A Practical Approach to Teaching Genomics for the Primary Care APN

Gary Laustsen, FNP-BC, RN, PhD

Disclosures

April 18, 2011

In This Article

Integrating Genomics Into the APN Curriculum

In some programs, the APN curricula may already be credit heavy or the school may not have faculty with the appropriate expertise to offer a unique genomics course. For these and other reasons, program faculty may elect to incorporate genomics content into existing courses. As a part of meeting accreditation and national standards, all APN programs are required to have students take courses in the "3-P's": advanced physical assessment, pathophysiology, and pharmacology. These courses and others can provide opportunities for student learning or activities related to genomics.

Advanced Physical Assessment

Advanced physical assessment orients the APN student in the skills and knowledge of acquiring patient subjective and objective data. An important skill generally presented and practiced in an advanced physical assessment course is the gathering of a detailed health history. Assessing a patient's health history can provide information in regard to current genetic-related conditions, potential pharmacogenetic considerations, and identify risks for potential heritable disorders. A possible course activity that relates genomics and health history is the creation of a patient pedigree (genogram): a member of the student's family or on an actual patient. A number of useful resources are available on the Internet that facilitate the student's creation of a patient or family pedigree. The US Department of Health & Human Services has developed an online tool, My Family Health Portrait for helping individuals create and share their family pedigrees, and there are other online sources for creating a family pedigree such as Family Tree Builder.

Advanced physical assessment also offers the APN student a chance to learn and develop relationships with other professionals involved in genomics assessment. Students can be introduced to this experience by inviting a genetic counselor to class. If the class is offered in a distance education format, the students could locate and meet with a nearby genetic counselor. With a guided learning activity, the student can develop an understanding of the professional role and relationship of a genetic counselor within the healthcare arena.

Advanced Pathophysiology

Advanced pathophysiology courses also offer appropriate forums for disseminating genomics content. APN students should have a basic understanding of molecular genetics, and most pathophysiology texts contain material on this topic. Throughout the pathophysiology course, genomic implications of specific diseases can be examined as they relate to epidemiologic factors (incidence, prevalence), physical symptomatology, and treatment options. To promote a practical application, students can be assigned to present case studies (see above) that relate genomic influences to a specific patient's disease manifestation and treatment plan.

The increased availability of direct-to-consumer genetic testing offers the advanced pathophysiology student an opportunity to analyze the influence of these tests in patient care. Students could be assigned in teams to develop a learning module or presentation to share with other course members that addresses the following aspects of specific direct-to-consumer tests:

  • Conditions test is designed to evaluate;

  • Sensitivity and specificity of test;

  • Evidence of efficacy of test;

  • Critique of information provided to consumer with test; and

  • Costs to consumer (insurance vs out-of-pocket).

A final practical activity related to genomics and advanced pathophysiology would be for the students to explore the workings of a laboratory's genetic testing routine. As future providers, the APN may be responsible for ordering genetic tests. Becoming familiar with proper test selection, specimen collection, and specimen transfer to the laboratory may help the future provider develop a more effective patient genetic testing process. The laboratory personnel may also be able to assist the student in understanding the reported results of genetic tests.

Advanced Pharmacology

The advanced pharmacology course provides an ideal forum for helping APN students develop an understanding of genomic influences in patient care. Pharmacogenomics is a rapidly developing science that examines how an individual's genetic inheritance affects that person's response to drugs. Information from the Human Genome Project has identified the following as potential benefits of pharmacogenomics.

  • More powerful medicines;

  • Better, safer drugs for initial drug therapy;

  • More accurate determination of appropriate drug dosage;

  • Advanced screening for disease;

  • Better vaccines; and

  • Potential to reduce adverse drug reactions and healthcare costs.[7]

The faculty teaching advanced pharmacology can develop activities that challenge students to apply pharmacogenomic knowledge to patient care. One activity is to ask students to create a list of drugs that are known to have pharmacodynamic variations. Another application activity would be to have students practice dosage adjustments of medications on the basis of presented genetic testing results. Faculty may also find within their local or regional universities pharmacogenomic researchers who could share their work through guest lectures or taped presentations.

In addition to the previously identified courses, genomic knowledge may be threaded through APN programs by incorporating various genomic aspects into other courses. Ethical issues are an important consideration in applying genomics to patient care. The complex dynamics from an individual's decision to get genetic testing and how that may influence other family member's health decisions is one aspect of ethics and genomics. APN students should also be aware of the financial implications of applying genomics in healthcare practices. Costs of the specific genetic tests and the approval process for insurance reimbursement are other aspects that could be explored.

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