Preparing Health Professionals for Individualized Medicine

Joseph D McInerney; Emily Edelman; Therese Nissen; Kate Reed; Joan A Scott

Disclosures

Personalized Medicine. 2012;9(5):529-537. 

In This Article

Abstract and Introduction

Abstract

Genomic medicine holds the prospect of transforming clinical medicine and public health, but the current understanding of genetics and genomics among health professionals is a major impediment to the integration of genomic technologies into mainstream practice. Effective and consistent education is a central component of the translation of research into practical application. The National Coalition for Health Professional Education in Genetics (MD, USA) has more than a decade of experience in the development of educational programs that help to incorporate genomic medicine into education and practice.

Introduction

Genomic medicine has a public relations problem: proponents tout it as the prime mover in an impending healthcare revolution,[1–3] while critics dismiss it as an over-hyped, expensive enterprise that has yet to deliver even on the proximate goal of identifying clinically useful genetic variants that can guide prevention and treatment of the major causes of worldwide mortality and morbidity.[4]

The following headline from the 8 February 2012 New York Times[5] is a case in point: 'Male Genes May Explain Higher Heart Disease Risk'. The accompanying story summarizes a paper published in the 8 February 2012 Lancet,[6] which reported on two Y-chromosome variants, one of which was associated with a 50% increase in the risk of heart disease, irrespective of traditional risk factors. References to the need for confirmatory research and the development of 'a screening test' rounded out the story, making clear that the clinical utility of these data is neither certain, nor on the near horizon – a typical scenario for reportage on new findings in genomic medicine. Although some have argued convincingly that the field is held to unrealistic standards with respect to the translation of research into practice, the question persists for many: does genomic medicine matter for day-to-day care now?

A January 2012 report from the Human Genomics Strategy Group in the UK – 'Building on Our Inheritance: Genomic Technology in Healthcare' (hereafter referred to as BOI) – does not hesitate to take sides:

"Genomic technologies are more than just another innovation: they represent a major step-change in medical practice and public health. Genomic medicine is not a niche, but rather an integral part of mainstream clinical practice. This in turn means that it is essential that mainstream clinical professionals understand genomics and can use genomic technology and information effectively within their everyday working lives". [101]

If critics have failed to embrace genomic medicine because they have found progress to date lacking, healthcare providers and public health professionals have failed to embrace it largely because they are unfamiliar with its relationship to day-to-day practice and because they lack the tools – both conceptual and practical – to implement it effectively. This situation, then, essentially is a subset of the larger issue of translational research: what are the barriers and drivers associated with the transition of research from the laboratory (or field) to practical application in the clinic? Clearly, the education of health professionals to ensure they have the requisite skills and knowledge is central to any such discussion.

This perspective takes the position that there is sufficient substance to genomic medicine as it now stands to justify its integration into mainstream practice and, further, that the trajectory of genomic medicine is such that all healthcare practitioners must be acquainted with its capabilities and limitations.[1–3,7] Our objectives in that context are to: first, demonstrate that lack of genomics education for health professionals is a rate-limiting step in the integration of genomic medicine into routine practice; second, provide some lessons learned from more than a decade's experience in the development and implementation of educational programs; and third, use those lessons to help guide educational efforts yet to come.

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