their courses program is to train leaders who
become active agents that search learning process.8 Today, selected and establish dynamic communi- are oriented toward on-the-
for information. They must ana- professionals are piloting the pro- cation with their students through ground jobs in a variety of public
lyze and apply the information, gram, and good results are online learning activities. This ed- health settings. This is different
compare and synthesize it, and expected in the near future. ucational platform facilitates ac- from the PhD program, which
relate everything they learn to real cess to relevant course informa- mainly prepares students for aca-
work situations that will prepare DIVERSE ACADEMIC tion. The format also allows demic work and research. The
them for what they will confront PROGRAMS TO MEET professors to design course activi- need for this type of professional
outside the classroom. So, one of LEARNERS NEEDS ties, customize the format of their became evident two decades ago,
the main tasks set before us at the documents, and apply collabora- and in recent years the need has
institute was to transform how INSP has followed the growing tive tools and assessments. increased, as new challenges in
professors taught and the educa- trend of variation in learning and A tutor is assigned to every 15 public health arise and require
tional resources they used. now offers diverse formats for its students. The students dedicate more of these types of leaders.10
Faculty members needed a mo- academic programs. We have approximately two hours daily to Students attend the INSP during
tivation to be and an interest in created 30 educational programs, individual and group assignments. fall and spring semesters for a
being trainedand untrainedto including Master of Public Health They also go online in real time month. During this time, they
fully implement the new educa- (MPH), Master of Science in public once a week for two hours and take core doctoral seminars. The
tional paradigm. The training we health (MSc), Doctor of Philosophy work with their professors rest of the year they follow online
required for faculty included (PhD), and Doctor of Public Health and their colleagues using courses and work with tutors on

Supplement 1, 2015, Vol 105, No. S1 | American Journal of Public Health Valladares and vila | Peer Reviewed | Commentary | S89
 COMMENTARY

their dissertations. To participate resources. Since 2010 all face-to- To ensure high-quality pro- with funds from the International
in this program, students are re- face programs have included a grams, courses, and resources, in Development Research Centre to
quired to work in a leadership virtual education platform. This 2006 the INSP founded the De- collectively promote the ecohealth
position in the health systems, and allows students to review online partment of Educational Innova- approach for the control of
their practicum has to be done in materials and supports the con- tion and Technology with a multi- vector-borne diseases in Latin
a different institution, usually one cept of an inverted classroom in disciplinary group of instructional America, has trained 147 tutors in
related to their dissertation. which students review all the ma- designers, multimedia profes- six countries in the region with
terials and videos at home. They sionals, Web experts, program- a blended educational format.
UPGRADING THE can then use class time to discuss mers, and online tutors. Since Also, our network with Harvard
LEARNING ENVIRONMENT the materials and work in teams. 2010, this department has had 18 and the Mexican nongovernmen-
INSP has developed massive full-time personnel who work with tal organization Tmatelo a Pecho
INSP has maintained a continu- online open courses on inuenza faculty members to develop, im- (Take It to Heart) has trained more
ous education program that has and cholera in response to recent plement, and evaluate all educa- than 3000 health professionals to
been strategic for maintaining an epidemics in Mexico in conjunc- tional programs. work in breast cancer prevention.
up-to-date public health workforce tion with the Ministry of Healths We have been able to offer In all cases, collaboration results in
in the elds arising in public strategy. These courses reached education that includes online, stronger and better courses. Al-
health. The ministries of health at more than 70 000 health profes- blended, project-based, and though the consensus process
federal and state levels are directly sionals, who completed the course community-based learning. Our takes time, it is worth the effort to
involved in developing and - during different health emergen- programs are achieving better collaborate with the best possible
nancing the annual program, and cies in Mexico. Another course, student engagement and satisfac- professors and produce the best
they promote personnel participa- Early Breast Cancer Detection, is tion because the content is rele- materials and content. These col-
tion. The education program aids being developed to train primary vant to local, national, and global laborations create partnerships
in lining up the objectives of the care doctors and nurses of the situations and because it can be that advance the public health
INSP with the priorities and needs Mexican Institute of Social Secu- customized to the specic needs of agenda and strengthen health
of the Ministry of Health. Our rity; it will reach approximately our students. The content also is systems by building a strong and
educational program, through the 16 000 primary care profes- customized to meet the needs of well-trained workforce. j
three formats, offers about 250 sionals. the Mexican frontline health
courses with approximately In 2010 the INSP designed and workforce. About the Authors
10 000 professionals enrolled an- implemented a training program By creating an innovative Laura Magaa Valladares and Mauricio
nually. for early breast cancer detection, learning environment, the INSP Hernndez vila are with the National
Institute of Public Health of Mexico,
To contribute to the public focusing on risk factors, self- has positioned itself as a leading Cuernavaca, Morelos, Mexico.
good and strengthen its human examination, methods of diagnosis, institute, both nationally and in- Correspondence should be sent to Laura
resources, the institute is devel- current laws and regulations, and ternationally. This innovation has Magaa Valladares, PhD, National Institute
of Public Health of Mexico, Avenida
oping an online repository of the survival and reincorporation contributed to the improvement in Universidad No. 655, Col. Santa Mara
learning tools, resources, and into everyday life of breast cancer education and the assessment of Ahuacatitln, C.P. 62100, Cuernavaca,
multimedia. With this repository, patients. This addressed many learning outcomes, equity, cost- Morelos, Mexico (e-mail: lmagana@insp.
mx). Reprints can be ordered at [Link]
professionals, students, and faculty primary health care staff groups in effectiveness, and student satisfac- [Link] by clicking the Reprints link.
can more easily augment their three states of Mexico. An ef- tion. INSP will continue to reengi- This article was accepted November 19,
learning experiences. By using ciency rate higher than 80% was neer its programs to ensure the best 2014.

educational technological tools, obtained after two years of imple- practices in public health education
the learning environments we menting the program. and educational innovation. Contributors
have developed at the INSP have In the near future the INSP In the years to come, we will L. Magaa Valladares generated the
enhanced human resources. will develop larger online open continue to innovate and provide main ideas of the article, gathered and
analyzed the information, and wrote
These educational technological courses to reach the public health personalized learning, using state- the rst and nal drafts of the article.
tools have beneted other health workforce, which needs to update of-the-art technology and services M. Hernndez vila reviewed the article,
sectors as well as the general skills, learn current on-the-job to reinforce our role as a leader in added relevant information, and cowrote
the nal draft of the article.
public by disseminating evidence- competencies,11 and build work- public health education in the re-
based knowledge. force capacity across sectors.12 gion and globally. This role is
Acknowledgments
By including information and Student competencies are evalu- further solidied through cultivat- The development of innovative learning
communication technology in our ated through the activities, exer- ing collaborative and global alli- materials has been possible thanks to
programs, we are using social net- cises, presentations, and exams ances with other academic and diverse nancing sources, such as Mea-
sure Evaluation Phase III Amendment No.
works, mobile applications, and that are incorporated into the in- public health institutions. For in- 1 (Agreement GHA-A-00-08-00003-00);
other technologies as teaching structional design of each course. stance, the Ecohealth Alliance, social determinants of health: building

S90 | Commentary | Peer Reviewed | Valladares and vila American Journal of Public Health | Supplement 1, 2015, Vol 105, No. S1
 COMMENTARY

sustainable research capacity for health 9. Elluminate, Inc. The impact of syn-
and its social determinants in low- and chronous online learning on academic
middle-income countries; the leadership institutions customer experiences from
initiative and development of ecohealth K---12 and higher education. 2009.
and vector-borne diseases by the Inter- Available at: [Link]
national Development Research Centre; com/downloads/whitepapers/
Mexican State Ministries of Health in [Link].
Morelos, Jalisco, Nuevo Len, and Puebla; Accessed on April 24, 2014.
the Instiuto Mexicano del Seguro Social 10. Curtis LM, Marx JH. Untapped re-
(Mexican Social Security Institute); and sources: exploring the need to invest in
the Estrategia Integral de Atencin a la doctor of public health-degree training
Nutricin (Comprehensive Care Strategy and leadership development. Am J Public
for Nutrition). Health. 2008;98(9):1547---1549.
The authors thank the teaching---
learning innovation team of the National 11. Meneses EL, Sanchez-Serrano JLS,
Institute of Public Health for supporting Cano EV. La Expansin del Conocimiento
and developing innovation tools for the en Abierto: Los MOOC. Madrid, Spain:
educational model with the use of infor- Octaedro; 2013.
mation and communication technologies 12. World Health Organization. Helsinki
that follow the competency-based ap- StatementFramework for Country Action.
proach. Geneva, Switzerland; 2014.

References
1. Gudio-Cejudo MR, Magaa-
Valladares L, Hernndez-vila M. La
Escuela de Salud Pblica de Mxico: su
fundacin y primera poca 1922---1945.
[The Mexican School of Public Health: its
founding and rst years: 1922---1945.]
Salud Publica Mex. 2013;55(1):81---91.
2. Frenk J, Ruelas E, Gmez-Dants O,
Lpez-Cervantes M, Magaa-Valladares
L, Gudio-Cejudo MR. Modernizacin
acadmica de la Escuela de Salud Pblica
de Mxico: 1983---1995. [Academic
modernization of Mexican School of
Public Health: 1983---1995.] Salud Pub-
lica Mex. 2013;55(5):528---535.
3. Carraccio C, Wolfsthal SD,
Englander R, Ferentz K, Martin C. Shifting
paradigms: from Flexner to competencies.
Acad Med. 2002;77(5):361---367.
4. Klein-Collins R. Sharpening Our Fo-
cus on Learning: The Rise of Competency-
Based Approaches to Degree Completion.
Champaign, IL: National Institute for
Learning Outcomes Assessment; 2013.
5. Lage MJ, Platt GJ, Treglia M. Invert-
ing the classroom: a gateway to creating
an inclusive learning environment. J Econ
Educ. 2000;31(1):30---43.
6. Mc Colgan K, Blackwood B. A
systematic review protocol on the use of
teaching portfolios for educators in fur-
ther and higher education. J Adv Nurs.
2009;65(12):2500---2507.
7. Yancey KB. Digitized student port-
folios. Available at: [Link]
eportfolio/les/2010/09/Yancey-
[Link]. Accessed on March 12,
2014.
8. Chen H, Penny-Light T. Electronic
Portfolios and Student Success: Effective-
ness, Efciency, and Learning. Washing-
ton, DC: Association of American Col-
leges and Universities; 2010.

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