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

Discussion

Pharmacogenomics has been a subject of interest for pharmaceutical and medical educators for over a decade. Several health science universities started implementing clinical pharmacogenomics courses in their curriculum with some minor success.[7] Indeed, many studies have shown that medical and pharmacy students are not certain about including pharmacogenomics in their future practices despite having some knowledge in this area.[4,5,7]

We used an innovative approach to teaching pharmacogenomics. Our approach combined the benefits of a flipped classroom, standard lecture, patient care laboratory, and personal genetic data to increase student competencies in pharmacogenomics. The flipped classroom focuses on critical thinking, independent active learning, and engaged discussions among students with teachers. For example, during the student-led discussions, one member of the class volunteered a personal family history related to heart disease and nonresponse to clopidogrel following surgery. Genetic analysis showed that the student was a CYP2C19 poor metabolizer, which could explain the inefficacy of clopidogrel. Another student discussed their complicated response to antidepressants that may have been related to their CYP2D6 metabolism status. Such real-life examples from students are very helpful in demonstrating relevance to this topic.

This kind of comprehensive approach has previously been shown to increase student learning outcomes and competencies.[8] Similar studies have been performed in elective courses and in postgraduate programs (eg, MS degree, postgraduate residency) with only a portion of the class.[3,9,10] In contrast, our study included an entire class of PharmD students who were participating in required courses. By selecting the whole class for the study, we minimized the potential biases and overestimations that can result from using only highly motivated students who sign up for an elective course and may already have strong feelings about the subject.

Expanding pharmacogenomics education, using various delivery approaches, has been explored to improve patient care using therapeutic regimen optimization based on genetic makeup. Furthermore, several published studies have not assessed competency,[9,11] whereas our current study tried to implement several learning processes including personal genetic testing to simulate real-life scenarios of patient care.

Our data supports that the combination of several activities improves students' confidence and comfort with implementing pharmacogenomics in their training and future practice. This improvement clearly increased with the addition of students' personalized analyses of their own pharmacogenomic results as reflected by the positive shift in responses from the pre-survey to the post-survey. Providing students the opportunity to voluntarily share personal anecdotes related to gene-drug pairings with their classmates was valuable in helping them to understand the relevance and clinical utility of pharmacogenomics. With respect to assessment, participant examination performance improved compared to that of the previous years of cohorts of students that did not have this activity but had all other content delivered in the same way.

Analyzing and discussing their own pharmacogenomic results in relation to different gene-drug pairs and by counselling each other, students' interest and level of confidence in incorporating this material into their future practice increased. Similar results have been observed in other studies,[11,12] although they used other approaches to teaching pharmacogenomics. In agreement with several studies,[2,3,10] competencies and learning outcomes related to pharmacogenomics have seen the greatest improvement for the majority of surveyed questions in our study.

Responses to the last set of questions in the pre-survey, before students had taken the course, clearly demonstrated that they were aware of the importance of pharmacogenomics to the future of pharmacy practice. This awareness of the importance of pharmacogenomics increased after participating in the study as shown by student responses on the post-survey. Indeed, our results indicated that pharmacy students at the MCW School of Pharmacy are strongly considering using pharmacogenomics testing to alter and optimize patients' therapies. Given that the demographics of our pharmacy students are comparable to those of other pharmacy students, one might anticipate similar results if this approach was replicated.

In agreement with recent publications,[4,9] our study provides a foundation that introducing pharmacogenomics as described, may have a positive impact on students' readiness to use pharmacogenomics in their future clinical practice. Based on these study findings, we are planning to expand our pedagogical approach to pharmacogenomics instruction to all future pharmacy students. We plan to keep surveying student pharmacists to assess the evolution of their attitudes toward and perceptions about pharmacogenomics counseling throughout the PharmD curriculum.

The six students who declined to participate in the pharmacogenomic testing were provided a mock report that enabled them to participate in class similarly to the other students. Their survey data were relatively similar to that received by the rest of the class in their reports, suggesting that participation albeit not from a personal pharmacogenomic assay, did have an impact on students' perceptions about incorporating pharmacogenomics in their learning.

There are some limitations of our work. Given the nature of the pre- and post-surveys administered to students, there is the possibility that response-shift bias occurred that may have resulted in inaccurate pretest ratings. One approach to reducing response shift bias is to ask subjects to reassess their judgment of their pre-program level of functioning following the post-survey. Unfortunately, a "retrospective-pretest" following the post-survey was not performed in this study.

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