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April 2018

Evolving Education: Education's Role in the Precision Medicine Movement
By Dave A. Buchanan, EdD, MBA
For The Record
Vol. 30 No. 4 P. 6

As health care stands in the national spotlight, it's joined by the ongoing Precision Medicine Initiative (PMI). Launched by the Obama Administration during the 2015 State of the Union address, the PMI proposes customization of health care tailored to the individual patient and seeks to dismantle the one-size-fits-all approach endemic to traditional medicine.

In this realm, genetics, environment, and lifestyle are considered important factors to health and wellness that must be tailored to the individual patient. As the initiative expands, it is important to understand its five principles:

At the helm of this contemporary approach are institutions of learning that hold the tools to transform medicine. Education, of course, must play a major role in the movement, and today's students must learn to become leaders within precision medicine. This will mean a difference in approach and thinking, construction of a new paradigm in contemporary medicine, and the establishment of training curricula that speak to informatics and customization.

Engaging and Renewing Patient-Physician Relationships
There must be a switch to a collaborative approach with a diversity of patients. Future doctors and researchers must realize that patients are indeed their own best asset, relative to their health, and must engage them in becoming active in accessing, understanding, and sharing their digital data for research. Practitioners must empower patients to realize their opportunity to influence and support their own health outcomes, as well as the outcomes of those with similar ailments.

For instance, Hackensack University Medical Center has provisions to provide individuals access to their clinical data by way of standardized application programming interfaces. This allows patients access to donate their data to support PMI-related research. According to U.S. News & World Report, medical schools must place a high value on patient-physician relationships to enable this approach. Too often, patients have complained that accessing their own private health data is difficult and at times frowned upon by health care practitioners. This must stop if patients are to become key stakeholders in research directly related to their own health. Curriculum reform in this context is necessary for charting a new course for future physicians.

According to Elaine Wallace, DO, MS, dean of the Dr. Kiran C. Patel College of Osteopathic Medicine at Nova Southeastern University, "The concept of patient as partner is a truly osteopathic concept. Patient accessibility to data is a primary requisite of this concept; however, this must be intimately coupled with another primary requisite: physician interpretation of data."

Early Focus on Informatics
For precision medicine to be successful, medical education programs must emphasize informatics. With EHR adoption legally mandated through the Affordable Care Act, the data collected in the continuum of care can "prove helpful in evidence-based decision making and in the sciences to verify or disprove existing models of theories," according to the Journal of the American Medical Informatics Association.

Rapid changes in HIT have created an increased demand for health practitioners well trained in the use of information in clinical care, relational databases, interoperability standards, and best practices. The ability to analyze large amounts of data is also a fundamental requirement, experts note. Many health care organizations have realized this need, and are currently developing new pathways into biomedical informatics field.

For example, AMIA has implemented a High School Scholars Program whose primary goal is to look beyond the traditional medical and graduate school pathways for expanding and increasing diversity in the field of health informatics. The program hopes to provide opportunities for high school students to engage in biomedical informatics research.

According to Ashley Valentine, EdD, an instructor at Bryant & Stratton College, "Reaching out to secondary school students is an excellent opportunity to increase diversity." For the Scholars Program to be successful, AMIA believes it must include high-quality student submissions and presentations, significant engagement from students and mentors, cross-institutional and cross-organizational collaboration, and financial support from universities that have expanded their informatics offerings exponentially.

Ongoing Diverse Community Collaboration
The PMI seeks to advance participation from populations that have been historically underserved from a research standpoint. Angee Burd, an assistant professor of education professions at McNeese State University, says this longtime deficit "is starting to change through an increased interest in STEM [science, technology, engineering, mathematics] as a result of a systemic effort to make STEM more accessible to underrepresented populations."

A 2013 study, "Student Perspectives on the Diversity Climate at a U.S. Medical School: The Need for a Broader Definition of Diversity," found that diversity and a climate of inclusiveness and respect are important to a medical school's educational and clinical care missions. Buoyed by that notion, many medical schools are evaluating the effectiveness of strategies aimed at promoting diversity, including sensitivity training, pipeline programs, and student scholarships. It is hoped these initiatives will influence potential health practitioners to seek further opportunities in research and practice for those who have been traditionally underrepresented.

Similar efforts are underway on a community level. These collaborations include reaching out directly to community organizations to develop needs assessments and remove barriers to precision medicine. For example, the organization Color Genomics pledges to double the number of underserved individuals who receive free breast and ovarian cancer testing through its Every Woman Program. This program partners with cancer centers to donate free genetic tests to at-risk community members who may not be able to afford such tests.

Such efforts fulfill a critical promise of the precision medicine movement. In essence, medical programs and other learning organizations must reach out to the community, including potential employers, to determine their needs and "supply the demand." Learning institutions must understand the needs of today's community employers while providing students the necessary skills to meet those needs tomorrow.

Leading the Charge
Education will continue to play a critical role within the precision medicine movement. In order to fulfil the PMI's promise and principles, institutions of learning must lead the charge to help pivot from medicine's current approach to design and build a new way of thinking. This includes a reexamination of the patient-physician relationship, focusing on informatics as early as possible, and collaborating with community leaders to better understand the needs of health care centers, patients, physicians, and biomedical researchers.

— Dave A. Buchanan, EdD, MBA, is manager of the biomedical informatics program at Nova Southeastern University's Dr. Kiran C. Patel College of Osteopathic Medicine. He may be contacted at bdave@nova.edu.