Friday, June 23, 2017

Optional Rotation: Cambridge, England

For my optional clinical rotation, I had the unique opportunity to spend four weeks in the United Kingdom.  Since I am dual degree student also pursing an MPH in Public Health Genetics, my main goal for this rotation was to observe the differences between UK and US genetics services.  My rotation took place in Addenbrooke’s Hospital, a teaching hospital that is part of the U.K.’s National Health Service (NHS) and is affiliated with the University of Cambridge.  The clinical genetics department at Addenbrooke’s is made up of 10 genetic counselors and 11 clinical geneticists with varying specialties and professional interests. 

Addenbrooke's Hospital of Cambridge gave one Pitt student
the opportunity for an optional rotation.
During my four-week rotation, I had the opportunity to observe and participate in patient encounters across a number of genetic specialties such as prenatal, pediatrics, and cancer.  For the most part, the genetic counseling sessions are handled in the same manner as they are in the US.  They contract with their patients the same way that we do, provide the same basic genetics information, and offer emotional support to patients and their family members.  The greatest difference, I found, was in the type of genetic tests and screenings that were offered to patients.

In the US, if a patient meets clinical criteria for genetic testing, the type of test offered, the testing laboratory selected, and subsequent health screenings recommended often depends on the patient’s insurance.  In the UK however, the vast majority of patients utilize the NHS, a single-payer system, which somewhat streamlines the genetic testing process.  However, because the NHS provides healthcare to so many people, the challenge of conserving resources is very real.  The clinical criteria for genetic testing and health screenings in the UK are stricter than they are in the US, and there is a more formalized process for getting an appointment with a geneticist or genetic counselor.  After having spent time in two very different healthcare systems, I am now more aware of the variety of medical services in the US and have gained an appreciation for the straightforward nature of the NHS.
An important historical message about the discovery of DNA
from a local pub in Cambridge.

In addition to participating in genetic counseling appointments, I also had the chance to observe a number of other genetics-related services.  I got to spend a day in the von Hippel-Lindau (VHL) clinic, working with patients living with this syndrome and helping to coordinate their other specialist appointments.  I spent another day sitting in with men who had a BRCA2 positive test result who were participating in a prospective prostate cancer research study.  I also had the opportunity to observe mammograms and colonoscopy procedures.  These experiences allowed me to appreciate the downstream impact of genetic services on patients, doctors, and research.

Although my rotation kept me quite busy, I was able to set aside some time on the weekends to explore Cambridge and other parts of the UK.  Much of Watson and Crick’s contributions to the discovery of DNA happened just down the road at the University of Cambridge’s Cavendish Laboratory, and it was exciting to feel a little closer to that important history.

My optional rotation in Cambridge was an amazing way to round out my clinical training.  Not only was I able to utilize the skills that I had honed up until that point, I also got to learn a great deal about the applications of genetics to other areas of medicine and its impact on public health.

-- Leslie Walsh, Class of 2017

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