Pharmacogenomics education seems to be making headway, but clinicians are bringing up the rear compared to their peers in the research lab and the pharmacy, according to experts.
When conference discussions turn to the factors slowing down personalized medicine, one issue that is always raised is the general level of education in the subject, and education for clinicians, in particular. Of the three relevant arms of medical science, "diagnostic [scientists] are getting there, pharmacists are also getting there, but the issue is that clinicians are a little more resistant," said Majiid Moridani, author of an article on pharmacogenomics in pharmacy education in a recent issue of the quarterly American Journal of Pharmaceutical Education. Moridani is also and an assistant professor at the Texas Tech University Health Sciences Center School of Pharmacy.
Underscoring gap in personalized-medicine education is a new program funded by the US National Heart, Lung, and Blood Institute to develop short courses on genomics and proteomics that will be intended largely for investigators. NHLBI is offering a total of $1.2 million over three years under the program, entitled Short Courses on Application of Genomics and Proteomics to Complex Heart, Lung, Blood, and Sleep Disorders.
There is some flexibility in which audiences the courses can teach, said Jane Ye, the NHLBI health science administrator responsible for the request for applications. "The audience can be graduate students, established [principal investigators], or clinicians that are interested in applying some basic studies or some translational studies, but this is not particularly targeted to clinicians," she said.
"Not everybody's getting continuing education in pharmacogenomics — [it] depends on the individual."
According to Ye, courses that qualify for funding under the new genomics and proteomics program will probably answer questions like: "What are the resources that [investigators] can use? What are the technologies and techniques they should learn to apply those resources to their own research?"
Moridani, who wrote his recent AJPE article on pharmacogenomics education in 2004, said the situation has not really changed since that time — clinicians still lag behind pharmacists and diagnostic scientists. The bright spot is that medical schools are incorporating some pharmacogenomics education, "so the future physicians, perhaps, [will be] more familiar with the concept," he said.
There are few studies that provide a window into the state of pharmacogenomics education. Moridani and colleagues conducted a 2004 survey (published this year) that found that 60 percent of 28 US colleges and schools of pharmacy offered at least six hours of pharmacogenomics-related courses. Some offered as many as 30 hours. David Latif and Alan McKay of Shenandoah University in Virginia reported in a separate article in AJPE that 78 percent of 41 US colleges and schools of pharmacy offered pharmacogenomics courses.
A pilot survey conducted in the summer of 2004 by David Gurwitz, director of the National Laboratory for the Genetics of Israeli Populations at Tel-Aviv University, found that only "a minority" of medical schools in Europe and North America include pharmacogenomics as part of their core pharmacology courses. Gurwitz and colleagues discuss the survey in the current print issue of The Pharmacogenomics Journal, which appeared online in April.
"It seems that medical schools in the United States are generally more open for changing the pharmacology curricula and for incorporating PGx education," said Gurwitz in an e-mail correspondence. "Indeed, the only dedicated PGx graduate program that I am aware of is being offered at [the University of California, San Francisco]," he said.
Gurwitz said that he has been adding pharmacogenomics to the curriculum at Tel-Aviv University, including four hours of education added to second-year courses in 2001, and a semester-long elective graduate course.
Gurwitz also noted "encouraging reports" on the incorporation of pharmacogenomics into medical studies in "several EU countries, as well as in Australia, Taiwan, Turkey, and Kuwait."
In contrast to newly minted clinicians, however, established clinicians receive only sporadic pharmacogenomics education, said Moridani. "Not everybody's getting continuing education in pharmacogenomics — [it] depends on the individual." But he opined that psychiatrists are likely the most open to the new techniques, due to pharmacogenomics' strong impact upon treatment in the field. Oncologists were probably next in line, Moridani said.
Several continuing medical education courses in pharmacogenomics have been made available recently. "These courses are on the increase," said Moridani. He presented a three-hour pharmacogenomics educational track lecture at the July meeting of the American Association for Clinical Chemistry, at which other speakers also held educational sessions in pharmacogenomics. "At AACC next year, the focus is going to be on personalized medicine — perhaps next year there will be a few 'Edu' tracks and minisymposia, and I will be repeating my session with an expansion on bioinformatics," he said.
(See the sidebar for further examples of CME courses in personalized medicine.)
But clinicians may not even be that serious of a bottleneck. Because pharmacists can call clinicians to question prescriptions, "there are more chances to incorporate this new information into pharmacotherapy in the future, even if physicians are resistant to use such information," said Moridani.
— Chris Womack ([email protected])
Current Continuing Medical Education Courses
|Lecture Courses||Psychiatric Genomics: Applications for Clinical Practice: Held Aug. 1 — 5, 2005, and Aug. 7 — 11, 2006, at the Mayo Clinic in Rochester, Minn. The course addresses genomic influences on the expression of psychiatric illnesses, including bipolar disorder, schizophrenia, chemical dependency, and major depressive disorder. It also presents the impact of genes on disease course, prognosis, and treatment responsiveness to somatic treatments commonly used in psychiatry.|
|Genomics in Clinical Practice: To be held October 20 — 21 at the Mayo Clinic in Rochester, Minn. The course is designed for a broad range of medical specialties, giving an overview of medical genomics and the impact of genetic testing on clinical practice.|
|Written Courses||Cancer Pharmacogenomics: Powerful Tools in Cancer Chemotherapy and Drug Development: Based on a journal article in the February issue of Oncologist by Wooin Lee, et al., the course is intended for "physicians who wish to advance their current knowledge of clinical cancer medicine in clinical pharmacology and are involved in providing patient care in a cancer care environment."|
|Clinical Relevance of Advances in Pharmacogenomics: The course is intended for physicians and other healthcare providers interested in the topic of pharmacogenomics and its impact on the management of persons with HIV/AIDS. The online test is available until July 20, 2006.|