Discussion

Important constructs in the learning and training process have been identified in this review of evidence that will strengthen the training of APPs in the cancer center. The minimum volume of procedures appears to have been validated; however, a more structured process for moving an APP from procedure provider to trainer needs to be developed. The preceptor utilizes the competency checklist and procedural policies, but each preceptor teaches based on his or her own clinical experience. The preceptor’s abilities to teach are not formally assessed before the preceptor is assigned a trainee.

Future directions to strengthen the procedure training program will include developing a train-the-trainer competency checklist. A focus group will be held with current trainers to discuss their philosophies and steps in the training process.10 The principles of teaching will be reviewed and guidelines for trainers will be developed and documented. These foundational guidelines for performing and teaching procedures will be available for future APPs, and for review and revision as practices and equipment evolve.


Continue Reading

Related Articles

Conclusion

Medical and nursing literature support 10 as a minimum volume of procedures to incur procedural competency for BMAs, BMXs, and LPs. A comprehensive BM and LP education program for APPs should include procedure guidelines with the requisite didactic and hands-on training, and instruction guidelines for APP trainers. The IOM calls for safe, efficient, and effective patient care. A well-trained procedure team of APPs can perform procedures safely, efficiently, and effectively, and provide high-quality care for pediatric oncology patients in the cancer center.


Patricia Wills Bagnato is assistant professor, Baylor College of Medicine, and director – advanced practice providers, Texas Children’s Cancer and Hematology Centers, Houston, Texas.


References

1. Pfeffer J, Sutton RI. Evidence-based management. Harv Bus Rev. 2006;84(1):62-74, 133.

2. Formulating new rules to redesign and improve care. In: Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. https://www.ncbi.nlm.nih.gov/books/NBK222277/. Accessed October 4, 2019.

3. Jackson K, Guinigundo A, Waterhouse D. Bone marrow aspiration and biopsy: a guideline for procedural training and competency. J Adv Pract Oncol. 2012;3(4):260-265.

4. Accreditation Council for Graduate Medical Education (ACGME). Emergency medicine defined key index procedure minimums. Review committee for emergency medicine.https://www.acgme.org/Portals/0/PFAssets/ProgramResources/EM_Key_Index_Procedure_Minimums_103117.pdf?ver=2017-11-10-130003-693. Accessed October 4, 2019.

5. Wen LS, Nagurney JT, Geduld HI, Wen AP, Wallis LA. Procedure competence versus number performed: a survey of graduate emergency medicine specialists in a developing nation. Emerg Med. 2012;29(10):822-825.

6. Kyser KL, Lu X, Santillan D, et al. Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence? Acad Med. 2014;89(1):71-76.

7. Hernigou J, Picard L, Alves A, Silvera J, Homma Y, Hernigou P. Understanding bone safety zones during bone marrow aspiration from the iliac crest: the sector rule. Int Orthop. 2014;38(11):2377-2384. doi: 10.1007/s00264-014-2343-9.

8. Lawson S, Aston S, Baker L, Fegan CD, Milligan DW. Trained nurses can obtain satisfactory bone marrow aspirates and trephine biopsies. J Clin Pathol. 1999;52(2):154-156.

9. Kelly M, Crotty G, Perera K, Dowling M. Evaluation of bone marrow examinations performed by an advanced nurse practitioner: an extended role within a haematology service. Eur J Oncol Nurs. 2011;15(4):335-338.

10. Ford R, Meyer R. Competency-based education 101. Procedia Manuf, 2015;3:1473-1480. 11. Merrill MD. First principles of instruction. Educ Technol Res Dev. 2002;50(3):43-59.