strengthening the non-oncology workforce through a competency-based approach maureen lichtveld, md,...
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Strengthening the Non-Oncology Workforce through a Competency-based Approach
Maureen Lichtveld, MD, MPHMaureen Lichtveld, MD, MPHTulane University School of Public Health and Tropical MedicineTulane University School of Public Health and Tropical Medicine
Alison Smith, BA, BSN, RNAlison Smith, BA, BSN, RNC-ChangeC-Change
Workshop Objectives
By the end of this presentation, attendees will be able to …
• Describe the Cancer Core Competency Initiative as a flexible and innovative approach to strengthening the knowledge, skills, and attitudes of non-oncology health professionals in the context of the health workforce shortage
• Outline a competency-based approach for designing educational interventions – from planning through implementation, and evaluation
• Identify sources for program curriculum, national standards, funding, advocacy, etc.
• Describe the quantitative improvements achieved by the learners and the qualitative benefits experienced by the faculty, institution, and community
Coalition Perspectives
• Your Challenges?
• Your Priorities?
Cancer Core Competency Initiative
Goal:Strengthen the basic cancer competency(knowledge, skills, and attitudes) of the non-oncology health workforce
Why?
The Challenge and Rationale for a Competency-Based Approach
Scope of the Workforce Supply
• Demand for oncologists is expected to exceed supply by 25%-30% by 2020 (ASCO, 2007).
• The social work labor force is older than most professions, with nearly 30% of licensed social workers over age 55 (NASW, 2006).
• By 2020 the projected gap between supply and demand for RNs will be 340,000 (three times larger than ever experienced in the U.S.).
• By 2020, more RNs will be in their 60s than in their 20s (Auerbach & Buerhaus & Staiger, 2007).
• The average age of a public health worker is 47; many public health agencies currently face a 20% vacancy rate (APHA, 2008)
• Cancer registrar vacancies remain difficult to fill in some regions of the country and demand for registrars is estimated to grow 10% in the next 15 years (NCRA, 2006)
• The proportion of minorities in the population outstrips their representation among health professionals by several fold (IOM, 2004).
Scope of the Public Demand
• Cancer is the second most common cause of death by disease claiming the lives of more than half a million people per year (ACS, 2007)
• Cancer rates are expected to increase as baby boomers age (CDC, 2000)
• The lifetime probability of developing cancer is 1 in every 2 men and 1 in every 3 women (NCI, 2005)
• Five-year cancer survival rates have risen to 64% for adults (CDC, 2005)
Untapped Opportunity
Oncology Specialists All Professionals
Social Workers1,200 AOSW Members
380 APOSW Members
320, 000 Licensed Clinical Social Workers
Nurses30,000
Oncology certified 2,000,000
Registered Nurses
Illustrative
Examples of Success
Pilot Site Results
Pilot Site Findings:Audrain Medical Center - Mexico, MO
• Public health nurses working in rural counties
• Skin cancer & early detection rotation• Course and clinical rotation
• Improvement in Knowledge: 39% from pre-post test
• Measureable increases in differentiating between benign and malignant lesions
-
Pilot Site Findings:Marshall University - Huntington, WV
• Medical Students• Breast cancer screening & patient communication• Standardized patient examination & communication
• Improvement in Knowledge: 119% from pre-post test• Measureable clinical & interpersonal skill increases
Pilot Site Findings:California University of PennsylvaniaCalifornia, PA
• Social Work Students & Field Instructors
• Cancer-related Anxiety and Depression
• Classroom, on-line, and standardized patients
• Improvement in Knowledge: 177% from pre-post test
• Measurable increases in ability to recognize and manage anxiety and depression
Pilot Site Findings:University of Pittsburgh Medical Center Pittsburgh, PA
• Primary care practitioners working in rural areas• Survivorship• Workshop, enduring Webcast, and toolkit
• Improvement in Knowledge: 20% from pre-post test
• Measurable increases in ability to assess and manage survivorship issues
Institution
Enhanced visibility/ credibility
Provided foundation for future trainings
Community
Enhanced relationship with institution
Addressed needs Benefits of better
prepared/ increased workforce
Professional
Professional development
Learner
Increased knowledge
Increased confidence
Received tangible reference materials
Enhanced academic experience
Enhanced professional self-reflection
Program Benefits
Pilot Site Findings
UTILITY• Pilot sites found the cancer core
competencies to be highly usefulFLEXIBILITY• Implementation of the competencies was
feasible across cancer core continuum, professional settings, and disciplines
Work in Progress
Pain & Palliative Care Grant Sites
Target audiences:
• RNs and MAs practicing in rural, long term care facilities
• MD, RN, MSWs, and office staff in rural health, primary care clinics (mostly FQHCs)
• Native health workers, cancer survivors, and caregivers
• Medical students and pediatric residents
South Puget Intertribal Planning Agency(SPIPA)
Program Resources:C-Change Toolkit
Pilot Site ReportUniverstiy of Pittsburgh Medical Center
Pilot Site ReportMarshall University School of Medicine
Pilot Site ReportCalifornia University of Pennsylvania
School of Social Work
Pilot Site ReportAudrain Medical Center
Addressing the Cancer Workforce CrisisUsing a Competency-Based Approach
with Non-Oncology Professionals
Pilot Project Evaluation Report
July 2008
Summary Publications
Overview & “How to” GuidanceExamples
Order free copies or download: www.cancercorecompetency.org
Templates
Building a Competency-Based Educational Program
Who?
Defining learners / audience
Discipline, Scope of Practice
Who?
• Physician• Nurse• Social Worker• Pharmacist• Public Health Worker• Nursing Assistant• Lay Health Worker• Multi-disciplinary team
Implications for Program Design
• Levels of education / training• Areas of expertise• Scope of practice• Roles and responsibilities• Interactions• Interdependence
Exercise 1
WHO? Who is your target audience?
Physician, Nurse, Social Worker, Pharmacist, Public Health Worker, Nursing Assistant, Lay Health Worker?
What?
Defining the targeted competency improvement
Bloom’s Taxonomy
Verb describeslevel of
independence
KNOWLEDGE
COMPREHENSION
APPLICATION
ANALYSIS
SYNTHESIS
EVALUATION
Anatomy of a Competency Statement
Competency statements define what a professional should know or do:
Define palliative and end-of-life care
Targeted cancer contentLevel of complexity and/or independence
Within context:Scope of PracticeLevel of Expertise
Role and Responsibilities
Competency Standards
In order to reduce the nation’s burden of cancer, any health professional must be able, within the scope of his/her professional practice, to:
Domain I – Continuum of Cancer Care Describe the components comprehensive cancer care, including team
communication , diagnosis and treatment, palliative care, survivorship Describe cancer prevention guidelines (e.g., USPSTF, ACS) Direct an individual to resources for palliative care
Domain II – Basic Cancer Science Define the purpose and requirements of cancer registries. Describe the clinical trial process beginning with informed consent
Domain III – Communication & Collaboration Incorporate cross-cultural communication strategies in conveying cancer
information Describe the contribution of each professional perspective in the development
of a cancer care plan
AdministrationAmbulatory Clinics Academics
Acute Care Clinics Cancer Centers
Home Health Agencies Professional Societies
Advocacy Organizations
Domain IContinuum of Care
Prevention / Early DetectionTreatment / Survivorship
Palliative Care
Domain IIBasic Cancer Science Etiology / Epidemiology
Clinical Trials Cancer Surveillance
Domain IIICommunication & Collaboration
Interdisciplinary CarePsychosocial CommunicationCross-Cultural Communication
Grieving
Work Setting
Dis
cip
lin
e
Competency Standards
Allied Health MedicineNursingPharmacyPublic HealthResearchSocial Work
StudentsResidents/FellowsField FacultyPracticing Professionals
Breadth & Depth of the Competency Statement
Exercise 2
WHAT? What should the professional know or be able to do?
Choose a competency statement:VERB + CONTENTLevel of complexity and/or independence + targeted cancer content
How?
Developing the learning activity
Adult Learning Principles
• Adult learning environments are designed to minimize dependence and maximize independence.
• Adult instructional strategies adapt to the learners’ previous experiences including skills and content.
• Faculty in adult learning settings function as both instructors and facilitators.
Educational Activity Design
Verb
Describe
Instructional Design
LearnerAssessment
Dialogue Short Answer
Apply Case Study Role Play
Synthesize Table Top Essay Question
Evaluate Peer Review StandardizedPatients
Competency to Curriculum
Curriculum Resources
See resources list:
• Best practice guidelines
• Professional education
• Clinical practice tools
• Patient Education
• Advocacy Materials
• Grant Funding
• e-News
• National Conferences
Clinical Practice Tools
Exercise 3
HOW? How should we design the educational activity to achieve the desired competency?
Match the competency with:
Adult learning principles
Knowledge or skill format
Tools for changing practice
So What?
Evaluating Impact
INPUTS OUTPUTS OUTCOMES
Program resources
Activities Participation Short Medium Long-term
Efforts on the part of the program or intervention staff
Changes in practice, care delivery system, patient outcomes
Changes in the learner’s knowledge, skills, and attitudes
The logic model assures that all of the program resources directly support the achievement of the desired competency outcome.
Planning, Implementation & Evaluation Tools
Logic Model
Evaluation Measures
Short Term Medium Term Long Term
Learner •Attendance in pain CE program
Pre/Post Test % improvement:• Knowledge• Skills• Attitude – Intent to change
•Change in practice as observed or thru documentation audits and f/u tests
•Utilization of practice tools, order sets, or resource materials
•Sustained knowledge and skills per repeat competency testing
•Sustained resource utilization
•Career specialization
Program / System
•Support for competency program planning and implementation
- Funding- Faculty- PR / Awareness
•Consultations, Referrals, Admissions
•Utilization levels• Institutional policy
changes r/t clinical standards and tools
•Sustained consultations, referrals, admissions
•Requirement of employment or graduation
Patient Impact
• Patient use of resources (self assessment tools, support group participation, medication adherence)
• Improved quality measures
•Patient / Family satisfaction
Exercise 4
SO WHAT? How will we know if competency has been improved?
Develop measures:
Short term learner knowledge, skills, and attitudes
Medium and Long Term program and patient outcomes
Now What?
Taking the next steps toward program implementation
Sustain Efforts
Through Sharing
Implement & Manage
with Attention to Details
Evaluate and Interpret
Data
Define Audience & Topic Area
Refine Competency
Focus
Build a Balanced
Leadership Team
Develop Logic Model & Validation Template
IMPLEMENT
EVALUATE PLAN
PLAN
Complete Needs Assessment & Interpret Findings
Plan Implement Evaluate
Key Aspects of Planning
Leadership and faculty
• Coalition members
• Cancer center experts, hospital personnel
Needs assessment
• Talking circles
• Staff surveys
• Performance data (individual, institutional, state)
Incentives and program promotion
• CEs, gas card, food, free registration, advancement
• Job, graduation, certification requirement
Resources and partnerships
• Iowa – long term care facilities, school of nursing
• Florida – AHEC, cancer centers, university
• Missouri – Department of Public Health
• Pittsburgh – primary care network, state coalition
• CA Univ of PA – Local social service agencies, Drama Dept
Exercise 5
WHAT NEXT? What additional issues will need to be explored to prepare for implementation?
Leadership and faculty
Learner needs assessment
Incentives and program promotion
Resources and partnerships
Validation Template
Logic Model
Map for Next Steps
WHO?
WHAT?
HOW?
SO WHAT?
WHAT NEXT?
INPUTS OUTPUTS OUTCOMES
Program resources
Activities Participation Short Medium Long-term
Curriculum Validation Template
Tools for Success
Summary
• Effective method to address the cancer workforce shortage
• Applicable in a variety of professional disciplines and settings
• Provides numerous resources for competency-based program development
www.cancercorecompetency.org
Additional Examples
Pain & Palliative Care Competency Programs
Examples of Success
Target audience:
• RNs and MAs practicing in rural, long term care facilities
Focus:
• Describe palliative and end of life care, and explain the role of hospice
Results:
• 40 participants
• 12% increase in knowledge from pre- to post-test scores
• Possible addition to Iowa nursing school curriculum
Unique Approach:
• Order sets for palliative/hospice care
• Scripts/ talking points for difficult conversations
Population:
• Native health workers, cancer survivors, and caregivers
Focus:
• Address culture-specific cancer pain
• Explain how cancer pain differs from other types of pain
• Perform a cancer pain assessment
• Differentiate pain and distressResults:
• 102 participants
• 100% improvement in confidence
• 8% increase in knowledge Unique Approach:
• Pre-Assessment with talking circles
• Patient symptom journal
• “Discomfort” Barometer
South Puget Intertribal
Planning Agency(SPIPA)
Pain & Palliative Care Grant Site Example of Success
Target Population:
• MD, RN, MSWs, and office staff in rural health, primary care clinics (mostly FQHCs)
Focus:
• Describe cancer-related symptoms, methods to screen for needs, and referral pathways and palliative care resources for patients.
Results:
• (pending – 37 participants to date)
Unique Approach:
• Interdisciplinary program
• Video with cancer patient perspectives
• Video with a standardized patient scenario
Examples of Success
Population:
• Medical students and pediatric residents
Focus:
• Recognize the barriers to effective pediatric pain management
• Perform a pediatric pain assessment
• Describe the pathophysiology of pain in children
• Manage pediatric-related pain and analgesic side effects
Results:
• (pending – 400 participants expected)
Unique Approach:
• Online, interactive course
Examples of Success