1
|
Berger AS, Niedra E, Brooks SG, Ahmed WS, Ginsburg S. Teaching Professionalism in Postgraduate Medical Education: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:938-946. [PMID: 31517687 DOI: 10.1097/acm.0000000000002987] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This systematic review sought to summarize published professionalism curricula in postgraduate medical education (PGME) and identify best practices for teaching professionalism. METHOD Three databases (MEDLINE, Embase, ERIC) were searched for articles published from 1980 through September 7, 2017. English-language articles were included if they (1) described an educational intervention addressing professionalism, (2) included postgraduate medical trainees, and (3) evaluated professionalism outcomes. RESULTS Of 3,383 articles identified, 50 were included in the review. The majority evaluated pre- and posttests for a single group (24, 48%). Three (6%) were randomized controlled trials. The most common teaching modality was small-group discussions (28, 56%); other methods included didactics, reflection, and simulations. Half (25, 50%) used multiple modalities. The professionalism topics most commonly addressed were professional values/behavior (42, 84%) and physician well-being (23, 46%). Most studies measured self-reported outcomes (attitude and behavior change) (27, 54%). Eight (16%) evaluated observed behavior and 3 (6%) evaluated patient outcomes. Of 35 studies that evaluated statistical significance, 20 (57%) reported statistically significant positive effects. Interventions targeting improvements in knowledge were most often effective (8/12, 67%). Curriculum duration was not associated with effectiveness. The 45 quantitative studies were of moderate quality (Medical Education Research Study Quality Instrument mean score = 10.3). CONCLUSIONS Many published curricula addressing professionalism in PGME are effective. Significant heterogeneity in curricular design and outcomes assessed made it difficult to synthesize results to identify best practices. Future work should build upon these curricula to improve the quality and validity of professionalism teaching tools.
Collapse
Affiliation(s)
- Arielle S Berger
- A.S. Berger is a lecturer, Internal Medicine (Geriatrics), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-7896-3638. E. Niedra is a physician, Baycrest Health Sciences, Toronto, Ontario, Canada. S.G. Brooks is a first-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. W.S. Ahmed is a second-year resident, Internal Medicine, University of Toronto, Toronto, Ontario, Canada. S. Ginsburg is professor, Internal Medicine (Respirology), and scientist, Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
2
|
Wilkes MS, Day FC, Fancher TL, McDermott H, Lehman E, Bell RA, Green MJ. Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling. BMC MEDICAL EDUCATION 2017; 17:163. [PMID: 28903733 PMCID: PMC5598050 DOI: 10.1186/s12909-017-0982-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. METHODS One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. RESULTS PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. CONCLUSION While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.
Collapse
Affiliation(s)
- Michael S Wilkes
- School of Medicine, Office of the Dean, University of California, One Shields Avenue, Davis, CA, 95616, USA.
| | - Frank C Day
- Department of Emergency Medicine, University of California, Los Angeles, CA, 90095, USA
| | - Tonya L Fancher
- Department of Internal Medicine, Division of General Medicine, University of California, Davis, Sacramento, CA, 95817, USA
| | - Haley McDermott
- School of Medicine, University of California, Davis, CA, 95616, USA
| | - Erik Lehman
- Departments of Humanities and Medicine, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Robert A Bell
- Department of Communication, Department of Public Health Sciences, University of California, Davis, CA, 95616, USA
| | - Michael J Green
- Departments of Humanities and Medicine, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| |
Collapse
|
3
|
Talwar D, Tseng TS, Foster M, Xu L, Chen LS. Genetics/genomics education for nongenetic health professionals: a systematic literature review. Genet Med 2016; 19:725-732. [PMID: 27763635 DOI: 10.1038/gim.2016.156] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/25/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The completion of the Human Genome Project has enhanced avenues for disease prevention, diagnosis, and management. Owing to the shortage of genetic professionals, genetics/genomics training has been provided to nongenetic health professionals for years to establish their genomic competencies. We conducted a systematic literature review to summarize and evaluate the existing genetics/genomics education programs for nongenetic health professionals. METHODS Five electronic databases were searched from January 1990 to June 2016. RESULTS Forty-four studies met our inclusion criteria. There was a growing publication trend. Program participants were mainly physicians and nurses. The curricula, which were most commonly provided face to face, included basic genetics; applied genetics/genomics; ethical, legal, and social implications of genetics/genomics; and/or genomic competencies/recommendations in particular professional fields. Only one-third of the curricula were theory-based. The majority of studies adopted a pre-/post-test design and lacked follow-up data collection. Nearly all studies reported participants' improvements in one or more of the following areas: knowledge, attitudes, skills, intention, self-efficacy, comfort level, and practice. However, most studies did not report participants' age, ethnicity, years of clinical practice, data validity, and data reliability. CONCLUSION Many genetics/genomics education programs for nongenetic health professionals exist. Nevertheless, enhancement in methodological quality is needed to strengthen education initiatives.Genet Med advance online publication 20 October 2016.
Collapse
Affiliation(s)
- Divya Talwar
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Tung-Sung Tseng
- Department of Behavioral &Community Health Sciences, School of Public Health, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Margaret Foster
- Medical Science Library, Texas A&M University, College Station, Texas, USA
| | - Lei Xu
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
| | - Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
4
|
Guerrini CJ, Majumder MA, McGuire AL. Persistent confusion and controversy surrounding gene patents. Nat Biotechnol 2016; 34:145-7. [PMID: 26849516 DOI: 10.1038/nbt.3470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christi J Guerrini
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
5
|
Affiliation(s)
- Jason L Vassy
- Section of General Internal Medicine, VA Boston HealthCare System, , Boston, Massachusetts, USA
| | | | | |
Collapse
|
6
|
Bell RA, McDermott H, Fancher TL, Green MJ, Day FC, Wilkes MS. Impact of a randomized controlled educational trial to improve physician practice behaviors around screening for inherited breast cancer. J Gen Intern Med 2015; 30:334-41. [PMID: 25451990 PMCID: PMC4351290 DOI: 10.1007/s11606-014-3113-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/14/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN Randomized two-group design. PARTICIPANTS 121 California and Pennsylvania community physicians. INTERVENTION Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer. MAIN MEASURES Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer. KEY RESULTS Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6%), and fewer (43.8%) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3% versus 60.7%, P = 0.048), encourage genetic counseling before testing (38.3% versus 21.3%, P = 0.048), ask about a family history of prostate cancer (25.0% versus 6.6%, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0% versus 1.6%, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3% versus 34.4%, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3% versus 54.1%, P = 0.03). CONCLUSIONS Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.
Collapse
Affiliation(s)
- Robert A Bell
- Department of Communication, Department of Public Health Sciences, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA,
| | | | | | | | | | | |
Collapse
|
7
|
Effectiveness of a Web-based genomics training for health educators in Texas. Genet Med 2013; 16:271-8. [DOI: 10.1038/gim.2013.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/12/2013] [Indexed: 11/09/2022] Open
|