Interactive ELSI Curriculum for Primary Care Residents

背景：初级保健医生几乎没有接受过遗传学培训，也没有接受过基因检测、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。这些方法包括自主学习、自我评价方法、充足的课程时间、积极强化、自我效能评估和指导。目的：我们建议为内科和儿科的初级保健住院医师开发、实施和评估与遗传学相关的ELSI网络课程。方法：在三年的时间里，我们将建立一个基于网络的课程，涉及与遗传学相关的ELSI问题，包括一系列基于案例的模块。我们强调将遗传概念整合到初级保健实践中，指导居民了解那些建立在已建立的初级保健实践基础上的概念，以及那些代表护理提供新方法的概念。每个模块将为20-45分钟，并以互动元素为特色，加上展示相关最佳实践的视频片段（例如，关于预测性测试的非指导性咨询，或模拟关于预后的困难对话）。我们将链接到GeneClinics获取遗传学内容。开发完成后，我们的课程将在儿科（加州大学洛杉矶分校和华盛顿大学西雅图分校）和内科（加州大学戴维斯分校和华盛顿大学西雅图分校）的住院医师中实施。住院医师将通过自主学习或与预定的教学课程相结合来完成这些模块。每个案例都有特定的学习目标和能力。此外，我们将使用一个工具来创建一个在线的临床病人住院日志，鼓励对咨询实践的自我反思，行动计划的形成，并与关键教师进行在线指导。与elsi相关的遗传内容将集中在遗传学的三个领域：遗传性疾病的诊断；预测性基因测试，以及生殖决策测试。学习目标将包括协商遗传学和初级保健之间的接口；评价遗传信息在不同环境下的利用价值

DESCRIPTION: (provided by applicant) BACKGROUND: 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.