Introduction

The EMPH Program

As a trailblazer in distance learning at Emory University, the Executive MPH (EMPH) Program caters to the needs of busy working professionals aspiring to attain an MPH degree. Originally called the Career MPH Program, its inception at the Rollins School of Public Health (RSPH) in 1997 attracted students seeking the convenience of distance-based learning, supplemented by immersive, conference-like on-campus weekends held six times per year (Alperin, Gaydos, & Phillips, 2020). This hybrid approach not only allowed academic pursuits but also fostered a global community, connecting students with peers and RSPH faculty/staff, all while maintaining a balance between professional and personal goals.

The EMPH student body comprises a diverse range of individuals from various professions and academic disciplines. On average, students are 36 years old, with about seven years of full-time work experience.  Between 2016 and 2020, 79% of students were female, 38% identified as Black, 30% as White, 12% as Asian, 5% as Hispanic, and 15% as Other (Alperin, Gaydos, & Phillips, 2020).

To remove barriers to students, such as time and travel costs, the most recent iteration of the Executive MPH program has moved to fully online learning, and the didactic in-person weekends have been replaced with synchronous online class sessions.  As a result, the program explored opportunities to build in-person, interactive events into optional offerings for students and alumni who wanted to connect beyond the distance space.  One such offering, a public health residency intensive focusing on racism as a public health issue, is described below.

The Residency

When developing the Racism as a Public Health Issue Residency, we considered the importance of creating a sense of belonging, beyond the classroom, among our distance learners. The need for a sense of belonging is a strong motivating factor for distance learners to participate in on-campus residencies. A survey of residency participants, composed of distance learners, at the University of New England showed that they left the residency with a “feeling that they belonged” (Beaudoin & Hylton, 2004). In health sciences and related graduate programs, such as dentistry, health administration, and social work, intensive experiences specifically, such as short-term residency programs, enhance the curricular experience of distance learners, professional team building, and connection to the university (Campbell et al., 2022; Duś-Ilnicka et al., 2024; Stebbins & Hill, 2015). 

In recent years, case challenge competitions have also become increasingly popular in health science education, including schools of public health (Mishori et al., 2015). Case challenge competitions provide students an opportunity to work with an interdisciplinary team to devise solutions for real-world problems that may not be typically addressed in their curriculum (Ali, Grund, & Koplan, 2011). Within the context of an in-person residency, a case challenge provides another opportunity for students to feel like they belong.

The Racism as a Public Health Issue Residency was developed for the purpose of fostering community, creating networking opportunities, and promoting interprofessional development among participants while exploring a timely, specific, and important public health issue. In particular, the residency centered on the topic of improving the lived experiences of pregnant people and mothers incarcerated in the state of Georgia. Incarceration disproportionately affects Black and Latino women and children. Black women are incarcerated at twice the rate of White women, and Latino women are incarcerated at a rate of 1.3 times that of White women. One in nine Black children and one in 28 Latino children have an incarcerated parent, as opposed to one in 57 White children (Kajstura &Sawyer, 2023). The topic of mass incarceration viewed through public health and diversity, equity, and inclusion (DEI) lenses also brought attention to issues contemporarily being addressed around the country and allowed participants to approach the topic from an interdisciplinary perspective.

The five-day intensive residency took place in Atlanta, GA in April 2024. It consisted of visits to educational and historical sites related to public health and racism and panel discussions with individuals with lived experience in the carceral system and with community organizations serving incarcerated persons. The residency culminated with a case challenge competition.

To introduce participants to the program and provide them relevant information, we developed a general informational site that contained an overall weekly agenda; information about the case challenge; and individual pages for daily events, which included both background information on venues and panelists and practical details like embedded maps and parking information. To ensure only participants had access to the site, it was created within the Canvas learning management system.

Description of Innovation  

During planning, it was determined that the combination of a five-day residency and case challenge competition would provide the most benefit to participants and ensure a comprehensive experience. A conscious effort was made to ensure that the residency topic aligned with public health and current DEI issues. The residency was optional and was open to current EMPH students and EMPH alumni. Communications to students emphasized the optional nature of the program.

The Racism as a Public Health Issue Residency activities consisted of four important categories: case challenge working time, Atlanta-based site visits, panels on mass incarceration, and the case challenge competition (Table 1).   

For the required case challenge competition, participants (n=17) were split into four working teams that consisted of a mix of current EMPH students and recent alumni. On the first morning of the week, we provided the case challenge prompt (“Identify a problem related to mass incarceration of mothers and pregnant people in the state of Georgia and develop a solution”). Group work time was built into the agenda throughout the week.

During the week, participants visited Atlanta historical and educational sites relevant to the topics being covered. Atlanta has been called the “Public Health Capital of the World” (News Team, 2022) and the “Cradle of the Modern Civil Rights Movement (Myrick-Harris, 2006). These site visits were integral in providing foundational context on the legacy of racism in the southern United States, its impact on society and institutions of justice, and the history of public health. The sites visited were the David J. Sencer CDC Museum, Ebenezer Baptist Church, and the National Civil Rights Museum.

Two panels of speakers were carefully chosen. Panel One was composed of organizational leaders and researchers working on the issue of mass incarceration, and Panel Two was composed of individuals with lived experience in the carceral system. Panels were designed as question-and-answer sessions, with both a moderator and participants asking questions. Residency participants could hear answers informed by both lived experiences within the carceral system and leaders and researchers in the field.

Lastly, the case study competition culminated the week. After attending multiple panels on pregnancy and incarceration and being given a case study document with background information and resources, participants were asked to identify a problem focused on high levels of incarceration among mothers/pregnant people in the state of Georgia. They were then asksed to create and present a solution. Group work time was built into each day of the residency schedule, and workspace was reserved for groups that chose to work on-campus.  As the presentation was a significant undertaking, no other deliverables were required. Groups presented their solutions to their fellow participants and a judging panel comprised of community leaders and EMPH faculty. Proposals included maternal advocacy and mentoring programs, diversion programs aimed at keeping families together, and reentry programs for mothers and pregnant people. The winning team had a donation made on its behalf to the organization of its choice. Current students could also use their participation in the program to fulfill the interprofessional education (IPE) graduation requirement.

Immediately after the residency, participants were sent a survey via email and asked to evaluate their experience. Questions included Likert scale rating (‘strongly disagree’ to ‘strongly agree’ with a ‘not applicable’ option) of individual events, the case competition experience, their understanding of the issues, and resources about the residency. The survey also included free text questions about participants’ reasons for attending and goals for the residency.  The survey was intended to gauge participants’ immediate experience with the residency; broader evaluation comparing students who did and did not attend and long-term effects of the residency have not been undertaken.

Results

The residency cohort consisted of 17 participants (eight students; nine alumni) from multiple states who were employed in a broad spectrum of public health settings. Of the total participants, 11 completed the survey.  When asked to briefly share their reasons for attending the residency, students cited the opportunity for in-person interaction and the opportunity to engage in-depth with the topic in roughly equal measure.  As one participant noted,

“I wanted to attend to interact with other like-minded individuals in an academic setting. I also wanted to learn more about the issue of mass incarceration.”

While the sample size was small, and feedback was self-reported, reaction to the residency was overwhelmingly positive. Between seven and 11 of the 11 respondents agreed or strongly agreed that each event provided them with meaningful information. In addition, all participants agreed or strongly agreed that the residency improved their understanding of issues regarding mass incarceration and broadened their thinking about interactions between social justice and public health. The panel discussions with professionals working on mass incarceration and people with lived experiences in the carceral system were particularly well-received, with all respondents strongly agreeing that those events provided them with meaningful information. All students agreed or strongly agreed that working in their case challenge teams was worthwhile, enjoyable, and offered opportunities to network and expand their knowledge of issues surrounding mass incarceration, and all reported their personal goals for the residency were met.

Participant responses included:

“I was interested in learning more about the intersection between gender and incarceration and we definitely did that. I also got to meet other students and alums which was very helpful.”

and

“I wanted to test my ability to work on a project with people I didn’t know on this topic. It was great to see how everyone worked together to create their proposal in such a short period of time.”

The residency consisted of 3.5 days of programming plus an opening reception on the evening of the first day. In both their evaluation responses and in conversation with EMPH faculty and staff, the main challenges participants reported involved the length and intensity of the residency. Participants from outside Atlanta also incurred significant expenses for travel, lodging, and meals not provided by the program. In addition to being cited as difficulties by those who participated in the residency, this was also cited as a factor for non-participation or cancellation.

One participant noted the cost burden to attending, saying: “I think the program should have paid for all meals or at a minimum lodging. I imagine a lot more current students would have come if it had not been so expensive.”

Discussion

The inaugural residency week was well-received by participants and met the goal of providing participants with the opportunity to foster community, create networking opportunities, and promote interprofessional development. For institutions exploring or developing a residency, the length and intensity should be considered when target participants are distance learners who are also working professionals. Institutional resources and the frequency of the residency are also considerations. Planning and implementation required investment of significant human and financial resources. Departmental administrators and staff, as well as a temporary, part-time residency coordinator, had multiple responsibilities, including writing the case study used in the competition, developing the informational site and promotional materials for participants, communicating with residency participants and panelists, securing space and coordinating catering for on-campus events, and acquiring tickets for events that required them. In addition, several professors in the EMPH program and representatives from local non-profits donated their time to be panelists and judges for the case study competition. To ensure that the residency is budgeted, planned, and promoted appropriately, we suggest that a residency be held every other year.  Costs such as meals, admission tickets to local sites, and additional staffing needs can be planned efficiently between residency years. Also, the time between residency sessions will allow potential participants to receive well-crafted marketing communications and develop their own budget for travel and other relevant expenses for the residency.

While the inclusion of the case competition as the culminating experience for the week was well-received, it is important for institutions to consider the significant commitment required of participants. Feedback received suggested that the case competition should be an optional component of the residency due to the intensity and time required to research, develop, and present a solution in a compressed timeframe. In this residency, the case competition was required for those seeking to meet IPE requirements for graduation. If a residency is marketed as optional, it will be important to establish how IPE requirements will be met if participants choose to use the residency to meet these requirements.

Lastly, institutions should consider making the topic of the residency dynamic and ever-changing to attract participants with different interests and professional backgrounds and to utilize local resources and currently relevant topics. This will provide participants with an immersive experience that is relevant, diverse, and intersectional.

Conclusion

An intensive in-person residency with case study competition allows participants to foster community, create networking opportunities, and promote interprofessional development. For students in a completely distance-based program, the residency experience is an important factor in creating a sense of belonging in students and a sense of presence on the part of the program. It also allowed participants in-depth engagement with a timely topic. Some considerations when implementing a similar program are the length and intensity of the residency, the topic, geographic setting, and human and financial resources required to develop and produce the program.

Acknowledgments

We would like to thank Executive MPH Program Director, Dr. Moose Alperin, and Deputy Director Dr. Laurie Gaydos, for their support. We received no grant support for this work. The authors declare that we received no payment or services from any third party to support this work. This project was determined as not requiring Institutional Review Board review because it is not “research” as defined in federal regulations.