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International Field Epidemiology Training Program (IFETP) -
Thailand
Curriculum for the 14th Batch of IFETP - Thailand



       Challenges
The modern world is facing many new health threats because of a multitude of factors, including an increase in population movement, the degradation of the natural environment, risky human behavior, the irrational use of drugs (e.g. antibiotics), and the increase of drug resistance among infectious agents. Diseases are emerging and re-emerging as non-communicable diseases are increasing.
A common problem for most Asian countries is that there are limited resources allocated towards health, financial and human resources. Public health systems are threatened and many countries find that they are compromised in their ability to control or prevent disease.


       Response
To ensure the protection of public health, countries need competent epidemiologists and public health professionals that can:
Design and implement effective surveillance systems to identify and monitor threats to health and their contributing factors,
Understand and utilize surveillance information to aid health planning, monitoring and evaluation,
Detect health problems early and initiate appropriate investigations that lead to proper intervention measures, and,
Create an international collaborative network to fight against emerging health problems effectively.


       Training Center Profile: Field Epidemiology Training Program (FETP), Thailand
1980: FETP established at the Ministry of Public Health in Thailand
1985: Certified by The Thai Medical Council for specialty training in Preventive Medicine
1988: FETP was designated WHO's Collaborating Center for Field Epidemiology Training
1998: International FETP offered to other Asian countries
Since inception, over 200 Thai and 35 International FETP alumni have been responsible for various health programs conducted in Thailand and other countries.
Each year, FETP conducts between 20-30 outbreak investigations and field research projects.
Active participants include knowledgeable, multidisciplinary and skilled faculty members and lecturers from Thailand's Mahidol University, Chulalongkorn University, Khonkaen University, Chiangmai University, and Songkhla-nakarind University.
Telecommunication and computer facilities are supported by the Computer Center of the Ministry of Public Health.
Access to technical information can be obtained from our libraries and the WHO Documentation Centers located at the Ministry of Public Health.


       Program Objectives
General Objective:
To give health practitioners the skills and experience in field epidemiology as they become competent leaders in public health.
Specific Objectives:
Obtain epidemiological skills to identify public health problems and make recommendations for priority health conditions
Effectively manage and respond to outbreaks and other urgent public health events
Enhance the current surveillance system
Become trainers in Field Epidemiology
Enhance cross-border health network.


       Program Design and Expected Benefits
The two-year program is designed for physicians who would like to improve the health of the population through the use of epidemiology. The philosophy of FETP is "learning-by-doing." Thus, trainees work with current public health issues utilizing epidemiological tools. To apply epidemiology to public health concerns, trainees return to their own country to complete program assignments that involve situation analysis, outbreak investigation and surveillance evaluation.
Expected benefits:
To the participant:
Gain knowledge and skills in modern epidemiological and statistical methods through work experience.
Develop a broad national and international perspective.
Participate in international training activities and meetings.
Network with resource people.
Gain competence in the handling of word processors, a statistical package and graphic presentations.
Published work
Certification of accomplishment by WHO, Ministry of Public Health Thailand, and the US CDC.
To the participant's country:
Human resource development.
Strengthened national surveillance and response.
International collaboration in priority health programs.
To the region:
Strengthened regional surveillance and control activities.
Partnership across international borders.


       Overview of Curriculum and Requirement
The course will officially start on 26 May 2011 at the Ministry of Public Health, Thailand as the main venue. Main events are:

First component:(10 weeks) The main activities are:
- Orientation
- Training Course on Surveillance and Rapid Response for a Public Health Emergency (6 June to 1 July 2011)
- Field trip for surveillance system evaluation
- Epi data workshop
- Participate in an outbreak investigation
- Develop and present draft proposal for situation analysis

Second component: All trainees go back to their own country to conduct studies and outbreak surveillance per the program's requirements. Trainees are requested to return to the FETP training center for three weeks at six-month intervals to present their work progress, attend workshops and complete examinations. Distance-based consultation and on-site supervision (approximately two times per year) from FETP advisors will be provided as well as support and supervision from identified advisors in the trainee's country. The tentative schedule:
- First seminar: February 2012
- Second seminar: August 2012
- Third seminar: February 2013
- Fourth seminar: May 2013

Third component: (Up to 4 weeks) Visit US CDC or another relevant institution. The tentative date for this visit is April 2013.

Requirement
During the two-year training period, each trainee has to conduct work per the program's requirements. This work should be finished within the two-year training period and a full report or manuscript must be submitted. The work assignments include:
- 1 Situation analysis
- 1-2 Outbreak investigations
- 1 Surveillance system evaluation or field research
Experience (optional)
- International fellowship
- Presentation (oral or poster) at an international conference
- Submit a full report or manuscript for publication


       Monitoring and Evaluation
Evaluation is based on continuous monitoring by the advisor and other faculty members. Faculty members closely monitor trainees in four aspects:
1. Skills in performing an epidemiological study and investigation
2. Responsibility and quality of work
3. Ability to work with colleagues
4. Basic knowledge in epidemiology, biostatistics and competence in applying epidemiology to public health (asessed through at least 60% from oral examination and manuscript or take home examination).
Evaluation scale has three levels: pass, fail and conditional pass.
o If the trainee fails at least one of the four aspects, they have failed the entire program.
o Trainees must submit all reports in order to get the certificate from the program.


       Evaluation Methods:
I: Performance Report (every six months). The topics to evaluate include:
1.1 Situation Analysis
- Proposal
- Presentation of the proposal
- Presentation of the results
- Report/ Manuscript
1.2 Epidemiological Investigation
- Presentation
- Report/ Manuscript
1.3 Surveillance System Evaluation
- Proposal
- Presentation of the results
- Report/Manuscript
1.4 International Fellowship
- Mentor evaluation
- Trainee evaluation: Trainees have to submit output that they get from the CDC or the other institution they visited
1.5 National or International Presentation Conference
1.6 Publication
II: Written, Oral Examination, Report and Manuscript
The program requires all trainees to complete an oral examination and a written examination during the two-year program to demonstrate their knowledge. At the end of the first year, one report of the work performed during the first year should be submitted to the training center. Toward the end of the second year, the submission of a manuscript will be used to assess the trainee's knowledge.
Oral examination
Trainees should bring their Portfolio to examination committees. The portfolio should cover the trainee's work, including outbreak investigation, situation analysis, evaluation of a surveillance system and other work that demonstrate performance.
Areas of oral examination are:
- Epidemiology knowledge based on trainee's work.
- General knowledge of Epidemiology and biostatistics.
- Natural history of the diseases related to the trainee's work.


       Schedule of Examinations and Evaluations:
Year in ProgramDateExamination/Assessment
1st year February 2012 - written/oral examination
- portfolio
2nd yearAugust 2012- one final report of first year's work
February 2013- submit one manuscript
- written/oral examination
- portfolio
- assess criteria for going to an international fellowship (details under International Fellowship)
May 2013- international fellowship report
- portfolio
- assess criteria to receive FETP certificate (see details below)


       Criteria to receive FETP certificate
Pass evaluation in all aspects
Submissions of all reports (excluding surveillance evaluation or research) that can be used to assess progress.
Note: When trainees are ready to submit their final report/ manuscript, they will include a cover sheet that contains the signature of their advisor and the FETP director. This will fulfill the completion of each work.


       Supervision and Supervisors
The supervision system of IFETP depends on the input from both training centers, the FETP advisor and the advisors identified in the trainee's country, the country technical advisor and the country supervisor. For each assignment, the trainee will select a topic with the approval of each supervisor; the FETP advisor must also agree with the plan to conduct work. If an outbreak occurs, the trainee will conduct an outbreak investigation instead of working on a selected topic.
During the period the trainee visits the FETP training center in Thailand, FETP advisors (main and co-advisors) will play a major role. While the trainee is in their own country, the country technical advisor and country supervisor are responsible for the training. However, distance-based supervision with the FETP advisor, via e-mail or telephone, should be done as well on a regular basis. The FETP advisor team should conduct on-site visits to the trainee's country twice a year.


       On-site Supervision
One to two FETP advisors, or a relevant resource person, will visit the trainees's country to supervise field work or other activities. One main objective is to discuss the study plan and potential problems of the trainees with local supervisors and/or their boss. In a country that does not have a local supervisor, the on-site supervision will be done twice a year. In the case that the trainee has local supervisor, the on-site supervision will be reduced to once a year. However, this does not include the field supervision during an outbreak investigation. The frequency of the visits will be adjusted depending on the case.


       Advisor in the Country
Country technical advisor
- Provide day-to-day supervision of the trainee's work for each assignment
- Give advice on the selection of the topic for each assignment of the trainee
- Help in the steps of planning for data collection, data analysis, preparation of presentation
- If possible, accompany and supervise trainees in their first outbreak investigation
- Help to prepare presentation for scientific meetings
- Edit every report, including the proposal
- Give additional knowledge or learning material to the trainees as appropriate
- Advise trainee to contact local experts in the event special expertise is needed
- Encourage the trainee to submit the final report or manuscript on time.
- For special tasks such as writing an abstract for the international meeting or writing a manuscript, this is up to the interest or availability of the advisor
- Monitor the progress of work, knowledge and skills (e.g. field work, computer and communication)
- Evaluate trainee performance every 6 months
Prerequisites
- Have formal training in public health and years of field experience
- Available to work with the trainee on average once a week
Country supervisor
- Provide help for policy commitment of the trainee's studies; especially ensure adequate time allocation for routine work.
- Facilitate the logistics and financial support of the trainee's work (e.g. situation analysis, outbreak investigation and surveillance system evaluation)
- If the trainee has difficulty in accessing an outbreak (especially for the notification part or for the engagement of field work), help the trainee find an outbreak
Prerequisites
- Work in public health system of the country
- Have authority to work with the trainee


       Advisor in Thailand
Main advisor
- Supervise each assignment, including field work such as outbreak investigation (if possible) and surveillance evaluation
- Make decisions, under agreement with the country supervisor/advisor, regarding the selection of a topic for each assignment
- Attend trainees' presentation in FETP scientific meeting (held on Mondays)
- Edit every report, including the proposal of the trainees
- Provide feedback to the manuscript the trainees submit to FETP during their second year of evaluation - Encourage the trainees to submit the final report or manuscript on time.
- Help the trainees write an abstract for the international presentation
- Give additional knowledge or learning material to the trainees as appropriate
- Visit trainees in their country twice per year to follow up on the work progress, identify obstacles (administration and technical) and find solutions with country advisor and supervisor
- Monitor the progress of work, knowledge and skills (e.g. field work, computer and communication) of trainees
- Participate as a committee member that evaluates the oral examination of the trainees
- Evaluate trainee's performance every six months
Prerequisites
- Has formal training in field epidemiology
- Has international work experience
- Has time to work with trainee at least two to four days during the trainee's visit to the training center and has time to visit the trainee in their country for at least two to three days per visit
Co-advisor
- Help the main advisor supervise trainees as they prepare each assignment, including the presentation done in each visit to Thailand
- Help provide budget information related to the trainee's work
- Supervise the trainee as they prepare for the MMWR reading, journal club and tutorial section of the weekly scientific meeting at the FETP training center
- Help the main supervisor monitor the progress of trainees
- Attend trainees' presentation at the FETP scientific meeting
- Give additional knowledge or learning materials to the trainees as appropriate
Prerequisites
- Has formal training in field epidemiology
- Has time to support trainees when the main advisor is unavailable