EXPECTED COMPETENCIES RELATED TO GENETICS AMONG BOARDCERTIFYING ORGANIZATIONS

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EXPECTED COMPETENCIES RELATED TO GENETICS AMONG
BOARD-CERTIFYING ORGANIZATIONS

• Carrie A. Zabel, M.S.
• Certified Genetic Counselor
• Paul V. Targonski, M.D., Ph.D.
• Associate Professor of Medicine
• Mayo Clinic
• Eisenberg Genomics Education Program

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Background

• Understanding genetics and genomics is important
  to clinical care.
• Medical professionals show deficiencies in the
  practice of genomic medicine.
• "Translation of genomic research discoveries to
  improved clinical outcomes can occur only with an
  informed professional workforce."
• -Collins, F. (2004). AMFP 70(9) 1637-42.

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Theory

• The lack of genetics/genomics knowledge by
  current physicians is, in part, influenced by
  competing priorities among certifying specialty
  boards.
• Breadth of competence
• Clear evidence of application
• Few physicians are expected to know practical
  applications of genetics to become certified.
• Thus, curriculum and extramural learning does not
  make genetics content a priority.

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Methods

• 24 specialties were identified via the American
  Board of Medical Specialties website
  (www.abms.org).
• Also included 19 subspecialty categories of
  American Board of Internal Medicine (ABIM).
• Reviewed online certification study guides and
  exam content outlines to extract
  genetics/genomics-related concepts.

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American Board of Medical Specialties

• American Board of Allergy and Immunology
• American Board of Anesthesiology
• American Board of Colon and Rectal Surgery
• American Board of Dermatology
• American Board of Emergency Medicine
• American Board of Family Medicine
• American Board of Internal Medicine
• American Board of Medical Genetics
• American Board of Neurological Surgery
• American Board of Nuclear Medicine
• American Board of Obstetrics and Gynecology
• American Board of Ophthalmology

• American Board of Orthopaedic Surgery
• American Board of Otolaryngology
• American Board of Pathology
• American Board of Pediatrics
• American Board of Physical Medicine and
  Rehabilitation
• American Board of Plastic Surgery
• American Board of Preventative Medicine
• American Board of Psychiatry and Neurology
• American Board of Radiology
• American Board of Surgery
• American Board of Thoracic Surery
• American Board of Urology

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American Board of Internal Medicine
Subspecialties

• Adolescent Medicine
• Cardiovascular Disease
• Clinical Cardiac Electrophysiology
• Critical Care Medicine
• Endocrinology, Diabetes Metabolism
• Gastroenterology
• General Internal Medicine
• Geriatric Medicine
• Hematology

• Hospice Palliative Medicine
• Infectious Disease
• Interventional Cardiology
• Medical Oncology
• Nephrology
• Pulmonary Disease
• Rheumatology
• Sleep Medicine
• Sports Medicine
• Transplant Hepatology

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Methods

• No content
• No exam preparation materials available OR
• The information which was available was
  non-specific.
• Syndromes only
• Recognition of specialty-specific syndromes for
  which a genetic etiology has been defined
  knowledge of genetics was not otherwise specified.

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Syndrome Examples

• Cystic fibrosis
• Sickle cell anemia
• Myotonic dystrophy
• Down syndrome
• Huntington disease
• Hereditary breast and ovarian cancer syndrome
• Lynch syndrome
• Fragile X
• Tay-Sachs disease

• Marfan syndrome
• Ehlers-Danlos syndrome
• Phenylketonuria
• Congenital adrenal hyperplasia
• Factor V Leiden
• Polycystic kidney disease
• Spinal muscular atrophy
• Tuberous sclerosis
• Neurofibromatosis

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Methods

• Basic genetics
• A statement regarding the basic understanding of
  genetics was included.
• Detailed
• A statement regarding the basic understanding of
  genetics was included, as well as specific
  concepts.

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Basic genetics example
https//www.abos.org/documents/Part_I_Exam_Content
s.pdf
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Detailed example
http//www.abpath.org/MOCCS-CP-MG.htm
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Results
Note A majority of the boards that expected
detailed content also expected basic and
practice-specific syndrome knowledge.
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Methods

• In the specialties which were considered
  detailed, additional themes were further
  distilled including
• Molecular Biology
• Family History
• Patterns of Inheritance
• Genetic Counseling
• Genetic Testing
• Laboratory Techniques
• Ethics

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Results
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Results
Note American Board of Medical Genetics (ABMG)
is included in this data set.
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Conclusions

• Certifying organizations most commonly (35)
  expect practicing physicians to only know genetic
  syndromes specific to their practice.
• Approximately 40 of these organizations expected
  certifying physicians to have a basic working
  knowledge of the science.

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Conclusions

• The most common detailed content was genetic
  testing however, a majority of these same boards
  lacked any emphasis on genetic counseling.
• NCHPEG core competencies list the collection and
  assessment of family history as a basic skill,
  but virtually none of the boards (4.7) expected
  certifying physicians to be competent in this
  area.

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Conclusions

• NCHPEG provides a solid framework to advocate for
  additional content in certifying exams to bring
  genetics to medical practice.
• Practical applications of genetics and genetic
  counseling competencies will be critical for the
  optimal application of genetics to health.

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Acknowledgments

• The George M. Eisenberg Foundation for Charities
• Mayo Clinic Eisenberg Genomics Education Program