I served my summer 2013 practicum as a Public Health Leader in Practice with the Granville-Vance District Health Department located in Oxford, NC. Granville-Vance is a combined department serving a diverse population of 105,000 in a mostly rural region of North Carolina. The Public Health Leaders in Practice Program, sponsored by the North Carolina Institute for Public Health, places students in local health departments throughout the state where they spend 8 – 10 weeks working on specific projects of interest to the department.
Deaths from opioid analgesic overdose is a growing problem both in North Carolina and nationwide. My initial work with the department focused on assessing the extent of opioid overdose mortality in Granville and Vance Counties, and investigating the available options for policy interventions. I participated in fact-finding conferences with policy experts with Northern Piedmont Community care, gathered background information from health providers, and worked with the Health Director to evaluate the department’s capacity to implement an intervention.
While working on the opioid overdose issue I became intimately familiar with local health department operations and observed how Health Directors lead their organizations. WIC (Women, Infants and Children), Home Health, Care Coordination for Children (CC4C), Maternal and Child Health, and Health Education are just some of the many community service programs I worked with during my practicum. I participated as an active member of department’s Quality Improvement team, where I provided research support to improve efficiency and customer service. An important function of health department leadership is maintaining links with outside organizations. The Health Director enabled me to accompany her to meetings state health officials, partner agencies, and physicians’ groups where I gained a deep understanding of communications and leadership skills.
Mid-way through the practica I found myself assigned to an exciting new role: Project Manager for the department’s initiative to obtain a state license to operate a Home Hospice within Granville County. As Project Manager I directed the work efforts of the department staff and coordinated with a team of consultants, attorneys, financial analysts and private sector partners to assemble a competitive application on a very short time scale. The work was not exclusively internal to the department. As part of the effort we assembled a team of department staff to meet one-on-one with health providers in the community to garner their support and commitment to use the department’s Home Hospice if approved. Thanks to strong efforts on the part of the entire team the application was delivered on schedule.
Before I started the practicum I expected to focus my efforts on a single project and produce a written deliverable at the end of the process, much like an academic course. Luckily this expectation was dispelled almost immediately as I was drawn into multiple programs and slowly became an integral member of the health department staff. The most rewarding aspect of the practicum was the Project Management experience; working with a group of motivated professionals dedicated to the success of the project proved to be an outstanding lesson in team dynamics and leadership.
I feel very grateful that my practicum experience far exceeded my expectations. My good fortune was not solely due to my own efforts; I spent time talking with my advisor and other professors when researching practicum opportunities. I credit their advice in steering me to a program that matched my background and interests. I recommend to my fellow students to start your practicum search early! Many programs are very competitive, draw many applicants, and have strict submittal deadlines. Starting your search 12 months prior to your desired timeline is not too early!
Over the summer, I worked on multiple projects related to post-market surveillance of medical devices. I learned how to work with hospital discharge and claims data, and contributed to two systematic literature reviews. I gained hands-on experience while helping to implement the National Medical Device Postmarket Surveillance Plan and FDA’s Sentinel Initiative.
I went to usajobs.gov and saw a Pathways posting for a position at FDA. They were looking for public health students to help work on systematic literature reviews and various studies. Each intern was assigned a specific mentor and project. I was offered the opportunity to work on the uterine fibroids study under a fabulous mentor, and I gratefully accepted!
I was surprised by how large FDA is! I worked in in the Center for Devices and Radiological Health (CDRH), Office of Surveillance and Biometrics (OSB), Division of Epidemiology (DEPI) where I was a Medical Device Fellowship Program (MDFP) Summer Intern. Every employee I spoke with cared deeply about their work and the mission of their division or center. I was inspired by the atmosphere cultivated by the employees. I learned a lot about teamwork and leadership through this immersion.
The most challenging aspect of working at FDA, it seems, is keeping in mind the impact of each decision we make in our day-to-day work. The stakes are much higher when you work for a national regulatory agency, and everyone experiences that pressure.
I worked on two systematic literature reviews, including one for a reclassification panel regarding Extracorporeal Membrane Oxygenation (ECMO) therapy. In September 2013 the results of the ECMO systematic literature review were presented at a panel meeting. The FDA Advistory Panel recommended ECMO to be reclassified from Class III to Class II with special controls. I also used hospital discharge data from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to compare robotic and non-robotic assisted hysterectomies, and presented my work in a poster session attended by FDA Commissioner Margaret Hamburg. In addition, I began working on a comparative effectiveness study that compares surgical treatment options for uterine fibroids using claims data.
My advice for students beginning to look for practicum opportunities is start early! I started looking for summer internships in the fall semester. I attended the NC Master’s and PhD Career Fair, and information sessions offered by SPH and Career Services. I also did a lot of research online. I kept an ongoing list of opportunities that captured my interest, ranked the opportunities, and applied for as many as I could by order of rank and deadline. I spent my winter break filling out applications and writing essays. In the end, I was offered four of nine paid internships I applied for.
“Having worked on quality improvement projects in health care prior to graduate school, I was curious about how quality improvement (QI) is applied in public health practice. I applied for the Cappie L. Stanley Public Health Quality Improvement Internship at the Center for Public Health Quality (CPHQ) in Raleigh in spring of last year.
“One thing that really drew me in were the innovative projects on the CPHQ website, especially the Improvement Map (iMap), which helps health departments and other public health organizations choose evidence-based interventions based on the resources they have. Some iMap initiatives focus on improving internal processes within the organization and others focus on improving community health outcomes. During my practicum, I helped design and test a user-friendly interface for entering evidence-based interventions. I also wrote an After Action Report for the Wake County Community Health Assessment (CHA) team to summarize the lessons learned from the first joint CHA process between the health department, local hospitals, and other partners.
“In addition, I had the chance to attend QI training sessions and visit several health departments in our state. During a visit to one health department, I attended a Community Action Advisory Board meeting; I subsequently reviewed proposals for Childhood Obesity community action plans and provided recommendations to the Director of Community Initiatives.
“My advice for other students is to start looking for practicum options early, especially in global health, as many travel scholarships have Fall semester deadlines. Look at job postings and websites of organizations in your area of interest to learn about their work and the skills those organizations are looking for, and use the practicum as an opportunity to meet the team. While high profile internships have their appeal, I found that it’s equally beneficial to think smaller for your practicum and choose an organization where you can build a relationship with a good mentor. Some of the most rewarding aspects of my practicum were learning from and working with a fun and supportive team at CPHQ and building relationships with local public health professionals (including several UNC-MPH alumni!).”
“I wanted to use my practicum as an opportunity for an international experience. I also wanted to expand my business analysis and quality improvement skills. I contacted several Gillings School of Global Public Health professors to consider options and learned about Jacaranda Health from Dr. Rohit Ramaswamy.
“Jacaranda Health is a social venture to create a scalable model of maternal health services providing high-quality, low-cost care for women in urban East Africa. Success within this model relies on implementing proven low-cost interventions and efficient business processes. Jacaranda Health aims to incorporate continuous quality improvement into clinical and business processes to meet the goals of high quality and low cost care.
“As a quality improvement consultant at Jacaranda Health, I collaborated with clinical and business leadership to identify three high-priority process areas for improvement: (1) inventory management & ordering, (2) housekeeping & infection control, (3) dietary & food safety. Through interviews, shadowing and observations, I documented a future state for these process areas. The documentation included supporting process documents, such as checklists, sign-off procedures, inventory logs and order forms to improve process integrity, oversight and sustainability. I developed an implementation plan for the inventory management process and continuous quality improvement will be incorporated into the new inventory management process.
“Getting to know people living in different cultures is always fun. Doing that in the context of improving maternal health doubled the fun. It was highly fulfilling to watch Kenyan mothers leave the clinic with their one-day-old healthy babies and think that maybe I played a small role in making that experience better for those mothers.
“Two challenges were important to address for success of the project. Prioritizing my goals so that I could accomplish tangible work within a six-week time frame required effort. There was a lot that I wanted to do with only a limited amount of time available, so continually focusing on specific goals was important. Also, identifying a project owner who would be responsible for sustained implementation once I returned to the United States was critical.
“My adviser, Dr. David Steffen, gave me great advice: before deciding on a practicum, take some time to thoroughly consider what you want out of the practicum. Is it a step forward for your professional exposure within public health? Is there a personal experience you would like? There are lots of options…take a risk and have fun!