Advances in technology have facilitated emerging genetic tests, genetic therapies, and reconsideration of how diseases are classified that directly impact clinical practice for nurses. As evidenced by the Institute of Medicine Report on Precision Medicine,  the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees,  and other consensus statements , application genomic technologies in health care and the pursuit of precision health are relevant across the age span, care settings, and disease areas. In parallel, APNs caring for patients across the age span (e.g., pediatrics, adult-gerontology), in diverse care settings (e.g., acute/critical care, public health), and across all specialty areas (e.g., oncology, mental health) urgently need education about the clinical implications of current genomic technologies.
In order to address challenges related to educating APNs about genomics, a series of three in-person courses were adapted to a hybrid online and in-person format. Through application of evidence based pedagogical approaches [14, 16], students first viewed material on fundamental concepts related to genomics (e.g., structure and function of DNA, family history and pedigrees, genetic testing, pharmacogenomics). Students were provided with self-paced, graded quizzes in order to assess learning. Then in-person class sessions were designed to supplement and enrich online presentation of materials and forum discussions with greater depth on complex topics (e.g., patterns of inheritance, ethical, legal, and social issues).
Completion of all three courses conferred APN students with a minor in genomics. The challenges overcome by this pedagogical approach included management of schedule conflicts and academic credit load across specialty areas within a Master’s of Science degree program for nurses. This approach was successful at the three pre-specified goals: increasing accessibility of the courses to a broader range of specialties, achievement of competencies related to genomics, and acceptable student satisfaction with the courses.
Evaluation of students’ free text comments for course satisfaction showed overall positive comments for the genomics courses. Importantly, students gained an appreciation for the importance of genomics for APN practice. In the example provided in the Discussion section, students highlighted the breadth of topics and critical importance of the topic area as strengths of the courses. Critiques of the courses had a specific recurrent theme of wanting more in-person class sessions and/or more engagement in the online learning forum. This is a common challenge for online learning environments. Future evidence-based modifications to the courses could include synchronous video sessions and greater moderation of discussion boards by the instructor and/or teaching assistant in order to increase student engagement within an online learning forum .
Course evaluation scores showed students gave primarily “somewhat agree” ratings for all three courses with some “somewhat disagree” and some “strongly agree” responses. The lowest overall scores were for the first in the series of courses, which focused on fundamentals of human genomics (Table 2). Students’ free text comments indicated frustration with the lack of connections between genomics fundamentals and nursing practice. The courses are structured so that the first in the series focuses entirely on fundamental concepts related to genomics and not at all on clinical practice. One possibility is that this connection is then made in the second and third courses by building on the foundational knowledge gained in the first course. Repeated assessment of whether students felt genomic fundamentals inform their clinical practice across all courses suggested that this linkage became more clear after the first course. The highest overall evaluation was for the second course, which focused on implications of genomics for APNs (Table 2). Based on students’ free text comments, the frustrations from the prior term were decreased and the linkages between genomics and nursing practice were clarified.
At baseline, students consistently reported having achieved competency with two of the 38 individual competencies (Fig. 1). The first was competency #1: Identify clients with inherited predispositions to diseases as appropriate to the nurse’s practice setting. A fundamental competency for Registered Nurses is to obtain and three-generation family history and construct a pedigree . The observation of high agreement with competency #1 suggests pre-licensure programs are meeting this competency, and nurses enter APN programs with sufficient training in this area. This competency also showed the greatest agreement upon completion of all three courses, with substantial increase in the agreement score compared to baseline (Fig. 1).
The lowest agreement scores at baseline and after completion of all three courses was competency #16: Select appropriate genetic/genomic tests and/or studies. Overall, students went from an average score within the disagreement range to an average score of agreement (Fig. 1). Given the current landscape and pace of genomic technological advances, mastery of this competency within general courses on genomics targeting a broad range of APN specialties is not a realistic goal. Rather, courses should provide education about principles of test selection (e.g., clinical validity, clinical application) that students can use as a foundation to build knowledge about resources and tools specific to their specialty areas.
Overall, the students rated higher competency within the professional practice domain compared to the professional responsibility domain (Fig. 1, Fig. 2). Another competency with low agreement at the completion of the coursework was #35: Influence health policy at the local, state, national, and international levels related to genetics/genomics. A possible future modification of the coursework is to create an assignment to draft a letter to a local or national elected representative that advocates for or against legislative action related to genomic policy.