KNOWLEDGE, SKILL SETS, AND TRAINING OPPORTUNITIES

What are the necessary knowledge and skill sets required for analyzing, interpreting, and using genomic information? The first principle Korf posited was that education and training should focus on competencies, not knowledge. The important issue should be what clinicians are able to do, not necessarily what they know.

Much of the accumulated knowledge concerning health care will be embedded into point-of-care decision-analysis tools associated with electronic medical records, Korf said. When pharmacogenetic testing is routine, clinicians will not order pharmacogenetic tests and wait for the results to decide on a drug and dosage. Instead, some sort of electronic prescribing system will search a database, find a patient’s pharmacogenetic results, and recommend the proper drug and dosage to use. Clinicians will still need to know about pharmacogenetics, but the skills they will need will be different. For example, they might need to explain to a patient why he or she is taking a drug and dosage that differ from what someone else is taking.

Given this background, the kinds of competencies that a non-specialist health provider might be expected to have will include the ability to explain the concept of carrier status and to provide a referral to a genetic counselor for additional information. He or she would also need to recognize and order tests when there are indications that the diagnosis would benefit from the use of genomic sequencing and be able to use pharmacogenetic data for guiding therapies. Other necessary competencies will include using sequencing data to formulate an individualized disease management plan and improving differential diagnoses.

Laboratory geneticists would need a somewhat different set of competencies, Korf said. These will include proficiency in the use of bio informatics tools and databases to interpret whole-genome sequencing results and the ability to annotate genomic data in the context of phenotypic information. The laboratory scientist would also need to provide clinicians with tools and genomic data interpretation that would guide clinical decision making. These lists, Korf said, provide a starting point for thinking about the competencies that different health care providers should have.

Health care competencies for genomic medicine will need to extend from pre-health professionals to the health professions. Undergraduates will need to be attracted to the field and be better prepared for their chosen health care careers by learning about subjects that they will need in the future, said Korf. In addition, genetics and genomics should be integrated into health professional education, residencies, and maintenance of certification, Korf said.

Korf described a recent effort organized by the Howard Hughes Medical Institute and the American Association of Medical Colleges in 2009



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