The objective of the Frontliners initiative is to implement an evidence-based training programme in precision medicine targeting frontline healthcare professionals. The design phase of this training is built upon three focus areas including content development, research and communications (figure 1). Since 2019, the project team have continued to build each of these focus areas with an end goal of implementing an online evidence-based training programme, presenting quality interactive modules on key topics in precision medicine, which can be combined with onsite training.

Financing

We are very grateful to the funder ‘health2030’ for supporting this innovative initiative and supporting Frontliners for the duration of the time needed to reach our intended aims.

Five online modules have been included in the launch of Frontliners: an introduction to precision medicine, shared decision-making, genomic testing, pharmacogenetics and precision medicine in primary care. Topics were carefully selected and informed from the targeted needs assessment research study. Each module was built upon the foundations of learning theory, conceptual frameworks, and evidence-informed education. https://frontliners.openolat.com/dmz/
The production of educational content requires sound educational design based on evidence. The approach taken by the project team to deliver quality education has required a step-by-step approach to curriculum design including Needs assessment – Content development – Organisation and implementation – Monitoring and Evaluation [1, 2].

1. Prideaux D: Curriculum design. Bmj 2003, 326(7383):268-270.
2. Thomas PA, Kern DE, Hughes MT, Chen BY: Curriculum development for medical education: a six-step approach: JHU Press; 2016.

This project applies a scientific empirical approach for education needs assessment to design, plan and implement a blended learning programme to deliver Precision Medicine, to frontline healthcare professionals. The accompanying research track with a PhD in Medical Education investigated learning needs, applied teaching and learning and effectiveness of an online intervention in acquiring new knowledge and skills, key  theoretical and applied research issues., This research protocol has enriched and strengthened the developed product

Central to the development of FRONTLINERS is the aim to meet the needs of the target group, and to tailor the communication and a dissemination strategy accordingly. Through the dissemination of the Platform, we will rely on easy access to the online resources, for learner as well as for trainers. Various dissemination processes are to be implemented. The evidence based principles and new insights will be made accessible through publications, conference presentations and outreach activities

1. Content development of a state-of-the-art training programme

The institute for Medical Education (IML) is hosting the platform and responsible for the management of access and maintenance of current and future users. All Frontliners modules are hosted on Open Olat and have been organised and presented within an easy to use, digital, self-paced learning environment. Learners with access to the platform will have the possibility to progress through their learning independently, with opportunity to reflect on their learning, complete assessments of their learning and receive feedback.

Each learning module includes an interactive learning experience that includes;

• Didactically presented content on the specific topic.
• Patient case videos
• Illustrations
• Assessment items and feedback opportunities
• Learning tasks

2. Evidence-based education for evidence-based practice

While the key focus area has been development of online modules in Precision Medicine, the team has also successfully implemented a face to face learning with  online course modules in a blended learning approach.

The blended learning concepts build on a combination of the online modules and onsite training to facilitate learners acquisition of new knowledge and skills. We designed and delivered two onsite trainings in a blended learning approach, during 2022 and 2023. The possibility to balance online learning with onsite practice (figure 2), is an asset of this production.

3. Knowledge dissemination, research and outreach activities

This project intended to apply an evidence-based approach for education from the start. This implies that decisions for implementation and development are based on proven didactic principles, and newest insights for online learning design. All the steps are accompanied with applied research, when needs for clarifications have been identified. By way of example, we identified that a needs assessment for this development was necessary. This has been implemented in two sub-studies reported below. Further, it is important to thoroughly test the effectiveness of the learning activities with the online platform, which also resulted in a study. Further studies, relevant in this context are reported below.

Journal articles:

• Mitchell, S., Evrim , J., Schmitz, F. M., Von Kanel, E., Collombet, P., Cornuz, J., Weber, G., Guessous, I., Guttormsen, S. (2022). Investigating acceptability of a training programme in Precision Medicine for frontline healthcare professionals: A mixed Method study. BMC Medical Education (2022, 22:556). https://doi.org/10.1186/s12909-022-03613-2
• Mitchell S, Sehlbach C, Franssen GHL, Janczukowicz J, Guttormsen S. (2024) Taxonomy of teaching methods and their use in health professions education: a scoping review protocol BMJ Open 2024;14:e077282. doi: 10.1136/bmjopen-2023-077282
• Mitchell, S., Jaccard, E., Cardineaux, R., Collombet, P., Cornuz, J., Waeber, G., Guessous, I., Guttormsen, S. (2020), Implementing an Online Training Programme in Precision Medicine for Primary Care Professionals: a Multi-Method Approach. Short paper in the Proceedings of 17th IADIS international conference on Cognition and Exploratory Learning in Digital Age (CELDA), 18. – 20.11.2020, Lisbon, Portugal.

The following publications are in preparation:

• Mitchell, S, Schmitz, F.M, Pless, A et al. Exposing the knowledge gap in precision medicine among primary care professionals: results of a survey study. [in preparation]
• Mitchell, S, Schmitz, F.M, Buzzi, AL. A new online module on genomic testing improves students’ and general practitioners’ skills performance in simulated patient encounters: Results from a Pre-test post-test trial [in preparation]
• Sharon Mitchell, Evrim Jaccard, Felix Schmitz, Jolanda Elmers, Gérard Waeber, Idris Guessous, Sissel Guttormsen. Efectiveness of educational interventions on genetics / genomics for primary care professionals. A systematic Review [in preparation]

Outreach and conference contributions

• Mitchell, Sharon; Guttormsen, Sissel (25 March 2023). Genomic Testing, a blended learning approach. In: Swimsa SMSC 2023 congress on Precision Medicine Bern, Switzerland , 25 March 2023.
• Schmitz, Felix Michael; Mitchell, Sharon; Hitzblech, Tanja; Buzzi, Ann-Lea; Guttormsen, Sissel (September 2023). Zur Abklärung und Kommunikation genetischer Risiken und Testverfahren unter Berücksichtigung gemeinsamer Entscheidungsfindung: Resultate einer Prä-Post-Studie zur Wirksamkeit eines Online-Lernangebots. In: Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA): German Medical Science GMS Publishing House. Düsseldorf, Germany 14 September – 16 September 2023
• Mitchell, Sharon; Sehlbach, C.; Janczukowicz, J.; Guttormsen, Sissel (31 August 2022). A classification structure for teaching methods and their use in health education: A scoping review. In: AMEE 2022. Lyon, France . 27. - 31.08.2022
• Mitchell, Sharon; Jaccard, E.; Schmitz, Felix Michael; Guessous, I; Guttormsen, Sissel (2022). Entering an era of Precision Medicine: A needs assessment guiding design of a targeted training programme in CPD. In: AMEE Abstract Book 2022. Lyon, France.
• Mitchell, Sharon; Jaccard, Evrim; Schmitz, Felix; Collombet, Prune; Guessous, Idris; Guttormsen, Sissel (2021). Using Needs Assessment to design a new training programme for frontline healthcare professionals: Part 1 - A Focus Group Study. In: AMEE 2021. virtual conference, Dundee, UK. 27-30 August 2021. 27. - 31.08.2022
• Mitchell, Sharon; Jaccard, Evrim; Cardineaux, Regula; Collombet, Prune; Cornuz, Jacques; Waeber, Gérard; Guessous, Idris; Guttormsen, Sissel (2020). Implementing an Online Training Programme in Precision Medicine for Primary Care Professionals: a Multi-Method Approach. In: Sampson, Demetrios G.; Ifenthaler, Dirk; Isaías, Pedro (eds.) Proceedings of 17th International Conference on Cognition and Exploratory Learning in the Digital Age (pp. 359-364). Lisbon, Portugal: IADIS Press, Online November 2020

The interdisciplinary approach within this project has been a key to success. The principle of the development was the seamless cooperation between content experts, medical educators, infrastructure experts and management. To deliver such a project with the intended high quality, and fit for purpose, is indeed a grand project.

Executive board
Prof. Dr. med. Idris Guessos, Geneva University Hospitals, UNIGE (Co-IP)
Prof. Dr. phil. Sissel Guttormsen, IML, medical faculty, University of Bern (Co-IP)
Prof. Dr. med. Jacques Cornuz, Unisanté/UNIL (Co-Applicant)
Prof. Dr. Dr. med. Gérard Waeber, CHUV/UNIL (Co-Applicant)

Team IML, focus medical education
Sharon Mitchell (PhD Candidate), Felix Schmitz (Scientific collaborator), Daniela Schmid (Web Design), Sissel Guttormsen (Co-Project head, PhD Supervisor)