Primary care physicians have almost no training in genetics, nor in the ethical, legal and social implications (ELSI) of genetic testing, diagnosis and therapy. Further, mere provision of curricular content fails to impact physician behavior. However, programs with elements that are based on established educational and adult learning principles have been shown to effective in affecting behavioral change. These methods include self-directed learning, methods for self-evaluation, adequate curricular time, positive reinforcement, self-efficacy assessment, and mentorship.
AIM : We propose to develop, implement, and evaluate a web-based curriculum on the ELSI related to genetics for primary care residents in internal medicine and pediatrics. METHODOLOGY: Over three years, we will build a web-based curriculum on ELSI issues related to genetics with a series of case-based modules. We emphasize the integration of genetic concepts into primary care practice, guiding residents to those concepts which build on established primary care practice, and those which represent novel approaches to care delivery. Each module will be 20-45 minutes, and feature interactive elements, plus video clips demonstrating relevant best practices (for instance, non-directive counseling about predictive testing, or modeling difficult conversations about prognosis). We will link to GeneClinics for genetics content. After development, our curriculum will be implemented with residents in pediatrics (University of California, Los Angeles & University of Washington, Seattle) and internal medicine (University of California, Davis & University of Washington, Seattle). Residents will complete these modules through self-directed study or in conjunction with scheduled teaching sessions. Each case has specific learning objectives & competencies. Further, we will use a tool to create an online clinic-patient resident log, encourage self-reflection about counseling practice, action plan formation, and have on-line mentoring with key faculty. ELSI-related genetic content will focus on three domains of genetics: diagnosis of genetic disease; predictive genetic testing, and testing for reproductive decision-making. Learning objectives will include negotiating the interface between genetics and primary care; evaluating the utility of genetic information in different clinical situations; understanding the role of non-directive counseling; cultural issues and personal values; and the perspectives of bioethics, religion and law in the use of genetic information. EVALUATION: Before and after the curricular implementation, we will assess resident's ELSI related genetic knowledge (testing of knowledge), skills (self-report, follow-through with learning plan), and attitudes (survey and self-efficacy assessments). TIMELINE: In Years 1 & 2, we will develop our curriculum. In Year 3, we will implement and evaluate the curriculum. OUR TEAM: We have a unique set of experienced medical educators, multi-media experts, geneticists, lawyers, ethicists, medical anthropologists, communication researchers, and primary care doctors as the core of our development team. Our curriculum will be implemented at three major academic medical institutions. Our research group is composed of key faculty from GeneClinics, and faculty involved with the Genetics in Primary Care group. We have already met weekly or bi-weekly for 6 months to develop our curricular template. Finally, we have experience, resources, motivation and programmatic support to successfully develop, implement and evaluate this ELSI curriculum.
| Srinivasan, Malathi; Day, Frank C; Griffin, Erin et al. (2011) Implementation outcomes of a multiinstitutional web-based ethical, legal, and social implications genetics curriculum for primary care residents in three specialties. Genet Med 13:553-62 |
