 We're very excited to have some wonderful what we call exemplars of education, ways that can integrate genetics and genomics into the curriculum. It will be a panel presentation, so I'm going to give you a little bit of background about each of the speakers before we begin so that they can just keep flowing with their wonderful expertise that they can share with you. So as we mentioned earlier, there's a number of ways that you can provide education about genetics and genomics, and many people have tried different ways and have learned about the pros and cons of doing each of those, so you're going to hear some of those examples and then as Kathy and I mentioned next year, we want to hear what has worked in your setting or what has not worked and so we can learn from each other. So today we're going to have panelist Janet Williams. Janet, you want to wave at them? Dr. Janet Williams is the Calting Professor of Nursing and Director of the NINR, RT32, Funded Clinical Genetics Nursing Research Postdoc Fellowship at the University of Iowa. She also chairs the University of Iowa's Behavioral and Science IRB, and her research has been funded by NIH, HRSA, and private foundations looking at teen experiences, family management, genetic discrimination, and function of persons with Huntington's disease, and also a lot about communication among families and healthcare providers about genetic testing. She recently served as a panel member on the NIH State of the Science Conference about family history, and if you haven't heard about that or you would like to learn more about that, go on to NIH.gov and look for the State of the Science Conference Family History Report, which has just been drafted. She was very much an intimate part of that discussion. Dr. Williams is also a member of the NINR Advisory Council, and her clinical background is in Pediatric Nursing and Genetic Counseling, and she has been a mainstay of genetics nursing for many, many contributions in years. Thank you, Janet. Janet will be sharing with you an integrated model of education. Then Lorraine Frazier. Lorraine, you want to share your hand? Lorraine Frazier, Dr. Frazier is the Distinguished Nancy Willerson. Thank you, Professor of Nursing at the University of Texas at Houston School of Nursing. Dr. Frazier is the Principal Investigator on our R01 Protocol, Depressive Symptoms and Genetic Influences on Cardiac Outcomes, funded by NINR. She is also the Project Director of Texas Gen Research, which supports multi-center, multi-institutional biobank development of clinical data and biological sampling for cardiovascular and cancer patients at the Texas Medical Center. She's also the Director of the Center for Clinical and Translational Science Biobank at the University of Texas at Houston. Lorraine will be sharing with you an example of shared courseware that has been developed for advanced practice primarily, but also could be a model for things that you're thinking about in the baccalaureate setting. Dr. Judith Lewis, who you've heard from a little bit already. Dr. Lewis is a Professor, Emerita? Merita, excuse me, School of Nursing, Virginia Commonwealth University in Richmond, Virginia. Judy has been also a Mainstay in Genetics Nursing representing us quite well on the Secretary's Advisory Commission for Genetics, Health and Society, with the previous one, SACGT. SACGHS is the one that is also now on the website. So if you search for SACGHS, you can see where she and Agnes Masny and other nurses have made contributions to policy setting at the federal level. But that is a resource you might want to know about. Judy has 30 plus years of teaching in baccalaureate and higher degree programs including Boston State College, University of Massachusetts in Boston, MGH Institute of Health Professions and Virginia Commonwealth University. And I won't tell you about all of their publications and presentations, but if you looked up any of these people, you would find lots and lots of literature to share. Judy has been kind enough to talk about a standalone course that is being offered in your setting, correct? Was. Okay, so lessons learned from that. And then the last panel is Dr. Yvette Conley. Yvette is there also. Dr. Conley is an Associate Professor of Nursing and Human Genetics at the University of Pittsburgh. Now, see what is different about Yvette is I tell you that she has a BA in Biology and MS in Genetic Counseling and a PhD in Human Genetics. What's different? She's a doctor with a PhD, but not a nurse. But what Yvette is going to share with us is how valuable interdisciplinary resources can be to us. We're not in this alone. There are many, many, many disciplines going through the same thing we are and can learn from each other and can support each other. And Yvette has been amazing at that. She was the first geneticist in the country to hold a full-time primary appointment in the School of Nursing and is devoted to educating nurses and nurse scientists. She's been involved with the Oncology Nursing Society Genetics Online Education Series and many of our professional organizations have resources for us to get and utilize in our teaching as well. She has also been involved as Administrative Faculty for the NINR Summer Genetics Institute and is a co-director of the NIH Training Program titled Targeted Research in Academic Training of Nurses in Genomics. She also runs a fully equipped molecular genomics laboratory that conducts NIH funded research on the contribution of genetic variation to patient outcomes. So I don't tell you all that just to say, you know, these are experts because obviously I could have said that in one sentence, but they bring a wealth and a diverse experience that I think you'll gain from as you hear from their presentations and then we will have some time for discussion so you can pick the brains about what might work in your area. There may be some examples of models of curriculum integration that we haven't thought of or that you're using, so feel free also in the discussion to share that so we learn from you as well. So Janet, I need to find your slides. And Kathy walked in. Are you on here? Maybe you're down here. Thank you. It's obvious, but thank you. I should see Williams right here. There we go. Sorry. 98. No, this one. Thank you, Janet. Thank you. It's exciting to be here. Been at this for a little while and it's fun to talk with people who are interested in starting genetics in their programs. So I'll try to talk about the practical things of what happened when we did this in Iowa, what was helpful, what maybe a couple things maybe weren't so helpful, and I tried to make very detailed slides in case you have questions about the details of what various faculty are doing and I'm happy to take your questions back to them if you'd like further information. So we started this in the mid-1990s, myself and another faculty, so there were two of us, Deb, Shudi and I, were very interested in genetics, myself from my clinical background and Deb from clinical and academic background. And so we were rather lucky in that that was the year we were doing curriculum change, so that the curriculum was pretty open and there was a lot of work that needed to be done and we were eager workers. We were ready to come help, you know, solve those problems. We also were lucky in that we, so we started having a group that met and we thought of people that would be interested in this topic, but we included the program chairs and the deans and we were just lucky that we did that because there was buy-in from those folks as well. They could see kind of on into the future things that we hadn't thought about. For example, you'll see in 2001 we were awarded a T32 post-doctoral training fellowship. We certainly didn't have that on our plate, but it was part of the vision that the administration had. So we had buy-in from the top down and from the bottom up kind of at the same time. What we did is we went through the curriculum. Deb and I identified areas where we thought genetics might fit the objectives of the existing courses. We went out and went door to door and talked to each faculty. So this is what we think might be useful to you. Would you be interested? If you'd like, we could give the guest lecture. We could provide information for you, whatever fits your needs. And so that's how we started it. What we have today is it's not the same courses that we started with, but we are currently, I could identify genetics content in the following courses. And I'll just briefly go through a little bit about what's going on in each of those courses. As I said, it needed to fit the course objectives, whatever that faculty needed to deliver as far as education. It currently fits the new ACN essentials. And so we had information and we looked at the new essentials and could see a very nice fit for many of the things that we have ongoing. We also have an elective human genetics course that I mentioned to you. Our students can take electives. I think maybe there's one slot for an elective in their baccalaureate program. And this elective is taught by Sandra Dakhersch on our faculty. She's a genetic nurse and nurse researcher. And she has many years experience in genetic counseling. So she teaches this course and it's to mainly upper level undergraduate students and some graduate students. And then we have students from across the country who are looking for an online human genetics course that is relevant to nursing. And so that's been a very successful opportunity. We also have independent study available for our undergraduate students with genetic clinical or research faculty. I'm at a research intensive university. So people who are on the tenure track also have research programs. And we are in the place in our state where the tertiary care medical center is located. So that's where the genetic program is. And we have very good partners, very good friends in the genetic nursing and genetic counseling community and the nurse practitioner community. People who are working with patients with cystic fibrosis. People who are working in the hemophilia clinic. So we have a nice, we hope, array of places where students might get to have additional experiences. That has been also very exciting. It creates a certain amount of effort on the part of the faculty to help students identify what an independent study might be. But the rewards are exciting because of the interest of the students. One student that I mentored as an undergraduate was interested in people with disabilities. And I said, well, I know we have a new Down Syndrome clinic. And I know that families over there have a lot of trouble accessing community services. How would it be if I set you up with a family with a toddler and I'll set you up with a family who have an adult with Down Syndrome. And I think they're actually facing some of the similar issues but at very different places in the lifespan. How to write the will to take care of this young woman when her parents were gone. How to access a preschool. What happened to this family when they wanted their daughter in gymnastics as compared to what's happening for this family now? So the families were willing to do that. And the student wrote a very nice paper. And this one stands out in my mind because she learned much more than she thought she would learn about the issues that people face and what nurses could be doing to help people facing very similar problems. So I've set up the slides. I tried to make them fairly detailed. I'm not going to talk too much about what's on the slide. But I've tried to organize them according to the current AACN essentials. And human growth and development is a course that we teach within our faculty but it is in our pre-nursing kind of part of the program. And so I put it under essential number one, an element of liberal education. Sandy Deck Hirsch teaches this. We've probably been through three or four faculty. Different people teaching this course and human growth and development always contains things about genetics. So we've done various things. At the current time, these are the types of topics that are included in that course. And what Sandy does in addition to lecture and, you know, the online resources is that she uses a coin toss activity with students to illustrate the relevance of genomics, genetic and environmental factors on a common trait where there's variability and it happens to be height. So that's the action activity that she's built into that course. That is also a terrific place to identify those students who are especially interested in genetics. And usually this is in our classroom of about 200 people. It's a course that people take to qualify to get into nursing. So there's a high interest in doing well in this course because it's part of what's evaluated when people apply to the program. And there are always people who come up afterwards and say, I was really interested in what you said about cancer. I was really interested in what you said about nurses' careers. And so it's an excellent way to start building on that interest that students bring into the program and helping them see what kinds of experiences might be especially valuable such as that elective in the independent study and some of the other options. Pathophysiology is taught by Sue Gardner and that also I grouped under Essential One. These are the kinds of things that she includes in the Pathophys course. I've never contributed to this course. Usually the person who's teaching this is very well acquainted with genetics and builds in the content on their own. We have acquired clicker technology and so she uses clickers to build in quizzes when she goes through a concept such as translation or she goes through a concept about RNA. She'll embed some quizzes and that would give her a chance to get feedback from the students to find out how much of that did they grasp, what kinds of things does she need to pause and repeat. The basic concepts for nursing practice is taught by Martha Driesnack. Some of you might have met Martha if you went through the Summer Genetics issue recently. She calls this the New Fundamentals so those of us who learned on Mrs. Chase would know that some of that is now in this course. As she goes through the content and basic concepts it gives attention to human diversity and variation. So when she's talking about applying skills to patients she talks about the individual. So she uses examples like a person who has a Factor 5 allele and the issues for birth control pills. She brings in pharmacogenetics as part of the stories and part of the content that she talks about with her students. It makes it a very ordinary part of nursing. It's brought in at the entry level when they're just beginning to get their nursing theory and concepts. As well she brings in some things about nutrigenomics. I'm kind of jumping to the end of the curriculum here. It just happened to fall into my slide sequence at this point. What I'm calling the course kind of at the end of the curriculum and that's where much of our ethics content can be found. We have an online continuing education program that you'll hear about a little bit later and within that there are some case studies that we developed through some funding through the LC program. We hired actors from our summer theater program and students in the Fine Arts program to take the roles of family members. Kathy Calzone is in this. She didn't act as anybody except herself in illustrating how to obtain an informed consent. But students in the leadership course can go online. They can click on one of these case studies. The case studies are built around an ethical dilemma. So there are various components in the cases. There's the mother. There's the father. There's the children. There's the nurse. There might be the brother and the sister and there might be the pastor or whatever goes into that story. The stories are built so there's no resolution. There's no one resolution that will satisfy everybody. The ethics committee at the hospital may not be satisfied. The partner may not be satisfied. The teenager in the family might be the person that's not satisfied. Anyway, these are the ethical dilemmas that are illustrated in some of these cases. We have written up questions for students to answer after they view the case. It's on their own. When they go on the course site and choose a case, look at it, go through the exercise, answer the questions, turn those in to Howard Butcher, the course director, and that's then he grades it as like a quiz. He has also used some of that information in building short answer questions on his exam. Ethics is part of all of our curricula. We choose to use some clinical examples that revolve around current clinical situations involving genetics and genetic testing. There are things that come out of Essential 5 and Essential 6 that are part of the content that we deliver. It's not really a lecture by itself, but whenever I'm talking with undergraduate students I'm mentioning things about disparities in healthcare, especially in the areas that I know something about which is access to genetic testing, genetic literacy, the ways that family members might share information with each other. And so I'm going to give you an example in a little bit about how I bring that in to a class that I give in our communications course. We also then also bring up information about referrals and communication with healthcare resources. If nurses are going to practice in the state of Iowa, I tell them about the regional genetic clinics, about how people can receive healthcare, genetic healthcare through specialty services in Iowa. I tell them about newborn screening and how each state will implement that in a little different way and remind them how to find that information. If many of them do move out of the state, nurses who become educated in Iowa really like to go see the mountains for a little while in Colorado and so often they're going off and then they'll come back to Iowa, many of them when they get along a little later in their careers. So these kinds of concepts that we bring to students, but it isn't necessarily a genetics umbrella, it is not necessarily labeled as such in the course, but it is illustrated in the examples and the content that we give. Essential 7 is where you'll find the information about assessment, the family history assessment, how to conduct a health history and so Sandy Deck Hirsch teaches that in the introductory level course and just as we've heard from many other people, it is the elements of how to conduct a family medical history, including a genetic history, but it's not limited to that certainly. Pedigree and construction, simple pedigree interpretation and again when to make a referral. Jean mentioned the family history consensus conference and one of the things you'll find if you go out and look at that document is that our evidence base for the clinical utility of genetic family history is very thin. It's something we've all, it's been an element of healthcare and medical care and nursing care for as long as anybody can trace back and so it existed long before anyone thought of the terms evidence base practice or evidence base medicine but when looking at our evidence we don't have an organized body of knowledge on how to do it well. What works with particular cultures? What are the ways to assist family members who are not from the family culture to access and communicate information? What does the term family mean in various settings? So those are all areas that we don't have a lot of evidence to guide us. What we do have is all of our traditions. So we talk with students about this and again try to emphasize with them when we get to pedigree and interpretation and making a referral for example that there are people many people will have, if I asked you to raise your hands if there was a family history of heart disease or cancer or memory loss in your family or hypertension or diabetes pretty soon everybody's hands would be up because these are common complex condition. Yet within each of those categories there are going to be subsets of families that have particular risks based on a higher component of genetic risk in that particular family and we want our undergraduates to get some sense of that so when we hear a story from an individual and it's many family members with early onset cancers for example that's a red flag that they should be paying attention to and be thinking about what to say to that family about what information have they had, what they like to have do they know about the resources that the nurse can help them find. This course is paired with a course on communication skills and I volunteered to give a presentation in this a long time ago that would build on the assessment course but then talk about how the nurse would use these new communication skills what I learned once was active listening, it's therapeutic communication. When you're talking about sensitive information with families so I continue what was introduced in the health assessment course and now I tell them some stories I have three families I have some photographs that people send me permission to use I tell them about the family stories and I said then we go through what are the elements of therapeutic communication and we use those family stories to illustrate what is it when there's denial what happens when there's anger I ask students how many times have your patients become angry with you what happens when that, what's your response what do you do when that happens what about denial when you want people to understand something for it and I give them the example one of my stories is about Fragile X syndrome and I tell them what Fragile X is and show them the family picture and I tell them that in this family the reason that those young men had learning problems was because their grandmother wrapped them too warmly and they got overheated and that is the true story in that family and no matter what you say as a nurse it's not going to change and then I go on to tell them how with actually the mother it became acquainted with me she said to me one day I've been reading about Fragile X and I kind of think our family fits I'm not buying this thing about grandma wrapping the babies too tight and I said well yeah you know I think you make a really good point here and there are some people here that could help you find answers to your questions I don't know what the answers will be so she was among the first to involve herself in some of the research on detection of the gene for Fragile X syndrome and that's truly what was going on in the family so we talk about what kinds of responses can you as a nurse give when you encounter something that doesn't quite make sense to you but yet there's some resistance so as we go through this this one hour long presentation that I make I talk about stigma, I talk about privacy I created a story about families where there's colon cancer and the word colon is not mentioned in that family and then I talk about the area that I'm most familiar with Huntington disease even though it's a rare disease it brings up a lot of issues about psychiatric illnesses, stigmatizing behaviors that are not acceptable within and outside of a family things about family secrets and family myths and then at the end of the class I leave about 10 minutes and by then the students have written down all their therapeutic communication skills and all of the elements of what people might do and what they're supposed to do in response and I say now this third of the room you turn to the person next to you you're going to be a pair, one is the nurse, one is the patient this is where you're going to think about the colon cancer this over here is the Fragile X and we're going to talk about some reproductive issues over here, this is the group that would pay attention to the risk for Huntington disease and I ask the patient in the pair to come up with a communication behavior they're going to challenge their nurse in some way they're going to be angry they're going to be in denial, they're going to be very sad they're just going to be totally uninformed and clueless about and then the other part of the pair is the nurse so the nurse is going to have to respond to whatever their partner's behavior is give them a few minutes to do it and then they write down for me what they did what nursing, what was the behavior of this quote patient what therapeutic skills would be appropriate, what the nurse tried the patient gives a little feedback how well did his or her partner do and then they turn those in it's very instructive for me to read them because it gives me a sense of what did they get out of the lecture and the presentation it also has a side benefit that I don't care about but the faculty does know who was in class that day because we have those little bits of information and feedback from the student I mentioned the honors independent study and I've already described this a little bit for you that we do try to set this up it's a very popular option and we could probably take more if we had more faculty who could take these students or the clinical faculty had students who wanted to have experience with psych mental health and genetics issues, had students had a student who was very interested in turner syndrome and some of the behavioral issues that families face and that actually ended up she was one of our presidential scholars and she wrote a publishable paper on that we have a young scientist program at our university it's funded by an alum and it is an effort to identify those students who are especially promising as far as developing a research career and moving on into nursing research and students compete for this and then we are signed to faculty so of course some of us receive these matches with students and had a young scientist student as an undergraduate student joined my research team conducted a literature review did helping us with a survey construction this was on Huntington disease and then she got to present this at Isong we sent her to Isong with a poster and really introduced her to the world of scientific inquiry and on to have a career as a research coordinator this is something that did not work so well so I'm glad I put this in we have genetics journal club and we have this primarily for our doctoral and postdoc students we thought faculty would just be really enthused about coming and you know what they weren't they don't come and I think it's there are a lot of reasons faculty are very busy and what we do in journal club is we really try to push people's analytic thinking and critical thinking about what's published in the literature and some faculty find that more or less interesting on a given day so we do also have our masters and some of our undergraduate students who have an opportunity to come as well I'll just very quickly mention what else is going on because I think that's one of the keys to success for us is that genetics is part of the whole package that you get at Iowa it doesn't it's almost like a bookend is pre-nursing all the way through the postdoc and then into the faculty so we have a primary care course for our nurse practitioners I developed that component where students use case studies that were published in I think it was contemporary pediatrics and little little snippets of clinical cases that nurse practitioners would or physicians would go through you know what is this what's the diagnosis I have a lecture series or set that goes on line for the course and then when we meet in class I ask them to discuss their cases and to prioritize what their clinical decisions would be what are you going to attend to first what when you do that what impact does it have on the rest of the family for example there's a teenager that looks like he has Marfan syndrome so what are you going to do first you're going to think about cardiology you're going to think about participation in sports are you going to think about the rest of the family and their risk for Marfan's and so it's a really rich discussion with the nurse practitioner students the other thing we do is that we make sure every nurse practitioner student in this course spends a few hours in our genetics program or with an advanced practice nurse working in an area where they apply genetic knowledge maybe the hemophilia clinic for example we have two online courses that are available at the master's level or the graduate level and these are taught by Sandra Dak Hirsch these are also resources for you if you are interested in a graduate level course and we now can offer them for variable credit so each topic in here is worth one credit hour and it is offered through our distance learning program on campus people who take this are master students some of our postdocs are interested if they are missing certain components in their own background we've had faculty from around the country take this we've also had clinicians we had nurse who went from the ICU to a metabolic clinic that's a big leap in your clinical practice and she wanted to prepare herself for that change like many places we have a DMP program and the genetics is in our DMP emerging science course Ken Kulp teaches that and some of the content that he selected we also Sandy gives presentation on aging at our PHD of course gerontology is a major emphasis at our university and these are the kinds of topics that Sandy includes and also at our PHD level I'll mention we have this seminar and I've collaborated with Julie so we have students from Clemson that come in through distance learning we've had other doctoral students from other universities often people who are planning a dissertation on a genetics topic and they want to be in a seminar course examining the literature so what has and is continuing to happen with us is that we started out and we continue to collaborate with course faculty so this was that door to door one to one communication with our colleagues what can we do to contribute to your course what fits with your course needs we provide resources whether it's ourselves or materials sometimes as I mentioned those ethics case studies give them to Howard and he uses them as he wishes we have students who are interested that's one of the biggest benefits was mentioned previously this is not new to students they're not they're not daunted by the topic and it wets the appetite especially these early courses for students who are really inclined to enjoy learning more about science and how you apply it to human health issues we have the advanced practice and genetics opportunities so that does move sometimes people on into a career path that they hadn't considered several of our tenure-track faculty have completed the SGI so we started out as two faculty now we have a number of people who get it and they get it and apply it in different ways so that has been very helpful Sandy and Martha are now conducting a faculty survey on the needs in genomic nursing education and a little bit on assessing genomic literacy of faculty and students and one of our research science students is helping with that we partner with the faculty that I already mentioned it's across our entire curriculum as the research conducted by many faculty we have this wonderful network of clinical partners and we've been through three deans since 1995 and they have all found this to be an important part of our program and they endorse it so that top down part sometimes when I first started meeting the people along the wall we worried a lot about deans and how to get dean by in and then we realized deans sometimes were far away from what happens in the day to day of education yet that dean endorsement is a very powerful endorsement because it brings attention to the program it it helps elevate the importance in the eyes of the faculty and the students and I wholeheartedly endorse Allen's comments partnership is key to long-term survival so you've got partnership right here I'm glad somebody mentioned Isung because that is a wonderful place to get renewed and get your batteries recharged when you get kind of worried about how this is all going to fit together so I'll be here until four o'clock when I have to catch a ride to the airport and I'd be delighted to try to answer any questions that you might have how are they figures okay you weren't in the room when I started it so sorry maybe that's what the problem is is it okay so everybody knows they're going to go right really and truly most of the people here I know through Isung every one of us I can't think of how we would have really done what we've done through Isung so if you haven't thought about it you really need to think about it because this is an ongoing journey for you it's not a one-time event where you're going to go and do a project and be through in six months or a year have any of you guys ever seen the five minute university on YouTube anybody seen that well all of our deans were talking about it at UT and I had to go look at it it's really funny this guy stands up he goes I can give you a degree in five minutes for twenty dollars because what I'm going to tell you is what you're going to remember if you are a political science major and he has two sentences and he goes through all the disciplines like this and then he said oh and one minute more if you also want a degree in law so I guess what that says to me is Judy I think you mentioned we've got to teach students how to learn and what you're going to find in genetics and it's if anything scares me it's that I'm not keeping up you know because we're very busy and so we're busy managing and teaching and doing research and doing everything else and my only fear is oh my gosh I wonder what was published in the last two months that I haven't read so when you think about genetics you have to think about this is kind of a long-term commitment not to just doing a course but to be creating a course that can be used effectively someone said here that they taught anatomy and physiology for so many years who was that right Kathy how long did you teach that right it doesn't change it's one of those things you can teach for years and kind of go home and do the same thing genetics is not that course if that's the type of teaching you're going to like to do genetics is not the thing for you so I'm going to talk a little bit and I think Janet could have also talked about this shared course where how we're sharing so I guess what you should get from what Janet is talking about and what I'm talking about is there are other resources to it other universities that have already done this and they may be available to you and they may not and they may be available for some students but not for all students so think about that as your beginning wherever you are to look at all the resources of other institutions and resource resources that are on the web because it was already suggested today that data and research done by NIH supported efforts belong to all of us so you can snatch those NCI slides because they're beautiful so let me go on to look at sorry this okay everybody does this differently I graduated in 2000 with my doctorate and then I did a postdoc in genetics and the faculty weren't really into genetics in fact the main thing I heard was diabetes happens across populations but we don't have a course on diabetes I thought that's true that's true and I wasn't convinced that I had to tell everybody that genetics was the way things were going to go and I think one of the issues that you might hear is people say I know you think everything is genes well it's not that we think everything is genes is we think if you understand your genetic predisposition you may understand how the environment affects your health and that when I tell people that they seem to be more open I'm not just I haven't given away nursing and thought only as a scientist and I think you need to think that when you go back and talk to your faculty so what I did was people would have me lecture in their classes I'm sure you've all done that and I still lecture in some of those classes and then our faculty have come along and our faculty are pretty sophisticated a lot of them are on oncology with M.D. Anderson and they have a pretty good background in genetics so check out your faculty and see what they know because they may know more than you think they do because all the nursing societies are teaching genetics as it applies to their discipline so my mantra in life is and I don't know why it is I don't like to kill birds but I mean make things really effective so when we I was asked to develop a program for the DMP students the doctorate of nursing practice I thought that will be really great we will do this but when we talk about shared courseware you can even share it in your institution before people would come and they would say well I'm a master's student can I take that? but first they couldn't but now we think well why not why can't they take it as an elective if they're a master's student and why couldn't we kind of make a basic class that we can apply across our curriculum to some extent we've done that so we developed an unlined genetic course and for the DMP program it was emerging so I also have two hours of the genetic course that can stand alone killing two birds with one stone and then when I add it to to the DMP course I have lectures where people come in and talk about stem cells they talk about proteomics they talk about other things that are not necessarily related to genetics and but you have to remember there's a big difference in student population from all over the country and we have students that are even DMP students you think they're very sophisticated and they're not they come and they say you know I took an elective but I couldn't handle the technology so I dropped it and I'm not talking about sophisticated technology I'm talking about classes that are broadcast from our university that go to another one so I think really when you start talking about these these teaching methods like blackboard sounds very simple to us it is not to new students it's not to those doctoral prepared students or even master's prepared students and second degree students so we have to think about that change this again did I go too far? I did okay so we started our formal genetics course and I really like doing that I like focusing initially on one population I mean a one student population you may not do that you may go back and just decide to integrate it across the curriculum we've heard both ways but you don't have to do it all if it's already been done find out what's been done so we started with 16 students and they're all from all around Texas states so one of the things you have to remember when you're designing a class like this is people have genetic problems in their families right? they're still people even though they're nursing students a lot of times you're going to have students and maybe faculty come to you because they've been touched personally by what you're saying and you can't always do that when you're working on a web based course so that's kind of a drawback so I'm sorry yet this keeps jumping around you know what I think this is not the presentation I brought but that's okay we're going to go with it that's okay I can just wing it because I can change it well it's somewhat similar but I'm thinking I'm going crazy okay I got a problem here you were what was the name of it it was just genetics for nursing practice this is the one that you was it? the other one okay all right well here we go let's not think of a deal see things happen okay yes it's the same one okay well I just didn't bring this one but we're going to go with this okay so this course is also developed for the SREB is anybody familiar with the SREB here are any of y'all from Texas from Alabama from southern states I have a list of southern states here and I didn't know what they were Georgia, Delaware, Florida, Kentucky Louisiana, Maryland Delaware did I Delaware? Judy you scared me I thought it is on here yeah Delaware, Georgia, Kentucky Louisiana Maryland, Mississippi, North Carolina Oklahoma, South Carolina Tennessee, Texas, Virginia and West Virginia are in the south I don't know because I'm not a native but I was surprised but anyway if you're in those states we now have on the SREB website or electronic campus a way for you for your graduate students and DMP and PhD students to get on our campus and take this class as part of your campus you'll get credit for it at your campus so this was something that we started years ago Sharon and I were on this program together and it's kind of neat because you can, you don't have to develop it for them but they actually come to the UT campus sign on as UT register with our campus and we actually teach the course so because we were going to develop this for other states and for our school we wanted to do a very good job it's very nerve wracking to teach it at your own school but when other people start coming to you you really want to do a stellar job of this so what I did was how many of you at your institution have been structural design specialists get them on board because I think you're really going to need them if you haven't done anything like this before and you haven't used course where I'm sure most of you have but you haven't done a completely different course and if you're going to do a standalone course I did and what I did was I thought I'm a nurse but I got somebody with a non nursing background who's a geneticist with me and I got this specialist as a scientist together and as a team we developed the course so it was really nice but that instructional design specialist brought the whole project into perspective we each had our niche I was the nurse and we each had something that we wanted to put in this course but she made sure that it was balanced and that the scope was good and that it ran well together and we met six months every week together as a team before we put the course together because it was a distance course and we wanted it to be really good and we had a steering committee with the SREB and we identified topics and objectives for those topics and like everybody else for our topics we used the essentials of nursing practice genetics and genomics so we went down each one of those and really took from them what we wanted to put in the class we wanted them to understand basic genetics and genomics concepts we wanted to analyze family history and pedigree which we have done we've talked about a lot here advocate for the rights of clients apply understanding of a relationship in genomics to help prevention screening diagnostics you'll get all this look at the competencies all this has already developed for you and then we also wanted them to base practice with clinical practice because it's been said here and I think the important part of all of this is not that they know about mitosis who really cares that they can apply it to clinical practice whatever that is your story was great it was just taking the pedigrate that was the application to clinical practice it can go from there to being very sophisticated in those decisions but for the MP students they really really focused on their clinical practice so I have here examples of things that were geared for the clinician each student had to develop a case study using a patient they were likely to encounter in their clinical population now if you're not with those students you have to put likely to encounter Judy I appreciate the fact that you didn't even want to look at their pedigree because it's personal to them and I agree with that to some extent too you have to kind of wing it on how you do your projects on this one some students actually have case studies and some don't the ones that have a case study we wanted them to write them up and we had I see the hand up in the air we wanted them to do a case study that was really good SREB it's non-profit okay and we're on their electronic campus and you can learn and understand educational opportunities go on their electronic campus I've been hearing this out just SREB you can google it I google it all the time okay so the course development is a web based course it's to suit the needs of the nurse clinician let's talk about barriers and barriers we had to work through the costs if you have students from other universities you can't charge them for lab you can't charge them for the library so I actually had to sit down myself and negotiate this with the registrar and with everybody at our university and that sounds like an easy thing to do it was not an easy thing to do and every time I would think it was accomplished the next semester it was like we're back at stage one and then I would talk to the SREB I would talk to numerous people it was really enough to drive you crazy so if you're going to do that think about it up front and the registrar you would think it might be their job but it is not it is your job I think it is in my university so the other thing and that's a continual journey every semester you have to revisit that reference books we did not use a reference book it was very hard for our students we really need to do that they did not like it and different ways that faculty approach it if you're teaching in the course with other faculty you have to know that everybody does things differently and the students have to get used to that successes we developed a team that works well together the students love the course and they help shape that course from year to year you can actually know there are other methods other courseware besides blackboard how many people use blackboard but there are other methods and I know I don't remember the names of them okay D2L there are ways to transfer courses to different courseware and you have got to arrange them according to specific standards when you do that so if you plan to do that make sure that you have a specialist work with you initially that's a priority I enjoyed starting with a new program I'm a focused person I'm a researcher it was great for me they didn't come to me and say just integrated everywhere in the program that does not appeal to me so I think what you have to do is and also I was given the task that we would have the students that's required course I like that method have enough experience faculty and maintenance issues you can't design a course like anatomy and blackboard or anything else and expect it to be good for 10 years or a year things change so you've got to go back with that faculty and visit it each semester and update it that has to be done work with the curriculum development experts I love them I have a great respect for them use interactive learning blogs, reflection, discussion board directed discussion I wasn't really into doing the blogs the students love them use a textbook offer a lecture if possible on basic genetics our students to be honest did not like web based initially for the basics they wanted to talk to a real life person and we're glad because we like to be real life people the other thing I want to talk about exciting is how many people are I know we talked a little bit about the neighborhood how many people are familiar with second life how many of you have an avatar my avatar's name is Ginger it's Italian I can't remember the last name I think of you Kathy I think Bellatario or something and that's who I am as teacher and so we across the UT system so that means there's two UT people here and I'm not trying to glorify Texas I know everybody's tired of that so what we're going to do is have a systems wide initiative that I'm leading a nursing where we will have an island if you don't know this language I didn't know it two weeks ago so it's okay and that island is where you develop a community of avatars which are people and the students will come as avatars and attend our classes and we're going to probably put genetics in second life so there's lots when you talk about it's so exciting how education is changing how we can go forward how we can make this exciting the only thing that scares me is the faculty are not really with it I'm not with it but you know I celebrate each and every one of you guys because you have volunteered to do something different to go beyond what you know to apply it to be scared there is a fear factor that keep going anything that comes up use it have fun with those students listen to them don't be afraid become an avatar as I am now ginger and have fun with this thanks well Kathy's finding the slides I'm going to go ahead and just tell you that I came about to this from the other side of the topic education or interest in genetics other than I'm the sole survivor of three siblings born to parents both of whom carry the gene for cystic fibrosis and my brother died before I was born I was the replacement child my sister died when I was 10 and she was 6 so I was interested in genetics from a personal perspective and I had a doctoral student who was working with me named Shirley Jones she came to me as wanting me to chair her dissertation which was on the diffusion of innovation and the innovation she was looking at was genetics in practice and at that year Shirley was president of iSong and yeah that's what I called it and so she said to me you've always had an interest in genetics I think you should join iSong well I was trying to be supportive of my doctoral students so I said yeah sure I can do that for you Shirley it's only $100 what's the big deal and the next thing I know I got a phone call one day Shirley had nominated me to be the nurse on the secretaries advisory committee on genetic testing and Deja vu all over again this was the room we met in for three years and I said well I really don't know very much about genetics and Shirley said well that's really good but you do know about public policy and you do know about nursing and we need nursing's voice at the table well it's very scary to represent 2.7 million people and I knew I could never represent nursing because we don't agree on a whole lot of things but what I could do was bring a nursing perspective to the table so here I sat with you know the last genetics I had had was a course in 1968 Shirley was my friend and I was a women's health nurse practitioner but I sat here my Ph.D. is in public policy so I thought oh it's going to be really cool and we sat here for three years to the secretary who had appointed us in the Clinton administration she was gone the new administration came in they had a different view on genetics and they appointed a different committee but I sat here for three years knew very little about this and then I thought you know I was able to represent genetics bring a genetics perspective to the table and talk about you know clinician as opposed to medicine healthcare as opposed to medicine primary care provider as opposed to physician and make sure that a nursing perspective was part of all the discussion so I did that for a while and then I thought I really owe the nursing community something this has been a peak life experience for me so like Dale Lee who was sitting with me and Dale sitting back there she's the guilty party after her one day you know I'll be really happy to help the genetics community because this has been a great experience that if I saw needs any help I'm happy to help I could be a board member or something and the next thing I know I got a phone call from the executive secretary saying we're so pleased you're running for the presidency if I saw I went I am Dale what did you do to me and I decided at that point I had probably better learn something about genetics other than of course I took in 1968 and my ongoing interest in what I had learned being on the secretary's advisory committee so at that point I signed up for Cindy's web based genetic institute took that for 18 weeks then signed up for the summer genetics institute here at NIH did that for 8 weeks and then I figured I knew a little bit about genetics and then I was ready to be president of ISONG and Kathy followed me and she came that summer while I was here she interviewed me before she agreed to run for president elect because she wanted to know what my strategic plan was so I sat there with a really good somebody who had really good basic solid clinical knowledge I had taken these two courses and I was ready to roll so that's how I got into genetics which was very different than most of the other people sitting on the side who had a lot of formal training I was always interested I had a passion for it it was something that had my mother lived she would have been really pleased that I had done this and then I went back home and I wanted to start putting this in the curriculum in Virginia I found out being for Boston and moving to Virginia was a real eye-opening experience because we do things if Mr. Jefferson didn't want it done it didn't need to be done things move very slowly the White House of the Confederacy is in the middle of our campus they keep re-enacting the war of north and aggression because they keep hoping it will come out differently and it's just a very different place to be so what happened to me was I was teaching undergraduate nursing of women had genetics in that course that was fun and our RN program is set up so that the RN to BS students had to take an elective and they were desperately looking for enough electives because we had over enrolled students didn't have enough electives to go around so a friend of mine said to me how would you like to teach an elective in genetics and I thought yeah I know this stuff now I can do that so for three times I went I taught this course and you can in our school you can teach a course as a special topics for three times without getting formal curriculum approval so my colleague who was my big champion who was the coordinator of the RN program we offered this course three times it never did get to go through the formal curriculum approval process well when I when she said to me how would you like to teach this course I had retired at the point so a little extra income isn't going to be bad I'm going to be teaching it online but I needed you know I didn't have a semester to develop the course because when you're an adjunct faculty member they don't give you release time nor do they pay you for course preparation so I remembered all the material that Cindy will be talking to you about it later had developed as part of the web-based genetic institute and I noticed that you could license this material I think at that point it was $300 $250 $300 it was a reasonable I'm sure it's more now but at that point it was maybe $500 was somewhere in that range it wasn't astronomical so I went to the school and I said hmm I'd love to teach this course this is wonderful material out there that can be a course master and they said well if you know we're not really interested in that and I thought I'm going to make my life easy I bought it negotiated for personal license for Cindy which meant I could use it in one program so it was mine I talked to my friend and I said if I ever stop teaching this you're going to buy the license from me right well she's gone but yeah that was that was the deal we had set up so I put the course together it was for our NBS students taking the course as an elective totally online and you can see what the enrollment was that I had a total of about 70 students over a calendar year and these were students who ranged from brand new associate degree graduates or diploma school graduates we still have diploma schools in Virginia they're alive well and thriving and we moved slowly I told you so the students ranged from people who had graduated the month before they started the IRN program two people who had been out there forever practicing and for some reason they were going back for their bachelor's degree they were all working as registered nurses and let me tell you what I learned from what they knew about some of the practice issues that's scary but they're all out there working as nurses and so what I did is Cindy's material at that point had 16 modules in it well the first time I taught the course was in the summer and the summer is six weeks so I looked at what can I do when I took like 8 of the 16 or 10 of the 16 modules that I put together the stuff that didn't include the basic clinical genetics but included the application and Cindy's got it laid out in a way that you know it says here's what you could do if it's a total standalone course here's what you could do for clinical practice so I started with just these particular units this is right out of the syllabus and those are the dates that I used just to give you a sense of how long the students had then when I taught it for a full year for a full semester that was 16 weeks long I decided to use all 16 modules and the stuff is out there it's a beautifully designed thing if you want to make your life easy you get Cindy's license and I'm not I'm not selling her material this is you know I'm sorry but it you know I was out there you know I'm an adjunct I'm retired I want to make life simple somebody's already developed this stuff why would I reinvent the wheel every week there are there is you know readings there are case studies there are quizzes there's all sorts of stuff it's just there paste put it into black but I once said to Cindy if you had it in black board and I could just copy it life would be much easier I wouldn't have to cut and paste but you know I know how to cut and paste really well so I put the course together and then in the spring of 2008 it looked basically the same what happened there are assignments there were quizzes the quizzes are in the course you just take the quiz you put it into blackboard quiz it's there blackboard grades it very easy discussion forums like for example one of the discussion forums was read the newspaper find something in the newspaper that relates to genetics or genomics discuss it in 250 words or less respond you know you have to respond to at least one of your classmates pedigree interpretation there are pedigrees in the course cut and paste admit ask the students to do the pedigrees what I decided for these our ends who are scared to death of this stuff especially the ones who have been in practice for 20s they were scared spitless and or maybe not spitless but anyway they were out there I decided that they would get credit if they completed the assignment there would be no taking off points if you got it wrong other than on the quizzes if you complete the assignment you get full credit and what I would do is I would leave the assignment up the last day of the assignment I would post the answer and say to them take a look at what you did compare it to the answer so that you have the individual learning but I'm not going to grade you as wrong now it was very interesting because in some of the ethical issues these nurses who have been practicing for 20 years they knew the answer the world is black and white the family must do da da da da da da bed read my answer which would say these are the issues you may want to consider in talking to the family but I decided I was I never called anybody out on their you know rigid answers it was like here's it was for them at the self level they got to draw a pedigree they got got mrs smith and mr. jones and at first I had them set up to make like we did in the web-based genetic institute we were given a partner we had to make a phone call do it over the phone well these are ends that was too stressful for them they work different hours they didn't if they didn't know the apartment they were scared to death to make the phone call so anyway I just gave them a pedigree gave them a history and said you know give the answer draw the pedigree submitted by email they had to identify resources there were case studies and case scenarios and at the beginning I assigned them their cases randomly so that they couldn't just choose the cases that they were part of their practice if you were a peds person you know because Cindy works at a children's hospital the nice thing about this course is the peds people don't feel like orphans you know a lot of times in health assessment the peds people feel like real orphans because it's not pediatric specific content there's cases across the life cycle so I would just assign them you know five if you do this case five if you do this case five if you do this case and at the end after they went through four or five cases I said okay pick the scenario you want so towards the end they had some choices over which scenarios they picked so they had required textbooks which were the consensus document the ISONG standards and Jean and Dale have a wonderful book that's case studies the students love the book and then I gave them some optional readings and I said to them you know I had sent them an email that said here are some optional books take a look at them figure out which ones best fit your learning style so they had some books that they could choose among if they wanted them they didn't want them but they a lot of them felt like they needed some of that basic genetic information because they didn't have access to it so they had some choices in terms of textbooks these were adult learners now these are some of the student comments that I got unsolicited these were not on the course evaluations these were emails that I got from the students towards the end of the course I really enjoyed learning about genetics now I have a better understanding and so it was really interesting in terms of what some of the students you know self admitted to learning and you know I did find people who were really you know their life got turned on and this particular student is looking at an advanced practice role in genetics and she's not sure whether she's going to go and do a master's degree in nursing or she's going to go do the genetic counseling and I tried to work with our genetic counseling folks to see if maybe we could combine the nursing core and the genetic counseling to make some kind of a hybrid program but the director of that program didn't think it was appropriate for nurses to have that kind of content so we decided I wasn't going to fight that battle anymore and you know these are the kind of comments I got from students looking at you know their interest and to me this was very rewarding there were additional comments on the course outlines but I just went with what I had in my email inbox as I prepared these slides because I ended up not having as much time as some of the others because I ended up being a last minute substitute for one of the speakers so I just put this together with what was in my inbox didn't get downstairs to the file cabinet or all of my pre-retirement documents are stored but they really did learn a lot and they enjoyed the course and it was a good learning experience for most of them some of them struggled more than others so you know here's somebody who was running a little bit late which you know on an online course I think it's wonderful because you can learn at your own pace I'm teaching online right now I'm teaching a course in our RN to BS program called information literacy and health care we started in August one of the students already has completed all of the assignments except for the collaborative project there are others who are still on week one so what happened to the course well the curriculum changed and electives were no longer necessary so the RN students no longer have an elective and then given like all of us are facing budgetary issues anything that's not required isn't offered anymore it will cut to the bone the RN to BS coordinator changed so my champion is now living in California doing stained glass which I'm going to see her next month I hope she's got some pretty stained glass but you know like if there's somebody who really believes this is important okay the material is now quote-unquote integrated in the curriculum whatever that means I don't believe it because we are an NLNAC school and our site visit is next month and we just got the final copy of the self-study in a PDF so I opened it up and I searched the self-study found five instances of the word genetic two of them I know are not accurate the other three are examples of what's happening and I still am going in and doing a guest lecture in the nursing of women course in genetics and that isn't even listed in the self-study so I don't know where they're at but I it just went away because it wasn't something that was suiting the purpose so what's needed I really think that what's needed like when Kathy called and told me about this faculty champion meeting I said I'm not the right one for VCU I don't work there full time anymore you really need a faculty champion that's very important you need someone who's paying attention to this material and there need to be curricular mandates I think the essentials is going to make a whole world of difference having you know because if you know quite frankly we're like everybody else if it's you know I have this cartoon it's a bunch of dogs coming up to the desk of the teachers the dog teacher sitting there and the dog student is going is rolling over on the final if it's not on the test if it's not in the accreditation stuff you know we're not going to do it we're no different than the dog who isn't going to roll over if it's not on the final so there need to be some there need to be carrots but there also need to be sticks and I believe that's important I also believe you need to have support when the essential when the book came out that talked about the competencies I made an appointment with the undergraduate curriculum committee and with the graduate curriculum committee to bring in the book and share the competencies with them they were very polite they took the book and they said thank you and I said do you have any questions oh no if we do we'll be in touch with you well that's the last I've heard from them because we have an associate dean that doesn't see this as important as I see it so you really need to have some cheerleaders in the institution I think that's very critical and so what I would say is get a friend and be obnoxious because that's what makes change happen you know nice people don't get change made you know what is it you know there's also a cartoon that says that you know nice women never change the world you know being nice isn't enough so you really need to focus and work with people and I had a great fun developing the course I was very sad when it went away all I can say is the students who had the experience found it to be very good and my advice is don't spend hundreds of hours recreating the wheel there's lots of wonderful good resources out there if you know how to copy and pasting you know how to ask people for permission and licensing it's very easy to get good material and you don't have to spend hours and hours developing it on your own because it's already out there brilliant people have done it and if any of you have been in things like the summer genetic institute or the web based genetics institute or any of these other short courses that are out there there's tons of material and it makes it very easy to get what you need so I thank you all very much and I wish you luck and I'm happy to talk to anyone who's looking for helping guidance along the way. Okay thank you very much so today I'm going to talk a little bit about the interdisciplinary model and what we've done at the University of Pittsburgh I think it's important to discuss this model because I think some of you may need it want it may need it at the beginning when you're getting things off the ground and then not need it so much anymore but I think it's important that we discuss this model because and to discuss some of the barriers that I ran into as well as some of the little nuggets of advice that I have for you so let me tell you a little bit of background about how I came to be at a school of nursing so when you start talking about this top down approach and having the buy-in from your upper administration the dean at the School of Nursing at the University of Pittsburgh was actively recruiting a faculty member to come into the school to integrate genetics and genomics into the curriculum as well as hopefully bring on board some of the genetic and genomic research into the school as more and more of their nurse scientists became interested in integrating genomics into their research so she tried very very hard to find a nurse faculty member who could bring all of that we're talking about the end of 1999 here and it was just really hard to find those individuals and that is not the case anymore ok, things have progressed enormously over the last 10 years but at that point in time her only alternative was to look towards a non-nurse to bring into the School of Nursing and this is not unusual for the University of Pittsburgh we actually have a fair number of non-nurse faculty that teach in our program and that have their primary appointments in the School of Nursing so, but however I did want to point it out that one of the things that happened at that point in time may not need to happen today but it's still an option for your school alright, so in the year 2000 I came on board at the School of Nursing primary appointment in the School of Nursing with a secondary appointment in the Department of Human Genetics so that I could keep my grassroots simmering there in the department and I'll tell you a little bit about some of the advantages and disadvantages of having a geneticist in your School of Nursing so, first let me tell you the advantages to me have far outweighed any advantages and advantages to the School have been that for those of you who are here and fretting about incorporating genetics and genomics into your curriculum if a geneticist were to come along and be able to do all of that for you you may breathe a little sigh of relief okay, so that's one advantage that you can bring in someone who can actually incorporate this into the curriculum and alleviate that from some of the faculty while they're also trying to incorporate genetics and genomics thread them into their curriculum alright, so it alleviates some of the burden on the faculty I'll talk a little bit about the barriers that I encountered later on because the faculty were you know a lot of them were happy to have this person come on board and help them but then there were also some faculty who were part of the barrier that I encountered another advantage to the School is having brought in a geneticist that actually brought in the ability to incorporate genetic and genomic research into a lot of the nurse scientists trajectory of research so over time we now have, you are in the minority if you're a nurse scientist at the School of Nursing at the University of Pittsburgh and do not have a genetic or genomic component to your research so we've been able to facilitate that I'll talk a little bit later about our training grant and how training, that training grant as well as the research that's going on at the School benefits our undergraduate students so they're not mutually exclusive issues I have seen great advantages to myself and one of the best advantages that I can tell you is from dealing with my nurse colleagues I have a better appreciation of the phenotypes that I want to investigate and I'll give you a really good example some of my NIH funded research is looking at the contribution of molecular variation that accounts for recovery after traumatic brain injury so that's why I love hearing Dr. Guttmacher talk because I would love to just pick him up and plop him in study section so that people will realize this is stuff that we need to be doing we need to be looking at how are the genetic variation that we bring to the table for folks who have sustained these injuries how you recover after that injury could be very variable and I did not have an appreciation for patient outcomes until I came to the School of Nursing and so a big chunk of my research trajectory I owe to collaborations with my nurse colleagues so I have by and large encountered a lot of advantages from being in the School of Nursing I would say a disadvantage has also been somewhat of an advantage so I am an oddity alright so when I go to the eye-song meetings I know that I am one of the few non-nurse members of eye-song so it is I am a little bit of an oddity and sometimes that gives you one of those feelings like you do want people who are like you and understand you sometimes it's difficult to be a little odd but at the same time that oddity has actually been an advantage to me the President of the American Society of Human Genetics invited me to be a member of the Information and Education Committee for three years for the society and that was based on my unique role as a nurse educator and so being odd has its advantages and its disadvantages and I think the oddity actually has been more of an advantage over the years so what have we done at Pitt so I know that there is less advocacy for a stand-alone course than you know some of the other models that you've probably heard about but I advocated real strongly for a full semester genetics, genomics molecular therapeutics course for our undergraduate students and since the year 2000 all of our undergrad students have been required to take a full semester genetics course currently all of our DMP students it's required of them and for our other doctoral students as well as our specialty role students the course is an elective however you know let me give you a little bit of background about why I advocate for the stand-alone course now I also advocate for the threading and the integration throughout the curriculum I think that that is a very important piece because as your students move through the curriculum it's very important that we show some solidarity here and if you know and if you have faculty who are not incorporating genetics and genomics when it's appropriate I mean we don't want to shove it down their throats but when it's appropriate our faculty need to be incorporating it because we need to thread that and show the students that we have solidarity and that what they're learning in that full semester stand-alone is actually being applied so I advocated for the full semester stand-alone course because my philosophy in teaching is if you teach the students the scientific basis of genetics and genomics you have now empowered them to understand what's currently going on in genetics and genomics and you have empowered them to understand what's going to happen 10 years from now and that is incredibly important because as we all know we are right now at the tip of the iceberg for understanding genetics, genomics how our genome works, how genes interact with one another, how the environment interacts with our genes we are only seeing the tip of the iceberg right now and then as far as translation to healthcare is concerned we're not even at the tip of the iceberg yet so empower your students by making sure that they understand the basic science of genetics and genomics and that will serve them well in the future now this may sound scary but that's why sometimes you need to bring in someone who can do that if you don't feel comfortable doing that yourselves alright and we'll talk a little bit about where you can find these experts and I advocate for this because you know and I advocate for integration throughout the curriculum because I think we need to show our students resources that they can use to carry themselves forward I think that a really good example is a lot of us will talk about oncotyping in our courses so oncotype DX is a test that looks at the level of gene expression of a battery of genes in breast cancer cells and we use a lot of that information for prognosticating we use a lot of that information for figuring out what intervention what chemotherapy might work best for some of these individuals alright and it's based on the gene regulation that's going on in their cancer cells now if you talk about that without discussing with your students some of the background science in gene regulation and gene expression then the next time the next test comes along that uses a lot of the same type of information they're gonna have to relearn because they're learning about a new test if they learn the underlying science behind these tests the next time a new test comes out they're not gonna have to reeducate themselves they're gonna say ah this is just another application for that science so if we teach them about gene regulation, gene expression and tell them how our endogenous environment for example hormones as well as our exogenous environment such as micronutrients vitamins, meds that we give folks how those actually interact with our genes to turn them on and off once you've explained the science of that to them the next med that comes along that interacts with the gene and that's its mechanism of action they're gonna understand that they're gonna get it even though that med might not be out for another 5 or 10 years so that was my biggest advocacy for a standalone course was if we can get the science across within that full semester course at a great rate throughout the curriculum then I think we would be setting our students up for the best success for the future we do have separate courses for undergrad and graduate students and I'll talk a little bit about that later when I talk about my advice to you guys because one of the things that we did not start out doing was separate them and learned very quickly that we needed to do that we do cross list our graduate course and I will talk to you a little bit about the advantages of that what it brings to the table for that graduate course we do have other full semester offerings we have a minor in genetics that we offer at the school as well as a post back and a post master's healthcare certificate in genetics that we offer to our students and a lot of the full semester courses that we've been able to develop as electives and these additional courses those have actually come about through the training grant that we got through the NINR so again you see a lot of things intertwining to pull in resources and then how it helps our students so our undergrad students are welcome to take graduate level elective courses we actually encourage it in their last semester of course work because the way the University of Pittsburgh works is that automatically becomes a graduate course that you can apply toward your graduate education degree so we do advocate for students to take graduate level classes as undergrads so I'm not suggesting everybody go out and hire someone bring someone in to teach genetics especially in our current economic environment where it's hard to bring in anybody but to really give some thought to if you don't feel comfortable would you feel more comfortable bringing someone in to help co-teach a course with you guess lecture in your courses or maybe even bring someone in to teach a standalone course to your nursing students from somewhere else on campus so in other words you're not hiring someone the University and your School of Nursing is not hiring someone you're actually using expertise from elsewhere on campus and we use this a lot at the University of Pittsburgh we actually use it more basic science courses are not taught by School of Nursing faculty we bring in folks from other schools of the health sciences to teach those courses for us and that works out really well because everybody does what they do best and our students benefit from it so it is something that I think everyone here needs to entertain you know going out and looking on campus and seeing who you have available to you to bring in and help you teach these courses at least in the beginning and then as you feel more comfortable with the content you can move towards relying more on your own in-house faculty so some of the barriers that we encountered so again we had that upper level buy-in from the administration but I encountered a lot of faculty who really weren't sure why we were bringing genetics into the curriculum who really weren't sure why they needed to even hire someone to think about bringing this into the curriculum and so that barrier one of the ways that we came up to deal with that barrier because we thought that maybe some of the barrier was ignorance and so we moved ahead with faculty workshops we had four half-day faculty workshops spread out over four weeks and it was elective so in some respects we were preaching to the choir to the folks who showed up to these workshops however in the end I think what these faculty workshops did was they gave faculty a little bit more empowerment because they now had more of an understanding about genetics and genomics and how it was impacting clinical care alright clinical care in their arena of expertise that they weren't necessarily fully appreciative of so once faculty realized how much back in 2000 genetics and genomics was already getting into the healthcare system then they started to realize that maybe this is something I need to be paying attention to the other thing was bringing these faculty on board giving them some empowerment with a better understanding of genetics and genomics to know what kind of expertise was now in the School of Nursing that they could pull upon and then also giving them ideas about where to go and get more information if they needed to be brought more up to date in their area of expertise that was then passed along to the students so we had nursing faculty who now felt empowered and impassioned and then brought that into their courses and that was passed along to the students so really we took this top down approach where we had buy-in from the administration and then brought in the rest of the faculty through education alright another barrier that I encountered and some of you may have this situation or have experienced it also other schools on campus schools of the health sciences had no idea what we were doing over at the School of Nursing and so this is true for all campuses a lot of times you don't realize what's going on down the street you may know more about what's going on across the country than you do about what's going on down the street and this was exactly what was going on when I would talk to colleagues outside of the School of Nursing and told them where I was residing they had no idea the great things that the School of Nursing was up to the research that was going on there the curriculum that had been developed that they could offer nurses at the School of Nursing they had no idea and so I was out there advocating for the School of Nursing and your profession with all of these non-nurses people to bring them up to date because people really didn't have an appreciation of the awesome things that were going on at the School of Nursing so that was a barrier for a little while most of these barriers are now gone alright I wish I could say every faculty member at least they're like yay, Genomics it's getting there, it's better and we have built a large cadre of folks who are not only interested in genetics and genomics but now are advising students who are interested in genetics and genomics so if you're a faculty member at the University of Pittsburgh School of Nursing and you're not into genetics and genomics eventually a student's going to come along that you're going to advise into it because our students really are also pushing some of this advocacy so some of the successes the student feedback has been wonderful and nothing is more heartwarming than having a student who has taken your class come up to you and say you're not going to believe what I saw over at Children's Hospital today and I actually understood what was going on or you know I was in the adult cancer risk assessment clinic down at the women's hospital and you're not going to believe it I completely understood what they were talking about and you know it's so heartwarming to know that you participated in that and I've had students say to me you know I was at Children's Hospital and I saw a child with a particular condition I thought you made that up it sounded so odd that it couldn't possibly be real I said you know nature we don't need to make things up and so you know the students really brought that forward and their feedback has been wonderful the other thing I think is when we think about benefits to the clinical sites our undergrad students are actually out there a lot of times educating staff nurses who did not have genetics or genomics as part of their curriculum so the number of times that I've had students say we saw someone with this rare disease and nobody really knew what to do and so I took them to online Mendelian inheritance in Manlach you told us to do and we looked it up and we found out the clinical synopsis and what the gene is and then we went to see if testing was available and what they did was they also empowered that staff nurse at the hospital to also understand a little bit more about genetics or genomics than what they did before they came on the job that day so there is benefits there is this whole trickle down into the clinical sites by having our students have this education and then bring it to the clinical sites we do now have recognition across campus we have, especially in our graduate genetics course we have a fair number of non nursing students that register for our nursing genetics class and I have to tell you a lot of it is because we bring to the basic science piece of genetics and genomics we bring in the clinical aspects so we use the same textbook okay as the folks who are biology majors at the university of Pittsburgh we use the exact same textbook but it is a completely different lecture course because we bring in the clinical aspects that the folks down in the department of biology are not getting and there is just so much more of an appreciation when you bring that in so we get a lot of folks that register for our course a lot of that has to do with the fact that it is cross listed okay so what that means is the graduate genetics course that is offered through the school of nursing is cross listed and also offered through the department of human genetics so a lot of times you will have students looking for an introductory basic genetics course at the graduate level through the department of human genetics and say oh I am going to register for their course then they find out when they show up that it is cross listed with this nursing course it is great because of the diversity in student body that then shows up at this graduate course every time we offer this course we have biostat students, epi students rehabilitation science students communication disorder students dental medicine students in there with our nursing students again bring a broad array of expertise to the table themselves and the dialogue that you have because of the diversity and background of these students is amazing so we really have put the word out across campus either through cross listing or because of word of mouth and people are registering for the nursing course now by allowing by allowing students from other disciplines on campus to come in and take this genetics class that then allows us a little bargaining chip to say hey we now need your expertise to come in and guest lecture or provide a piece of this course and there is a little bit of that back and forth we are supplying your students with something can you supply our students with something and it really does scratching of the back thing that goes on a little bit the T32 that we have now this is for pre-doc students as well as post-doc fellows and while that is not really what we are here to talk about I can't say enough about how you need to also give some thought to bringing on some resources into your school that can show that can be an example of how your school is moving forward with genetic and genomic integration and one of the ways that you can do that is to bring in something like a training program especially if you are at a research intensive university there are courses that come along with that that benefit our undergraduate students are immense like I said there is other courses that had to be developed as part of that training program that is now available to our undergraduate students it brings in more students more post-doc fellows and as a result has actually brought in more faculty that are involved with genetics and genomics that opens up research opportunities for our undergraduate students a lot of our undergraduate students a fair number of them are interested in genetic and genomic research and the other thing that it brings in is some of the other resources that the T32 brings in like a journal club that we have so we are really diversifying ourselves across the curricula by offering many different things elective and required for our students so our students kind of see a whole menu of things that they can do in genetics and genomics at the school and it's not just something that they're going to get a taste of here and there so a couple of nuggets of advice so yes I think that you've heard from other folks use the competencies to guide course objectives it's wonderful that a lot of what has been developed and what's out there was developed with Bloom's Taxonomy because it makes it very easy to integrate into your objectives which is something that our school is really big on is those level you know making sure that your Bloom's Taxonomy is at the right level incorporate clinical examples as much as possible like I mentioned before this sets the School of Nursing course apart from any of the other genetics courses that's offered on campus and again for nursing students really helps bring it around to reality if they can see how they may be able to use it in clinic or remember a clinical experience that they had and bring it into real life for them I mentioned before you know undergraduate students are different from graduate students we actually when we first started out thought you know undergrad students and graduate students need the same topics they need the same information so why should we put ourselves out there let's just have a combined course will assign a dual numbers that the undergrads are signing up for an undergrad number and the graduate students are signing up for a graduate number so how do you sit there together and maybe we evaluate them a little bit differently depending on what they've registered for but the delivery of the content will be the same alright because everybody needs the same topics well then we started to realize exactly what's been mentioned here it's the reciprocal of what you might think for other topics the undergrads are coming in already with an appreciation of genetics and genomics as well as actually a pretty decent foundation of some of the basics especially when it comes to inheritance patterns and things like that and our graduate students did not have that they didn't have it in their nursing undergrad curriculum they probably didn't have it in their high school curriculum and they just didn't have the appreciation so what we realized was if we separated the two courses the undergrads needed a little bit more time spent on the clinical applications whereas the graduate students you still had the clinical applications there but they got that more quickly but you had to spend more time on some of the earlier things some of the more basic things you'd be surprised how many graduate students in our genetics courses have not done a Punnett Square before and if they have it's because they sat down with their child that's in seventh grade and watched them do a Punnett Square so or they don't remember doing it so these are the issues that we were dealing with so now we separated them for logistical purposes and they remain separated now I can't emphasize enough when you can use online resources like Judy had mentioned you don't reinvent the wheel that's one reason but I can't emphasize enough if your job as a teacher is to make sure that you're empowering your students for the future give them tools that are going to grow with the future so if you give them a textbook and five years from now they open that textbook it's going to be completely out of date it's actually quite sad I keep some of my old genetics textbooks just so I can go back and really appreciate what's happened over the last 10, 15, 20 years so that's not going to do it for them if you're going to empower your students introduce them to some of the online ongoing constantly updated websites and online resources so that a year from now when they encounter something you've taught them what tools to use they can go out there and that tool is actually going to be updated for them a year from now and of course make sure that there are good websites from government and educational institutions and things like that but empower your students for the future by introducing them to some of these online tools that are constantly kept up to date bring in content experts when appropriate and with all of the technology that we have today this doesn't have to be someone at your university if you feel like the most appropriate person to deliver some content for your course is across the country there are ways to bring that person in without physically bringing them in to give a lecture in your course take advantage of the technology way back when when this technology wasn't as well developed we actually brought experts to Pittsburgh and taped them delivering lectures and then used those tape lectures for years okay because what it did for our nursing students was it showed them how nurses were incorporating genetics into their clinical practice we didn't have anyone who could do that on campus on Pitts campus we had to bring those folks in from around the country nowadays you don't even have to bring them in web them in okay all kinds of technology that's available so don't be afraid because there's experts out there to help you so even if what you've decided at your school of nursing is that you're going to integrate throughout the curriculum that doesn't mean that you still need to do everything because it's integrated into your particular course that you've been doing for 10 years bring in a content expert open up a little bit of time to bring that person in from outside alright and it doesn't always have to be a nursing colleague alright the other thing the other piece of advice that I will give is something that the students have always appreciated that I've done at the beginning of every class is I have a little in the news segment alright and especially for the students who are out there reading the lay press there's so many things about genetics out there in the lay press on a weekly basis and so if you if you don't read the lay press granted your students probably are especially undergraduate students so to make it more real for them you can do it in the news segment at the beginning of each of your classes helps keep it real and I think you know one of the important pieces that you can do is sign up for the CDC's public health genomics weekly update and what they'll do for you is email to you once a week what's out there in the scientific literature as well as the lay press things that your students are probably reading give you a little flavor for what's been out there give you resources to get to the actual scientific literature to back it up if you want to do that but it gives you an idea of what your students might be reading and gives you an opportunity to bring it in in a very fresh way to your students and that's that's been an important piece of what I've gotten feedback from my students about is that they really appreciate that and then the last thing that I'll mention is the university of Pittsburgh school of nursing really is an advocate for evidence-based practice and as a result almost all of our courses have to have a component in it where students are reviewing the literature and critiquing the literature in a very specific way we even have forms for students to use when they're critiquing the literature and within the genetics course we actually do a critique of the literature from the genetics point of view so that students can critically evaluate what's out there so that they can understand what the difference is between a meta-analysis one of these huge reviews versus something that's out there a candidate gene association study on 100 people that has never been replicated so you know there's a lot of information out there in the literature you can guide your students by providing them with literature to read and then discussing that literature again if you don't feel comfortable doing that there's advantages to getting your students out there and reading the literature if you don't feel comfortable doing that bring someone in who does feel comfortable doing that because I think showing them how you can bring evidence-based practice into genetics makes it very real clinically for them also so those are my words of advice again you have my email on the list and feel free to email me anytime but also if you have questions I think the panel will entertain them Dr. Connolly can you share how you differentiate the content for your graduate and your undergraduate course genetics course the topics the weekly topics are identical so the topics themselves are no different for the undergrad versus the graduate courses what is slightly different now I will say the big difference between the two is in the graduate level course I do cover research design so I cover what an association study is what a linkage study is what a genome-wide association study is what all of these things are and how to when you see it in the literature interpret what you're seeing that is not going to be of interest to our undergrad students at least I don't think it would be when you're teaching a class the size of we have now divided our undergraduates up so that we teach it once in the fall and once in the spring and so we usually have about 75 students per semester but they all used to be grouped together into 150 students in a large lecture hall and so that really impedes some of what you can do and granted the majority of those students would not appreciate the research design stuff so some of the topics are a little bit different but for the most part of the topics we just go into them in a little bit different depth and I will say at the undergrad as well as the graduate level I never hold students to the clinical presentation of disease and this is because my philosophy has always been if you can look it up I don't want you committing it to memory I'd rather you develop a basic understanding understand genetics from a conceptual point of view so that you can critically think about the situation and look up what the clinical presentation of something is and the week after you take an exam you're probably never going to remember what that clinical presentation was anyway you're not going to trust yourself so you're going to look it up a lot of genetic conditions especially when you're talking about the monogenic conditions are rare enough that you probably won't trust yourself to what you learned a year ago two years ago because you haven't seen it since then you do that a little bit less in the graduate course a little bit more in the undergraduate course because our students haven't been out there and done as much clinical at the undergraduate level whereas when you're teaching the graduate students and you're bringing up something that's clinically relevant some testing for example they'll all be shaking their heads they've heard about it so you feel like you probably don't need to go as in depth with the clinical capability of that particular topic but then you find yourself needing to actually go into more depth about the conceptualization of that test what's actually done when they do that genetic testing that sort of thing and then I will say we do have ethical, legal and social implications within the undergraduate course however that is something again that has been integrated throughout the curriculum and we do have a standalone ethics course we do have a standalone health promotion course and both of those courses have one day set aside for genetic and genomic testing and family dynamics associated with that and all of the implications that go forward and that's different that's also different at the undergrad and the graduate level the case presentations and then to which you go into those case presentations so again most of the topics are identical it's just how in depth clinically versus how in depth basic science you go is usually a little bit different between the undergrad and the graduates and then the evaluation of their knowledge is completely different especially when you're talking about a large undergrad class versus a class of 30 graduate students where you can get a lot more creative in how you evaluate them on the traditional or the standalone courses are they offered in a traditional way face-to-face lecture or is part of it online or is the whole course online both, thank you the course that I taught was totally online because first of all that's what I wanted to do and second of all I really believe for the RN student who's working full time who has family responsibilities full time many of whom in this day and age are the sole support for their families because their husbands aren't working or their wives aren't working just to be able to have the flexibility of being able to schedule when they're going to learn for me that was very important to be sure that the students had as much control as possible using principles of adult learning could I have taught it face-to-face yes but I really believe that online learning is very rigorous I believe that you can't sit in the back of the room and be the quiet one everyone has to have a voice you can't be the one in the front of the room who's monopolizing the teacher everyone has the opportunity and the responsibility to participate and I really feel that an online course enhances learning in a way that a face-to-face course doesn't the three courses that I mentioned are also online or for credit programs and so the human genetics courses online topics are covered on a weekly basis and there are assignments same way with the advanced practice course usually that's a discussion topic with an asynchronous discussion opportunity at our university people can sign up for as many as three courses without being enrolled in the university and that's been in place for a long time and many nurses have taken courses for professional advancement for example under that format so that's how these courses are offered as well and for us at the University of Pittsburgh they are traditional face-to-face they are web assisted so like a lot of the lectures are available online the lectures that I talked about that we recorded from the experts those are available on demand through the web assist however the University of Pittsburgh has a very strong stand against online teaching and only this semester opened up online teaching as a possibility for our faculty for a course that was 100% online only this semester are we this is the first time that they've allowed us to do that so it has always been face-to-face but some of that decision was made for us by the university can you tell me what the rationale was for being so strongly against online at the University of Pittsburgh I won't pretend to understand exactly how the upper administration at the university works however their big stand was the caliber of teaching that they felt students got online that there were you could hide a lot of poor teachers in online courses and so we needed face-to-face and I disagree with that and I think it's a lot of work to do online courses and it's a lot of time however that was their stand that they did not want online courses available that if somebody wanted that they could go elsewhere to get it and Pitt has taken the stance on many things you can go elsewhere to get it we are not going to be everything to everybody but then we fast-forward to this semester and because we are nobody wants to think of a university as a business but when some of your business starts getting taken away start to change a little bit so while I always disagreed with them about their stance on online they weren't supporting it and without the infrastructure to do online courses you just can't do it so they had our hands tied but that has changed now but again I do not claim to understand the workings of the upper administration and I completely disagree with a lot of the things that they originally used as rationale for not doing it well you know one of the challenges I've had with online teaching and I've been doing it now for 10 years in various and sundry ways is the philosophy that you can create the course online and then I've been assigned as many as 60 and 70 students in an online course in which case I've sectioned the course and I've basically taught six sections because that's what you needed in that particular course is educating people and in our administration we have some of the issues that my successor in the role of director of information technology has presented the administration with evidence as to the optimal size for online teaching well it's like you're just not teaching it right but really the evidence says that once you get beyond about 25 it's very difficult to have the kind of interactivity that you need in an online course so the same as we have to educate people about genetics and genomics sometimes we have to educate folks about teaching strategies and there's lots of battles you can choose to fight okay we have reached the 3pm point which is the close of the webinar thank you for those of you who have joined in the webinar process and we look forward to working with you in the future and for those of you in the room it's break time for 15 minutes