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Article Excerpt
The nation's ability to fight cancer depends upon the health of its cancer workforce. A critical shortage of cancer specialists threatens the country's ability to provide cancer care across the continuum from prevention to survivorship. Nearly all professional disciplines that play a role in the delivery of comprehensive cancer services are experiencing a shortage, including physicians, nurses, social workers, pharmacists, public health workers, researchers, scientists, technologists, and cancer registrars (see Table 1). Without a healthy workforce, achievement of any national goals to improve cancer research, prevention, and care will be difficult, if not impossible.
These national trends directly threaten the ability of individual health care institutions to meet the needs of the public for timely and comprehensive cancer care. Delayed access to screening, early detection, treatment, and survivorship support services compromise optimal patient outcomes. Workforce burnout and turnover result from working short-handed, which also negatively impacts care quality and service. The inability to meet the competency and service expectations of patients and referring clinicians undermines the stability of health care institutions by discouraging follow up by patients and referrals by clinicians. In addition to impeding the achievement of national goals, lack of a healthy workforce will make achievement of institution-specific goals to improve cancer research, prevention, and care difficult, if not impossible (Buerhaus, Auerbach, & Staiger, 2007).
Envisioning a Solution: A Competency-Based Approach for the Non-Oncology Health Workforce
Many cancer-focused organizations continue to invest in efforts to expand the number of cancer specialists. Rather than duplicate their expert work, C-Change chose to complement those efforts by strengthening the knowledge and skills of non-oncology health professionals through its Cancer Core Competency Initiative. Table 2 illustrates the opportunity to improve access to health professionals with at least basic knowledge in cancer.
These examples illustrate the power of the Cancer Core Competency Initiative--the potential for giving approximately 2 million registered nurses some of the basic knowledge held by the 21,000 oncology-certified expert nurses. With greater awareness of all aspects of cancer diagnosis and treatment, health professionals will be better able to meet the needs of people at risk for or living with cancer and better leverage the expertise of cancer specialists.
Investment in a competency-based program directly contributes to solving the workforce crisis in several practical ways (U.S. Department of Education, 2002). This intervention, which is a key component to recruitment and retention efforts, has offered students and professionals a meaningful and relevant opportunity for professional growth and development. Program development fosters collaboration among experts serving as faculty. The host organization benefits from a stronger workforce and from an improved image in the surrounding community of patients and professionals. Ultimately, such a program increases the knowledge, skills, and attitudes of staff to address appropriately the special needs of people at risk for and living with cancer.
Creating a Flexible and Useful Approach
The first phase of the Cancer Core Competency Initiative, described in an earlier article (Smith & Lichtveld, 2007), included the rationale for a competency-based approach, the definition of the targeted professional populations, and a complete inventory of the competency statements. To summarize, standards for knowledge and skills (competency statements) are the building blocks for workforce development. Competency statements define the tasks or functions a person should be able to perform and can be used to determine if competency has been achieved. The cancer competency statements were written to address the learning needs of any health professional who has general knowledge of cancer and can initiate the cancer care continuum from prevention and screening through palliative care (see Table 3).
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The competency statements also were written to be interpreted at basic, intermediate, or advanced levels of expertise. Similarly, they can be interpreted within a particular profession's scope of practice, or in the context of an individual's years of experience or current role and responsibilities. For example, the general competency "manage symptoms of the cancer patient" will be performed differently by:
* A physician, who may prescribe specific medications.
* An occupational therapist, who may assist a patient in developing new approaches to activities of daily living.
* A psychologist facilitating an understanding of new limits in physical activity.
All these disciplines play an important role in managing symptoms for a cancer patient, but the focus and expertise the practitioners bring to the bedside are quite different. Thus, a competency-based approach provided a set of measurable standards with which to drive professional education and training.
The expert panel developed a set of competency statements that cross the continuum of care, science, and communication; are relevant among multiple health professionals; and are applicable across diverse training and care delivery settings. The application of the competency statements in any work setting, with any discipline, and across the continuum of care is illustrated in Figure 1. Several examples from the comprehensive content addressed by cancer competency statements are provided in Table 4. Again, each statement should be interpreted within the context of a professional discipline and scope of professional practice. A comprehensive list detailing the domains and examples can be found on the Internet (www.cancercorecompetency.org).
Considering a More Rigorous Approach to Professional Education
Many health care organizations routinely provide ongoing educational programs in the form of inservice training for staff or continuing medical education for physicians. However, these educational investments often fail to include the planning methods recommended to achieve material and measurable gains in competency. Competency-based education is an approach that is best supported using a logic model for curriculum development, participant-focused teaching methods, and measures of participant improvement (Wlodkowski, 2008). The logic model and validation template described here assure that each aspect of the curriculum supports the ultimate competency goals. It also assures that the educational method matches the desired outcome. For example, didactic lectures, analytic exercises, or reading...
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