Precision Medicine, Race, and Health

As a member of the Fellowships in Research and Science Teaching program here at Emory, I have been taking a course this semester on “How to Teach” (which led to the quick demise of my project to document my reading and very much impacted my Twitter presence - it turns out that as things get busy in my work life, keeping up with Twitter goes out the door). But we’re nearing the end of the semester now, and I wanted to take some time to reflect back on my most recent experience teaching within the course and to share some teaching tools for discussing Precision Medicine, Race, and Health.

Our class meets once a week and consists of first-year postdocs within the FIRST program (and a few other postdocs from Emory and Spelman who are also interested in education). We spent the first third of the semester discussing our teaching philosophies, the present and future of undergraduate education, types of teaching practices (e.g. lecturing, small groups, discussion), assessments, and course design. We discussed the available data on best practices in science education, and concluded that active learning is the best approach to increase student engagement and performance in our classes. This approach fits well with my own experiences as a student and a learner - I don’t feel as though I’ve truly learned anything until I’ve engaged with the material and applied it.

In keeping with this spirit, after our initial foundation in teaching practices, we collectively designed a 10 week 50 minute freshman seminar on “Race and Health” and then took turns teaching the course to each other. Each week we had a randomly assigned pedagogical tool or technique that we needed to incorporate into our lesson and we worked in teams of two to three. This past week, I co-taught a class on “Precision Medicine, Race, and Health” with fellow FIRST fellow Elizabeth Millings. Our assigned pedagogical technique was to use the primary literature, but otherwise the topic was broad and quite flexible. This class was #9/10 in the course and we wanted to include explicit connections to the material from previous weeks.

We ultimately decided to have our students read a background article from the Atlantic related to Precision Medicine and race. We next asked them to search the literature for primary research articles related to the risk for coronary artery disease and precision medicine. Here is a link to our assignment. You’ll note that we tried to walk our students through the process of both searching the literature and assessing their article, as we assumed that incoming freshmen would have relatively little experience reading scientific articles.

In class, we opened with a video from the recently launched All of US initiative from NIH, which led into a discussion that drew upon the Atlantic article on why people - especially those in minority populations - might hesitate to participate and share their data with the government. From this discussion, we transitioned to discussing the articles using a framework of “Why? (Intro), “How?” (Methods), “What?” (Results), and “Who cares?” (Conclusions and Implications). Elizabeth led the group in outlining 3 articles fully using this method and we followed up by having everyone else summarize their article in one sentence (a feasible approach in a class of 9, but would be much harder with more students!).

Once we had the information from literature summarized on the board, our next goal was to see if we could apply these results to individual cases. This section of the class was the most fun for me to prepare and to execute and it sparked a lot of discussion. Together, Elizabeth and I created three case studies of metro Atlantans (our city) and their experiences in several key areas:

Race
Family history (genetics and ancestry)
Psychosocial Stress
Exercise and weight
Nutrition
Education and work
Interaction with healthcare system (including prior experiences of healthcare bias)

These topics directly related to prior course topics and allowed students to apply what they had learned in those classes (such as having at least one of our metro Atlantans live in a food desert, a topic we had discussed a few weeks prior). Students divided into groups of 2-3 and each group received a one-page assignment. They then could ask for information from one of those categories one at a time. Here are the cases themselves. We deliberately set this one-piece-of-information-at-a-time rule to mimic how you talk with a patient (one question at a time) and to force students to prioritize and consider which pieces of information they thought would be most important. Students then tried to see where they thought precision medicine would be useful for patients and when they thought it would be a distraction.

This exercise was really interesting for me as a former physician, scientist, and educator. Our class really dove into discussing these people’s stories and it brought alive the challenges of applying expensive clinical technologies in a society with high income inequality, prior and current racism, and lack of access to universal basic healthcare. One student shared that his perspective on precision medicine shifted after considering the case of a poor white man without insurance coverage who actively smoked and was sedentary due to his work as a truck driver. The group that considered that man’s story ultimately concluded that bringing in expensive genetic technologies (if they were somehow were to be made available to him) might prove to be a distraction from other more pressing issues, like quitting smoking, losing weight, and potentially finding a job that allows for a healthier lifestyle. In discussion of our other cases, the groups saw more potential for precision medicine to help tailor recommendations and individualize care. For example, one of our cases was a 32 year-old Hispanic female who was overweight and ate a meat and carbohydrate heavy diet. That group discussed the possibility that perhaps the tools of precision medicine could help to better define her true risk for coronary artery disease and that perhaps she does not need to change her diet (I must admit here that my own beliefs about nutrition make it hard for me to accept that she shouldn’t eat more vegetables and less saturated fats, but it’s not wise to fight with hypotheticals). We ultimately stumbled into an interesting discussion on the difference between precision / personalized medicine vs. person-centered care. Unfortunately we ran out of time to discuss more as a lot of folks were charged up with lots of ideas that they wanted to share (a nice place to end).

I found this pairing of the literature with case studies to be very effective to bring abstract research concepts to personal stories. Building the cases was a fun exercise in creativity and I felt like a novelist unearthing characters who reveal themselves gradually. We deliberately had all of our cases be local Atlantans, to try to connect their stories with our community. As I prepared the stories, I could tell that my many years living in and exploring Atlanta (most often by bike) enriched the stories that I could craft. Unsurprisingly, I also could see how my medical training and experiences enriched both the case studies and my ability to discuss these concepts in class. As a teacher, I’m able to draw upon hundreds of clinical cases and experiences when considering these topics – which makes the process more meaningful and thought provoking for me.

Of course, I have ideas for small tweaks I might make to the assignments and cases if I were to teach on this topic again, but in the interest of time, I think I’ll save those for another post. Please do feel free to draw upon my case materials and assignments if it’s useful to you. I’d love to hear feedback if anyone is considering using these tools and we can discuss how to make it most effective in your classroom.