Medical Education: A Key Partner in Realizing Personalized Medicine in Gastroenterology

Abstract

Listen

Translate article

Completion of the human genome sequence heralds an era that utilizes the “individual patient’s genome [to] help determine the optimal approach to care, whether it is preventive, diagnostic, or therapeutic,”1 defining personalized medicine broadly to provide biomarkers for disease prevention and treatment, new targets for drug development, and tools to make drugs safer and more efficacious. Limitations to personalized medicine include genetic testing availability, cost, insurance coverage, ethical concerns, scientific progress, and evidence of clinical usefulness; education in these areas may help to bridge a growing knowledge gap between science and practitioners. Genomic information and pharmacogenetic testing have already improved our understanding and treatment of common gastrointestinal disorders such as inflammatory bowel disease (IBD), peptic ulcer disease, and colon cancer, but training at every level must integrate new concepts and treatment options. Medical educators must prepare physicians, the public, trainees, and other health care workers to realize personalized medicine’s promise to deliver “the right dose of the right drug for the right patient at the right time.” Along with scientific advances, educational tools have advanced significantly in the communication age and can reach target audiences more quickly than previously, for example, the delay of teaching Mendelian genetic principles until Gregor Mendel’s work was rediscovered and disseminated almost 40 years after publication. The gastrointestinal tract represents a unique model for investigating, understanding, and teaching the broadest implications of personalized medicine and clinical genomics. Uniquely, the digestive tract contains complex interactions between networks of host mucosal defense mechanisms and a vast, coexistent luminal microflora and other luminal contents, with important ramifications in disorders such as IBD and Helicobacter pylori-associated disorders. In addition, recent insights offer new strategies for the diagnosis and treatment of colon cancer and other malignancies. A targeted survey of important recent breakthroughs will provide a basis for educational strategies in personalized medicine in gastroenterology.