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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
Workshop Objectives
By the end of this presentation, attendees will be able to …
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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
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Identify sources for program curriculum, national standards,
funding, advocacy, etc.
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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
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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 &
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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
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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
Nurses
Social Workers
30,000
Oncology certified
1,200 AOSW Members
380 APOSW Members
All Professionals
2,000,000
Registered Nurses
320, 000
Licensed Clinical
Social Workers
Examples of Success
Pilot Site Results
Pilot Site Findings:
Audrain Medical Center - Mexico, MO
• Public health nurses working in rural
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counties
Skin cancer & early detection rotation
Course and clinical rotation
• Improvement in Knowledge: 39% 
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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 Pennsylvania
California, PA
• Social Work Students & Field
Instructors
• Cancer-related Anxiety and
Depression
• Classroom, on-line, and
standardized patients
• Improvement in Knowledge:
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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
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rural areas
Survivorship
Workshop, enduring Webcast, and
toolkit
• Improvement in Knowledge: 20% 
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from pre-post test
Measurable increases in ability to
assess and manage survivorship
issues
Program Benefits
Professional
 Professional
development
Learner
 Increased
knowledge

 Increased
confidence
 Received tangible 
reference materials
 Enhanced academic
experience
 Enhanced
professional selfreflection
Institution
Community
Enhanced
visibility/
credibility
Provided
foundation for
future trainings
 Enhanced
relationship with
institution
 Addressed needs
 Benefits of better
prepared/
increased
workforce
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
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
Order free copies or download: www.cancercorecompetency.org
Overview & “How to” Guidance
Examples
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
Templates
Addressing the Cancer Workforce Crisis
Using a Competency-Based Approach
with Non-Oncology Professionals
Pilot Project Evaluation Report
July 2008
Building a Competency-Based
Educational Program
Who?
Defining learners / audience
Discipline, Scope of Practice
Who?
Implications for Program Design
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Physician
Nurse
Social Worker
Pharmacist
Public Health Worker
Nursing Assistant
Lay Health Worker
Multi-disciplinary team
Levels of education / training
Areas of expertise
Scope of practice
Roles and responsibilities
Interactions
Interdependence
Exercise 1
WHO?
Physician,
Nurse, Social
Worker,
Pharmacist,
Public Health
Worker, Nursing
Assistant, Lay
Health Worker?
Who is your target audience?
What?
Defining the targeted
competency improvement
Bloom’s Taxonomy
Verb
describes
level of
independence
EVALUATION
SYNTHESIS
ANALYSIS
APPLICATION
COMPREHENSION
KNOWLEDGE
Anatomy of a Competency Statement
Competency statements define what a
professional should know or do:
Define palliative and end-of-life care
Level of complexity
and/or independence
Targeted cancer content
Within context:
Scope of Practice
Level 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
Breadth & Depth of the
Competency Statement
Advocacy Organizations
Domain I
Continuum of Care
Prevention / Early Detection
Treatment / Survivorship
Palliative Care
Work Setting
Competency
Standards
Domain II
Basic Cancer Science
Etiology / Epidemiology
Clinical Trials
Cancer Surveillance
Discipline
Administration
Ambulatory Clinics Academics
Acute Care Clinics
Cancer Centers
Home Health Agencies
Professional Societies
Allied Health
Medicine
Nursing
Pharmacy
Public Health
Research
Social Work
Students
Residents/Fellows
Field Faculty
Practicing Professionals
Domain III
Communication & Collaboration
Interdisciplinary Care
Psychosocial Communication
Cross-Cultural Communication
Grieving
Exercise 2
WHAT?
Choose a
competency
statement:
VERB +
CONTENT
Level of
complexity
and/or
independence +
targeted cancer
content
What should the professional know
or be able to do?
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
Competency to Curriculum
Instructional
Design
Learner
Assessment
Describe
Dialogue
Short Answer
Apply
Case Study
Role Play
Synthesize
Table Top
Essay Question
Evaluate
Peer Review
Standardized
Patients
Verb
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?
Match the
competency
with:
Adult learning
principles
Knowledge or
skill format
Tools for
changing
practice
How should we design the educational activity
to achieve the desired competency?
So What?
Evaluating Impact
Planning, Implementation &
Evaluation Tools
Logic Model
INPUTS
Program
resources
OUTCOMES
OUTPUTS
Activities
Participation
Efforts on the part of the program
or intervention staff
Short
Medium
Longterm
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.
Evaluation Measures
Short Term
Learner • Attendance in pain CE
program
Pre/Post Test % improvement:
• Knowledge
• Skills
• Attitude – Intent to change
Program / • Support for competency
System program planning and
implementation
- Funding
- Faculty
- PR / Awareness
Patient
Impact
Medium Term
Long Term
• Change in practice
• Sustained knowledge
as observed or thru
documentation audits
and f/u tests
• Utilization of practice
tools, order sets, or
resource materials
and skills per repeat
competency testing
• Sustained resource
utilization
• Career specialization
• Consultations,
• Sustained
Referrals, Admissions
• Utilization levels
• Institutional policy
changes r/t clinical
standards and tools
consultations,
referrals, admissions
• Requirement of
employment or
graduation
• Patient use of
• Improved quality
resources (self
assessment tools,
support group
participation,
medication
adherence)
measures
• Patient / Family
satisfaction
Exercise 4
SO WHAT?
Develop
measures:
Short term
learner
knowledge,
skills, and
attitudes
Medium and
Long Term
program and
patient outcomes
How will we know if competency
has been improved?
Now What?
Taking the next steps
toward program implementation
Plan Implement Evaluate
Sustain
Efforts
Through
Sharing
Define
Audience &
Topic Area
Complete Needs
Assessment
& Interpret
Findings
Evaluate
and Interpret
Data
Implement
& Manage
with Attention
to Details
Build a
Balanced
Leadership
Team
Develop
Logic Model
& Validation
Template
Refine
Competency
Focus
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?
Leadership and
faculty
Learner needs
assessment
Incentives and
program
promotion
Resources and
partnerships
What additional issues will need to be
explored to prepare for implementation?
Map for Next Steps
Curriculum Validation Template
Validation Template
WHO?
WHAT?
HOW?
SO WHAT?
WHAT NEXT?
Logic Model
INPUTS
Program
resources
OUTCOMES
OUTPUTS
Activities
Participation
Short
Medium
Longterm
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
[email protected]
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 preto post-test scores
• Possible addition to Iowa nursing
school curriculum
Unique Approach:
• Order sets for palliative/hospice care
• Scripts/ talking points for difficult
conversations
Pain & Palliative Care Grant Site
Example of Success
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
South Puget
Intertribal
Planning Agency
(SPIPA)
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
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