1991: The Association of American Medical Colleges maintains a data base on courses offered at all U.S. medical schools. A review of curricula for 1992 shows that in terms of courses required, more medical schools are including human and medical genetics in their curriculum (AAMC, 1991).

During 1991-1992, 79 of 126 medical schools (63 percent) required a human or medical genetics course. Of these, 70 percent required the course in the first year and 30 percent required it in the second year. The number of hours spent in the course ranged from 4 to 74, with the average course entailing 30 hours.

ident should possess in dealing with prenatal genetic counseling. The resident was expected to be able to discuss the principles of and give examples for Mendelian inheritance, define multifactorial inheritance, understand and be able to discuss chromosomal anomalies, obtain a genetic history and construct a family history chart, know the indications for amniocentesis, discuss the principles of cell biochemical analysis for the detection of inborn errors of metabolism, discuss maternal serum alpha-fetoprotein (MSAFP) screening, and discuss the value of population screening for genetic disorders as well as the prerequisites for such a screening program (CREOG, 1984). In June 1992, CREOG issued its revised core curriculum, including requirements for genetic counseling, which includes much more detailed and extensive knowledge and skills in genetics required for obstetrics-gynecology residents (CREOG, 1992) (see Box 6-7).

The Association of Professors of Gynecology and Obstetrics (APGO) proposed similar standards in its 1992 Guide to Basic Science Prerequisites to a Clerkship in Obstetrics and Gynecology to assist basic science departments of medical schools with developing essential curricular materials (APGO, 1992). The recommended proficiencies essential to genetics are listed in Table 6-6.

Continuing Medical Education

Continuing education credits for physicians wanting to learn more about medical genetics have been in existence for some time. Many medical centers offer courses, as do specialized centers such as the Jackson Memorial Laboratories in Bar Harbor, Maine, and the annual March of Dimes birth defects meetings. Such courses could also help to attract human and molecular geneticists into clinical genetics. The effects of such training on changes in clinical genetics practice are not known.

Physicians can also voluntarily engage in self-assessment activities in specific disciplines. For example, the American College of Physicians (ACP) offers a Medical Knowledge Self-Assessment Program in Genetic and Molecular Medi-



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