Applied epidemiology elective at the Centers for Disease Control and Prevention, 1997-2002.

The Division of Applied Public Health Training (DAPHT) at the Centers for Disease Control and Prevention (CDC) is responsible for training health professionals in preventive medicine, epidemiology, and other applied public health sciences. To increase awareness of and interest in public health and epidemiology, DAPHT has offered an elective rotation to fourth-year medical and veterinary students since 1975. The elective program is administered from July through June of the following year, and a student's rotation ranges from 6 to 8 weeks. In 1999, American Journal of Preventive Medicine (AJPM) published a description of the elective's progress—from its inception in 1975 through June 1997—including demographics of participants, the types of assignments, and the number who returned to CDC for the 2-year Epidemic Intelligence Service (EIS) postdoctoral program in applied epidemiology.1 We have since compiled data from July 1997 through June 2002 to update AJPM's readers on the progress of the epidemiology elective.

From 1975 through June 1997, enrollment in the elective peaked at 58 students during the school year July 1996–June 1997. Since July 1997, the peak enrollment was 70 students during the July 2001–June 2002 academic year. Table 1 presents the types of assignments, background, and other information about the participating students. The trend toward greater interest in infectious disease assignments may continue because of the intense media attention surrounding the public health response to recent outbreaks of West Nile Virus, anthrax, Severe Acute Respiratory Syndrome (SARS) and monkeypox.

Table 1

Comparison of CDC epidemiology elective for medical/veterinary students, 1975–2002

Years	Type of assignment: n (%)	School of origin: n (%)	Academic years: average no. of students	Students in field investigation: n (%)
1975–June 1997	Infectious disease: 438 (69)	Medical: 548 (87)	1975–1979: 16/year	278 (44) through June 1997
	Environmental health: 95 (15)	Veterinary: 84 (13)	1980–1989: 29/year
	Chronic disease: 59 (9)Other*: 40 (7)		1990–1997: 42/year (Total range: 11 in 1976 to 58 in 1997)
July 1997–June 2002	Infectious disease: 252 (77)Environmental health: 21 (6)Chronic disease: 26 (8)Othera: 28 (6)	Medical: 246 (75)Veterinary: 81 (25)	1997–2002: 56/year (Total range: 43 in 1998 to 70 in 2002)	131 (40) through June 2002

Other includes state or local health departments, occupational health, public health surveillance, injury prevention, and health informatics and computer science.

Currently evaluation of the epidemiology elective is informal, so determining its effect on the students is difficult. Beginning this academic year, we plan to institute a formal evaluation to assess the effect of the epidemiology elective. As one measure of influence, of the 728 students participating in the elective through June 1998, almost 15% (104) had enrolled in the EIS program by March 2003. (Note that medical students must complete at least an internship before they apply to EIS and most complete a residency in a clinical specialty.)

While the 6- to 8-week epidemiology electives will continue to be a valuable introduction to applied public health, DAPHT has worked to identify ways to allow students a more in-depth and integrated CDC experience. With a grant from The Pfizer Foundation and Pfizer Inc. through the CDC Foundation, DAPHT is developing a 10–12 month fellowship in applied epidemiology for eight competitively selected medical students, beginning in Fall 2004 (i.e., The CDC Experience at www.thecdcfoundation.org/thecdcexperience). The program offers students a combination of didactic training and interactive seminars, participation in applied epidemiology projects (including Epi-Aids and other field investigations), and opportunities to present their work. The students will benefit from direct mentoring by their specific assignment supervisors and the many opportunities to network with public health professionals working in a variety of areas. Although the fellowship assignments will be based primarily in noninfectious disease programs at CDC, the students will be assured a wide range of experiences and opportunities in all fields.

In addition, the fellowship's emphasis on noncommunicable disease and the role of public health in clinical medicine will provide students with a firm grounding in applied public health regardless of their future career paths. Several organizations have underscored the importance of integrating public health concepts into undergraduate medical education.2, 3, 4 Most recently, the Institute of Medicine (IOM), in their report “Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century,” stated that all medical students should receive “basic public health training in the population-based prevention approaches to health.”5 Recognizing this critical interdependence of medicine and public health, CDC is developing training opportunities such as The CDC Experience.