Gynecologists’ training, knowledge, and experiences in genetics: a survey

doi:10.1016/S0029-7844(99)00581-5

Obstetrics & Gynecology

Volume 95, Issue 3, March 2000, Pages 421-424

https://doi.org/10.1016/S0029-7844(99)00581-5 Get rights and content

Abstract

Objective: To explore gynecologists’ knowledge, training, and practice experience with genetic screening and DNA-based testing.

Methods: A questionnaire survey was sent to 1248 ACOG Fellows, of whom 564 (45%) responded. One hundred thirty-four respondents (24%) reported that they do not order DNA-based tests or take family histories to screen for heritable diseases or disorders. Results from the 428 respondents who provide genetic screening services are reported.

Results: Most physicians (90%) knew that genetic tests are most informative when used in conjunction with family histories. Gynecologists gave more correct responses regarding genetic testing for breast and ovarian cancers than for colon cancer and other adult-onset diseases. Sixty-five percent of the respondents had not received formal training in DNA-based testing in gynecologic practice. Older physicians were less likely to have had training. Younger physicians generally gave more correct responses on the knowledge portion of the survey (r = −.165, P < .01). Physicians who had formal training in genetics gave more correct answers. Physicians who order DNA-based tests scored higher than those who do not and had no formal training, but not higher than those who had formal training and do not order DNA-based tests.

Conclusion: Gynecologists were more knowledgeable about genetic issues pertaining to breast and ovarian cancer than to other cancers or certain adult-onset disorders. Training appeared to increase knowledge. Increased training and affiliation with genetic specialists and others could improve gynecologists’ ability to use genetic screening in clinical practice.

Section snippets

Materials and methods

Questionnaires were mailed in September 1998 to all 248 members of the Collaborative Ambulatory Research Network and to a control group of 1000 ACOG Fellows not in the Collaborative Ambulatory Research Network. The Collaborative Ambulatory Research Network is a group of ACOG Fellows who voluntarily participate in questionnaire survey studies. We chose a total sample based on similar studies with comparable numbers of surveys. Reliable effects have been found using survey mailings of

Results

Data from respondents who returned the questionnaire before January 1999 were included in the analysis. Five hundred sixty-four (45%) of the 1248 questionnaires mailed were returned within the allotted time. The response rate for the Network group was 59%, compared with 25% for the non-Network controls. One hundred thirty-four (about 24%) of all respondents said they did not provide any genetic screening services (ie, DNA-based testing or assessment of patient risk factors for heritable

Discussion

Physicians’ knowledge of issues relevant to DNA-based genetic testing was mixed. Gynecologists appeared more knowledgeable about breast and ovarian cancers than they were about colon cancer and other adult-onset disorders. We found that gynecologists recognize that test results are most informative when used with family history. Obtaining structured reviews of patients’ family histories in the gynecology office could provide opportunities for preventive care and patient education.

Our study

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To assure a coordinated collaboration of centers at different levels of patient care (=cross-sectoral care, e.g. between county/urban hospitals and university clinics) further education of breast and gynecological cancer specialists in the context of hereditary cancer is necessary [8,15]. Teaching objectives apart from basic genetic knowledge and state-of-the-art background information about hereditary cancer should include the SOPs of the GC-HBOC as well as psychological information on how to discuss this sensitive information with the patients [15,16]. Colleagues from the Cologne GC-HBOC Center developed a curriculum for gynecologists from specialized hospitals certified by the German Cancer Society (Deutsche Krebsgesellschaft, DKG) to train them on how to inform their patients about the possible genetic background of breast and ovarian cancer, discuss implications and obtain informed consent before drawing blood for genetic testing [28].
To strengthen cross-sectoral care by disseminating specialized knowledge about hereditary breast and ovarian cancer across underserved areas.
We report on a training course about genetic counseling and testing of hereditary breast and ovarian cancer patients for gynecologists from certified cancer centers. In total, 50 gynecologists attended the course which was offered once annually between 2017 and 2019. Before and after the course, participants were asked to answer a self-assessment questionnaire and completed the training with a multiple-choice test. The results of the self-assessments and knowledge tests were analyzed to steadily improve the training.
The self-assessments imply a perceived increase in certainty regarding the inclusion criteria for specialized genetic counseling, pedigree analysis, and contents of the initial consultation. Both the knowledge tests and self-assessments showed that participants had difficulties in interpreting and differentiating between age-specific and lifetime risks.
The courses successfully conveyed knowledge necessary to identify patients at risk and to provide timely genetic analyses even in rural areas.
The results are a promising basis for creating additional training courses addressing specialists in hospitals and gynecological practices. Further education of physicians might improve cross-sectoral cooperation and thereby enable specialized care supply in rural areas.
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Residents and fellows had higher pretest scores than specialists and subspecialists, respectively, but post-test scores were not significantly different. Our findings are in line with previous reports from the literature, which show that knowledge in genetics is linked to a younger age, since recently graduated clinicians are better trained in this field.7-9 The more senior physicians, many of whom are chairmen, department heads, regulators, etc., showed less knowledge at both stages.
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During 2012–2018, 774 clinicians from multiple disciplines and career stages attended 35 programs; 334 (43%) attended the 5-day extended format. Evaluations showed significant improvement of genomic literacy (mean 15.05/100 points, p < 0.001). Residents initially had higher scores than specialists (pre: 66.3 ± 17.3 vs. 58.7 ± 16.6, respectively, p = 0.002); both significantly improved, with specialists “catching up” (post: 79.1 ± 17.2 vs. 75.7 ± 15.9, nonsignificant (NS)); there was a similar trend between fellows and subspecialists (pre: 70 ± 18 vs. 59.4 ± 16.4, respectively, p = 0.007; post: 78.6 ± 16.4 vs. 73.2 ± 17.7, respectively, NS). Younger specialists (≤10 years residency) had significantly higher pre- and post scores. Absolute improvement in scores did not depend on medical specialties.
Our program is effective in improving genomics literacy for clinicians, irrespective of career length or expertise, and could be a model for improving skills in practical genomics for all medical professionals.
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Genetic testing for cancer susceptibility is an emerging technology in medicine. This study assessed the knowledge, attitudes and professional behavior of Italian physicians regarding the use of predictive genetic tests for breast and colorectal cancer, including the BRCA1/2 and APC tests.
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A response rate of 69.6% (1079 questionnaires) was achieved. A significant lack of knowledge was detected, particularly for APC testing. Less than half of the physicians agreed on the importance of efficacy and cost-effectiveness evidence in the selection of predictive genetic tests to be offered to the patients. Multiple logistic regression analyses showed that education had a positive influence on knowledge, attitudes and, to a lesser extent, professional use. The factor most strongly related to the physicians' use of genetic testing was patients requests for breast (odds ratio = 12.65; 95% confidence interval 7.77–20.59) or colorectal cancer tests (odds ratio = 7.02; 95% confidence interval 3.61–13.64). A high level of interest for specific training was reported by almost all physicians surveyed.
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^☆: Supported by a grant (MCJ 117016) from the United States Department of Health and Human Services Bureau of Maternal and Child Health.

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Original ArticlesGynecologists’ training, knowledge, and experiences in genetics: a survey☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Cell

Lancet

Obstet Gynecol

Role of molecular cell biology in understanding disease

BMJ

Molecular genetics of human hypertension

J Hypertens

Original Articles
Gynecologists’ training, knowledge, and experiences in genetics: a survey☆