|Year : 2021 | Volume
| Issue : 1 | Page : 3-7
Integrating genomics education into Nigerian undergraduate medical training - A narrative review
Oluwasegun Joshua Afolaranmi1, Omolola Salako2, Kehinde S Okunade3, Ayorinde B James4, Gabriel T Fagbenro5
1 College of Medicine, University of Ibadan, Ibadan, Nigeria
2 Department of Radiobiology, Radiodiagnosis, and Radiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
4 Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Lagos, Nigeria
5 College of Medicine, University of Lagos, Lagos, Nigeria
|Date of Submission||11-Feb-2020|
|Date of Acceptance||26-May-2020|
|Date of Web Publication||2-Feb-2021|
Dr. Oluwasegun Joshua Afolaranmi
College of Medicine, University of Ibadan, Ibadan
Source of Support: None, Conflict of Interest: None
Nigeria, as well as other low- and middle-income countries, still lags significantly behind in the development, understanding, and application of genomics-based approaches in the diagnosis and treatment of diseases. To close this gap, and to enjoy the monumental opportunities of genomics and precision medicine, training and education in genomics must become a priority and must commence early enough in medical training. This article presents a synopsis of the development of genomics, the current state of genomics research and education with a focus on Nigeria and importantly, provides critical suggestions on how best to integrate genomics into undergraduate medical training in Nigeria. There is no doubt about the need to prepare Nigerian physicians to be able to tap adequately into the countless opportunities of the genomics era. As a matter of urgency, steps must be taken to introduce carefully designed, unified and competency-based genomics training module based on sound pedagogy into the Nigerian medical undergraduate curricula.
Keywords: Curriculum, genomics, medical education, Nigeria
|How to cite this article:|
Afolaranmi OJ, Salako O, Okunade KS, James AB, Fagbenro GT. Integrating genomics education into Nigerian undergraduate medical training - A narrative review. J Clin Sci 2021;18:3-7
|How to cite this URL:|
Afolaranmi OJ, Salako O, Okunade KS, James AB, Fagbenro GT. Integrating genomics education into Nigerian undergraduate medical training - A narrative review. J Clin Sci [serial online] 2021 [cited 2021 May 15];18:3-7. Available from: https://www.jcsjournal.org/text.asp?2021/18/1/3/308603
| Introduction|| |
Developing countries of the world have been caught in a phase of epidemiologic transition where changes in lifestyle and increased urbanization are leading to rapid rise in incidence of noncommunicable diseases. Concurrently, however, these countries are still combating the scourge of infectious diseases coupled with increasing levels of deaths and disabilities from injuries resulting in a triple-burden of diseases.
The peculiar challenges of this situation demand that we embrace the strategy of “precision medicine,” where specific, personalized and individualized care is offered to each patient. This novel approach, with a potential to transform health care, is hinged largely on advances in scientific research that birthed the field of genomics and is fast improving the health outcomes and quality of life of individuals. For example, cancer patients can now have personalized drugs such as targeted therapy designed to target specific mutations found in their own tumors with a promise of increased chances of survival even with reduced risk of adverse effects seen with conventional chemotherapy.,
Genomics is defined as “the study of genes and their functions, and related techniques” and the applications of genomics extend beyond treatment alone to include prenatal diagnosis, risk assessment, and prognostication among others. While genetics, as a field, studies single genes for their composition and roles, genomics attempts to understand all the genes that make up an organism, their interrelationships as well as their composite effect on health and disease in the individual.
Most low- and middle-income countries, including Nigeria, lag behind in the development, understanding, and application of genomics-based approaches in the diagnosis and treatment of diseases. To close this gap, and to enjoy the monumental opportunities of genomics and precision medicine, training and education in genomics must become priority and must commence early enough in medical training as this is a cornerstone for advancing health care.
This article presents a synopsis of the development of genomics, the current state of genomics research and education with focus on Nigeria and importantly, provides suggestions on how to integrate genomics into undergraduate medical training in Nigeria.
| The Genomics Story: History and Impact|| |
The word genome was introduced as far back as 1920 by Hans Winkler to connote the complete genetic makeup of an individual. However, the birth of the discipline of genomics may be traced back to the 1980s when Thomas H. Roderick, a scientist at the Jackson Laboratory, Bar Harbor, Maine, coined the word to encompass the then budding field of genome mapping and analysis with its application on understanding and treating diseases., The ensuing years featured attempts to sequence whole genomes beginning with the yeast genome, to more complex organisms such as Caenorhabditis elegans and then to the launch of the phenomenal Human Genome Project.
The field of genomics has now grown to be an important part of biology with overwhelming impact within and beyond medicine. The discipline has made available an enormous amount of data from the human genome to allow interesting and spectacular studies of complex and hitherto faintly understood diseases. In medicine, the fields of oncology, cardiovascular diseases, neuroscience, infectious diseases, pediatrics, and drug discovery have particularly benefitted from the transformative effects of genomics. Genomics has also opened up a number of other fields of study including but not limited to proteomics, transcriptomics, metabolomics, epigenomics, pharmacogenomics, and bioinformatics.
Some of the translational effects of genomics include aspirin treatment for colon cancer patients with a particular mutation in the PIK3CA gene and rapid whole-genome sequencing to screen for up to fifty inherited genetic diseases in newborns. In infectious diseases, application of genomics is helping to investigate and curb outbreaks of very deadly diseases such as Ebola virus. The list of applications is indeed endless and beyond the scope of this article, and the field continues to show promise of transforming health care.
| Genomics in Nigeria: Current Realities|| |
Nigeria is a West-African country with the largest African population and seventh largest in the world. The country is indeed one of the most diverse, with over 250 ethnic groups and numerous languages. This geographical and anthropologic landscape makes Nigeria a fertile ground for genomic studies. The epidemiological pattern and disease burden in Nigeria further emphasize the need for genomics research and application in training institutions. For instance, the country has perhaps the largest number of people in the world with the monogenic sickle cell disease. Other monogenic disorders such as glucose-6-phosphate dehydrogenase deficiency as well as congenital genetic disorders such as trisomy 21 (Down's syndrome) are also fairly common. Moreover, multigenic chronic diseases such as cancer, diabetes, and hypertension are rapidly increasing in prevalence and now account for about one in three deaths in Nigeria.
Despite the obvious need, the current state of genomics research and training in Nigeria is still low. Indigenous genomic studies are few, and most of the available genomic data are from international collaborations that included Nigerian populations such as the International Collaborative Study of Hypertension in Blacks and the Africa America Diabetes Mellitus Study. Olopade and collaborators have used genome wide association studies to understand breast cancer in African populations with insightful results. Many of these efforts are in collaboration with Nigerian researchers in Diaspora, and there is inadequate local funding and infrastructural support.
Notably, however, some significant strides are being made that are already improving the prospects of the genomics landscape in the country. The World Bank-funded African Centre of Excellence for Genomics of Infectious Diseases at the Redeemer's University is leading regional efforts in understanding the genomics of deadly infectious agents to better curb and combat epidemics. Several other efforts from researchers across the country have provided results such as work by Adeyemo and Butali on the genomics of orofacial cleft in Nigeria.
Although there are some notable governmental efforts to build genomic research capacity in the country, there is still much to be done. The Nigerian Institute of Medical Research, for example, provides some training, tools, and infrastructure to encourage researchers to engage in genomics research.
There is also a huge deficit in private sector involvement. Indeed, many research facilities in developed nations are donations from the private sector to adequately train scientists to provide answers to germane medical issues affecting the society. The implication of the current realities is that genomics research and training must become prominent in the Nigerian health-care space and this should begin from undergraduate education.
| Genomics in Medical Education|| |
In spite of the potential opportunities of the field of genomics, there exists a downside which requires urgent attention. That is the widening gap between the exponential growth rate of genomics and its translation into routine clinical practice. This gap is certainly multifactorial but is due, at least in part, to inadequate genomics education at all levels of clinical training.,, Evidence has shown that practicing physicians have deficient genomics and genetics knowledge. A study done among internists in two academic centers in the United States reported almost 75% of the participants admitting to poor knowledge of genetics and about 80% of them feeling the need for more training in genetics. Haga et al., studied 597 primary care physicians in the United States and found that only about 13% of them felt comfortable with requesting for genomic tests or explaining them to their patients as one in four of them had not received any prior education in pharmacogenomics. These reports, even in developed countries, point to inadequate education in genomics in medical school training. A survey of course directors across various medical schools in the United States of America in 2016 showed that while 94% of respondents agreed that genomics is an important element of medical school curriculum, only 42% of them admitted to having a local genomics curriculum in their medical school.
There is a paucity of data on the state of genomics education in medical training in Nigeria and anecdotal experience leaves little to be desired of the current state. Most medical schools in Nigeria at best provide theoretical genomics and genetics education as topics in basic medical science courses such as biochemistry and pathology subjects in their medical training. However, facilities for quality laboratory exposure are scarcely available and most of the skilled personnel in the country received training abroad through fellowships or short course programs. This makes the subject appear difficult and uninteresting to students, thus obliterating their interests in the subject area. Unfortunately, many of these courses are considered as medical school hurdles and not knowledge enhancement tools for tomorrow's physician.
The implication of this poor state of genomics education is huge for Nigeria. First, if the poor state persists, the country may miss out on the opportunities that genomic medicine presents us to change the narrative of health care despite our very diverse population and heavy burden of disease. This is because graduating physicians will not be properly equipped to make use of genomic tools and resources in their clinical practice. Furthermore, limited exposure to genomics and genetics at such an early stage in physicians training may preclude the much-needed increase in the number of genomic researchers in the country leading to continued lag in locally driven genomic research and its clinical application to push the frontiers of health-care delivery in Nigeria. There is, therefore, an urgent need to integrate genomic education into undergraduate medical curriculum in Nigeria.
| Genomics in Nigerian Medical Education: Charting a Way Forward|| |
The current challenges notwithstanding, there is a pressing need to take important steps to prepare future Nigerian physicians for modern practice by rethinking training curricula to involve emerging fields like genomics.
Perhaps, the first step in this direction will be conducting elaborate research to build evidence base on the current state of genomics education in medical schools, identify the existing structural and infrastructural gaps, and determine key competency areas that need to be covered. The studies must be designed to evaluate students' knowledge and perspectives as well as faculty alike and to review training curricula extensively.
Second, medical schools then need to develop the necessary infrastructure and build capacity of faculty members to be able to deliver quality genomics education. This can be achieved through international and national trainings on course content development to drive appropriate genomics education for medical students. The trainings will be geared toward identifying key competency areas in genomics to be covered in medical education as well as strategic pedagogical techniques that will guarantee adequate transfer of these competencies.
As a third step, a national consortium on genomics education can be convened to achieve this purpose of training and curriculum design similar to the Undergraduate Training in Genomics initiative. This consortium can design a course module in genomics for medical students. To deliver on its best potential, the module should preferably be designed to span through both preclinical and clinical years with the preclinical phase focusing on basic principles in genomics while students are then acquainted with real applications of genomics in patient testing, diagnosis, and treatment in the clinical phase. Needless to say, this would require a truly multidisciplinary team involving basic scientists, clinicians, bioengineers, bioinformaticians, computer scientists, and even health-care innovation experts for the holistic design and delivery of such a module. Key competency areas to be taught must be agreed upon, clearly spelt out and uniform across centers. A cue can be taken from the Association for Professors of Human and Medical Genetics established set of genetics competencies for medical students with adaptation to suit specific local needs and available resources.
There is a possibility that if the traditional methods of instruction currently being used in medical schools in Nigeria are employed in the delivery of genomics education, students will find the subject difficult and unappealing. To mitigate this, there must be a shift to better learning methods and the module should adequately inculcate case-based learning, small-group teachings, student seminar presentations, laboratory attachments, local and international summer research positions, and even relevant industrial internships.
The field of genomics is expanding rapidly, and the genomics ecosystem is also gradually developing in Nigeria, as such, there will be a need for continuous monitoring and evaluation of the genomics education even after it is initiated. This should include student and faculty assessments, continued research, and curriculum reviews at stipulated times to ensure that the training provided to medical students remains relevant and matches with health-care needs of the populace. The steps suggested here and others, if executed adequately, will help close the unacceptable gap between genomics and its clinical application in Nigeria, and in no time, will position the country to not only consume genomics data but also be actively involved in genomics knowledge generation and application to ensure a healthier world.
| Conclusion|| |
There is no doubt about the need to prepare Nigerian physicians to be able to tap adequately into the countless opportunities of the genomics era. As a matter of urgency, steps must be taken to introduce carefully designed, unified and competency-based genomics training module based on sound pedagogy into the Nigerian medical undergraduate curricula.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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