• Utilize informatics—Communicate, manage knowledge, mitigate error, and support decision making using information technology.

The current weaknesses in health professions education in these five areas impede the delivery of psychosocial services to cancer patients in very concrete ways. Inattention to patient differences, values, preferences, and concerns contributes to psychosocial needs being undetected and unaddressed. Difficulties in communicating hamper collaboration with patients and families and undermine shared decision making about strategies for meeting psychosocial needs. The absence of skills related to interdisciplinary, team-based care creates a barrier to establishing the linkages with other professionals that are essential in connecting patients and families to available psychosocial resources. A tendency to rely on clinical tradition rather than evidence leaves the workforce unaware of emerging evidence on the effectiveness of psychosocial services and unfamiliar with new practice guidelines that are drawn from that evidence. A lack of familiarity with informatics creates an aversion to innovative, computer-assisted methods for the critical tasks of screening and assessment of psychosocial needs.

Inconsistent Use of Competencies to Guide Training

In response to growing concerns about the abilities of health professionals to keep up with the rapid pace of clinical developments and changes in health care systems, many health professions groups are undertaking initiatives to rethink the competencies their clinicians need to practice effectively. ACGME, for example, has launched a major, multiyear initiative to identify, better develop, and assess the competency of physicians in residency training (Swing, 2002). The Council identified six general competencies addressing patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice (http://www.acgme.org/outcome/). ACGME required the committees that establish accreditation criteria for residencies in each specialty to incorporate these general competencies into their requirements. In a graduated fashion, residency programs are being required to define the specific knowledge, skills, and attitudes that make up each general competency; to redesign their programs to teach the competencies; and to formally assess the competency of their residents. There is emerging evidence that these requirements have had an impact on training programs. For example, Weissman and colleagues (2006) found that psychiatric residency programs provide didactic and supervised clinical experience in evidence-based psychotherapies much more frequently than do graduate-level psychology or social work programs. In the latter two



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