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Appendix C: Immunization Competencies Levelling Tool

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The Immunization Competencies Levelling Tool is intended to help assess various segments of the public health workforce in order to tailor training programs, practice standards, or performance assessment.

Because of the complexity of the health workforce and the settings in which immunization is provided, levels of proficiency should be adapted as appropriate to the specific performance requirements of a given set of professionals in a given work setting.

How to Use the Levelling Tool

Identify and define the specific segment of health professionals you will be assessing, and use the following scale to identify the level of proficiency for each learning objective:

  • Aware indicates a basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a relatively limited ability to perform the skill.
  • Knowledgeable indicates an intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.
  • Proficient indicates an advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

1. The Immune System and Vaccines

Competency:
Explains how vaccines work using basic knowledge of immune system.
Targeted Health Professional:
1. Compare and contrast innate and adaptive immunity.
  • Aware
  • Knowledgeable
  • Proficient
2. Differentiate between the primary and memory immune response to a vaccine.
  • Aware
  • Knowledgeable
  • Proficient
3. Differentiate between passive and active immunity.
  • Aware
  • Knowledgeable
  • Proficient
4. Explain why some vaccines induce a memory response while others do not.
  • Aware
  • Knowledgeable
  • Proficient
5. Name some host- and vaccine-related factors that affect the immune response to vaccines.
  • Aware
  • Knowledgeable
  • Proficient
6. Explain how the immunization schedule accommodates factors that affect the immune response to vaccines.
  • Aware
  • Knowledgeable
  • Proficient
7. Respond to the concern that giving too many vaccines will overload the immune system.
  • Aware
  • Knowledgeable
  • Proficient
8. Discuss the pros and cons of immunity gained through immunization as opposed to the wild-type infection.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

2. Vaccine-Preventable Diseases

Competency:
Demonstrates an understanding of the rationale and benefit of immunization, as relevant to the practice setting.
Targeted Health Professional:
1. Describe the key clinical features, including acute and long-term complications, of each vaccine-preventable disease.
  • Aware
  • Knowledgeable
  • Proficient
2. Describe the key epidemiologic features of each vaccine-preventable disease.
  • Aware
  • Knowledgeable
  • Proficient
3. Describe the historical impact of immunization on the epidemiology of vaccine-preventable disease.
  • Aware
  • Knowledgeable
  • Proficient
4. For each of the vaccines administered in the practice setting, formulate a response to the question "Why should I be immunized when vaccine-preventable diseases are so rare in Canada?"
  • Aware
  • Knowledgeable
  • Proficient
5. Explain why accurate diagnosis of vaccine-preventable diseases is important.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.


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3. Vaccine Development and Evaluation

Competency:
Integrates into practice knowledge about the main steps in vaccine development and evaluation.
Targeted Health Professional:
1. Describe, in general terms, the process to obtain marketing approval for vaccines in Canada.
  • Aware
  • Knowledgeable
  • Proficient
2. Describe what can be learned about vaccines after they are approved for marketing, via surveillance activities and more formal post-marketing studies.
  • Aware
  • Knowledgeable
  • Proficient
3. Characterize, in broad terms, the key roles and responsibilities for each of the following relative to the post marketing assessment of vaccine safety and effectiveness:
  • Vaccine manufacturers
  • Canadian regulatory authority (Biologics and Genetic Therapies Directorate)
  • Public Health Agency of Canada
  • Provincial/territorial Health departments
  • Vaccine providers
  • Healthcare providers who don't administer vaccines
  • Vaccine recipients or their parents/caregivers
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

4. The Types of Immunizing Agents and Their Composition

Competency:
Applies the knowledge of the components and properties of immunizing agents as needed for safe and effective practice.
Targeted Health Professional:
1. Classify each immunizing agent used in practice as live attenuated, inactivated, or subunit.
  • Aware
  • Knowledgeable
  • Proficient
2. Demonstrate the ability to describe live attenuated, inactivated, and subunit immunizing agents to an audience with minimal or no science knowledge.
  • Aware
  • Knowledgeable
  • Proficient
3. Compare the major advantages and disadvantages of live attenuated versus inactivated/subunit immunizing agents.
  • Aware
  • Knowledgeable
  • Proficient
4. Identify key differences in the immune response to purified polysaccharide versus polysaccharide protein conjugate vaccines.
  • Aware
  • Knowledgeable
  • Proficient
5. Describe, in general terms, the purpose, action, and potential concerns of each of the following components that may be present in a given vaccine product: adjuvant, preservative, additives, glass vial, stopper, and pre-filled syringe.
  • Aware
  • Knowledgeable
  • Proficient
6. Locate and utilize current information resources on the types and content of immunizing agents used in practice.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

5. Population Health

Competency: Applies relevant principles of population health for improving immunization coverage rates.
Targeted Health Professional:
1. Use specific examples to show how immunization is a population-based health strategy.
  • Aware
  • Knowledgeable
  • Proficient
2. Explain the concept of herd immunity (also called community immunity) in non-scientific terms.
  • Aware
  • Knowledgeable
  • Proficient
3. Explain, using examples, why vaccine-preventable diseases return when immunization coverage rates decrease.
  • Aware
  • Knowledgeable
  • Proficient
4. Explain how immunization registries can benefit not only individuals but also populations.
  • Aware
  • Knowledgeable
  • Proficient
5. Present the case for the importance of having a highly immunized healthcare workforce.
  • Aware
  • Knowledgeable
  • Proficient
6. Use health promotion planning model to identify barriers (economic, educational, system-based, and social factors) to immunization uptake.
  • Aware
  • Knowledgeable
  • Proficient
7. Use health promotion strategies to improve immunization coverage rates.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.


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6. Communication

Competency:
Communicates effectively about immunization as relevant to the practice setting(s).
Targeted Health Professional:
1. List the components of the evidence-based decision-making process.
  • Aware
  • Knowledgeable
  • Proficient
2. Explain the concept of herd immunity (also called community immunity) in non-scientific terms.
  • Aware
  • Knowledgeable
  • Proficient
3. Respond appropriately following an assessment of client knowledge, attitudes, and beliefs regarding immunization.
  • Aware
  • Knowledgeable
  • Proficient
4. Deliver clear, concise messages about the risks of vaccine-preventable diseases and the benefits and risks of vaccines.
  • Aware
  • Knowledgeable
  • Proficient
5. Provide appropriate evidence-based information and resources to clients regarding immunization and vaccines.
  • Aware
  • Knowledgeable
  • Proficient
6. Provide guidance to clients so they can correctly identify credible sources of information on immunization and vaccines.
  • Aware
  • Knowledgeable
  • Proficient
7. Apply, as appropriate to the practice setting, mass media strategies for public communication.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

7. Storage and Handling of Immunization Agents

Competency:
Implements Canadian guidelines when storing, handling, or transporting vaccines.
Targeted Health Professional:
1. State where to access the most recent national guidelines dealing with vaccine storage, handling, and transportation.
  • Aware
  • Knowledgeable
  • Proficient
2. Describe the national guideline requirements for vaccine storage, handling, and transportation and their importance in maximizing the potency and efficacy of each vaccine.
  • Aware
  • Knowledgeable
  • Proficient
3. Outline the key steps for maintaining the cold chain in the practice setting.
  • Aware
  • Knowledgeable
  • Proficient
4. Explain actions taken to report and manage breaks in the cold chain or other insults that compromise vaccine integrity.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

8. Administration of Immunizing Agents

Competency:
Prepares and administers immunization agents correctly.
Targeted Health Professional:
1. Prepare a checklist for pre-immunization patient assessment, including precautions, contraindications, and indications for rescheduling.
  • Aware
  • Knowledgeable
  • Proficient
2. Ensure the seven "Rights" of immunization: right drug, right client, right dose, right time, right route, right reason, and right documentation.
  • Aware
  • Knowledgeable
  • Proficient
3. Demonstrate the steps involved in vaccine preparation, including reconstitution, if appropriate, administration, and disposal.
  • Aware
  • Knowledgeable
  • Proficient
4. Name the resources that are used to guide the immunization administration process and decision making.
  • Aware
  • Knowledgeable
  • Proficient
5. Develop a table listing the vaccine, age, dose, route, site, contraindications/precautions, and side effects for each vaccine used in the practice setting.
  • Aware
  • Knowledgeable
  • Proficient
6. Demonstrate the age-appropriate injection sites and proper client positioning used for immunization.
  • Aware
  • Knowledgeable
  • Proficient
7. Choose the correct needle length and gauge for the age and size of the client.
  • Aware
  • Knowledgeable
  • Proficient
8. Describe actions taken to increase safety in immunization clinics related to the provider, the recipient, and the environment.
  • Aware
  • Knowledgeable
  • Proficient
9. Demonstrate the appropriate technique for immunization.
  • Aware
  • Knowledgeable
  • Proficient
10. Describe techniques to reduce the pain associated with immunization.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.


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9. Adverse Events Following Immunization

Competency:
Anticipates, identifies, and manages adverse events following immunization.
Targeted Health Professional:
1. Use reliable, evidence-based resources to list the frequencies of the common, uncommon, and rare adverse events associated with vaccines.
  • Aware
  • Knowledgeable
  • Proficient
2. Inform recipients and/or their caregivers on what to expect and what to do regarding adverse events that could follow immunizations.
  • Aware
  • Knowledgeable
  • Proficient
3. Draft in detail an effective step-by-step response to anaphylaxis
  • Aware
  • Knowledgeable
  • Proficient
4. Document all adverse events following immunization on the appropriate form and submit it to the appropriate agencies.
  • Aware
  • Knowledgeable
  • Proficient
5. Distinguish between reporting an adverse event following immunization and proving that immunization caused an adverse event.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

10. Documentation

Competency:
Documents information relevant to each immunization encounter in accordance with national guidelines for immunization practices and jurisdictional health information processes.
Targeted Health Professional:
1. Describe the role and importance of immunization records.
  • Aware
  • Knowledgeable
  • Proficient
2. Identify the information to be documented on an immunization record.
  • Aware
  • Knowledgeable
  • Proficient
3. Record an immunization encounter on the appropriate documentation instruments accurately and completely.
  • Aware
  • Knowledgeable
  • Proficient
4. Facilitate the transfer of information in the vaccination record to other providers and to appropriate agencies in accordance with requirements.
  • Aware
  • Knowledgeable
  • Proficient
5. Record the reason and planned follow-up action when a scheduled immunization is not given.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

11. Populations Requiring Special Considerations

Competency:
Recognizes and responds to the unique immunization needs of certain population groups.
Targeted Health Professional:
1. Describe the unique immunization needs of certain populations, as relevant to the practice setting, including
  • individuals who are off course of a recommended immunization schedule;
  • individuals who have had a serious adverse event following a prior immunization;
  • individuals with certain medical conditions, including transplant recipients;
  • pregnant women;
  • women who are breastfeeding;
  • occupational risk groups;
  • travellers;
  • new Canadians;
  • international students;
  • individuals with behaviours that put them at risk for vaccine-preventable infections;
  • "hard-to-reach" individuals; and
  • outbreak populations.
  • Aware
  • Knowledgeable
  • Proficient
2. Appropriately refer to expert professionals/resources when required to address the immunization needs of certain populations.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.


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12. The Canadian Immunization System

Competency:
Demonstrates an understanding of the immunization system in Canada and its impact on his/her own practice.
Targeted Health Professional:
1. Describe how the National Immunization Strategy is relevant to practice.
  • Aware
  • Knowledgeable
  • Proficient
2. Distinguish between federal and provincial/territorial responsibilities as related to immunization programs in Canada.
  • Aware
  • Knowledgeable
  • Proficient
3. List who can administer immunizations in Canada.
  • Aware
  • Knowledgeable
  • Proficient
4. Describe the current status of immunization registries in the province or territory where practice is based.
  • Aware
  • Knowledgeable
  • Proficient
5. Describe the process required to introduce a new publicly funded vaccine in a province or territory.
  • Aware
  • Knowledgeable
  • Proficient
6. Explain the reasons for the variable immunization schedules among the provinces and territories.
  • Aware
  • Knowledgeable
  • Proficient
7. Locate the current immunization schedule for the province or territory of practice.
  • Aware
  • Knowledgeable
  • Proficient
8. Identify laws and regulations that may affect immunization delivery programs in provinces and territories.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

13. Immunization Issues

Competency:
Addresses immunization issues using an evidence-based approach.
Targeted Health Professional:
1. Describe factors which lead to scepticism regarding immunization for both healthcare providers and the general public.
  • Aware
  • Knowledgeable
  • Proficient
2. Describe the impact that misperceptions regarding immunizing agents have on immunization programs and on the population.
  • Aware
  • Knowledgeable
  • Proficient
3. Address misperceptions regarding immunizing agents using an evidence-based approach.
  • Aware
  • Knowledgeable
  • Proficient
4. Locate evidence-based sources of information on current issues relating to immunization.
  • Aware
  • Knowledgeable
  • Proficient
5. Use evidence-based scientific knowledge to develop clear, concise key messages regarding true immunization benefits and risks.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

14. Legal and Ethical Aspects of Immunization

Competency:
Acts in accordance with legal and high ethical standards in all aspects of immunization practice.
Targeted Health Professional:
1. Discuss the implications of basic ethical principles, including individual's right, confidentiality, privacy, informed consent, and informed refusal.
  • Aware
  • Knowledgeable
  • Proficient
2. Describe the legal requirements relevant to immunization administration, documentation, recording, and reporting.
  • Aware
  • Knowledgeable
  • Proficient
3. Describe the legal requirements in the province/territory of immunization practice that relate to immunization status and exclusion from daycare, school, workplace, or other settings.
  • Aware
  • Knowledgeable
  • Proficient
4. Identify his/her own professional scope of practice as it relates to immunization (jurisdiction, organization, practice setting – institutions, etc.).
  • Aware
  • Knowledgeable
  • Proficient
5. Discuss the ethical issues arising from:
  • mandatory versus voluntary immunization; and
  • targeted versus universal immunization.
  • Aware
  • Knowledgeable
  • Proficient
6. Discuss the responsibility of health professionals to inform patients regarding the availability of all recommended vaccines regardless of whether they are publicly funded or not.
  • Aware
  • Knowledgeable
  • Proficient
7. Describe the ethical implications when a provider's beliefs conflict with evidence-based recommendations for immunization.
  • Aware
  • Knowledgeable
  • Proficient


Aware = Basic level of mastery of the competency, in which individuals are able to identify the concept or skill but have a limited ability to perform the skill.

Knowledgeable = Intermediate level of mastery of the competency, in which individuals are able to apply and describe the skill.

Proficient = Advanced level of mastery of the competency, in which individuals are able to synthesize, critique, or teach the skill.

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Date Modified: 2009-12-10

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