Abstract
Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians’ background in medical genetics.
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Notes
The study was funded by the EU Program FP5 Contract QLG4-CT2001-30216.
Effects of the variable “country” will be presented subsequently in Part 2.
References
Baars MJ, Henneman L, ten Kate LP (2005) Deficiency of knowledge of genetics and genetic tests among general practitioners, gynaecologists, and paediatricians: a global problem. Genet med 7(9):605–610
Benjamin CM, Anionwu EN, Kristoffersson U, ten Kate LP, Plass AM, Nippert I, Julian-Reynier C, Harris HJ, Schmidtke J, Challen K, Calefato JM, Waterman C, Powell E, Harris R, GenEd Research Group (2009) Educational priorities and current involvement in genetic practice: a survey of midwives in the Netherlands, UK and Sweden. Midwifery 25(5):483–499
Bottorff JL, Blaine S, Carroll JC, Evans J, Nicolson Klimek ML, Meschino W, Ritvo P (2005) The educational needs and professional roles of Canadian physicians and nurses regarding genetic testing and adult onset hereditary disease. Community Genet 8(2):80–87
Burke S, Martyn M, Stone A, Bennet C, Thomas H, Farndon P (2009) Developing a curriculum statement based on clinical practice: genetics in primary care. Br J Gen Pract 59(559):99–103
Calefato JM, Nippert I, Harris HJ, Kristofferson U, Schmidtke J, ten Kate LP, Anionwu E, Benjamin C, Challen K, Plass AM, Harris R, Julian-Reynier C (2008) Assessing educational priorities in genetics for GPs and specialists in 5 countries: factor structure of genetic educational priorities (Gen-EP) scale. Genet Med 10(2):99–106
Carroll J, Rideout AL, Wilson BJ, Allanson J, Blaine SM, Esplen MJ, Farrell SA, Graham GE, MacKenzie J, Meschino W, Miller F, Prakash P, Summers A, Taylor S (2009) Genetic education for primary care providers—improving attitudes, knowledge, and confidence. Can Family Physician Le médecin de famille canadien 55:e92–e99
Challen K, Harris HJ, Julian-Reynier C, ten Kate LP, Kristofferson U, Nippert I, Schmid-tke J, Benjamin C, Harris R (2005) Genetic education and non-genetic health professionals: educational providers and curricula in Europe. Genet Med 7(5):302–310
Darzi A. Quality for all: next stage review, Final Report, London: Department of Health, 2008
Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L (2006) Accuracy of physician self-assessment compared with observed measures of competence. JAMA 296(9):1094–1102
Emery J, Watson E, Rose P, Andermann A (1999) A systematic review of the literature exploring the role of primary care in genetic services. Fam Pract 16(4):426–445
EuroGentest: Core competences in genetics for health professionals in Europe, source: http://www.eurogentest.org/web/info/public/unit6/core_competences.xhtml, July 2010
Geller G. (1999) Americans’ attitudes toward informed consent for breast cancer susceptibility testing: questions for cross-cultural research. In: Nippert I, Neitzel H, Wolff G (eds.) The new genetics: from research into health care—social and ethical implications for users and providers. Springer, Berlin, pp 13–21
Harris R (1994) Genetic counselling and testing in Europe. J R Coll Physicians Lond 32(4):335–338
Harris R (ed.) (1997) Genetic services in Europe: a comparative study of 31 countries. European Journal of Human Genetics 5 (Suppl 2):1–220
Harris R, Harris HJ (1999) Clinical governance and genetic medicine. Specialist genetic centres and the confidential enquiry into counselling for genetic disorders by non-geneticists (CEGEN). J Med Genet 36:350–351
Henriksson K, Kristoffersson U (2006) Education in medical genetics for non-genetic health care providers in Sweden. Community Genet 9(4):240–245
Holtzman NA, Watson MS (ed.) (1997) Promoting safe and effective genetic testing in the United States. Final report of the task force on genetic testing
Hunter A, Wright P, Cappelli M, Kasaboski A, Surh L (1998) Physician knowledge and atti- tudes toward molecular genetic (DNA) testing of their patients. Clin Genet 5(6):447–455
Julian-Reynier C, Nippert I, Calefato JM, Harris HJ, Kristofferson U, Schmidtke J, ten Kate LP, Anionwu E, Benjamin C, Challen K, Plass AM, Harris R (2008) Genetics in clinical practice: general practitioners’ educational priorities in European countries. Genet Med 10(2):107–113
Korf BR (2002) Integration of genetics into clinical teaching in medical school education. Genet Med 4(6, Suppl):33S–38S
Manek N, Allen K. (2009) Changes to GP training, BMJ Careers, July 15, 12–14
Modell B, Harris R, Lande B, Khan M, Darlison M, Petrou M, Old J, Layton M, Var-navides L (2000) Informed choice in genetic screening for thalassaemia during pregnancy: audit from a national confidential inquiry. BMJ 320:337–341
Nomura K, Yano E, Fukui T (2010) Gender differences in clinical confidence: a nationwide survey of resident physicians in Japan. Acad Med 85:647–653
Nuffield Trust (2000) Genetics and health. Policy issues for genetic science and their implica- tions for health and health services. Nuffield Trust
Plass AM, Baars MJH, Cornel MC, Julian-Reynier C, Nippert I, Harris HJ, Kristofferson U, Schmidtke J, Anionwu E, Benjamin C, Challen K, Harris R, ten Kate LP (2009) Testing the children: do non-genetic health care providers differ in their decision to advise genetic pre-symptomatic testing of minors? A study in five countries in the EU. Genet Test Mol Biomark 13(3):367–376
Royal College of General Practitioners (2008) A review of GP specialty training in the UK: Interim report for the Department of Health. RCGP, London
Schmidtke J, Paul Y, Nippert I (2006) Education in medical genetics for physicians: Germany. Community Genet 9(4):235–239
Smit C, Kent A, Poortman Y. (1996) Biomedical research and patenting: ethic, social, and legal aspects. European Platform for Patients’ Organisations, Science and Industry
Suther S, Goodson P (2003) Barriers to the provision of genetic services by primary care physicians: a systematic review of the literature. Am Coll Med Genetics 5(2):70–76
Acknowledgements
For the patient organisations: The contributions and support of Alastair Kent and Ysbrand Poortman are greatly appreciated. We also appreciate the technical support of Jean-Marc Calefato, Gaelle Santin in France; the contribution and support of Prof. Dr. E. Harms (paediatrician), Prof. Dr. W. Holzgreve (obstetrician/gynaecologist) and Prof. Dr. K. Wahle (general practitioner) in Germany; the contribution and support of Prof. Dr. Martina Cornel (community genetics), Dr. Marieke Baars (clinical geneticist), Dr. Attie Go (gynaecologist), Frans Boonekamp (general practitioner) and Dr. Michiel Weijers (paediatrician) in The Netherlands and the research and administrative support of Prof. Tony Heagerty (Professor of Medicine) and technical support of Daniel Cottam and Christine Waterman in UK.
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Nippert, I., Harris, H.J., Julian-Reynier, C. et al. Confidence of primary care physicians in their ability to carry out basic medical genetic tasks—a European survey in five countries—Part 1. J Community Genet 2, 1–11 (2011). https://doi.org/10.1007/s12687-010-0030-0
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DOI: https://doi.org/10.1007/s12687-010-0030-0