Armenia and Israel are countries with high prevalence of genetic disorders. However, health care systems in these countries have not responded appropriately to the rising needs of genetic services. Although in both countries medical profession and public health officials consider genetic conditions as a priority, there is a scarcity of workforce trained in clinical genetics, genetic counseling and laboratory genetics which are playing a critical role in facilitating genome-guided preventive and curative medicine into mainstream patient care.
Genetics and genomics on health care
Genetic diseases represent a significant percentage of health problems, and the integrated science of genetics and genomics is getting increasingly important to health care establishment. A major shift is anticipated to occur from treatment-focused to prevention-oriented medicine in the coming years. Genome sequence-guided preventive medicine holds tremendous potential for improving health in the general population and on a personalized level. Genetic health care has been offered for several decades by doctors working in the context of genetics clinics. Now, there is a requirement in knowledge in genetics to practice in the current genomic era, and provide these essential services, workforce in MG should be trained to interpret and transfer the tested results to the individuals using modern high-throughput genomic technologies.
Need for health professional competence in MG
Genetic services will stay required for providing genetic diagnosis and counseling for inherited conditions. As novel genomic technologies entered clinical medicine, MG specialists are also expected to provide counseling for complex disorders, play a critical role in imparting genetic information to the general public to prevent severe genetic diseases, and to specific individuals to enroll them into a personalized prevention or treatment plan. Practitioners in primary and secondary care will need to be prepared to deal with initial patient enquiries and to refer individuals or families to other health care providers, including specialist MG services.
Competencies in MG
In September 2010, the European Health Committee (CDSP) identified Medical Genetics as a medical specialty at the European level, and provided recommendation on the impact of genetics on the organisation of health care services and training of health professionals in the European community. Although a minimum standard for practice is required, setting curricula was not viewed as a practical way of ensuring that those standards were met, given the differences in systems of different countries. Because of the dynamic nature of the field, practitioners at all levels of health care require continuing education in MG to ensure early diagnosis and prevention of diseases. One of the most important goals of MG education is to teach students to understand advantages and limitations of different genomic technologies used in clinical practice.
Lack of workforce capacity in MG
In Armenia, the Ministry of Health recognized MG as a medical specialty. However, physicians are not trained in MG to practice clinical genetics and genetic counseling. Genetic tests are performed by specially trained biologists or PhD geneticists only in 1 specialized centre in Armenia. Specialized genetic education of health professionals is clearly deficient both at undergraduate and graduate levels. While basic genetics is generally taught in most medical schools, this is not the case with MG. There are no postgraduate training programs for physicians leading to Master or Doctorate degrees, or clinical residency training programs in MG.
In the current clinical training programs for genetic counseling in Israel, only 20% of the course is specifically designed for the training of genetic counselors. The clinical training of most genetic counselors is largely observational, and two years of supervised counseling sessions after the completion of M.Sc. degree are required to be eligible to take the board examination. 16 hospitals in Israel have MG departments with about 40 medical geneticists and 50 certified genetic counselors, of whom only 10 are actually working in the field of clinical genetics in MG centres.
Thus, despite of an increasing awareness of public health officials and medical professionals about the role of genetic factors in health and diseases in Armenia and Israel, the development and implementation of effective MG interventions is critically constrained by a lack of professional workforce capacity.
In synergy with other European initiatives
In 1997, a comparative study of genetic services in Europe found considerable variety in genetic service practices of different countries. The EU funded EuroGentest project has been created to address some of the challenges of the genomic era with the main objective to harmonize and improve the quality of European genetic services.
The wider objective of MedGen is the development and implementation of solid basis with active workforce of MG corresponding to EU recommendations of educational and professional standards in MG (CM/Rec(2010)11) and reinforcement of international cooperation capacity in Armenia and Israel.
MedGen aims to:
- Develop and implement modules, MSc and/or Clinical Residency Programs in MG
- Build capacity for teaching MG
- Introduce EU standards in teaching MG
- Build international MG network
National consultations with presentation of the policy brief for MG will result in the development of student graduate profiles in MG. Detailed content of each module and program will be elaborated for specialization in MG with new teaching materials and blended learning content. The faculty training provided by the European partners will upgrade the teaching capacity of Armenian and Israeli teaching staff to deliver the MG courses corresponding to EU standards. Accreditation and delivery of new MG modules and programs, and university cooperation agreements will be the strongest indicators of the overall success and the sustainability of MedGen. The developing MG workforce will acquire necessary competencies to practice MG in multiethnic societies. The harmonized education in MG as an obligatory medical discipline will establish a hub for international programs and will contribute to the overall quality of health care in partner countries.