Strengthening the Non-Oncology Workforce through a Competency-based Approach

1. Strengthening the Non-Oncology Workforce through a Competency-based Approach Maureen Lichtveld, MD, MPH Tulane University School of Public Health and Tropical Medicine Alison Smith, BA, BSN, RN C-Change

2. 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

3. Coalition Perspectives • Your Challenges? • Your Priorities?

4. Cancer Core Competency Initiative Goal: Strengthen the basiccancer competency (knowledge, skills, and attitudes) of the non-oncology health workforce

5. Why? The Challenge and Rationale for a Competency-Based Approach

6. 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).

7. 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)

8. Untapped Opportunity Illustrative Oncology Specialists All Professionals 30,000Oncology certified 2,000,000Registered Nurses Nurses 1,200 AOSW Members 380 APOSW Members 320, 000 Licensed Clinical Social Workers Social Workers

9. Examples of Success Pilot Site Results

10. 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 • -

11. 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

12. 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

13. 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

14. Program Benefits • Professional • Professional development • Learner • Increased knowledge • Increased confidence • Received tangible reference materials • Enhanced academic experience • Enhanced professional self-reflection • Institution • Enhanced visibility/ credibility • Provided foundation for future trainings • Community • Enhanced relationship with institution • Addressed needs • Benefits of better prepared/ increased workforce

15. Pilot Site Findings UTILITY • Pilot sites found the cancer core competencies to be highly useful FLEXIBILITY • Implementation of the competencies was feasible across cancer core continuum, professional settings, and disciplines

16. 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)

17. Program Resources:C-Change Toolkit Order free copies or download: www.cancercorecompetency.org Examples Overview & “How to” Guidance Pilot Site Report Universtiy of Pittsburgh Medical Center Summary Publications Pilot Site Report Marshall University School of Medicine Pilot Site Report California University of Pennsylvania School of Social Work Pilot Site Report Audrain Medical Center Addressing the Cancer Workforce Crisis Using a Competency-Based Approach with Non-Oncology Professionals Pilot Project Evaluation Report July 2008 Templates

18. Building a Competency-Based Educational Program

19. Who? Defining learners / audience

20. 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 Discipline, Scope of Practice

21. Exercise 1

22. What? Defining the targeted competency improvement

23. Bloom’s Taxonomy Verb describes level of independence EVALUATION SYNTHESIS ANALYSIS APPLICATION COMPREHENSION KNOWLEDGE

24. Anatomy of a Competency Statement Competency statements define what a professional should know or do: Define palliative and end-of-life care Targeted cancer content Level of complexity and/or independence Within context: Scope of Practice Level of Expertise Role and Responsibilities

25. 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

26. Work Setting Competency Standards Discipline Breadth & Depth of the Competency Statement Administration Ambulatory Clinics Academics Acute Care Clinics Cancer Centers Home Health Agencies Professional Societies Advocacy Organizations Allied Health Medicine Nursing Pharmacy Public Health Research Social Work StudentsResidents/FellowsField FacultyPracticing Professionals Domain I Continuum of Care Prevention / Early Detection Treatment / Survivorship Palliative Care Domain II Basic Cancer Science Etiology / Epidemiology Clinical Trials Cancer Surveillance Domain III Communication & Collaboration Interdisciplinary Care Psychosocial Communication Cross-Cultural Communication Grieving

27. Exercise 2

28. How? Developing the learning activity

29. 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.

30. Educational Activity Design Verb Competency to Curriculum Instructional Design Learner Assessment Describe Dialogue Short Answer Apply Case Study Role Play Essay Question Synthesize Table Top Standardized Patients Evaluate Peer Review

31. Curriculum Resources See resources list: • Best practice guidelines • Professional education • Clinical practice tools • Patient Education • Advocacy Materials • Grant Funding • e-News • National Conferences

32. Clinical Practice Tools

33. Exercise 3

34. So What? Evaluating Impact

35. Planning, Implementation & Evaluation Tools Logic Model OUTCOMES INPUTS OUTPUTS Program resources Activities Participation Short Medium Long-term Efforts on the part of the program or intervention staff Changes in the learner’s knowledge, skills, and attitudes Changes in practice, care delivery system, patient outcomes The logic model assures that all of the program resources directly support the achievement of the desired competency outcome.

36. Evaluation Measures

37. Exercise 4

38. Now What? Taking the next steps toward program implementation

39. Define Audience & Topic Area Evaluate and Interpret Data Refine Competency Focus Develop Logic Model & Validation Template Plan Implement Evaluate Build a Balanced Leadership Team Sustain Efforts Through Sharing PLAN EVALUATE Complete Needs Assessment & Interpret Findings PLAN IMPLEMENT Implement & Manage with Attention to Details

40. 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

41. Exercise 5

42. OUTCOMES INPUTS OUTPUTS Program resources Activities Participation Short Medium Long-term Map for Next Steps Validation Template Curriculum Validation Template Logic Model

43. 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 kcox@c-changetogether.org

44. Additional Examples Pain & Palliative Care Competency Programs

45. 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

46. Pain & Palliative Care Grant Site Example of Success South Puget Intertribal Planning Agency (SPIPA) 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 distress Results: • 102 participants • 100% improvement in confidence • 8% increase in knowledge Unique Approach: • Pre-Assessment with talking circles • Patient symptom journal • “Discomfort” Barometer

47. Examples 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

48. 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