One of the biggest challenges in my current work toward the doctoral degree is to reconcile the two kinds of ways that I am being taught epidemiology. The first way is as if I was going to become a researcher. The second is what I’m actually aiming for, becoming a public health practitioner. The school of public health is very, very heavy on the first kind of epidemiology, and very, very light on the second kind.
The research and academic epidemiologist looks at a public health problem and designs a study to better understand it. He or she makes sure that the measurements are valid and that the information collected from the study is reliable. They take good care to choose the subjects carefully so as to not introduce bias into the study. With data in hand, they test several hypotheses about the mechanisms that cause whatever disease or condition that they’re studying. They use the “dark arts” — as one frequent reader/commenter has called biostatistics — to make sure that their observations are not due just by chance, or that they’re not being influenced by things seen or unseen. Finally, they put all of their findings in a research article and get it published at one of many reputable scientific journals.
In between all that, the research and academic epidemiologist needs to spend time making money for whatever institution they are working for. These days, most of that money comes from grants. To get those grants, they need to spend an innumerable amount of hours writing the grants, getting them approved, and getting published as much as possible in order to advance within their institution. They also function as managers of whatever team they’re leading. Or, if they’re part of a team but not leading it, they work on becoming leaders of their own team. Finally, if time allows, they’ll teach a class or two per semester in order to satisfy the educational needs should they be working at an institution of higher learning. (This is not always a good thing, by the way.)
The other kind of epidemiologist, the one I want to be (and was, to some degree while I worked at the health department), is not interested in grants, institutional politics (which are different from governmental politics, and I’ll discuss in a bit), or teaching. The other kind of epidemiologist sees a public health problem and goes looking for solutions. They look in journals, in the experience of colleagues, and other disciplines which might help them. (You don’t fix HIV epidemics with antibiotics alone.) Many times, the other kind of epidemiologist doesn’t have time to wait for grants to be approved, funds to be distributed, or student evaluations to be submitted. The other kind of epidemiologist grabs the bull by the horns, so to speak, instead of studying said bull and comparing it to counterfactual bulls.
These two kinds of epidemiologists don’t live in a constant struggle with each other, as some would think. They actually collaborate and work well with each other. The research/academic epidemiologist puts in the long hours and sacrifices a lot to try and understand complex public health problems in a way that could truly save the world. The other kind of epidemiologist wakes up in the morning and thinks of at least seven different ways to save said world. Then they go and pull up the knowledge created by the research/academic epidemiologist and performs some sort of alchemy that turns that knowledge into wisdom.
Unfortunately for those of us who want to be “the other kind,” there are not many things about being that kind of epidemiologist that can be taught in the classroom setting. Sure, we can learn about confounding, effect modification, and about all the different constructs that fit within epidemiological surveillance. We can learn about the different steps to take in an outbreak investigation, too. What is hard to learn is what to do with all that knowledge.
The alchemy that I mentioned above is something not taught in academia.
This is where I have found myself time and time again in the last two years. I have found myself sitting in some classes that have absolutely nothing to do with what I want to be, but they are necessary for two reasons. The first reason is that it is essential that I be able to discern between good and bad epidemiological evidence. The second reason is that the school says so. Their curriculum, their rules. The downside has been a less-than-stellar performance on my part not because I’m not smart, but because I get bored easily. The boredom translates to distraction. The distraction translates to missing some important concept or two, and then the grades take a hit. (To be fair to myself, I never claimed to be smart.)
So time and time again, I’ve found myself needing to focus and redouble my efforts. And this can be exhausting. Adding to the exhaustion is that so many of the other students (master’s and doctoral students) have an enormous rock tied to their necks and dragging them down on many different dimensions. That rock is their ridiculous and obsessive pursuit of straight A’s. Of course, I write this from the point of view of someone on who is much more relaxed about his grades and much more looking toward the future, doctoral degree or none… Someone who has a wife to go home to, two awesome siblings, plenty of loving friends, and a set of quadrupeds who rely on him. Grades have pretty much become secondary or even tertiary.
Don’t get me wrong, though. I want to perform well in my classes, even stand-out. Lots of opportunities await if I can show different people at the school that I am actually smart. (Again, I never said I was.) And those opportunities will translate into work that I can do to continue to help people, continue to keep the world from burning.
What can I say? I’m that kind of an epidemiologist.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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