Precision Medicine (PM) is a rapidly advancing field that challenges the traditionally taught clinical approach and encourages a multi-disciplinary approach to patient care. While the pace of genomic discovery is at an all-time high, the adoption and application of these advances has been slow. Therefore, it is crucial to assess the knowledge and attitude of both medical students and practitioners towards precision medicine, as well as identify the barriers to its implementation. The results of this study can help inform medical education curriculums and improve patient outcomes through the incorporation of PM into clinical practice. 11 The present study included 607 respondents of which 312 were medical students and 295 were physicians of varying levels of expertise.
Understanding the current state of knowledge of both students and practitioners is essential to the implementation of PM. A baseline allows for providing adequate training and emphasizes the urgency of doing so. It was highlighted by Mason-Suares, H. et al (2016) that a new spectrum of skills is required from healthcare providers, to implement precision medicine; these skills include but are not limited to managing diagnostics facilities, gauging the relevance of tests, and implementing cost-effective procedures.12 The present study showed that medical students and physicians had a moderate knowledge level about genetic testing and PM, indicating a need for further training and education. Studies conducted in various countries have consistently established the gap in knowledge about precision medicine among healthcare workers of all levels of seniority. 13 14 15 16 17 18
Knowing how receptive future and current practitioners are to the practice of PM is important to gauge the true application of such innovations in clinical practice. The present study demonstrated positive attitudes despite limited current knowledge, with 80.9% of respondents willing to use a patient's genetic information to guide decisions in clinical practice. This value is comparable to a study from Adelaide Medical School in Australia, where 73% (85/116) showed willingness to implement PM.3 This similarity was also found when measuring the willingness to use genome-guided prescribing tools even if more senior physicians were not, which was 78.4% in the selected Jordanian sample, and 72% (83/116) at Adelaide Medical School.3 This indicates the potential for widespread implementation of PM in Jordan.
A great majority of the participants were willing to expand their knowledge of the topic. However, they were hesitant to take up learning on their own, regardless of their level of expertise. This implies that practitioners are largely unfamiliar with the field of PM. Students preferred to see PM integrated within the curriculum, while physicians showed interest in workshops, external to core learning. Webinars and courses were also popular choices, but reading material was not. This indicates the need for external assistance from professionals in the field and highlights the importance of adapting teaching methods to the level of expertise of the learners. As expected, younger participants were more malleable to adapting to change, and showed greater eagerness to learn. Integrating PM into the medical curriculum will require overcoming limited funding, relevant expertise, foundation, and framework. Medical education is reliant on the presence of good examples for students to emulate, which in the case of PM, is lacking.19
However, while PM has been received in a positive light from both medical students and physicians, concerns arose with regards to its application. Concerns regarding patients’ anxiety about test results (77.8%) and a breach of confidentiality (75.3%) were reported by most participants. Additionally, participants, regardless of their level of expertise, were uncomfortable with interpreting genomic test results and recommending them to patients. To ensure the preparedness of practitioners for the application of PM, it is important to not only provide them with the necessary knowledge but to also supplement them with the confidence to apply this knowledge gained. Innovative teaching methods may be helpful in doing so. A study at Stanford School of Medicine found that students that analyzed their own genotyping data had increased knowledge and confidence in the results of personal genome testing.20
Interestingly, there was a stark difference in the perceived barriers towards integrating PM. Most (80.2%) of medical students identified cost to be the main hurdle, while physicians almost unanimously agreed (92.9%) believed it was limited accessibility. A study in the UAE concluded that cost, lack of training and insurance coverage, (62%, 57.8% and 57.2% respectively) were the 3 major barriers perceived amongst healthcare workers.4 Concerted efforts must be made to address these hurdles and broaden the application of precision medicine.
The present study had several strengths, including being the first of its kind in Jordan. The sample included medical students from all medical schools and physicians with different seniority levels across the country. One strength was that we explored the interests of medical students and physicians in learning more about PM, and their preferred teaching tools, which can inform effective teaching strategies in the future. However, there were some limitations. One limitation was the use of Likert scales which are susceptible to central tendency bias due to selection of neutral answers. However, the low percentage of neutral answers helped decrease the potential impact of this bias on the results. Another limitation was the aggregation of all physicians in one category regardless of their specialty and seniority level. Future studies should focus on physicians in each specialty to inform the proper adaptation of PM into different residency programs.