title: Implementation outcomes of a multiinstitutional web-based ethical, legal, and social implications genetics curriculum for primary care residents in three specialties.
abstract: OBJECTIVE
  Medical genetics lends itself to disseminated teaching methods because of mismatches between numbers of physicians having patients with genetic disorders and availability of genetic specialists.
  
  
  METHODS
  During 3 years, we implemented an interactive, web-based curriculum on ethical, legal, and social implications in medical genetics for primary care residents in three specialties at three institutions. Residents took five (of 10) cases and three (of five) tutorials that varied by specialty. We assessed changes in self-efficacy (primary outcome), knowledge, application, and viewpoints.
  
  
  RESULTS
  Overall enrollment was 69% (279/403). One institution did not complete implementation and was dropped from pre-post comparisons. We developed a six-factor ethical, legal, and social implications self-efficacy scale (Cronbach α = 0.95). Baseline self-efficacy was moderate (71/115; range: 23-115) and increased 15% after participation. Pre-post knowledge scores were high and unchanged. Residents reported that this curriculum covered ethical, legal, and social implications/genetics better than their usual curricula. Most (68-91%) identified advantages, especially in providing flexibility and stimulating self-directed learning. After participation, residents reported creating learning goals (66%) and acting on those goals (62%).
  
  
  CONCLUSIONS
  Ethical, legal, and social implications genetics curricular participation led to modest self-efficacy gains. Residents reported that the curriculum covered unique content areas, had advantages over traditional curriculum, and that they applied ethical, legal, and social implications content clinically. We share lessons from developing and implementing this complex web-based curriculum across multiple institutions.
authors.affiliation: Department of Medicine, University of California Davis, School of Medicine, Sacramento, California 95833, USA. malathi@ucdavis.edu
authors.forename: Malathi
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Frank C
authors.initials: FC
authors.lastname: Day
authors.forename: Erin
authors.initials: E
authors.lastname: Griffin
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: Wylie
authors.initials: W
authors.lastname: Burke
authors.forename: Linda
authors.initials: L
authors.lastname: Pinsky
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Pagon
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Hoffman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wilkes
mesh_terms: D004503:Education, Medical, Graduate / Q000592:standards*; D005826:Genetics, Medical / Q000193:education* / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D011320:Primary Health Care; D000078329:Workforce