MS in Chronic Disease Epidemiology Provides Intensive Training in Research Methods

Jessica Illuzzi, M.D., M.S. ’06 , had a strong background in basic science and treating patients, but felt that she lacked the clinical research skills needed to address the issues she was interested in exploring. “There were unanswered questions in my field and I didn’t have the tools to do that type of research,” said Illuzzi, associate professor of obstetrics, gynecology, and reproductive sciences.

To deepen her skill set, Illuzzi pursued a Master of Science in Chronic Disease Epidemiology (CDE) at the Yale School of Public Health. This program offers rigorous training in research methodology, helping investigators develop skills in such areas as trial design, advanced biostatistical methods, and epidemiology.

“We’re finding that increasingly, clinical investigators need to have training in things like how to do clinical trials, or confidence in genetic epidemiology if they’re going to be doing genetics,” said Susan Mayne, Ph.D., the C.-E.A. Winslow Professor of Epidemiology and chair of the department of chronic disease epidemiology. The curriculum ranges from introductory level to more sophisticated courses in methods that clinical investigators need to master.

The program is particularly well suited to clinical fellows or junior faculty, including YCCI Scholars, who often fund the tuition through a K award. Marney White, Ph.D., M.S. ’09, who included the M.S. tuition in her K application, noted that the education component of her proposal was very well received. Unlike auditing classes, an approach sometimes used for K awards, the master’s degree in cde offers in-depth training through a solid and structured didactic approach.

Students may tailor electives to their own interests in addition to completing core courses in data analysis, epidemiology, developing a research proposal, and research ethics. White, associate professor of psychiatry and of epidemiology (chronic diseases), who specializes in eating and weight disorders, chose electives in nutrition and food policy. She attended the program part time, taking several years to get her degree, although it can be completed in one year of intensive full-time study.

Alumni note that the program has made a significant difference in their ability to conduct research, providing quantitative skills and informing new avenues of pursuit. “It really equipped me with the basic steps necessary to understand trial design and epidemiology better,” said 2008 YCCI Scholar R. Douglas Bruce, M.D., M.A., M.Sc. ’08, assistant professor of medicine (AIDS) and of epidemiology (microbial diseases), whose research focuses on pharmacology and operations. These skills can be especially important for new investigators, because they don’t necessarily have the funding to support a statistician, for example. “If you’re always waiting for someone else to analyze the data for you, you’re very limited on how quickly you can do things and how much you can do,” said Illuzzi.

Earlier in her career, Illuzzi was focused on how to prevent the transmission of Group B streptococcus from mothers to newborns during birth. While she was enrolled in the master’s in CDE program, she conducted a systematic review of the literature based on a course she took in evidence-based medicine. She was subsequently the first investigator to publish findings that questioned the Centers for Disease Control and Prevention protocol for prevention of neonatal Group B streptococcal disease. She went on to receive NIH funding to investigate the topic further and published several additional articles. Illuzzi then proceeded to try to determine the cause of rising cesarean rates in the United States. She conducted a large study at Yale-New Haven Hospital, looking at 30,000 births over 7 years and analyzed factors that contributed to the increase. Her study, which found that the increase in primary cesarean delivery was due to labor arrest disorders and non-reassuring fetal status, was one of the first published reports of this finding. It prompted the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to investigate the issue; it has been widely cited by subsequent studies; and has led to increased attention on reducing primary cesarean delivery rates.

“I couldn’t have done any of that research without the degree,” said Illuzzi, who had never taken statistics before enrolling in the program. At the time she finished the program, she was one of the few faculty members in her department with skills in statistical methods and programming, and was often asked to collaborate with colleagues. She contributed to a series of publications on gynecologic oncology and other areas, and is currently embarking on a cost-effectiveness analysis of the impact of high cesarean rates on health care costs across the country.

This spring, the department of chronic disease epidemiology offered a mini-course on concepts and applications of health outcomes research, an area that is experiencing tremendous growth. “This is the way things are moving in the future, so Yale needs to be well positioned to train investigators to do that work,” said Mayne. The three-lecture course, taught by Shiyi Wang, M.D., Ph.D., assistant professor of epidemiology (chronic diseases), filled up within two days. “There’s enormous demand for rigorous research methodology training, and we’re trying to build programs that help supply that demand,” said Mayne.

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