The aim of this study was to analyze the effectiveness of a distance learning course on genetics and genomics for Italian physicians. In recent years, a growing interest in promoting courses on genetics/genomics topics is clearly emerging [16, 17], due to rapid developments in genomic technologies and to the not sufficient knowledge of healthcare practitioners in this field [18–20]. Previous research in learning field suggests that different aspects of an educational intervention may have impacts on its effectiveness, including the type of intervention, and the amount of practice-reinforcing strategies it contains . Indeed, it appears that interactive learning, including case studies, is generally more effective at improving medical knowledge than learning based on theoretical principles alone .
This course represents the second Italian experience in distance training in genomics .
The main innovative aspect of the "Genetics and Genomics practice" course is related to the teaching methodology, oriented to an active training. The PBL methodology encourages the participants to "learn to learn" by solving real-world problems that reflect their work context [11, 12]. Schmidt et al.  indicated that in PBL the presentation of a problem activates the participants’ prior knowledge, enabling more effective learning to take place. Compared to a conventional approach, in PBL learning occurs in a more active way, since participants attempt to solve a problem and to identify their specific learning objectives. This way, learners face a cognitive conflict and construct their learning on their previous knowledge and experience . Although in some studies CBL is contrasted to PBL in terms of structure, being guided learning, we integrated these two approaches, in order to provide a comprehensive andragogic and active orientation to the course . CBL, indeed, encourages participants to integrate their learning in the context of realistic clinical environment and to connect theory to clinical practice. The learning theories applied to CBL derive mainly from adult-learning and inquiry-based learning approaches, relaying also to cognitive and social constructivist models .
The results of our “Genetics and Genomics practice” course suggest that distance-learning training in genetic/genomic practices represents an effective and satisfactory method to improve physicians’ knowledge across all age groups of participants.
Among the 1637 participants who completed the course, the most represented age class was those of 51–65 years. This result may be related to the educational need of the over-50 age physicians in an innovative field as omics sciences are. In fact, most healthcare professionals did not receive an adequate training on this topic, as demonstrated by a negative correlation between time from medicine degree and omics sciences knowledge .
Participants declared their previous training experience on the course issues at the beginning of the course and results reports that the majority of participants had never attended other courses on that topic before.
The effectiveness of the course was measured through a Knowledge test made of a set of 10 MCQs that was repeated before the start and at the end of the course. The overall results suggest that the course improved the general level of knowledge. Nevertheless, as revealed by the stratified analysis, the improvement was not homogeneous for all the medical specialties. For example, the knowledge improvement was greater for Primary Care physicians and Sport Medicine physicians. These results accomplish our expectations regarding the course, since it was intended mainly as directed to GPs and FPs (primary care), that don’t receive a specific education in genetics during their specialization, but deal with genetic problems during the daily practice. The low pre-test score of this specialty group confirmed the educational need we hypothesized in planning the course. As for Sport Medicine physicians, the lowest pre-test score they reported could be explained with the fact that they deal with genetics more rarely than other specialties physicians; however, the great improvement obtained in the post-test score could demonstrate the effectiveness of the course in filling the knowledge gap. On the opposite, the Gynecologists and Occupational Medicine physicians reported the lowest difference between the pre and post-test. For the first category, this might be related to the high pre-test score they reported, while for the latest both the pre-test and the post-test scores were low, if compared to the overall scores. The highest pre-test and post-test scores were registered for the Geneticists, demonstrating their pre-existing knowledge on the topic. Our results are consistent with the results reported by Michelazzo et al. , that analyzed the effect of a previous course in genetics and genomics for physicians, organized with different educational methodologies.
To our knowledge, this is the first study that attempts to measure the knowledge retain and the educational effects of the course after a follow-up period. This was obtained by inviting all participants to complete the same pre/post-test after a follow-up period of eight months. Although the proportion of respondents was low compared to the high number of participants, the overall scores shows that after eight months the knowledge level decreased if compared to the post-test score, but it was higher than the pre-test score, thus supporting the effectiveness in knowledge retain.
The follow-up data also allows some considerations on the self-perceived sense of competence, before and after the course, in giving information on genetic tests to patients by medical staff. Among the 258 Responders the sense of competence has improved at follow up and there was an increase in the number of doctors who felt more capable of providing information about diagnostic/prognostic utility of predictive genetic test.
Our study presents some limitations. Firstly, the effectiveness of the course could be overestimated, due to the fact that only data of those who completed the entire course were collected. Therefore, it might be possible that the “dropouts” would have reported lower improvements or less satisfaction than the “completers”. Secondly, the sample size of those who completed the course was quite heterogeneous in terms of specialties, not allowing a significant representation of all the discipline categories, many of which were grouped into one “other specialties” category.
Despite these limitations, the results of our study confirmed the effectiveness of genetic and genomic courses in improving participants’ literacy on omics sciences, not only in terms of knowledge, but also in terms of managing genetic information in daily practice. In particular, our results suggest that especially primary care physicians are those who can have the most important benefit from a course about this topic.