Education in personalized medicine

Personalized medicine involves medical treatments based on the characteristics of individual patients, including their medical history, family history, and genetics. Although personal genetic information is becoming increasingly important in healthcare, there is a lack of sufficient education in medical genetics among physicians and the general public.[1][2][3] For example, pharmacogenomics (genetic factors influencing drug response) is practiced worldwide by only a limited number of pharmacists, although most pharmacy colleges in the United States now include it in their curriculum.[3] It is also increasingly common for genetic testing to be offered directly to consumers, who subsequently seek out educational materials and bring their results to their doctors.[1] Issues involving genetic testing also invariably lead to ethical and legal concerns, such as the potential for inadvertent effects on family members, increased insurance rates, or increased psychological stress.[4][5]

Training

As of 2009, the primary of the care physicians did not have adequate training in genetics or genomics.[2] Although medical school curricula typically include medical genetics, fewer than half offer a standalone course, and the emphasis on practical applications is weak.[1][2][6]

In the United States, Stanford University was the first medical school in the United States to offer a course teaching the interpretation of genetic data.[7] Students were able to study their own genotypes, determined using commercially available genotyping platforms (23andMe or Navigenics).[8] Although there was skepticism that this would improve educational outcomes,[8] a survey later showed that this had increased students’ enthusiasm for the subject.[9] A similar class is offered at Mount Sinai School of Medicine, launched in 2012, in which students have the option of analyzing their entire genome sequence instead of only their genotype.[10][11]

Personal genotyping and education

In 2010, the University of California, Berkeley offered entering students a genetic test for SNPs affecting alcohol, lactose, and folate metabolism.[12][13] The goal was “to spark discussion during orientation on how genetic testing works, the results of the students' tests and their decisions on whether or not to participate.”[8] However, criticism of the program led to an informational hearing by the California State Committee on Higher Education, and a bill was introduced by Chris Norby to prevent California state universities from genetically testing their students.[14][15] The California Department of Public Health concluded that the program constituted clinical testing, and the university released only aggregate information instead of personal results.[16][17]

As described in the preceding section, in some courses on personalized medicine, students have been able to study their personal genetic information. For the Stanford course, which was designed for graduate and medical students, a review was conducted in 2009-2010 by a “joint genotyping task force” including research and clinical faculty, biomedical ethicists, genetic counselors, and legal counsel.[4][12] The recommendations adopted included: making genetic testing optional (with instructors blinded to the choice of the students), strict data confidentiality (only aggregate data was made available during discussions), incorporation of lectures discussing issues related to personal genotyping, and availability of genetic counseling to students if necessary.[4]

See also

References
  1. Lamb, N. E.; Myers, R. M.; Gunter, C. (2009). "Education and personalized genomics: Deciphering the public's genetic health report". Personalized Medicine. 6 (6): 681–690. doi:10.2217/pme.09.57. PMC 2821046. PMID 20161675.
  2. Salari, K. (2009). "The Dawning Era of Personalized Medicine Exposes a Gap in Medical Education". PLOS Medicine. 6 (8): e1000138. doi:10.1371/journal.pmed.1000138. PMC 2719811. PMID 19707267.
  3. McKinnon, R.; Anderson, C. (2011). "Transforming Pharmaceutical Education to Accelerate the Acceptance and Implementation of Personalized Medicine". American Journal of Pharmaceutical Education. 75 (6): 107. doi:10.5688/ajpe756107. PMC 3175667. PMID 21931445.
  4. Salari, K.; Pizzo, P. A.; Prober, C. G. (2011). "Commentary: To Genotype or Not to Genotype? Addressing the Debate Through the Development of a Genomics and Personalized Medicine Curriculum". Academic Medicine. 86 (8): 925–927. doi:10.1097/ACM.0b013e3182223acf. PMID 21795901.
  5. Robertson, J. A. (2003). "The $1000 Genome: Ethical and Legal Issues in Whole Genome Sequencing of Individuals". The American Journal of Bioethics. 3 (3): 35–36. doi:10.1162/152651603322874762. PMID 14735880. S2CID 15357657.
  6. Thurston, V. C.; Wales, P. S.; Bell, M. A.; Torbeck, L.; Brokaw, J. J. (2007). "The Current Status of Medical Genetics Instruction in U.S. And Canadian Medical Schools". Academic Medicine. 82 (5): 441–445. doi:10.1097/ACM.0b013e31803e86c5. PMID 17457062.
  7. Kathryn Roethel (July 12, 2010). "Stanford genotype class asks: What's your type?". SFGate. Retrieved 14 May 2013.
  8. Ferris Jabr (September 24, 2012). "Exposing the Student Body: Stanford Joins U.C. Berkeley in Controversial Genetic Testing of Students". Scientific American. Retrieved 14 May 2013.
  9. Vernez, S.; Salari, K.; Ormond, K. E.; Lee, S. S. O. J. N. (2013). "Personal genome testing in medical education: Student experiences with genotyping in the classroom". Genome Medicine. 5 (3): 24. doi:10.1186/gm428. PMC 3706781. PMID 23510111.
  10. "Student Physician, Sequence Thyself". Genome Web Daily News. October 10, 2012. Retrieved 14 May 2013.
  11. Monya Baker (October 11, 2012). "Personal genomics in the classroom: Students sequence themselves". Nature News Blog. Retrieved 14 May 2013.
  12. "A DNA education". Nature. 465 (7300): 845–846. June 16, 2010. Bibcode:2010Natur.465R.845.. doi:10.1038/465845b. PMID 20559338. Retrieved 14 May 2013.
  13. Tamar Lewin (May 18, 2010). "College bound, DNA swab in hand". Nature. Retrieved 14 May 2013.
  14. Rachel Gross (August 11, 2010). "UC Berkeley DNA testing goes before state committee". Berkeleyside. Retrieved 14 May 2013.
  15. "California Legislation Seeks to Bar UC Berkeley's Genetic Testing Plans". Genome Web Daily News. July 14, 2010. Retrieved 14 May 2013.
  16. Alla Katsnelson (August 12, 2010). "State halts UC Berkeley's gene testing plans". Nature News Blog. Retrieved 14 May 2013.
  17. Gina Shaw (February 2012). "The Right Type: Personal Genetic Testing in the Medical School Curriculum". AAMC Reporter. Retrieved 14 May 2013.
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