A Knowledge Gap

Many pediatricians don’t feel competent to treat patients with genetic disorders, according to a new study that raises questions about how to better prepare physicians for these cases.

Led by a team at the Children’s Hospital at Montefiore in New York, researchers polled members of the American Academy of Pediatrics’ Quality Improvement Innovation Network about the number of genetic tests they order, how often they discuss genetic testing and related medical conditions with their patients, their approach to collecting family histories and whether they felt they had sufficient training to treat patients with genetic conditions.

The study, published in the American Journal of Medical Genetics, found that most pediatricians ordered just three or fewer genetic tests per year and only 13 percent discussed the potential risks, benefits and limitations of genetic tests with patients and families seeking that information. More than half said they felt unqualified to provide even routine health care to patients with genetic diseases.

Treating genetic conditions in children often involves a team of medical professionals — including pediatricians. This, coupled with a shortage of practicing medical geneticists in the United States, could mean that doctors will see more patients with genetic disorders in their waiting rooms in the near future, says Gail Herman, MD, PhD, president of the American College of Medical Genetics and Genomics.

“Medical schools and pediatric training programs often have different levels of genetics education built into their curriculums, so it’s easy to see how some pediatricians would feel comfortable treating these patients while others aren’t,” says Dr. Herman, who also is a physician-scientist in molecular and human genetics at Nationwide Children’s Hospital. “But it does call attention to the need for more education during training and continuing education throughout a pediatrician’s career.”

The ACMG offers several classes and workshops for physicians on genetics at professional meetings and through the group’s website. Offering resources online is a great way to elevate the genetics know-how among practicing pediatricians, Dr. Herman suggests. Meanwhile, medical schools should consider a heavier emphasis on genetics in the training of students and residents.

“Genetics is quickly becoming the foundation for the treatment of many different medical conditions, and everybody is going to need to know it to some degree,” Dr. Herman says. “We must do more with our medical students and our pediatric residents in terms of genetic concepts and how to look at genetics in disease.”