Pharmacogenomics Implementation Training Improves Self-Efficacy and Competency to Drive Adoption in Clinical Practice.
Ontology highlight
ABSTRACT:
SUBMITTER: Adesta F
PROVIDER: S-EPMC8273230 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Considerable efforts have been exerted to implement Pharmacogenomics (PGx), the study of interindividual variations in DNA sequence related to drug response, into routine clinical practice. In this article, we first briefly describe PGx and its role in improving treatment outcomes. We then propose an approach to initiate clinical PGx in the hospital setting. One should first evaluate the available PGx evidence, review the most relevant drugs, and narrow down to the most actionable drug-gene pairs and related variant alleles. This is done based on data curated and evaluated by experts such as the pharmacogenomics knowledge implementation (PharmGKB) and the Clinical Pharmacogenetics Implementation Consortium (CPIC), as well as drug regulatory authorities such as the US Food and Drug Administration (FDA) and European Medicinal Agency (EMA). The next step is to differentiate reactive point of care from preemptive testing and decide on the genotyping strategy being a candidate or panel testing, each of which has its pros and cons, then work out the best way to interpret and report PGx test results with the option of integration into electronic health records and clinical decision support systems. After test authorization or testing requirements by the government or drug regulators, putting the plan into action involves several stakeholders, with the hospital leadership supporting the process and communicating with payers, the pharmacy and therapeutics committee leading the process in collaboration with the hospital laboratory and information technology department, and healthcare providers (HCPs) ordering the test, understanding the results, making the appropriate therapeutic decisions, and explaining them to the patient. We conclude by recommending some strategies to further advance the implementation of PGx in practice, such as the need to educate HCPs and patients, and to push for more tests' reimbursement. We also guide the reader to available PGx resources and examples of PGx implementation programs and initiatives.
| S-EPMC10233068 | biostudies-literature
Project description:AimThe limited formal study of the clinical feasibility of implementing pharmacogenomic tests has thus far focused on providers at large medical centers in urban areas. Our research focuses on small metropolitan, rural and tribal practice settings.Materials & methodsWe interviewed 17 healthcare providers in western Montana regarding pharmacogenomic testing.ResultsParticipants were optimistic about the potential of pharmacogenomic tests, but noted unique barriers in small and rural settings including cost, adherence, patient acceptability and testing timeframe. Participants in tribal settings identified heightened sensitivity to genetics and need for community leadership approval as additional considerations.ConclusionImplementation differences in small metropolitan, rural and tribal communities may affect pharmacogenomic test adoption and utilization, potentially impacting many patients. Original submitted 3 September 2014; Revision submitted 3 December 2014.
| S-EPMC4360986 | biostudies-literature
Project description:The mapping of the human genome and subsequent advancements in genetic technology had provided clinicians and scientists an understanding of the genetic basis of altered drug pharmacokinetics and pharmacodynamics, as well as some examples of applying genomic data in clinical practice. This has raised the public expectation that predicting patients' responses to drug therapy is now possible in every therapeutic area, and personalized drug therapy would come sooner than later. However, debate continues among most stakeholders involved in drug development and clinical decision-making on whether pharmacogenomic biomarkers should be used in patient assessment, as well as when and in whom to use the biomarker-based diagnostic tests. Currently, most would agree that achieving the goal of personalized therapy remains years, if not decades, away. Realistic application of genomic findings and technologies in clinical practice and drug development require addressing multiple logistics and challenges that go beyond discovery of gene variants and/or completion of prospective controlled clinical trials. The goal of personalized medicine can only be achieved when all stakeholders in the field work together, with willingness to accept occasional paradigm change in their current approach.
| S-EPMC3603526 | biostudies-literature
Project description:To graduate internal medicine residents with basic competency in palliative care, we employ a two-pronged strategy targeted at both residents and attending physicians as learners. The first prong provides a knowledge foundation using web-based learning programs designed specifically for residents and clinical faculty members. The second prong is assessment of resident competency in key palliative care domains by faculty members using direct observation during clinical rotations. The faculty training program contains Competency Assessment Tools addressing 19 topics distributed amongst four broad palliative care domains designed to assist faculty members in making the clinical competency assessments. Residents are required to complete their web-based training by the end of their internship year; they must demonstrate competency in one skill from each of the four broad palliative care domains prior to graduation. Resident and faculty evaluation of the training programs is favorable. Outcome-based measures are planned to evaluate long-term program effectiveness.
| S-EPMC3162123 | biostudies-literature
Project description:BackgroundPhysical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program.MethodsData were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained in schools.ResultsThe estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers' adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop.ConclusionsThe RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1st February 2021.
| S-EPMC8425054 | biostudies-literature
Project description:BackgroundDeficiencies in musculoskeletal knowledge are reported at every stage of learning. Medical programs are looking for effective ways to incorporate competency-based training into musculoskeletal education.AimTo evaluate the impact of bedside feedback on learner's shoulder examination skills, confidence, and knowledge of common shoulder conditions.SettingFour-week musculoskeletal clinic rotation.ParticipantsUCSD third year medical students and internal medicine residents.Program descriptionLearners completed three baseline evaluations: videotaped shoulder examination, attitude survey, and knowledge test. During the 4-week intervention learners received bedside observation and feedback from musculoskeletal experts while evaluating patients with shoulder conditions. Post-intervention learners repeated the three assessments.Program evaluationEighty-nine learners participated. In the primary outcome measure evaluating the pre/post videotaped shoulder examination, significant improvement was seen in 21 of 23 shoulder examination maneuvers. Secondary outcomes include changes in learner confidence and knowledge. Greatest gains in learner confidence were seen in performing the shoulder examination (61.5% improvement) and performing injections (97.1% improvement). Knowledge improved significantly in all categories including anatomy/examination interpretation, diagnosis, and procedures.DiscussionDirect observation and feedback during clinical evaluation of patients with shoulder pain improves shoulder examination competency, provider confidence, and knowledge of common shoulder conditions.
| S-EPMC5653557 | biostudies-literature
Project description: Not available
| S-EPMC10709853 | biostudies-literature
Project description:BACKGROUND: The American Board of Internal Medicine approved the use of Practice Improvement Modules (PIMs) to help training programs teach and assess practice-based learning and improvement (PBLI) and systems-based practice (SBP). METHODS: We surveyed individuals who ordered a PIM in a residency or fellowship training program between June 2006 and August 2009. The 43 programs that volunteered to participate completed a 30-minute anonymous online survey. RESULTS: Program directors or associate program directors led the PIM process in 30 programs (70%). Trainees' degrees of involvement in PIMs were highly variable between programs, and several respondents felt that trainees were either not sufficiently engaged or not engaged with enough consistency. The most common activity for trainee involvement was data collection through patient surveys or chart review, although only 17 programs (40%) provided protected time for this activity. Few trainees participated in higher level activities such as data analysis or identification for areas of improvement or were given leadership roles; yet most respondents reported that completing the PIM helped trainees learn basic principles of QI and develop competence in PBLI and SBP and that PIM completion improved the program's ability to develop QI initiatives and resulted in program or institutional improvements, including sustainable improvement in patient care. Most respondents reported that the outcome warranted the effort to complete PIMs. CONCLUSIONS: PIMs may be a valuable but underused educational experience for trainees as well as training programs. Focusing on particular themes and facets of PIMs may facilitate implementation.
| S-EPMC3613323 | biostudies-other
Project description: Not available
| S-EPMC9816836 | biostudies-literature
Project description:BackgroundAlthough transition from residency to practice represents a critical learning stage, there is a paucity of literature to inform local curriculum development and implementation.ObjectivesTo describe local curriculum development for Transition to Practice (TTP) for use within a competency-based medical education model, including important content and suitable teaching and assessment strategies.DesignWe reviewed the literature to construct a definition and develop initial curriculum content for TTP. We then gathered local residency program directors' views on TTP content, teaching, and assessment via online survey and an international educational conference workshop.ResultsWe identified 21 important TTP content areas in the literature and analyzed 35 survey responses, representing 33 residency programs. Survey participants viewed Further sophistication of clinical skills, How to set up a practice, and Time management skills as the three most important content areas. Views on content importance varied by program. For teaching and assessment strategies, most respondents preferred: assessing what residents could do, providing real-life practice opportunities, and offering workplace-based assessments.ConclusionsTTP curricula implementation should reflect nationally set, specialty-specific curriculum elements; locally developed priority content; and assessment and teaching strategies. Individual learner needs and imminent practice context should guide faculty approaches to curriculum delivery.Résumé.
| S-EPMC7417824 | biostudies-literature