Educating military primary health-care providers in genomic medicine: lessons learned from the MilSeq Project

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.

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Acknowledgements

This material is based on research sponsored by Air Force Medical Support Agency, Research and Acquisition Directorate AFMSA/SG5 under cooperative agreement number FA8650-17-2-6704. The US Government is authorized to reproduce and distribute reprints for Governmental purposes notwithstanding any copyright notation thereon. The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of Air Force Medical Support Agency, Research and Acquisition Directorate AFMSA/SG5 or the US Government.

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Correspondence to Megan D. Maxwell MS, LCGC or Megan D. Maxwell MS, LCGC.

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R.C.G. receives advisor compensation from Alzheimer’s Institute of America, Inc., Applied Therapeutics, Inc., Humanity, and Verily Life Sciences, LLC, and is cofounder of Genome Medical, Inc. The other authors declare no conflicts of interest.

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Maxwell, M.D., Hsu, R., Islam, R. et al. Educating military primary health-care providers in genomic medicine: lessons learned from the MilSeq Project. Genet Med (2020). https://doi.org/10.1038/s41436-020-0865-7

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Keywords

  • genetic counseling
  • genetic services
  • education
  • intervention
  • exome sequencing