with a review of federal and private funding resources available to support education and training efforts.


Who Should Be Trained?

The education and training of health care providers occur on dual fronts, each of which has a unique set of challenges. First, those in training must be exposed to course work and clinical experience that reflect current evidence-based guidelines for cancer prevention and early detection interventions. Although updating of curricula would at first appear to be straightforward, such changes can be very difficult to make because of the competing demands among the various medical disciplines, each vying for the limited training time available. The second, and perhaps more daunting charge is providing continuing education to practitioners who are already trained but who have deficits in prevention education. As of 1997, most physicians (55 percent) had graduated from medical school before 1980 (American Medical Association, 1999), long before the publication of the U.S. Preventive Services Task Force’s Guide to Clinical Preventive Services in 1989 and the availability of comprehensive smoking cessation guidelines.

In 1999 the United States had an estimated 9 million health care practitioners and health care technical and support staff (Bureau of Labor Statistics, http://stats.bls.gov), but this number does not capture fully those who may need to be trained in cancer prevention and early detection. 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-to-date 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. Although this chapter recognizes the diversity of needs for education and training, the focus is on the education and training needs of direct providers of ambulatory health care services.

Among direct health care providers, answers to the questions of who should be trained and how they should be trained depend in part on who has regular contact with patients and the environment of contemporary practice. Where do individuals go for their routine or preventive care? In 1998, the vast majority of individuals relied on doctor’s offices and health maintenance organizations (69.7 percent) and clinics or health centers (15.6 percent) for

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