Cancer Registrar Training: A Model to Meet Today’s Challenges Carol Hahn Johnson, BS, CTR Lois A. Dickie, CTR NCI/SEER

The Challenge Providing Needs-Based Training Needs evolve over time Training must be renovated to meet the new needs Whether you are training on a new data item or changes to existing rules, or you are training a new employee the most effective method is to utilize the Needs Based principle. The needs evolve over time. In order to meet the evolving needs, the training materials must be renovated.

Phase 1 Initial Training “Shotgun” approach The “Shotgun” approach simplistically means that you present all of the information to all of the people. Because this is new to the participants you have to teach all of the background and general information, as well as the rules them selves to as wide an audience as possible. The disadvantages is that it is very time consuming and that people “turnoff” after awhile- adult learners listen for only so long before they only hear “blah blah blah”. Another disadvantage is that it is extremely time consuming to present a new data system in its entirety. Your audience will be composed of beginners, intermediate and advanced and that your presentation should be geared to the beginners. Example: newspaper add for Sears. Some readers may only be interested in one certain item, while another may be interested in several. This intent of this approach is to saturate the market- get the information to as many readers as possible. Despite these disadvantages, you have to start with this shotgun approach.

Phase 1 Methods Train the Trainers 3 SEER 96 Trainers 7,777 Registrars Here is an example of the “Shotgun” approach to training the new MP/H rules: the 3 SEER QC/QI staff provided training to 96 people representing the US, Canada, and other countries. (49 states, VA and DoD, 11 Canadian Provinces and 5 countries (Guam, Palou, Puerto Rico, S. Korea and Taiwan). The trainers attended an intensive 2 day in-person workshop. Not only were the trainers taught the new rules, but also how to train adult learners, how to answer questions and handle difficult situations. SEER provides ongoing support to including a website (download training materials, chat with other trainers and post questions to SEER). MP/H had 2 trainings- both the shotgun approach were used. The first training was held 9/05 and introduced the MP/H rules. The 2nd training (8/06) was 3 days long. There were many new trainers attending, so the 1st day repeated the 9/05 day 1 agenda (bringing the new trainers up to speed on training methods). The following 2 days included all of the trainers.

Phase 1 Methods Documentation/presentation Multiple formats to accommodate different styles of learning There are different types of learners: auditory (need to hear you speak), visual (need to see the presentation), you also have to remember that visual learners also need graphics/symbols that augment the text. Make provision for all these types of learners, otherwise you will loose half of your audience. Tactile (kinesthetic).

Methods cont’d Basic Web-based training Interactive Recorded Basic web-training: 1st training was interactive. It was recorded and a transcribed. The recording and transcript were placed on the SEER website. This allowed for 24/7 access to those who could not attend the live training. It also allowed people to go back and review the sessions if they were having problems with that particular site. Feedback showed that having both the recording and the transcripts were valuable.

Phase 2 Starts after registrars start using the product Questions/problems differ from those asked during the initial phase Must keep a record of questions Use this record to identify problems Plan a focused training based on the needs analysis Phase 2: This is the point that you are able to really focus in on those issues that need attention. After they have used the new code, system, data item new questions are identified. You must develop new training modules that focus on the problems identified.. Best indicators are from questions submitted..

Phase 2 Methods for Trainers Follow-up TTT conferences to identify FAQs Training issues There were also follow-up teleconferences designed to identify problems the trainers were having and discussing the most frequently asked questions. From those trainers that reported their training activities, at least 7,324 registrars attended training workshops. TTT is not a new concept, having followup meetings to identify problems and answer questions is a new concept. SEER and the trainers both found it very helpful.

Phase 2 Methods for Registrars Web Based Training Beyond the Basics January 2007 to May 2008 Approximately 28,000 visits to the sessions This training is based on all of the information gathered from the trainers and questions asked by users. The web-based education focused only on the problem areas identified by the users. The adult learners respond very well to that approach. This is no longer the shotgun approach. You are now targeting or focusing on specific issues. This was recorded and post on the web along with the transcript. This again was available 24/7 and available for review at will.

Phase 2 Methods for Registrars SINQ and I&R Clarifications to rules SINQ= SEER inquiry system. I&R is the inquiry and response system for CoC. Both of these give the registrars that chance to post questions and get answers. Sometimes the feedback we get show that the users are not clearly understanding the rule and clarifications are a way in which the instructions are stated a little differently-for clarity and understanding. The rules themselves are not changed.

Phase 3 Re-evaluate and retrain Identify problems Test cases Random selection of cases You need to use a tool to help evaluate what you have taught them, such as the MP/H rules. you really have to do a type of study or audit where everyone codes the same case under the same circumstance. At a both the state registry level and hospital level you can do this manually, electronically and select charts at random. Includes both central registry staff and hospital staff. Process- don’t get hung up on whether they get the right answer, but rather how they arrived at their answers. This is a needs based assessment. You need to draw the rationale out from the registrars.

Phase 3 Evaluating the re-testing results Emphasize the reasons for discrepant answers (Problem identification) Identify documentation and education needs Implementation (problem solving) Do not focus on whether or not they get the right answer, but rather why the discrepancy happened.

Conclusion Use multi-step approaches to education Identify problems/needs Continued needs based trainings and documentation You need to change the one-step training. You must approach as a multi-step approach. You need to identify the proble. Have process in place to talk with the people doing the training, the coding and have a method to collection feedback, take action. Follow-thru with needs-based documentation and education.