House of Lords Inquiry on Genomic Medicine Overview of the Physician Assistant Profession and Medical Genetics Education

Michael A. Rackover PA-C, M.S. Philadelphia University 1 Physician Assistant Program Director AmericanAmerican AcademyAcademy ofof PhysicianPhysician AssistantsAssistants

SummarySummary ofof 20072007 NumberNumber ofof PeoplePeople PAPA DemographicsDemographics EligibleEligible toto PracticePractice asas PAsPAs

ƒ 79,70679,706 eligibleeligible toto practicepractice asas ofof 3/24/20083/24/2008 ¾ 68,12468,124 inin clinicalclinical practicepractice

2 Patient Care Integration Throughout the United States 141141 ACCREDITEDACCREDITED PAPA PROGRAMSPROGRAMS

„ TypicalTypical PAPA programprogram isis 2424--3232 monthsmonths longlong „ Approximately 4600 graduates each year

1 1 1 1 2 1 1 3 1 19 1 3 5 2 16 2 2 2 5 1 4 2 10 1 2 1 2 4 1 2 3 1 4 2 2 1 1 1 2 3 8 2 5

Source: PAEA Annual

Report 2007 updated 4/084 TheThe FourFour PAPA OrganizationsOrganizations

PAEA curricula CME AAPA Physician Assistant Education Association American Academy of Physician Assistants The Programs Practicing PAs

Students & STANDARDS Educators

NCCPA ARC-PA National Certification Exam Commission on Accreditation Certification of Review Commission Physician on Education of Assistants Physician Assistants Certification Accreditation

5 IntegrationIntegration ofof GenomicsGenomics intointo PAPA EducationEducation && ClinicalClinical PracticePractice

6 StepStep 11 HumanHuman GeneticsGenetics CurriculaCurricula forfor thethe HealthHealth ProfessionsProfessions ConferenceConference NovemberNovember 33--5,5, 20002000

„ American Speech-Language Hearing „ 12-member team from Association a variety of health „ American Dietetics Association professions „ American Physical Therapy Association „ American Dietetics Association-Alliance „ Evaluation of curriculum Program „ National Accrediting Agency for Clinical Laboratory Sciences „ American Occupational Therapy Association „ American Society of Radiologic Technologists „ Association of Physician Assistant Programs (now -Physician Assistant Education Association) „ National Society of Allied Health „ Commission on Accreditation of Allied Health Education Programs-Respiratory Therapy „ American Board of Genetic Counseling 7 STEPSTEP 22 EvaluationEvaluation PhysicianPhysician AssistantAssistant ProgramsPrograms HumanHuman GeneticsGenetics CurriculaCurricula InitialInitial GeneticsGenetics SurveySurvey OctoberOctober 20002000 „ ReportReport „ 123123 AccreditedAccredited „ 18.5% have a free standing Programs Programs genetics course in „ 44% response curriculum rate from 54 programs „ In programs without a course „ Average of 5 hours of genetics lecture interspersed throughout curriculum 8 HumanHuman GeneticsGenetics CurriculaCurricula forfor thethe HealthHealth ProfessionsProfessions FinalFinal ProductProduct forfor EachEach ProfessionProfession

1. WhatWhat levellevel ofof humanhuman geneticsgenetics knowledgeknowledge shouldshould bebe includedincluded inin thethe curriculum?curriculum? 2. WhatWhat areare thethe corecore competenciescompetencies thatthat shouldshould bebe includedincluded inin thethe curriculumcurriculum acrossacross allall healthhealth professions?professions? 3. WhatWhat areare thethe ELSIELSI implicationsimplications thatthat shouldshould bebe includedincluded ?? 4. WhatWhat areare thethe importantimportant futurefuture researchresearch topicstopics && implicationsimplications thatthat shouldshould bebe included?included? 5. WhatWhat shouldshould bebe thethe processprocess forfor includingincluding humanhuman geneticsgenetics inin thethe certificationcertification && licensurelicensure exams?exams? 9 DynamicsDynamics ofof GenomicGenomic OrganizationOrganization

„ 10/19/01 “The Human Genome Project and Its Impact on Physician Assistant Education” „ 11/25/02 Educational Forum Lecture, “Medical Genetics for PA Educators Made Easier.” „ NCHPEG liaison AAPA „ 5/26/03 Medical Genomics for Physician Assistants, AAPA Annual Meeting, New Orleans „ 10/17/03 The Impact of the Human Genome Project – “Its Impact on PA Practice”, Pennsylvania Society of Physician Assistants 28th Annual Conference „ 11/05/04 APAP Integration of Medical Genetics into the PA Curriculum „ 5/12/05 American Holistic Medical Association, Philadelphia, PA, The Impact of the Human Genome Project on Holism and Family Health „ 11/04/05 APAP Educational Forum Lecture, Las Croabas, Puerto Rico, Panel Presentation- The New ARC-PA Standard for Genetics; What’s a Program to Do? „ Sabbatical NHGRI Fall 2006 & initiation of PA organization change

10 ARCARC--PAPA StandardsStandards

„ The new Accreditation Standards for PA „„ e)e) thethe geneticgenetic Education, in effect as of andand molecularmolecular September 2006, include the following standard: mechanismsmechanisms ofof healthhealth andand „ B2.02. Instruction in the professional phase of the diseasedisease program must include instruction in the following basic medical sciences: STEP 3

11 12 Step 5

13 AAPAAAPA AnnualAnnual ConferenceConference ContinuingContinuing MedicalMedical EducationEducation

„ CME 2007 Annual „ CME 2008 Annual Conference Philadelphia Conference San Antonio „ Ethical Challenges of „ Headlines and Heredity Individual Genome Sequences and „ Tailoring Anticoagulation Personalized Medicine Therapy Personalized Medicine „ Daily Dose of DNA: The „ Cancer Genetics and Importance of Family Genomics: Implications Importance of Family History for PA Practice History „ Genetics and Major „ Race-based Psychiatric Disorders Therapeutics? What's the Psychiatric Disorders Big Deal? „ Race, Genetics, and Health Care „ Personalized Medicine: Integration of Medical „ Genetics of Common Genetics into Clinical Disease Practice „ Hereditary Breast & Ovarian Cancer 14 15 16 17 StatusStatus ofof GeneticsGenetics CurriculaCurricula inin PAPA ProgramsPrograms NationwideNationwide 1/20071/2007

„ PAEAPAEA SurveySurvey 75%75% responseresponse raterate „ (100(100 ofof 134134 programsprograms responded)responded) „ ToTo determinedetermine howhow geneticsgenetics isis taughttaught inin PAPA programsprograms nationwidenationwide „ ToTo determinedetermine whatwhat geneticsgenetics contentcontent isis coveredcovered andand whatwhat gapsgaps existexist „ ToTo assessassess facultyfaculty needsneeds forfor supportingsupporting aa geneticsgenetics curriculumcurriculum

18 PotentialPotential EducationEducation BarriersBarriers

Very Quite Not very Not at all significant significant significant significant a. Structure of existing curriculum 20 40 38 11 b. Curriculum already overloaded 40 40 13 7 c. Genetics not seen as a priority by colleagues 9 19 40 32 d. Lack of resources to champion changes & developments 6 27 47 20 e. Lack of faculty with sufficient genetics experience or knowledge14 26 36 14 f. Lack of time to develop resources 20 41 29 10

LookingLooking toto thethe futurefuture

„„ 8181 %% ofof programsprograms perceivedperceived aa needneed toto enhanceenhance theirtheir geneticsgenetics curricula.curricula.

„„ 6262 %% planplan toto changechange theirtheir approachapproach toto teachingteaching geneticsgenetics inin thethe nearnear future.future.

20 OpportunitiesOpportunities

„ PositionPosition PAPA educatorseducators asas leadersleaders inin teachingteaching ofof geneticsgenetics inin medicalmedical educationeducation

„ MonitorMonitor andand reportreport innovationsinnovations inin geneticsgenetics educationeducation

„ DevelopDevelop curriculumcurriculum resourcesresources andand bestbest practicespractices

„ CreateCreate facultyfaculty developmentdevelopment opportunitiesopportunities

„ DevelopDevelop assessmentassessment toolstools forfor studentsstudents andand facultyfaculty

„ DevelopDevelop aa databasedatabase toto tracktrack geneticsgenetics activitiesactivities andand outcomesoutcomes inin PAPA educationeducation

21 NationalNational CommissionCommission onon CertificationCertification ofof PhysicianPhysician AssistantsAssistants (NCCPA)(NCCPA) „ ActivitiesActivities regardingregarding genetics/genomicsgenetics/genomics 1. ExamExam ContentContent „ beginningbeginning toto codecode newnew itemsitems onon thethe examexam withwith aa geneticsgenetics codecode whenwhen applicableapplicable „ newnew itemitem writerwriter withwith experienceexperience inin genomicsgenomics willwill bebe addedadded inin 2008.2008. 2. PromotionPromotion „ educateeducate theirtheir BoardBoard aboutabout geneticsgenetics

22 SuccessfulSuccessful IntegrationIntegration ofof GeneticsGenetics inin MedicineMedicine

curricula CME AAPA PAEA Practicing The PAs Programs/ Educators STANDARDS Certification Exam NCCPA ARC-PA Certification Accreditation

23