Transcript Slide 1

Developing genetic learning
outcomes for medical practitioners
based on clinical practice:
experience from the UK
Michelle Bishop
Peter Farndon
NHS National Genetics Education and
Development Centre
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
National Health Service
Northern
Ireland
1.7 m
Wales
3m
Scotland
5.1 m
England
(50.4 m)
United Kingdom population >60 million
© 2009 NHS National Genetics Education and Development Centre
• Set up in 1948
• Free at the point of delivery
• Funded by central
government from taxation
• Delivered through local
organisations
1.3 million staff in England
>120,000 doctors
>400,000 nurses,
midwives, health visitors
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Patient access to specialty services
• General Practitioner (GP) = gatekeeper
General
Practice
community
© 2009 NHS National Genetics Education and Development Centre
Specialist
hospital
General
Practice
community
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Medical training in the UK
Direct from high school
Graduate entry
Medical School
Training
Foundation
Training
General Practice
Training
© 2009 NHS National Genetics Education and Development Centre
Specialty
Training
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
The NHS National Genetics
Education and Development
Centre
Awareness raising
and educational
needs assessments
Promoting
clinically
Evaluation of
Embed genetics
Centre activity
in curricula and
relevant
genetics
and impact
courses
education for health
Developing resources
professionals
and supporting
educators
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Step 1:
Awareness raising and
educational needs assessment
• Genetics……
‘not relevant to my work’
• Why?
– Presented as a series of facts
– Clinical utility was not explained
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
‘What genetics knowledge do you
need to know in order to do your job’
General
Practice
Hospital
General
Practice
Identifying
patients and
families with, or
at risk of, genetic
conditions
Making diagnosis
Treating/
managing
condition
Indications for
referral to
specialist
© 2009 NHS National Genetics Education and Development Centre
Ordering and
understanding
genetic test
results
Recommending
treatments
Implications for
patient with
condition and for
other family
members
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Medical students: Knowledge base
“You have to know things without thinking before
you can think about a patient’s problem”
Janet Grant, AMEE 2009
In combinatorial mathematics, a combination is an
un-ordered collection of distinct elements, usually of
a prescribed size and taken from a given set.
In multifactorial inheritance, people develop a
condition if their liability, made up of polygenic
influences and environment factors, is above a
threshold.
Establish a ‘genetic framework’ they can use
when presented with clinical problems
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Step 2:
Developing educational outcomes
Identify which genetics concepts are important for
a trainee to know at each stage of medical training
Medical School
Training
Foundation
Training
General Practice
Training
Specialty
Training
Practice based approach
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Approach used
• Collaborative
– Participants from specialty and clinical
genetics
• Consensus
– Modified Delphi technique
Note of interest:
How survey was administered speciality specific
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Modified Delphi approach
Round 1:
Open question: ‘list knowledge, skills and attitudes’
Round 2:
Opinion on the inclusion of statements
Round 3:
Consensus of round 2 results
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Round 1:
Identifying genetic topics relevant to practice
•Open ended question
“What does the trainee need to know/do in order to do their job”
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Round 1:
Identifying genetic topics relevant to practice
Round 1:
Open question: ‘list knowledge, skills and attitudes’
Responses collated and
grouped under broad
headings
Round 2:
Opinion on the inclusion of statements
Round 3:
Consensus of round 2 results
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Round 2:
Opinion on the inclusion of statements
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Round 2:
Opinion on the inclusion of statements
Round 1:
Open question: ‘list knowledge, skills and attitudes’
Responses collated and
grouped under broad
headings
Round 2:
Opinion on the inclusion of statements
Results summarised
Round 3:
Consensus of round 2 results
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Round 3:
Achieving consensus
Round 1:
Open question: ‘list knowledge, skills and attitudes’
Responses collated and
grouped under broad
headings
Round 2:
Opinion on the inclusion of statements
Results summarised
Round 3:
Consensus on results:
50% agreed ‘needed’ or ‘essential’
= Statements included
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Moving from knowledge
acquisition to outcome based learning
Topics, Knowledge,
Skills, Attitudes
- what a trainee knows
a) Chromosomal basis of
inheritance (mitosis and
meiosis
b) Mechanism of origin of
numerical chromosome
abnormalities
Learning Outcomes
- what a trainee does
with their knowledge
Understand and describe the
mechanisms that underpin human
inheritance
•Be able to describe the chromosomal
basis of inheritance and how alterations
in chromosome number or structure
may arise during mitosis and meiosis
Consensus process: Core research team
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Medical students
• Understand and describe the mechanisms that underpin human
inheritance
• Have an understanding of the role of genetic factors in health
and disease
• Be able to identify patients with, or at risk of, a genetic condition
• Be able to communicate genetic information in an
understandable, non-directive manner, being aware of the impact
genetic information may have on an individual, family and society
• Be familiar with the uses and limitations of genetic testing and
the differences between testing and screening
• Know how to obtain current information about scientific and
clinical applications of genetics, particularly from specialised
genetics services
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Specialist registrars in
non-genetics specialities
• Be able to identify patients with, or at risk of, a genetic
condition
• Describe the mechanism that underpin human inheritance
and the role of genetic factors in disease
• Appreciate the heterogeneity in genetic disease and
understand the principles of assessing genetic risk
• Be able to manage genetic aspects of a condition including
referring patients to genetic services where appropriate
• Be able to obtain and communicate up-to-date information
about genetics in an understandable, comprehensible, nondirective way
• Be able to use genetic testing appropriately, recognising its
uses and limitations
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
GP speciality registrars
• Learning outcomes reflect three main themes of genetics
in primary care practice
Identifying patients
with, or at risk of, a
genetic condition
Communicating
genetic
information
© 2009 NHS National Genetics Education and Development Centre
Clinical
management
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Genetics learning outcomes
across the continuum of medical
education
“Knowledge into action”
Medical School
Training
Foundation
Training
General Practice
Training
Specialty
Training
Underlying concepts
© 2009 NHS National Genetics Education and Development Centre
Clinical Application
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
For example: genetic testing
By the end of training
The medical student will……
The specialist trainee will…..
Be familiar with the uses and
limitations of genetic testing
and the differences between
testing and screening
Be able to use genetic testing
appropriately, recognising its
uses and limitations
• Be aware of the differences and
similarities between diagnostic,
presymptomatic, carrier and
susceptibility genetic testing
• Be aware of the main laboratory
techniques to investigate
genetic material and their
advantages and limitations
• Know the clinical indications for
ordering genetic tests
• Know how to organise genetic
testing
• Incorporate the concepts of
informed choice and consent
into practice
Underlying concepts
© 2009 NHS National Genetics Education and Development Centre
Clinical Application
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Step 3: Learning outcomes in practice
Medical School
Training
Foundation
Training
• Endorsed by:
General Practice
Training
Specialty
Training
– Joint Committee Medical Genetics
– British Society of Human Genetics
• Integration at local level
– Medical school genetics teaching leads
• Recognition at National level
– General Medical Council
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Learning outcomes in practice
Medical School
Training
Foundation
Training
General Practice
Training
Specialty
Training
Genetic topics included
• Know risk factors for disease including genetics
• Know genetic susceptibility to
adverse drug reactions
• Take a focused family history
• Construct and interpret a family
tree when relevant
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Learning outcomes in practice
Medical School
Training
Foundation
Training
• Endorsed by:
General Practice
Training
Specialty
Training
– Royal College of Physicians
• Integration into specialist curricula
– Paediatrics
– Neurology
– Cardiology (2010)
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Learning outcomes in practice
Medical School
Training
Foundation
Training
General Practice
Training
Specialty
Training
Integrated into national curriculum
– Curriculum statement 6
‘Genetics in Primary Care’
– Genetics also forms part of the
knowledge base assessment
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Step 4: Supporting the educators
RCGP curriculum
– Workshops for GP educators
‘Genetics in Primary Care’
Tips and tools for GPs
– Network of education
facilitators
– Scenario-based factsheets
– Journal articles
– e-learning modules
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Mental shift in clinician’s perception
of genetics
Initial project (2003)
• Some cardiologists felt genetic education was
not necessary
“I don’t feel that genetics training would make
us better cardiologists”
NCHPEG 2006
Fast forward (2009)
• Formal request from curriculum committee for
learning outcomes
• Included revised curriculum 2010
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
What we have learnt
• Collaboration
– Engagement → acceptance
– Network of champions
– Driver integration into curricula
• Resources to support educators
– Develop resources to support learning
outcomes
• Process for regular review
– Representative panel
– Respond to genetic advances
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Summary
• Developed learning outcomes
– Clinically relevant
– Collaboration
• Nationally endorsed and integrated into
curricula
• Support educators by developing resources
• Continually reviewed
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk
Michelle Bishop
[email protected]
NHS National Genetics Education and
Development Centre
www.geneticseducation.nhs.uk
© 2009 NHS National Genetics Education and Development Centre
Supporting Genetics Education for Health
www.geneticseducation.nhs.uk