Increasing confidence and changing behaviors in primary care providers engaged in

描述（由申请人提供）：初级保健医生几乎没有遗传学方面的培训，也没有基因检测、诊断和治疗的伦理、法律和社会影响（ELSI）方面的培训。此外，仅仅提供课程内容并不能影响医生的行为。然而，基于既定教育和成人学习原则的项目已被证明在影响行为改变方面是有效的。我们建议评估参与一个以初级保健遗传学的伦理、法律和社会问题为重点的网络课程是否会改善初级保健医生对遗传问题的处理方法。具体来说，我们将评估参与是否会改善医生的知识、态度和实践行为。我们将在加州的五个卫生系统（加州大学戴维斯分校、农村卫生网络、加州大学洛杉矶分校、凯撒医疗机构、萨克拉门托萨特医疗集团）招募120名pcp。pcp将按实践地点随机分配，以控制（纸质课程）或积极干预先前由NHRGI资助开发的交互式网络课程。本课程利用视觉工具、视频片段和其他互动内容来说明风险评估、基因筛查和SDM的要点。PCP与宣布的标准化患者学习目标的接触将用于评估PCP与ELSI相关的行为改变。评估还将包括遗传知识课程（知识测试）、技能课程（自我报告、学习计划跟进）和态度课程（调查和自我效能评估）的有效性。如果证明有效，这些基于网络的工具可以很容易地在全国和国际上传播，以提高医生和患者对遗传筛查的知识和态度。

DESCRIPTION (provided by applicant): 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. We propose to evaluate whether participation in a web-based curriculum focusing on the ethical legal and social issues in primary care genetics will improve primary care physicians' approach to genetic issues. Specifically, we will assess whether participation will improve physician knowledge, attitudes, and practice-behaviors. We will recruit 120 PCPs across five health systems in California (UC Davis, Rural Health Network, UC Los Angeles, Kaiser Permanente, Sutter Medical Group Sacramento). PCPs will be randomized by practice site to control (paper curriculum) or active intervention with an interactive web-based curriculum previously developed with funding from the NHRGI. This curriculum utilizes visual tools, video clip vignettes, and other interactive content to illustrate key points about risk assessment, genetic screening, and SDM. PCPs encounters with Announced Standardized Patients Learning objectives will be used to assess PCP's ELSI related behavioral change. Evaluation will also include the effectiveness of the curriculum for genetic knowledge (testing of knowledge), skills (self-report, follow-through with learning plan), and attitudes (survey and self-efficacy assessments). If proven effective, these web-based tools can be easily disseminated around the country, and internationally, to improve knowledge and attitudes about genetic screening among physicians and patients. PUBLIC HEALTH RELEVANCE: Most primary care physicians have almost no training in genetics, nor in the ethical, legal and social implications (ELSI) of genetic testing, diagnosis and therapy. This project evaluates a novel web-based curriculum focusing on the ethical legal and social issues in primary care genetics in order to improve primary care physicians' understanding of the implications of genetic disorders in patients' lives. If proven effective, these web-based tools can be easily disseminated to improve physician's knowledge of the social context of genetics and improve their ability to engage in shared decision-making with patients about genetic screening.