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.
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| 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.
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| 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
