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Genetics in Clinical Practice: A Revolutionary Approach

Hanover, NH -Harnessing computer technology for medical education, a Dartmouth Medical School physician has created a virtual clinic with world leaders in genetics to teach the specialty in medical practice. Joseph V. Henderson, MD, a professor of community and family medicine who heads Dartmouth Medical School's Interactive Media Lab (IML), developed the new program, based on his pioneering "virtual practicum," model, using state-of-the-art interactive multimedia.

"This virtual course shows how the testing is done, how to counsel patients, how to understand the test results," Henderson says. The central goal is to help non-geneticists (primarily third-year medical students and residents) use genetic testing and services appropriately by improving their understanding of the process. Another mission is to help generalists, specialists and laboratory professionals form an integrated patient care team.

Users of the practicum have access to genetics experts and patient simulations that form the backbone of training. Henderson assembled a team that represents the world's best in genetics and says, "You have real experts--some of the most prominent clinical geneticists out there. " Case discussions and counseling demonstrations are led by Edward McCabe, MD, a UCLA School of Medicine geneticist, and by physicians from the Centers for Disease Control and Prevention (CDC), the National Cancer Institute, the National Human Genome Research Institute and the National Institutes of Health."

The result of a three-year project, funded through an educational grant from the CDC, the virtual clinic is an idealized environment for learning about genetics in clinical practice. The core lies in interacting with simulated patients, who are accessed from the grid-like Patient Visit Roster in the hallway. With each patient, the physician is asked to assess and counsel the patient(s), and make decisions about their care.

"For the generalist physician or the medical resident, ordering a genetics test for a patient is not like ordering a standard test, such as for cholesterol. There is not only the science, but the associated psychosocial aspects. It's one thing to know about the genetics, for example of cystic fibrosis, but it's another thing to counsel a couple who are pregnant with a child who may be affected by CF," says Henderson. This program offers that real-world aspect by virtual interaction and exposure to patients.

The program's flow and content centers on three simulated patients who have, or are at risk of developing, diseases for which knowledge of clinical genetics can affect outcomes. In some instances, patient outcomes will depend on the management decisions and other actions of the learner. The highly detailed, computer-based environment is intuitive and easy to use any time, any place via a broadband Internet connection or on a CD. The CD will be available to outside users through professional organizations such as the American College of Medical Genetics and at little or no cost to the Dartmouth community.

The program is intended for health care providers who may see patients with disorders--or who have concerns about disorders--for which clinical genetics knowledge can positively impact outcomes. It addresses three central topics: genetics in clinical practice, working with genetics labs and lab workers and working with genetic counselors, and may also be helpful in training students, genetic counselors, medical laboratory professionals, public health practitioners and others interested in genetic testing. Users participate in a "virtual mini-fellowship" with a master clinician/master teacher.,

IML specializes in combining emerging technology with innovative instructional design, producing high-end interactive multimedia educational programs for both patients and health care providers and develops distance learning systems capable of delivering multimedia over the Internet. The genetics virtual clinic can be accessed on the web at http://iml.dartmouth.edu/education/cme/Genetics/.

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