 Good morning. Welcome to our ISCC PEG nursing genomics expert commentary Q&A session. Our project group has convened a set of experts to answer frequently asked questions for nurses at three levels of practice, entry level nurses, advanced practice nurses who are nurse educators, and advanced practice nurses who are nurse practitioners. First, we'll watch a short video together and then reconvene for a live Q&A session. Please enjoy. The ISCC PEG nursing genomics project group has convened a group of experts to create a set of frequently asked questions for nurses at three levels of practice, entry level nurses, advanced practice nurses who are nurse practitioners, and advanced practice nurses who are nurse educators. The following video will expand upon six of those answers, two from each FAQ in the series. We hope that you enjoy learning more about these areas of nursing genomics. Please share your thoughts in the comments thread of this video. Entry level nurses. Why is genomics important for nurses and in which practice settings can it be used? This is a great question because genomics is just so very important for nurses for many reasons. Genomics is a rapidly developing science and we're already seeing improvements from the use of genomics in various sectors, including our health, environment, and the economy. In healthcare, we see genomic knowledge from bench science being translated into direct clinical care with improvements in the screening, diagnosis, treatment, and prevention of disease. Improvements in health related to the incorporation of genomics can be seen at individual, family, community, and population levels. The integration of genomics into healthcare has led to the development of a new approach to care called precision healthcare. Precision healthcare combines a person's unique genomic information with other relevant biological, social, environmental, and behavioral determinants of health to develop a care plan tailored to the individual. Genomics can sometimes seem like it is outside the scope of practice for nurses. However, with this shift to precision healthcare approach in clinical care, nurses should consider genomics to be fundamental to nursing. Nurses should be reassured that not only is genomics not outside their scope of practice, but that precision healthcare is very similar to the personalized care approach historically taken by nurses. Precision healthcare combines the holistic approach to care embedded in personalized care with an individual's unique genomic information. The vital aspects of precision healthcare that are already foundational to the personalized care nurses provide include advocacy, equity, access, ethics, patient autonomy, patient education, and family relationships. Nurses can take small steps to learn about how genomics can be integrated into their current practice. Another example is by learning what genomic factors to ask about and be aware of when obtaining a family history. A family history that includes this information is commonly referred to as the most cost effective genetic tests and can be crucial to appropriate and timely diagnosis and risk assessment. It is vital that nurses integrate genomics into their nursing practice and increase their capacity to provide precision healthcare because nurses are the largest group of healthcare of the healthcare workforce and spend the most time with patients and their families. No other group can make as big an impact on the accessibility quality and effectiveness of precision healthcare. Nurses are key members of the healthcare team and need to have foundational genomics knowledge to help with the team approach to precision healthcare. Additionally, nurses can and should be leaders in precision healthcare. Parallels between personalized nursing care and precision healthcare make this an area with many opportunities for leadership from nurses. This voice is critical to ensuring a holistic person and family centered approach to the implementation delivery and evaluation of precision healthcare. I'm so excited for the future of nursing as more and more nurses integrate genomics into their practice. In terms of which nursing practice settings genomics can be used in to reference an Oscar winning movie genomics can be used in every nursing role, every setting, all at once. To learn about how health outcomes are influenced by genomic variations as well as interactions between the genome and the environment. We are seeing applications of genomics that are relevant across the lifespan and in all practice settings. Nurses need to be prepared to integrate genomics into the nursing process, including gathering important information about the patients environment. And nurses in all practice settings need to be prepared to provide patient education and be patient advocates in this new precision healthcare era. Nurse Practitioners. What is the role of a nurse practitioner as it relates to genetics and genomics? Nurse practitioners are critical to providing genomics informed care to individuals, families and communities. As advanced practice providers, how nurse practitioners integrate genetics and genomics into their role builds on what registered nurses do. The nurse practitioners scope of practice related to genetics and genomics includes assessing, diagnosing and creating care plans based on precision health principles, ordering genetic tests and providing pre and post test counseling, providing individual and family risk information and following risk based screening guidelines. Genetics and genomics informed care also includes taking and continually updating a comprehensive family history to identify those at increased risk and ensure they receive appropriate care. Based on the information they collect, nurse practitioners can provide genetic counseling to educate individuals and families, refer them to genetic counselors, if necessary, and implement tailored screening approaches for those at increased risk. Nurse practitioners are key members of the health care team and are critical to implementing precision health care for all. They should work with their colleagues to incorporate genetics and genomics into clinical care. These colleagues include other health care professionals who may be able to provide genomics related information and guidance. Although some nurse practitioners in practice may have received limited content on genomics during their graduate education. There are widely available resources to support lifelong learning, including local genomics experts, continuing education courses and webinars. Nurse practitioners should use these resources to support integration of genomics into their practice. Because of their involvement in every aspect of patient care, nurse practitioners play an extremely important role in implementing genomics informed precision health care for all. How can nurse practitioners be prepared to respond when patients share DTC results? Consumers who have undergone some type of direct-to-consumer genetic test or DTC testing is expected to surpass 100 million very soon. DTC genetic tests are readily available, often marketed as gifts for family or friends, and can be purchased quickly online. Patients bringing DTC genetic test results to primary care providers, such as nurse practitioners, has and will become more frequent. Nurse practitioners should be aware of what these results mean, where to go for assistance, and recommendations for next steps. Patients trust their health care team and are counting on you for the most sound and educated advice. In these cases, it's up to you to remain knowledgeable about how to interpret these results, as well as keeping an updated list of genetic specialists who may be able to help you. There are nurse practitioners with clinical genomics nurse credentials, or those who may be working in a genetics clinic. Additionally, there are physicians who work as clinical geneticists, as well as genetic counselors to name a few. While DTC genetic tests can provide details about ancestry, traits, and some health risks, they do not test for all known variants that can be disease-causing. This means they should not be used to rule out or screen for a particular condition. Even if the DTC genetic test results show an abnormality that may be clinical actionable, these results typically need to be confirmed with a clinical genetic test. While DTC tests look at some genomic information, clinical genetic tests are more comprehensive and are based upon current genomic information known for a certain disorder. Due to this, DTC genetic test results should not be used for clinical decision-making. It is important to communicate with patients about the risks of a false sense of security if the results in fact come back normal. As mentioned, all known variants are typically not tested, which means that the patient may still be at risk and patients should really understand this. For instance, if a DTC genetic test result identifies a single gene high-risk variant, such as those we see with the BRCA gene variants for breast cancer, clinical genetic testing should be initiated and or referral or further discussion with a genetic specialist should occur. In the meantime, it's your duty as a nurse practitioner to maintain and update a thorough family history. And then depending on the results of the clinical test, patients, family members, and close relatives should be educated about their risk and offered any screenings, treatments, or other interventions as indicated. For patients with a low risk variant or one considered to be multifactorial involving genetics plus the environment, such as with type 2 diabetes, providers should be prepared to explain that this may indicate increased risk for condition, but does not mean that they have or will even get the condition. Patient education in this case should focus on lifestyle management as well as ongoing screenings. However, DTC genetic testing has been approved for a few variants for medication management via pharmacogenomics. Tests that are FDA approved do not need to be confirmed with a clinical genetic test. Currently there are just a few medications for which this is approved. However, one caveat here again is that patients may not be tested for all known genetic information and may only get results for a handful of the variants that are known. For drug metabolism specifically, you always want to remember your chemist, also known as your pharmacist, as someone to seek professional guidance from as well. With the increase in DTC genetic test access as well as the increased use interpretation of these results will fall on nurse practitioners or other healthcare providers who are trusted to provide the most sound advice. In order to do this, nurse practitioners are expected to remain knowledgeable and up to date just as they would with any other clinical practice update in order to provide the best evidence-paced care for every patient. Nurse educators. Where is Genomics included in the American Association of Colleges of Nursing, AACN Essentials? So you want to know where Genomics is included in the Essentials. The American Association of Colleges of Nursing, the AACN, released a new version of the Essentials document in 2021. And the Essentials document is intended to provide a framework for the preparation of nurses at four-year colleges with specific guidance about developing and revising nursing curricula at specific degree levels. A very important document for academic nurse educators. So to answer the question, where is Genomics included in the Essentials, it's everywhere in the Essentials. Each one of the 10 domains includes competencies and sub-competencies for which Genomics-informed nursing has relevant and concrete applications. Genomics is referred specifically several times in the document, but you won't always find the elements related to Genomics simply by clicking and entering a search on genetics or genomics. I'll give you just a couple of examples. So the first domain in the Essentials document talks about foundational knowledge that nurses need to practice. Sub-competency 1.2A states that entry-level nursing education should enable nurses to apply or employ knowledge from nursing science as well as natural physical and social sciences to build an understanding of human experience and nursing practice. Advanced practice nurses need to take this idea one step further and in sub-competency 1.2F it's noted that they should be able to synthesize this knowledge from nursing and other disciplines. Notice that in these two sub-competencies the word genomics or genetics does not appear. However, biology is one of the natural sciences and the study of genomics is essential for understanding the fundamental biological processes that make up human physiology, anatomy, including growth development and the maintenance of homeostasis. Domain 2 is another example. Domain 2 of the Essentials document focuses on person-centered care with applications to individuals and families. What gets more genomic than that? One of the sub-competencies in this domain discusses the importance of being able to apply individualized information, specifically genomic information for the delivery of personalized health care. Both entry-level and advanced practice nurses must understand that personalized or precision health care is taking into account individual risk levels, screening decisions and treatment plans. For example, if a woman has a lifetime risk for breast cancer that exceeds 20%, guidelines recommend that she receive annual screening MRI in addition to mammography. The Nursing Genomics Project workgroup from ISCCPEG has developed a frequently asked questions page and on that page we provide a table that maps a few important nursing learning objectives and activities that will help nurse educators teach students the application of genomics-informed nursing care. So final answer, nursing genomics is everywhere in the Essentials. Nurse Educators, how can genomic competency be assessed? It's my opportunity to provide some additional information on how we as nursing educators can assess genomic competencies. With the publication of the new Essentials by the American Association of Colleges on Nursing, our profession is moving towards a new model of competency-based education. Competencies are the knowledge, skills, attitudes and behaviors that contribute to a nurse's performance. Transitioning to this new model presents an ideal time to ensure nursing students have the foundational genomic competencies needed to enter the practice environment. In nursing education, we must also consider the novice to expert model developed by Dr. Patricia Benner. Assessment of genomic competency acquisition can also be viewed through the same five levels of proficiency, novice, advanced beginner, competent, proficient and expert. Teaching and assessment strategies for each of these stages can be scaffolded to help students gain skills and knowledge as they progress through each stage. Let me illustrate how we can map course objectives to the AACN Essentials domain of person-centered care while keeping in mind levels of proficiency as students demonstrate competency attainment. Gerald is a second-year nursing student who is taking his first clinical course health assessment. In this course, students must show competency by utilizing interviewing skills and assessment skills to elicit a comprehensive health history. At the novice level, Gerald was able to identify and gather essential components of a person's individual health history. Meanwhile, Sophia is in her fourth and final year of her undergraduate nursing program and enrolled in a leadership course where students must apply strategies for increased collaborative practices. At a competent level, Sophia was able to obtain a full patient and family health history and discern a relative hereditary risk. She was then able to advocate for genetic counseling for this family. Monique is a family nurse practitioner student about to graduate and take her licensure exam. Monique is enrolled in the Transitioning to Act Advanced Practice course. One course objective requires students to evaluate healthcare clinical process and practice problems and identify possible solutions. Monique works alongside her preceptor in a rural clinic located in parts of Appalachia. Most of their patients hesitate to obtain genetic testing when warranted. Monique demonstrates expert communication skills to gain trust and develop a variety of modalities to improve the genomic literacy of the patients that she serves. Whether your school of nursing has a concentrated genomic course or genetics and genomic information is threaded throughout the curriculum. These examples identify ways that genomic competency skills can be observed and assessed in the clinical setting. As you can see, competencies mature over time and become more sophisticated with ongoing practice. Within the classroom, we can also assess proficiency levels for baseline and advancing competency attainment through case studies, simulation activities, and even validated assessment tools. See other FAQs in this section for more details on resources and ideas on ways to map and assess genomic competencies within this new model. And I encourage you to explore all the FAQs that encompass rich information for practicing nurses just entering the field or have an advanced degree. Thank you for joining us, everyone. My name is Trina Walker. I'm assistant professor at Creighton University in Omaha, Nebraska. We welcome all of you and hope that you enjoyed our video. I believe in the chat the link to our newly developed FAQ has been added so we encourage you to go check that out. We do have roughly four to six questions for each practice level of nursing so we brushed on just a couple of them from each from each nursing level in this video, but the FAQ does expand on that. I'm now going to share with you real quickly. I survey that the American Nurses Association is requesting us to promote that is focused on genomics and precision health and nursing practice. So, there's a QR code here that you can see please go ahead and scan this with your phones. There's also a link in the chat as well if you prefer to use your link. And we would appreciate you to fill out this survey takes about 20 minutes. Obviously, your responses are voluntary and kept confidential, but this will really help us to develop new genetic genomic competencies for nurses in partnership with American Nurses Association. So I'll leave this up for just a few minutes. If anybody has any questions this is now our live Q&A session so we do have all of our expert commentators available here today. If you would like to ask a question, please just type your question into the Q&A box, and then we will get to that momentarily. I don't know if do we have any questions just yet. We do not have any questions just yet. Okay. So think of some things we would love to have some questions during this so we can help. Again, check out our FAQ the link is in the chat it has a lot of good information. There's one common one that I'm asked since I covered the DTC information the direct to consumer testing. My major area of focus is pharmacogenomics. And so I can kind of highlight that that there's just a few medications and when I say a few. There are three variants and eight genes that are FDA approved to be utilized as a clinical genomic test so the specific medications where this has been approved for is for clopidogrel or plavix cytolaparam or Selexa and so those are the three that are mainly FDA approved and then again, there is an FDA site to that I can output in the chat as well that shows specifically which genes and which variants have been utilized with the 23 and me precision. I think it's personal genome is what they do and that's the one that's been approved FDA approved through the government so there is that. And then in terms of general pharmacogenomics. I know that's something that I, you know, focus on again as I was saying, it's not utilized as much in practice as we would hope. I don't know any or many of you know about the CPIC guidelines. So the CPIC guidelines are actually clinical practice guidelines to help help with decision making in terms of dosages, different medications to start or stop based upon a patient's genetics. I think this is something that's going to be very up and coming in the future, and something that you know patients are going to be bringing results to nurse practitioners and primary care providers and asking what do I do with this and I think that it's, you know, our job to really be knowledgeable to say well this is what we need to do next. This is what I know about this this is what I don't know about this but I have these resources available to me so keeping that Rolodex as these DTC results and as genetic testing in general just becomes more readily available and more usable. I know insurance coverage is a kind of a big deal for a lot of genetic tests which I know is becoming a little bit better in the pharmacogenomics space it's getting a little bit better with mental health, a little bit in cardiac. And so it's definitely, you know something that's up and coming and I think very, very important for all healthcare providers, all the way from nurses and entry level nurse practitioners as well as our nurse educators who are going to be those ones that are going to be teaching the future nurses how to utilize this information why it's important to practice so application is key for sure. I think we've got some questions popping up here so give us just a minute. Okay, I think I think I'm taking the next question. This is Deborah Heinz. And the question was about what will you recommend for a nurse practitioner wanting to get involved in genomic research. And I would say there's a lot of pathways for that so I worked for about eight years as a women's health NP before I went back and did my PhD and with my PhD I did a focus in genomics and did a dissertation on the topic of communication among family members about risk and risk perception and I had to do a lot of coursework to come to understand methodology for research. I also had to do a lot of coursework about just the foundations of genetics and genomics because that wasn't really covered in my program. And so, and so. Yeah, there was there was knowledge but now I work at a university and I have master's level students who come and need to do a thesis. And so they'll work with me on my research so the question of, if you're an NP and you want to get involved in research, there's a lot of avenues, maybe you go on and get a PhD in research and and lead the research, but maybe you join a research team. And I know people in the field who worked as MPs, but do everything from bench and finding new genes to things that are more about communication and risk, risk assessment. Some of the, some of the things that we really need I think nurse practitioners to help with is is the management element of how do you manage somebody with a genetic disease and and interdisciplinary coordination so a lot of ways. If I follow up question I don't know if I was going where your answer. You wanted the answer to go, but I know that Becky Cronk has a question next so I'm going to mute myself and I'll watch for follow up. Hi, there was a question about additional resources. I answered that with a website but if you go to genome.gov slash health for healthcare professionals. You can see that there are educational resources there. There's some information also about ISCC peg, and also family health history for healthcare professionals and I can share my screen to show you that. I think you can see that now. There's some educational resources here and again about ISCC peg and some additional on there's also resources on this website, you know for patients and families, and then overall genomics and medicine so I hope that answers that question there. I had a question asked that was about any professional organizations for nurses interested in genomics so I will touch on a few key ones. There are many out there, especially if you're looking at a specific specialization so in cancer for instance there is a nursing cancer association that is specific to nursing. I know there's cardiology specific organizations as well that are for nurses they have NPs and PAs they think also have specifics for cardiology so you can kind of peruse some of those some of the main ones for nursing would be ISOM. So it's the International Society of Nurses and Genetics, and I know their website is isong.org. So you can go in and kind of peruse that they have a lot of different subcommittees and they have a professional practice committee. They have Education Committee, a research committee, and a lot of other different ways to get involved. I will tell you that's where I became involved in nurse genomics specifically and found this wonderful group of people so. And a lot of us are also involved with ISOM so I'd say that's a very good place to start. They do have a World Congress every fall, typically in November. This year will be November 3rd through the 5th in Providence, Rhode Island. So, go check that out that is one really great organization and everybody is very welcoming and can kind of help guide you with any interests you may have. So, I'm basically ISCC Peg here with the nurse genomics group. I am the chair and Anne Ursic who is also on here is the co-chair. Donna Messersmith is the chair of the ISCC Peg conglomerate. So please don't hesitate to reach out to any of us you know if you'd be interested in joining the nurse genomics project group through ISCC Peg we would love to have you. We're a very active group. So, boots on the ground running, you know, if you come our way but we'd be welcome to have you as well. And another one that's more practice driven and again an international one would be G2NA and that's the global nursing alliance. So you can kind of check that out they do have quarterly webinars and majority of those are, you know, from international groups and so it's very interesting to see how different countries are doing nursing genomics. Obviously our scope of practice is a little bit different in the US here as it is in other countries and so it does, you know, help to spark some ideas and things like that. So G2NA is also another, you know, group, again to check out. As I mentioned, there's several other ones that are specific to a specialization. And so if you have any questions about those I can help to guide through. We can go on and on and on about all the different organizations that are there. I hope that this was helpful to you and help to give you some guidance in terms of where to go to to become more involved in the nurse genomics professional organization sector. Thank you. I think there was a question about advocacy and maybe oh sorry and did you want to I was just going to say there's a question about advocacy and so we're working on mustering our resources for that specific one it would actually help to know for the person who posted that are you interested specifically in advocacy for genetics and genomics and nursing related to say legislation or things like that it would just help to have a little bit more detail so we can know where to direct you in terms of resources and information. And then there is another, I will post this in the chat some additional information shared on a group that is specific to inherited gastro and technical cancer so if there are any other participants who have an interest in that topic. You can take a look at this particular group and I want to thank I think it's charity rigor for providing that information in our Q&A. So as far as just until we hear any more information, you know one thing about the ANA is they have a very strong ethics component to the ANA and there is some statements some organizational statements on genetics and personalized medicine there I think that's a good place to start when you're thinking about advocacy and the ethical component of genetics and genomics. And I'll chime in a little bit. I think we've mentioned ISONG, the International Society of Nurses and Genetics, and they have a policy work group. I belong to their education work group, and we have actually, oh okay we got a clarification the question related to advocacy is targeted to national legislative advocacy, as well as ANA positions or other policy work. So yeah I'll continue on with this just a little bit. So I belong to the education group, and we have been working to broaden the scope and standards of practice for genetics and genomics nursing to include academic nurse educators who specialize in teaching genomics we've recognized a need for very well prepared nurse to do that. And so the ANA has a document that we've relied heavily on it's called Recognition of a Nursing Specialty, and they have subsections about, oh good okay we're on the right track with this one. They have a subsection of what it takes to be approved as a specialty area of nursing. And if you go through that document it talks about developing competencies and standards. And so we're undertaking a Delphi research study right now to develop competencies for academic nurse educators. And let's see the other thing I'll say is when you're looking at scope and standards related to genetics and genomics. There's two documents currently that you want to look at. There are more in process and I know even some people participating are working on those works in process. But one of them is the essentials document that was developed and published by both the ANA and also I song that is the essentials of genetic and genomic competencies for everyone. And then there's this document I'm going to hold it up. This one is the scope and standards of practice for genetics and genomic nurses. So this is specialty. And the other one is all nurses, all levels. And so what I was talking about that we're working on is adding in academic nurse educators as an element of the specialty, an advanced practice specialty for genomics nurses. So, anyone want to add anything on that I know I know Sarah do will hop down also. No, I, I added a resource it's a article that came out in 2019 how American nurses Association Code of Ethics informs genetic and genomic nursing cell. I referenced that in the question and answer section. I do just want to highlight again the potential for joining our group we are a very collaborative group and we are actually thinking about developing further FAQs and so if you would like to get involved in this kind of work on behalf of genomics education for nurses. We would love to have you join our group. I'm going to say, Trina and I lead the group Trina really leads the group I just sort of helpful help out with some other things along the line. And we really do aim to actually get things done we're not just sitting around talking about genomics as much as we could do that all day because we love this stuff. So, please do reach out to us. I put my my email and Trina's email in a response to one of the questions in the Q&A but I don't think you can see that so I will put that in the chat for all of you as well. And then please do I will post the link to our FAQ as well because we'd love to have your engagement on that. So just say while I'm talking and then I'll stop. If anyone has questions that come up after this, like if you think about something and it pops up in your brain. The video will be posted and you will be able to post comments or questions on the video once it is on the genome back of website so please do And so I will share our emails and the link to our FAQ as well again so thank you and we love forgetting all the questions so please do keep that up. And just to reiterate what Anne was saying too if you do have a question that pops up and don't know where to find the video on genome TV. As she said she's giving, she's posting our emails so please don't hesitate to reach out to us as well we would definitely be more than willing to answer via email to support as well. However, if you're thinking the question, it is nice to have it in the comments box because I'm sure there's a lot of others who also have the same question so that's our way to kind of share with the whole nursing community so if you would be willing to do have a question later please don't hesitate to locate that video. Additionally, as Anne said, since we may be expanding on FAQs and having additional series of FAQs. If there are any questions that you would like to see answered on an FAQ, please let us know that as well, because we're always looking at what things we can do better to answer so that you can continue to move forth and either practicing genomics in your practice utilizing genomics in your practice or educating about it to your nursing students so please let us know how we can help you. We had another participant put another resource in the Q&A that maybe we can shuffle over to the chat. The City of Hope. Yep I've posted that so thank you again charity for sharing that you all are this is again why we love this stuff it's kind of crowdsourced information everyone has expertise that they can share. This is all teasers right if you go to the FAQs we do have a long list of resources there with links that are easy to access so that will get you to the all of our FAQs. Yes, and if we're talking of courses to again we do have many courses and learning series and things located within the FAQ. One from our very own Becky Cronk through Duquesne University so please go check that out as a wonderful genetic genetics course I think that most of us on this call have taken it and it's absolutely fantastic so again please check out the FAQ I think there's also another NHGRI funded course called Tiger, a little bit different obviously than the one offered through Duquesne, but both very good programs so please go check those out and become involved because they are wonderful. Give people just some more time to kind of type we like the conversation so if there's anything you're like, oh maybe I shouldn't ask this maybe I should just ask it because we love this stuff so we're here for you today. And I just posted both of those course links on there and IH funded and and you can look those up. Great. Thank you Becky. We're getting the link here for the video that we watched at the first part of this session that will be placed on genome TV and so we'll have the link for that if you want to share it with anybody. Watch it again, again place comments anything like that so we'll have. We will have that link here momentarily I believe. We'll as we kind of have some filler time here. I'm going to share this survey QR code and link one more time. For those that may not have seen it the first time or didn't have time to get to it if you were busily typing in questions so let me share this really quick as well. And again that's just a partnership through the American Nurses Association just really wanting to find out. Knowledge and perceptions of genomics as it relates to nursing care so that's going to help us develop new and improved genetic and genomic nursing competencies that will match with the new essentials through ACN so we appreciate your input and assistance with this. I think Sarah was going to share a little bit more about G2NA which is the international organization Sarah do you want to hop on and do that. Yes, I can run. I can't see myself so I don't know with. Oh, there I am. Good morning everyone. I'm Sarah dual and I'm actually an assistant professor in Canada in the School of Nursing, and I am a member of ICC peg and I saw and as well on the student committee for the global genomics nursing and so I want to talk about G2NA a little bit and G2NA is an international organization like ISOM and we have we're we have quarterly webinars I think Trina talked about that and they are recorded and on the G2NA website as well. If people are interested in seeing previous webinars that we've held and we're really focused on that genomics for every nurse aspect of this picture. So we're working right now on developing global minimum competencies for nurses in genetics and genomics so working with you know the International Council of nurses and nurses across the world on what is a feasible foundation for competencies for nurses that every nurse can integrate into their practice regarding genomics. So, you can sign up G2NA.org, you can sign up and you'll receive information about our webinars, there's no cost to that. And you'll receive, you know, lots of other information about all of the interesting things happening with genetics and genomics. Yeah. And so if there's any questions about that I'm happy to answer but that's just a little overview of that group as well that some that's another fantastic resource. Thank you. I'm going to spend a lot of things placed into the chat you guys might be a little bit overwhelmed right now. We put the G2NA website in there and iSongs website in there. Again there's those courses that are NHGRI funded courses. I know there was the City of Hope put in there, obviously our FAQ please go check that out. Also the link for our, the video that was shown at the beginning of this session has also been placed into the chat. So that will be on Genome TV, hopefully for a really long time so please share the link to that use it and reach out to us with any questions or put any comments in the comment box. Again we are seeking, you know, motivated members that can help us develop more FAQs more projects around genetic genomics, as well as you know if you have any ideas for a question that you want answered on an FAQ. Please let us know that in the comments box. Again, as I said if you have the same question and a lot of other people probably do so as well so if you put it in the comments box and everybody can see the response and the answer, and the expansion of that so it would be very helpful to be very active there. And then, yeah, do we have any other questions or popping in. Well we do actually have an international participant who just posted that they work in genomics in the UK, and they are still creating competencies to help nurses feel confident in offering genetic testing for patients. The UK is probably right around where we are in terms of integrating this into practice. And I believe this was posted by Mandy so Mandy if you want to share the link to our video where it will be posted after the fact we would love for you to do that and to spread the word in the UK. And yeah, we, we look forward to engaging with all of you we really do appreciate all of the expertise that different nurses can bring to this discussion and every single meeting every single time we get together to chat. We learn something more from from our colleagues and from people who are even new to our group so thank you everyone has something to contribute in this area. And your stories helps us know what questions might come up that we can also help answer for you. And Donna noted that the ISCC peg homepage, which is genome.gov. Oh, Trina just put that in there to everyone includes membership applications and so if people are interested in being part of ISCC peg, then they can get directed towards the nursing genomics project group that Ann and Trina so fearlessly lead us in. And it's wonderful it's a really good working group so I'd encourage people to join and be a part of that I really enjoyed it. Thank you Deb. Yes I put the link in there so go check it out. And let us know if you're interested in being a working volunteer, as I like to say. There's no rest in this group, but we do amazing things as do you know everybody in this in this entire group has been very fantastic and we kind of work together I think on several different projects and other different areas so it's been a nice collaboration. And one of the fun things about the group, honestly, so we have our nurses working group, but then there's all these other health care professions there's the pharmacists there's medical doctors there's there's people who focus on rare disease and on cancer and they all have their different work groups. So they're working, you know, separately through the months and then we come together and we get to hear what everyone's doing and then people get to support one another. So it's, it's fun to hear and see what the other educators of health professions are are struggling with are doing to rise to meet the challenges to educate the next generation of health care professionals that will be able to take us into the era of precision medicine it's it's really, it's really fun so I guess this almost goes back to the like how do you have influence and make change be parts of groups like this you know. Okay, Mandy's got something there too about. Nice to know we're in the same boat about integrating genomics and helping educate nurses to make this a normal part of nursing because it definitely is right nursing is built on life sciences that's what genomics is so and helping educate nurses. Oh, and just took it away from me. Sorry, but you had said something that she's my apologies. Yeah, my apologies Trina so it. The importance of testing for patient outcomes, especially for things like Lynch syndrome. And I know that there are also recommendations coming out very very recently for familial hypercholesterolemia and the RCA there have been some very recent publications in. I don't want to say it's jam up and I'm not entirely positive so yes, this is absolutely fundamental fundamental to nursing practice and again my apologies, Trina. No, no worries. I know I had met and Sarah you probably know. There was a participant at I song last year that maybe Mandy works with because I know she's talks about the Lynch syndrome and educating nurses Joe. Yeah, Joe swimming, swimming, I can remember her last name. Yeah, I don't know. Yeah, Joe is just finishing up her PhD and she is, she's working with Emma Tonkin was also someone that sent a lot of work in the UK with genomics and nursing was part of kind of the development of those original studies for nurses in the UK and genomics. Yeah, I'm, there's always so much going on in both us and the UK in terms of genomics it's fantastic. And I know there's a lot through, you know the genomics education England I think it is. So there's always lots of information coming out of there to as well as courses and some of that information is available for people that are not in the National Health Service as well so like me and others. So that's another good spot for some resources I know they have some neat kind of images that I've used in PowerPoint that kind of thing to that are nice little bite size pieces of information. So kind of coming down on our time here keep the questions coming in we'll still be here for a few minutes, but just to kind of reiterate the ISCC pig website is in the chat so if you want to look at membership with that it's free there's not too many of those around right. And we can definitely you can get connected with the nursing genomics group. Otherwise, like, like Deb said there's several other project groups as a pharmacogenomics group cardiac group, rare disease many other ones that if that's your specific area of interest by all means, you can join multiple groups to so check that out. We would love to have you. We talked about I song we put the link in there as well as G2 and a so go check out those organizations a very good place, especially if you're starting you don't really know where to go but you have some interest. It'll help you develop kind of where your area of interest really is. I know I think all of our emails are probably in the chat at some point there so we definitely you know welcome any feedback or if you have any specific need any specific information please let us know. Again the video that was shown at the beginning of this broadcast will be placed on genome TV and that link is also in the chat. You might just need to copy and paste the entire chat into a Word document right now. But anyway, again, please put comments on there because as I keep saying, if you have the question probably a lot of other people do too and so then that way we can answer that and everybody gets to see the answer. So if you have any recommendations for a question for a next series for our FAQs. So if there's something that you just really want to know more about, we would love to answer it for you. Again we really enjoy having you guys here today and hope you got something out of this. I don't know is there any other housekeeping things that we need to talk about. Just expressing our sincere thanks for your engagement and your participation. And hopefully we shared some information that's helpful to all of you. I think this video was also helpful and please do check out the full FAQ because these were just six questions from that FAQ there is a lot of information on that page including links to resources and other things that you can access to your access for your own work, whether it's an education in, you know as a nurse practitioner, or as an entry level nurse there's a role for all of us in genomics and nursing. And I just put the link in the chat again. So for that, thank you. Thank you. Thank you so much for participating in healthcare professionals genomics education week there's a lot of events. And so enjoy the other talks. Absolutely. I think about ICC peg in general with all of the project groups they're all volunteer, you know this is all people doing this out of the grace of their heart but just because we're so passionate about this topic and about improving healthcare and really individualizing health for everybody. It's just a passion that we all share so it's a great group a very motivated group. ICC peg in general not just the specific project group so do enjoy the rest promote all of your colleagues and genomics so yay. You can make good friends, good colleagues you're right. Thanks for attending everyone. Thank you everyone. Thank you.