Medical Genetics residency training in USA

Medical genetics residency training is relatively new medical specialty training in USA. As the growing body of genetic knowledge, the realization of application in practical medicine, this field has been developed but in a slow pace than previous expectation. Doctors who have been enrolled in the training will sit for the examination for board certification of clinical genetics. Only MD can be entered into this type of training. Currently, there are about 1000 american board certified medical geneticists in US and elsewhere in the world. This number is only about 1% of all doctors.


There are other three laboratory based subspecialty training: biochemical genetics, molecular genetics and cytogenetics which allow both MD and non MD doctorate graduate to enter this type of training. Another genetics sub specialty training are molecular genetics pathology and Neurogenetics that are run by American Board of Pathology and American board of neurology and psychiatry respectively. We will focus on training that are accredited by board of medical genetics.



Pathway of training

1.single specialty training with or without subspecialty training

2.combined specialty training (combined with internal medicine/ pediatrics or OB-GYN)



The first one is the most common pathway. There are about 50 programs owned for this type of training. These are the list of accredited programs from all states in USA.

 
 
 
 
 
or you can follow this link: http://www.acgme.org/ for accredited programs search.
 
The eligible for enter each programs are set different by institution but the eligibility for sit in the exam for amedican board of medical genetics are set and evaluated by American Board of Medical Genetics as followings:


Training Requirements for Certification




Foreign Medical Graduates Credentials Check



Individuals seeking ABMG certification must fulfill all of the requirements for certification, as detailed in this document. Individuals who hold doctoral degrees earned outside of the US, Canada, or Puerto Rico or who underwent medical training outside of the US, Canada, or Puerto Rico, may need to meet additional requirements.



Doctoral degree requirements for each genetics specialty are as follows:

Clinical Genetics………………………...MD or DO

Clinical Cytogenetics……………………MD, DO, or PhD*

Clinical Biochemical Genetics…………. MD, DO, or PhD*

Clinical Molecular Genetics……………..MD, DO, or PhD*



*PhD must be in genetics, human genetics or a related field, as determined by the ABMG.



The Clinical Genetics specialty training requirements include:



24 months of satisfactorily completed full-time training in an ACGME-accredited residency program in a specialty (other than clinical genetics) that is recognized by the ABMS, (e.g., pediatrics, obstetrics and gynecology, internal medicine, etc.) and an additional 24-months of satisfactorily completed full-time training in an ACGME-accredited clinical genetics residency training program;



OR



48 months of satisfactorily completed full-time training in an ACGME-accredited 4-year clinical genetics residency. (Note: In this instance the 48 months of training satisfy both the graduate medical training requirement and the medical genetics residency training requirement);



OR



60 months of satisfactorily completed full-time training in an ACGME-accredited combined residency such as pediatrics/medical genetics, internal medicine/medical genetics, or obstetrics and gynecology/medical genetics. Upon successful completion of all the requirements of the combined residency, a trainee is qualified to apply for certification by either the American Board of Pediatrics (ABP), the American Board of Internal Medicine (ABIM), or the American Board of Obstetrics and Gynecology (ABOG) (depending on the other discipline) and the ABMG. Applicants must satisfactorily complete the specific credentialing requirements of each board to be eligible to sit for the examination of that board. Certification in one specialty is not contingent upon certification in the other specialty.



The laboratory specialties (Clinical Biochemical, Clinical Cytogenetics and Clinical Molecular Genetics) training requirements include a minimum of 24 months of satisfactorily completed full-time training in an ABMG-accredited laboratory genetics training program.



For certification in each additional ABMG specialty (except Clinical Genetics): an additional 12 months of completed full-time training in an ABMG-accredited fellowship program in that specialty is required. For certification in Clinical Genetics as an additional ABMG specialty, the same requirements as those detailed above in IB apply.



Number of months of ABMG-approved medical genetics training to be completed by number of ABMG specialty certifications sought:



Number of ABMG

primary specialty certifications* Months of completed ABMG-approved medical genetics training

1 24 months

2 36 months

3 48 months

4 60 months



*Note: Certification in Clinical Genetics always requires 24 months of completed training in an ACGME-accredited clinical genetics residency.





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Credentialing Requirements and Process



The credentialing process determines an applicant’s candidate status for the ABMG certifying examination. All documents required for the credentialing process must be submitted to the ABMG Administrative Office and postmarked by the deadline (see Deadlines, Section VI).



Full training options can be found at American Boards of Medical Genetics website
http://www.abmg.org/pages/training_options.shtml

Gene patents: pros and cons (again)

There is a recent hot debate again about gene patents after the New York federal Judge Robert Sweet ruled that human gnee isolation is unpatentable. (2010) Seven patents involving genes and genetic diagnostic methods by Myriad Genetics were invalidated. A decade before, the United State Patent and Trademark office argued that gene sequences can be patented and it open the era of BRCA gene for breast cancer genes research and diagnostics in Europe and USA. The decision is under appealed and the European community is still unchanging but who know the future impact of this rule by the US legal system that always have a strong impact in world market.

In US patent law, the subject matter may be patentable if it belongs to one of four classes: a process, a machine, manufacture or composition of matter. It has to be new and non-obvious. In Europe, an isolated gene  from human body or produced by other technical process can be patented even if the structure of that element is identical to that of the natural element. In USA, in 1980, the Supreme court held that a human made, living, genetically modified bacterium, capable of breaking down components of crude oil was patentable. The products had to have markedly different characteristics from a product of nature. According to Judge sweet, the identification of the BRCA genes is unquestionably a valuable scientific achievement for which Myriad deserves recognition,  but that is not the same as concluding that it is something for which they are entitled for a patent. The techniques of purification and isolation of DNA are well-known to those skilled in the art and as a consequence, such claims on isolated DNA constitute unpatentable subject matter.

We will consider about the health care access, scientific research and moral issue of gene patents.
From the patent-pro stand points, patent exclusivity is needed to incentivize invention and innovation. Big pharmaceutical companies have benefited from this principle and claim that drug development and research cost them a lot. It is actually insufficient evident to conclude that patent system is the only effective system to encourage such invention and innovation.

Gene patents can limit the access to the particular gene based therapy, biologic drug and diagnostic modalities. Such restriction can increase patient burden and costs. Ethical and moral against human gene patents go further to human dignity. We are not the same as birds, flies, plants and bacteriu. It seems weird that someone can own the body of knowledge about somepart of the human, in this case, gene sequence and isolation for their own benefits. Although there is some objections of this moral argument, it is still debatable about what can be patented and what should not be patented based on different legal sets, big pharma or scientist, health care providers or people.