Myriad Live episodes are recordings of an open-forum webinar hosted by Dr. Thomas Slavin. The opinions and views expressed in this recording do not necessarily represent those of Myriad Genetics or its affiliates. To participate in a future recording, visit myriad-oncology.com/myriad-oncology-live for a list of dates, times, and subjects.
References for this episode:
COH-Registration now openhttps://www.cityofhope.org/education/health-professional-education/cancer-genomics-education-program/intensive-course-in-cancer-risk-assessment-overview
Medical Breast Training Program - Mayo, Cleveland Clinic and Women's College of Toronto : https://ce.mayo.edu/online-education/content/medical-breast-training-program-all-sessions#group-tabs-node-course-default2
Diversification of Nurse Practitioner Practice: Genetic Cancer Risk Assessmenthttps://www.sciencedirect.com/science/article/pii/S1555415520301276?via%3Dihub
The Myriad Oncology RMS team also leads a series via webinar for GC's and Nurses "Evolving Strategies in Hereditary Cancer". These can be viewed live by invitation. contact your local RMS team to get on that invite list. Also these are available on demand after the live presentation at our webpage https://myriad-oncology.com/continuing-education-webinars/
0:00:13.3 Dr. Thomas Slavin: Welcome this episode of inside the Genome is a recent recording of Myriad oncology Live a webinar hosted by me, Dr. Thomas Slavin, chief medical officer for Myriad genetics. The opinions and views expressed in this recording do not necessarily represent those of Myriad genetics or its affiliates. To participate in a future recording please visit Myriad live for a list of dates, times and subjects. I look forward to exploring the world of genetics with you all.
0:00:40.2 DS: Hello, everyone welcome to Myriad live so excited to have everyone here. So we have a good audience we also have a special guest, we have two special guests I should say. But first little housekeeping. So if this is your first time to Myriad live, what is it? Well, it is just a every other week it used to be weekly, but it's hard to do a weekly webinar series on a new topic every week so we're doing it every other week or so. Trying to at least do two a month that's the goal so and we do take some down, but we just had March hot topics in prenatal genetics you can go to the Myriad live website if you just Google Myriad live. And you'll be able to find all the upcoming talks.
0:01:30.3 DS: Today we're doing let's talk advanced practice provider, genetics, practice, education, and certification so it'll be exciting, and then we have at the end of April spring oncology conference review, we have all these great conferences wouldn't you want to learn what's going on, If so, come join us. We in may it's mental health month, so we're gonna get into mental health genomics, and then we're building out a few more right now in the works end of May and June. So those will be up pretty soon and then you know, if you have not been here before 'cause I say this pretty much every time, but if you haven't been here before these do all reside on a podcast, so this is inside the Genome podcast, we put them all up here and anything that says Myriad live you know, we do leave it.
0:02:24.6 DS: So these are recorded we do encourage people to ask questions though I mean, so if you know, this is a pretty laid back format, so if you have any questions, please chime in ask whatever you want. We do keep them theme based I mean, today is on advanced practice provider genetics training. But you know, if you have a question about this particular gene or something and, and you know, you have to ask it feel free and we'll make sure we answer it to the best that we can. Also send any chats if you prefer to not unmute yourself and you just wanna send a chat question that can get read you can send those to Shelly who is on, thank you, Shelly. So Shelly Cummings who heads our oncology medical affairs.
0:03:14.6 DS: So she's on and will make sure that that gets addressed. And yeah, so we've been putting up you know, a lot of content, anything that doesn't say Myriad live on the podcast like this recent one with Allison DiPasquale that was posted, these are just me sitting down with somebody like Allison and we're just kind of bantering about something with genetics, you know, and that case it was, you know, how is she you know, her genetics training and then how she incorporated genetics into just routine care in her breast cancer practice. So thank you there. And just to introduce our special guests today. So I said we have two special guests, so we have Edie Smith who... Edie is a medical science liaison for Myriad.
0:04:05.7 DS: I have known her for a long time. Well, before I started at this role through our city of hope course, she is one of the most passionate people I've ever met in genetics education. So she's joining us and then we also have, and are privileged to have Tina Marie Bowman. So, and I have not met you formally Tina Marie, but you know, very excited to talk to you today, learn a little bit more about you and your background and everything. Edie, anything you wanna add?
0:04:37.2 Edie Smith: Sure, sure. So I am just super excited to introduce Tina Marie, to all of you. She is a nurse practitioner like myself. She is also board certified in genetics as an advanced practice nurse like myself. There's not really a whole lot of us out there, a handful of us that carry that credential. Tina Marie is the system director for nursing clinical genetics program for Amita health in Chicago, Illinois, and who better to have on this particular call to do a kind of a Q&A with Dr. Slavin on what is advanced practice provider, a genetics practice? What does it look like? How did she get there? How did she gain that expertise? What challenges has she faced? What does her practice look like? How does she educate others? What credentialing opportunities are there for nurses and non-genetics professionals in the way of genetics? So it's gonna be a really fantastic hour and I'm looking forward to it.
0:05:40.4 DS: Yeah. No, thank you for helping to coordinate. Yeah, so very excited. So I think Tina Maria, I mean I probably wanna start first with just yeah, I mean, if you want to tell everyone a little bit about you know, Edie did a nice intro, but what you do at Amita health, how you got into you know, cancer risk assessment.
0:06:00.7 Tina Marie Bowman: Yeah. Good morning thank you so much I'm so excited I've watched many of your live webinars, so it's so great to be here.
0:06:07.5 DS: Thank you.
0:06:07.6 TB: So I'm an advanced practice nurse. I've been involved with genetics since... For credential since 2004. So interesting, I have a dual role. I am a clinician. I do see genetics throughout the day consults, which I love. I can't imagine not doing full clinic, but I also have... I also am a director. So I have a team of five advanced practice nurses, amazing team, which are very passionate. Like Edie and I are about providing genetics, taking care of folks. Interesting how we got involved.
0:06:40.2 TB: It's interesting that Myriad's doing this webinar but back in 2000, which I'm dating myself, we had a Myriad rep come to an office. Dr. Maganini I did genetics together. We were doing... He's a breast surgeon. He was doing general surgery at that time. I was his nurse navigator and a rep came in and talked about doing BRCA one and two, that's what was available back in 2000. And then after the rep left, he said, what do you think? Do you wanna do this? Could we... I said, we could do this. So we... That's how we got started. And Dr. Maganini... Robert Maganini, he's an amazing breast surgeon. He's a champion for genetics, as you know. He's... He was back then, he still is today. He's very supportive of our program and very... Offers genetic risk assessment to all his patients. So very excited, but that's how we got started. And in terms... We were educated. We were educated by the Myriad rep and the genetic counsellor. Shelly Cummings who is on here was one of my mentors and it's incredible.
0:07:37.4 DS: I know. It's funny.
0:07:38.3 TB: Yeah. And Amy Walter, and they were so instrumental in training us and teaching us and getting us started.
0:07:45.3 DS: Yeah, I know, that's great. Yeah, and Dr. Maganini we've been having a few meetings here and there with him over the last year. So yeah, he's still definitely an advocate that's for sure. Yeah. That's great.
0:08:00.2 TB: He's a strong advocate. He's amazing.
0:08:03.0 DS: Yeah. And I mean, so this... You had probably a little bit of education to kind of get the lay of the land but what other things have you done over the years to really feel like you probably secure a really good knowledge base around genetics?
0:08:23.2 TB: Yeah. So now there's formal programs, which Edie and I can talk about. Back then I had to piece it together. There's a Fox Chase Program. I don't know if anybody on this call attended it, but in 2005, I attended a formal Fox Chase Program and it was a lecture program and a simulation. It was a very intense program. Genetic counselors, advanced practice nurses taught the program. So great program, we received a certificate for attending. It was a great foundation. Also attended some classes and online coursework at Emory. They... And so I had to piece it all together. ASCO, you're so young Dr. Slavin, you don't remember, but ASCO had a genetics course so I took the genetics course. So we had to do all this... You had to seek it out, whatever you could find and whatever. Myriad back in the day, and I know, Shelly may remember this, the nurse who was on the phone was amazing, he was our rep. But Myriad actually had formal Education programs. So they actually would have these auditoriums, we've had formal education. Genetic counselor would come in. We actually had pedigree drawing classes. So all this together is how I just... I kept seeking out education programs.
0:09:43.4 DS: Yeah. And I've not heard of the Fox Chase Program. Is that still on going? I don't know if anyone knows.
0:09:49.7 TB: No.
0:09:50.4 DS: No.
0:09:50.5 TB: Unfortunately not. And it... I'm actually on a board for credentialy nurses and genetics and soon I'll talk about it. I still have the picture of the group picturing. It was an amazing program, but no, that's no longer available.
0:10:03.3 DS: Yeah. And the ASCO one you mentioned, I know there was an original kind of webinar one, is that what you're referring to?
0:10:11.7 TB: Yes.
0:10:12.0 DS: They... We... That was revised about probably three or four years ago. And it's pretty good content. I mean, it's like 10 or 12 off the top of my head 15 minute modules. Yeah, I missed the first one, but I did get pulled into the second one. So I gave, I think the intro lecture, like genetics 101 as a lecture of mine. Assuming they still have it. I haven't looked in last year, but that's a good course for sure if people are just looking to... Because you could probably do it all in three to six hours if needed.
0:10:51.6 TB: Before the modules, they had the ASCO train the trainers. So you would come to big hotels in Chicago, big conference room with the goal of training these individuals who had the interest and they would go back to their facilities and train others. So that was the, kind of the goal of the early onset of the ASCO.
0:11:12.0 DS: Yeah.
0:11:12.2 ES: And I would add...
0:11:13.1 DS: Yeah, it's interesting seeing how things Evolve.
0:11:17.0 ES: Go ahead Dr. Slavin.
0:11:18.1 DS: Oh, no, that was it, yeah.
0:11:19.7 ES: I was just gonna say, something Tina Marie said it's so true, those of us that were kind of... Our introduction to genetics if you will, as a non-genetics professional as advanced practice provider, or even physicians back in the late 1990s, early 2000s, mid 2000s, there weren't a whole lot of formal education programs in cancer genetics. And we... I did the same thing as Tina Marie. I had to piece this thing together. I sought out mentors, I sought out any kind of CEU or continuing articles, conferences like NCBC they had a high risk post-conference then I would attend that. And then obviously we have the city of Hope's Intensive Course now, which is phenomenal. It's been available for non-genetics professionals to be trained in cancer genetics for over 20 years. So they were really, kind of the pioneers and that is one of the most robust and well attended and sought out courses for providers today.
0:12:31.1 DS: Yeah. No, it's... I mean, many of us probably on this call have taken that course or have been involved in it in some way, shape or form. So no, and it's still going strong and... You know, I know Cathy Blazer is really thinking about ways to continue innovate it. They've been letting more people in every year, which has been great, bringing in virtual options which keep improving the access to people to be able to take it. So that's a really good one. I mean, what about... What are some of the other things out there? I know, Edie, you're working a lot with NCBC.
0:13:09.3 ES: Yeah, so there are so many options today. And they just keep becoming more and more available through different professional organizations. So the national consortium of breast centers has a phenomenal pre and post conference session at their conference every year on geared toward high risk, plus they have high risk cancer genetics woven throughout the main conference. And then Oncology Nursing Society has a cancer genetics 101 course. And they have that content woven out throughout their conferences. Now the newest opportunity for more primary care, advanced practice nurses and providers is through the nurse practitioners in women's health. Last year, they had their very first genetics course that offered CEUs and this year, they're going to have their second genetics course. It includes cancer genetics, but women's health providers also do other types of genetic care, like prenatal, carrier screening. And that is woven throughout that course as well. So, I think even ASBS, they have opportunities. ACOG has a genetic scores for OBGYN positions, and those are just off the top of my head. But those are more formalized courses that, depending on what your specialty is, you can kind of tap into whatever best fits your needs and your patient's needs.
0:14:30.8 DS: Yeah. And I know, Mayo is releasing new content, this year for a genetic course.
0:14:37.3 ES: A most brand new course. Exactly.
0:14:38.4 DS: Yeah. That's really extensive. At least the material I was looking at, it said that 40 hours CME. So, I mean it's very detailed and goes into management very strongly.
0:14:49.3 ES: [0:14:49.3] ____ toward breast, mostly focused on breast I understand.
0:14:54.1 DS: Mm-hmm. And Stanford, I mean, does anyone on this call know about the Stanford program? I do hear about it from time to time. And Holly, I see Holly on. If you want to elaborate a little bit on that Mayo course, since you were part of...
0:15:08.5 Holly: Yeah.
0:15:08.5 DS: The foundation of it.
0:15:10.4 Holly: I don't know how to put my hand down.
0:15:11.7 DS: It's alright.
0:15:12.2 Holly: Can you hear me?
0:15:13.9 DS: I think it goes away at some point.
0:15:16.0 Holly: Oh, okay. All right.
0:15:17.8 DS: I'm not sure.
0:15:18.9 Holly: Yeah, so Sandy [0:15:19.3] ____ and I put together a very extensive medical breast program training program that includes some of genetics, but the focus is really more on on either enhancing or creating a role in high risk breast care. And I think it's 10 sections with multiple lectures...
0:15:45.0 DS: Yeah. That's great.
0:15:45.8 Holly: Inform live stream sessions. So, we've had a lot of fun with that. My hand will just remain permanently raised.
0:15:51.6 Holly: I'll raise my other hand, if I have an actual question.
0:15:55.9 DS: Yeah, I'm not sure.
0:15:56.9 Holly: Thank you. Yeah, we're really excited. We have 48 people enrolled right now, you can enroll like on a rolling basis, like you can enroll up till the end of the year.
0:16:07.4 DS: That's great. And then it's just up to you to watch things at your own pace.
0:16:14.1 Holly: Right. You watch it at your own pace, and you even watch the live stream things if you happened to have missed those. So, if people who feel like they missed the deadline. There's a rolling, rolling entry.
0:16:27.2 DS: Yeah. That's great. Yeah. Thank you for coming on. And, yeah, I don't know if anyone on the line knows also about the Stanford course. I've definitely heard things over time about it...
0:16:38.9 Holly: I don't know anything about it.
0:16:39.1 DS: But I can't say I know anyone that has taken it.
0:16:45.2 ES: I haven't taken it, but I have perused the site. And so, it looks like there's different modules, you can take everything from pharmacogenetics to you know, it's very broad genetic options. And certainly cancer genetics is in there. And you do have the opportunity to gain a certificate of completion by attending a certain number of modules. That's all I know about that course. It's all virtual. It's all online. And it's like I said, web based modular format. And that seems like a pretty neat opportunity. But it's not as focused as what Dr. Peterson just shared about the Mayo program being very high risk, breast specific. And then City of Hope is very much cancer genetics specific. And I don't know, it doesn't appear that the Stanford course is really honed in on one particular area. It's got lots of really cool options and Obviously an opportunity to get a certificate.
0:17:46.4 Speaker 5: I know a nurse in Texas who took the Stanford course. And I got the impression you do get that certificate. It's much more academic, genetically less practical for especially she was in a breast center what she was really looking for in a course. But I think it gave her some good foundation for when she took the City of Hope course later. And when she took the GCRA course, I think it kind of helped her with some of the genetics concepts, but as far as practically speaking, I think a lot of what the providers are looking for here, it just wasn't the right fit as far as if that's all she did. It wouldn't have been enough.
0:18:25.0 DS: Yeah. I know. Thanks. Domine.
0:18:28.1 ES: Holly, there's a question in the chat. And I think I know the answer to this, but I'm gonna ask you because you will. What is the cost of the Mayo Clinic course? I thought it was a ride around maybe $3900?
0:18:41.1 Holly: Yeah, I think it's $4000 and it's a six month experience with I think about 40 lectures and four live stream sessions. And it also... You can take it at any point. There was something else. Oh 48.5 CME hours.
0:19:07.2 DS: Yeah it's great. I remember that.
0:19:07.7 Holly: This year for a couple of years...
0:19:11.0 DS: The City of Hope course, when I did that when I got 109 hour CME Certificate. [laughter] So I was set for a while.
0:19:17.3 Holly: Yeah.
0:19:20.5 DS: [laughter] Yeah, no, that's great. Anything else that people have seen out there as we're talking through all the different options. But these are great options. And I'm glad we're recording this as well. So people can go back and listen to the different opportunities that exist out there because they are growing really fast. Probably a lot of people didn't know about the Mayo course, for instance, and I didn't know about the Fox Chase course, but that sounds like it doesn't exist anymore right now.
0:19:45.0 TB: No.
0:19:50.1 DS: Tina Marie, I mean, what, what kind of credentials do you feel like have helped you? 'Cause, we're talking about all these different options for courses, but would you say that there's... I noticed that you have a title of Advanced Genetic Nurse. Was that from one particular certificate that you obtained, or were you bestowed that title from someone?
0:20:15.3 TB: Yeah. So that's an interesting question. So I started out with APNG. So ISONG which is an International Society of Nurses in Genetics. They had a separate credentialing committee, which is GNTC. So it was separate, so unbiased, somebody actually grading your portfolio and I was the 23rd, advanced practice nurse in the world that passed that back in 2004. It was very difficult I'm gonna be honest with you and not to scare anybody off it was difficult, because don't forget, I didn't have a formal education program. I had to piece it all together prove my competence.
0:20:52.3 DS: And that was your ISONG you said? Just for clarity.
0:20:52.8 TB: This was ISONG? Yes.
0:20:54.9 DS: And that still is in full effect right now.
0:21:00.6 TB: So ISONG stopped doing the credentialing with the GNTC, then it went to ANCC. So that became a board certification, that's Advanced Genetic Nurse Board Certification. So that is now a board certification. And from what I'm understanding, there wasn't a lot of interest or the pass rate wasn't as high as they felt it should be. The ANCC only allows renewals now they are not doing any new. So that board certification, unfortunately, is no longer available. So I am part of a board which is the nurse portfolio, the NPCC, which is now credentialing, nurses in genetics. So I'm very passionate about it. I think it's very important. And we are doing that. We have a separate credentialing team, separate than the board that reviews portfolios and provides credentialing. And that's the... And I have that as well. So the Advanced Clinical Genomic Nurse, the ACGN. So then now that took the place of the board certification.
0:22:04.7 DS: Yeah, and when you say review portfolio? Can you just walk through that course a little bit?
0:22:09.9 TB: Yeah. So you have to meet the requirements, you have to have so many hours in genetics, clinical application, you have to actually show your competence, we had to do four case studies, provide a log, education. So there's a whole litany of items that you had to complete and submit for this portfolio, and then it gets graded. So if you can imagine walking through a case how we talked about it, we had to write it all out. So from start to finish your risk assessment, your pedigree, your follow-up care, all those had to be in there. So the portfolio when I completed it, it was in a huge box for four cases, it was enormous, because you had to write out everything you did with that, and all the multidisciplinary people that were involved. So, so you have to do the four case studies. So still a portfolio is you still have to prove your competence in it, and they're graded, and then you do receive your credentialing through the NPCC.
0:23:08.8 ES: So to elaborate on what Tina Marie said, Thank you, Tina Marie, that was a great summary. So there are two opportunities to gain a certification or a credential in genetics for non-genetic professionals right now in the US. One of them is through the nurse portfolio credential and commission which Tina Marie just explained. That is the credentialing arm of ISONG the International Society of Nurses in Genetics. So many advanced practice providers on this call will understand the whole credentialing body. That's how we all gain our national certification as NPEs. There's a credentialing body that, that that provides the opportunity for that. So this is the credentialing body for ISONG that provides the opportunity for nurses that are already practicing in genetics that have a certain level of expertise to prove that they have that expertise.
0:24:09.3 ES: And so there is a group of professional portfolio reviewers who are all genetics experts themselves that review these portfolios and determine if the applicant has met the criteria to have to receive the credential. I was one of the portfolio reviewers for the ANCC that Tina Marie talked about. And she's right, it's a rigorous process. You are proving to this group of genetic nurse experts who are these portfolio reviewers for the group that I deserve to have this credential because I've met these requirements. Thus Tina Marie's explanation of this box of this all this detail in cases. And it's not that it's daunting or can't be done. It's just that it is a bit of a process to put together a professional portfolio to show that you have this expertise. Now, the national consortium of breast centers, on the other hand, they have an opportunity to gain a certification in cancer genetics. It's the cancer genetic risk assessment certification or CGRA, that's through examination.
0:25:21.8 ES: Now, so we have one professional portfolio opportunity through NPCC. And then we have a certification opportunity through NCBC, through exam. Again, you have to meet criteria. You have to have so many years of experience. You have to have said so many CEUs. Come in with knowledge because you're sitting down for an exam, and you're basically showing that you have the knowledge to be awarded the certification. So those are the two opportunities available in the US today.
0:25:57.1 DS: No, it's really helpful, Edie. I mean, and... You know, if I'm a new APP out there, how do you sort through all this? Are some... Do some give any ability to bill, for instance... Or is there any benefit to one over the other in anyone's minds? Where do you start? I guess, is coming in to it...
0:26:18.8 TB: Yes, so I...
0:26:20.0 DS: And say, I have an interest in genetics and I wanna get going. What would you recommend to people?
0:26:25.1 TB: So I'll start. Edie, please chime in. So, you know, you always want professional recognition, right? You want... Be recognized that you are competent, and I think credentialing is so important. It's also important for payers. Cigna requires that you have a credential like that. We're talking to them about updating, 'cause you know, it's no longer the APNG, now it's the Advanced Genetic Nurse BC, and the others. So you wanna do that. You also, for our CLC and APBC, they require that you really have this... These credentialing behind you. It's great to be practicing, and we all have to start somewhere. We all have to train. But you wanna have that credentialing behind you to show that you're for professional recognition and first, accreditation and payers. Edie, do you wanna add to that?
0:27:11.0 ES: Yeah, I agree with all that completely. I think there is... There's certainly something to be said for being recognized by your peers in your multi-disciplinary team that you actually have a certain expertise in this. So professional recognition is a piece of this as well. And most certainly accrediting bodies, payers, even institutions are requiring if you're going to be providing a genetic cancer risk assessment, that you have a certain... You've met a certain bar. And that's what this credential through NPCC or NCBC offers. These are not easy things to obtain. And you have to meet a certain level of expertise to gain those credentials. And it means something. So the credential and the certification, they mean something. They mean something professionally, as well as with the ability to see certain patients, or to meet a requirement by an accrediting body. Holly, were you gonna jump in?
0:28:14.9 Holly: I just wanted to know, do you have any idea how many of you there are in the country? Just out of curiosity.
0:28:25.4 ES: Tina-Marie, do you know through... Gosh, GNCC, then ANCC, now NPCC, that's all the kind of the portfolio-based. Do you have any idea how many nurses, nurse practitioners, advanced practice providers, have obtained that particular portfolio-based credential and maintained it?
0:28:48.0 TB: Yeah, unfortunately I don't. And this actually came up in one of our board meetings because the ANCC is no longer... They're only doing...
0:28:56.6 ES: Renewals.
0:28:57.2 TB: Renewals. Obviously, GNCC stopped, and then we just started, as you know. This is a... There's a newer process for the MPUCC. And some, from what I'm understanding is, some people, you know, they retired it out. They stopped. So there's no formal actual database that we know exactly how many people have it. And that is something that we're searching for as well.
0:29:21.6 ES: Yeah, I would say... Now on NCBC side, we have over a hundred people who have sat for that exam.
0:29:28.7 S?: Yes.
0:29:29.7 Holly: And then how many passed? [chuckle]
0:29:31.5 ES: Well, we're running about an 80% pass rate.
0:29:35.5 Holly: Okay. I was just curious. That's a hard test. That's a really hard test.
0:29:39.5 ES: Right now, there are 88 people that currently hold the GCRA certification that I'm aware of through NCBC. We just had a number of people sit for the exam at the conference just two weeks ago. I don't think we have scores on those yet, but they announced at the conference that 88 people had currently been [0:30:08.2] ____.
0:30:09.1 Holly: That's really good.
0:30:10.5 ES: Yeah.
0:30:12.5 TB: Yeah, and...
0:30:12.6 DS: Yeah, we... Oh, go ahead, Tina.
0:30:13.7 TB: I mean, Edie here... Oh, I'm sorry. Just, Iddy, I mean, I think people have to realize that this is... It's all about an expertise, right? An expert level. And showing... And that, you know, genetics is amazing. If it was easy, everybody would have this credential. So you have to put the... You have to be invested. You have to invest in yourself. You have to seek out education and be prepared for this. You can't think, "I'm going to do this portfolio overnight," or take the exam without any training or self-study.
0:30:42.2 ES: I would say too that the NPCC opportunity through professional portfolio is only available for nurses; bachelor's prepared nurses to gain one certain type of credential, and then advanced practice nurses. That is a nursing-specific genetics opportunity, and it is a broad genetics opportunity. Meaning, you could be a pediatric genetic specialist, or cardiac, or metabolic, or adult, or cancer, or prenatal. You can apply for that credential in any genetic specialty. Through NCBC, it is specific to cancer risk assessment. And it is available for a broader group of healthcare providers: Physicians, physician assistants, advanced practice nurses, nurse navigators, and those that have... Even outside of those healthcare provider credentials that have gained an expertise that want to sit for the exam.
0:31:43.4 TB: And that's great if you want to specialize and you only do cancer. When I did my portfolio, I had to do four separate cases. They could not overlap. You couldn't do four breast cancer or four colon, so I had to do four separate cases. And you had to be... You had to be competent in all areas. So you have to look at what is best for your own practice and where your... If you wanna be into cancer genetics or if you wanna do all genetics. So I think everybody has to look at what's best for their practice.
0:32:14.9 ES: I've had people want to gain both for different reasons and they've carried both credentials.
0:32:21.2 DS: Yeah, no, that's great. I see some questions in the chat, maybe we could tackle some of these and Shelly, I don't know if you have anything on your radar, coming in on the private side?
0:32:34.1 Shelly: No, I think... Let's go in the order of the chat. There's a question from a physician starting at his neurogenetics program in the UK, in setting up a nurse-led clinic for complex patients, with complex epilepsy and neuromuscular disorders. And the question is multi... Three questions. Is there a course or a module for neurogenetics in any of these programs that you're discussing? Then there was another question about, how does an APN differ from a genetic counselor? And he finds that there's significant overlap between the two and therefore, collaboration can be tricky. Tina Marie can definitely speak to that. And are genetic APNs from the US, focused on diagnostics or treatment intervention and management. So those are the three buckets of questions.
0:33:37.8 TB: So in terms of motor neuron disease, I don't... I'm not aware of any formal program. I mean, I try and stay in my lane. I did collaborate with a genetic counselor recently, in a very complex motor neuron case and that'll kinda tie over to genetic counselors and advanced practice nurses. I think it's always good to stay in your lane. I think in our program, and I have five APNs and I can talk about that. You know there's... Genetics is difficult. We had positions opened for two years and I could not get a genetic counselor in our program, I would love to have a genetic counselor in terms of our cancer genetics. So I had to be creative and train advanced practice nurses, in genetics. And I have a great team. But I have to tell you that we do collaborate with genetic counselors, I'm very fortunate to collaborate with a local genetic counselor, Scott Wiseman, who is amazing.
0:34:27.7 TB: Who is... Very much respects our role, we respect his role and we do refer back and forth. I utilize genetic counselors within our Ascensions, Stephanie Cowen and Dawn Nixon, that we do collaborate. So I think it's important to know your limitations, know what you don't understand if you're... If this is... You gotta do a service, not a disservice. Learn to collaborate and learn to refer. And so I did work with a case with this neuron... I do not know of any formal program, maybe someone else can answer? But I did work with the team of genetic counselors on this case and it was great because we were able to work together, it was... I worked with some genetic counselors in the city. They... You know, I was able to... I was well read on it and we worked together and we were able to get this patient taken care of. Does anyone else know anything about a formal program in neuro-diagnostics?
0:35:21.6 ES: I don't know if Stanford has it but that is exactly where I'd probably go first. Is look at the Stanford website and on their genetics... Because they had such a broad array and I just wanna piggyback on what Tina Marie said, "Collaboration is key". None of us practice in isolation, this is a multi-disciplinary team approach, it always has been, it always will be. Where we have a geneticist, genetic counselors, along with oncologists and primary care doctors and nurse practitioners and a whole team of people. We all have our expertise but none of us individually are as good as we are collectively. So, I love that about the City of Hope course and the other courses that are taught, that really push the importance of collaborative care.
0:36:11.4 DS: And the only thing I'll add to this is, you know general genetic counselors do get training in neuro genetics and so that could be a resource. If you're looking to hire or something and you're looking for people, that can help fill out that specialty with some training already. I mean, clearly that's a... Yeah, it's it's whole... Own field, with a lot of complexities but...
0:36:34.1 ES: I wanna add one more thing... Go ahead Shelly.
0:36:38.0 Shelly: I was just gonna say even... You know, there are many genetic counselors who have specialized in specific areas, so neurogenetics, cancer, ophthalmology and so they have... You eventually have to go through the same things that many of us did very early on is self-train, seek out the resources, so it could be something similar, that your APNs need to do in the UK, is kinda seek out experts, that they can shadow and learn from. The one other thing that I was going to ask, that is, of all of these programs and training, what would be the best one for somebody just starting out, who really needs the basics to move forward? 'Cause some of them are a little bit more advanced. And I'm curious, on your opinions.
0:37:28.0 ES: My opinion on that is something like, the nurse practitioners in women's health genetics course 'cause that's really geared towards primary care... You know practitioners. Holly's nodding because she's on the faculty, in that course and just absolutely stellar and her lectures are just absolutely amazing, for that group of, again, not seasoned genetic professionals or working in oncology. I also think oncology nursing society, they have a cancer genetics 101, there's a lot of good basic opportunities there. ACOG, same thing, OBGYN, focused course. That would be good. I wanna just touch on one thing that Shelly, you brought up, what is the difference between genetic counselors and those of us that have a credential or a board certification in genetics? There's a huge difference. Yeah, genetic counselors... That is a degree, they're sitting for a national board to be able to use that title, nobody can hold themselves out as a genetic counselor, except a genetic counselor who has taken their boards and has the ability and the right and the licensure even, to call themselves that. Now, what is offered to other professionals outside of genetic counselors and geneticists, is the ability to gain a certification.
0:38:54.8 ES: Credential, you can put those initials behind your name, but your base knowledge is what you're coming in with MDNP nursing, what have you, and you have an expertise that you've gained through that professional route in genetics. So there's a big difference and nobody is claiming to be a genetic counselor nor should they.
0:39:21.1 DS: Mm-hmm.
0:39:21.4 Holly: Yeah.
0:39:21.7 S?: Yeah.
0:39:23.2 TB: I'd like to interject, I think it's very important that sometimes, I've been doing this long enough that there... You hear genetic counselor, genetic counselor, and it's important to make sure that you're always correcting and saying, "No, I'm an advanced practice nurse in genetics and I'm not a genetic counselor". I... We work... I think both roles are so important and both very amazing, very intelligent and clearly very important to individually. So I think it's very important to know the difference between a genetic counselor and advanced practice nurse doing genetics. And that collaboration is key.
0:40:01.6 DS: Yeah. And what do people see as the difference in the practice? Anyone wanna chime in there?
0:40:10.5 TB: So Shelly, you and I have talked about this for years, probably like 10 years ago. And I have to tell you that interesting nurse practitioners are very directive in our approach. We can obviously diagnose, treat, manage, bill, genetic counselors can bill as well. But yeah, I feel like we're... When we talk about medical management, surgical management, we're very directive in our approach versus some genetic counselors. Now, Shelly, I have to say, Shelly, I'm sorry. I'm gonna tell, Shelly is probably as a genetic counselor is one of the most directive of practitioners, I think I've ever met as a genetic counselor, but that's I think an approach that there's a little bit of a difference. Shelly you wanna interject about that?
0:40:53.3 Shelly: No, I do agree. I think the struggle that I've had professionally, just in a moment of transparency is if somebody's coming in, when I was seeing patients and is worried about their risk for breast cancer, but they smoke two packs of cigarettes a day. That's when my non-directiveness's training as a genetic counselor kind of goes out the window right or wrong. But that is the tenant of genetic counseling training programs is you are providing the information, that's going to fit into the life's life of that person and they're gonna take that information after you've informed them and use it the way they want. And so that's the non-directiveness, I do feel like some of the programs have pulled back a little bit on that message, but it is still very much patient directed and not, "I'm the white coat, this is what you need to do, this is how you need to change your medical management". And there are quite a few genetic counselors on this call. So I think it would be nice to hear their voices too, but yeah, I have my moments where I definitely slip out of my non-directive genetic counseling training... Find that surprising, I'm sure. [chuckle]
0:42:13.5 DS: Yeah. Does anyone wanna add?
0:42:20.6 Holly: I think that one thing that you mentioned TJ is try to, try to find people to shadow or genetic counselors to shadow. I think that one-on-one personal experience can just be so invaluable.
0:42:37.0 DS: Mm-hmm.
0:42:40.3 ES: Yeah, I did that early on, I had the director of the genetic counseling program at the university hospital that I worked at, take me under her wing.
0:42:50.6 Holly: Yeah.
0:42:51.2 ES: And I learned directly from her, I sort that out and that was probably the best education I got outside of just trying to seek out articles and conferences and learning on my own before I went to city of hope. It was...
0:43:04.3 Holly: Well, and TJ's lectures, lest we forget.
0:43:09.7 ES: Yeah.
0:43:10.0 DS: Yes. Pretty amazing.
0:43:10.2 ES: For sure, but I do, I agree with Holly. I mean, it's sometimes thinking outside the box.
0:43:15.3 Holly: Yes.
0:43:16.8 ES: And seeking out people that have an expertise in this and learning from them.
0:43:20.8 DS: Yeah. So there's a chat from Ellie Franklin about sounds like you're waiting for the city of hope program because yes, that is on a set schedule. I think it kicks off in October so with the... And it is open right now for application, any suggestions while I'm waiting to brush up, get up to speed. I'm assuming any thoughts there from our esteem panel?
0:43:51.5 TB: Yeah, so I guess, I don't know if this hasn't been brought up, but I have to say, and not that Myriad is sponsoring this talk. I have to say my... The biggest, the best partnership I've had has been with Myriad, Myriad is... They have a genetics bootcamp that is fabulous and provides those now to our new APNs. Your webinars are amazing, we have Chris Freeman who just did a huge presentation with Vanessa and the amount of education to support along with the genetic counselors has been invaluable, I can't stress that enough about how much education and support has been provided and attending those foundation courses and then building, obviously you wanna take online courses and Jackson laboratory has great and you wanna take all those, but those hereditary cancer one-on-one Lynch syndrome breast, and piecing it all together is an amazing tool, it's a great partnership. I have to say that, and my team who's on here will say that as well.
0:44:53.6 DS: Yeah, no, that's good, no one reads books anymore, but has anyone seen any [laughter] actual yeah, I'm just trying to think if there's any good resources there too that could be digestible.
0:45:07.1 ES: There've been some great articles and CEU articles of that in some of the professional journals. I'm a nurse practitioner, so I'm more familiar with the nurse practitioner literature, but journal of nurse practitioners has a really excellent starting a genetic risk assessment program for NPs, the PA associations peer review journal's gonna have one coming out soon on a genetic cancer risk of PA practice.
0:45:38.5 DS: Oh, that's nice.
0:45:38.8 ES: I think, look at your professional journals, there is genetics, cancer genetics and broad genetics content throughout the International Society of Nurses and Genetics, and that's a great resource. Going back to that neuro-genetics question, I would definitely look at ISONG, that's an international group, and you've got broad genetics expertise from the membership there. Now, Tina Marie brings up a really good point about the genetic counselors that work in industry, and they are great resources at Myriad, the genetic counselors and the nurse practitioners, advanced practice nurses that are on our medical team have created a genetics handbook that has numerous opportunities to gain education and knowledge in genetics. Reach out to your regional medical specialists, they have that handbook and can share that with you.
0:46:36.5 DS: Yeah, no, that's great, and I appreciate everyone putting on the links in the chat, what I'll do is, I'll see if we can at least get the links put in at the bottom of this when it goes up on the podcast, because these are really valuable sources.
0:46:56.3 S?: And I just wanted to speak off of what Tina Marie said with Myriad resources, you have your regional medical specialist, your RMSs like Edie said, who are genetics counselors or nurses or nurse practitioners in genetics, and we have seen any approved courses, basics and oncology, genetics 101, Ellie that they can provide you or anyone else in the call, and then have other ones in different cancer focuses, depending on what your specialty is, colon and endometrial, breast, ovarian. So we would be happy to work on setting those up with you all one-on-one, I think that's a really good... Shelly's question was kind of a basics, and I think those are really good intros prior to City of Hope that you will like to have under your belt before doing any of these big courses.
0:47:55.6 Holly: I also would love to hear back from people who are wanting to learn what they find useful, and I don't know whether they can contact Tina Marie or Edie or how we can figure that out, but maybe we can make a link at the bottom of the links as to what you found useful because it is... You would just have to piece it together yourself and that seems absurd. So it's just an exploding field that should be better organized somehow, but let us know what you find helpful and what you didn't find helpful, that would be great.
0:48:39.1 DS: Yeah, and I don't know if it's obvious to our audience, but a lot of the people here talking, like Holly and Edie, myself, others, we have lectures on different throughout multiple of these courses to some degree, or help assist with the education content or planning for a lot of these. So there is a lot of cross-pollination. That's really interesting. So they're all similar but different.
0:49:09.7 ES: It's the same crowd. It's like the same crowd it seems like we're crossing over all the time.
0:49:13.5 DS: Yeah. Yeah.
0:49:14.5 S?: I think we offer a couple more podcast ideas. So in addition to inside the genome, and this might be good for anybody who wants to broaden your interest in genetics, so Genetics and Medicine from, I think that's sponsored by ACMG, American College of Medical Genetics, they have a podcast. There's also CGA the Colorectal Group of America, is that right? [0:49:39.7] ____. Yeah, the CGA has a podcast, and then there was one other one I was gonna try to remember, but those are great, I think for if you're just trying to, like I said, broaden or just getting in or someone asked about filling the gap before that course officially starts, those might be great things, especially while you're traveling.
0:50:00.1 DS: Yeah, that's a good point. Yeah.
0:50:01.7 TB: There's another one called podcast called DNA Today.
0:50:05.4 S?: Yes.
0:50:06.9 TB: That's very interesting as well.
0:50:12.0 DS: Those are all great, yeah.
0:50:13.3 ES: I saw a question or a comment in the chat talking about how do you maintain the credential or certification.
0:50:20.3 DS: I was gonna ask that too.
0:50:21.4 ES: Yeah, and Tina Marie you can address NPCC, but I'll say with NCBC, once you pass the exam, that is a life-long on certification, however, it needs to be maintained. It needs to be maintained annually. I think it's a certain number of CEUs annually, as well as kind of a renewal or a maintenance fee, but you don't have to sit and take the exam again, but you absolutely need to maintain that credential through appropriate CEU documentation.
0:50:57.2 TB: Yes, I agree.
0:50:57.8 ES: What about NPCC, Tina Marie?
0:51:00.4 TB: Yes, you have to have the minimum of the education credits, the ANCC and then PVC, it's pretty aligned, but 75 continue education credits. And you have to list them. You can't just say, "Yes, I did them." You have to list them, you have to make sure they're proved. Out of that 75, 25 have to be pharmacogenetic, you have to be have that pharmacology, and they have to be approved pharmacology actual courses, so you have to make sure you'd be mindful when is that renewal. Did I do all my... Make sure that you're attending these conferences and doing online courses or workshops to get the appropriate. Also for ANCC, we have to do one out of 8 like a professional development, whether that's... I do some precepting before COVID or I'm part of a research study, I'm doing genetics research study, something like that, or a teaching a course or presentation. You have to show personal development as well, so you have to be mindful of what is required to do your renewal. It's not great that you passed, but this is an ongoing life-long learning.
0:52:01.9 ES: And that is consistent with genetics, goodness gracious, genetics is moving so fast, you have to maintain your expertise, if you will.
0:52:11.1 TB: Exactly.
0:52:12.0 DS: Yeah, absolutely. And yeah, when Tina Marie mean... You just spoke about building a program, and did you seek out people? First of all, in your experience, do you feel like... Clearly, you're passionate about genetics. Do you feel like that's still the momentum in this country, it's someone at a program this is, "I'm passionate about this", or is it coming down almost from the leadership service lines that, "Look, we need this certification, we need somebody to do genetics," and then once you start that nighteous of a program, how are you recruiting people? Are you just trying to share your passion or are you looking for specific individuals when you recruit them?
0:52:54.0 TB: Yes. Those are good questions. So I think, obviously, I'm very passionate. I did start both genetics programs within our system, and now I'm actually the Assistant Director of all of Chicago, so we do cover it. Our physicians are amazing, Our leadership really has ascension as amazing in terms of... They do believe in genetics, they do promote us, they do allow us to share the practice within the whole Chicago line area. Our doctors are amazing. Like I said, Dr. Maganini, we have a number of doctors that continually seek out genetics for their patients, and they'll call us and want that expertise. So we're very, very fortunate that we do have that shared passion within our system. And like I said, there is... Chicago is a very competitive market, it's difficult, positions are open, even to try to get an advanced practice nurse for a year, two years, so I had to train advanced practice nurses. But I can't stress enough that, obviously, advanced practice nurses, we have our education, obviously, we have passion, but it's a collaborative, I work within, work with genetic counselors within our system, within partnership with the laboratories and locally when to refer. I can't stress enough, both are amazing professions and genetic counselors are highly intelligent, so learn when to refer to them and make sure that you're referring appropriately. But together building a program is incredible.
0:54:22.0 DS: Yeah, no, that's a great question. When do people with... On the call that are APPs with Advanced Genetics credentials, when are you or how are you utilizing genetic counselors? Specific cases? Anything you wanna discuss?
0:54:40.9 TB: For myself, anything out of my comfort zone. I obviously, I'm very strong clinically. I have an advanced practice in oncology, that's all I've ever done, and then pulse graduate, I did genetics early on, I do have a pretty strong oncology base, but any time... We do exome testing or Neuro case, I actually worked with a team of genetic counselors and together we worked on this, so I think you have to really understand you wanna do a service and not a disservice, and genetic counselors are amazing, they're great individuals that will pick apart a case and really make sure that nothing is being missed. Either through your own collaboration or through the genetic counselors with the lab, you always wanna run complex cases through, to make sure that nothing's being missed.
0:55:29.0 DS: We also have a geneticist. [laughter]
0:55:30.2 TB: Yeah, geneticist, of course.
0:55:33.5 DS: We're a limited breed, but we're out there.
0:55:36.5 TB: Very limited.
0:55:37.6 DS: Roaming the earth. [laughter] Yeah, no, good. Well, anything else? We have a... We're running up on time. This was a fantastic discussion, I'm so glad we got to capture this. We did this last year... No, I don't know what you think Edie, but I don't think we went this deep to be honest.
0:55:55.9 ES: This is great, this was awesome, Tina Marie, and Holly and everybody who participated, and it just added to this so much more than last years... Yep.
0:56:07.7 DS: Yeah, and then last years we weren't recording yet, so now this would be nice because people can go back and listen to all these acronyms until their heart is content. [chuckle] For all the organizations, and then... Yeah, I'll get some of these links for sure in the chat. Yeah, thank you so much, Tina Marie for coming out.
0:56:28.4 TB: Yeah, thank you both.
0:56:28.5 ES: Thank you.
0:56:28.7 DS: Yeah, thanks for popping on, Holly. This is a great and Edie thank you for setting this up. And shout out, April 26th, if you're not doing anything at 1:00 PM Eastern, come here, we're gonna do spring oncology conference reviews, and Shelly is helping to organize that. It should be a really, really fun. We'll cover the hot topics going on in oncology that have been presented to some of these spring conferences that we've been going to over the last few months, some of us. Well, great. Well, thanks everyone.
0:57:02.5 ES: Thank you.
0:57:02.8 DS: Until next time.