PTH-130 Genomic medicine in gastroenterology, present and future: a nationwide survey of higher specialty trainees

IntroductionGenomics and personalised medicine are increasingly important for patients with gastroenterological conditions. The higher training curricula of other specialities (e.g. cardiology and oncology) have been revised with the addition of modular training in genomics. Our aim was to capture the present state of genomics training in gastroenterology to review current trainee understanding, clinical experience and long-term training needs, and to assess their preparedness for future consultant practice.MethodsA web-based nationwide survey of all UK Gastroenterology specialty trainees was carried out in November and December 2017, supported by the British Society of Gastroenterology national training committee.Results100/658 UK Gastroenterology trainees (15.2%) across 17/18 deaneries and all specialty training levels responded to this survey.Only 9% and 16% of trainees believe that their local training adequately prepares them for future clinical practice utilising genomic medicine and personalised medicine respectively. Barriers identified (% agreeing or strongly agreeing) include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%).When assessing current mainstream genetic and personalised tests, trainees felt prepared to interpret HFE genotyping (98%), TPMT status (97%), and coeliac disease HLA subtyping (85%). However, only a minority of trainees felt prepared to interpret gene tests in patients with polyposis (34%), hereditary pancreatitis (30%), Lynch syndrome (33%), and KRAS in colorectal cancer (20%). For their future clinical practice, 76% of trainees did not know what mainstreaming of genomics would entail, with only 6% of trainees having recruited patients for the 100 k Genomes Project.Most trainees would support having dedicated training days on genomic medicine (83%), formal training provisions for mainstreaming of genomic testing (64%), an update to the gastroenterology JRCPTB curriculum and SCE examination (57%), and better-defined pathways for referral to local genomic services (91%).ConclusionsMost UK gastroenterology trainees feel ill-equipped to practice genomic or personalised medicine as consultants, at a time of progressive mainstreaming of genomic practice in our specialty. We propose that the gastroenterology specialty curriculum requires specific rev