American Journal of Epidemiology Advance Access originally published online on December 27, 2007
American Journal of Epidemiology 2008 167(3):375-376; doi:10.1093/aje/kwm377
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LETTERS TO THE EDITOR |
RE: "THE GENERAL EPIDEMIOLOGIST: IS THERE A PLACE IN TODAY'S EPIDEMIOLOGY?"
Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720
(e-mail: wangconstance{at}berkeley.edu)
We read with interest the provocative special article by David Lilienfeld entitled "The General Epidemiologist" in a recent issue of the Journal (1). We are writing for two purposes: 1) to strongly endorse Lilienfeld's assertion that there is a role for the generalist in modern epidemiology and 2) to respond to the critical issues he raised with regard to training the next generation of generalists. We express our views here as two general epidemiologists, one at the twilight of a productive career (W. W.) and the other at the dawn of a career full of promise but clouded with uncertainty (C. W.).
Perhaps all is not lost: the fact that there are young epidemiologists with today's training, who consider themselves generalists and who aspire to such careers as Abraham M. Lilienfeld's (as referenced in David Lilienfeld's article (1)), is a testament to the far-reaching intellectual legacy of the generalists from eras past. However, the young generalists must confront pressures to specialize and make difficult trade-offs. The criteria for tenure and promotions at most academic institutions, where a substantial proportion of new epidemiologists will practice, emphasize accomplishment of, and depth in, topic-specific scientific contributions from individuals. Indirectly, this emphasis places less value on breadth and collaborative work, the hallmark of generalists. Yet, many public health problems call for a multidimensional, generalist solution.
We observe an interesting trend deserving of further study. In the past, epidemiology training took place largely in practice-oriented settings supported by training grants from the US Public Health Service. This training environment required students to adopt a generalist approach, since health agencies were required to investigate a wide spectrum of health concerns. When this support largely dissipated in the 1960s and 1970s, an important component of training was eliminated. In contrast, the training of the current generation is now taking place almost exclusively in the classroom and laboratory, with research experience derived largely from specialized epidemiologic projects likely to focus on a single disease outcome. Thus, the younger generation is afforded very limited opportunities for hands-on training in the community and in health agencies. The epidemiology faculty that once comprised those who themselves trained in health agencies with skills to address a variety of health concerns has, over time, been replaced by faculty with increasing levels of specialization.
In addition to David Lilienfeld's recommendations (1), we suggest that the field might reconsider the content of epidemiology training programs. This reconsideration might benefit from greater emphasis on opportunities for students to spend time in the community and in public health agencies. To reinvigorate the role of "general epidemiologist," a "workshop" at the Centers for Disease Control and Prevention in Atlanta, Georgia, to chart a course would seem to be a useful starting point.
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ACKNOWLEDGMENTS |
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Conflict of interest: none declared.
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NOTES |
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Editor's note: In accordance with Journal policy, Lilienfeld was asked whether he wanted to respond to this letter, but he chose not to do so.
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References |
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 TOP References |
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- Lilienfeld DE. The general epidemiologist: is there a place in today's epidemiology? Am J Epidemiol (2007) 166:1–4.
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