Sunday, September 13, 2009

Improving Medical Genetics

Alright, time for Point 2 on my Blurbs: My issue with the genetics course and my recommendations to the faculty.

So this course was to introduce us to medical genetics. I was on the M1 liaison committee for this course and it was honestly somewhat frustrating hearing the excuses made by the faculty (valid excuses though they were). Most of their arguments boiled down to "We didn't have enough time. We had to cut something and we decided to cut that." -_- In its current iteration, this course doesn't really help us as future clinicians recognize and diagnose genetic illnesses, nor really help us track them through family history. Some diseases and important points were highlighted, but certainly not enough to be useful. Apparently there's a lot of "turf war" going on between classes and allotting time. Ugh, inter-department politics (not to mention inner-department politics). Fact is, there are things they could've done to improve the quality of this course given it's very short class-time.

My recommendations on the eval were as follows:

- Simplify and combine the lectures on transcription and translation into a single lecture.
- Simplify the cyclin/CDK material and combine the lectures on mitosis and meiosis into a single lecture.
- Have a lecture on Mendelian genetics and non-Mendelian genetics.
- Have a lecture on epigenetics.
- Have a lecture on creating pedigrees and emphasize their importance in medicine (or make this a short online tutorial).
- Have a lecture on genetic counseling: who are genetic counselors, what they do, when to refer, etc (or make this a short online tutorial).
- Have a lecture on the ethics of genetics and genetics research (or make this a short online tutorial).
- Have 1-2 lectures on cancer genetics. The first can focus on the genetics of cancer (e.g. Knudson's two-hit hypothesis, transformation from normal cells to hyperplasia to malignancy, a little bit of pathology), and the second lecture can focus on specific genetic cancers (e.g. BRCA1/2 and breast cancer, APC and familial adenomatous polyposis, p53 and Li-Fraumeni).
- Reorganize the lecture on Huntington's corea, Duchenne's muscular dystrophy, and cystic fibrosis to highly other genetic diseases (specifically Huntington's corea, Prader-Willi, Angelman's, and sickle-cell anemia). DMD and cystic fibrosis have been repeatedly covered again and again in other lectures.
- Simplify the development section of this course. Combine weeks 1 and 2 into a single lecture, and weeks 3 and 4 into a single lecture.
- Enforce greater communication between faculty lecturers so that the same topic isn't lectured on over and over again (i.e. telomerase, DMD, and cystic fibrosis).

If they even did 1/3 of the recommendations above I believe this course would've been greatly improved next year. But it's not like it matters much in the long run, as in 2-3 years there's going to be a massive shift in the curriculum into something entirely new and unrecognizable, and the current classes we now take will be abolished for a new system. That could be interesting . . .


Anonymous said...

Reorganizing curricula in medical schools is an on-going affair. The determinant to much of the first two years is what's on the National Board Exams.

Also be aware you will hear about some diseases over and over because either everyone has heard of them or they are diseass you are sure to see in practice. We know a lot about Creutzfeld-Jacob Disease, but the chances you'll ever see a case are so small as to not exist. But people have heard about it. Oh, and expect to hear a lot about diabetes. A lot. With good reason: you will see a lot of it.

Aek said...

Anonymous: Yes, I understand it's an ever on-going affair and that it's based off what's on the National Board Exams, this much was said by the faculty. However, I don't see what's wrong with going "above and beyond" the Boards material if it can be done in an efficient and relatively simple way (without much added stress to med students). The problem was that the faculty "thought" they were teaching everything the Boards required, but the student body didn't feel the same, so they created the genetics course almost ad hoc 2-3 years ago (so it was rather disorganized to begin with, and their excuses were "You'll learn about this later over and over again, it's just fragmented and you have to recognize it's genetics").

I know there are diseases we'll hear over and over again, but we'll hear them over and over again in multiple courses - it seemed a bit redundant for it to reoccur in the same course (it almost seemed like they had nothing else they could talk about).

As for diabetes: I fully expect to hear a lot about it - it's more complex than I thought and it's actually something I'm possibly interested in. So I think I'll manage.

Pilgrim said...

Excuse me! What a trashcan of a is this? I got 3/4 of it thru my BA-time. Now, this first yr. of doctorate I focus on genetic cancers, the second yr. will be on Alzheimers and Parkinson. Same goes for my other doctorate in macro-physics, in different ways. Propz Pilgrim...word verification - abili

Aek said...

Pilgrim: Actually, most med schools are like this. Until about 4-5 years ago, genetics was viewed with very low priority (or so I hear). So it's really just now that genetics is creeping into the curriculum. It's not "in focus" yet but it's getting there (slowly).

Also, you're doing PhD work in illnesses that have strong genetic components. Thus it'd make sense that you'd be taking many genetics-heavy courses that we as med students would never take.

Anonymous said...


I'm waiting until you start talking like this about histo. there's so much material there, it makes your head explode.

Do they still use notetaking services in med school?

Aek said...

Anonymous: There's a reason why I'm particularly (unusually?) fired up about genetics. I'll blog about that soon. I'm sure there's tons in histo (and verily, any class in med school), but we'll see when I get to it next semester.

There's no formal/official note-taking service at my med school. There's an informal student one but I think it's inactive this year . . . There are, however, lecture audio recordings that I never listen to (since I always go to class, so far).

Anonymous said...

The purpose of the notetaking service was to let one focus on listening during class while not having to think about the notes one needs. Having to go back and listen to the lecture defeats the use of notes, but that was then. maybe a new generation has different ways of learning. What do you have this semester besides gross and genetics and intro to clinical practice?

If you think the genetics course is incomplete, wait til you get to the human sexuality stuff. Man, I had noooooo idea how incomplete it was!

Aek said...

Anonymous: Oh . . . well we have to buy all our notes for our courses. For the most part they're really complete, but it's annoying when the professors change their slides at the last minute so they don't quite match up. I'm also taking biochem and human development this semester. They're okay so far.

I don't expect human sexuality to be complete at all. In fact, there's a student group that had to heavily lobby the admin people to include LGBT health into the curriculum. There's a tiny bit, but I think nowhere near enough to truly be of use to that community.

Anonymous said...

The sexuality stuff was pretty good as far as it went, it just didn't go far enough. I wish they had had the mannekins for teaching us how to do pelvics when we were in the perineum during gross. It would have made so much more sense. As for LBGT issues, that wasn't something anyone in any medical school was really addressing--I'm hoping times have changed but maybe not. On the other hand, there's nothing like a few Friday and Saturday night 24 hour tours in the ER to acquaint one with all aspects of human sexuality--including the suicides among the gays and lesbians. Sad but true. Then there was the first time I treated a transgendered FTM. I was a bit unprepared, to say the least. So was my resident. And the attending wasn't much help either. So just be prepared, and remember that anything which gets into a human body can be removed from it--and I do mean anything.

Think House of God rule #8 (I think it was).

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