Impact of web-based case conferencing on cancer genetics training outcomes for community-based clinicians

Abstract

Introduction: Technology and market forces are driving the demand for cancer risk assessment services in the community setting, where few clinicians are trained to order and interpret predictive genetic tests. City of Hope conducts a three-phase course in genetic cancer risk assessment (GCRA) for community-based clinicians, comprised of distance didactics, face-to-face workshops, and 12 months of professional development. As designed, the course cannot meet increasing demands for GCRA training. Action research identified face-to-face workshops as a barrier to increasing course capacity. This study compared the learning effectiveness of Web-based case conferencing to face-to-face training.

Methods: A quasi-experimental design compared pre- to post-knowledge, skills, and professional self-efficacy outcomes from 2009 to 2010 course cohorts (n = 96). The intervention group (n = 52) engaged in Web-based case conferences during distance learning; the comparison group (n = 44) participated in the course as originally designed.

Results: Both groups and all practice disciplines demonstrated significant pre- to post-increases on all measures. Knowledge increases were higher for the intervention group (p < 0.015); skills and self-efficacy increases were comparable between groups (p < 0.33 and p < 0.30, respectively).

Discussion: Findings support the learning utility of Web-based case conferencing. Further studies may inform the development of tools to assess the impact of Web-based case conferencing on practice change and patient outcomes, in alignment with the highest standards of continuing professional development.

Fig 1

Standard (established) Course and Study Intervention Procedures, Instruments and Data Collection Time Points. The Community Cancer Genetics and Research Training course model is delivered in three phases over a 14-month period through nine weeks of interdisciplinary distance didactics (Phase 1), five days of face-to-face case-based workshops (Phase 2) and 12 months of prescribed Web-based professional development activities (Phase 3). The comparison group participated in the standard (established) course procedure, with initiation of case-based learning after completion of Phase 1 distance learning, during the five-days of face-to-face training in Phase 2 of the course. The intervention group engaged in case-based learning through participation in Working Group Web conferences concurrent with the established Phase 1 distance learning curriculum. Both the comparison and intervention groups completed pre-knowledge tests, case scenarios and professional self-efficacy surveys as a baseline measure prior to course orientation. The comparison group completed post-tests on the final day of Phase 2 face-to-face training, as prescribed in the original course design. In order to compare the effectiveness of the Working Group Web conference intervention as a case-based learning forum, the intervention group post-tests were collected upon completion of Phase 1 distance learning, prior to initiation of Phase 2 face-to-face training at City of Hope.

Fig 2

Participants, activities and outputs of Clinical Cancer Genetics (CCG) Working Group Web Conferencing (Study Intervention). CCG Working Group Web conferencing is a regularly-scheduled CME-accredited case conference series hosted each week by the City of Hope Division of Clinical Cancer Genetics (CCG). Sessions are co-moderated by CCG clinical faculty to facilitate interdisciplinary case discussion among face-to-face and distance participants. Participants include City of Hope and visiting physicians, cancer risk counselors, oncology and cancer genetics fellows, and molecular genetics laboratory staff. Affiliated clinicians and intensive course alumni across the U.S. and internationally participate in Working Group by distance from their clinical settings via Microsoft Live™ (Microsoft Corporation, Redmond, WA) Web conference interface. During Working Group sessions, clinicians present challenging cases from their practices for interdisciplinary discussion and recommendations for patient care and best practices in cancer risk assessment and counseling, genetic testing strategy, test results interpretation, cancer risk management, and patient research and support resources.

Fig 3

Comparisons of pre-post knowledge, case-based skills and professional self-efficacy assessment outcomes. Statistically-significant differences were demonstrated overall in pre- to post-knowledge, case-based skills and professional self-efficacy scores (p < .000 for each variable). Knowledge increases were higher for the intervention group (p < .015); skills and self-efficacy increases were comparable between groups (p < .33 and p < .30, respectively). Note: Overall by-discipline comparisons (not shown here) revealed statistically-significant increases for all disciplines (p < .000 for MDs, GCs and APNs).