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Stanford to Genotype MD/PhD Students for Pilot Elective Genetics Course

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Originally published June 8.

By Turna Ray

Stanford University announced it will begin offering its MD/PhD students the opportunity to learn about genomic medicine from their own genotype data as part of new elective course being offered during the summer quarter beginning June 21.

“In a step toward preparing physicians and biomedical researchers for a future where genomic testing increasingly becomes part of medical care, the Stanford University School of Medicine is offering a new course in which medical and graduate students will be given the option of studying their personal genotype data,” the university announced this week. “The students will learn how to analyze, evaluate and interpret the genetic data, the limitations of the existing technologies, and the legal and ethical issues raised by personal genotyping.”

UC Berkeley last month announced its plan to launch a voluntary program this fall that will test students in the Class of 2014 for three genes involved in the metabolization of alcohol, lactose, and folates. The announcement was criticized by genetics groups and others who felt that the program was premature in the face of increasing regulatory scrutiny of the marketing practices of direct-to-consumer genomics firms (PGx Reporter 05/26/10).

At the time UC Berkeley announced its plans, Russ Altman, professor of bioengineering, genetics, and medicine at Stanford, lauded the effort and hinted that Stanford might be moving forward with a similar plan.

According to Stanford officials, the university course is the first of its kind. However, it seems that the University of Pennsylvania School of Medicine offered its fourth-year medical students a similar course in personalized medicine this past year. At UPenn, students were offered the chance to have their genomes scanned for free by the Coriell Personalized Medicine Collaborative, and the course engaged students in a discussion of the ethical, legal, and social implications of personalized medicine.

Similarly, SUNY Upstate Medical University has been offering a course on personalized medicine, called "Personalized Medicine 101: Digitizing Diagnosis for Doctors," which also offers students genetic testing opportunities and discussion of related issues. According to Bob West, SUNY associate professor, the university offered this course for the first time in October 2009. First, second, and fourth-year medical students may enroll in this course.

At Stanford, the decision to offer the course was not taken lightly. An initial proposal that would have required students to be genotyped by commercial labs as part of the course was put on hold until a task force, involving members of the basic science faculty, clinical faculty, bioethicists, education officials and students, could mull the ethical issues involved in introducing such a class.

“The question of whether to offer personal genotyping to students has undergone a yearlong, vigorous debate by a medical school task force, with organizers addressing concerns raised by members of the group,” the university said in a statement. While not all task force members supported the implementation of such a class, the majority supported the idea as long as there were safeguards built in to protect the privacy of participating students.

The precautionary measures implemented by the course organizers include: Offering the course as an elective; making genetic testing optional for those enrolled in the course; giving students the option to use their own data or publicly available data for class exercises without professors' knowing which they used; and making counseling available for students with questions about their genomic data.

These measures were implemented in an effort not to “coerce” patients in having to be genotyped, and to minimize the risk that students might learn troubling data about themselves.

The course was developed by sixth-year MD/PhD student Keyan Salari, who will also serve as the course director. The faculty advisor for the course is Stuart Kim, professor of developmental biology and genetics.

Salari felt it was “important to help Stanford's medical and graduate students gain greater insight about the complexities of genetic testing and how these data will be used in the future to prevent disease and tailor specific treatments for patients.”

Students enrolling in the eight-week elective course this summer will meet once a week. The first two classes will focus on the legal, ethical and social implications of genetic testing, and familiarize students with different commercially available tests.

At the completion of the second session, students will decide whether to get genotyped either by Navigenics or 23andMe, two labs with licenses to operate in California. Both companies will offer the school “an educational rate” for their gene scans, part of which will be paid by the school, and the student will be asked to contribute $99.

The student co-pay is an attempt to avoid “the financial inducement of getting a 'free' test,” the university explained in a statement.

The last month and a half of the course will engage students in lectures, journal clubs, and hands-on workshops. Students will explore how personal genomics can be applied in medical decisions, aging, ancestry, and drug response.

Professors involved with the program expect approximately 50 students to sign up for the class. The university will interview students before and after the course to determine its successes and failures; additionally, participating faculty members will also be polled. “Whether the course is offered again depends on the feedback received,” the university said.

With UC Berkeley and Stanford having launched hands-on genetic testing programs for their students, Duke University might be next. Although Duke has not announced any formal plans toward this end, the university has "slated a discussion of the 'Berkeley experiment' in order to assess what interest or value the students would attach to such an exercise," according to Huntington Willard, director of the Institute for Genome Sciences and Policy at Duke University, who has spoken to Pharmacogenomics Reporter in the past.

In a recently released draft report on how to enhance genetic education of doctors, the HHS Secretary's Advisory Committee on Genetics, Health, and Society recommended that HHS convene a workshop to identify innovative education and training approaches to integrate genetics and genomics into clinical care.

In the report, the SACGHS task force reviewed the educational gaps with regard to genetics and found that institutions that train health care professionals do not have sufficient faculty with genetic training to teach basic genetics or its applications to patient care, and that even when students receive genetics instruction as part of their basic science training their clinical training often does not incorporate genetic perspectives. Overall, the task force found that “genetics instruction is poorly integrated into all relevant courses.”

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