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 contact-hours 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.

II. COURSE DATES / LOCATION

Dates:August 19 – December 14, 2010 (see detailed calendar pages 7-11)

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

Lectures:HSLC Rooms 1306 and 1325 (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 sessionsof 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 eight 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):

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 (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.

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 27-October 1 and November 8-12).

- Final Exam (35%): a multiple choice exam that will take place on December 14 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 pointsbeing 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. Lina Vera-Cala (), 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 hoursonthe 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. Vera-Cala (TA- ). Unless there is an emergency, the course director and course co-director will generally not respond to email from individual students. Should students feel a need to talk directly to the course co-directors (Drs. Nieto and Remington), contacting them right after lectures or during small group discussions would be much preferred (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,

Office hours by appointment:Patty Grubb (, 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,

Office hours by appointment:Patty Grubb (, 265-0516)

Teaching Assistant:Lina Vera-Cala, MD, MSc

PhD Student, Department of Population Health Sciences

Room 636 WARF Building, 265-2389,

Office hours: Tuesday and Thursday, 12:00 Noon-1:00 pm, HSLC 4262

Lecturers (subject to change):

Tom DeLeire, MD
Associate Professor, Dept of Population Health
Sciences
Maureen Durkin, DrPH, PhD
Professor, Dept of Population Health Sciences
Norman Fost, MD, MPH
Professor, Dept of Pediatrics and History of Medicine and Bioethics
Murray Katcher, MD, PhD
Wisconsin Division of Public Health and Professor of Pediatrics
F. Javier Nieto, MD, MPH, PhD
Professor and Chair, Dept. of Population Health Sciences / Thomas Oliver, PhD, MHA
Professor, Dept. of Population Health Sciences
Jonathan Patz, MD, MPH
Professor, Dept of Population Health Sciences and Institute for Environmental Studies
Patrick Remington, MD, MPH
Associate Dean, School of Medicine and Public Health and Professor, Dept of Population Health Sciences
Stephanie Robert, PhD
Associate Professor, School of Social Work
Maureen Smith, MD, PhD
Associate Professor, Dept. of Population Health Sciences

Small Group Discussion Faculty (subject to change):

Below is a list of faculty members from the Departments of Population Health Sciences (PHS), Medicine, Family Medicine, the Wisconsin Division of Public Health, and the La Follette School of Public Affairs who will facilitate and moderate the small group discussion sessions.

Leonelo Bautista, MD, DrPH
Assistant Professor, PHS
Shobhira Chheda, MD
Associate Professor(CHS)
Department of Pediatics
Karen Cruickshanks, PhD
Professor, PHS, Ophthalmology and
Visual Sciences
Christopher Crnich, MD, MS
Assistant Professor
Department of Medicine
David M. Deci, MD
Associate Professor
Department of Family Medicine
Thomas DeLeire, PhD
Associate Professor
PHS and La Follette School of Public Affairs
Maureen Durkin, PhD, DrPH
Professor, PHS
Corinne Engelman, PhD, MSPH
Assistant Professor, PHS
Ronald Gangnon, PhD
Assistant Professor, PHS and Biostatistics
Marty Kanarek, PhD
Professor, PHS
Kristen Malecki, PhD, MPH
Assistant Scientist, PHS
Ana Martinez-Donate, PhD
Assistant Professor, PHS
Kristin J. Meyers, PhD, MPH
ICTR Post-Doctoral Fellow, PHS / John Mullahy, PhD
Professor, PHS and Economics
F. Javier Nieto, MD, PhD
Professor, PHS and Family Medicine
Thomas Oliver, PhD, MHA
Professor, PHS
Jake Prunuske
Assistant Professor, Dept of Family Medicine
David P. Rakel, MD
Associate Professor
Department of Family Medicine
Patrick Remington, MD, MPH
Associate Dean of the School of Medicine and Public Health Professor, PHS
Ajay Sethi, PhD
Assistant Professor, PHS
Amy Trentham-Dietz, PhD
Associate Professor, PHS
David Vanness, PhD
Assistant Professor, PHS
James Vergeront, MD
Wisconsin Division of Public Health
Adjunct Professor, PHS
Mark Werner, PhD
Wisconsin Division of Public Health
Adjunct Assistant Professor, PHS
Whitney Witt, PhD
Assistant Professor, 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 2010

DATE / TIME (am) / LECTURE / HSLC ROOM / PLENARY DISCUSSION OR
SMALL GROUP EXERCISE1 / LECTURER
Faculty
Aug 19
Thu / 1:10-2:00 / (1) Introduction: Understanding the Determinants of Health / 1306 / Nieto
2:10-3:00 / 1306 / Screening for Lung Cancer (Plenary Discussion) / Nieto
Aug 23
Mon / 8:10-9:00 / (2) Epidemiology and the Natural History of Disease / 1306 / Nieto
9:00-10:00 / (1) Outbreak Investigation / Faculty facilitators
Aug 24
Tue / 8:30-10:00 / (1) Outbreak Investigation* / Faculty facilitators
Aug 25
Wed / 8:10-9:00 / (3) The Experimental Paradigm / 1306 / Nieto
Aug 26
Thu / 9:10-10:00 / (4) Measuring and Comparing Risk (1) / 1306 / Nieto
Aug 30
Mon / 8:10-9:00 / (5) Measuring and Comparing Risk (2) / 1306 / Nieto
9:00-10:00 / (2) Randomized Control Trials / Faculty facilitators
Sept 1
Wed / 9:10-10:00 / (6) Intro to Biostatistics Concepts(1) / 1306 / Nieto
Sept 2
Thu / 8:10-9:00 / (7) Intro to Biostatistics Concepts (2) / 1306 / Nieto
9:00-10:00 / (2) Randomized Control Trials / Faculty Facilitators
Sept 8
Wed / 8:30-10:00 / (2) Randomized Control Trials* / Faculty facilitators
Sept 9
Thu / 8:10-9:00 / (8) Study Designs: Case Series, Cohort / 1306 / Nieto
9:00-10:00 / (3) Observational Study Designs / Faculty facilitators
Sept 14
Tue / 8:10-9:00 / (9) Study Designs: Case-Control / 1306 / Nieto
9:10-10:00 / (10) Issues of Interpretation-Bias / 1306 / Nieto
Sept 16
Thu / 9:00-10:00 / (3) Observational Study Designs / Faculty facilitators
Sept 21
Tues / 8:10-9:00 / (11) Issues of Interpretation – Confounding / 1306 / Nieto
9:00-10:00 / (3) Observational Study Designs / Faculty facilitators
Sept 23
Thu / 8:40-9:30 / (12) Addressing Issues of Interpretation / 1306 / Nieto
9:30-11:00 / (3) Observational Study Designs* / Faculty facilitators
Sept 24
Fri / 9:30-10:30 / Review (HSLC 1306) / Nieto
Block 1 Exams and Integration Week (Sept 27-Oct 1)
Sept 28
Tue / 8:30-9:30 / Block 1 Exam (room TBD)
Oct 7
Thu / 9:10-10:00 / (13) Synthesizing and Interpreting Scientific Evidence / 1306 / Nieto
Oct 8
Fri / 9:10-10:00 / (14) Evaluating Diagnostic Tests (1) / 1306 / Nieto
Oct 12
Tue / 8:10-9:00 / (15) Evaluating Diagnostic Tests (2) / 1335 / Nieto
9:00-10:00 / (4) Screening / Faculty facilitators
Oct 13
Wed / 9:00-10:00 / (4) Screening / Faculty facilitators
Oct 14
Thu / 9:10-10:00 / (16) Cost Effectiveness Analysis / 1306 / DeLeire
Oct 15
Fri / 8:30-10:00 / (4) Screening* / Faculty facilitators
Oct 18
Mon / 9:10-10:00 / (17) Ethical Issues in Population Screening / 1306 / Fost
Oct 19
Tue / 9:10-10:00 / (18) Individual and Population Prevention / 1306 / Nieto
Oct 20
Wed / 9:00-10:00 / (5) Community Health Assessment / Faculty facilitators
Oct 21
Thu / 10:10-11:00 / (19) The US Public Health System / 1306 / Remington
Oct 25
Mon / 9:10-10:00 / (20) Community Health Assessment / 1306 / Remington
Oct 26
Tue / 8:30-9:30 / (5) Community Health Assessment / Faculty facilitators
Oct 28
Thu / 8:30-10:00 / (5) Community Health Assessment* / Faculty facilitators
Nov 1
Mon / 9:10-10:00 / (21) Evidence-Based Public Health / 1306 / Remington
Nov 2
Tue / 9:00-10:00 / (6) Programs for Community Health Improvement / Faculty facilitators
Nov 3
Wed / 9:10-10:00 / (22) Changing Individual Health Behaviors / 1306 / Katcher
Nov 4
Thu / 9:00-10:30 / (6) Programs for Community Health Improvement* / Faculty facilitators
Block 2 Exams and Integration Week (Nov 8-12)
Nov 9
Tue / 3:00-4:00 / Review (HSLC 1325) / Nieto, Remington
Nov 10
Wed / 3:30-5:00 / Block 2 Exam (room TBD)
Nov 16
Tue / 9:10-10:00 / (23) Health Care Systems (1) / 1306 / Oliver
Nov 17
Wed / 9:00-10:00 / (7) Evaluating Health Systems / Faculty facilitators
Nov 18
Thu / 8:10-9:00 / (24) Health Care Systems (2) / 1306 / Oliver
9:00-10:00 / (7) Evaluating Health Systems / Faculty facilitators
Nov 19
Fri / 8:30-10:00 / (7) Evaluating Health Systems* / Faculty facilitators
Tue
Nov 23 / 8:10-9:00 / (25) Quality in Healthcare Systems / 1306 / Smith
Wed
Nov 24 / 9:00-10:00 / (8) Evaluating Health Care Quality / Faculty facilitators
Tue
Nov 30 / 9:10-10:00 / (26) Research and Quality Improvement / 1306 / Smith
Wed
Dec 1 / 8:30-10:00 / (8) Evaluating Health Care Quality* / Faculty facilitators
Thu
Dec 2 / 9:10-10:00 / (27) Addressing Health Disparities / 1306 / Robert
Fri
Dec 3 / 8:30-10:00 / 1306 / Unnatural Causes (Plenary Discussion) / Remington
Dec 6
Mon / 9:10-10:00 / (28) Environmental Health: Place Matters / 1306 / Patz
Dec 7
Tue / 9:00-10:00 / (9) Global Environmental Health / Faculty facilitators
Dec 8
Wed / 9:10-10:00 / (29) Global Health / 1306 / Durkin
Dec 9
Thu / 8:30-10:00 / (9) Global Environmental Health* / Faculty facilitators
Dec 10
Fri / 9:00-10:30 / Panel Discussion / 1306 / Faculty facilitators
Dec 13
Mon / 11:00-12:00 / Review (HSLC 1306) / Remington
Dec 14
Tue / 1:00-2:30 / Block 3 Exam

1 Location: cluster rooms (HSLC 2272, 2276, 2280, 2284, 2288) unless otherwise indicated in “HSLC Room” column.

* Indicates general discussion of the exercise.

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