FETP - History and Value of Establishing Field Epidemiology Training Programs
The first applied epidemiology training program—the Epidemic Intelligence Service (EIS)—was established in the United States in 1951 to address a severe shortage of skilled epidemiologists in the public health workforce.
In 1976, Canada established the first FETP outside of the United States, modeled after the EIS. In 1980, the government of Thailand requested CDC’s assistance to establish its own program, with funding initially contributed by the United States Agency for International Development (USAID).
FETPs are country-owned programs located within ministries of health and are tailored to meet the public health needs of each country, in accordance with the country’s culture,
national priorities, established relationships,
and existing public health infrastructure.
Guiding Principle of FETP
The guiding principle of the FETP training model is “learning through doing,” a concept that is analogous to a medical residency in which physicians acquire on-the-job experience by learning and practicing the necessary skills to become capable clinicians. FETP trainees–often referred to as “residents,” “fellows,” or “officers”–spend between 20-25 percent of their time in the classroom, learning the principles of epidemiology, disease surveillance, outbreak investigation, and biostatistics. The other 75-80 percent of their time is spent in field placements, where residents "learn by doing," by participating in outbreak investigations, helping to establish and evaluate disease surveillance systems, designing and conducting studies on problems of public health concern in their country, and training other healthcare workers. Field work is typically conducted under the supervision and guidance of an experienced mentor.
Due to their focus on building epidemiologic competency outside of the classroom, FETPs are distinct from the majority of programs training in epidemiology, such as traditional Master of Public Health (MPH) programs (although some programs are affiliated with academic institutions and offer MPH degrees to program graduates). Residents are typically recruited from within ministries of health, or occasionally from other ministries, such as agriculture. Some differences between programs include affiliation with a degree-granting academic institution; incorporation of a laboratory component (called a Field Epidemiology and Laboratory Training Program, or FELTP) or other specialty area of concentration (e.g., veterinary, non-communicable disease); or whether it is a national or regional program.
Another unique feature of FETPs is the relatively small size of the training cohort, which is typically between 10-15 residents. FETP cohorts are kept deliberately small to ensure that each resident receives adequate supervision and mentorship throughout their training.
In recognition that different skill levels are needed at different levels of a country’s health system, and that an intensive two-year FETP training is not needed for all epidemiologists, CDC has begun to broaden its training scope and impact by targeting different audiences and different levels within the health system.
For example, in Central America, a three-tiered “pyramid” training was developed to build capacity at local, district, and central levels of the health system. All levels of training are based on the same core competencies, but the complexity and length of training differ among the different tiers. The most intensive training occurs at the highest level (third tier), which is the two-year FETP. The middle tier is nine months in duration and enrolls district-level public health workers, while the first tier is targeted at local health workers who participate in the training for three to five months. As with the traditional FETP model, the majority of the participants’ time is spent in the field, working on priority public health projects for their country and applying what they have learned in class.