Genetics in Primary Care:

A Faculty Development Initiative

By Preston Reynolds, MD

To increase the competency of primary care physicians in recent genetic advances, the Health Resources and Services Administration launched Genetics in Primary Care (GPC): A Faculty Development Initiative in cooperation with the Agency for Healthcare Research and Quality and the National Human Genome Research Institute. The Society of Teachers of Family Practice was awarded a $1.6 million grant over three years to develop this initiative beginning in 1998 with overall planning and the establishment of a national advisory board. Physicians and health professionals from over 30 organizations including experts in genetics and primary care medicine made up the national advisory board. The initiative is an outgrowth of earlier efforts to enhance collaboration between general internal medicine, pediatrics, and family practice through federal grant programs focused on primary care medical student education. The new GPC includes geneticists as content experts in the interdisciplinary teams. The national advisory board met twice in Fall 1999 and Spring 2000 to learn about the increasing relevance of genetics in primary care practice and develop a template for a national genetics curriculum for primary care faculty. The group envisioned a case-based curriculum to be used in a train-the-trainer model for academic faculty to integrate genetics into their teaching programs.

In Spring 2000, the national advisory board requested letters of intent from medical schools to formulate a formal proposal to participate in the GPC. The Request for Proposal required applicants to assess the need for genetics in their curriculae for medical students and residents and the level of genetics expertise that existed within their faculty. Fifty-three proposals, were received. Federal funding agencies provided resources to fund 20 proposals. In June 2000, the teams were notified of their selection and planning began for the first round of training in October.

Throughout Summer 2000, a team of education specialists under the leadership of Wylie Burke, MD, PhD, a geneticist educator from the University of Washington, selected content areas and wrote a case-based curriculum with content and information embedded into each clinical case. Eight core content areas were selected because of their relevance to clinical practice and illustration of various issues related to genetic testing in a primary care setting: cardiovascular disease, breast cancer, colorectal cancer, dementia, developmental delay, congenital hearing loss, hemachromatosis, and a module for Ethical, Legal, and Social Issues.

In October, over 80 faculty members throughout the country convened in Chicago for training. The sessions valued most highly by participants were small group workshops where case studies initiated discussions on how best to integrate genetics into primary care education. Geneticists and physicians actively debated various issues from test sensitivity and specificity to the complexity and importance of written informed consent. Many physicians met geneticists from their institutions for the first time who served as members of their institution's team and gained a greater appreciation of their role in referral, clinical care, and teaching. Jim Evans, MD, general internist with fellowship training in genetics from the University of North Carolina, presented on the utility of genetic testing from his practice, providing a framework understood by physicians in terms of evidence-based medicine, cost effectiveness, doctor-patient communication, and screening versus diagnostic testing. Lastly, various Web sites commonly used by genetic counselors and geneticists were presented to enable physicians to access the best databases on gene testing and genetic disorders.

Between October 2000 and April 2001, the 20 teams from around the country will implement the curriculum with medical students, residents, and faculty. Members of the national advisory board will visit each team. Feedback on effectiveness with suggestions for improvement will be integrated into an expanded and revised final curriculum product. At the end of the development initiative, the curriculum will be available publicly through the GPC website.

Currently, an external group of specialists from the University of Wisconsin is evaluating the GPC. The specialists have worked to insure a fair review process and score the applications for team selection uniformly. Each team has completed a pre-course and a post-course test. In addition, the evaluation group will assess the ability of the teams to use the curriculum materials to affect change in their medical schools and residency training programs, identifying barriers and resources to success.

Every national and regional survey to date has identified the need for primary care physicians to enhance their ability to deliver genetics knowledge and skills. The GPC is an innovative approach to meeting this need and helping medical school and residency faculty evaluate the risks and benefits of providing genetics services in their clinical practice.

Dr. Preston Reynolds is a general internist and a medical historian at the John Hopkins Medical Institutes. She is a member of the GPC national advisory board.