5-years later - have faculty integrated medical genetics into nurse practitioner curriculum?

Social Determinants of Genetics Referral and Completion Rates Among Child Neurology Patients

Objective

To investigate clinical, social, and systems-level determinants predictive of genetics clinic referral and completion of genetics clinic visits among child neurology patients.

Methods

Electronic health record data were extracted from patients 0-18 years old who were evaluated in child neurology clinics at a single tertiary care institution between July 2018 to January 2020. Variables aligned with the Health Equity Implementation Framework. Referral and referral completion rates to genetics and cardiology clinics were compared among Black vs White patients using bivariate analysis. Demographic variables associated with genetics clinic referral and visit completion were identified using logistic regressions.

Results

In a cohort of 11,371 child neurology patients, 304 genetics clinic referrals and 82 cardiology clinic referrals were placed. In multivariate analysis of patients with Black or White ethnoracial identity (n=10,601), genetics clinic referral rates did not differ by race, but were significantly associated with younger age, rural address, neurodevelopmental disorder diagnosis, number of neurology clinic visits, and provider type. The only predictors of genetics clinic visit completion number of neurology clinic visits and race/ethnicity, with White patients being twice as likely as Black patients to complete the visit. Cardiology clinic referrals and visit completion did not differ by race/ethnicity.

Interpretation

Although race/ethnicity was not associated with differences in genetics clinic referral rates, White patients were twice as likely as Black patients to complete a genetics clinic visit after referral. Further work is needed to determine whether this is due to systemic/structural racism, differences in attitudes toward genetic testing, or other factors.

Faculty education to improve integration of genomics education in nursing curriculum

Nurses play a crucial role in providing healthcare and need to possess essential knowledge and skill to integrate genomics into practice. Nursing faculty is charged with the education of nurses however, studies show the majority of faculty in the United States is ill-prepared to teach genetics/genomics concepts. Our aim was to increase genetics/genomics content in our college's nursing curriculum by bolstering our faculty knowledge and confidence through the implementation of a face-to-face educational program. Therefore, we launched an intentional, strategic plan in fall 2017. First a comprehensive review of the college's undergraduate nursing curriculum for genetics/genomics content was conducted. Five development workshops on genetics/genomics were delivered over an academic year with knowledge and confidence in genetics/genomics was measured pre- and post-workshops. After the workshops, faculty revised curriculum and added genetics/genomics content to align with the competencies. Participants in the end-of-program survey reported higher confidence levels in all genomics-related tasks and answered more knowledge-based items, as compared to participants in the pre-workshop survey. Changes to the curriculum were made to integrate genetics/genomics in BSN courses and an online genetics course was developed. Genetics/genomics workshops can improve faculty knowledge and confidence and facilitate the integration of genetic/genomic content in undergraduate nursing curricula.

Molecular Pathology Education: A Suggested Framework for Primary Care Resident Training in Genomic Medicine: A Report of the Association for Molecular Pathology Training and Education Committee

Developments in genomics are profoundly influencing medical practice. With increasing use of genetic and genomic testing across every aspect of the health care continuum, patients and their families are increasingly turning to primary care physicians (PCPs) for discussion and advice regarding tests, implications, and results. Yet, with the rapid growth of information, technology, and applications, PCPs are finding it challenging to fill the gaps in knowledge and support the growing needs of their patients. A critical component in expanding PCP genomic literacy lies in the education of physicians in training and in practice. Although a framework for developing physician competencies in genomics has already been developed, the Association for Molecular Pathology is uniquely situated to actively utilize the skills of its members to engage and support PCPs in this effort. This report provides an overview and a suggested basic teaching framework, which can be used by molecular professionals in their individual institutions as a starting point for educational outreach.

Current status and future directions of U.S. genomic nursing health care policy

BACKGROUND

As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.

PURPOSE

To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.

METHODS

We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.

FINDINGS

Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.

DISCUSSION

Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.

CONCLUSIONS

To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.