The University of Miami is vetting applications from first-year medical school students for a novel master's degree program that aims to teach future doctors how to understand and use patients' genomic information to personalize care.
According to the institution, this is the first time a university has launched a master's degree option in genomic medicine. Students picked for the program will earn their master's certification in the discipline at the same time they complete medical school. The purpose of the effort, said program director William Scott, is to prepare physicians on how to apply genomic information to inform their diagnosis and treatment of patients.
The master's degree program "grew out of our recognition that it was difficult to incorporate enough of this information in the traditional medical curriculum," said Scott, vice chair of education at the university's human genetics department. Scott said that the faculty will vet applications from first-year medical students and pick "only those who are most interested" in learning about genomic medicine.
"In essence we're trying to find the future leaders for incorporating this information into practice," he said.
The program is supported by a $100,000 grant from the John T. and Winifred Hayward Foundation. Classes will begin in January. After four years, when students graduate medical school, those who have taken courses on genomics and personalized medicine through this program will also receive a Master of Science in Genomic Medicine.
Most medical school curricula are structured so students learn the information necessary to pass their medical board exams. So students enrolled in regular medical school courses at the University of Miami's Miller School of Medicine already gain a baseline understanding of the role of genetics in the pathophysiology of diseases.
"The purpose of this [genomic medicine master's] program is to more thoroughly introduce them to how genomics can be incorporated into treatment decisions beyond what they learn in the medical curriculum," Scott said. "So, it's a more extensive education in those areas."
Students enrolled in the master's degree track will receive about four weeks of genetics instruction in the fall of their first year that will teach them the basic concepts. Then throughout their four years at the school, they will simultaneously take genomics courses that parallel the medical systems they are learning about in their regular medical school classes. "If they are studying neurology, for example, then we would provide genomic medicine topics in neurology in the [master's degree] curriculum at the same time," Scott said.
Genomic medicine master's degree students also take additional courses exploring ethics and policy debates in genomic medicine, learn about pharmacogenetics, participate in a rotation through clinical genetics laboratories, and take a course on bioinformatics so they can understand how data from the lab are interpreted and associated with patients' health conditions.
Finally, they also have to complete a project with a research mentor where they apply genomic information in a clinical setting. After completing their practicum experience, students present and defend their paper on the project before their peers and university faculty.
The University of Miami is currently implementing an electronic medical records system, which, when completed, will open up opportunities for physicians and students to look at patients' genomic data in the context of their family and medical history. "That is part of the genomic medicine practicum, as well as in the clinical lab rotation, because there are things that students would do in the lab that would be tied to decision support. So, that's all part of what's being developed," Scott said.
For academic physicians, the University of Miami is also trying to keep them up to date on genomic medicine through grand rounds and continuing medical education courses. Some of the online course modules developed for the master's degree program might be useful for practicing physicians as well.
"One of the problems we were concerned about is tacking on another degree program for students who were already very busy, and how do we get enough contact hours with the students to get them educated in genomic medicine," Scott said. "We felt one way to do this would be to provide some of the content of traditional lectures online, so students can review it at their own pace … We provide content that way and then reinforce it through small group, case-based learning in our in-person sessions."
Scott noted that this teaching model has been tried throughout the medical school and it seems to be working.
Getting physicians "genomic medicine literate" is an oft-cited barrier to the implementation of personalized medicine. Medco and the American Medical Association surveyed more than 10,000 US physicians and found that only 10 percent felt "adequately informed" about pharmacogenomic testing.
The survey, published in January in Clinical Pharmacology & Therapeutics, revealed that only 15 percent of physicians received any genomic education while at medical school, while 23 percent reported some training during postgraduate medical training. Respondents said they received information on pharmacogenomic testing from their professional colleagues (42 percent of responses), drug labels (39 percent), and the Internet (34 percent).
"Why don't we do [genomic medicine] now?" posited Scott. "One of the road blocks is that very few physicians would feel comfortable with their training in this area. That's one of the reasons we started this program because that's what physicians were telling us."
However, the few physicians interested in practicing genomic medicine are often thwarted by systemic challenges plaguing the emerging field. Battles with insurance companies reluctant to pay for genomic testing and the need to sift through the evolving evidence supporting the usefulness of available tests pose significant challenges for doctors attempting to adopt personalized medicine approaches today.
Moreover, most of these genomic tests and strategies being performed today by doctors occur in the academic setting. As such, many educators are concerned that although medical schools throughout the US may be updating their curricula to educate doctors in personalized medicine, once students step outside of academia, they won't get to apply what they've learned when they begin working in the real world.
Scott is hopeful, however, that physicians trained in genomic medicine will play a leadership role in lifting some of the barriers that have hampered broader adoption of the discipline. "Systemic changes will not happen unless we train people to do this," Scott said. "Yes, it's a concern that students might come back 10 years from now and say, 'I learned all that and I haven't used it.' But we're hopeful that we're priming the pump so they'll be ready when the field is ready for genomic medicine."