Medical student preparedness for an era of personalized medicine: findings from one US medical school

Abstract

Aim: The objective of this research was to assess medical student preparedness for the use of personalized medicine.

Materials & methods: A survey instrument measuring attitude toward personalized medicine, perceived knowledge of genomic testing concepts and perceived ability to apply genomics to clinical care was distributed to students in medical school (MS) years 1-4.

Results: Of 212 participants, 79% felt that it was important to learn about personalized medicine, but only 6% thought that their medical education had adequately prepared them to practice personalized medicine. Attitude did not vary across years; knowledge and ability increased after MS1, but not after MS2.

Conclusion: While medical students support the use of personalized medicine, they do not feel prepared to apply genomics to clinical care.

Keywords: genetics education; genomic medicine; medical education; medical student; personalized medicine; pharmacogenetics; pharmacogenomics; precision medicine.

Figure 1. Attitudes toward adoption of genomic and personalized medicine

(A) Four openness and (B) four divergence items comprise the attitude score (Cronbach's alpha 0.7). Pooled responses (n = 210) were collapsed into binary values as ‘not at all/to a slight extent/to a moderate extent’ and ‘to a great extent/to a very great extent’. (A) In the openness items, the majority disagreed with the statement: I am willing to use genome-guided prescribing tools even if more senior physicians are not (55%). The majority agreed with the statements: I would be willing to use genome-guided prescribing tools that are developed by researchers (67%); I would be willing to use a patient's genetic information to guide decisions in clinical practice (60%); and I would be willing to use new types of therapies or interventions to help patients (75%). (B) In the divergence items, the majority of students disagreed with all four statements: research-based genome-guided prescribing tools are not clinically useful (96%); clinicians know better than academic researchers how to treat patients (57%); I would not be willing to prescribe different medications or doses based on genetic information (90%); and clinical experience is more important than genetic information to make decisions (70%).

Figure 2. Attitude, knowledge and ability scores by medical school year

(A) Attitude scores: MS1 (mean: 24.76; standard deviation [SD]: 3.46), MS2 (mean: 25.11; SD: 3.72) and MS3+ (mean: 24.49; SD: 3.38). There were no significant associations between attitude scores and MS year. (B) Knowledge scores measured perceived knowledge of genomic testing concepts: MS1 (mean: 9.57; SD: 4.75), MS2 (mean: 12.79; SD: 2.95) and MS3+ (mean: 13.25; SD: 3.19). MS1 students had significantly lower knowledge scores than either MS2 or MS3+ students (p < 0.001). (C) Ability scores measured perceived ability to apply genomics to clinical care: MS1 (mean: 6.97; SD: 4.16), MS2 (mean: 9.72; SD: 3.71) and MS3+ (mean: 10.65; SD: 3.32). MS1 students had significantly lower ability scores than either MS2 or MS3+ students (p < 0.001). MS: Medical school year.

Figure 3. Extent of agreement with the statement “I think that it is important to learn about personalized medicine”

Responses were collapsed into binary values as ‘not at all/to a slight extent/to a moderate extent’ and ‘to a great extent/to a very great extent’. (A) Responses are shown according to MS year, dual degree program and interest in a research career. In total, 82% of MS1 versus 83% of MS2 versus 73% of MS3+ students agreed with the statement. MS1 students were significantly more likely to agree than MS3+ students (p < 0.05). There was no significant difference in agreement between students enrolled (79%) or not enrolled (76%) in a dual degree program (MD/PhD, MD/MPH or MD/MSCR). Students interested in a career involving research were significantly more likely to agree with the statement than students who were not or were unsure (86 vs 71%, respectively; p < 0.01). (B) Students who agreed with the statement had significantly higher attitude scores (mean: 25.34; standard deviation: 3.37) than those who did not agree (mean: 22.87; standard deviation: 3.39; p < 0.001). MS: Medical school year.