Educating military primary health-care providers in genomic medicine: lessons learned from the MilSeq Project
Maxwell, M.D.; Hsu, R.; Islam, R.; Robinson, J.O.; Pereira, S.; Gardner, C.L.; Green, R.C.; De Castro, M.; Maxwell, M.D.; Hsu, R.; Robinson, J.O.; Pereira, S.; Gardner, C.L.; Green, R.C.; De Castro, M.
Genetics in Medicine Official Journal of the American College of Medical Genetics 22(10): 1710-1717
2020
ISSN/ISBN: 1098-3600 PMID: 32647274 DOI: 10.1038/s41436-020-0865-7Document Number: 276609
With few trained genetics professionals, the Military Health System is ill-equipped to manage the rapid expansion of genomic medicine. The MilSeq Project introduces an alternative service delivery model (ASDM) in which primary health-care providers (HCPs) provide post-test counseling (PTC) to healthy Airmen who have undergone exome sequencing. We describe HCP performance after a prerequisite educational intervention (EI). After a brief EI and pre-/posteducation surveys, HCPs were eligible to provide PTC with a genetic counselor available for consult. PTC was recorded, transcribed, and reviewed. Opportunities for improvement were organized into four error adjustment categories: (1) knowledge limitation, (2) minor, (3) moderate, and (4) critical. Thematic analysis was also performed. Pre-/posteducation survey responses revealed statistically significant improvements in all domains. Minor error adjustments were most represented (n = 93), followed by knowledge limitation (n = 39) and moderate (n = 19). No critical errors were identified, and 17 transcripts required no adjustment. Thematic analysis revealed four themes that would benefit from more focused education: (1) family-centered care, (2) conveying risk, (3) disease knowledge, and (4) assay knowledge. HCPs demonstrated competence in basic PTC after a brief EI. This ASDM may be a viable interim response to the shortage of genetics professionals in some systems.