Utilising open educational resources for medical genomic medicine education

For the past 7 years I have been teaching and upskilling medical students and the healthcare workforce in genetic / genomic education using the more traditional face-to-face methods of teaching. However, during the COVID19 pandemic this has moved exclusively to online teaching. Thinking about the best way forward utilising open educational resources (OER) seemed to be the best approach. I needed to consider how much open educational resources (OER) existed or had already been developed, how could it be accessed and how I could deliver this. I also needed to ensure that I only signposted peer reviewed and accredited OER to students and the healthcare workforce that would benefit their learning of medical genomic education.

In my first blog for the OKHE1 assignment I discussed the use of Free Open Access Medical Education (FOAM) as an integral part of online education within the medical healthcare profession as a whole. FOAM encompasses an array of free open educational resources (OER) and discussion forums which are aimed at breaking down traditional barriers to knowledge translation but also encourage online dialogue between healthcare professionals where previously they may not have been able to interact. In this blog I will briefly explain the need for medical genomic education, discuss what open is, the development of new OER and how OER is used for delivery of genomic medicine education.

Why medical genomic education is needed

The term ‘Genomic Medicine’ is increasingly used in health services. Whilst Genetics focuses on the DNA coding for single functional genes, Genomics is the study of the entirety of an individual’s DNA, recognising the role of non-protein-coding DNA and the complex interactions between multiple genes and the environment. Genomic medicine involves using genomic information about an individual as part of their clinical care (for example, for diagnostic or therapeutic decision-making).

Clinicians have always personalised patient management. There is a now growing momentum to improve this further through the integration of genomic information into clinical care. This will incorporate powerful new tools through which clinicians can further tailor healthcare, improving disease prevention, prediction, diagnosis and treatment.

Advances in genetic technology and understanding, coupled with an increasing patient demand for genetic and genomic investigation, is driving this. The medical healthcare workforce needs to be empowered to identify the opportunities for genomic medicine and feel confident in their ability to deliver personalised care effectively and compassionately. They will need to have sufficient understanding of genomics to communicate effectively, support their patients and institute appropriate management.

Many skills required to manage families with genetic conditions are part of the core skills within the medical healthcare profession. Learning opportunities need to include: how to recognise conditions with a genetic component; how to appropriately manage genetic implications for the individual and family, particularly where there are ethical, social and legal issues; and when and how to refer patients to specialist services. As many common conditions seen in general practice including cancer, diabetes and heart disease are multifactorial with a genetic component, managing them can also help develop awareness of how genomics affects disease. Having accredited and accurate OER is vitally important to achieve the most effective management and care for patients. There are many other resources such as eBooks, journals available to students or the healthcare workforce. Students can access journals or eBooks easily through the University Library intranet, but the same cannot be said for GPs or small cottage hospitals for example. They may have difficulty in accessing this unless they pay and this, they may not be able to afford or maintain within their practice. OERs are very useful to clinicians or GPs for example in more remote areas who are not in a position to have regular face to face teaching or discussions. Being able to signpost them to OERs can keep them abreast of current genomic education and new technologies, discoveries and treatments.

Defining open in Open Educational Resources

The term open educational resources describes “any copyrightable work (traditionally excluding software, which is described by other terms like “open source”) that is licensed in a manner that provides users with free and perpetual permission to engage in the 5R activities”. OER are required to meet the “5Rs Framework” to ensure that users are free to:

1. Retain — Users have the right to make, archive, and “own” copies of the content
2. Reuse — Content can be reused in its unaltered form
3. Revise — Content can be adapted, adjusted, modified or altered
4. Remix — The original or revised content can be combined with other content to create something new
5. Redistribute — Copies of the content can be shared with others in its original, revised or remixed form.

OER are also defined by UNESCO, as “learning, teaching, and research materials in any format and medium that reside in the public domain or are under copyright that have been released under an open license that permits no-cost access, use, adaptation, and redistribution by others”. UNESCO aims to ensure that OER support quality education that is inclusive, open and participatory and will provide educators with more availability of educational material for both teaching and learning.

OER must promote equal access to high quality education ensuring there is a variety of learning materials, books, lectures and online courses freely available on the internet. Effective and equitable use of OER requires time and investment in people as well as content. This allows the integration of OER into teaching and learning by developing evidence-based approaches to identify new ways of how OER could be situated within a curriculum and provide better outcomes for the students. OER can add value to teaching and learning by encouraging students to collaborate, share and enhance knowledge and resources. Currently I feel that there are some good OERs out there that meet some of the genetic education requirements, but there is still a long way to go. HEE and the NHS do invest heavily in this, but I don’t think is promoted as well as it could be.

OER information has made a considerable impact on Higher Education (HE) learning just like any new innovation it has had both a positive and negative impact on student learning. The positives are some OERs have been assessed, for example University library intranet, Royal College of General Practitioners genomics toolkit or may have been accredited such as GatewayC, “a free online cancer education platform developed for primary care professionals across England, aiming to improve cancer outcomes by facilitating earlier diagnosis and improving patient experience”. These OER enable students to obtain accurate and up to date current information freely, quickly and effectively as well as enabling then to obtain OER from other countries that would otherwise be difficult to obtain. The negative that I have experienced from students having on-line teaching is that they are less likely to engage and ask questions compared to when I give face-to-face sessions. I find students may not be willing to ask questions during the on-line teaching session but will come and see me at the end of a face-to-face teaching session to check information and facts that they have obtained from OER.

The majority of my teaching to medical students or the healthcare profession is predominantly to upskill rather than what I would consider as new knowledge. The delivery of this education is part of my new role within the new Northwest Genomic Medicine Alliance (NWGMSA) as Workforce Development and HEE Liaison Lead looking at developing and signposting medical genomic educational OER regionally and nationally.

I also work alongside the Genomics Education Programme (GEP) aiding in the development of OER for medical students and the healthcare professions. Back in 2016, to assess the needs of GEP I undertook a cross-professional training needs analysis to identify gaps in and preference of delivery of genetic education within the healthcare profession as part of the 100,000 Genome Project and aid in the development of OER. In total 2814 responses were received from nine Genomic Medical Centres across the United Kingdom (UK). Analysis from this data identified that medical students and healthcare professional had a preference for online teaching, however many still preferred face-to-face education and training.

A number of respondents commented on the barriers in accessing either education and training or CPPD opportunities. This was predominantly focused on either not having sufficient protected study time or the lack of funding to access online courses, if not freely available.

“I am using my annual leave to do my further training in genomics as the (hospital) does not provide any training or allow study leave for this reason” (Junior Doctor, Foundation year training)

“If spaces are made available … there is no capacity within the (hospital) to allow time to train — understaffing, under resourced, plus not enough study days” (Healthcare Scientist, Genomics).

“I like the idea of learning more, but I don’t have the time, energy or funds” (Clinical Researcher)

“Can’t get study leave for online learning” (Medical Consultant, Pediatrics)

GEP is supported by Health Education England (HEE) to ensure staff in the NHS have the knowledge, skills and experience to keep this country a world leader in genomic and precision medicine. The analysis and the outcome of the above study resulted in (GEP) producing a number of free-to-access, online resources designed to be used by NHS staff to increase their knowledge in genomics. OER available range from short, one-hour training programmes to more in-depth, Massive Open Online Courses (MOOCs) available through the FutureLearn platform which include around nine hours of study spanning a number of weeks. MOOCs are teaching strategies to advocate students to access education remotely. They allow students to attend at any time and progress their study at their own pace. MOOCs have become an an alternative option for study in addition to other online educational platforms. There are a number of benefits in that they are interactive, self-paced, self-directed, and accessible by unlimited users. GEP also offers a number of resources to support the integration of genomics into clinical practice, including information about taking and drawing a family history, core concepts in genomics, genetic conditions, and genomic terminology.

“GEP now provides:

• online resources and self-directed education for medical students and NHS staff.
• Developing curricula and assuring delivery of formal academic-based training programmes for the entire workforce, such as the MSc in Genomic Medicine and Higher Specialist Scientist Training in genomics.
• Commissioning NHS-funded places for staff on training programmes.
• Supporting multi-professional clinical research fellowships and doctoral posts in genomics and bioinformatics and genomics.
• Through HEE, funding places are available for NHS staff on a Master’s Degree in Genomic Medicine delivered by partner Universities. Funding is also available to study individual, standalone modules for Continuing Personal and Professional Development (CPPD) across all NHS professions.”

I normally deliver my teaching / upskilling in 2 x three-hour face-to-face sessions, trying to ensure that I deliver as much information as possible but also having time for questions and discussions. Probably as you can appreciate this in itself is quite challenging. Due to the COVID19 pandemic and the need to change to online teaching has meant that these sessions either have had to increase or worse case that I do not deliver the full content. I needed to reflect on how much content I actually needed to deliver online but how much of the education material could in fact be OER. Thinking about the work I was involved in with GEP, HEE etc. there was a vast array of OER already accessible that I could use.

I redesigned my sessions to signpost students and the workforce to the appropriate OER that would give them as much if not more education than I was already providing. Utilising and signposting OER within my sessions reduced online teaching to 1 x 2-hour session. This benefited not only myself but gave the students more free time to undertake MOOCs or other relevant online courses. I also need to consider that not everything I deliver can be signposted or delivered online, learning practical sessions for example generating a family history need to be delivered face-to-face. Although there are excellent training videos held within GEP and GatewayC, https://youtu.be/hDSXdVL6VS0, there still needs to be interaction with the educator to ensure they correctly understand and can interpret them. Delivery of online education and being able to incorporate OER has the added benefit of being flexible thereby allowing students and the healthcare workforce to access learning materials as and when the time or place suits them.

An approach that I could also consider adopting for genomic education would be using blended learning and flipped classroom. Blended learning / hybrid learning often referred to as the “new normal” is the integration of face-to face and online teaching which is widely adopted throughout higher education. By integrating media resources, virtual learning environments, face-to face and automated feedback blended learning has proved to be very effective in training. It can assist in the early detection of at-risk students together with behavioural analyses of individual students and collaborative groups of students, allowing for adjustments to be made to the quality of teaching and learning outcomes. Flipped classroom is a relatively new pedagogy whereby the traditional face-to face teaching format is flipped by expecting students to do preparatory learning prior to face-to face allowing this time to be utilized for discussion and instructor-facilitated activities . This approach is being more widely used within the healthcare profession such as medicine, pharmacy and nursing and has indicated better student-teacher interactions and student engagement through real-time feedback .

All the education and training I provide is used to develop and upskill medical students and the healthcare workforce. This does not involve assessments or examinations; it relies heavily on the fact that they have to be motivated to access OER. Currently there is no way of identifying whether they will or have accessed any of the signposted resources. In a normal HE environment this could be checked by examination or assessment or discussion in a tutorial. Currently for example to access GatewayC you need to register, this is free, using your NHS email account. This could be monitored to see which courses have been undertaken by an individual and what CPD credits they have achieved. However, we need to be mindful of data protection as at the moment there is nothing stated in there for individuals to consent to their information and data being accessed or shared. I could look at how many people have registered on the course after their training session, this again would not identify individuals but more numbers of individuals, an example of which is shown below in Figure 1. If we want to monitor and identify those students have been accessing OER that they have been signposted to, I think time and investment is required by perhaps HEE to develop this.

Figure 1. Breakdown showing months and number of GP trainee attendees who have registered on GatewayC.

Within the NWGMSA website there will be a dedicated space for education and training to capture all the necessary online education and resources that will be needed for all of the Northwest medical students. This will ensure openness of online resources providing correct and peer reviewed education resources and information to be utilised by all. Utilising OER for medical genomic information will make it a lot easier for students and the healthcare workforce to access learning material. With the huge amount and variety of information already openly available it is imperative not only for the students but pivotal for patient care that we understand and utilise this environment to guide and direct students to reliable and peer reviewed OER. It is important that as educators we not only understand but can use OER to ensure we signpost students and the healthcare workforce to the right resources. There is a need for re-training of educators in identifying the most suitable OER for students and the healthcare professionals to ensure that not only are they signposted to correct peer reviewed or accredited educational materials but also that confidentiality of patients is not beached. Within Higher Education (HE) or upskilling of the workforce we as educators need to ensure that we meet the 5Rs framework. Significant benefits may be achieved by mutual enrichment between HE and OER which would offer and support renewed educational paradigms.

OER is without doubt the way forward in teaching within HE. Students need to be signposted towards accredited and peer assessed OER. It is important that students are examined or assessed on OER that they have been provided with to assist in their studies, in a similar manner to the way they are assessed through a normal lecture. Moving forward it would be good to see OERs such as GatewayC and GEP courses on the undergraduate medical degree to ensure students are upskilled sufficiently and assessed or examined on such before they move to their preferred profession. Being part of the GMSA this is something that I could review and discuss with HE bodies to see if this could be implemented. Also implementation of blended learning and flipped classroom would allow students or the healthcare professionals the flexibility to learn at their convenience via online activities and engage in preparatory learning prior to their online teaching session. It should facilitate learning, development and collaborative skills and increase self-efficacy and critical thinking skills. This should allow the online teaching session to be utilised for discussions and teacher facilitated activities.