Introduction to Epidemiology

Module details

Title

Introduction to Epidemiology

Type

Rotation

Module code

SBI202

Credits

10

Requirement

Compulsory

Aim of this module

The aim of this rotation is to provide trainees with an overview of communicable and non-communicable disease epidemiology. They will be introduced to a range of epidemiological concepts, including measures of disease frequency and association, study design, bias and confounding. The work of epidemiologists impacts on populations and individuals within populations, including the prevention and control of disease and associated morbidity. The information provided by epidemiologists also supports commissioners of health services to enable them to better prioritise and allocate resources and underpin health promotion activities. 

This module will provide the trainee with an introduction to epidemiology and its impact on patients, patient care and populations. They will understand and apply their knowledge of communicable and non-communicable disease epidemiology in the work base where epidemiological concepts are used to inform public health action. They will understand the role of epidemiology and the clinical scientist in: surveillance and monitoring of diseases; interpreting epidemiological surveillance data; and investigating outbreaks to guide interventions aimed at protecting and improving the public’s health.

Epidemiology examines the distribution of disease in populations and underlying causes. Examples of these include lead poisoning cases in children associated with ingestion of paint; food borne outbreaks involving bacterial or viral agents associated with poor food hygiene practices; clusters of cancers; the association between obesity and health-related outcomes.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Identify a surveillance system and its objectives.	Action View
# 2	Learning outcome 1	Competency Identify all potential attributes of this surveillance system.	Action View
# 3	Learning outcome 1	Competency Select and justify relevant attributes in consultation, and evaluate the system.	Action View
# 4	Learning outcome 1	Competency Prepare a surveillance system evaluation report and make recommendations based on your findings.	Action View
# 5	Learning outcome 1	Competency Present and defend the report at a departmental meeting.	Action View
# 6	Learning outcome 2	Competency Identify a surveillance system and extract data from it.	Action View
# 7	Learning outcome 2	Competency Analyse surveillance data (descriptive epidemiology).	Action View
# 8	Learning outcome 2	Competency Interpret the results of the analysis and prepare a report detailing the findings exercising professional judgement.	Action View
# 9	Learning outcome 3	Competency Identify a peer-reviewed analytic epidemiological study for review.	Action View
# 10	Learning outcome 3	Competency Critically appraise the peer-reviewed manuscript, focusing on potential biases and how these may impact on the findings.	Action View
# 11	Learning outcome 3	Competency Present and defend the critical appraisal, e.g. at a journal club	Action View
# 12	Learning outcome 4	Competency Attend outbreak control team meetings.	Action View
# 13	Learning outcome 4	Competency Support the outbreak control team during the investigation.	Action View
# 14	Learning outcome 4	Competency Critically reflect on and document the steps undertaken in the investigation that you have been involved in.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Learning outcomes

1. Generate a report describing and evaluating the attributes of a surveillance system.
2. Generate an epidemiological report analysing and interpreting surveillance data.
3. Present a critical appraisal of a peer-reviewed analytical study, discussing potential biases and their impact on the findings.
4. Participate in and document the steps that are taken to investigate an outbreak.

Learning outcomes

1. Define the key concepts of epidemiology.
2. Distinguish key features of communicable, non-communicable and environmental epidemiology.
3. Justify the rationale for surveillance and evaluate the strengths and weaknesses of different approaches.
4. Explain the application of measures of disease frequency and summary statistics.
5. Describe the principles of outbreak investigation.
6. Describe epidemiological study designs and their measures of association.
7. Calculate measures of association for cross-sectional surveys, case control and cohort studies.
8. Describe bias, confounding and chance, and their impact on measures of association.

Indicative content

• Define the key concepts of epidemiology
  • History of epidemiology
  • Time, place, person
  • Applications of epidemiology
  • How the output from applied epidemiology is used both clinically and to inform broader approaches in the determinants of health in a range of specialisms, and the consequences of decisions made on actions and advice
• Distinguish key features of communicable, non-communicable and environmental epidemiology
  • The theoretical basis of, and the variety of approaches to, assessment and intervention
  • Infectious diseases and causative agents
  • Infectious disease transmission, including vaccination and immunisation
  • Chronic diseases and conditions
  • Environmental exposures and disease
  • The wider clinical situation relevant to communicable, non-communicable and environmental epidemiology, and the effect of disease on patients and populations
• Justify the rationale for surveillance and evaluate the strengths and weaknesses of different approaches
  • The surveillance cycle: set objectives, data collection, data analysis, interpretation, action, evaluation
  • Surveillance system attributes
  • Population under surveillance
  • Active surveillance
  • Passive surveillance
  • Sentinel surveillance
  • Syndromic surveillance
  • Disease registration systems
  • Cancer registration (as an example of disease registration)
  • Benefits and risks of data linkage
  • Clinical uses of registration data
  • Examples of other disease registration systems
  • Risk assessment in the context of prevention and control of communicable diseases (e.g International Health Regulations)
• Explain the application of measures of disease frequency and summary statistics.
  • Types of data (categorical, continuous)
  • Frequencies and distributions
  • Numerators and denominators
  • Measures of disease frequency
  • Summary statistics, e.g. mean, mode, median, measures of spread (range, interquartile range, variance, standard deviation)
  • Prevalence and incidence
  • Rates (crude, specific and standardised)
  • Risk adjustment
  • Hypothesis generation
• Describe the principles of outbreak investigation
  • Aim to identify and control source
  • Multidisciplinary roles
  • Establishing the existence of the outbreak; defining the disease; finding cases; describing cases by time, place and person characteristics; establishing a hypothesis related to the mode of occurrence; testing the hypotheses; conducting an environmental investigation; conducting a microbiological investigation; controlling the outbreak, preventing further occurrences, and writing an investigation report to share experience with the public health and scientific community
  • Patient engagement
  • Social, institutional and political background
  • Need for timeliness to enhance preventive impact of control measures
• Describe epidemiological study designs and their measures of association
  • Qualitative and quantitative
  • Prospective and retrospective studies
  • Cohort studies
  • Case-control studies (matched and non-matched)
  • Cross-sectional studies
  • Ecological studies
  • Intervention studies, including clinical trials
  • Measures of association, e.g. odds ratio, relative risk, attributable risk, correlation
• Calculate measures of association for cross-sectional surveys, case control and cohort studies
  • Calculate prevalence ratios, odds ratios and relative/attributable risk using dummy data
• Describe bias, confounding and chance, and their impact on measures of association
  • Selection bias
  • Information bias
  • Observer bias
  • Loss to follow-up
  • Misclassification
  • Confounding and chance
  • Importance of effective communication with patients to minimise bias

Activities

• Visit a microbiology laboratory to gain an understanding of the processes and methods involved in identifying and typing infectious disease agents responsible for human infection, and with your supervisor, discuss how your experience will inform your future practice.
• Discuss with a relevant public health professional how surveillance data can be used to make decisions on programmes of work aimed at improving and/or protecting the patient’s and public’s health.
• Within an acute hospital setting, discuss with colleagues available hospital data sources and how surveillance data is used for decision making, e.g. data in relation to infection control, outbreak management, Hospital Episode Statistics.
• Shadow an environmental health officer during an inspection.
• Critically reflect on your experiences engaging with these public health professionals, including reflection on the effectiveness of the partnerships and communications underpinning good surveillance and outbreak investigation.