A Practical Approach to Teaching Genomics for the Primary Care APN

Gary Laustsen, FNP-BC, RN, PhD

Disclosures

April 18, 2011

In This Article

Teaching a Genomics in Healthcare Course

In some institutions genomic content for APN students is offered through a designated course. The following sections offer a suggested outline of activities for a 3-credit genomics course and include student self-assessment, building a common knowledge base, writing a genomics case study or genomics article critique, and using guest speakers.

Student Self-assessment

A reasonable place to start a genomics in healthcare course is to ask students to complete a self-assessment of their level of genomic competency. In 2007 the National Coalition for Health Professional Education in Genetics (NCHPEG) published a revised document titled Core Competencies in Genetics Essential for All Health Professionals.[3] From this document, a self-assessment tool was developed and students were asked to complete the tool during the first week of the course (Table). In 2008 the American Nurses Association convened a consensus panel of nurses from which a similar document was produced. The Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators[4] may also serve the APN educator as a suitable guide for assessing students' initial genomics competencies.

Table. Genomics Self-assessment Tool

The following is a list of competencies developed by the National Coalition for Health Professional Education in Genetics (NCHPEG). Score what you believe is your current level (minimal, moderate, high) of competence on each topic.

KNOWLEDGE- All health professionals should understand: Min Mod High
1.1 basic human genetics terminology      
1.2 the basic patterns of biological inheritance and variation, both within families and within populations      
1.3 how identification of disease-associated genetic variations facilitates development of prevention, diagnosis, and treatment options      
1.4 the importance of family history (minimum 3 generations) in assessing predisposition to disease      
1.5 the role of genetic factors in maintaining health and preventing disease      
1.6 the difference between clinical diagnosis of disease and identification of genetic predisposition to disease (genetic variation is not strictly correlated with disease manifestation)      
1.7 the role of behavioral, social, and environmental factors (lifestyle, socioeconomic factors, pollutants, etc) to modify or influence genetics in the manifestation of disease      
1.8 the influence of ethnoculture and economics in the prevalence and diagnosis of genetic disease      
1.9 the influence of ethnicity, culture, related health beliefs, and economics in the client's ability to use genetic information and services      
1.10 the potential physical and/or psychosocial benefits, limitations, and risks of genetic information for individuals, family members, and communities      
1.11 the range of genetic approaches to treatment of disease (prevention, pharmacogenomics/prescription of drugs to match individual genetic profiles, gene-based drugs, gene therapy)      
1.12 the resources available to assist clients seeking genetic information or services, including the types of genetics professionals available and their diverse responsibilities      
1.13 the components of the genetic-counseling process and the indications for referral to genetic specialists      
1.14 the indications for genetic testing and/or gene-based interventions      
1.15 the ethical, legal and social issues related to genetic testing and recording of genetic information (eg, privacy, the potential for genetic discrimination in health insurance and employment)      
1.16 the history of misuse of human genetic information (eugenics)      
1.17 one's own professional role in the referral to genetics services, or provision, follow-up, and quality review of genetic services      
SKILLS- All health professionals should be able to: Min Mod High
2.1 gather genetic family history information, including an appropriate multigenerational family history      
2.2 identify clients who would benefit from genetic services      
2.3 explain basic concepts of probability and disease susceptibility, and the influence of genetic factors in      
maintenance of health and development of disease      
2.4 seek assistance from and refer to appropriate genetics experts and peer support resources      
2.5 obtain credible, current information about genetics, for self, clients, and colleagues      
2.6 use effectively new information technologies to obtain current information about genetics      
2.7 educate others about client-focused policy issues      
2.8 participate in professional and public education about genetics      
Skills 2.9-2.17 delineate the components of the genetic counseling process is not expected of all healthcare professionals. However, health professionals should be able to facilitate the genetic counseling process and prepare clients and families for what to expect, communicate relevant information to the genetics team, and follow up with the client after genetics services have been provided. For those health professionals who choose to provide genetic counseling services to their clients, all components of the process, as delineated in 2.9-2.17 should be performed.
2.9 educate clients about availability of genetic testing and/or treatment for conditions seen frequently in practice      
2.10 provide appropriate information about the potential risks, benefits, and limitations of genetic testing      
2.11 provide clients with an appropriate informed-consent process to facilitate decision making related to genetic testing      
2.12 provide, and encourage use of, culturally appropriate, user-friendly materials/media to convey information about genetic concepts      
2.13 educate clients about the range of emotional effects they and/or family members may experience as a result of receiving genetic information      
2.14 explain potential physical and psychosocial benefits and limitations of gene-based therapeutics for clients      
2.15 discuss costs of genetic services, benefits and potential risks of using health insurance for payment of genetic services, potential risks of discrimination      
2.16 safeguard privacy and confidentiality of genetic information of clients to the extent possible      
2.17 inform clients of potential limitations to maintaining privacy and confidentiality of genetic      
ATTITUDES- All health professionals should: Min Mod High
3.1 recognize philosophical, theological, cultural, and ethical perspectives influencing use of genetic information and services      
3.2 appreciate the sensitivity of genetic information and the need for privacy and confidentiality      
3.3 recognize the importance of delivering genetic education and counseling fairly, accurately, and without coercion or personal bias      
3.4 appreciate the importance of sensitivity in tailoring information and services to clients' culture, knowledge and language level      
3.5 seek coordination and collaboration with interdisciplinary team of health professionals      
3.6 speak out on issues that undermine clients' rights to informed decision making and voluntary action      
3.7 recognize the limitations of their own genetics expertise      
3.8 demonstrate willingness to update genetics knowledge at frequent intervals      
3.9 recognize when personal values and biases with regard to ethical, social, cultural, religious, and ethnic issues may affect or interfere with care provided to clients      
3.10 support client-focused policies      
Source: The National Coalition for Health Professional Education in Genetics (NCHPEG). Available online at http://www.nchpeg.org

Genomics Awareness: Building a Common Knowledge Base

Because of the probable variability in students' genomic knowledge, early in the course or curriculum the APN instructor should incorporate a uniform activity for developing a common genomic knowledge base. Two suggested activities include either completing an online basic genomics course or reading a basic genomics text.

Genomics courses and textbooks. The University of Michigan School of Public Health, Ann Arbor, Michigan, offers an online course: Six Weeks to Genomics Awareness. This course is suitable for all APN students but is especially suitable for those in DNP programs because of the course's broad focus on genomics in relation to public health. Structured in 6 modules, the self-paced course builds a foundation for understanding genomic advances and identifying the relevance of genomics to public health.[5] With readings, guest lecture video presentations, and online quizzes, the course can also provide continuing education (CE) credit for students who may need this for license or certification renewal.

Another option for basic genomic learning online is the Cincinnati Children's Hospital Medical Center's Genetics Education Program for Nurses. This program offers 14 modules with assignments and instructional resources that can be integrated into existing credit awarding nursing courses or used to create an academic credit awarding genetics nursing course.[6]

If the APN educator decides to use textbooks instead of online resources, 2 texts are recommended for developing a common genomic knowledge among students: Essentials of Clinical Genetics in Nursing Practice (Felissa R. Lashley) and Genetics in the Clinic: Clinical, Ethical, and Social Implications for Primary Care (Mary Briody Mahowald). Both texts provide a solid foundation of basic genetic content and explore various topics on the relationship of genetics/genomics in nursing practice.

Genomics case study. The genomics case study activity is a written paper that provides an opportunity for the student to complete an in-depth analysis of a patient and to explore the practice implications of this case to a broader population. Each student identifies an individual patient from his or her current or previous clinical practice area whose care has a genomic-related aspect. Before the student proceeds with writing the case study, the patient case is presented to the instructor to verify appropriateness. The format for the case study report includes:

  • An introduction;

  • Presentation of relevant case data (history, physical exam findings, laboratory/diagnostic data, family, and other relevant aspects);

  • Description of the genomic-related health issue(s);

  • Case analysis including relevant social, cultural, ethical, economic, environmental, legal, and/or political influences;

  • Discussion of the interventions that were instituted or recommended, aspects of interprofessional collaboration, and expected outcomes; and

  • Reflection on the implications for practice at the student's expected level (master's or DNP).

An alternative to a written case study paper would be to have students give an online forum or live presentation of their case to the other students in the class.

Genomics article critique. While completing the genomic case study (see above), students are expected to review and use appropriate articles and resources from the literature. As a way of developing skills in critical analysis of the literature, students can complete a critique of a genomics article. The results of the critique can be shared with all class members in a 10-minute presentation or in a written format. The outline for the genomic article critique includes purpose of study, study methods, review of study subjects/instruments, nursing implications, and conclusions.

Guest speakers. A genomics course for APN students should attempt to include practical applications of the content as it relates to advanced nursing practice. Guest speakers with expertise in various facets or applications of genomics can facilitate student interest and the connection of genomic content to practice activities. Other activities that relate course content with clinical practice will help students bridge the book-to-bedside gap and learn the efficacy or problems related to genomics in real life. Examples of potential guest speakers and other activities may include:

  • Guest presentations by local or university researchers investigating pharmacogenetics;

  • Hospital ethics board or faculty involved in ethics and healthcare discussing genetic-related cases;

  • Students participating in direct-to-consumer genetic testing;

  • Visits to or presentation by a genetic counselor involved in primary care; and

  • Students identifying and contacting their nearest genetic counseling resources (especially useful activity for rural-based APNs).

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