Leaders from PAEA, Other PA Organizations Meet with National Genomics Leaders

NHGRI Targets PA Profession as “Fulcrum” for Incorporating Genomics into Medicine

By Steven Lane

If the efforts of last month’s high profile meeting bear fruit, the PA profession and the burgeoning science of genomics may soon be intertwined like two strands of DNA.

Leaders from the four national PA organizations pose with the Surgeon General and senior NHGRI staff at last month's meeting

In late March, PAEA leaders joined representatives of the three other national PA organizations at a special meeting hosted by the National Human Genome Research Institute (NHGRI), entitled, “Physician Assistant Competencies for Genomic Medicine: Where We Are Today and How to Prepare for the Future.”

The meeting, held at the National Institutes of Health Natcher Conference Center in Bethesda, Maryland, was designed to “develop an outline for how physician assistants could utilize current and anticipated knowledge of genetics and genomics as the basis for improving clinical care and make personalized medicine a regular part of patient care.” A draft set of PA clinical competencies has been developed and will soon be circulated to the four PA organizations for review.

Acting Surgeon General Ken Moritsugu (left) confers with NHGRI Director Francis Collins

The meeting grew out of a three-month sabbatical as a visiting scholar that Michael “Rocky” Rackover, director of the Philadelphia University PA Program, took at NHGRI in 2006. “Rocky raised our consciousness in all kinds of ways,” said Collins. To date, the PA profession is the only profession that has been invited by NHGRI to attend a meeting of this kind.

The 30 attendees at the meeting comprised leaders and staff from the four national PA organizations — PAEA, the American Academy of Physician Assistants (AAPA), the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), and the National Commission on Certification of Physician Assistants (NCCPA) — as well as invited academics, additional representatives of federal health agencies, and the executive director, Joseph McInerney, of the National Coalition for Health Professional Education in Genetics (NCHPEG), of which both PAEA and AAPA are members.

Each of the four PA organizations made a brief presentation on its mission and membership. Following PAEA President Anita Glicken’s presentation on the Association, preliminary results of PAEA’s recent genetics survey were presented by Constance Goldgar, a faculty member at the University of Utah PA Program and PAEA’s representative to NCHPEG. Highlights of Goldgar’s presentation can be seen here. Complete results will be reported in a future issue of the Journal of Physician Assistant Education.

Genomics and the PA Profession

Participants at the meeting identified several ways in which PAs are naturally suited to genetics practice and the PA profession to undertaking a multi-organizational educational effort.

Collins and the other speakers noted the emphasis in PA training on patient education and taking family histories and PAs' ability to spend the time with patients needed to obtain a detailed family history.

“The current system puts physicians in a difficult position,” Collins said. “There’s too much emphasis on procedures, and not enough on personal interaction. Therefore, the heavy lifting will have to be done by PAs and nurse practitioners.” He described the PA profession as a possible “fulcrum” for the integration of genomics into health care.

At the organizational level, several speakers remarked that the well-oiled working relationships among the major PA organizations and the nimbleness of a relatively small and well-integrated profession will allow the PA profession to move forward quickly with its genomics efforts. “I was very impressed by how this group stepped up to the challenge to collaborate across all four PA organizations in a highly effective way,” said Collins.

“Where We Are Today”

NHGRI speakers painted a picture of genomics as being on the verge of major advances that will quickly transform the practice of medicine from a model of diagnosis and treatment to one of prediction and prevention. One major driver of this will be the rapidly decreasing cost of sequencing an individual human genome, which may fall below $1,000 within a decade, said Guttmacher. The need to efficiently store and access the large amounts of genetic information that will be available on individual patients will also require the complementary advance of electronic medical records systems, he added.

One point repeatedly made at the meeting was that genetics affects almost every conceivable health condition. “We have to get past the mindset that genetics is about rare diseases,” said Guttmacher. “That’s too narrow a view. It is impossible to identify any disease that is not touched upon by genomics.”

If the full impact of genomics is yet to come, there is plenty that can be done right now. Bruce Korf, MD, chair of the Department of Genetics at the University of Alabama at Birmingham, in a presentation entitled “What the Physician Assistant Needs to Know About Genetics and Genomics,” described three main points:

• The family history can be a clue to risk (e.g., hemochromatosis).
• Clinical decisions will increasingly rely on the results of genetic tests.
• A new medical paradigm will emerge as a result of advances in genomics.

Next Steps

There was a sense of history in the making as the meeting came to an end, as well as a sense of urgency about moving forward with implementation.

PAEA President Anita Glicken and NCHPEG Executive Director Joseph McInerney listen to a presentation

Said Glicken, “It is rare for most of us to have the opportunity to touch the future; this NIH-sponsored initiative directly links the profession to the changing face of medical practice. As an Association, our first priority is to integrate this critical information into PA curricula as soon as possible. This initiative provides the profession with another opportunity for PAs to assume a leadership role in medical education and quickly affect the quality of patient care.”

AAPA President Mary Ettari added: “This meeting is the beginning of an exciting opportunity for PAs to become trailblazers in the field of genomics.”

The meeting closed with brief presentations from all four PA organizations on follow-up actions they will take to move the genomics agenda forward. The four organizations agreed that a coordinating committee made up of representatives from each organization would be needed to implement collective action. The groups will also consider developing a “face of genetics” campaign, as a way to humanize genomics and effectively use the affective aspect of some genetic diseases.

For PAEA, future activities will include the following

• Present a final draft of the PA competencies document to the membership at the 2007 Annual Education Forum
• Solicit a speaker for a plenary session on genomics at the 2007 Annual Education Forum
• Participate in the development of a short course for faculty
• Charge the Faculty Development Institute to review existing Web-based genomics resources
• Work closely with NCHPEG to develop additional faculty resources
• Investigate a mentorship program for preceptors
• Continue to work with NHGRI and the other PA organizations, including regular conference calls and a second meeting to be scheduled for the fall

Detailed proceedings of the meeting will soon be posted on the NHGRI Web site at http://www.genome.gov and on the PAEA Web site. Additional information will be communicated to PAEA members as the PA genomics initiative unfolds.

Editor’s note: There was significant discussion at the meeting on the difference between “genetics” and “genomics.” Essentially, “genetics” was used to refer to simple, single-gene inheritance patterns and “genomics” to the study of the more complex manifestations of the entire genome. In practice, the two terms were often used interchangeably.]