Introduction: Recent years have seen dramatic advances in the field of medical genetics and a corresponding growth in the development of genetic testing technologies. The National Human Genome Research Institute (NHGRI) and the National Coalition for Health Professional Education in Genetics (NCHPEG) have communicated a great need for physician education about the Ethical, Legal, and Social Implications of genetic testing and counseling. Physicians
and health care providers are not sufficiently trained to make decisions about genetic tests, interpret the tests, or counsel patients about the results.
Methods: With funding from NHGRI (R25-HG02266) and NCI (5R44-CA086720), we created a curriculum of web-based modules for medical students on genetic testing and counseling. We strove to prepare future physicians for the common and complex genetic issues they will encounter. A novel curriculum plan incorporated the genetics core competency guidelines from NCHPEG, the American Society of Human Genetics (ASHG), and the Association of American Medical Colleges (AAMC) with input from faculty, medical genetics instructors and instructional design experts. Five “Case Studies” of an hour’s length incorporated “think ahead” and “test yourself” interactive features, graphics, and one to two minute videos of patients. Additional modules reviewed the basics of genetics, clinical genetics, and cancer genetics. The online modules included, hyperlinks to supplemental material, high quality graphics and complete references. Medical school faculty chose the modules best suited to enhance their specific curriculum needs. We also developed and pilot-tested the use of “virtual” simulated patient assessment conducted via Internet based chat both with and without video.
Results: The evaluation reviewed which topic areas were in most demand by medical school faculty, and the overall effectiveness of the modules. Modules with case studies and clear clinical applications were well received by students and faculty alike; whereas more research focused modules were determined to be less relevant to medical students. Effectiveness was assessed using pre/post tests of knowledge, and retrospective surveys of attitude, self-efficacy, and intended behavior. Data from 897 medical students from 8 schools showed a statistically significant effect on knowledge, attitude, intended behavior and self-efficacy related to genetic testing. Students and faculty expressed high levels of satisfaction with the content, relevance, and usability of the course modules. We also implemented the virtual standardized patient assessment protocol and found that students had the necessary hardware and software to complete text as well as audio/video chat sessions. Importantly, they expressed interest in this
type of assessment and a desire to use it in future coursework.
Discussion: Web-based supplemental training can be successfully integrated into traditional medical school educational programs to enhance student learning in a specialized medical topic such as genetics. Assessments can be built into the learning experience and performed automatically without placing an additional burden on the institution. Web-based training affects a range of outcomes including knowledge, attitude, and behavior and yields high satisfaction.
Future evaluations can include standardized patient assessments via text and audio/video chat and thus assess the impact of web-based training on interpersonal skills development.
Medical students need to understand the role of practicing physicians in substance abuse treatment. In addition they may not be aware of complicated multi-disciplinary treatment issues, the biological and social basis of addictions, and how new treatments are developed then moved into practice. The topic of detection and treatment of opioid addiction is an excellent one to teach these basic skills and convey essential knowledge. By teaching medical students we can impact future physicians before potential negative attitudes regarding substance dependence have developed or solidified.
With research funding from NIDA/NIH, we are developing outlines for a suite of online educational modules addressing these issues. Curriculum development included medical school professionals and substance abuse experts. The prototype module, "Prevalence, Trends and Impact on Health: Opioid Addiction" was pilot tested with 22 medical students in their 2nd through 4th years of study. Pre/post-assessments of knowledge, attitudes, self-efficacy, and intended behavior showed significant increases following completion of the module. Satisfaction with the module was high and there was an interest in learning more about substance abuse. During the coming year (2008), we will perform a large-scale evaluation of the project using an innovative virtual standardized patient. As the need for physicians to recognize and treat addiction disorders grows, these
online modules hold promise for integrating the necessary knowledge, skills, and attitudes into the medical school curriculum.