AAMC Reporter: October 2005

The CDC's first class of fellows in applied epidemiology. Front row (l to r): Judd Flesch, Courtney Rowland, Cassie Kuo, Mehul Tejani. Back row: Heidi Brown, Sean Kearney, Nitin Kapur, Barbara DeBuono, Christina Mikosz

New CDC Fellowships in Applied Epidemiology Offer Hands-On Experience

By Anne Blank, Special to the Reporter

Pursuing a longstanding interest in maternal and fetal health, Courtney Rowland spent last year deeply involved in several key investigations: the role of folic acid in preventing encephalocele (a congenital neural-tube defect), the effects of maternal analgesics on congenital cardiovascular malformations, and the incidence of birth defects among infants born to mothers with the viral disease lymphocytic choriomeningitis.

Those would be formidable assignments for any medical researcher, let alone someone who was still a medical student. But that's what Rowland was (and still is) at the University of Kansas Medical School in Wichita, where she is now in her fourth year.

Rowland's investigations, which gave her a chance to learn first-hand about epidemiological methods and public health, were part of a new fellowship program in applied epidemiology offered by the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga.

Under the program—called "The CDC Experience: Applied Epidemiology Fellowship—eight medical students between their second and third, or third and fourth, years of medical school are selected each year to spend 10 to 12 months at the CDC, where they carry out investigations in areas of public health that interest them. They receive stipends of $17,000 to $20,000. The program is financed by Pfizer Inc. and the Pfizer Foundation through a grant to the CDC Foundation, a nonprofit group designed to facilitate collaboration between the CDC and other organizations.

Denise Koo, M.D., M.P.H., director, CDC fellowship program in applied epidemiology

"Graduates of this program have a better population-health perspective that they take back to their clinical practices, and which, I think, will improve their clinical practices," says program director, Denise Koo, M.D., M.P.H. "They will not just treat the patient, but ask: Why does this person have this illness? Why did it happen now? How could it have been prevented?"

The fellows are chosen on the strength of their letters of recommendation; previous jobs, research, and volunteer activities; quantitative and analytic skills, and proficiency in written and oral communication. According to program coordinator Cathy McCarroll, M.P.H., a committee that reviews the fellowship applications tries to match selected students with appropriate projects in the CDC.

Once accepted, the fellows interview in various CDC divisions, selecting those that most closely match their interests. Last year, epidemiology fellows could choose to work with the National Center for Environmental Health, the Office of Minority Health, the National Center for HIV and STD Prevention, the National Center for Chronic Disease Prevention, the National Center for Birth Defects and Developmental Disabilities, or the National Center for Infectious Diseases.

The coursework is largely hands-on, with students actively participating in field investigations, public health surveillance, analytic epidemiology projects, and other practical work experience. Epidemiology fellows also attend seminars and conferences, and participate in a monthly journal club. At the end of their fellowship year, students present their work orally and write scientific analyses of their findings.

Graduates of the program are expected to demonstrate competency in a number of areas, including data analysis and assessment, policy development and program planning, oral and written communication, cultural understanding, basic public health sciences, leadership, and community assessment.

The fellowship program is intended to enhance, rather than replace, a master's degree in public health. Rowland, for example, plans to complete her M.P.H. degree this year, her final year of medical school, and to pursue a career in clinical medicine combined with either public health or academia.

A Great Idea

"What I did at CDC was very specific to my division and the project I was working on, so it gave me a great idea of things you could do with an M.P.H. degree and the possibilities that exist," Rowland says.

Similarly, former CDC fellow Christina Mikosz, who is now in her third year of medical school at Rush Medical College in Chicago, attended the CDC program even though she already had a master's in public health.

"My experience is that public health and epidemiology really are not emphasized in the medical school curriculum," Mikosz says. "Everyone has courses in epidemiology, but they're very basic. I think a training program like this really fills a need that never was offered to medical school students before."

While working in the CDC's infectious-diseases division last year, Mikosz compiled a surveillance summary of rickettsial diseases, which are bacterial infections, among all 50 state health departments. She also collaborated on a study examining the incidence of Rocky Mountain spotted fever on American Indian reservations. As part of that project, she spent a few weeks on a reservation, helping to control an outbreak of the disease.

Rowland, meanwhile, says the program broadened how she thinks about medicine and gave her more of a population based" understanding of how medical treatment works. It was invaluable experience, adds Rowland, who spent her fellowship year in the agency's birth-defects division. In addition to collaborating on two medical articles based on the work she did, Rowland designed a Web site on lymphocytic choriomeningitis—which can cause congenital defects—for the CDC division, and she has submitted supplements to medical journals to help raise awareness of the disease among physicians.

"I really think that 10 years or 20 years from now we're all going to be doing things to make an impact on public health and health at large," Rowland says. "It's really exciting for me to know such a wonderful group of individuals, in addition to being trained through such a unique experience. It was a whole new world of health that we hadn't been exposed to as medical students."

Barbara DeBuono, M.D., M.P.H., senior medical director and group leader in Pfizer's U.S. Public Health division, led the Pfizer initiative to finance the CDC fellowships. She says her interest in epidemiology was sparked during her own experience with an epidemiology elective at the CDC while she was a medical student at the University of Rochester School of Medicine.

"This fellowship is about giving medical students both a sense of population health and an appreciation of the importance of epidemiology in medicine and in health," DeBuono says.

The need for physicians trained in epidemiology and public health perhaps has never been greater than it is today. Along with the ease and rapidity of worldwide travel comes the potential for worldwide exposure to certain dangerous infectious diseases, as underscored by fears about SARS two years ago and about avian influenza today. Added to the risk of global transmission of deadly pathogens is the unprecedented modern-day threat of biological terrorism.

"After 9/11, and really even before that, the public health community was very concerned about the work force," DeBuono says. "Are we going to have enough public health workers to meet the demand, both domestically and globally?"

Recognizing this need, AAMC staff and members participated in planning the CDC fellowship program, and continue to examine ways to make training in epidemiology and public health more widely available to students in medical school. Last June, in the first AAMC conference of its kind, medical and public health educators discussed opportunities and challenges for medical students who decide to pursue an additional degree in public health while going through medical school.

"From the AAMC's perspective, this is one of many opportunities for medical students to enhance their understanding of public health," says Rika Maeshiro, M.D., M.P.H., assistant vice president for public health and prevention in the AAMC's Division of Medical Education. "We're also very interested in trying to get this kind of education available for all medical students."

This year's fellows in the CDC Experience are from Duke University School of Medicine; State University of New York Upstate Medical University, Syracuse; University of Washington School of Medicine; Northwestern University Feinberg School of Medicine; Tufts University School of Medicine; Brown Medical School, and the University of Mississippi School of Medicine.

The application deadline for the 2006-07 CDC Experience fellowship program is Dec. 2, 2005. For more information, contact Cathy McCarroll, M.P.H., program coordinator, in the CDC's Career Development Division: cmccarroll@cdc.gov or (404) 498-6151.

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