Building a genomics-capable cancer workforce: a competency-based framework for education and training in precision oncology

Abstract

Background The Lancet Oncology Commission on cancer genomics and precision oncology identified workforce capability, education, and training as major constraints to equitable implementation. As genomic and multi-omic technologies become integrated into cancer care, structured approaches are needed to define competencies across the multidisciplinary workforce. Methods The Core Competency Framework for Precision Oncology was developed using a narrative review and iterative expert-informed framework development process. Competency frameworks, professional standards, policy guidance, organisational reports, and educational literature relevant to genomic medicine, precision oncology, and workforce development were identified through purposive searches of organisational repositories, peer-reviewed literature, and reference list screening between January 2025 and March 2026. Search terms included combinations of "precision oncology", "cancer genomics", "genomic medicine", "competenc∗", "education", "training", and "workforce". Competency domains, role functions, progression structures, and implementation concepts were extracted, compared, and synthesised into shared and role-specific competencies mapped across foundational, intermediate, and advanced levels. The framework was refined through iterative multidisciplinary expert consultation involving contributors to the Lancet Oncology Commission. Findings The framework defines three components; shared core competencies applicable across professional groups; role-specific competencies aligned with functions across the precision oncology pathway; and a progression model reflecting increasing interpretive complexity, autonomy, accountability, and leadership. An associated tiered workforce model links competencies to service contexts and levels of practice, supporting distribution of genomic responsibilities while preserving escalation pathways and governance structures. The framework is designed to be adaptable across professions, health systems, and resource settings. Interpretation This framework provides an implementation-oriented structure to support workforce development, curriculum design, continuing professional education, role mapping, competency assessment, and service planning in precision oncology. Its application may support scalable, equitable, and sustainable integration of genomics into routine cancer care. Funding No specific funding was received for this work.