 Thanks, Terry, thanks for the invitation to talk, I've enjoyed the meeting. So I'm going to talk about our concurrent masters in genomic medicine for medical students, and this is a program where they can get an MS and an MD in the same four years. So we all know the genomic information is to be incorporated, and about 12 years ago or so we started with DOD funding, Genomic Medicine Project in Guilford County that's now known as I think it's a geometrical connection, and that purpose was to really model more than practice at that time. And we went in thinking that we were going to have to do all this education of the public, and we were worried about all the ethical things that we all worry about, and we found out that the public was not the problem. Once they figured out it was prevention, they really were not as worried, and you explain things to them, they were not the problem, it was the physician that was clearly the problem. And the physicians in private, this was in private practice, which is where of course most physicians lie in the United States, were just reluctant to practice genomics. We had individuals who told us they wouldn't even take a family history because they were afraid of what they would find. And it came to us that the physicians are the actual consumers, they're the gatekeepers to the patients as we've talked about with the ACMG. And without creating a market for what we're generating and the data we're providing, if we don't have a market we're going to have, you know, we could have like a genetically modified food problem where you have many things that are quite appropriate, but because they have the name individuals don't follow it. And here the problem was that they came and presented all the information in the product before they had the market set up. So we found that one of the major bottlenecks is the lack of knowledge and comfort by physicians, and older physicians never were taught genetics, so that's a big problem. And for younger physicians and current medical students, the curriculum's already full, and they have to learn so much for their boards. And so if you were to put more genetics in, you have to yank things out. And this lack of training increases the concern for litigation. I was surprised having practiced all my time in academia about the amount of concern of litigation in the private sector, maybe I shouldn't have, but in academia I think we're all experts. This is not the case there. And they actually go to websites and follow float charts and patterns. So this is a huge problem if you don't understand what you're doing, you're even more or less likely to use it. And the time to catch up, as was mentioned previously, is a real problem. They already have enough to know in their own specialty. And with all the economics, this is just dissuades people. So we decided to do something that we could actually control. And that was create a master's program. But a master's program, not with a year off, but a master's program that you get the masters during the same four years of medical school. And there are a lot of advantages to this. It avoids the curriculum problem if we run it concordantly with the MD. We can train, you know, the old adage and we all know in medicine is C1, D1, teach one well, we can train one individual medical student and they can start to train others. It increases awareness in other medical students as they're going along in medical school. And the goal here is not to create a medical geneticist, but it's to create a qualified consumer and advocate. That's really what we're looking for is to create a market and increases the value, we believe, for the residency for the students. As I said, some medical schools take an added year for masters and certainly that's when I was a medical student. No one did that. But now that's about 15% of my daughter's medical school class. It took an extra year. But that is not the way we decided to go. Incorporating over four regular years gives a lot more time for masters, which is usually two years, one or two years. Gives time for questions, reinforces the training we hope. It also means they keep up to date into the residency, so they're still in the program when they actually graduate and move on to their residency. And for us, it creates a much less intense infrastructure that we have to build because we don't have to take care of people for an entire year and that's all they're doing, but we now can add on and it's less intense in terms of money and set up for us. So it's a 30 credit hour program over four years and we do all the didactic coursework online. And this was one of the first questions is how do we do this? And one night I was watching my daughter who's at University of Miami Medical School. And it was midnight and she was in her pajamas and she was listening to her lectures on the video because they only go to class anymore, really, for social reasons. And, you know, she made a lot of sense. She could move it back and forth. The guy had an accent. It was hard to understand. You could write, take notes. So I said, well, we could do this, too. So we do all our didactic discussions and coursework is online and they can do this any time during over the week. And then we have small group discussions once a week where students really like. And there we discuss either what we've on the online material or we go over papers or clinically oriented things. They'll have a laboratory rotation between their first and second year of about a month where there's mainly in the clinical labs get an idea of what's going on. They have one clinical rotation at least in their last, usually in the fourth year. And then they're going to do a thesis in genomics of some type, obviously a literature thesis. So, now, in the training workshop a couple a month ago or so, it was pointed out to do this, you need a lot of support. Genetics is clearly a multi-disciplinary function. And so we do have a lot, we're lucky that we have a lot of faculty that are involved in this process, as well as graduate students from the medical students to interact with. So this is the curriculum, I don't know if you can see it in this room, but the first year we have a teaching of fundamentals of genomic medicine, this is basic genetics. I taught this, this, whoops, I taught this semester the clinical applications, which we did about half of didactics and then small groups and then we did a lot of papers related to genomic medicine and concepts based on that. They've gone through some ethics with Susan Hahn, who's going to be the new president of the genetic counselors. And they'll do a laboratory because they have some free time between those two for first and second year. Computational methods in year two, clinical applications. Again, ethics and pharmacogenetics. And then they'll do a clerkship and their practicum, which is the thesis like. And we've decided already that we need to add some small group sessions, we'll have to figure out how to do it exactly, probably make it so they attend one in every two or three weeks, we'll have running ones. Because this is really an important time to interact. So we started our first class in the spring semester this year. We didn't advertise except internally. The medical school wanted us to let these medical students do gross anatomy first. They didn't want to tax them. We had ten students applied in November from 150. Nine were approved. There was one that was not doing quite well enough so that medical school felt that they were not going to be able to do both. We have five students in the first class, and Forty decided not to move on. Three was due to money. And of course that's one of the problems as a parent of a medical student when someone comes to me and says, well, it's going to be another $40,000. You know, I'm going to say, huh? But I have to say today's medical students it's incredible the loans they're supporting. I would say $200,000 is not an abnormal number or $250,000, unfortunately. Now these are not people who are interested in going into genetics. Neurosurgery, oncology, pediatrics, cardiology, internal medicine. So these are their current interests. I'm sure they'll change some, but that is not their goal. Here's a picture of our first students, five, and why did they enter into the program? Well, they came to realize that genetics is in all aspects of medicine. We went through several aspects, even papers were surgery and genomic medicine, and one of them said, geez, even in surgery, genetics is important. They all have a personal interest in genomics. Some of the interesting things is they've already known their usefulness in understanding some of their lectures, which do, of course, have genetics in it. The one I really enjoy is they love coming to me and telling me how their professors are making mistakes in their lectures on genetics. So they're already getting some background in training and they're also, I think, taking some ownership. And I'm happy to say that two of the students on their own sought out and receive funding for the Diversity Conference on Genomics this week, and they're taking time out and they'll have to make it up, so they're really interested. And it's my plug for the meeting this week with several of you, I think, are attending a conference to eliminate health disparities in genomic medicine. This is our second year. We're doing it with a Stanford, whoops, and Carlos Bustamani is the other co-host. And this year we're focusing on industry's role in creating diversity in genomics. So what are some of the problems of doing this? Well, the added cost is clearly a problem. For reasons that are somewhat bizarre, the out-of-state students at University of Miami, it's free. The program's free. It's only the students in Florida that are punished. But, you know, we're in Florida, so. And not all students can handle both programs. You do have to remain flexible in scheduling. The medical school decided to change the curriculum and the scheduling for physical diagnosis in the first year, so we had to change our curriculum. And it is added time for the students. And they've complained a little bit, because all medical students complain, but they're all doing very well, so in medical school. And that's the first thing, of course, we want them to do well in medical schools, so we don't want to interfere. So funding, the Hayward Foundation, which funds mainly in Florida, had funded the initial cost of setting up some of the videos helping fund the faculty. At 30, we calculated about 32 to 35 students. It should be self-supporting, so that's an important point. We shouldn't have to be funding this all the time. But we do need support for the program of students, and we'll be looking for that. And we're advertising now for our first class outside, so for the class coming in. We've had many inquiries. There's a lot of interest in this, in potential medical students. So we're excited about this, and we think it's going to be a real positive thing. And I should just say that Bill Scott has been real helpful, and Susan Blanton, and Kaleigh is the genetic counselor involved. And of course, my wife, Dr. Perichick-Vance, has been involved as well. So I'll stop there, take any questions. So I'm wondering if, underlying this, you also have a research agenda to really be able to follow these folks along and see what is the short, medium, and long-term impact of this type of a program in terms of creating that informed consumer that you're targeting? We haven't really, I mean, that's in the plans. I think we'll be doing that. We've been sort of totally focused on getting up and running, and you know, a little bit as Larry said, sometimes you have to make changes on the flight. But I think that's very important documenting that we're actually doing something. Other comments? Yes, Bruce? Those that are paying for this, what do you tell them about their, how this is going to enhance their career? I mean, what's the investment return that you can offer to them? Well... We haven't had to really sell them, I would say. Most of them realize genetics is important. And I think they see value in being the first ones early on. They all see value in their residency because they feel that this will be an added plus in their residency. You know, some of these residencies now are so difficult to get into. So I think there's added value there, for sure. It really hasn't, you know, but we're not looking for everyone, you know. So if we can take 10 students a year right now, that would be great. I think that's a good number, that's what we could handle. We had actually budgeted for five, so the first year because we were just internally advertising. But yeah, I think that's always true. But they're spending a lot of money on medical schools. They didn't know what's coming. Jeff, could I just ask, you said you're video taping or recording all of your lectures. Is there some way to make those widely available? I know I asked you this in April too. Is there some way to make those available to other groups that might want to share those either with medical students or practitioners? Yeah, I don't know that they're kind of being done on the fly. You know, they're being done a little bit. I don't know how, we have a, so right now we're using a pen op. I think that's right. So I can, I voice over. I chose not to make a talking head kind of thing, and most of us are doing that way. But yeah, we can certainly share with people who are interested. I know that at the other meeting, and I think it's true that this could be a packaged situation for places that don't have the depth of knowledge, but certainly that's it. And we hope to start a program for residents, or I think fellows would probably work even better than residents because of the time factor. But there's a lot of interest from residents, particularly primary care. In our place, the family medicine folks almost all have an extra two years of some specialty they're doing, geriatrics or whatever. Yeah, I mean there's a, this is a really, I think this is a great program, and I'm really glad to hear that you're talking about ideas relating to residency and fellowship. And I think even in the post graduate space, I mean one area that has done something similar to this is informatics, medical informatics, where you can go and you can do a one or two year program and, you know, get a certificate or masters or something of that nature and many of them involve actually doing hands on projects. So I think that's a really good model. So you don't, you know, you're not a full-fledged, dyed-in-the-wool informaticist that can write code and all that sort of stuff, but you understand the principles that are needed to be able to do the implementation sorts of things that we're talking about. That's the goal, is create the consumer in a sense. And I guess just to follow up, I would encourage you, even if it's not a perfectly packaged program and that, people watch a lot of stuff on the web and there's a lot of interest in watching these kinds of things. And there might be some simple way, I mean we have, I think we've talked about through our education branch or maybe it's the genomic medicine branch in Laura's group, the possibility of storing some of these kinds of materials and I think we'd be happy to do that. One really easy way is to just podcast the darn thing. I mean I listened to podcasts from MIT, from Stanford, from all over the place. You know, as you're going on the metro and you're bored out of your skull trying to get to work, at least you'll listen to a half-hour lecture and keep up with some stuff. Yeah, now most of these have slides hooked with them, but podcasts I guess nowadays that's not a problem I guess. But that may be the exact hook that you use. If you want to get people in, you want to get the full course, this is what you need to do. But here's what happens when you just listen to it. You learn enough, you can get anybody out there, you can get yourself the primary care practitioner learning about this and as genomics grows they don't feel outcast as well. They actually become a part of it. They come to you as a source. Yeah, so we're going to try to incorporate some of this and some of the stuff we're doing with neurology. Neurology, one of the things we're talking about doing, is the big problem here is for existing is everyone wants genetics for dummies because they're so angst about it. So we're thinking about having an online genetic for dummies that you have to take and then you can take neurology has a huge education system in their meetings and then you can take say genetics for MS. Seems like every neurologist does MS. So, because they don't want to know, if they do MS they don't want to know about dementia, they don't want to know about neuropathies, they want to know about MS. So you give them the stuff they need to know to understand what's going on in their subspecialty of their subspecialty because that's really what they want. So, but I think the podcast is a great idea. I had one question. Terry, over here. This is Jeannie. Where am I? Just interdisciplinary, within your school do you have other healthcare providers that could benefit from all this work that you're doing? Yeah, we have a nursing school, so we've had some interest from there. We don't have a pharmacy school, but there's one that Nova close by. Obviously third party payers, we've had some interest, we've had some interest even from sequencing, you know, technical companies who have individuals who are going out in the field who don't really know them a whole lot. Physician assistants? We don't have many a physician assistants. That's Jeff Duke, we had nothing but physicians assistants when I was there, but yeah, it's not a whole lot of them down there. Nurse practitioners South Florida is real big, so nurse practitioners would be another one. One of the interesting things, you know, in terms of looking at the overall educational environment, is that, you know, Nitchpe has had pretty good success engaging with these types of ancillary providers. They have a robust physician assistants course, advanced practice nurses, audiologists, you know, the group that they've had a problem engaging has been the physician group, much as you were starting out with. So in some sense, you know, rather than, you know, reinventing, this is I think is an opportunity to be able to connect with the successes that they've had and create that broader portfolio. No, I think that's true. You know, our focus here was just to get up and going and see if it would work, and it looks like it's going to work fine and in fact better than we thought. So I think that's absolutely right. There's a lot of places going. I do think education is, we shouldn't forget about education here as we move ahead with this you know, this group because we do have to create the market. It's just, you know, when we think business, we have to, it's a business, money runs everything. Great. I think Liz may have had one last question. Liz, did you have a comment today? Yeah, I was just thinking, you know, there are places like Coursera and stuff where you can take Stanford classes and things like that. And that's at your own leisure. It seems like if you had a filmed curriculum or whatever it was, it would be pretty easy to do that way. And I think you can even get credit for some of these courses. Yeah, I think for physicians, CME credit would be the thing to draw for them. Yeah, which they would have to then be hooked to some sort of facility that gives CME. But I think that would be for existing physicians, yeah. Okay, I think we ought to finish up. Thank you very much, Jeff. That's terrific. Super. Next we'll hear about something a little bit different. And that's Dan Rodin talking about a number of programs through the Pharmacogenomics Research Network related to genomic medicine and implementation. Dan, go ahead.