McClaren Belinda J, King Emily A, Crellin Erin, Gaff Clara, Metcalfe Sylvia A, Nisselle Amy
Australian Genomics Health Alliance, Melbourne, VIC, Australia.
Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Front Genet. 2020 Mar 3;11:59. doi: 10.3389/fgene.2020.00059. eCollection 2020.
Despite some early implementation of genomic medicine globally, there is a lack of rigorous, large-scale assessments of medical specialists' current practice and continuing education needs. As a first step to addressing this gap, we describe the development of a robust, expert-reviewed, survey using a mixed-methods sequential study design. We conducted semi-structured qualitative interviews with 32 education providers and 86 non-genetic medical specialists about current genomic medicine practice and need for continuing education. Key concepts were identified and used as an initial framework for the survey. These were: personal characteristics (medical specialty, years of practice); current practice of genomics in clinical and research settings; perception of how proximal genomic medicine is to practice; perception of preparedness (competence and confidence); and, preferences for future roles and models of care in genomic medicine and for continuing education. Potential survey questions that related to at least one of these concepts were identified from the literature or were created if no suitable question existed. Using a modified, reactive Delphi approach, questions were reviewed by a panel of 22 experts. Experts were selected purposefully representing four areas of expertise: non-genetic medical specialties; clinical genetics; genetic/genomic education and evaluation; and implementation science. Three Delphi rounds assessed relevance, clarity and importance of each question. The questions were also mapped to the behaviour change wheel theoretical framework which encompasses capability, opportunity and motivation (COM-B). The survey (included as supplementary material) was then tested with a small group of non-genetic medical specialists and feedback was written or verbal in 'talk-aloud', cognitive interviews. The final survey was then piloted with a further 29 specialists. We describe the methodology to create a robust, data- and theory-informed survey. The final survey captures not only levels of experience, practice of genomics and preferences for education but also the challenges around engaging with education. Survey data will provide evidence for education providers to inform development of education which meets learner needs and contributes to a medical workforce that is literate in genomics and more confident to competently practice genomic medicine.
尽管全球范围内已初步实施了基因组医学，但对于医学专家当前的实践情况以及继续教育需求，仍缺乏严格的大规模评估。作为填补这一空白的第一步，我们描述了一项采用混合方法序贯研究设计、经过专家评审的稳健调查的开发过程。我们对32名教育提供者和86名非遗传医学专家进行了半结构化定性访谈，了解当前基因组医学实践情况以及继续教育需求。确定了关键概念，并将其用作调查的初始框架。这些概念包括：个人特征（医学专业、执业年限）；基因组学在临床和研究环境中的当前实践；对基因组医学与实践接近程度的认知；对准备情况（能力和信心）的认知；以及对基因组医学未来角色和护理模式以及继续教育的偏好。从文献中确定了与这些概念中至少一个相关的潜在调查问题，若没有合适问题则自行创建。采用改良的反应式德尔菲法，由22名专家组成的小组对问题进行评审。专家的选择具有针对性，代表了四个专业领域：非遗传医学专业；临床遗传学；遗传/基因组教育与评估；以及实施科学。三轮德尔菲法评估了每个问题的相关性、清晰度和重要性。这些问题还被映射到行为改变轮理论框架，该框架涵盖能力、机会和动机（COM-B）。然后，对一小群非遗传医学专家进行了调查测试（调查内容作为补充材料），并通过“出声思考”的认知访谈以书面或口头形式获取反馈。最终调查随后在另外29名专家中进行了预试验。我们描述了创建一项稳健的、基于数据和理论的调查的方法。最终调查不仅涵盖了经验水平、基因组学实践和教育偏好，还包括参与教育过程中面临的挑战。调查数据将为教育提供者提供依据，以指导满足学习者需求的教育发展，并有助于培养一支具备基因组学知识且更有信心胜任基因组医学实践的医疗队伍。
