Working individually, write a thoughtful response (0.5-1.5 pages) to the following questions. Once you have completed the questions, submit the reflection assignment to your mentor.

1. In this rotation, there were a number of instances when you had to submit an Investigation Status and Plan and determine which hypotheses to test, how to test them, and whether or not people should be notified of the results. Thinking back about how the investigation proceeded and what ideas about the investigation you had in your ISP's, describe how your decisions were affected by the information available at each stage. What factors had the greatest influence on your decisions? If you were involved in another outbreak investigation similar to the one presented in this rotation, what would you do differently and what would you do similarly? (Note: In some cases the decisions you submitted in your ISP's and what you were directed to do may have differed. In these instances think about the differences and which direction you believe was more appropriate.)
   
   
2. In many situations an epidemiologist might have ample time to conduct an outbreak investigation and gather information before making decisions. In the outbreak investigation you went through in this rotation the illness (cocci) is typically mild and, although one case did die in this situation, is typically not life threatening. In other situations the illness may be much more serious, the threat of transmission much higher, and the timeframe much smaller. Discuss how the criteria you might use for that situation would be different from and similar to the criteria used in this rotation. Would the criteria used in a situation where time was crucial and information was minimal be more or less prone to errors, bias, and confounding factors? How would your decision be affected if the area in question were a facility that provided medical services people needed to take care of other diseases and closing the facility might prevent people from receiving those services while keeping the facility open might expose them to risk of infection from the outbreak?
   
   
3. In an outbreak investigation, investigators have to make decisions about whether or not to tell the public they may be in danger, and what information to tell them. Until they are notified, the public may unknowingly expose themselves and their children to potentially harmful situations. What is your opinion on the investigation team making decisions for the public regarding whether or not they will be able to understand what information at different stages of the investigation and whether they need to take actions or not without including the public in the discussion? Does the public have a right to be notified early that there may be a potential danger even when there is not substantial evidence at the time to support the worry? In your response make sure to address concerns on both sides of the argument.
   
   
4. In this rotation, Dr. Lyons acted as a buffer between you and the rest of the people involved in an outbreak investigation. In a real investigation epidemiologists deal with many different people involved from various fields who may or may not be cooperative with investigators. Using the following examples as a starting point (and including others as you see fit), discuss how you might deal with people who could be involved: a) a business manager who is resistant to doing a recall because of the financial impact it will have on his company, b) a professional who is a specialist in her discipline who uses jargon and gives you complex information that is difficult to understand, and c) a study subject, who did not finish high school, who has difficulty understanding questions and other information you give them about the study.
   
   
5. Think about the different tasks you completed during this rotation, which are intended to simulate the work of real epidemiologists. Do additional research for other descriptions of what a career in epidemiology might include. Based on your experience of this rotation and the information you find, provide a thoughtful response about which aspects about epidemiology you enjoy that might lead you to a career in epidemiology, and which aspects you didn't enjoy as much that might lead to you a different career. (Remember: Epidemiologists do a variety of things and those working in different companies and positions will do a variety of different tasks. There could be an area of epidemiology that you might enjoy more than others. Include these considerations in your response.)