School of Medicine, Office of the Dean, University of California, One Shields Avenue, Davis, CA, 95616, USA.
Department of Emergency Medicine, University of California, Los Angeles, CA, 90095, USA.
BMC Med Educ. 2017 Sep 13;17(1):163. doi: 10.1186/s12909-017-0982-4.
Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions.
One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information.
PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients.
While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.
基因疾病的筛查和咨询是初级保健实践中越来越重要的一部分，尤其是在美国，遗传咨询师的数量非常有限。然而，初级保健医生（PCP）通常对基于证据的筛查、鼓励共同决策的沟通方法、与筛查基因突变相关的伦理、法律和社会影响（ELSI）问题，以及临床遗传学的基础知识理解不足。本研究探讨了与传统教育方法相比，针对非学术初级保健环境中的 PCP 而设计的互动式网络遗传课程是否更能改变实践知识、态度和行为，尤其是在讨论常见遗传疾病时。
121 名加利福尼亚州和宾夕法尼亚州医生诊所的 PCP 被随机分配到干预组（IG）或对照组（CG）。IG 医生完成了 6 小时的互动式网络课程，涵盖沟通技巧、遗传检测基础知识、风险评估、ELSI 问题和实践行为。CG 医生则提供了传统的继续医学教育（CME）方法（临床评论文章），提供了同等的信息。
与对照组相比，干预组的 PCP 知识增加更多。干预组的医生对教育材料也更满意，对自己的遗传学知识和技能更有信心，而接受传统 CME 材料的医生则不然。干预组医生认为网络课程在医学管理、遗传学和 ELSI 问题方面的覆盖范围明显优于对照组，与传统课程相比也是如此。干预组医生认为在线工具提供了几个优势，并与标准化患者进行了更好的共同决策，但在增加 PCP 和患者之间的 ELSI 讨论方面，两组之间没有行为改变的差异。
虽然我们的干预措施被认为更有趣，显著提高了事实学习和保留，并且增加了共同决策实践，但在 ELSI 讨论方面的行为改变差异不大。不幸的是，在临床遗传学中实施行为改变的障碍并不是我们的干预措施所特有的。也许缺失的要素是忙碌的医生需要系统层面的支持，以进行有关遗传学问题的有意义的讨论。促进医生和患者之间积极互动的下一步可能是建立必要的工具，使 PCP 能够在需要时轻松访问他们在临床遗传学方面进行联合讨论所需的材料。
