2-08-01

1. Update on Genetics vertical theme – Dr. Matthew Warman, Assistant Professor of Genetics and Pediatrics

Plans for Year I:

• Desire for all students to have the same minimum font of knowledge containing the vocabulary and tools that Genetics uses to study human disease, mostly basic science.

• Introduce how to take a genetic family history in Year I Physical Diagnosis.  With respect to the Genetics perspective of the family tree, possible involvement of ten teaching faculty—clinical geneticists and clinical counselors

Dr. Warman sees the direction that Genetics will take during the future as moving from rare diseases to focusing on common diseases such as mental illness, hypertension and cancer.  Genetics faculty do not want an additional hour in each organ system.  Neither do they want to subtract anything.  They have intentionally tried to focus on genetic principles during Year I.  They would also like to increase their small group format.  There are discussions to try to pool the formats for Molecular Biology and Human Genetics to result in 1) a greater number of small groups consisting of less students, and 2) more teaching faculty.

Plans for Year II (which concentrates on Pathophysiology):

The Genetics faculty want additional time to bring out key concepts of Genetics that will be reiterated throughout the curriculum.  An example would be the concept that common disease-predisposing alleles exist within the population.   These are medicine issues, not solely genetic issues.  As of 2001, there are not that many well-characterized genetic disease-predisposing polymorphic alleles, but these will certainly increase over the next decade, and it is important the physician begin learning how to incorporate them into differential diagnoses, decision making, and clinical practice.  Outside-the-core options include 1) the currently existing Alzheimer’s seminar series, and 2) using afternoons and weekends for activities that the students would be “strongly advised to attend.”  Dr. Warman summarized Year II as introducing concepts and thinking relevant to practice in Year III.

Plans for Year III:

Recommended approach for examining a patient:  1) What is genetic? and 2) Examining the family tree.  The Genetics faculty are divergent in their thinking for the Year III approach.  Genetics faculty could:

• Put material on the WWW and hope that the medical students would open and read it.  This is unlikely to happen.

• Get permission from the clerkship director to introduce a lecture on, for example, the genetics of breast cancer or colon cancer.  It is important to choose diseases that every medical student will encounter during the rotation.   The student must have a hands-on experience dealing with a real, relevant patient on the wards.  Dr. Warman offered some suggestions:  a prenatal discussion during the Obstetrics rotation, breast cancer during Internal Medicine, hypertension during Internal Medicine, colon cancer during Surgery.  Can we include a section on genetics in all student write-ups in their differential diagnosis and discussions?

• Be present when there are patient management conferences.  Dr. Warman pointed out the necessity of knowing the diagnosis in a patient-management conference before deciding if Genetics faculty needed to be there, to ensure that they could be of value.

Dr. Warman summarized Genetics goals for Year III:  1) genetic differential diagnosis, 2) core teaching, and 3) invitation to case conference management, given a realistic time frame.

Plans for Year IV:

There already is an elective in Genetics.

Two possibilities for Year IV:

• If we can assure that all Year III students can be reached during their rotations and exposed to key Genetics concepts, then the year IV elective should remain enrichment for those particularly interested in genetics.  Specialty topics, such as population genetics, biomedical ethics and genetic counseling, cancer genetics, neurogenetics, etc., could be arranged prior to beginning the elective.

• If we are not able to reach all Year III students, important concepts could be reinforced in Year IV by having special events, such as a weekend symposium where a common disease or problem would be discussed from several perspectives, including genetics, and students would be strongly encouraged to attend.  However, to make these worthwhile, the symposium and the invited speakers would need to be top notch.

One discussant recommended using fourth year students during the third year.  Fourth year students could attend medicine rounds and look for cases.  They would collect cases and tell the faculty about them.   Students would in effect be teaching faculty members.

Dr. Warman summarized the desired Genetics mission:  Accustom the medical student within his/her four years of undergraduate medical education to think of Genetics predispositions with equal importance and ease as deciding which antibiotic to prescribe for a patient.  Every family has a family tree to consider.  The student should also be familiar with diagnostic and prognostic tests.

Dr. Warman emphasized that the Genetics faculty would welcome being approached by the general faculty.  Dr. Warman is looking for paradigmatic diseases touching on many perspectives:  family, health care industry, Genetics, pathophysiology.  These need to be offered at a time convenient for the students and tailored to their level.

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