Podcast Review: #GenomicsConversation 2021 – It's complicated! or is it?

'It's Complicated! Or is it?' – this is the notion that Dr Michelle Bishop, Amelia McPherson and Dr Ed Miller from the Genomic Education Programme team, a part of Health Education England, are aiming to challenge in this podcast. It is aimed at midwives, nurses and health visitors who have likely been, and will continue to be, questioned about genomics by patients in their practice.

The podcast began with a very clear explanation by Dr Bishop of the word 'genomics' and how it is closely related to 'genetics', but it considers the collective genetic information instead of looking at just one gene. She further emphasised healthcare professional's prior familiarity with the topic by highlighting that genetic testing in the NHS has been conducted for decades.

Another important aspect that was strongly brought to the listeners' attention was the fact that, midwives routinely collect information directly relevant to genomics whenever they collect family history data at the booking in appointment women have in early pregnancy. In addition to obstetrics, other medical fields with the more obvious applicability of genomics that were mentioned included oncology and the field of rare diseases. All of these examples were very important for revealing to healthcare professionals their existing genomics knowledge that they may not have realised they had prior to the podcast.

On the other hand, the Genomics Education Programme team emphasised that nobody is an expert on all areas of genomics, and thus the genomics experts within their specialised medical departments will typically be proficient 'just' in their particular field. For example, clinical geneticists or genetic councillors trained in genomics in the cardiology department will have an in-depth genomics knowledge relevant to cardiology, but not in other areas, and not necessarily genomics overall. This was another important argument aiming to reassure nurses, midwives and health visitors that they are not required to know and fully understand everything, and that it is not a weakness to be able to admit this. However, the Genomics Education Programme team stressed, it is important that the healthcare staff have the required foundations to confidently guide their patients to appropriate sources, where they can get appropriate information.

Conversely, contrary to the authors' aim, some fragments of the podcast may have led the listeners to come away with the conclusion that genomics is indeed complicated. For instance, contrasting the medical fields, in which the application of genomics is less obvious, with cancer medicine and obstetrics may have not succeeded in encouraging healthcare professionals in other fields.

The Genomics Education Programme team kept encouraging the listeners to 'be curious' about how genomics may present, or may be used, in their area of clinical practice as well as to explore the Genomics Education Programme's online resources to be able to figure out 'where to start'. However, specific examples were not provided. This is certainly an area for improvement, because some examples may have been helpful in inspiring the very busy and hard-working healthcare staff in, for instance, internal medicine , where the application of genomics may not always be immediately clear.

Moreover, the mention of the cross-professional competency framework, which guides the healthcare professionals in identifying their genomics training needs, based on the context of their specialty, may again have left some staff feeling that more specific instructions would benefit them more than the general guidelines.

Similarly, admitting that even clinical genomics experts are still in the process of figuring out, or optimising, how to best use the available knowledge and technologies in clinical practice, again may have led some listeners to keep up their preconception about the complexity of genomics. This impression may have prevailed even though the goal of that argument was again to reassure healthcare professionals that it is not expected that they should know everything about genomics or be able to answer all their patients' questions independently with experts' support.

Overall, the podcast certainly contributed to raising awareness of the increasingly ubiquitous and important role of genomics in clinical practice. For example, both Dr Bishop and Dr Miller repeatedly emphasised that genomic testing is starting to be available throughout the healthcare system and has been becoming a part of routine care. Therefore, it is important for nurses and other healthcare staff to be aware of these practices and relevant training needs and opportunities in order to be able to support clinical activities around genomics. Hopefully this emphasised the requirement for healthcare professionals to start, or continue, to expand their understanding of this science and relevant technologies.

However, the goal of challenging the preconception that genomics is complicated has probably not been achieved fully, despite many convincing arguments, such as the fact that within many specialties, healthcare staff would have been exposed to and involved in activities related to genomics, sometimes without even realising. Another argument that kept being highlighted throughout the podcast was the statement that it is natural and acceptable not to be an expert in the field of genomics as long as one has an understanding of where to direct a patient for specialist advice.

Genomics Education Programme is run by Health Education England, responsible for the education of healthcare professionals in the UK. The podcast was the fourth one in a series of the #GenomicsConversation 2021 week of action.