Lab Genetics & Genomics Fellowship, ACGME

As a component of the Laboratory Genetics and Genomics fellowship program, trainees spend concentration time in the specialty area of cytogenetics.  Training in the Cytogenetics Laboratory consists of ongoing exposure to, and involvement with, laboratory testing, interpretation and reporting in various types of constitutional and neoplastic specimens using standard (banding-based) and molecular cytogenetic methods (fluorescence in situ hybridization and cytogenetic array), with increasing levels of involvement and responsibility as the training period progresses. Trainees first observe testing performed by licensed technologists, and then perform parallel testing of patient samples. Following a period of detailed instruction on interpretation and practice with archived abnormal samples, trainees provide preliminary interpretations of patient testing, integrate results of multiple tests, and incorporate the clinical history into a final interpretation. These cases are then discussed in detail with the laboratory director at regular sign-out meetings and revisions to the trainee’s interpretations are reviewed. The trainee is expected to learn the basic principles and implementation of each test, so as to fully appreciate the complexities and pitfalls that are part of cytogenetic testing. For select cases, trainees communicate laboratory results directly to clinical geneticists and/or other physicians and health care providers. Feedback for improving communication performance is discussed.

In addition to laboratory activities, trainees attend the Biochemical Genetics Teaching Conference, the General Genetics Clinical Conference, and all other required seminars, conferences, and courses. Finally, trainees attend the General Genetics Clinics and Specialty Genetics Clinics. In these clinics, trainees are assigned patients and are involved with the delivery of test results, either as full participants in the clinical diagnosis, treatment, and genetic counseling of patients and families [physician trainees] or as observers and discussion participants [PhD trainees].

Clinical Genetics Patient Conference

This conference is a formal review of the patients evaluated that week in various Genetics Clinics and in-house consultations. The clinical fellows present the patients with the history and pertinent physical findings (including photographs when appropriate). Interesting cytogenetic and prenatal diagnosis results of the past week are also discussed, and the clinical fellow for the month is responsible for presenting and leading the discussion on recent inpatient consultations of note. The subsequent discussion is rigorous, and includes issues of differential diagnosis, disease biology, diagnostic testing, treatment, genetic counseling and basic science correlates. In this forum, the trainee gains experience in organizing and more formally presenting medical genetic information, in leading the interactive discussions that ensue, and in addressing the questions and problems that arise in these discussions. Over the years, this conference has been a hub for medical care providers interested in clinical genetics, from UCSF and nearby medical centers. Full and part-time members of the core clinical genetics faculty, physician and non-physician post-doctoral trainees, genetic counselors, interested graduate students, and medical students and house officers rotating through medical genetics all attend this conference. An additional half-hour each week is devoted to didactic presentations on topics or journal articles of particular interest to attendees. All attendees (residents, fellows, faculty, genetics counselors, and students) make presentations.
 

The UCSF Clinical Cancer Genomics Lab, Genomic Medicine Lab and Molecular Diagnostics Laboratory offer a variety of tests that have, over the past 15-20 years, served as a solid training ground for individuals interested in Clinical Molecular Genetics. Training in the Molecular Diagnostics Laboratory consists of ongoing exposure to, and involvement with, laboratory testing, interpretation and reporting in various types of constitutional and neoplastic specimens using available techniques (PCR, Southern Blot, Sequencing (dideoxy and Next-generation sequencing), Real-Time PCR, Methylation-specific PCR, and Microarrays) with increasing levels of involvement and responsibility as the training period progresses. Trainees first observe testing performed by licensed technologists, and then perform parallel testing of patient samples. Following a period of detailed instruction on interpretation and practice with archived abnormal samples, trainees provide preliminary interpretations of patient testing, integrate results of multiple tests, and incorporate the clinical history into a final interpretation. These cases are then discussed in detail with the laboratory director at regular sign-out meetings and revisions to the trainee’s interpretations are reviewed. The trainee is expected to learn the basic principles and implementation of each test, so as to fully appreciate the complexities and pitfalls that are part of molecular testing. The trainee will further gain knowledge and experience by reviewing laboratory protocols for each test and performing the relevant procedures on the bench. In addition, clinical information pertaining to each case logged in the logbook will be available or solicited by the trainee to foster interaction with genetic counselors and physicians. For select cases, trainees communicate laboratory results directly to clinical geneticists and/or other physicians and health care providers. Feedback for improving communication performance is discussed. Finally, based on previous bench experience, trainees will be asked to develop or assist in the development of a new test and write a laboratory protocol that will allow medical technologists to unambiguously perform the new test.

In addition to laboratory activities, trainees attend the Biochemical Genetics Teaching Conference, the General Genetics Clinical Conference, and all other required seminars, conferences, and courses. Finally, trainees attend the General Genetics Clinics and Specialty Clinics. In these clinics, trainees are assigned patients and are involved with the delivery of test results, either as full participants in the clinical diagnosis, treatment, and genetic counseling of patients and families [physician trainees] or as observers and discussion participants [PhD trainees].

Clinical Genetics Patient Conference

This conference is a formal review of the patients evaluated that week in various Genetics Clinics and in-house consultations. The clinical fellows present the patients with the history and pertinent physical findings (including photographs when appropriate). Interesting cytogenetic and prenatal diagnosis results of the past week are also discussed, and the clinical fellow for the month is responsible for presenting and leading the discussion on recent inpatient consultations of note. The subsequent discussion is rigorous, and includes issues of differential diagnosis, disease biology, diagnostic testing, treatment, genetic counseling and basic science correlates. In this forum, the trainee gains experience in organizing and more formally presenting medical genetic information, in leading the interactive discussions that ensue, and in addressing the questions and problems that arise in these discussions. Over the years, this conference has been a hub for medical care providers interested in clinical genetics, from UCSF and nearby medical centers. Full and part-time members of the core clinical genetics faculty, physician and non-physician post-doctoral trainees, genetic counselors, interested graduate students, and medical students and house officers rotating through medical genetics all attend this conference. An additional half-hour each week is devoted to didactic presentations on topics or journal articles of particular interest to attendees. All attendees (residents, fellows, faculty, genetics counselors, and students) make presentations.