Development of an Evidence-Based, Theory-Informed National Survey of Physician Preparedness for Genomic Medicine and Preferences for Genomics Continuing Education

Abstract

Despite some early implementation of genomic medicine globally, there is a lack of rigorous, large-scale assessments of medical specialists' current practice and continuing education needs. As a first step to addressing this gap, we describe the development of a robust, expert-reviewed, survey using a mixed-methods sequential study design. We conducted semi-structured qualitative interviews with 32 education providers and 86 non-genetic medical specialists about current genomic medicine practice and need for continuing education. Key concepts were identified and used as an initial framework for the survey. These were: personal characteristics (medical specialty, years of practice); current practice of genomics in clinical and research settings; perception of how proximal genomic medicine is to practice; perception of preparedness (competence and confidence); and, preferences for future roles and models of care in genomic medicine and for continuing education. Potential survey questions that related to at least one of these concepts were identified from the literature or were created if no suitable question existed. Using a modified, reactive Delphi approach, questions were reviewed by a panel of 22 experts. Experts were selected purposefully representing four areas of expertise: non-genetic medical specialties; clinical genetics; genetic/genomic education and evaluation; and implementation science. Three Delphi rounds assessed relevance, clarity and importance of each question. The questions were also mapped to the behaviour change wheel theoretical framework which encompasses capability, opportunity and motivation (COM-B). The survey (included as supplementary material) was then tested with a small group of non-genetic medical specialists and feedback was written or verbal in 'talk-aloud', cognitive interviews. The final survey was then piloted with a further 29 specialists. We describe the methodology to create a robust, data- and theory-informed survey. The final survey captures not only levels of experience, practice of genomics and preferences for education but also the challenges around engaging with education. Survey data will provide evidence for education providers to inform development of education which meets learner needs and contributes to a medical workforce that is literate in genomics and more confident to competently practice genomic medicine.

Keywords: Delphi; genomic education; qualitative; survey development; theory.

Figure 1

The survey development process: curate survey questions using qualitative findings, review of literature and craft additional questions; review questions using a modified reactive Delphi approach; pilot for usability and functionality; and, deploy the final survey (Michie et al., 2011)¹.

Figure 2

An example of Delphi expert tasks for Round 2 as shown in the REDCap online database.

Figure 3

The Behaviour Change Wheel theoretical framework, encompassing capability, opportunity and motivation (COM-B), as applied to behavior defined as: appropriate engagement with genomics in clinical practice. Examples are given of potential behavior change interventions applicable to the practice of genomic medicine (adapted from Michie et al., 2011).

Figure 4

An example of Delphi expert tasks for Round 3 as shown in the REDCap online database.