Diploma in Field Epidemiology Training Program

The Saudi Arabian Field Epidemiology Training Program was founded to train Saudi and other Gulf countries nationals as epidemiologists. It fosters the professional development of field trained epidemiologists who are competent in the practical application of epidmeiologic methods to a wide range of contemporary public health problems. This will enable them to assess the health status of the population, recognized disease and public health problems early and design culturally appropriate interventions, and generate information. Collaborating agencies include the Ministry of Health (MOH), King Saud University (KSU) and the U.S. Centers for Disease Control and Prevention. The location of the program is in Al-Rawdha Health Centre. The duration of the Diploma Program is two years. There are 50 graduates since the establishment of the program in 1409. For more information please call 01-496-0163.

1.     Background

2.     Qualifications for admission

3.     Study requirements

4.     Objectives

5.     Methods of Training

6.     Summary Curriculum Outline

7.     Graduates

1.    Background

In-service training which follows academic studies is a hallmark of complete and successful medical training. Through these residency and internship programs, a graduate, possessing raw medical knowledge, molds himself into a truly competent and proficient practitioner of his specialty. In this respect, epidemiology does not differ from clinical specialties. Of course, both physicians and other medical graduates play important roles as practicing epidemiologists. The level where epidemiology is practiced differs. The patient is the community and the hospital is the country. However, the epidemiologist has responsibilities to human life and well being that parallel the bedside physician. On the positive side, his sound judgment and timely investigation and action can erase a widespread source of ill-health. The potential patients will never reach the safety-net of curative medicine. Conversely, a lack of epidemiologist or mistakes by overworked or under trained epidemiologist, may allow easily correctable problem to continue unabated. Defects in existing control program, without careful epidemiologic assessment, will persist. The patient (the community) will suffer. He will receive inadequate therapy (control measures) and his illness will linger.

The Ministry of Health (MOH) recognizes the need for practicing epidemiologist to staff positions in the preventive medicine system.

2.    Qualifications for admission

To be eligible for the FETP applicants must possess either:

A.    An MBBS degree or equivalent with a grade of "good" or better and have satisfactorily completed the year of internship with "good" or better ratings on every service.

B.    A 4 year degree (B.S. or equivalent) or higher in a health-related profession with a grade of "good" or better from KSU or other recognized universities. For allied professions requiring an internship, applicant shall have also completed their internship with "good" to "very good" ratings before beginning the course of study. 

All applicants will undergo a written examination to show an understanding of the uses of epidemiology and interviews with FETP representatives. A second interview may be requested. The applicant will be expected to show an understanding of the importance of preventive medicine and public health. He should also show a capability for independent professional activity. His capacity for leadership, coordination, planning, and teamwork will also be considered. 

3.    Study Requirement

The FETP has a two year curriculum to be completed in two years. Exceptions will be only under special throughout the Kingdom. Accordingly, the decision was made to establish a Field Epidemiology Training Program (FETP). The FETP is not for the sole benefit of the MOH graduates will also be encouraged to seek positions at other institutions. Those who fortify their field experience with advanced academic training may wish to follow an academic career. Moreover, universities will have a new, vigorous avenue to the field through joint projects with the FETP. This can work in two ways. Researches may team with FETP trainees on special projects and students in other university programs may spend rotations with the FETP. Eventually, this skilled manpower will allow Saudi Arabia to solve its public health problems with careful investigation specifically applied to the distinct and rapidly changing conditions in Arabia. Circumstances where, for reasons of illness, the epidemiology resident must be allowed additional time. Even in these exceptional cases, the course must be completed within five years. Forty-eight credit hours accompany the required curriculum. The program work will be at King Saud University. The Ministry of Health, and at field locations throughout the Kingdom. Reports and examinations required in lieu of the thesis will be done according to KSU guidelines. The work load will be distributed evenly throughout the 24 hour months. Residents will be enrolled and in continuous study for 12 months per year less two weeks vacation and of the two Eid holidays. The epidemiology resident will also be allowed two weeks of study leave to take approved Continuing Education Courses offered by KSU. The language of instruction is English.

4.    Objectives

·         Program objectives: The FETP is intended to fortify the capacity of the MOH and other health institutions in the Kingdom of Saudi Arabia and other Gulf States to use epidemiology to find appropriate solutions to existing and emerging health concerns. This enhanced capacity will manifest itself as a cadre of epidemiologist trained under Arabian conditions using real, existing health problems as training material.

·         Trainee Objectives:

a)    To acquire the confidence and proficiency to rapidly detect and investigate disease outbreaks using epidemiologic methods.

b)    To develop the skill of defining a specific health concern and then designing and executing a long-term epidemiologic study to approach solution.

c)     To communicate the findings of their investigations to epidemiologist, preventive medicine specialist, the medical community at large, and lay public. The trainees will develop both written and oral communication skills. These will include preparation of scientific reports suitable for publication and oral presentations at scientific meetings.

d)    To gain proficiency in the fundamental principles of epidemiology and the associated epidemiologic and statistical methods.

e)    To understand the epidemiology of the priority diseases of the Kingdome and the epidemiologic rationale underlying control.

f)     To apply their epidemiologic skills to the control and prevention of these priority disease.

g)    To design, conduct, analyze and evaluate epidemiologic surveillance.

h)    To understand and apply survey methodology.

i)      To develop the ability to train others in epidemiologic investigation.

j)     To be able to use microcomputers for epidemiologic analysis and report preparation.

5.   Methods of Training:

Training will be two-way, as in a clinical residency program. The epidemiology resident will not be spoon-fed facts to parrot back to an examiner. The resident's initiative and ability to gather and use the facts in real life situations will determine his success. Thus, input will be necessary from him as well as the teaching staff.

The FETP will provide the epidemiology resident with epidemiologic fundamentals and additional tools (biostatistics, scientific writhing, use of computers, and public health practice) that complement epidemiologic skills. These courses are designed to supplement knowledge and skills acquired during previous academic work. 

The FETP will then offer the epidemiology resident continuing input of public health problems and issues to practice and refine his medical and epidemiologic skills. Residents who already possess some specialty training or interest will be provided with special problems in their area of expertise. As the resident's epidemiologic proficiency develops, he will be given more challenging responsibilities. In the end the graduate should possess the proficiency to confidently and efficiently handle health issues that require epidemiologic skills and input. 

Performance and progress will be evaluated by the staff of the relevant Department concerned with the course work. The FETP coordinator and supervisors will evaluate performance during in-service training. These evaluation reports, compiled every six months, will be discussed with the resident and submitted to the appropriate KSU committee.

A standardized examination in epidemiologic practice will be administered at the completion of the program.

·         Theoretical Training

a)    Introductory classroom training: The purpose of the initial classroom training will be to give the students basic statistical, computer, and epidemiologic fundamentals to allow them to begin developing and mastering epidemiologic skills during the subsequent field training. They will also need these fundamentals to acquire more sophisticated epidemiologic skills through seminars, reading, and working with special consultants.

501 FETP Principles of Epidemiology: 3 Cr. (2+1).

This course will present didactic material on reasoning and measurements used in epidemiology. It will stress the methods and importance of careful question and questionnaire design. The methods for outbreak investigations and the principles of epidemiologic surveillance will be reviewed. The lecture material will find focus in epidemiologic problem-solving practicals. The students can practice interweaving the statistical and epidemiologic methods with his previous medical training to find the source or reasons for epidemics and then fashion appropriate control measures. He will use skills from FETP 502 and FETP 503 to manage and analyze data in these practicals. The design of each problem will emphasize distinct epidemiologic and biostatistical principles in coordination with lecture material.  One practical will involve a complete field survey from the design through actual collection of data in the field to presentation of the final report.

502 FETP Biostatistics: 2 Cr. (2+0).

This course will provide the trainees with basic statistical fundamentals including the presentation of statistical data. It will go on to cover probability and frequency distributions. Statistical testing will emphasize tests most often used in epidemiology, in particular those test dealing with binary variables. Lectures will include survey methodology for simple random surveys and cluster surveys. Methods learned in this course will be used during practicals in course 501 FETP.

503 FETP Epidemiologic Applications of Microcomputers: 2 Cr. (0+2)

Students will receive basic instruction in the operation of microcomputers that they will use during their field training. They will learn epidemiologic software (EPIINFO), word processing and graphics software. They will also develop their computer proficiency during epidemiologic practicals of FETP 501.

504 FETP Infectious Disease Epidemiology: 2 Cr. (2+0).

Students will learn the characteristics of infectious diseases that are essential to the practicing epidemiologist in Saudi Arabia. The course will cover the criteria necessary to confirm the diagnosis. It will go on to give incubation periods, of infectivity, characteristics of asymptomatic infections, intermediate and reservoir hosts. The interplay of environmental factors, vectors, zoonotic hosts in transmission will round out the review of each disease. The currently accepted methods of control of the case and his contact and
the community will complete the material on each disease.

505 FETP Chronic Disease Epidemiology: 2 Cr. (2+0).

Students will first learn the basics epidemiology of chronic diseases such as atherosclerosis, diabetes, a selected group of cancers, and some occupational diseases. They will go on to learn of the uses of epidemiology in detecting disease from environmental hazards. Finally they will be exposed to the uses of epidemiology in planning chronic disease prevention programs and assessing their results.

506 FETP Scientific Writing and Report Preparation: 2 Cr. (1+1).

This course offers a series of lectures on the preparation and clear writing of epidemiologic reports. Students will learn the scientific style for use in preparation of articles for peer-reviewed journals. Additional emphasis will be placed on preparing less regorous but clearly written reports for timely feedback of the results of their investigations to practicing health professionals, politicians, and the public. Preparation of oral reports and visual aids will also be stressed. Students will be given practical experience in preparing oral and written reports based upon practicals from FETP 501. Students will also receive instruction in searching the biomedical literature.

507 FETP Public Health Programs: 1 Cr. (1+0).

Saudi Arabia now operates several programs for the control of high priority diseases (tuberculosis, immunizable diseases, malaria, etc.) It also manages programs involving environmental sanitation and management. While getting a firsthand exposure to these programs, students will receive more detailed lecture material on the theory underlying them.

508 FETP Seminars in Epidemiology 1:1 Cr. (=+1) - For Year 1-Sem 11

509 FETP Seminars in Epidemiology 11:5 Cr. (0+.5) - For Year 1-Summer

510 FETP Seminars in Epidemiology 111: 1 Cr. (0+1) - For Year 2-Sem 1

511 FETP Seminars in Epidemiology IV:1 Cr. (0+1) - For Year 2-Sem 11

512 FETP Seminars in Epidemiology V: .5 Cr. (0+5) - For Year 2 summer

Special topics in epidemiologic study and analysis will be presented to build on FETP 501 and FETP 502 (epidemiology and biostatistics courses). Some topics will be supplemented with an epidemiologic exercise. Guest speakers will deliver seminars on the epidemiology of diseases of emerging importance in the Kingdom. Epidemiology residents will be required to present reports of their twice during the entire seminar series.

·         Practical In-Service Training: After the initial 2 month acquisition of basic knowledge and skills, each epidemiology resident will begin his period of in-service training. This training will center about the investigation of disease out-breaks and health priorities. 

513 FETP Epidemiologic Practice 1:2 Cr. (0+2) - For Year 1-Sem 11

514 FETP Epidemiology practice 11: 1 Cr. (0+1) - For Year 1-Summer

515 FETP Epidemiologic Practice-111: 2 Cr. (0+2)- For Year 2-Sem 1

516 FETP Epidemiologic Practice - IV: 2 Cr. (0 + 2) - For Year 2-Sem 11

517 FETP Epidemiologic Practice V: 1 Cr. (0+1) - For Year 2-Summer

The epidemiology resident will have responsibility for the daily monitoring of selected diseases in the Kingdom. Each resident will also have responsibility for general surveillance of a portion of the Kingdom. As an initiation to his area, the resident will visit key preventive medicine, primary health care, curative medicine, and laboratory personnel in his area. Thereafter, residents will routinely take epidemiologic histories from these field contacts and decide when investigation and action are necessary (in consultation with other residents, the consultant, and supervisors). They will also give advice and feedback on public health issues to regional public health officials. The resident should keep accurate notes of his daily monitoring activities. It will be the resident's responsibility to develop a systematic program to cover basic and advanced reading material to enable him to answer the more difficult questions. He will report his findings and defend his actions at weekly staff meetings.

518 FETP Outbreak Investigations - 1:2 Cr. (0+2) - For Year 1-Sem 11

519 FETP Outbreak Investigations - 11: Cr. (0+1)- For Year 1-Summer

520 FETP Outbreak Investigations - 111: 2 Cr. (0+2) - For Year 2-Sem 1 

521 FETP Outbreak Investigations - IV: 2 Cr. (0 + 2) - For Year 1-Sem 11

During the 22 months of practical experience, each resident will act as the lead investigator on at least two disease outbreaks. A field survey on an epidemiologic issues can substitute for one investigation. These investigations will involve direct contact for taking epidemiologic histories and making other measurements (as necessary on ill and well individuals) in the community. Preliminary findings and recommendations for control will be due within 5 days of returning from the field. He shall prepare a final report describing the purpose, methods, findings, and recommendations for control. Each resident shall also participate on at least 4 other disease outbreak investigations. These are minimum standards. Depending upon the workload, trainees should have about 8 investigation opportunities during their 2 years of training.

522 FETP Surveillance System - 1: 1 Cr. (0+2) - For Year 1-Sem 11

523 FETP Surveillance System - 11: 1 Cr. (0+1) - For Year 1-Summer

524 FETP Surveillance System - 111: 2 Cr. (0+2) - For Year 2-Sem 1

525 FETP Surveillance System - 1V: 2 Cr. (0+2) - For Year 1-Sem 11

Each epidemiology resident will undertake an assessment of the surveillance of one disease in the Kingdom. Disease is a generic term and can include health problems such as nosocomial infections, pregnancy wastage, or traffic accident casualties. He will review existing data, identify operational and technical difficulties (such as lack of a standardized diagnosis), develop solutions to those difficulties, and assess the impact of those changes. The resident will present written findings for review and inclusions into recommendations for developing the surveillance system. Each resident will also prepare one or more surveillance reports from the actual surveillance data. This surveillance report will describe the epidemiology of the disease in the Kingdom.

526 FETP Long-term Project: 4 Cr. (0+4) - For Year 2-Summer

Each resident shall design and execute one in-depth epidemiologic study of a priority p0ublic health concern of the Kingdom. This project may be done in conjunction with the trainee's surveillance project (522 FETP through 525 FETP). The resident will prepare a final written report (2000 to 3000 words) in a style suitable for publication in a peer-reviewed journal. This project will be developed and supervised over the full term of the field training. However, credit will be granted during the last summer session when the final paper is submitted.

527 FETP Scientific Presentations - 1 : 1 Cr. (0+1) - For Year 1-Sem 1

528 FETP Scientific Presentations-11: 1 Cr. (0+10 - For Year 2-Sem 11

The epidemiology residents will have several opportunities to present the findings of their investigative work to audiences of their peers and the general preventive medicine community of Saudi Arabia. Moreover, two international forums, the annual Epidemic Intelligence Service Conference in Atlanta, Georgia, U.S.A. and the bi-annual Field Epidemiology Training Program Conference, specifically seek oral presentations from FETP trainees. Residents will prepare for submission to these national and international conferences. They will then receive instruction and coaching for the eventual oral presentation.

29 FETP Training Activities: 1 Cr. (0+1)- For Year 2-Sem 1

530 FETP Training Activities: 1 Cr. (0+1) - For Year 2-Sem 11

Epidemiology residents will themselves assist in the training of newly entering trainees. They will deliver practicals for 501 FETP during the first semester. As senior residents, they will guide newly entering residents during outbreak investigations and epidemiologic practice. Residents will be encouraged to develop epidemiologic training problems from actual disease outbreak investigations in the Kingdom. 

6.    Summary Curriculum Outline