The Founding and Growth of the Clinical Epidemiology Unit
In 1978, the Clinical Epidemiology Unit (CEU) was formed within the Division of General Internal Medicine (then General Medicine) to integrate epidemiologic methods and knowledge into the teaching, clinical practice, and research of the School of Medicine at the University of Pennsylvania. The formation of the CEU was prompted by the recognition of the large number of clinical topics to which epidemiologic knowledge was relevant and the awareness that the questions that epidemiology addressed were central to pressing medical and societal concerns.
Initially funded by the Charles A. Dana Foundation, the Rockefeller Foundation, and the Andrew W. Mellon Foundation, the CEU was extremely successful in bringing epidemiology to the bedside and vice versa. Collaborative research was undertaken with multiple different clinical programs in the School of Medicine with the support of external foundation funds and major funding from the federal government.
The CEU eventually outgrew its base within General Internal Medicine, evolving into three new administrative structures: the Center for Clinical Epidemiology and Biostatistics (CCEB) - a "Type 2" center, the Department of Biostatistics and Epidemiology (DBE), and the Graduate Group in Epidemiology and Biostatistics.
Formation of the CCEB and DBE
The creation of the CCEB was announced on February 1, 1993. Brian L. Strom, M.D., M.P.H. was named its Founding Director. The CCEB has two subunits: a Clinical Epidemiology Unit and a Biostatistics Unit. The Clinical Epidemiology Unit is composed of all clinical and non-clinical epidemiologists in the Medical Center, and most of those elsewhere in the University. Likewise, the Biostatistics Unit is composed of all biostatisticians within the Medical Center and most biostatisticians elsewhere in the University.
The Director of the CCEB reports directly to the Dean of the School of Medicine. While the CCEB has its own space and resources, all the CCEB's faculty have primary appointments elsewhere, in contrast to a department. Thus, consistent with the desire to maintain integration with clinical departments, clinical faculty are not forced to decide whether they are clinicians or epidemiologists; they can be both.
In response to the need for increased biostatistical support for the Medical Center, a Department of Biostatistics and Epidemiology (DBE) was formed, in close association with the existing CCEB. Epidemiology was included in the name of the department as formal recognition of the role of non-clinician epidemiologists. The DBE contains two separate divisions - Biostatistics and Epidemiology - each with its own Director. J. Richard Landis, Ph.D. was recruited as Director of the Biostatistics Division in 1997. Dr. Strom directed the Epidemiology Division until Harold I. Feldman, M.D., M.S.C.E. was named his successor in 2001.
Formation of the Graduate Group in Epidemiology and Biostatistics
The third administrative structure, the Graduate Group in Epidemiology and Biostatistics, was formed in 1995. Penn's Ph.D. programs bring faculty and students together according to "graduate groups." The graduate group system promotes cooperation among faculty and graduate students in different departments and facilitates organization of interdisciplinary efforts. The Graduate Group in Epidemiology and Biostatistics includes clinician and non-clinician epidemiologists and biostatisticians. Many have primary or secondary appointments in the DBE and most are faculty members within the CCEB. The Graduate Group in Epidemiology and Biostatistics is responsible for managing the Ph.D. degree programs in Epidemiology and in Biostatistics, and the M.S. program in Biostatistics, including curriculum development and related educational activities. (The Master of Science in Clinical Epidemiology degree program is managed by the CCEB.)
National and International Impact
CCEB/DBE faculty make important contributions to clinical practice and health policy through their research findings, which are published nationally and internationally in high-impact journals. In 2004, CCEB/DBE faculty published more than 400 Medline-indexed papers.
Since its inception in 1993, the CCEB has grown to over 450 faculty, staff, and fellows with an annual budget of more than $45M. The CCEB would be ranked first in NIH funding in comparison with comparable programs in medical schools elsewhere (i.e., Departments of Public Health and Preventive Medicine). The CCEB would be ranked fifth in NIH funding when compared to similar programs in schools of public health. The DBE would be ranked first in NIH funding if a comparison were to be made between the DBE's biostatistics faculty only and comparable organizations within medical schools elsewhere (i.e., departments of biostatistics and other mathematical sciences in medical schools). Notably, these rankings consider only grants for which a CCEB Senior Scholar served as the principal investigator.
With the CCEB, the DBE and the Graduate Group, the School of Medicine at Penn has created major national and international programs in the fields of Epidemiology and Biostatistics. Epidemiologists and biostatisticians appointed in the CCEB and DBE provide assistance and support to the clinical research activities of faculty throughout the School of Medicine, enabling the School to enhance its position as a national leader in clinical research. The structure created within the School of Medicine that links epidemiology, biostatistics, and clinical medicine has become a model emulated by other schools of medicine around the world.