Maintaining Competence for Pharmacists Practicing in Oncology
Maxwell A. Brown, PharmD
Clinical Pharmacy Manager, Stem Cell Transplantation
New York–Presbyterian/Weill Cornell Medical Center
The American Cancer Society estimates that the number of cancer survivors will increase from 15.5 million in 2016 to more than 20 million in 2026.1 This improvement in cancer survivorship creates a significant demand for oncology services, one that the American Society of Clinical Oncology predicts will be unmet by 2020, because of a shortage of qualified oncologists.2
Recent publications advocate for the use of oncology clinical pharmacy services to mitigate the effects of the impending shortage of oncologists.3-6 However, the current number of postgraduate year-2 (PGY-2) oncology trained and board-certified oncology pharmacists (BCOPs) is insufficient to fill the growing number of oncology pharmacist positions.7 Consequently, many pharmacists without advanced training in oncology are being tasked with providing clinical services to cancer patients. These services may include chemotherapy counseling, comprehensive medication reviews, management of adverse effects and drug interactions, and supportive care services. Given that the management of patients with cancer is becoming increasingly complex, it is crucial for pharmacists who are caring directly for patients with cancer to maintain a high level of competence.
Competence can be broadly defined as the possession of knowledge and skills across multiple domains required for one to perform adequately in a given setting.8 The development of a standardized framework of competencies that must be completed by individuals within an organization can serve as a guide for recruiting qualified personnel, training existing employees, and maintaining knowledge of the ever-expanding list of cancer medications.
In 2010, Carrington and colleagues published an article describing the development of a competency framework for pharmacists providing cancer services in Australia. The authors stated that “practitioners may be considered competent when they are able to successfully apply their knowledge and skills to complete a framework of defined activities associated with their role.”9 The framework consisted of clusters of competencies in three basic categories: pharmaceutical care of oncology patients, knowledge of oncology, and practice management. Assessment of the degree of competence in each of these areas allows for designation of oncology pharmacists at varying levels of clinical practice and can inform managers about what responsibilities are appropriate for their staff. For example, pharmacists with less experience may benefit from the mentorship of a more seasoned pharmacist if they wish to specialize further in oncology, while oncology pharmacists with a high degree of competence may be able to independently engage in direct patient care.
The development of a competency framework for oncology pharmacists should be considered a best practice, and assessment of pharmacists’ competence should be tailored to experience level as described by Carrington and colleagues.9 The use of self-paced electronic modules, clinical in-service trainings, and team-based skills labs may be sufficient for assessing pharmacists who possess either extensive experience or specialty training in the care of patients with cancer.10 However, opportunities for advanced on-the-job training should be offered to pharmacists without specialty training in oncology, who are involved in the care of oncology patients, to allow for professional development, career advancement, and safe, effective patient care. Strategies for improving knowledge in oncology will allow pharmacists without residency or equivalent training to help fill gaps in the care of oncology patients.
In 2016, Saylor and colleagues described the implementation of an oncology pharmacy training course (OPTC) for pharmacists in oncology positions within their institution who did not possess PGY-2 training or BCOP certification. The OPTC employed bimonthly didactic education sessions led by PGY-2 trained pharmacists over the course of 1 year on a variety of oncology topics, including the basics of chemotherapy, supportive care in cancer, and disease state overview and management. Pharmacists participating in the OPTC were evaluated with the use of written examinations derived from the Oncology Pharmacy Preparatory Review and Recertification Course. Preliminary results reported at 3 months postimplementation demonstrated a significant improvement in oncology knowledge scores among the 29 pharmacists enrolled (29.6% to 52.2%, p < .01).7 These results demonstrate that a formalized training course in oncology can effectively improve oncology knowledge among pharmacists who lack specialized training in the care of patients with cancer.
The implementation of a competency framework and training program for pharmacists within an organization is not without its challenges. Especially within larger institutions, it can be difficult to ascertain where to focus educational effort to ensure maximum impact. A thorough needs assessment should be conducted to determine where existing knowledge gaps exist. If available, medication adverse-event reporting systems within an institution can also be used to guide competency development through identification of commonly reported events. Learner fatigue can also become problematic with expansion of the number of required annual competencies. Every effort should be made to streamline the process of competency evaluation to avoid lack of engagement on the part of the learner.
As the scope of practice of oncology pharmacists grows in depth and complexity, it is our professional responsibility to maintain expertise in the provision of care to patients with cancer. The establishment of a standardized competency framework within an institution paves the way for continuous training and professional development for pharmacists practicing in the field of oncology.
1. American Cancer Society. Cancer Treatment and Survivorship: Facts and Figures 2016-2017. Atlanta: American Cancer Society; 2016.
2. Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract. 2007;3(2):79-86.
3. Sessions JK, Valgus J, Barbour SY, Iacovelli L. Role of oncology clinical pharmacists in light of the oncology workforce study. J Oncol Pract. 2010;6(5):270-272.
4. Ignoffo R, Knapp K, Barnett M, et al. Board-certified oncology pharmacists: their potential contribution to reducing a shortfall in oncology patient visits. J Oncol Pract. 2016;12(4):e359-368.
5. Dobish R, Chambers C, Iwaasa K, Hubley B, Brigden M. Expanding the role of clinical pharmacists in community oncology practice. Oncology Exchange. 2014;13(4):24-28.
6. Merten JA, Shapiro JF, Gulbis AM, et al. Utilization of collaborative practice agreements between physicians and pharmacists as a mechanism to increase capacity to care for hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant. 2013;19(4):509-518.
7. Saylor MS, Blanchette LM, Smith MB, Cambron K, Andricopulos K, Brown MJ. Initiation and preliminary evaluation of an oncology pharmacy training course for staff pharmacists. J Oncol Pharm Pract. 2016;22(4):611-617.
8. Koster A, Schalekamp T, Meijerman I. Implementation of competency-based pharmacy education (CBPE). Pharmacy. 2017;5:1-16.
9. Carrington C, Weir J, Smith P. The development of a competency framework for pharmacists providing cancer services. J Oncol Pharm Pract. 2011;17(3):167-178.
10. Lapointe S, Philip L. Implementing pharmacist training and annual competencies. Pharmacy Today. 2015;1:52-53. Available at http://pharmacytoday.org/article/S1042-0991(15)30548-X/pdf