Wednesday, July 20, 2016

Washington State Department of Health - Optional Rotation

Photo by: Bala Sivakumar
I spent my optional rotation block in a non-clinical genetic counseling role with the State Genetics Coordinator Deb Lochner Doyle MS, LCGC at the Washington State Department of Health (DOH), Screening and Genetics Unit. This unique opportunity just outside of Seattle was ideal for me because it allowed me to utilize both my Genetic Counseling and Public Health backgrounds together. In Washington, the Screening and Genetics Unit is where genetic public health interventions are developed and implemented. This is an exemplary environment for a genetic counselor with a public health background to use the special training that we have to communicate data and risks effectively to a wide audience, a skill that I fully utilized to succeed in my rotation.

For the main portion of my rotation, I was tasked with a specific project at the DOH; I created a Lynch syndrome toolkit to distribute to gastroenterologists in Washington and Oregon. This toolkit, which was named the Lynch Syndrome Patient and Provider Resource Guide, contains items that can be utilized by both providers and their patients. For providers, I developed resources such as a Lynch syndrome fact sheet, cascade screening information, and local genetic clinics contact information. For patients, the resource guide contains informational brochures about Lynch syndrome, a letter template for patients to write to their at-risk family members, and tools for family history information collection. Using these components together as a public health intervention, the Washington DOH is hoping to see an increase in Lynch syndrome diagnoses, by way of diagnosing asymptomatic relatives, in both Washington and Oregon.

One of the most important lessons I learned at the DOH was the value of collaboration. For the resource guide project, the Washington DOH collaborated with the Oregon state health department in order to generate a larger impact by reaching out to more gastroenterologists and a larger patient population. Additionally, the overall cost of the project was significantly reduced as a direct result of the collaboration, which was a key priority. Furthermore, during the production process of the resource guide I found that speaking to other members of the DOH in various offices directed the guide’s focus. Though collaboration, I gained tips and insights to help me design the intervention in the most effective way possible.

Besides developing the resource guide, I was able to participate in several other activities at the DOH. I attended meetings with stakeholders and members from other departments. In Washington, the Screening and Genetics Unit works closely with the Early Hearing-loss Detection Diagnosis and Intervention (EHDDI) program. In fact, the two sections recently developed a patient guide together to assist families when their child is diagnosed with any degree of hearing loss. I was also given the exciting opportunity to tour the Washington state newborn screening laboratory to see how newborn bloodspots were analyzed for early detection of genetic conditions.

My optional rotation in Washington State was rich with opportunities to explore how I could blend my MS in Genetic counseling and MPH in Public Health Genetics together. I strongly feel that when I graduate I will be able to grow my career in a unique direction that will always be intellectually stimulating and fulfilling whether I am seeing patients in the clinic or serving a larger population in a genetic counseling public health role.

- Bryony Lynch, Class of 2017

Wednesday, July 6, 2016

International Rotation: Canada

For my optional rotation block I had the wonderful opportunity to head home to Canada. My goal for this rotation was to learn more about the genetic testing environment within a socialized healthcare system. I completed my rotation at the Credit Valley Hospital in Mississauga, Ontario. This clinic serves a large and diverse population within the ever growing Toronto metropolis. The clinic staffs 8 genetic counselors and 3 geneticists who work in all areas of genetics.

During my four week rotation at Credit Valley Hospital in Canada, I observed many differences. Some of these differences were from clinic to clinic, others province to province, and many country to country. One of the most notable differences between Canada and the USA is testing approval. In Canada, there are no insurance companies that counselors must interact with to determine coverage of genetic testing for their patients. Instead, genetic testing that is not performed within the province requires approval from the ministry of health. This approval process requires a simple application and justification letter. If testing is sent for something common, and sent to a well-known lab in Europe or the USA, then approval will usually take a few weeks. 

Photo by: Paul Gierszewski
Currently, many common genetic tests are being performed within the province of Ontario. The government funds and pays labs within hospitals and universities to perform one or more specialized tests for the entire province, or a specific region depending on the test type. The hospital where I completed my rotation housed a lab that was responsible for prenatal tests in their local area. During my rotation I had the opportunity to attend a meeting with a commercial diagnostics company coming in to promote advanced first trimester screening. The meeting included lab staff, geneticists, and genetic counselors. It was interesting to see the counselors playing such an important role in this decision making process. How counseling plays out in the clinic, based on provincial guidelines, has the potential to result in lab cost savings. This experience made me realize how important it is to have genetic counselors sitting at the table and contributing to decisions being made regarding genetic testing. 

I also observed differences in testing guidelines between the USA and Canada. For example, the National Comprehensive Cancer Network guidelines are used as a reference, but the province has its own testing guidelines for breast cancers, lynch syndrome, and other conditions. Some of these guidelines were less conservative and geared toward a socialized health care system. For example, breast cancer panel testing was reserved for patients with very significant family histories compared to what I have observed in Pittsburgh so far. Observing these differences I noted the balance between what was best for the patient, what was medically necessary, and what was the best use of sometimes limited resources. The province of Ontario has a strict budget specifically set aside for genetic testing and so the balance between patient care and resources is a real one. 

Overall, this was an exciting and unique opportunity for an optional rotation that provided exposure to a healthcare system very different from that in the USA.
- Christine Munro, Class of 2017