Effectiveness of educational interventions to improve genomic competency in non-­‐geneticist medical doctors: a systematic review of the literature

Background. Given rapid advances in genomics, continuing medical education of medical doctors (MDs) is crucial for appropriate integration of human genome discoveries into healthcare and disease prevention. This work presents a systematic review of educational interventions aimed at improving genomic competency in non‐geneticist MDs, with consideration of how outcomes are affected by intervention type (face-to-face learning, distance learning, decision aids and information provision). Methods.  We performed a systematic search of MEDLINE, ISI Web of Science, and SCOPUS databases for the relevant studies on educational interventions and genomic competency, published in English language between January, 1st, 2001 and March, 31th, 2017. In order to synthesize the results of the eligible studies, we evaluated the effect of education on knowledge, management and confidence, and we compared the outcomes between different intervention types. Results.  We included sixteen studies including different educational interventions. The majority of studies reported significant effects on at least one component of genomic competency. When the improvement in clinical application of genomic knowledge was evaluated, moderate or null effect has been reported for the different intervention types. Conclusions. The majority of studies included reported a positive impact of genomic education on non‐geneticist MDs genomic competency. However, no clear conclusion can be drawn given the heterogeneity of the studies in terms of methods, intervention types and outcome measurements. Future studies considering effectiveness of interventions with a focus on long-term outcomes are recommended

A Systematic Review on the Existing Screening Pathways for Lynch Syndrome Identification

BackgroundLynch syndrome (LS) is the most common hereditary colon cancer syndrome, accounting for 3–5% of colorectal cancer (CRC) cases, and it is associated with the development of other cancers. Early detection of individuals with LS is relevant, since they can take advantage of life-saving intensive care surveillance. The debate regarding the best screening policy, however, is far from being concluded. This prompted us to conduct a systematic review of the existing screening pathways for LS.MethodsWe performed a systematic search of MEDLINE, ISI Web of Science, and SCOPUS online databases for the existing screening pathways for LS. The eligibility criteria for inclusion in this review required that the studies evaluated a structured and permanent screening pathway for the identification of LS carriers. The effectiveness of the pathways was analyzed in terms of LS detection rate.ResultsWe identified five eligible studies. All the LS screening pathways started from CRC cases, of which three followed a universal screening approach. Concerning the laboratory procedures, the pathways used immunohistochemistry and/or microsatellite instability testing. If the responses of the tests indicated a risk for LS, the genetic counseling, performed by a geneticist or a genetic counselor, was mandatory to undergo DNA genetic testing. The overall LS detection rate ranged from 0 to 5.2%.ConclusionThis systematic review reported different existing pathways for the identification of LS patients. Although current clinical guidelines suggest to test all the CRC cases to identify LS cases, the actual implementation of pathways for LS identification has not been realized. Large-scale screening programs for LS have the potential to reduce morbidity and mortality for CRC, but coordinated efforts in educating all key stakeholders and addressing public needs are still required