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To the end of October 2017, there were 7349 different visits to the website. Visitors originated from 110 countries and all busy continents: 5066 (68.9%) were from Europe. A absolute of 1330 visitors acclimated the articulation from the www.primarycaregenetics.org website to the Gen-Equip online alternate modules. Visitors to the website were directed to added types of assets and 1989 acclimated these links.

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The demographic abstracts of the respondents are presented in Table 2. Demographic abstracts are not attainable from appearance 1, as the array were absolutely anonymized.

We present the after-effects of the abstraction according to Kirkpatrick’s model15 (Fig. 1). Against the quotes, WSP denotes “workshop participant,” while qualitative interviewees are apparent as “interview.”

Satisfaction with the assets was adjourned during phases 2–4.

Eighty learners from 14 countries responded to a analysis on the acquirements resources. Of the respondents, 73.8% appear the bore was awful or actual accordant to their own analytic practice, while 78.8% believed it was awful or actual accordant to primary affliction convenance about and 76.3% appear the assets akin able-bodied to the primary affliction curriculum. That the agreeable was acutely or actual bright was appear by 83.8%, and that the assets were attainable to cross by 78.8%, while 87.5% appear that the assets were presented with an adapted akin of detail. Respondents were asked how they acquainted afterwards accomplishing the module; 53.8% begin it enjoyable, 71.3% begin it stimulating, 1.30% begin it boring, 1.30% not enjoyable, and 1.30% were balked (more than one acknowledgment could be given). Back asked if they would acclaim the assets to a colleague, 82.5% said they would do so.

These after-effects were accepted by branch attendees and interviewed learners, who appear that the Gen-Equip assets were useful, interactive, attainable to access/use, and applicative to practice. The simple diction fabricated the assets attainable to nongenetic bloom professionals and helped the user to apprentice how to explain analysis to students, patients, and their families. Respondents appear that they alternate to the modules again in convenance back they capital to affirm whether a accommodating was in a aerial accident group. The achievability of accessing the assets as generally as bare and the assorted presentation and interactivity were additionally appreciated.

Interviewees additionally appear that they had recommended the modules to others. However, some queried whether abridgement of time ability anticipate their use by accepted practictioners (GPs), with acknowledgment that some of the modules were absolutely long.

Changes in ability and abilities were adjourned via the pre- and postmodule tests. The after-effects for the English modules until mid-October 2017 are presented in Table 3.

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The cardinal of bodies demography anniversary bore assorted from 4 to 120 and the numbers activated to how continued anniversary bore was alive on the website. Combining abstracts from all modules (N = 423) the boilerplate pretest account was 66.7% and the boilerplate posttest account was 89.9% with a commutual t analysis acceptation of p < 0.001. In every bore a statistically cogent access in array was empiric afar from the bore on a adolescent with a abiogenetic condition, area the sample admeasurement was too small, due to actuality the aftermost bore to go alive and alone accepting a few canicule attainable to learners. For this acumen we accept afar this bore from added altercation here. The modules with the everyman premodule array were those accoutrement familial colorectal blight and the abundance bore 3, on accident to the bloom of the fetus due to affectionate altitude or medication. These modules additionally showed the better allotment access in account posttest (53.5 and 57.9% respectively).

The questions on the tests were breach into two categories, those that were inquiring about analytic abilities and those that accompanying absolutely to knowledge. Boilerplate access in abilities and ability was 46.8% and 34.7%, respectively.

When because the skills-based questions, all modules generated a cogent access in the posttest array afar from, rather unexpectedly, the abundance bore 3. Despite the all-embracing low pretest account in this module, the abilities questions were answered acutely well, demonstrating that the affair with this affair is a astringent ability deficit.

When because the knowledge-based questions, every bore resulted in a cogent access in posttest scores: greatest differences were apparent in the colorectal blight and abundance 3 modules (56.7% and 73.2% respectively). Across all categories (overall, skills, and knowledge), the boilerplate mark posttest was aloft the canyon mark of 80.0% in all modules. This canyon mark was set in accordance with antecedent observations of the charge for medical apprenticeship to be challenging, as able-bodied as absorption about the canyon marks acclimated by able analytic bodies for their exams. In the pretests, alone the abundance 4 bore had an boilerplate mark that would canyon the threshold. The premodule quizzes had canyon ante of amid 9.10 and 64.9% (for abounding account see Supplementary Table S2) by module-naïve learners. Whilst anniversary bore was appropriately academically difficult to pass, these differences may reflect the difficulties learners accept with assertive capacity or against that they may accept advantaged demography modules they were already accustomed or absorbed in.

The cardinal of learners commutual added than one bore (keeners) was 387/502 (77.1%) with 43 (8.57%) accomplishing four or added modules and two learners commutual all nine. Due to our admiration to aggregate basal claimed admonition about alone learners we are clumsy to characterize added any differences amid keeners and single-module learners.

Learners who completed the postmodule analysis and accomplished a account ≥80.0% were awarded a affidavit to authenticate their continuing able development. This was alternative and not all learners completed the test. By October 2017 >600 achievement certificates had been awarded.

Despite accepting already anesthetized the postmodule quiz, learners revisited the modules at afterwards dates. The boilerplate cardinal of visits to anniversary bore per abecedarian was amid 2.84 and 3.82 (see Supplementary Table S3 for breakdown). For some of the qualitative abstraction interviewees, the modules complemented and active what they had already learned. However, abounding appear that their ability of abiogenetic issues had changed. Examples accustomed were an access in their ability on and acquaintance of “red flags” that should accession suspicion of a abiogenetic condition, barometer criteria, compassionate of abiogenetic aspects of ache and bequest patterns, and alive what to ask back demography a ancestors history.

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According to some interviewees, the modules additionally added acquaintance of patients’ perspectives and preferences:

“I am abundant added acquainted back I am talking to patients about abiogenetic testing, about the added implications […] compassionate the affecting appulse it has on patients.” (interview 10)

From the interviews, it became bright that afterward the modules added learners’ aplomb in talking about abiogenetic after-effects and abiogenetic testing with families and back demography a ancestors history:

“[patients] appear in and they are anxious about cancer, breast blight or ovarian cancer, there is a able ancestors history, and do I absolutely charge to accredit them?……because you accept added ability and you anticipate about what questions to ask and you feel added assured back you accomplish that assessment, you feel added up-to-date.“ (interview 9)

Others acquainted added assured in teaching, amalgam analysis in their own apprenticeship for students:

“Not alone for me, in my practice, but added for what I am teaching the students….” (interview 6)

When asked how the Gen-Equip modules had afflicted their convenance and teaching, abounding cited that they had fabricated them added acceptable to “be suspicious” of a abiogenetic action area this was possible, to ask added questions about the ancestors history, to seek admonition from analysis colleagues, and to accredit to specialist casework (Fig. 1). Others paid added absorption to the patient’s perspective:

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“I do leave options accessible added and I allocution to bodies about why they ability not appetite to be tested, [stating that] they don’t accept to do this but this is an advantage for you…it has afflicted my convenance with anniversary patient.” (interview 3)

Four months afterwards the Gen-Equip workshop, attendees appear application the Gen-Equip assets in three capital means alfresco their own practice. First, they had afflicted added practitioners to use the resources:

“As affiliate of the [country] Network of Public Bloom Genomics I will advertise the Gen-Equip assets amid added associates of the Network.”(WSP21)

Second, they had activated the assets for educational purpose:

“I teach…GPs on analysis and this advance has afflicted my focus added appear accouterment GPs with added clinically accordant analysis information.” (WSP11)

Third, they had acclimated Gen-Equip as a agent to anatomy stronger links amid primary affliction and analysis in their own countries, by autograph papers, acclimation workshops, and/or basic new alive groups (Fig. 1):

“I accept accounting an commodity to […] Medical Journal about the educational needs in medical analysis in ancestors practice.” (WSP4)

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