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A ENCHPEG? Lessons from the GPC and NCHPEG. P. Preston Reynolds, MD, PhD, FACP Member, Board of Directors, National Coalition for Health Professional Education in Genetics Chief, Primary Care Medical Education Branch Health Resources and Services Administration preston.reynolds@hrsa.hhs.gov.
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A ENCHPEG? Lessons from the GPC and NCHPEG P. Preston Reynolds, MD, PhD, FACP Member, Board of Directors, National Coalition for Health Professional Education in Genetics Chief, Primary Care Medical Education Branch Health Resources and Services Administration preston.reynolds@hrsa.hhs.gov
Response to the Problem: Faculty Development and/or ENCHPEG?
Teams selected through competitive review process, all but one from a medical school • All team leaders were Generalists • Required to attend 2 Train-the-Trainer sessions and implement faculty development programs at home institution • Teams selected through competitive review process, all but one from a medical school • All team leaders were Generalists • Required to attend 2 Train-the-Trainer sessions and implement faculty development programs at home institution • Teams selected through competitive review process, all but one from a medical school • All team leaders were Generalists • Required to attend 2 Train-the-Trainer sessions and implement faculty development programs at home institution • Teams selected through competitive review process, all but one from a medical school • All team leaders were Generalists • Required to attend 2 Train-the-Trainer sessions and implement faculty development programs at home institution
GPC Curriculum Breast Cancer Case-based Colorectal Cancer Cardiovascular Disease Congenital Hearing Loss . Dementia Developmental Delay Hemochromatosis Ethical, Legal and Social Issues
The Collaborative Process:Implementation Phase II: Implementation July 2000 – Summer 2001 • Implementation of Train-the-Trainer (2) and Faculty Development Programs • External Presentations and Site Visits
GPC Site Visits: CollaborationN=20 1. Is there evidence of collaboration among the primary care team members? Yes 14 No 1 Not Clear 5 2. Is there evidence of collaboration among the primary care and genetics team members? Yes 13 No 5 Not clear 2
The Collaborative Process: Products Phase III: Complete Curriculum and Working Group Products, Evaluation September 2001 – September 2003 • Four Working Groups, Revision of GPC Core Curriculum • Final Evaluation of External Team
GPC Products • Currently 8 module case-based curriculum url = http://genes-r-us.edu/resources/genetics/ primary_care.htm • Clinical tools from working groups: cultural competency, red flags, evidence-based medicine, family history + revision of the core curriculum w/ new cases, chapters
GPC External Evaluation Before After I have genetic knowledge to incorporate 50% 100% into my clinical practice I have genetic knowledge to incorporate 51% 98% into my teaching with students and residents I have faculty development knowledge to 42% 92% Incorporate genetics into faculty development programs
GPC External Evaluation • 85% of responding faculty felt adequately to very well prepared to incorporate clinical application of genetic information into undergraduate and graduate medical education • >50% rated their ability as good to excellent in incorporating genetics into faculty development programs
GPC External Evaluation • > 850 faculty trained using GPC materials • > 50% of teams used 7 modules • Most faculty development activities occurred after 2nd Train-the-Trainer • Inadequate time and money = greatest barriers to successful implementation
NCHPEG and the GPC + (GIFT) Collaboration: Five Essential Features • Stakeholders are interdependent • Solutions emerge by dealing with differences • Joint ownership of decisions • Stakeholders assume collective responsibility for future direction • Collaboration is an emergent process
A ENCHPEG?Stakeholders Are Interdependent • Primary care needs geneticists for content expertise • Geneticists needs PC for context expertise • Previous failed efforts by geneticists to bring genetics into curriculum
A ENCHPEG? Solutions Emerge From Dealing with Differences • Dialogue Is Essential • Adequate time to develop common vision, understand perspectives and appreciate expertise • Common end-goal must be clear
A ENCHPEG?Joint Ownership of Decisions • Leadership who sees both perspectives • Sr. leadership empowers other groups • Collegial interactions among specialists and generalists all along the way
A ENCHPEG? Collective Responsibility for Future Direction • Working groups with clear charge and interdisciplinary membership • Monitoring of progress with timelines and conference calls • Adequate time and support • Leadership open to creative product development
Competing Collaborating Compromising Assertiveness Avoiding Accommodating Cooperativeness
ENCHPEG: Benefits of Collaboration • Enhanced relevance of genetics education • Potentially enhances quality of patient care, and reduces risk of missed diagnoses • Gives geneticists greater access to curriculum • Potentially increases appropriateness of referral