Navigating genomic testing: Evaluation of an e-learning module with general practitioners

Bronwyn Nicole Terrill; Angela Pearce; Amanda Chau; Mary-Anne Young

doi:10.11157/fohpe.v25i1.630

Authors

Bronwyn Nicole Terrill Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, UNSW, Australia https://orcid.org/0000-0003-0263-363X
Angela Pearce Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research UNSW, Australia https://orcid.org/0000-0002-5258-5421
Amanda Chau Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research UNSW, Australia
Mary-Anne Young Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research UNSW , Australia https://orcid.org/0000-0002-2493-6394

DOI:

https://doi.org/10.11157/fohpe.v25i1.630

Keywords:

genetics education, genomics education, general practice, genomic testing, medical education, continuing professional education

Abstract

Background: Primary care, or general, practitioners (GPs) are increasingly expected to communicate with and support their patients through genetic or genomic testing. However, GPs worldwide report a lack of knowledge about genetics and what constitutes a genetic or genomic test. Few Australian educational resources for medical practitioners address core capabilities in genetics or genomics.

Methods: We developed and evaluated a 90-minute online education module, Navigating Genomic Testing in General Practice, hosted online for 12 months. The module aimed to increase GPs’ awareness and knowledge of genomics, increase confidence in their capability to support genomic testing and foster intention to utilise that knowledge. GPs residing and practising in Australia who completed the module also completed a mandatory post-module survey. They were then invited to complete a behavioural intention survey and participate in an interview.

Results: Between December 2018 and 2019, 216 Australian GPs completed the module and mandatory survey. Fourteen GPs went on to complete the optional survey. Most Australian GPs who completed the module reported gaining knowledge that was relevant to their practice (n = 215, 99.5%) and entirely met their learning needs (n = 168, 77.8%). Respondents of the optional survey (n = 14) indicated that confidence in their capability significantly increased post module, together with intention to support patients undergoing genomic testing.

Conclusion: GPs in this study reported increased confidence, ability and intent, which are factors that can lead to changes in behaviour. Our findings support use of this type of online course as an educational tool to help GPs navigate genomics as it increasingly impacts their practice.

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T

Australian Institute of Health and Welfare (AIHW). (2022). Australia’s health 2022: Data insights. https://doi.org/10.25816/ggvz-vr80

Biesecker, L. G., & Green, R. C. (2014). Diagnostic clinical genome and exome sequencing. The New England Journal of Medicine, 370(25), 2418–2425. https://doi.org/10.1056/NEJMra1312543

Bhanji, F., Gottesman, R., de Grave, W., Steinert, Y., & Winer, L. R. (2012). The retrospective pre-post: A practical method to evaluate learning from an educational program. Academic Emergency Medicine, 19(2), 189–194. https://doi.org/10.1111/j.1553-2712.2011.01270.x

Brodaty, H., Gibson, L. H., Waine, M. L., Shell, A. M., Lilian, R., & Pond, C. D. (2013). Research in general practice: A survey of incentives and disincentives for research participation. Mental Health in Family Medicine, 10(3), 163–173.

Carroll, J. C., Allanson, J., Morrison, S., Miller, F. A., Wilson, B. J., Permaul, J. A., & Telner, D. (2019). Informing integration of genomic medicine into primary care: An assessment of current practice, attitudes, and desired resources. Frontiers in Genetics, 10, Article 1189. https://doi.org/10.3389/fgene.2019.01189

Carroll, J. C., Makuwaza, T., Manca, D. P., Sopcak, N., Permaul, J. A., O’Brien, M. A., Heisey, R., Eisenhauer, E. A., Easley, J., Krzyzanowska, K., Miedema, B., Pruthi, S., Sawka, C., Schneider, N., Sussman, J., Urquhart, R., Versaevel, C., & Grunfeld, E. (2016). Primary care providers’ experiences with and perceptions of personalized genomic medicine. Canadian Family Physician, 62, e626–e635.

Carroll, J. C., Morrison, S., Miller, F. A., Wilson, B. J., Permaul, J. A., & Allanson, J. (2021). Anticipating the primary care role in genomic medicine: Expectations of genetics health professionals. Journal of Community Genetics, 12(4), 559–568. https://doi.org/10.1007/s12687-021-00544-1

Cusack, M. B., Hickerton, C., Nisselle, A., McClaren, B., Terrill, B., Gaff, C., Dunlop, K., & Metcalfe, S. (2021). General practitioners' views on genomics, practice and education: A qualitative interview study. Australian Journal of General Practice, 50(10), 747–752. https://doi.org/10.31128/AJGP-05-20-5448

Delatycki, M., Laing, N., Moore, S., Emery, J., Archibald, A., Massie, J., & Kirk, E. (2019). Preconception and antenatal carrier screening for genetic conditions: The critical role of general practitioners. Australian Journal of General Practice, 48(3), 106–110. https://doi.org/10.31128/AJGP-10-18-4725

Haga, S. B., Kim, E., Myers, R. A., & Ginsburg, G. S. (2019). Primary care physicians' knowledge, attitudes, and experience with personal genetic testing. Journal of Personalized Medicine, 9(2), Article 29. https://doi.org/10.3390/jpm9020029

Hayward, J., Bishop, M., Rafi, I., & Davison, V. (2017). Genomics in routine clinical care: What does this mean for primary care? British Journal of General Practice, 67(655), 58–59. https://doi.org/10.3399/bjgp17X688945

Hill, L. G., & Betz, D. L. (2005). Revisiting the retrospective pretest. American Journal of Evaluation, 26(4), 501–517. https://doi.org/10.1177/1098214005281356

Human Genetics Society of Australasia. (2022). Core capabilities in genetics & genomics for medical graduates. Retrieved on October 24, 2023, from https://hgsa.org.au/common/Uploaded%20files/pdfs/policies,%20position%20statements%20and%20guidelines/eesic/Core%20Capabilities%20in%20Genetics%20and%20Genomics%20for%20Medical%20Graduates.pdf

Légaré, F., Borduas, F., Freitas, A., Jacques, A., Godin, G., Luconi, F., Grimshaw, J., & CPD-KT team. (2014). Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions. PLOS ONE, 9(3), Article e91013. https://doi.org/10.1371/journal.pone.0091013

Légaré, F., Freitas, A., Turcotte, S., Borduas, F., Jacques, A., Luconi, F., Godin, G., Boucher, A., Sargeant, J., & Labrecque, M. (2017). Responsiveness of a simple tool for assessing change in behavioral intention after continuing professional development activities. PLOS ONE, 12(5), Article e0176678. https://doi.org/10.1371/journal.pone.0176678

Manolio, T. A., Abramowicz, M., Al-Mulla, F., Anderson, W., Balling, R., Berger, A. C., Bleyl, S., Chakravarti, A., Chantratita, W., Chisholm, R. L., Dissanayake, V. H., Dunn, M., Dzau, V. J., Han, B. G., Hubbard, T., Kolbe, A., Korf, B., Kubo, M., Lasko, P., … Ginsburg, G. S. (2015). Global implementation of genomic medicine: We are not alone. Science Translational Medicine, 7(290), 290ps13. https://doi.org/10.1126/scitranslmed.aab0194

Metcalfe, S. A., Hickerton, C., Savard, J., Stackpoole, E., Tytherleigh, R., Tutty, E., Terrill, B., Turbitt, E., Gray, K., Middleton, A., Wilson, B., Newson, A. J., & Gaff, C. (2019). Australians' perspectives on support around use of personal genomic testing: Findings from the Genioz study. European Journal of Medical Genetics, 62(5), 290–299. https://doi.org/10.1016/j.ejmg.2018.11.002

Mikat-Stevens, N. A., Larson, I. A., & Tarini, B. A. (2015). Primary-care providers' perceived barriers to integration of genetics services: A systematic review of the literature. Genetics in Medicine, 17(3), 169–176. https://doi.org/10.1038/gim.2014.101

Nisselle, A., Janinski, M., Martyn, M., McClaren, B., Kaunein, N., Barlow-Stewart, K., Belcher, A., Bernat, J. A., Best, S., Bishop, M., Carroll, J. C., Cornel, M., Dissanayake, V. H. W., Dodds, A., Dunlop, K., Garg, G., Gear, R., Graves, D., Knight, K., … Gaff, C. (2021). Ensuring best practice in genomics education and evaluation: Reporting item standards for education and its evaluation in genomics (RISE2 Genomics). Genetics in Medicine, 23(7), 1356–1365. https://doi.org/10.1038/s41436-021-01140-x

O'Shea, R., Ma, A. S., Jamieson, R. V., & Rankin, N. M. (2022). Precision medicine in Australia: Now is the time to get it right. The Medical Journal of Australia, 217(11), 559–563. https://doi.org/10.5694/mja2.51777

Ong, C. S. B., Fok, R. W., Tan, R. C. A., Fung, S. M., Sun, S., & Ngeow, J. Y. Y. (2022). General practitioners' (GPs) experience, attitudes and needs on clinical genetic services: A systematic review. Family Medicine and Community Health, 10(4), Article e001515. https://doi.org/10.1136/fmch-2021-001515

Paneque, M., Cornel, M. C., Curtisova, V., Houwink, E., Jackson, L., Kent, A., Lunt, P., Macek, M., Stefansdottir, V., Turchetti, D., & Skirton, H. (2017). Implementing genetic education in primary care: The Gen-Equip programme. Journal of Community Genetics, 8(2), 147–150. https://doi.org/10.1007/s12687-017-0296-6

Paneque, M., Turchetti, D., Jackson, L., Lunt, P., Houwink, E., & Skirton, H. (2016). A systematic review of interventions to provide genetics education for primary care. BMC Family Practice, 17, Article 89. https://doi.org/10.1186/s12875-016-0483-2

Petrie, D., Conway, N., & Shelbourne, J. (2016). Australian patients’ and families’ perspectives on genome sequencing: Report and patient charter. Genetic Alliance Australia. http://www.geneticalliance.org.au/genome.php?1

Phillips, A. M. (2016). Only a click away — DTC genetics for ancestry, health, love … and more: A view of the business and regulatory landscape. Applied & Translational Genomics, 8, 16–22. https://doi.org/10.1016/j.atg.2016.01.001

Reed, E. K., Johansen Taber, K. A., Ingram Nissen, T., Schott, S., Dowling, L. O., O'Leary, J. C., & Scott, J. A. (2016). What works in genomics education: Outcomes of an evidenced-based instructional model for community-based physicians. Genetics Medicine, 18(7), 737–745. https://doi.org/10.1038/gim.2015.144

Royal Australian College of General Practitioners (RACGP). (2016). Curriculum for Australian general practice 2016: Core skills unit (CS16). https://www.racgp.org.au/education/education-providers/curriculum/previous-versions

Royal Australian College of General Practitioners (RACGP). (2018). QI&CPD program: A guide for all providers of accredited activities. https://www.racgp.org.au/FSDEDEV/media/documents/Education/Professional%20development/QI-CPD/QICPD-Guide-for-all-providers-activities.pdf

Royal College of General Practitioners (RCGP). (2016). RCGP curriculum: Professional and clinical modules—3.02 Genetics in primary care. https://www.gmc-uk.org/-/media/documents/RCGP_Curriculum_modules_jan2016.pdf_68839814.pdf

Talwar, D., Tseng, T. S., Foster, M., Xu, L., & Chen, L. S. (2017). Genetics/genomics education for nongenetic health professionals: A systematic literature review. Genetics in Medicine, 19(7), 725–732. https://doi.org/10.1038/gim.2016.156

Vassy, J. L., Davis, J. K., Kirby, C., Richardson, I. J., Green, R. C., McGuire, A. L., & Ubel, P. A. (2018). How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation. Journal of General Internal Medicine, 33(6), 877–885. https://doi.org/10.1007/s11606-017-4295-4

Williams, M. S. (2019). Early lessons from the implementation of genomic medicine programs. Annual Review of Genomics and Human Genetics, 20, 389–411. https://doi.org/10.1146/annurev-genom-083118-014924