Teaching medical genetics in the internal medicine course

Dr. Ana L. Vargas
National University of Cuyo, Mendoza, Argentina

Dr. Vargas is an alumnus of the 2000 physician-educator course at the Harvard Macy Institute. Alumni are encouraged to share examples of their education projects in HMI World.

Dr. Ana Vargas is pictured with Dr. Daniel Federman, senior dean for alumni relations and clinical teaching at Harvard Medical School

Genetics in medicine is a basic science and also a clinical specialty. Physicians in this century need to understand the principles of genetics, their application in clinical problems, and also develop specific skills to communicate information about genetic diseases to patients and colleagues. A curriculum that includes general genetics in the preclinical courses is not enough to accomplish the specific required objectives in medical education at present time. This project was designed to acquaint the fourth-year students of our medical school with medical genetics in the clinical years.

To accomplish this goal, a rotation of one work week at our Institute of Genetics was planned, to introduce groups of students to the usual clinical work performed by faculty. Since working with patients can be difficult to schedule, a set of twenty written cases concerning common genetic diseases was also prepared, to be solved by students alone or in small groups. This activity complemented the clinical work, and the final conclusions of the cases were presented as an oral report at the end of the week. The real patients were studied and analized by students as well and presented by them during the weekly clinical meeting, with all the faculty involved in the outpatient clinic work of our institute.

The students also attended four lectures on genetics of common diseases, made a thorough research of medical literature concerning the cases, observed the sessions of genetic counseling and watched all laboratory activities. They were evaluated for their performance using a checklist and had to answer a short written test as well during the last day of work.

At the same time, they were given a questionnaire of open-ended questions to express their opinions about the course and faculty performance, and also make suggestions to improve the rotation. In year 2000, the rotation was done by all the fourth year students of the internal medicine course who expressed a high degree of satisfaction.

Last year, the curriculum of the clinical years was redesigned and this rotation was established as an elective one. A group of twelve fourth-year students spent two weeks at our institute, participating in all the activities and also solving writtten cases

This time the lectures were prepared by the students under one faculty member´s directions. The questionnaires to evaluate the rotation also demonstrated a high degree of satisfaction. For year 2002, the rotation of medical genetics will continue to be an elective within the course of internal medicine and will follow the same scheduled activities.

A group of participants in the 2000 course: from left to right, Dr. Radhika Ramanan, Dr. Mary McCarthy, Dr. Ana Vargas, Dr. Marie-Louise Dick, Dr. Patricia Thomas, and Dr. Steven Ytteberg

There is a general consensus now that general practitioners should be trained to give the first information on genetic diseases to patients. Our next step in the future will be the use of simulated patients to help students develop the communication skills to give genetic counseling in common diseases and also train them to interpret special genetic studies.

The present crisis in Argentina has strongly affected our lives. With fifty percent of our population living in poverty and our hospitals lacking imported supplies, an emergency in the health system is expected in the near future.The budget reduction will also hit education and the process of change in higher education will slow down eventually.Our medical school is still steady enough to continue the reforms initiated a few years ago.

My project on teaching medical genetics will not be greatly affected by financial problems, but the use of simulated patients will require extra money. Our Dean and the Council of Representatives have made a firm decision to get private funding and special financial resources. Meanwhile, we keep working and thinking of the best way to prepare our graduates to face future health problems.