How to Best Teach Primary Care Genetics to Family Medicine Residents?
What is the best way to teach family medicine residents primary care genetics? A recent study authored by Department of Family and Community Medicine (DFCM) faculty determined that three different methods of teaching residents clinically-relevant primary care genetics were equally effective.
Advances in genetic medicine are increasingly impacting primary care. Patients may ask for genetic testing when they are at low risk for a disease. Alternatively, high-risk patients may be unaware of their increased risks, which require more surveillance and screening tests. Family physicians need to be equipped with the knowledge and skills to address this in practice.
“We did a qualitative study before this study to examine the learning experiences and perceived value of primary care genetics for family medicine residents. We found that residents wanted to learn practical information that focused on real patient scenarios ” says Dr. Deanna Telner, principal investigator, Assistant Professor at DFCM and family physician at Southeast Toronto Family Health Team. “A lot of them felt that they were not equipped with knowledge and skills in this area to respond to patient questions and concerns.”
In the study, first-year family medicine residents at the University of Toronto were taught core principles of primary care genetics that were then specifically applied to hereditary colorectal cancer. The 60 residents in the study were divided into four groups: one group did not receive any educational intervention (control group); another group had access to a web-based module with the material content; a third group received a live presentation of the web-based material; and the last group also attended the live presentation, and then subsequently participated in a standardized patient (SP) encounter (i.e. an actor playing the role of a patient with a high risk for hereditary colorectal cancer).
Three months after these educational interventions, all participating residents wrote a knowledge test, attitude survey and performed a simulated examination with an SP. The four competencies assessed in the study were: taking a three-generation family history; assessing risk for hereditary cancers particularly for colorectal cancer; offering appropriate referral for genetic counselling; and, understanding the benefits, risk and limitations of genetic testing. Residents who received any intervention—access to the web-based module, live presentation, or live presentation with a subsequent patient encounter—all had equally improved knowledge and skills compared to the control group.
“The study’s findings demonstrated that all types of intervention were equally beneficial to residents without one prevailing over the other,” says Dr. Telner, “Those who did not receive any intervention scored significantly lower than the other three groups. Few educational research studies use a randomized controlled design, and there are none that we are aware of that assess primary care genetics teaching with trainees. As well, most studies assess knowledge alone; how this knowledge translates to clinical care of patients is unclear. In our study, we assessed clinical skills by directly observing how residents assess and counsel an SP at high risk for colorectal cancer. This was a strength of our study design.”
The web-based group enjoyed the convenience of accessing the material on their own time and at their own pace. Participants in the SP group found the experience of applying the knowledge they learned in the lecture to a real patient scenario helpful in solidifying their knowledge and its practical application.
The study concludes that other factors, such as financial resources and faculty expertise, should guide decisions on curricular development in the expanding field of primary care genetics. As well, a curricular format that allows for the wide dissemination of this material to teaching sites is important. Dr. Telner has always had an interest in medical education and how to most effectively teach residents the knowledge and skills they will need for their future practice.
