Harvard School of Public Health | Panel 4: Public Health Education Unbound - Transforming the Field

PRESENTER 1: For purposes of time, I know some are still in the hallway, but we're going to head into our capstone fourth panel, moderated by Donna Peterson. Donna, take it away.

DONNA J Thank you. Friends, thank you. Thank you for hanging in there with us. It's been a long day but I think a fruitful PETERSON: day and a rich day, with some fabulous, fabulous discussions and fabulous points raised. We have the task as your closing panel of perhaps addressing some things that haven't been raised yet, perhaps pulling together some of the threats that have been identified, but ideally, and most importantly, thinking about the future and what all of this might mean for us as we go forward.

I will say, in all the discussion of C's, we've had lots of wonderful C words, I haven't heard some that are very important to me, one being chocolate, one being Cabernet, and one being Coltrane. So I am looking forward to the reception and I hope there's all of those things. So get your clarinet, your saxophone, because we're looking to have some fun and have that party that we heard about earlier that we never did hear about the parties.

But we have a very distinguished panel with us as our closing panel, delighted to present to you two distinguished leaders, two provosts. We have the provost from Harvard, Dr. Alan Garber down there on my far right. We have the provost from MIT Dr. Chris Kaiser, is with us. And I think that's only fitting, as we began the morning hearing about the historic partnership of 1913 between Harvard and MIT. So we thank you both for being with us.

We also have with us from Harvard's Institute for Global Studies, Sue Goldie is here with us from Harvard. They didn't put the slide up. So I'm trying to remember who these people are. Everybody else had a slide.

Chocolate-- lots of chocolate. Anita Berlin joins us from London. I don't have my glasses on. This is a shorter session. That's good. Anita Berlin, Alan Garber, Sue Goldie, Chris Kaiser, and the famous Donna Peterson, moderating. So we have a slightly shorter session.

We're going to try to have more of a conversation up here. To stimulate you to join us in conversation, we're going to try to open it for questions a little earlier. So this is your last shot to ask those questions. Commentary is reserved for the reception.

Ask your questions of our wonderful panel. So we've heard, as you know, those of you who have been with us all day, very, very stimulating ideas about where higher education is going and what it means for education in this particular health profession, that being public health. And we've heard about how much of what we've been doing perhaps isn't serving us well, how the idea of being bound to semesters and credits and classrooms might not be the model, particularly given the technology affords us all kinds of opportunities to do things in different ways.

We've heard about our faculty perhaps not being skilled in the ways that they need to be 21st century facilitators of learning and what might that mean for us. We've learned that we're perhaps not engaging in sufficient research on pedagogical techniques, nor evaluation of those pedagogical techniques to figure out if we are in fact impacting the field of public health. So all of these things really beg the question, where is the university of the future? What will it look like? How will it enable the kind of lifelong learning that we've talked about? How will it enable us to rethink education, particularly in the profession of public health, where we know-- we've identified this several times today-- we can't possibly learn everything we need to know over an entire career in a one and 1/2 half or two year program.

That's not realistic. So how will universities function in the future? How will they help us as public health professionals continue to create the public health professionals for the future? So I'll start with our provosts to tell us what they see the university of the future looking like, being like. What will it feel like? Start with you, Professor Garber.

ALAN M. Well, I think one of the most interesting questions that we're going to face is whether the university is a, place or GARBER: is it a URL? And actually, Harvard School of Public Health is leading the way. And I just want to take a moment to congratulate Julio and his colleagues on this 100th anniversary. And I also want to say that the School of Public Health is really leading the way and trying to address this very question of what will the university of the future look like.

Those of you who know about edX know that edX is an organization that was created by Harvard and MIT to basically promote online education. And you may think that I would believe that the future of higher education is

online, I think that's a little bit like saying the future of higher education involves books. It's going to be a set of tools that we will probably adopt.

The interesting question to me is not whether it will displace residential education but how it will be used. And let me say that when we thought about creating edX and Harvard X, the Harvard component, we said that there were three goals. One was to increase access to the best courses, to everybody in the world.

One was to improve teaching on our own campuses. The third was to promote research into how people learn, because we saw this just as a tremendous opportunity to rethink what we do and to actually know whether we're making a difference with the educational innovations. Now, having said that, what really excited us was something that we heard from various faculty, including faculty at MIT who had had their courses on OpenCourseWare, which was this extensive MIT imitative that Chris could tell us all about, where courses were put online.

They were not curated the way that edX courses are curated. But sometimes it would be video, sometimes it might just syllabi. People put varying amounts of work into it. But one of the curious things that some of the MIT faculty said was, when we put the courses online, actually our teaching really improved. It got much better. Now, part of this was, the whole world could see their teaching.

Part of this was, their colleagues could see their teaching. And so they really had to up their game. And I'll be quite honest with you. We saw this as a way to start a new conversation about what teaching can and should be on our campuses, because I think that the university of the future is still going to be a physical place.

And it's still going to be a place where a lot of the learning comes from human interaction. There's a fair bit of virtual interaction that can be quite meaningful. But for the foreseeable future, the virtual interaction is not going to produce the results that in-person interaction produces. Now, having said that, I believe that strongly it needs to be tested. And we are very much committed to research. I want to just say one other thing, that in my role as provost, I've decided to go around different parts of the university to see various forms of pedagogy that I hadn't been too familiar with. When I was a Stanford, I taught in the business school for many years. But actually, I did not teach by the case method.

I taught a course on economic evaluation of health care. And it was sort of a hybrid between a typical business school course and a typical lecture course in university, although it was highly interactive. I want to see a case method course. And Harvard Business School invented the case method as it's used in business schools.

And it was really quite edifying to see how the teaching worked. I want to see a case method teaching course. Harvard Law School introduced the case method, period, predating the business school. I want to see a design studio critique session for a studio course at the Graduate School of Design.

Each form of teaching-- and I've seen many conventional lectures and seminars and so on-- and each form of teaching is distinct. And what I realized is that although this have largely evolved to meet the needs of whatever the professional school is or the undergraduates, there are actually ways that these forms of pedagogy could be improved by learning from what the others are doing.

And I could go on and on about how this works. And one of my goals for Harvard, and I suspect this is going to happen naturally everywhere, is that we will not only use online tools to improve teaching, but actually seeing how others in our own universities teach, we'll start to question how we're teaching and adopt some of the most promising methods that are used by others.

So I think that the future of higher education is going to involve some things that will required difficult adjustments. I don't think the cash will be quite as plentiful for any of us in the near future. But I also think that what you'll see is an improved version of what we're teaching now. How improved, we don't know. How efficient, we don't know.

But I'm hoping that what we do in the future will be guided by research. And that's going to make us far more effective.

DONNA J Thank you. Provost Kaiser. PETERSON:

CHRIS KAISER: So actually, one of the great side effects of edX is that Alan and I both serve on the edX board. And I've gotten to be friends with Alan. I predicted that he would say most of the things that he said. So I was able to kind of adjust

my comments not to be redundant. Although both of us I think have very similar views on this.

I wan to maybe peer a little bit deeper into the murky crystal ball looking forward into the future. And of course, this maybe means given how fast things are progressing, maybe just looking forward six months or a year from now. This morning, there was a lot of discussion about how these online courses are developing and MOOCs are developing and so forth. And I think it's inevitable, regardless of how things are structured now-- and by the way, I think this particular moment in time, I think is a little bit like the period in the development of motion pictures, where they would just take a movie camera and sit it in front the play, just film the play. And I think very much we've already heard this morning that most of how regular lecture courses are being taught are essentially a gigantic scheduling artifact.

I think as that the scheduling constraint is obviously removed in the online world, and I think that things are going to start evolving more and more and more. And one thing that I think probably has not been given enough consideration is that just the notion of a course from a university online I think will more or less disappear, because no matter how you try to protect the integrity of a course, I think it's inevitable that it'll just be sliced and diced and broken up into lectures and maybe just snippets of lectures and so forth.

And so students are going to start learning from a whole variety of lectures spread out across the world. So one problem then comes is, how do universities like Harvard and MIT start to deliver credentials? What are you actually credentialing for?

And I think in a very positive way, I think there's going to be a very strong push in the near future to come up with much, much better kinds of online problems and exercises that really have the depth and richness of the kinds of questions that you would really want to use to assess whether somebody really understands a subject or not. And I'm personally very much looking forward to this, because I think at MIT, in our science and engineering classes, I would say most faculty spend about as much or more time developing problems for problem sets and exams as they do actually preparing for lecture.

And this is something that we tend to enjoy doing. And coming up with problems that are difficult and realistic, but they're difficult because the difficulty surrounds a core concept, not some kind of just artefactual puzzle. And so anyway, I'm very much looking forward to the migration of that kind of thinking of rich, deep, relevant problems migrating onto the web-based exercises for the use of credentialing.

So that's one point. The other is, producing MOOCs or even online modules is very expensive, both in terms of just money and faculty time. The MOOCs that we've produced at MIT cost between $200,000 and $600,000 per course. There has been I think an erroneous assumption in thinking about the economics of this, that all of the expense is upfront, and then the cost of offering that course again the next year is going to drop.

But because of the aforementioned fragmenting, I think there's going to be a very high premium placed on currency. I think courses that are not kept up to date religiously will just fall by the wayside. So I think it's going to cost a lot of money, much more money to produce these courses certainly than we'll probably be able to recover in terms of revenue for paying for certificates or something of the like.

So there is going to be certainly a limit as to how much broadcasting, let's say, of Harvard and MIT course content that actually is going to be possible. One of the things I've been thinking about is the leveraging effect. We're talking about democratizing the learners. But I think if we could democratize the producers of course content, that would then have this kind of exponential leveraging effect that really could provide education to a much, much broader audience. And so two things that we're thinking about MIT along these lines are first, we are starting to think about how to incorporate training for online course development. We're right now in the process of putting together a little masters program in this area. But we're thinking about including that training in some of our other graduate programs. So you have students that are learning about how to teach by TA.

And I think appropriately, there should be students that have opportunities to develop online course content and so forth as part of their training. So that will in turn produce kind of a cadre of people that are coming out trained or with a sensibility of how to develop online content. And then the other is to essentially try to get out ahead of this slicing and dicing of courses that I talked about.

And one of the things that we're considering doing it's taking all the OpenCourseWare-- this is the program that Alan alluded to-- course content and making that compatible with the edX platform, and then just giving that to the world of course producers for free. It's kind of like bundling a giant clip art file with the drawing program. So the final point I wanted to make comes back to this point that came up this morning about faculty incentives.

And I think this is really an important issue, particularly when it comes to broadcasting course content to the world. This is kind of a pro bono activity. I think it's going to be fine at our institutions to get faculty to think about developing online tools in order to teach their own courses better. I think that's going to happen naturally. But in terms of actually developing content that's going to be useful for a world audience, I think there's right now limited time and capacity in our faculty to do this.

And I think one kind of strategy where I think Harvard and MIT can show leadership is to try to come up with ways that faculty can both combine dissemination of online material and at the same time, that they enhance their own scholarship. So let me give you one idiosyncratic example. But I think it's useful to think about it and think about perhaps how to generalize it.

So we have a professor in linguistics, who is Haitian. And he's been very interested in helping Haiti after the earthquake with their problems. And what he's done is take a lot of the online tools have been developed, STEM educational tools that have been developed at MIT, and he's translated them into Creole.

Now, the important thing about doing that of course is that the Haitian students all speak Creole. But they're being forced to learn in school in the French language. And so Michel DeGraff is using this as a way of introducing-- he's kind of using the online as a back door entry into getting Creole into the classroom. It would never be possible to do it in a textbook or something.

But online is new, and it creates this back door. So he has developed this wonderful program. Now, the program is funded by NSF, of all agencies. And the reason is, Michel got a grant to study the effect of language on learning. And he's using this Haitian initiative, which is really essentially-- truth be told, Michel really is trying to do this to help his country, but he managed to kind of craft this proposal, where he's going to use this Haitian experiment as a way of actually learning about how language affects the student's ability to acquire STEM concepts. So right now, we're in the process of thinking about-- and this is sort of where the leadership comes in-- thinking about, are there ways that we can combine with both the Haitian government and NGOs and maybe other federal agencies, like USAID, put proposals together that actually will create opportunities for other academics in the US to engage in this type of project? So in this sense, it's a kind of a leadership in terms of figuring out how to get all of these different threads weaving together so you can have faculty members who feel they are properly rewarded and properly enhancing their own scholarship in terms of doing some of this more work that's more aimed at actually just simply helping the developing world.

And I think I will stop there.

DONNA J So you both alluded to something that I think is very important for us in public health. And you've made it clear PETERSON: that it's also important in the education sphere. And that's reaching out across disciplines and across schools. You talked about we could learn teaching from how other schools and colleges and professions teach. And you talked about content that could cross different professions and different areas of learning.

And that's very important for us in public health. We are an interdisciplinary profession in and of ourselves. And it also speaks to, I think, something we've talked a lot about today, which is, where does public health belong in terms of learning and knowledge acquisition and the development of people who feel part of this profession? We've talked a lot in the Framing the Future task force about, well, what about public health and all professions training ideas.

If we could do a better job teaching public health, in not only other health professions, but other professions at large, what would the community look like? What would public health look like? And so to help us think a little bit more about that, Sue has a university role in looking at global issues across all the colleges at Harvard, if I understand it, and would love to hear your perspective, again, thinking to the future, how might we think about public health education given your perspective across different colleges and different modes of learning?

How could we perhaps better enhance our field as a whole by engaging other professionals? And what do we stand to gain by that interaction across professions?

SUE J. GOLDIE: Thank you for having me. I was actually thinking to myself, because we have had the benefit of reflecting all day and listening to the conversation, that I could choose to talk about two passions. And I'm not going to talk about one.

One is, what are the institutional enablers and obstacles? And the other is what you asked me to talk about. And then I glanced at my right, and I see one of my bosses. An over there is my other boss. And I thought, I'll save for party time the institutional obstacles and enablers and talk more about what I was asked.

I say that with love, because it's something we have to embrace, both the obstacles and the enablers. So I have two hats. One is as the faculty director of the Harvard Global Health Institute, and the other is as a faculty member in the Harvard School of Public Health. And I care deeply about both of those identities.

The Harvard Global Health Institute-- you don't have the mic. One moment. Can you hear me now? I'm sorry. Did you hear the beginning? I told a joke. So with my Harvard Global Health Institute hat, to give you one line, this is a institute that was made an institute by President Faust a couple of years ago. It has a long history of interest in global health across the university that I'm going to leave aside, because this iteration has a very specific goal. And that is to catalyze a paradigm shift about how we think about health of the world's populations.

So for just a few moments, let's drop what we think of as public health, global health, public global health, and just say, health of the world's populations. And from that large perspective, there are really four big things, if I was to simplify them, that motivate a university, real responsibility to look at this. So number one-- the world's changing.

There is large global forces. There's incredible global opportunities, whether we're talking about new stuff in material science or cognitive science, as we talk today. And in terms of the risk, we are all facing the risk, whether it's geopolitical conflict or health inequalities or economic inequalities. So we live in a complicated, pretty dynamic global context, interconnected world.

That already puts everyone in the university at a level playing field for some of the real challenging questions we need to ask about both education and profession in that paradigm. The second piece is that populations are changing. We would be remiss as a public health faculty as well as the university faculty if we didn't think of the large adolescent bulge and the aging population as two big population areas that we need to care about through many lenses. Third, our health patterns are changing, and Julio often talked about this. But we have a complicated array and mosaic of health problems and many more shared problems than ever before, as well as potential for shared solutions.

And then finally, health is in a very different position on the political agenda both for good reasons and for reasons we might question. However, it is no longer just the domain of the health sector. And in addition to that piece, there is a need and I think a recognition on all of the public health identifiers that we need other sectors to improve health in addition to our more classic public health goals.

So with that contact, if I'm sitting in a university seat, it's, what are the roles and responsibilities or potential opportunities a university can lend to that set of challenges? And it comes down to really two things. One is, we need new kinds of leaders.

And we heard a little bit about this today, but it's new global health leaders or public health leaders. It's new global or public leaders who value health. It's new actors with influence that are interdisciplinary competent in conversation and policy, and an educated citizenry. Those are really new educational goals if we're thinking big picture. On the other hand, we need new kinds of knowledge.

We have a large knowledge gaps. And many of the most difficult social problems are living at the edges of the interdisciplinary spaces. And how do we create the new knowledge to begin to converse, whether it's pedagogy or whether it's actually content, to share across domains to tackle these large problems? So if we talk about urbanization in public health, we can't have that conversation without urban planners and architects and public health folks and government and policy. So we have two kinds of activities. And I won't give you specifics, because I think in the context of this conversation, I can provide examples. But the idea is that we look to see opportunities in the university that we can leverage to have a bidirectional flow. A simple example is, you heard this morning about the undergraduates and the popularity of the secondary field for undergraduates interested in public health and global health.

But really, I would tell you that the incredible success is that we've now had 5,000 undergraduates take a public or global health course within a general education curriculum. And what we stand to gain from the incredible innovation on liberal education, what global learning is, how we impart a global outlook to undergraduates in the general education sphere has huge lessons for us in the public health sphere as we try to think about competencies that are leadership competencies and views of the world and skill sets of which they keep growing.

The other piece of our activities is really what I'm going to call loosely an incubator. And that is similar to what the provost just mentioned, there are opportunities for collaboration. And we are now collaborating with 10 on different types of pedagogy, where we're co-producing the material and the way of teaching that both benefits a school of public health but also benefits, let's say, the business school or the divinity school in terms of their capacity to have a health lens on some of their important topics and educational goals.

And within that paradigm has been the most innovative space. It's the best part of my job. So whether it's looking at the design school and their ideas of creating a portfolio and writing to Julio at night, saying, here's a great idea for our new doctoral program and to think about what that offers, or if it's about the design of certain experiential learning in a studio format linked with a government or with urban planners.

There are ideas that we need to, a, share and experience together, and b, capture and analyze. And so the other piece to the institute is an educational repository, which over the next couple months, we'll roll out. And I hope that would be one of the innovations that we've talked about today that would provide a public good that's not just a knowledge or product, but how do we curate different kinds of material and different things we learn such that we're really thinking out of the box about what do we want those learners to be capable of?

So I'm going to pause there to give you the broad overview. And I can provide examples as the conversation goes on.

DONNA J. I love that. I want to give Anita a chance to say a few words. You also bring a multidisciplinary prospective within PETERSON: yourself and your work. You also bring a global perspective to us. I think you were here this morning when Ian talked about the revolution. And I believe it was against England, Great Britain.

So we're delighted that you're here to close the day. Help us spark a revolution of a different sort. And also, this issue of bi-directionality, not only across disciplines, across different levels of education, but across global community prospectus. We'd love to hear your thoughts, Anita.

ANITA BERLIN: Thank you very much. I have to say I'm very, very grateful, incredibly humble to be here. I've learned an enormous amount, and it feels a little bit strange to be now sharing with you. But I do come from a slightly different perspective. And I was actually very struck by what Sue was just saying.

I found myself on-- what day is it--

DONNA J. Friday.

PETERSON: ANITA BERLIN: It's coming up to bed time, so you will you forgive me. A couple of days ago I was in London at an interdisciplinary workshop And so some of the things I want to say actually come from some of the discussions we had there, which included architects, philosophers, urban designers, a sanitation expert, engineers, lawyers, a human rights lawyer, and myself. And we were having a conversation, which is essentially I think a bit like your incubator, which actually took the form of what we called an imaginary.

So we were all trying to imagine various futures, in which we brought our own research and thinking and found some common ground. And so what I thought I might do just in the couple of minutes that I've got is, one is, tell you a little bit about what I do and a challenge that I'm grappling with at the moment, which I think is very relevant to this discussion, but then perhaps to reflect a little bit on some of the things that have happened.

But to go back to what Ian showed us first of all this morning in the word cloud, which if I remember right, the three big words that came out were engagement, practice, and application. And I want to relate to something my discussion with my colleagues earlier this week, one of whom also was a professor of comparative literature from Harvard, who I flew back on the airplane with.

And we were talking about the idea of three different ecologies. You may have come across this. This is an idea from philosophy-- the idea of how the macro ecology, which one could say applies to this discussion, which is about the global institution of public health. The other is a meso-level ecology, which relates to in particular, things like the interpersonal, the quality of interpersonal relationships of which perhaps the practicum and the idea of the apprenticeship is something that has been touched on.

And I wanted to expand a little bit on, because that's really about also taking the idea of public health education outside of the academy. And then the third ecology is the micro, which is the human and the intra-human ecology, so the ecology of human subjectivity. And that takes us into the idea of the being and the being there, which people have referred to or the practitioner to be.

And what are the important things about in the inner world that then affect people's ability to carry out their work as practitioners? But also, we touched a lot on constructs of leadership and things that go with that. So just a little bit about the conundrum that I find myself in-- I'm what we call a GMP, a family practitioner.

I've worked for 20 years in the inner city, mostly in London. And I found myself many, many years ago-- actually very interestingly-- being offered a job in a ladies wash room. I was at [? a little ?] meeting, and I to the washroom with a colleague. And she said, you know what we're talking about. You could do this job.

This is what got me into being an academic. I just finished my residency program. It was a job about a bidirectional program between Spain and the UK on the training of family practitioners. This is when they started to introduce a universal health system in Spain, which was based around a primary care system with health centers which had properly trained nurses, doctors, pharmacists, et cetera.

That got me into being an academic. And through various different probably good, not so good things I did, I ended up initially being the dean for educational quality at the medical school. So this is a medical school for training doctors. I was actually initially in a school for science and technology.

So I know what it's like to work in a place which doesn't have any arts or humanities in it. And it's a very peculiar

place. I was very struck-- Laurie's description of communicating with the colleagues. I then became an associate

dean for quality at University College for the medical program. And most recently, I was the lead for finally of the program completely rewriting the final program so that it fitted better with a new internship. So the internship had been changed. And we had a complete dissociation between what was happening pre-qualification and post-qualification. Sitting here today, I think, I did quite a lot of the right things, like I broke down all the departmental barriers.

Everything was co-produced by a team. It felt like a multi-disciplinary team, with nurses and doctors and surgeons as well as physicians and various-- and it was run by a family practitioner, god forbid, so somebody who actually came from the outside into the hospital setting. And one of the things that went with that was becoming a co-chair for the qualifying exam board.

Now, the thing about the qualifying exam board is that if you just focus on the clinical, you're not actually getting to grips with the real depth of knowledge base you may want. But if you just focus on the knowledge base in the clinical, then you're not able to actually look at someone more professional, the broader professional areas, such as ethics. And one of things that seeing 40 to 60 patients every week allowed me to do was to imagine patients that could be part of a clinical exam, a written exam.

And we are then introduced to portfolios. Somebody else was talking about portfolios. Having done that, I decided that I'd done that. I'd introduced the new [? final year. ?] Everybody was really pleased with it. And our ratings went up.

We went up to becoming the top medical school in London. And I was absolutely convinced it was because we had a new [? final year, ?] and we had a new set of exams. I now lead on an integrated program. So we talked about integration and synthesis, which is a program that runs throughout-- our courses are undergraduate and postgraduate, so it's six-year program that includes what would be your pre-med in the medical program, which includes all the public health, all the social epidemiology, all the sociology, all the health promotion , all the occupational health, all the global health are now under my purview.

And I have to structure this, running all the way through the years. Now, what I don't now have is I don't have a locus, a locus for learning and practicum. It's fine when you're teaching [? final-year ?] medical students in a hospital or in a general practice.

I have a practicum that's practice that I can tangibly understand. I can translate that into sophisticated assessments. I'm not saying OSCE exams are the be all and end all, because they have real limitations. But now I struggling with-- and so this brings us to our three ecologies, which is the issue of engagement.

Because I find it hard to get the students to engage, I need the students to engage at a personal level with what is going on, when in fact, the locus is a diffuse locus, because it is the thing that we call the population. And because we have-- this is my plug-- because we have a sophisticated and extensive and universally available system of primary care, public health in the UK isn't doing community interventions. It is actually population interventions.

It's understanding population interventions and then working with practitioners as well as politicians as well as local government to actually affect those. And so I was really struck by some of these issues that have come up. And I won't go into the details, and we can talk about them perhaps as we go along. But the idea of the human, what do we have to do that's stress-busting, mindfulness-- I'm a great advocate of mindfulness, the idea of mental presence-- all these things you have to attend to in the human. What are the behaviors we're rewarding by our assessment systems for that individual's motivation? And we can talk about that, not just for the students, but also for the faculty-- so the need for feedback and affirmation. But one of the things about engagement is also the importance of relevance.

And so again, this idea of what is it that we are asking our learners to engage with, and therefore, what is the practice, where is practice, is something that's a real challenge. And it takes us outside of the immediate academic concerns. And it's not just about being out there in the virtual classroom.

And one of my main concerns about that is because these things are all about personal engagement. So they're about the ideas of self-efficacy, about agency, and about advocacy. And so until we can engage with all those things, we can't actually get leadership, because those are the fundamentals of leadership. My understanding of leadership is not about the team and leading the team. It is about personal ability to see your role within that and actually then say, this is where the changes need to be.

And we can talk about courage separately. But it's about then, how does that translate and what the problems are with professional credentialization into collective efficacy and collective activism? So that brings me to the idea of, where is the practicum? And what is the challenge at an institutional level?

So these are the things that link with Sue's comments. I think this is highly relevant. The development of the inner person is highly relevant to be able to understand-- and this is the lady in red made this [INAUDIBLE] thing-- about the engagement in, what is public health?

And so if we start to wonder about our practicum we've heard about, the issues of time poverty and then about actually being able to re-orchestrate time, that time no longer matters when you can have a virtual classroom, even though, I think it was [? Kathy ?] who make the point about, we have these online technology. We're not quite sure what to do with them, but we're getting there.

And I think that was the point about the Khan University, which I thought was fascinating, but how we then move to using these technologies. I discovered that I'm doing a SMOC-- SMOOC-- what was it?

DONNA J. SPOC. PETERSON:

ANITA BERLIN: A SPOC, which is using the online environment to create a private peer-to-peer learning environment. So those sort of things that increase self-efficacy. But one of the things we talked about here a lot is, in creating the practicum, we can create it case-based learning. I tread on the area of case-based learning with great trepidation, because this is the birthplace of case-based learning.

I'm a great fan of simulation. And I really welcome the efforts in high-fidelity simulation. But I also am very well aware that if we are going to develop a ethical and moral compass-- so if we think about learning not as just cognition but as meta-cognition, which needs both an affective and a moral dimension as well as a cognitive dimension-- then there is a limit to simulation, because by definition, the wonderful thing about simulation is you can make mistakes, you can make it up. But it is scripted. It is scripted by the teachers. It is not real. And even though we can script in the messiness of the swamp, it is still not [INAUDIBLE] the swampy lowlands of real practice. So we still need a practicum which is real, because you cannot engage that meta-cognition, because the affect and the moral compass is not fully engaged in a simulation. It's still not real.

DONNA J. So if we want to prepare the kinds of professional that we've all been talking about, we believe they will spend

PETERSON: some time in our physical campuses, we believe they will gain some knowledge and perhaps some skill online, we believe that they need to be in field in the swampy lowlands of our practice. What does that say about our faculty and-- I'm going to look to my provost bookends here-- and how we reward teaching in environments where teaching has not been as valued as other enterprises in the academy, given the intensity of the work involved in creating these kind of learning spaces? Did I say that right?

ALAN M. You're looking at me. We think a lot about teaching. And I want to correct one comment misapprehension that in GARBER: a research university, like MIT, like Harvard, like many other institutions, that we devalue teaching. It's really not true, although we do value research. And it's very hard to be successful in this environment without succeeding at both.

And the real issue that arises to which you're alluding in part is the investment. When Chris was talking about how much it costs to create an MITx course, I don't know whether he was counting the value of faculty time. But the usual accounting procedures for this don't account for that time. Julio may shoot me for saying this publicly, but it typically takes, a s told, roughly three to four times as much time for a faculty member to produce an online course, as compared to a conventional classroom course.

So there are some real questions about how we want our faculty to spend their time, assuming that they will dedicate the time to teaching. And one of the fascinating aspects of this is, it's the faculty who are most interested in teaching and in pedagogy who jumped on it first in producing these courses. And will other people follow them, who maybe aren't prepared to spend as much time? And we ask how we'll reward them.

And we are working through these issues. You have to remember one thing. The term "MOOC" was invented only about two years ago. And there is, at this point, I think among most universities, no model that's being employed that people think is going to remain the model for more than a few years in compensating faculty in getting them to produce courses.

So this issue that you raise about how to engage faculty is one that you're asking in the middle of a period of great turmoil. And another way to phrase it is great experimentation, because they are both true. And let me add the implied question as well. How do you reward faculty in terms of things like promotion and in terms of, in addition to the financial compensation, how do you make sure that this is a great platform for a satisfying career?

And one of the beauties of online courses is, everybody can see them. And it's actually, I believe, going to lead to improved evaluation of the quality of teaching, with all the advantages that implies and disadvantages. It's going to be much harder to screw up. And now I have people notice.

Of course, it will be easy to correct at the same time. DONNA J. And I think you spoke about the democratization of teaching, as well as of learning. And so as a follow-up, do we PETERSON: have to limit teachers to those in the academy? And does the university see as it retains its place in learning, is it also a place where other teachers can come in and facilitate learning, who aren't in the traditional [INAUDIBLE]?

CHRIS KAISER: I think we have examples actually of online courses that are created by students just out there in the world. The first MIT MOOC was 6.002x or whatever. And I think there's 6.003 was a class that some student someplace in the world-- I can't remember where he was from-- wanted to have. So he just simply took the OpenCourseWare version and cobbled together his own 6.003z, he called it.

And apparently it's a pretty good class. So I think this is why I made the comment earlier that this slicing and dicing is just going to happen automatically-- or sampling or whatever. And I think it's something that we should welcome and embrace. I just wanted to give the MIT perspective on incentives for teaching, because the reality is that promotion cases at a research university like MIT mainly float or sync on the basis of the research accomplishments of the faculty, not the teaching.

Basically people have to be really good researchers in order to get tenure at MIT. And no amount of good teaching can make up for that. I don't think there's anybody who really wants to change that equation. But if I look across MIT, there are phenomenal teachers across MIT. But they do tend to cluster in certain departments. And it's my belief that good teaching comes out of a tribal culture of a department. I love this concept of a tribe. If you have a department where decorated senior faculty take teaching seriously-- and we do have some wonderful examples of that-- then the younger ones coming up will take it seriously.

If you have the older faculty say, just do the absolute minimum, then the younger ones will do the absolute minimum. So it's a kind of a culture that's built into the departments. And I think that's part of the reason that at MIT, we prefer to hire junior faculty and bring them up through the ranks, because they can then have the service culture devoted to the departments.

And when you bring people in from the outside, very often they aren't willing to teach as much as others and so forth and so on. But I think the incentive for teaching really comes from a sense of place and community in a department.

SUE J. GOLDIE: Just to add, I think in context of the School of Public Health, and I'd be interested to hear what your opinion is, I think there is a false dichotomy between teaching and learning. And sometimes I'm a teacher, sometimes I'm a learner. Most often, I'm both.

And we talked this morning about that very interesting dynamic relationship between a teacher and a learner, even shifting in the same two people back and forth. In public health in particular, that process is really part of public health. So whether the same tools we use to teach and experience and think about the range of teaching goals or pedagogies that we spoke about today, many of those, if we dial down to the principles, are about communication, communication across sectors, introspection, self-reflection.

And so I think with creativity, we can create teaching and learning spaces that are much more than just teaching but that enrich our whole being of our profession. And in addition, I want to just echo what Julio said this morning-- the motivation for our research questions in public health are the real world. There's a relevancy and there's a feedback loop. And so we have to find creative ways to have overlapping communities teaching us one aspect of that-- but there's lots of them-- so that we do have that relevancy, rigor, translation loop, which is so much a part of the experiential education our students need to have, as well as we have to continue to be in as lifelong learner.

DONNA Thank you, Sue. Anita? PETERSON:

ANITA BERLIN: Just thinking about, I think, in a way, think about who are teachers and what is faculty. And there's a number of different ways we can think about this. But just following on from Sue's discussion, my point earlier about simulations and cases, is that if we have many different disciplines and what happens at the boundaries and loosening those boundaries and how valuable that is, similarly, loosening the boundaries between the academy and what's happening outside is terribly important.

And the potential for groups or individuals from the community to become the teachers is something that we perhaps-- and I'm there's many examples, particularly from volunteering services and what students and faculty may be doing in their service-related roles-- but actually, to what extent do we want to formalize that? To what extent is there a reasonable expectation of people paying a lot for a course that they should be taught by people who are professionals?

I would argue that the best replacement or the best thing to complement the case-based learning is actually first person stories. And so bringing in refugees or community leaders or people who have not just-- because it's not just about the problem-solving. It's the problem posing and how that can be engaged with in the classroom. If you can't imagine a population locus, then at least you can being representatives of the population into the academy.

But then it raises questions about, who's the teacher? How do you credential? How do you distinguish? How do you reward?

I don't know the answer to that, except we had a very big argument. We're bringing in a number of community members to run a session on global health called the Global is Local. So London, like Boston, I'm sure, is a wonderful place for doing that. But we had a big argument amongst the teaching faculty about whether we paid the people who are coming in.

And one of the issues is, what would that mean? What precedent do we set? Some of these people would lose their state benefits if they actually were being paid to do work. It's not an easy challenge, and there's a lot to overcome. But the transformative potential is huge.

You have to break start breaking down some of the formalities.

DONNA So I'm going to pose one more question. Anyone can answer it. And if you have questions in the audience, you, as PETERSON: always, please get to the microphone. Now that I can see the slide-- public health education unbound. How important is the degree in the future of higher eduction?

ALAN M. We have some market tests to respond to your question. For the foreseeable future, it's extremely valuable. And GARBER: perhaps there's another way that you might have phrased question, which is, how important is a degree from the institutions that currently offer degrees, which is a very unsettling question if you're from one of the institutions

represented here. There's an issue of, what does a degree signify? As you all know, there's a considerable amount of advocacy for competency-based instruction, measures of competency, mastery, whatever you want to call it, which would in essence, change some of the certification role from something that's conferred by a college or university and move it into some other body, maybe an accrediting body, maybe a commercial institution of some kind, which could be an accrediting body. But the point is that if there were a set of tests that you were to impose and they were recognized as valid measures of mastery of the materials, the degree from an institution, particularly if it only demonstrated you put in time and achieve certain grades in courses, whose meeting is not clear to, say, employers, if you have all that in place in a test, it's viewed as valid, that represents a threat to traditional modes of education.

So I don't foresee a day when some form of certification broadly construed like a degree doesn't matter. But it is possible that there will be a day when conventional degrees, as we give them, won't matter so much. Having said that, try to get a consensus about what constitutes mastery of a subject or a set of skills.

It's remarkably difficult. And a lot of people won't trust the government to be behind any such effort. The body that's going to make a decision about what represents acquisition of knowledge. So I think that there will be some pushes in this direction, but it's not clear how successful they will be.

And at the end of the day, when you talk about real world learning and so on, putting in time actually probably matters. Most of my teaching actually was in clinical settings. And I think simulation is pretty promising, but most of you would not want to be treated by a physician who hadn't actually taking care of real life patients for a significant amount of time. And so I think you raise a very interesting question.

But I really don't think it's something that's going to change dramatically in the next decade.

DONNA Yes, Anita? PETERSON:

ANITA BERLIN: I think that's, in a way, where the rub between higher education and professional education is, because professional education is already given itself up by definition, the specific professions. And this goes back to this question about, what is public health? But certainly, the more clearly-defined professions, such as medicine, the law, architecture-- there's a wonderful quote from Bernard Shaw, which is, I think, at the very beginning of the Doctor's Dilemma, which says something like, I think we've lost faith in God, and we've we put it in the general medical council.

And so we already have this need. And I think that's what the panel were talking about a lot in the assessment panel, was that we have to come to some agreement about what it is that defines a doctor. And that is one of the issues that an institution such as this-- and it's so wonderful that it's happening. And yes, Harvard is having conversations about education and about learning, which is fantastic at this level to have these types of conversations.

But it goes back to the big question, which is, what is public health? Is it something that imbues a lot of other academic and professional activities? Or is also something that people want to get a credential for because it is a stepping stone for an explicit set of activities that need some sort of safety net within it and also some sense-- and we talked about this before-- belonging? Who mentioned belonging? I think Julio mentioned it. Belonging is terribly important for our personal identities, but it is also a way of excluding others. And the other reasons that we want credentials is to say that I'm one and you're not in the same way. We're talking about this for individuals, but one of the important things we're talking about is, is this for institutions?

I was having a conversation with a colleague recently. He said, you know all those visitors who have come from one of the Brit countries, you know I work in that country? And that institution isn't even a real medical school, and it isn't properly credentialized. And somehow the people who invited them here as part of their study program aren't aware of this, because they don't understand how this works in China.

That's like the country in question-- big enough country. But the point is, we do care. And the people who are paying us to teach them care that we are institutions that credentialize and our teaches are credentialized. But the problem with that is, it is, by definition, excluding.

And how do we actually get over that?

SUE J. GOLDIE: I would just echo that I think all three statements are actually true. And I think we can have both and the thinking that has to happen on how we do that. So if we forget about competencies for a moment and say, there's some knowledge, and there's knowledge we need to know. And there's knowledge we need to have literacies in, to be able to talk about.

And there's ways we need to be able to know what we don't know so we can go find it out and how to find it out. That's one thing. There are basic skills. There are values.

And then there are competencies that are more associated with our professional identity et cetera. And then there's that other thing we talked about. I think competency sounds like it has a ceiling. So I like to think of it as capacity, as that highest level, that ways of thinking, the kind of quality of mind, leadership that all those pieces that come from the self-reflection et cetera.

So how do we retain the professional identity but enrich the opportunities for how to stay with the times on that profession by leveraging the whole community, both across the boundaries, as you said, university-wide and across boundaries of sectors and practitioners. But both are, I think, really important and really have a place.

ANITA BERLIN: Completely with you about, can we get rid of competencies and have capacity of something else? Competency is so associated with outcomes and with finite outcomes. And they're so limiting in their own right.

DONNA Are no questions from the audience? Please, sir? PETERSON:

AUDIENCE: Hello. My name is Ramon Sanchez. I work in the Harvard School of Public Health in the Extension School, the . I teach Energy and the Environment, and because of that, I participated in a MOOC taught by Jack Spangler, and it was about my topic-- energy, renewable energies, and everything.

But something that happened is that I made a mistake. I put my real email in the presentation so I got like 700 emails one day, 800 the next day or something like that. But then everyone was asking about one thing-- carbon capture. And so I say, well, what I'm going to do is, I'm going to put them together in a group of interest, and I'm

going to ask them the questions about how to do this technology and everything. So I start to crowd source brains. And in two days, they come up with a great idea, great ideas, the cost, the whole thing. We have plan managers talking about this and people selling plastics and everything. But at the end, it was great.

Now, my question is, do we have a book of best practices for things like this? It's like, bad practice, put your real email there. Good practice-- do the crowd sourcing of brains and getting ideas and everything. And actually, I'm going to use what I learned in the MOOC in my class in the Extension School.

I will have like 150 students. And I think that what I learned from the MOOC I will use it on my class. But do we have a book of best practices? If there is one, can I come trade you? If there is none, can we make one?

ALAN M. This is a really great question. We do not have a book of best practices, but we do have a MOOC of best GARBER: practices. And I'm serious. Chris knows all about this. edX has produced a MOOC on how to produce MOOCs. And it's sort of like a live document, because it's constantly being revised.

Your story is fantastic. And I am sure we would love to have that knowledge incorporated. Let me just add briefly, the crowd sourcing approach is one that's just tremendously fascinating. There are many stories of great successes of the kind that you described. There are also cases where it's led people down the garden path to something that wasn't really quite so useful.

And part of the best practices is learning about how to encourage the right kind of crowd sourcing, knowing when it will work, knowing when it won't. But thanks very much for your question. And we should get you in touch with edX so that you can add to the information base.

AUDIENCE: Can I just add, the teaching and learning center in the university, although they're good without [INAUDIBLE], has a pretty good booklet on those practices.

AUDIENCE: My name is Nancy Krieger. I'm a professor of social epidemiology here at the Harvard School of Public Health and deeply investigating issues of pedagogy, including through the spirit of 1848 caucus that I lead in the American Public Health Association, which actually, every year runs sessions on progressive pedagogy in public health. And I've been able to hear part of the conversation today, not all of it, because I actually teach from 9:00 to 12:00 on Friday mornings a course that's actually about theories of disease distribution in public health, in epidemiology from historical and critical perspective.

And I think the thing that really strikes me of the parts today that I've been able to hear and then also not able to hear because of being actively teaching right now is wanting a much larger historical context for some of the questions that are being raised. So for example, the question of, do you bring people in from the community and learn from them or not? I think back to Hull House and Jane Addams and the work that was done there and the divisions against what was happening with professionalization, for example, of sociology, where the idea was that community people were seen as simply advocates, uninformed, ignorant, and biased.

Whereas academe provided objectivity. And yet within academe, we also know it's not just objectivity. There's actually partisan views. Disciplines are split. And there will never be just one definition of public health. But there will be an awareness that there is action that needs to be taken that cannot be taken just simply by individuals in private capacity, that's required to improve public health. So I guess my question is, how do you reflect on the kinds of issues that you're raising about the nature of pedagogy with the much larger questions of where academic freedom lies for raising controversial questions that will not be necessarily seen as palatable to some people who have power, whether that's in different kinds of political parties-- you could have power in this country of Tea Party right now, busy cutting food stamps, you have power that's on progressive types that would have views on other aspects of public health. Because I think that to just frame things in terms of leadership and in terms of content, without dealing with the context in which we do public health and the historical debates that are inherent in what we're teaching, I think no method by itself will resolve those questions.

So I would be interested in those reflections, because I think that's critical to the fundamental nature of pedagogy and critical pedagogy in public health and also other fields.

ANITA BERLIN: It's a great question. In a way, it goes back to the last point, which was the point-- you weren't here this morning. Ian started with a big word cloud, which came out of a question. I can't even remember what the question was, but I know what the answer was, which was that three big themes came out, which was the engagement, application, and practice.

We talked about practice. We talked a little bit about engagement. I think the thing about application is, what is public health? What is it we think it can do? What is it therefore that we think we're doing when we're educating? And I think what we've touched on-- and actually, your question could've come earlier-- is, perhaps the long bit of the T, or something that turns education on its side, that uses some of the potentially very dangerous constructs within critical pedagogy, which says things like, no, we don't want to just ascribe to a competency approach, because actually, that's about obedience.

It's about signing up to something in which-- and particularly when you belong to a professional body and you're signed up by your board, what you cannot be seen to be doing is being dissenting. And therefore, the idea that you put your email at the bottom of a MOOC when the checklist says you shouldn't do that. That could be in breach of some sort of guideline with your checklist, best practice checklist.

You did it. It was brilliant. And so actually, it's about courage. And one of the reasons we're here today is because somebody talked about professionals have to be disinterested. Actually, they have to be appropriately interested. And that sometimes involves being angry and passionate and using that to galvanize yourself, because if we are really thinking about public health, then we're thinking about things to do with increasing issues of health inequity.

We're dealing with issues to do with very unstable health systems, with lack of investment in human resource development. So we actually have to use all those ideas from the original Freire idea of transformative learning, which is about increasing agency and about being able to be dissenting. And actually, that doesn't fit within a professional construct.

When people were talking earlier about leadership and ethics, the idea that you can bring leadership and ethics into a set of competencies is pretty actually an anathema almost, because it's actually about a way of being. It's about the passion and the critique.

DONNA Thank you, Dr. Krieger. Last question, and then-- guess what-- we get to go to the reception.

PETERSON: CHRIS KAISER: No,, no, no, no.

DONNA No, we have [INAUDIBLE]. We have one C before the other C's. Yes, ma'am? PETERSON:

AUDIENCE: My name is [? Ming Ho ?]. I'm a research scholar in . I'm focus on pharmaceutical policy and the pharmacy practice. As a pharmacist, I know America Association of College of Pharmacy and American Association of Health System Pharmacists have developed the compentence standards and outcomes for pharmacy profession.

I know it's pretty different of the public health profession and the pharmacy profession. And I very thankful here today, giving me a very excellent experience to learn so many great ideas here and learn many things about the engagement [INAUDIBLE] and the leadership and the transforming ideas and digital science and so on. But I'm still confused.

And in fact, I just want to put forward in the last panel, that is, I'm still confused. Could you give me, briefly, ideas about what's the key competence outcomes of public health profession?

SUE J. GOLDIE: No, and we're not going to.

AUDIENCE: But in our country, in China, it seems public health play actions everywhere. And it seems public health is very strong in the health care system. I just know as a pharmacy profession, I know it's a very clear orientation. I don't know. I'm just curious.

As a public health professional, [INAUDIBLE] and a graduate student--

DONNA If I could refer to you the aspph.org website, you will find a whole array of materials that would be useful to you in PETERSON: helping to understand where we are as a field today. I would note that pharmacy has been very assertive in making the connection for students of colleges of pharmacy learning about public health for the professions coming together.

The Inter-Professional Education Consortium has come up with a set of competencies across the disciplines, which I think also lend itself to understanding how clinical professionals need to understand more about population health and community health. You can find all of that either directly or links to it on the aspph.org website.