Letters to the Editor _ HUMAN GENETICS HEOUCATION
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Am. J. Hum. Genet. 47:750-752, 1990
Physicians and Other Nongeneticists Strongly Favor Teaching Genetics to Medical Students in the United Kingdom To the Editor:
It has been hard to convince medical schools in the United States and the United Kingdom that adequate genetics should be taught to medical students. A recent survey carried out by the Royal College of Physicians (RCP) in England suggests that things may be about to change for the better (Harris et al. 1990). (This report, "Teaching Genetics to Medical Students,' contains the scores given by nongeneticists to 14 genetic skills and 25 curriculum topics, recommendations including a clinical syllabus, and the aims of a Genetic Education Task Group. For details of the full report, please contact The Publications Department, Royal College of Physicians, 11 St. Andrews Place, Regents Park, London NW14LE, England.) Two years ago Riccardi and Schmickel (1988) found that nearly half of U.S. schools probably had nonexistent or poor human genetics teaching. In the United Kingdom, medical education is arranged differently in that students generally arrive in first year directly from secondary school -allowing, in theory, greater potential for longitudinal integration ofpreclinical and clinical teaching. However, there was little to suggest that this resulted in better genetics teaching, according to data collected for more than 10 years by the General Medical Council (GMC), the body set up by the Act © 1990 by The American Society of Human Genetics. All rights reserved. 0002-9297/90/4704-0024$02.00
750
of Parliament in 1858 for the regulation of the medical profession in Britain. The GMC, in reviewing the teaching to clinical and diagnostic disciplines in British medical schools for the academic year 1984-85, found major deficiencies in teaching genetics in some of the 19 schools that responded (General Medical Council Education Committee 1988). In 1988-89 a working party of the RCP (London) investigated genetic teaching by writing to all 28 British medical schools. Full cooperation and complete data were received from all schools, and these confirmed that the GMC findings were still valid. There was very variable teaching of genetics, including a range of 2-66 h (mean 20 h) preclinical and 5.5 h timetabled clinical teaching. Teaching was given by many different departments and was generally of unknown quality or clinical relevance. The survey was extended to 429 individual preclinical and clinical teachers in the main subjects and specialties. Each received two questionnaires asking them to rate, on a five-point scale, 25 possible topics for a genetic core curriculum and 14 genetic skills to be possessed by new medical graduates. A total of 61% replied, and their responses were consistent with a sample of 14 individuals who only replied to a reminder. Analysis showed strong and consistent support for a genetic curriculum and for the development of genetic skills by medical graduates. Thus 19 of the 25 preclinical topics were considered "valuable/obligatory" by two-thirds or more of respondents (table 1), and none of these topics was rejected as "of little value/not required" by more than 10%. The average percentage of respondents giving "valuable/obligatory" to the top 19 topics was
751
Education Section Table I Respondents' Views on Genetic Topics
% of Respondents Awarding "Valuable/Obligatory" Score
Topics
Patterns of inheritance, genetics of common disease, chromosome structure and function, medical applications of molecular genetics, prenatal diagnosis, and malformations ..... .............. >90 Genetic counseling, cell division, chromosome aberrations, sex determination, prevention of genetic disease, inborn errors of metabolism, structure of human genome, and mutations ............. 81-90
Immunogenetics/HLA and linkage . ................................................... 61-70 Population genetics, risk calculation, protein synthesis, gene mapping, and twinning
71-80
.............
Pharmacogenetics, genetic services and medical audit, basic molecular techniques, and karyotype preparation ............................................................
84.6%, and that for "little value/not required" was 3.7%. Of the 14 skills, 12 were considered "valuable/obligatory" by two-thirds or more of respondents (table 2), and none of these skills was rejected as "of little value/not required" by more than 10%. The average percentage of respondents giving "valuable/obligatory" to the top 12 skills was 82.5%, and that for "of little value/not required" was 5.0%. Medicine is exposed as never before to new clinical discoveries and new technologies, including the use of recombinant DNA. Doctors can no longer be expected to be totally familiar with all the facts and skills that are necessary for their patients' care. Greater technical complexity has also brought greater involvement of scientists and other paramedical professionals with
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Am. J. Hum. Genet. 47:750-752, 1990
Physicians and Other Nongeneticists Strongly Favor Teaching Genetics to Medical Students in the United Kingdom To the Editor:
It has been hard to convince medical schools in the United States and the United Kingdom that adequate genetics should be taught to medical students. A recent survey carried out by the Royal College of Physicians (RCP) in England suggests that things may be about to change for the better (Harris et al. 1990). (This report, "Teaching Genetics to Medical Students,' contains the scores given by nongeneticists to 14 genetic skills and 25 curriculum topics, recommendations including a clinical syllabus, and the aims of a Genetic Education Task Group. For details of the full report, please contact The Publications Department, Royal College of Physicians, 11 St. Andrews Place, Regents Park, London NW14LE, England.) Two years ago Riccardi and Schmickel (1988) found that nearly half of U.S. schools probably had nonexistent or poor human genetics teaching. In the United Kingdom, medical education is arranged differently in that students generally arrive in first year directly from secondary school -allowing, in theory, greater potential for longitudinal integration ofpreclinical and clinical teaching. However, there was little to suggest that this resulted in better genetics teaching, according to data collected for more than 10 years by the General Medical Council (GMC), the body set up by the Act © 1990 by The American Society of Human Genetics. All rights reserved. 0002-9297/90/4704-0024$02.00
750
of Parliament in 1858 for the regulation of the medical profession in Britain. The GMC, in reviewing the teaching to clinical and diagnostic disciplines in British medical schools for the academic year 1984-85, found major deficiencies in teaching genetics in some of the 19 schools that responded (General Medical Council Education Committee 1988). In 1988-89 a working party of the RCP (London) investigated genetic teaching by writing to all 28 British medical schools. Full cooperation and complete data were received from all schools, and these confirmed that the GMC findings were still valid. There was very variable teaching of genetics, including a range of 2-66 h (mean 20 h) preclinical and 5.5 h timetabled clinical teaching. Teaching was given by many different departments and was generally of unknown quality or clinical relevance. The survey was extended to 429 individual preclinical and clinical teachers in the main subjects and specialties. Each received two questionnaires asking them to rate, on a five-point scale, 25 possible topics for a genetic core curriculum and 14 genetic skills to be possessed by new medical graduates. A total of 61% replied, and their responses were consistent with a sample of 14 individuals who only replied to a reminder. Analysis showed strong and consistent support for a genetic curriculum and for the development of genetic skills by medical graduates. Thus 19 of the 25 preclinical topics were considered "valuable/obligatory" by two-thirds or more of respondents (table 1), and none of these topics was rejected as "of little value/not required" by more than 10%. The average percentage of respondents giving "valuable/obligatory" to the top 19 topics was
751
Education Section Table I Respondents' Views on Genetic Topics
% of Respondents Awarding "Valuable/Obligatory" Score
Topics
Patterns of inheritance, genetics of common disease, chromosome structure and function, medical applications of molecular genetics, prenatal diagnosis, and malformations ..... .............. >90 Genetic counseling, cell division, chromosome aberrations, sex determination, prevention of genetic disease, inborn errors of metabolism, structure of human genome, and mutations ............. 81-90
Immunogenetics/HLA and linkage . ................................................... 61-70 Population genetics, risk calculation, protein synthesis, gene mapping, and twinning
71-80
.............
Pharmacogenetics, genetic services and medical audit, basic molecular techniques, and karyotype preparation ............................................................
84.6%, and that for "little value/not required" was 3.7%. Of the 14 skills, 12 were considered "valuable/obligatory" by two-thirds or more of respondents (table 2), and none of these skills was rejected as "of little value/not required" by more than 10%. The average percentage of respondents giving "valuable/obligatory" to the top 12 skills was 82.5%, and that for "of little value/not required" was 5.0%. Medicine is exposed as never before to new clinical discoveries and new technologies, including the use of recombinant DNA. Doctors can no longer be expected to be totally familiar with all the facts and skills that are necessary for their patients' care. Greater technical complexity has also brought greater involvement of scientists and other paramedical professionals with
