Fulfilling the Potential of Cancer Prevention and Early Detection (2003) / Chapter Skim
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8. Professional Education and Training
8. Professional Education and Training
Pages 294-331
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From page 294... ...
Instead, education and training need to be coupled with other interventions so that practitioners are supported in their efforts with office systems that prompt them to adhere to guidelines, adequate reimbursement for behavioral interventions and screening services, and quality assurance systems that instill accountability. Enhancing professional education and training nevertheless remains one of the essential ingredients of a package of reforms needed to achieve national goals for cancer prevention and early detection set forth in Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000~.
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From page 295... ...
Health plan managers not directly involved in hands-on care may need information on cancer screening guidelines to assess a proposed quality improvement program, and insurance company analysts may need up-todate information on the costs and benefits of smoking cessation interventions to accurately price their package of benefits. Likewise, administrators who establish curriculum guidelines for public school systems and health educators who work in community-based social services settings may all require cancer-related education and training.
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From page 296... ...
In 1996 the U.S. Preventive Services Task Force included a recommendation that flexible sigmoidoscopy be used to screen asymptomatic adults age 50 and older, and since 1998 Medicare has provided reimbursement for screening flexible sigmoidoscopy, but only physicians are iFifteen of 16 of these states allow nurse practitioners, but not registered nurses, to perform screening flexible sigmoidoscopy (Cash, 1999)
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From page 297... ...
Smoking cessation guidelines include recommendations for the prescription of medications for certain individuals, but limitations on nonphysician practitioners' authority in this area could limit their role as primary providers of smoking cessation interventions. Most state practice laws limit prescriptive authority to physicians, dentists, and certain advanced practice providers such as nurse practitioners.3 One counseling strategy would be to have a medical clinician or a health care clinician deliver messages about health risks and benefits and deliver pharmacotherapy (e.g., bupropion or a nicotine patch)
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From page 298... ...
Perhaps the most important component of any education and training program is a clear statement of what is expected of the student following completion of the course of study. A set of expectations of health care providers regarding cancer prevention and early detection has been set forth in the objectives of Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000)
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From page 299... ...
Lack of health insurance coverage is a key predictor of lower rates of use of cancer screening tests, but other sociocultural factors may also be at play. In a nation of increasing diversity, health care providers must be trained to accommodate language differences in their practices and must be aware of cultural values and beliefs that might need to be addressed during discussions of cancer prevention and early detection.
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From page 300... ...
Wherever they are offered and however they are organized, professional education and training programs ideally would include the following key components: · a focus on established goals and objectives, such as those established as part of Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000~; · an emphasis in the curriculum on evidence-based interventions and the interpretation of evidence in the context of population-based medicine; · interdisciplinary didactic material and training experiences spanning the disciplines of the basic, population, and behavioral sciences; · development of skills to integrate community-based resources into office practice; · training and experience in providing services to special populations;
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From page 301... ...
STATUS OF PROFESSIONAL EDUCATION AND TRAINING The previous section of this chapter explored in some detail the National Cancer Policy Board's vision of who should be trained to provide cancer prevention and early detection services and what should be learned in education and training programs. This section examines how this ideal can be approached by reviewing the status of health promotion and disease prevention education and training in medical, nursing, and dental schools.
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From page 303... ...
An effort to improve medical schools' disease prevention and health promotion curricula and the ability to evaluate medical students' knowIedge of disease prevention and health promotion principles and their application was launched in 1994. The effort was called the Prevention Curriculum Assistance Program (PCAP)
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From page 304... ...
Among the educational objectives recommended by the AAMC Population Health Perspective Pane! is that medical students be able to "incorporate principles of disease prevention and behavioral change appropriate for specific populations of patients within a community" (Association of American Medical Colleges, 1999, p.
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From page 305... ...
In 1998, these groups developed a set of core competencies in preventive medicine for undergraduate medical education (Pomrehn et al., 2000) so that students could: · identify recommended clinical prevention services including screening tests (e.g., the Pap test and mammography)
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From page 306... ...
After publication of the results of Cancer Education Survey I in 1981, the American Association for Cancer Education (AACE) in 1986 published Cancer Education Objectives for Medical Schools (Bakemeier and Edwards, 1986)
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From page 307... ...
Training in Smoking Cessation in Undergraduate Medical Education According to Cancer Education Survey II conducted in 1989-1990, only a third of medical schools taught smoking prevention and cessation methods in lectures, and less than a third of schools provided instruction on these topics by another mode (Chamberlain et al., 1992; Gallagher et al., 1992~. An expert panel convened by NCI in 1992 recommended that by 1995 smoking cessation and prevention interventions be mandatory com
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From page 308... ...
. Educational interventions during formal medical training, in particular, opportunities for hands-on practice, improve trainees' ability to deliver smoking cessation interventions and in some cases increase smoking cessation rates, according to some evaluations of these interventions.
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From page 309... ...
The use of simulated patients has also been shown to improve the smoking cessation skills of medical students (Coultas et al., 1994~. One randomized study of 261 internal medicine, family practice, and pediatric residents showed that educational interventions improved trainees' behavior but did not lead to subsequent changes in smoking behavior among patients seen by the trainees (Strecher et al., 1991~.
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From page 310... ...
In particular, NCI R25 training education grants have funded nutrition education development and innovations at selected medical schools since the late 1980s: · The University of Nevada School of Medicine developed a required 20-hour freshman course, Medical Nutrition; elective courses in nutrition for juniors and seniors; and for seniors, an assignment in nutrition and cancer during a rural rotation with faculty preceptors. Funding also supported integration of nutrition education into the basic science courses, patient care courses, and specialty clerkships (Ashley et al., 2000~.
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From page 311... ...
Methods that can be used to improve training in nutrition in medical school have been suggested and include the following: curriculum analysis, the use of computer-aided instruction modules, Internet Websites, case-based tutorial discussions, physician nutrition specialists and dietitians, administratively separate nutrition units, and observed structured clinical examinations, and faculty development (Lo, 2000~. Graduate Medical Education Preventive medicine specialists often teach cancer prevention and early detection courses within medical schools or provide the needed leadership in state health departments to oversee population-based prevention programs.
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From page 312... ...
Educational interventions targeted to medical residents have increased confidence in the ability to provide counseling and have increased counseling activity according to the few assessments that have been published. Most studies on improvements in the nutrition knowledge and counseling skills of medical residents have focused on cardiovascular disease or general health promotion.
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From page 313... ...
Other literature describes the roles of nurse practitioners in risk assessment, teaching, patient advocacy, and cancer screening programs aimed at early detection (Leslie, 1995~. With few national surveys of nurses' practice activities, however, it is difficult to judge the level of nurses' involvement in cancer prevention.
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From page 314... ...
This is likely explained by the fact that most of the nurses responding to the survey worked in hospital settings (Becker et al., 1995~. Nursing workforce projections suggest that the hospital will remain the major employer of registered nurses but that in the future, because of a shift of care to outpatient settings and the aging of the population, nurses will need to focus on primary care and health promotion (http://bhpr.hrsa.gov/dn/bwrepex.htm)
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From page 315... ...
Training in Smoking Cessation in Nursing Education Most oncology nurses who participated in a 1998 survey (38 percent response rate) could not recall whether they had received information about smoking or tobacco use prevention or cessation in their nursing curricula.
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From page 316... ...
Dental patients, perhaps more so than medical patients, represent a "captive audience" for which there are "teachable moments" (Tones, 2000~. Regularly scheduled dental hygiene visits also provide oral health care professionals with a unique opportunity to reiterate smoking-related messages and provide support for patients attempting to quit (Severson et al., 1998~.
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From page 317... ...
. A 1998 review of the curricula in 47 of the nation's 52 dental schools revealed that only 33 percent of the schools taught smoking cessation as part of the curriculum.
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From page 319... ...
In the early 1990s, for example, relatively few medical schools had any training in smoking cessation. Therefore, reaching providers after they have completed their training with continuing medical education (CME)
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From page 320... ...
· Development of educational materials. Put Prevention into Practice, a program sponsored by the Office of Disease Prevention and Health Promotion of the U.S.
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From page 321... ...
Preventive Services Task Force, 1996~. CME in cancer has been critiqued as being "off target" too often with too little emphasis on smoking cessation, for which there is ample evidence that providers are not trained.
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From page 322... ...
When support was assessed in 19891990 in Cancer Education Survey II, 66 of 125 medical schools had been the recipients of an NCI R25 training grant. NCI R25 training grant support was viewed as instrumental in maintaining key elements of the cancer education program, such as cancer education coordinators, cancer education committees, and student assistantships and fellowships (Chamberlain et al., 1992; Gallagher et al., 1992~.
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From page 323... ...
Cancer Education Grant Program (R25E grant) Institutional award for education and training predoctoral and postdoctoral candidates in multidisciplinary research settings Institutional award for postdoctoral training ..
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From page 324... ...
A consortium of eight Texas medical schools has charged 50 faculty "champions" with developing instructional resources, sharing their expertise, and leading the way in making changes to the curricula in their local institutions. Goals are to progress toward longitudinal integrated curricula, performance-based education, and competency-based testing (www.catchum.utmd.edu/catchumgoals.htm)
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From page 325... ...
. · A 3-day interactive course offered through the West Virginia Breast and Cervical Cancer Screening Program certifies public health nurses (primarily in county health departments and primary care centers)
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From page 326... ...
Through its Bureau of Health Professions, HRSA attempts to promote and maintain the nation's supply of health professionals by supporting faculty to meet current health care challenges, designing new curricula, and providing student loans and scholarships to encourage lower-income, disadvantaged, and minority individuals to become health care professionals (Sampson, 1995~. HRSA also funds primary care offices in each state health department and funds primary care associations to build statewide coalitions for primary care health delivery systems (Health Resources and Services Administration, 2000b)
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From page 327... ...
The broadcasts have covered principles of population health but nothing specifically related to cancer prevention. HRSA's Cancer Action Plan has proposed means of improving cancer prevention and early detection services (Health Resources and Services Aclministration, 2000a)
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From page 328... ...
With funding from an ACS professional education grant, for example, nurses at
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From page 329... ...
. support physician training in accredited preventive medicine residency programs Awards to institutions (master's level)
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From page 330... ...
NTAO's mission is to (www.aahp.org/atmc/ntaosum.htm) : · develop a comprehensive network of key contacts in health plans who are responsible for smoking cessation and health promotion; · establish a clearinghouse of smoking and tobacco use prevention information gathered from academic and professional journals, conferences, newsletters, and white papers; · provide technical assistance to health plans in developing smoking and tobacco use prevention and cessation programming, including the development and dissemination of a newsletter, a regularly updated annotated bibliography, an NTAO website, and phone and online consultations; · conduct a benchmarking awards program highlighting exemplary initiatives by health plans in smoking and tobacco use prevention and cessation; · distribute an annual survey to health plans to determine the current status of smoking and tobacco use cessation initiatives and to evaluate best practices; and · promote best practices in smoking and tobacco use cessation and prevention through a series of training workshops, national and regional 1 1 1 1 1 _ _ , _ conferences, and a managed care smoking and tobacco use prevention and cessation too!
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From page 331... ...
Some solutions follow: · requirements that educational institutions meet established curriculum guidelines (e.g., the population health guidelines of AAMC) , · inclusion of cancer prevention and early detection questions on national board and licensure examinations, · assurances that adequate continuing education opportunities are available through training institutions and professional organizations, · applications of new learning technologies (e.g., distance learning and online CME)
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