As a researcher at the Broad Institute in Cambridge, MA, I have a front row seat to the rapidly evolving field of medical genetics. If my time at the Broad has taught me anything, it’s this: the future of medicine is personalized. However, our education system for medical trainees lags behind what is necessary for an accelerated adoption of precision medicine into the clinic. A more thorough training in medical genetics would better prepare aspiring physicians to function in a changing, advancing healthcare landscape, and could help usher in a new era of more effective, precision medical treatments.
Precision medicine is a term encompassing any therapeutic strategy that is designed to treat a specific patient population based on their genetic or molecular profile. The concept seemed especially promising after the completion of the Human Genome Project in 2003, and since then, great effort and billions of dollars have been funneled into pursuit of its actualization.
The future of precision medicine looks bright, particularly for certain applications. Cancer patients, for example, are increasingly likely to benefit from sequencing of their tumor as more variants become actionable. Currently, there are specific mutants in at least 14 genes that are used to guide treatment decisions for various types of cancer, and many other gene targets look promising.1 Rare diseases are also becoming understood through the lens of genetics, resulting in greater rates of diagnosis and treatment for such patients.2 And for more common diseases with multiple molecularly-distinct pathways, there may be opportunity for targeted routes of treatment. Cystic fibrosis is one noteworthy example, with about 60% of patients now treatable by molecularly-targeted therapeutics. Given the progression of precision medicine research across a range of disease areas, it seems likely that physicians of many specialties will be able to make use of clinical sequencing data to guide treatment decisions in the future.
We will rely in large part upon the efforts of clinicians as precision medicine is introduced into new areas of medical practice. In many stages of the genomic medicine research process, from the collection of patient data to the testing of newly-developed therapeutics, physicians are key partners of scientists and pharmaceutical companies. Much remains to be learned in the arena of precision healthcare, and as such, the need for doctors that are competent in genetics and enthusiastic about its potential to transform disease treatment has never been greater.
Unfortunately, many medical colleges overall do not train their students well enough for a future of healthcare in which genomics plays a major role. A 2016 study of the Icahn School of Medicine at Mount Sinai revealed that 94% of students felt that their medical education had inadequately prepared them to practice personalized medicine.3 This shockingly large percentage draws attention to the need to make genomics and precision medicine core competencies in medical training.
Encouragingly, certain American medical colleges have made appropriate changes to their curricula to reflect a heightened need for genetics training, and they may serve as models for other programs. One standout example is the curriculum introduced by Johns Hopkins University in 2009 entitled “Genes to Society”, which prompts students to think about human disease in the context of individual variation at multiple levels, including genetics.4 Other schools have demonstrated an interest in furthering medical students’ genomics understanding as well: Tufts School of Medicine has updated its coursework to include clinically-relevant genetics concepts such as direct-to-consumer test interpretation, DNA diagnostics, and cancer genetics. Stanford University has recently launched a more flexible program to allow medical students time to conduct research, with the goal of furthering the school’s “precision health vision”.5 Medical schools nationwide would benefit from a restructuring of their programs to follow the lead of these examples.
If genetics is to be reframed as a priority in medical training, this should also be reflected in the requirements for medical school applicants. Premed requirements for genetics knowledge are surprisingly minimal at present. Of all medical colleges in the US, only a few include an undergraduate course in genetics as a prerequisite for applicants. Genetics is listed as a recommended course for prospective applicants by only a fraction of schools. While the Medical College Admissions Test (MCAT) does include content on the basics of genetics, there is no explicit requirement for examinees to demonstrate understanding of genetics in the context of human disease. With genomics becoming increasingly relevant in clinical practice, such minimal genetics education seems wholly inadequate as preparation for medical school and beyond.
In my opinion, genomics should be deeply integrated into a premed’s concept of medical practice well before they enter any medical school classroom. Genetics must take a central seat in premed education, on par with the current standing of general biology, chemistry, and physics. Medical schools should minimally require of their applicants an undergraduate course in genetics, and the MCAT should include genetics concepts that exceed the bare bones. Correspondingly, undergraduate institutions should offer courses that prepare students to meet such requirements, helping them to understand genetics in the context of disease and therapeutics.
With a more intensive education in genetics from undergrad to medical school, our future physicians can become effective partners in the push toward precision medicine. As individuals who are passionate about patient care, this should be a priority: the future of healthcare is personalized and better for patients, and we ought to be committed to accelerating its arrival.
References
1. Hyman DM, Taylor BS, Baselga J. Implementing Genome-Driven Oncology. Cell. 2017;168(4):584-599.
2. Dawkins HJS, Draghia-Akli R, Lasko P, et al. Progress in Rare Diseases Research 2010-2016: An IRDiRC Perspective. Clin Transl Sci. 2017;11(1):11-20.
3. Eden C, Johnson KW, Gottesman O, Bottinger EP, Abul-Husn NS. Medical student preparedness for an era of personalized medicine: findings from one US medical school. Per Med. 2016;13(2):129-141.
4. Weiner CM, Thomas PA, Goodspeed E, Valle D, Nichols DG. “Genes to society”–the logic and process of the new curriculum for the Johns Hopkins University School of Medicine. Acad Med. 2010;85(3):498-506.
5. Greicius, Julie. “New Med School Curriculum Expands Opportunities for Research, Learning.” News Center, Stanford Medicine, 12 Sept. 2018, med.stanford.edu/news/all-news/2018/09/new-med-school-curriculum-expands-opportunities-for-research.html.
Julia Bauman recently received a B.S. in Neurobiology from the University of Washington, Seattle and is currently a research associate at the Broad Institute of MIT and Harvard. She plans to pursue an M.D./Ph.D. in the future.