Resident Education in Molecular and Genetic Testing in Dermatology: An Opportunity Not to Be Missed
“It is time to get serious about genomics education for all health care professionals,” Director of the National Human Genome Research Institute (2011).1
In the coming years, there will continue to be a tremendous shift in medical practice favoring the incorporation of molecular and genetic information into patient management to deliver high quality, cost-effective care.1–4 In dermatology, the molecular mechanisms underlying both genodermatoses and acquired skin conditions continue to be identified, with concurrent development of relevant diagnostic assays and targeted therapies.4 Such discoveries hold the potential to facilitate earlier and more accurate diagnoses, improve prognostication and risk stratification, aid in the selection of personalized treatment regimens, assess response to therapy, and identify novel therapeutic targets for a range of skin cancers, in addition to inflammatory, infectious, and inherited dermatoses.4 However, these molecular breakthroughs have yet to be fully integrated into clinical dermatology practice, or indeed dermatology resident training.5–9 The recent literature highlights both practice and educational gaps in clinical molecular dermatology, and suggests strategies to overcome these barriers.5–9
Recent surveys of both dermatology residents and program directors confirm a widely held belief that molecular technologies will begin to play a greater role in the management of patients with skin diseases.6,7 However, dermatology residents have reported their limited understanding of molecular testing, and described not feeling adequately equipped to educate patients on this subject.6 In addition, two-thirds of responding dermatology program directors believe their residents are not receiving adequate instruction in molecular testing, genomics, and personalized medicine at this time.7 In fact, these concepts may not be formally taught as part of the dermatology residency curriculum in as many as 30% of training programs; although, most (>83%) surveyed program directors expect to incorporate additional education in this area in the near future.7
Educational meetings, continued professional activities, dermatology textbooks, and journal articles should provide both practicing and trainee dermatologists with updated, functional information on molecular testing strategies available for patients.4,5 However, formal instruction in this area must begin in medical school and extend into postgraduate training. According to Schaffer,8 in the case of inherited skin disorders, resident education should include case presentations and patient viewing sessions. Teaching should focus on understanding key molecular pathways that are disrupted in these patients, and not on the memorization of a long list (>1000) of disease-specific genes.8 In addition, residents must learn how to access relevant online databases (PubMed and OMIM) and gain experience in educating and counseling patients and families affected by genodermatoses.8
The recent publication of a curriculum in molecular diagnostics, genomics, and personalized medicine for dermatology residents is another important step. This presents a framework for programs to develop their own specific training syllabi, based on relevant expertise and resources available.9 Such a curriculum provides trainees with a working knowledge in clinical molecular dermatology. Residents gaining familiarity with the range of molecular tests available, reviewing a broad variety of dermatology-focused cases and gaining “hands-on” experience.9 Individual programs will need to determine how to best evaluate resident comprehension and mastery of molecular concepts within the context of current or revised Accreditation Council for Graduate Medical Education (ACGME) milestones. It is hoped that this initiative will stimulate response and discussion among program directors concerning the best ways to proceed. Such a curriculum will require constant updating and stakeholder consensus to integrate new data and information that may be ready for incorporation into clinical practice. Accreditation and certification bodies must also develop related requirements and assessments tools.