Students’ engagement during the sessions was high, and they raised many complex points. David Litwack, a AAAS Science and Technology Policy fellow and an opponent of direct-to-consumer genetic testing, felt vindicated after hearing the case studies at the seminar. Myriad Genetics was targeting primary care doctors and gynecologists to conduct these tests. Case Studies - Walking The Tightrope. Identify the critical need to protect individual privacy as it relates to genetic test results and genetic databases in order to safeguard their impact on patients’ family relationships, employment status, and ability to secure health insurance. We need to talk! An increasing number of GWAS is taking place in lower income countries and there is a pressing need to identify the particular ethical challenges arising in such contexts. * Recombinant DNA Technology and Biosafety As technology has progressed, ethical issues have warranted further discussion, and the medical students have been highly engaged in these discussions. However, an important advantage of using the electronic clickers is that responses on these systems occur instantly in real time and are anonymous to peers. This collection of cases has been successfully deployed over the past 13 years, with the content adapting over the years to developments in the field of genomic medicine. Show Slide #2. Appraise the nuances and consequences of the current recommendations around the reporting of genetic test results with respect to whole genome sequencing. Medical schools are embracing more active forms of learning.24 This type of activity offers students an in-depth and active experience regarding the content surrounding the rapidly evolving fields of precision and genomic medicine. As understanding of the genetic basis of human disease has grown, genetic testing applications for these conditions have grown in parallel.1,4 Discussion of the nuances of these testing strategies in the context of direct-to-consumer genetic testing, identification of secondary findings in genomic strategies, and other ethically complex scenarios is imperative in order for trainees and physicians to fully consider responsible use of genomic technologies.3–5. These discussions served as an excellent launching point to allow students to break into smaller groups within the lecture hall, compare their perspectives on these issues, and then share their views with the larger student group. Such studies present important ethical challenges. Furthermore, the cases are designed to work well both in small-group settings (discussion cases) and in large-format lecture halls (clicker questions and discussion cases). One of the The following setup procedures have been found to be important when administering the session with a large group (approximately 180 students). Family-based genetics research studies typically begin with identification of an index case. This case collection, although covering a range of ethics topics relevant to genomic medicine, allows only for introductory analysis of these issues. Keywords: case studies, case-based teaching, genetics I. If an instructor is planning to use the full set of discussion cases in one session, allotting 2 hours of class time is recommended. At the end of this session, learners will be able to: Consider the potential advantages and disadvantages of widespread use of whole genome sequencing approaches and direct-to-consumer initiatives. Case study prepared by Rosemary Flanigan, PhD, director of ethics committee education, Midwest Bioethics Center, Kansas City, Missouri. 7. This is likely beyond the scope of what is appropriate for first-year medical students, but it would be an interesting exercise for trainees wishing to specialize in this area. Discussion of these cases does require some comfort on the part of the learners when discussing potentially controversial issues in a classroom setting. “In most cases, the results of genetic testing cannot be used for practical decisions about health care,” Litwack said, “but companies providing these tests tend to implicitly or explicitly overstate their utility.” Small group discussion activity: perspectives in cancer genetics, Non-invasive prenatal testing for single gene disorders: exploring the ethics, Design of a platform to discuss ethical considerations of preimplantation genetic diagnosis: a case for integration of ethics in foundational science medical curriculum, Differential acceptance of genomic medicine approaches between future and practicing physicians, Introductory TBL exercise on genetic risk, Medical education reimagined: a call to action, https://doi.org/10.15766/mep_2374-8265.10562, https://doi.org/10.1126/scitranslmed.3005785, https://doi.org/10.1146/annurev-genom-090413-025522, http://media.wix.com/ugd/3a7b87_7064376a9eb346cfa1b85bc2f137c48f.pdf, http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Ethical-Issues-in-Genetic-Testing, https://www.ama-assn.org/about-us/code-medical-ethics, http://doi.org/10.15766/mep_2374-8265.9897, https://doi.org/10.1007/s40670-016-0234-y, https://doi.org/10.1007/s40670-015-0146-2, http://doi.org/10.15766/mep_2374-8265.10381, http://www.genetics.edu.au/Publications-and-Resources/Genetics-Fact-Sheets/FactSheetELSI, http://www.nature.com/naturejobs/science/articles/10.1038/nj0342, https://doi.org/10.1097/ACM.0b013e3182a368bd, Medical Genetics Ethics Cases Presentation.pptx, Medical Genetics Ethics Cases Handout.docx, Medical Genetics Ethics Cases Facilitator Notes.docx, Ethics Cases Audience-Response Results.pdf. * Using Fetal DNA for Gender Selection The cases in this collection may be used both throughout an integrated foundational sciences curriculum and in a special session focusing on ethics. Although general frameworks for ethics in the practice of medical genetics have been proposed,6–8 with the development of new genetic and genomic technologies have come new specialized cases requiring application-specific ethical analyses. * Should Genes Be Patentable? Alternatively, the room can be set up conference style, with microphones in the aisles that students step up to so as to be amplified for the discussion. This current collection of discussion and clicker/discussion cases aims to delve further into these emerging areas in genomic medicine and provide educational tools to encourage critical thinking and analysis of the scientific, ethical, legal, and social implications of these genomic technologies. Introduction: This collection of cases in medical genetics focuses on ethical dimensions of genetic testing. Genetics Generation - If time permits, perhaps in the context of a specialized clinical elective on medical genetics, students could engage with the practice guidelines in these areas to develop a deeper understanding of the principles governing these guidelines’ development. 2013. This clicker-based audience-response technology lets students submit their responses to questions posed on the slides, thereby allowing for immediate polling of student opinions on topics. Patient Confidentiality * Reporting Incidental Findings * Gene Therapy for Enhancement Purposes * Huntington’s Disease and Personal Autonomy * Preimplantation Genetic Diagnosis and “Modern Eugenics” * Recombinant DNA Technology and Biosafety * When Informed Consent is Unclear * … Case Study - Is More Better in Oncology A 44-year-old, divorced mother of two teenagers is diagnosed with metastatic breast cancer. * Gene Therapy for Enhancement Purposes However, it should be noted that despite this supportive feedback demonstrating student engagement with the content, a limitation of this resource is the lack of quantitative data to support the effectiveness of introducing ethics into a medical curriculum using these cases. Case study 4: Consumer genetic tests for athletic ability In December 2008, Atlas Sports Genetics began selling a genetic test for ACTN3, the -actinin-3 gene.

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