title: Effect of comprehensive oncogenetics training interventions for general practitioners, evaluated at multiple performance levels.
abstract: General practitioners (GPs) are increasingly called upon to identify patients at risk for hereditary cancers, and their genetic competencies need to be enhanced. This article gives an overview of a research project on how to build effective educational modules on genetics, assessed by randomized controlled trials (RCTs), reflecting the prioritized educational needs of primary care physicians. It also reports on an ongoing study to investigate long-term increase in genetic consultation skills (1-year follow-up) and interest in and satisfaction with a supportive website on genetics among GPs. Three oncogenetics modules were developed: an online Continuing Professional Development (G-eCPD) module, a live genetic CPD module, and a "GP and genetics" website (huisartsengenetica.nl) providing further genetics information applicable in daily practice. Three assessments to evaluate the effectiveness (1-year follow-up) of the oncogenetic modules were designed: 1.An online questionnaire on self-reported genetic competencies and changes in referral behaviour, 2.Referral rates from GPs to clinical genetics centres and 3.Satisfaction questionnaire and visitor count analytics of supportive genetics website. The setting was Primary care in the Netherlands and three groups of study participants were included in the reported studies:. Assessment 1. 168 GPs responded to an email invitation and were randomly assigned to an intervention or control group, evaluating the G-eCPD module (n = 80) or the live module (n = 88). Assessment 2. Referral rates by GPs were requested from the clinical genetics centres, in the northern and southern parts of the Netherlands (Amsterdam and Maastricht), for the two years before (2010 [n = 2510] and 2011 [n = 2940]) and the year after (2012 [n = 2875]) launch of the oncogenetics CPD modules and the website. Assessment 3. Participants of the website evaluation were all recruited online. When they visited the website during the month of February 2013, a pop-up invitation came up. Of the 1350 unique visitors that month, only 38 completed the online questionnaire. Main outcomes measure showed long-term (self-reported) genetic consultation skills (i.e. increased genetics awareness and referrals to clinical genetics centres) among GPs who participated in the oncogenetic training course, and interest in and satisfaction with the supportive website. 42 GPs (52%) who previously participated in the G-eCPD evaluation study and 50 GPs (57%) who participated in the live training programme responded to the online questionnaire on long-term effects of educational outcome. Previous RCTs showed that the genetics CPD modules achieved sustained improvement of oncogenetic knowledge and consultation skills (3-months follow-up). Participants of these RCTs reported being more aware of genetic problems long term; this was reported by 29 GPs (69%) and 46 GPs (92%) participating in the G-eCPD and live module evaluation studies, respectively (Chisquare test, p<0.005). One year later, 68% of the respondents attending the live training reported that they more frequently referred patients to the clinical genetics centres, compared to 29% of those who attended the online oncogenetics training (Chisquare test, p<0.0005). However, the clinical genetics centres reported no significant change in referral numbers one year after the training. Website visitor numbers increased, as did satisfaction, reflected in a 7.7 and 8.1 (out of 10) global rating of the website (by G-eCPD and live module participants, respectively). The page most often consulted was "family tree drawing". Self-perceived genetic consultation skills increased long-term and GPs were interested in and satisfied with the supportive website. Further studies are necessary to see whether the oncogenetics CPD modules result in more efficient referral. The results presented suggest we have provided a flexible and effective framework to meet the need for effective educational programmes for non-geneticist healthcare providers, enabling improvement of genetic medical care.
authors.affiliation: Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: Elisa J F
authors.initials: EJ
authors.lastname: Houwink
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Arno M M
authors.initials: AM
authors.lastname: Muijtjens
authors.affiliation: Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: van Teeffelen
authors.affiliation: Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Lidewij
authors.initials: L
authors.lastname: Henneman
authors.affiliation: Skillslab, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jan Joost
authors.initials: JJ
authors.lastname: Rethans
authors.affiliation: Dutch College of General practitioners (NHG), Utrecht, The Netherlands.
authors.forename: Florijn
authors.initials: F
authors.lastname: Jacobi
authors.affiliation: Dutch College of General practitioners (NHG), Utrecht, The Netherlands.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: van der Jagt
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Irina
authors.initials: I
authors.lastname: Stirbu
authors.affiliation: Department of Resident Training, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: Scheltus J
authors.initials: SJ
authors.lastname: van Luijk
authors.affiliation: Department of Clinical Genetics, School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, The Netherlands.
authors.forename: Connie T R M
authors.initials: CT
authors.lastname: Stumpel
authors.affiliation: Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hanne E
authors.initials: HE
authors.lastname: Meijers-Heijboer
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
authors.affiliation: Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martina C
authors.initials: MC
authors.lastname: Cornel
authors.affiliation: School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D003258:Consumer Behavior; D004502:Education, Medical, Continuing / Q000379:methods*; D058005:General Practitioners / Q000193:education*; D005826:Genetics, Medical / Q000193:education*; D006801:Humans; D020407:Internet; D008495:Medical Oncology / Q000193:education*; D009426:Netherlands; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
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