Personal DNA Testing Increases Pharmacy Students' Confidence and Competence in Pharmacogenomics

Mahfoud Assem, PhD; Ulrich Broeckel, MD; George E. MacKinnon, PhD

Disclosures

Am J Pharm Educ. 2021;85(4):8249 

In This Article

Results

A total of 45 (100%) students were enrolled in both courses and 39 (89%) agreed to personal pharmacogenomic testing. Students were provided with their pharmacogenomics report for analysis and use in class discussions. The students who declined to participate in the genetic testing received mock personal genetic test results to enable them to participate fully in class discussions and not identify them as not having received a personal pharmacogenomic result. The majority of students in the study cohort were 25 years of age, female (60%), Caucasian (60%), and had a bachelor's degree (82%).

From the students' clustered pharmacogenomic data, the following genetic polymorphisms were identified and used to initiate student led discussions: CYP3A5 normal metabolizers (24% heterozygotes and 4.4% homozygotes), which are used in determining tacrolimus dosing; CYP2C9 poor metabolizers (9%), which are used in determining warfarin dosing, CYP2C19 (24.4%) rapid metabolizers, which are used in determining clopidogrel clinical response; and SLC01B1 decreased function (30%), which is used in analyzing a patient's risk of developing rhabdomyolysis while taking statins.

All 45 pharmacy students enrolled in the course completed the pre- and post-course surveys. On the first survey item, which asked about students' understanding of the risks associated with pharmacogenomics, 55.3% of students indicated on the pre-intervention survey that they had little or no grasp of this concept before the course and activities. This percentage dropped to 6.7% after completion of the course (post-survey) (Table 1). Similarly, on the second survey item which evaluated students' knowledge about the potential benefits of pharmacogenomics, students indicated their understanding increased from 62% to 94%. Furthermore, for the following set of questions relating to testing and test results interpretation in a clinical pharmacy setting, students' comprehension increased from an overall average of 32% before the course to 97% after the course (Table 1). The changes in all responses from the pre-course to the post-course survey were significant (p<.001).

The next set of survey questions investigated students' confidence in conducting different aspects of pharmacogenomics consulting (Table 2). In terms of student's confidence in consulting patients, 77.8% of students indicated on the pre-survey that they had little or no confidence in their ability to consult patients in pharmacogenomics. After the completion of the courses, this percentage dropped to 4.4% on the post-survey. Concerning the confidence to discuss results with physicians and other prescribers, student confidence increased from 22.2% to 97.8%. The last question assessed student confidence on the possibility of modifying a patient's medications based on pharmacogenomics test results. The perception jumped from 20% to 89%. Here, too, the changes in all responses from pre-to-post survey administration were significant (p<.001). The next group of three questions assessed the usefulness of pharmacogenomics testing (Table 3). While there were changes in perceptions from baseline of usefulness, they were not significant.

The final set of questions investigated students' comfort about their future readiness in pharmacogenomics prescribing, results analysis, and patients counseling (Table 4). This set was the largest in the survey and included 13 questions exploring all aspects of pharmacy practice and future specialization in the area of pharmacogenomics. Student responses improved from approximately 30% to over 90% (p<.001) on all but two of the 13 questions. The overall evaluation scores for the two questions in the pre-survey were high and the scores improved only slightly on the post-survey. These two items were question 13, "Pharmacogenomics is a useful tool that pharmacists and medical professionals can use to optimize medication efficacy and/or prevent adverse events," and question 12, "Post-graduation, I intend to read up on pharmacogenomics especially on how it influences my practice and/or specialty."

To assess objective data, in addition to the subjective results of the survey, we compared student learning outcome data from quizzes and examinations using ExamSoft for this cohort of students (class of 2022) with that of the previous two cohorts (i.e., class of 2020 and 2021) who did not participate in this new activity but did complete the identical two-course sequence, covered the same material, and had the same instructors of record. Although not significant, a trend toward improvement in overall course grades was seen when the aggregate classes were compared: 2020 class (n=43) 79% ± 7.6%, 2021 class (n=51) 79% ± 7.61%, and 2022 class (n=45) 82% ± 7.71% (Mean ± SD).

The six students who declined to undergo pharmacogenomics testing still received a mock report for analysis that contained some of the same conditions in other students. We also assessed the aggregate performance of these students compared with the rest of the class and saw a significant improvement but to a lesser extent than seen among students who participated in the testing (53% improvement vs. 60.8% in the participating group; p=.036).

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