One of the three Sanford Health Medical Genetics Laboratory directors, Debbie Figueroa, Ph.D., has only worked at Sanford for a year and a half, but she’s already growing the culture.
Before joining the health care provider, Dr. Figueroa did her fellowship at the National Institutes of Health. During that time, she participated in a small pharmacogenomics component offered by the NIH, which was optional for these types of fellowship programs.
Determining if a drug works
Pharmacogenomics, Dr. Figueroa explained, “take into consideration the gene-drug interactions, and make sure the drug a provider is giving a patient is actually one they can metabolize.”
Essentially, it’s determining how a patient’s genes respond to medications/drugs. There are two main components to this process. The first is determining if a patient can metabolize, or process, an inactive drug into an active drug. Secondly, is whether a patient can excrete a drug or get rid of it.
If either don’t work, there’s a risk for the drug to not work at all, or for there to be toxicity and hurt the patient instead of helping them.
“By being able to do this pharmacogenetic testing within the lab, we’re able to preemptively know what drugs this patient may or may not be able to take. Then, accordingly, change the drugs that they are being exposed to so that they are, or are not, dependent on that particular gene pathway,” Dr. Figueroa explained.
Figueroa, Sanford step in
As Dr. Figueroa wrapped up her fellowship, the pharmacogenetics component of the NIH fellowship wrapped up as well.
“The laboratory that was offering (pharmacogenetics) actually closed that division during my last year. So, at that point, I realized there was going to be a need and a void.
“I thought Sanford would be perfectly positioned to fill (that). We have such a collaborative environment between the pharmacy team and genetic counseling teams that could help not only fill that particular void, but also other gaps that could help enrich the fellowship program,” she said.
So, she brought up the idea of a virtual pharmacogenomics rotation at the Medical Genetics Laboratory to the leaders at both Sanford Health and the NIH. Both were on board and provided enthusiastic support.
How the fellowship works
Sanford Health is providing a remote, two-week program giving fellows exposure to many aspects of lab techniques, with a specific focus on the Sanford Preemptive Genomic Screen and Pharmacogenetics. The fellowship includes video contributions together with high-impact live interactions with Sanford’s leadership, laboratory, pharmacy, and genetic counseling teams.
“I think this is a very important partnership. We’re in the middle of our first pilot rotation for the fellows. Everyone that has interacted with them, myself included, has been getting really great feedback from them. Lots of really great questions.
“Not only do we have the pharmacogenomics component, but we also have some lab (and) genetic counseling components to it. (There’s) some ethical questions that are being brought up that maybe they didn’t think about as part of their fellowship, they’re being exposed to clinical cases,” said Dr. Figueroa.
Once they’ve completed the NIH’s laboratory of genetics and genomics training program, the fellows are eligible to sit in on the American Board of Medical Genetics and Genomics certification examination.
Both sides benefit
Dr. Figueroa said this is the first set of a series. The first set concluded in November. Sanford Health is offering four rotations this academic year, with the next one being offered in December. They’ll also have two more in the spring with plans to continue offering these for years to come.
There are three fellows in this pilot rotation, but Sanford Health has the capacity for as many as six at one time.
“We’ve opened it up to not only NIH fellows, but if there’s any pharmacy residents that want to be involved within the Sanford Health system, they can jump in on to some of those fellowship opportunities,” said Dr. Figueroa.
She said it’s been a great experience for both sides.
“It’s been beneficial also to the people working here. The feedback we’ve been getting from the fellows is genuine inquiry, a desire to learn, which has been really fulfilling. I have even received feedback from some within the lab, saying it was fun to be able to interact with them and actually have that sounding board (for new perspectives),” said Dr. Figueroa.
To get involved in the next rotation(s), Dr. Figueroa said a perspective fellow would need to already be a resident in one of the Sanford Health programs or a Laboratory Genetics and Genomics fellow at the National Institutes of Health.
“As new residents come into the pharmacy, or into pathology, there’s a molecular rotation aspect to the program (where) they have the opportunity to get plugged in. We’re hoping, based on feedback, that if they want more of a particular experience, we already have all of these videos and assignments built, so it will be easy enough to offer it to them.”
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