Megan D Maxwell1,2,3,4,5, Rebecca Hsu6, Rubaiya Islam6, Jill O Robinson6, Stacey Pereira6, Cubby L Gardner7, Robert C Green8,9,10, Mauricio De Castro11. 1. University Health System, San Antonio, TX, USA. Megan.Maxwell@uhs-sa.com. 2. University of Texas Health Science Center, San Antonio, TX, USA. Megan.Maxwell@uhs-sa.com. 3. Lackland Air Force Base, San Antonio, TX, USA. Megan.Maxwell@uhs-sa.com. 4. Brigham and Women's Hospital, Boston, MA, USA. Megan.Maxwell@uhs-sa.com. 5. Harvard Medical School, Boston, MA, USA. Megan.Maxwell@uhs-sa.com. 6. Baylor College of Medicine, Houston, TX, USA. 7. US Army Medical Research and Development Command, Fort Detrick, MD, USA. 8. Brigham and Women's Hospital, Boston, MA, USA. 9. Harvard Medical School, Boston, MA, USA. 10. Broad Institute of MIT and Harvard, Cambridge, MA, USA. 11. Air Force Medical Genetics Center, Keesler Air Force Base, Biloxi, MS, USA.
Abstract
PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.