Abstract:
Purpose: Relatively little is known about how medical genetics is being taught in the undergraduate medical curriculum and whether educators concur regarding topical priority. This study sought to document the current state of medical genetics education in U.S. and Canadian accredited medical schools.
Method:
In August 2004, surveys were sent from the Indiana University School of Medicine to 149 U.S. and Canadian medical genetics course directors or curricular deans. Returned surveys were collected through June 2005. Participants were asked about material covered, number of contact hours, year in which the course was offered, and what department sponsored the course. Data were collated according to instructional method and course content.
Results:
The response rate was 75.2%. Most respondents (77%) taught medical genetics in the first year of medical school; only half (47%) reported that medical genetics was incorporated into the third and fourth years. About two thirds of respondents (62%) devoted 20 to 40 hours to medical genetics instruction, which was largely concerned with general concepts (86%) rather than practical application (11%). Forty-six percent of respondents reported teaching a stand-alone course versus 54% who integrated medical genetics into another course. Topics most commonly taught were cancer genetics (94.2%), multifactorial inheritance (91.3%), Mendelian disorders (90.3%), clinical cytogenetics (89.3%), and patterns of inheritance (87.4%).
Conclusions:
The findings provide important baseline data relative to guidelines recently established by the Association of American Medical Colleges. Ultimately, improved genetics curricula will help train physicians who are knowledgeable and comfortable discussing and answering questions about genetics with their patients.
The recent mapping and sequencing of the human genome promises to revolutionize the field of biology and the practice of medicine. All aspects of medicine and all medical specialties will ultimately benefit from and be dramatically altered by changing genetic technology. In recognizing the emerging importance of genetics in medicine, the Association of American Medical Colleges (AAMC) issued a report in 2004 entitled Contemporary Issues in Medicine: Genetics Education.1 This report, part of the AAMC's Medical School Objectives Project, outlines the core competencies in genetics that all medical students and residents should attain by the end of their training. These core competencies provide specific recommendations regarding the attitudes, knowledge, and skills pertaining to genetics that all graduating medical students should possess, as well as effective educational strategies. Korf et al2 have noted that the number of physicians entering the field of medical genetics is small and getting smaller. With rapid advances in medical genetics and with fewer physicians specializing in the field, all physicians must be better prepared to extend the revolution in genetic knowledge to patient care.
Medical schools are responsible for imparting the next generation of physicians with an adequate knowledge of medical genetics so that they can take full advantage of the coming advances in genomic-based diagnosis and treatment. However, despite the emerging importance of medical genetics in health care, there has been no systematic appraisal of what and how medical students are being taught about medical genetics. The purpose of this study was to document the content and form of medical genetics education in U.S. and Canadian medical schools.
Method:
In August 2004, we mailed questionnaires to 149 medical genetics course directors or other knowledgeable faculty, including curricular deans, at all 149 U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education. The names and addresses were drawn from individual medical schools' Web sites or the AAMC Curriculum Management and Information Tool. Because our primary interest was in undergraduate medical education, we excluded individuals whose medical genetics instruction was limited to continuing medical education classes or postgraduate training programs. Follow-up mailings were sent to all nonresponders in January 2005. Those who failed to respond to this second mailing were contacted by phone or e-mail in April 2005 and were urged to return the survey. We collected questionnaires through June 2005 at Indiana University School of Medicine.
The two-page instrument consisted of 10 questions with a check-box or fill-in-the-blank design, with one space at the end for written comments or clarifications. Participants were asked about the year of medical school in which a course was taught (first, second, third, or fourth); whether the course was stand-alone or integrated into another course; whether it was taught by a single instructor or multiple instructors; the total hours scheduled for the course (<20, 20-40, 41-60, or >60); the name of the sponsoring unit; whether board-certified geneticists were involved in teaching; the instructional formats used (instructor lectures, guest seminars, group discussions, case studies, clerkships, Web-based, or other); the principal course objective (broad survey of medical genetics concepts, critical evaluation of the scientific literature regarding basic human genetics, practical training in the use of medical genetics in general practice, or other); and the specific topics covered and the time devoted to each (selected from a checklist of 30 medical genetics topics, with space for the respondent to provide additional topics if needed). An additional question asked whether medical genetics was incorporated into third- and fourth-year clinical rotations at the participant's institution. The questionnaire was designed to be completed in 5 to 10 minutes. IRB approval was obtained for this study.
Results:
Of the 149 individuals we contacted, 114 returned completed questionnaires; of those, two replied that they were not currently teaching medical genetics topics to medical students. Because we were interested in the current state of medical genetics instruction, these two respondents were excluded from the analysis, yielding a response rate of 75.2% (112/149). As shown in Table 1, 46% (52/112) of the respondents indicated that medical genetics was taught as a stand-alone course at their medical schools, and 54% (60/112) indicated that it was integrated into other courses. Most medical genetics courses (88%, 99/112) were team taught in either the first (77%, 86/112) or second (31%, 35/112) year of medical school. These courses were of moderate duration, with nearly two thirds of the respondents (62%, 69/112) reporting 20 to 40 contact hours. However, almost one fifth (20/112) of the respondents taught courses with fewer than 20 contact hours. Clinical departments sponsored about half (55/112) of the courses taught by the respondents, with the majority of these (46/55) being sponsored by some type of genetics department or division. Twenty-nine percent (32/112) of courses were affiliated with basic science departments, and 17% (19/112) were multidisciplinary.
