care professionals in health promotion and disease prevention, there is evidence of programmatic deficits in medical, dental, and nursing schools. A problem of greater magnitude is upgrading the knowledge and skills of practicing clinicians whose performance reflects their lack of training. The demand for behavioral and early detection services will increase as the population ages, placing new strains on ambulatory care providers. 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),

  • assessments of the adequacy of the future supply of providers, and

  • research and demonstrations to test different delivery models to clarify who should be trained and how interventions can be best be delivered.

Although education alone is not sufficient to change the behaviors of providers, it remains an important factor in ensuring the delivery of evidence-based standard practices for cancer prevention and control. Many reciprocal factors can affect provider and patient behaviors at the health care plan and organizational levels. Structure and process characteristics, such as the availability of automated clinical reminder systems and quality improvement expectations, can enable and reinforce the practice of providing the needed prevention services. Required educational programs coupled with a system that identifies at-risk patients and that reminds the provider to intervene will produce increases in providers’ rates of provision of counseling (Adams et al., 1998; Fiore et al., 1996, US DHHS, 2000a; Ockene et al., 1996).



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