# Presentation: 100785

## Genomic Competencies 

**For the **
**Public Health Workforce**

**Notes:**
Explain your professional role and why you decided this project was needed.
Your role in the creation of this document.

## Workforce CompetenciesforEffective Practice of Public Health

- Skills
- Knowledge
- Attitudes

**Notes:**
Define competencies. Competencies are skills, knowledge, and attitudes necessary for the effective practice of public health.  They are cross-cutting and discipline specific.  They are also used to develop curriculum and content for education and training programs.  They are also used to develop goals and evaluation templates.
**What do you want an individual to be able to do.**

Most of the people in the current system trained under a knowledge based system rather than competency based.

## Why Genomics

- Now ?

**Notes:**
This is meant to be a transition slide.  This was the first step for the Team Leaders when recruiting their team members.

## Prevention of Disease and Disability

- Is a Major Goal of Public Health
- -----
- Current Programs
- Target
- Modifiable Lifestyle & Environmental Factors

- “**One Size Fits All”**
***? Effectiveness***

**Notes:**
This is the big why now.  Public health has had limited effectiveness in reducing health problems like obesity, diabetes, heart disease, ....  Targeted prevention might be more successful – we don’t know.

*Mapping & Sequencing of ALL Human Genes*

- Understand Biological Basis of Diseases
- Predict Disease Susceptibility Before Symptoms
- Interventions Targeted to Disease Biology
- Pharmacotheraphy

- Individualized Prevention – *“Individually Sized”*

**Notes:**
Currently we treat most diseases by trying to reduce the symptoms.  Often we don’t understand the biological basis.  By finding the genes involved and then determining the proteins they code for, we will learn the biological basis of diseases.  It may then be possible to target the cause, not the symptom.  It might also be possible to slow down or prevent the onset of adult diseases if we understood the biological basis.

Pharmacogenomics realizes that we react different to medications because of metabolizing enzymes, etc. and that is controlled by genes.

## To be proactive!

- Technology will produce inexpensive and efficacious genomic risk tests
- The Future:  Environmental Health evaluating relative risk to toxicants for a community
- The Future:  Health Educators directing their focused messages to the high risk

## Genetics Plays a Role in Most Disease(small in some, large in others)

- Heart Disease
- Cancer
- Stroke
- COPD
*Injury*
- Pneumonia / Influenza
- Diabetes
- Suicide
- Kidney Disease
- Chronic Liver Disease

- Heart Disease
- Stroke
- Pneumonia
- HIV / AIDS
- COPD
- Diarrhea
- Perinatal
- Tuberculosis
- Trachea/bronchus/lung cancer
*Traffic Accidents*

**CDC**

**WHO**

**Notes:**
There are now published reports which can show that genes play a role in 9 of the CDC’s leading 10 causes of death and 9 of the WHO’s ten leading causes of death.
Genetics can now be shown to play a role in all but Injury in the CDC list and Traffic Accidents in the WHO list.  And even those are possibilities if you considered reflexes and dexterity, etc.
Currently in public health we look at environmental and lifestyle influences, but are we trained to consider the genetic factors.

## Why CDC ? / Why Now ?

- Public Health Workforce Initiative
*Opportunities while competencies being developed*

**Notes:**
The rapid advances in human genetics – the mapping of all human genes – are beginning to change the clinical diagnosis and treatment possibilities for chronic diseases such as cancer and diabetes.  Consider BRCA 1⁄2 and breast cancer or colon cancer.  Public health workers will be asked to incorporate genetic information into public health programs.  An understanding of genetics as it pertains to each public health discipline will be essential to develop effective programs that benefit and protect the public.

## Joint Effort

- Office of Genetics and Disease Prevention
- Public Health Practice Program Office
- Public Health Practitioners in the Field

## Team Leaders

- Laboratory		Lou Turner
- Administration		Deborah Klein-Walker
- Clinicians		Kristine Gebbie / Mary 					  Ellen Mortensen
- Health Educators	Karen Greendale
- Environmentalist	Robert Marino
- Epidemiologist		Peter D. Rumm

**Notes:**
I would show quickly.  The idea with this slide and the next two is to show the number of people and broad representation in this project.

## Team Members

| Administration | Clinician | Health Educator | Laboratory | Environmental | Epidemiology |
| --- | --- | --- | --- | --- | --- |
| Robert Jones | Elizabeth Tilson | Karina Boehm | Eric Blank | Susan Metcalf | Robert Teclaw |
| Kathy Peppe | Alan Gutmacher | Kathleen Minor | Frances Downes | Luann White | Jennifer Woodward |
| Jean Chabut | Theresa Long | Kathy Vincent | Katherine Kelly | Elaine Krueger | Robert Rolfs |
| Joe Kimbrell |  | Andy Faucett | Scott Zimmerman | Harold Bengsch | Richard Hopkins |
| Vaughn Upshaw |  |  | Steve Hinricks | Luanne Williams | Tal Holmes |
| Michele Puryear |  |  | Jan Friedman | Bob Fineman |  |
|  |  |  |  | Jesse Huang |  |

**Notes:**
Again the numbers are what’s important.  You might want to highlight the lab people and/or the epidemiology members for this group.

## CDC Support

**OGDP**
- Stephen Margolis
- Kim Geissman
- Tim Baker
- Ruth Thornburg
- Betsy Gettig

**PHPPO**
- Andy Faucett
- Joe Boone
- Ira Lubin
- Eunice Rosner
- Bin Chen
- Karen Mulawski
- Ana Stankovic
- Laurina Williams

**Facilitators**
- Stephanie Bailey
- Morry Fiddler
- Kevin “Doc” Klein

**Notes:**
Here I would explain that the CDC’s role was support and organization.  The CDC did not write these competencies.

## The Process

- March 2000 – Team Leaders Meet
- August 2000 – Teams Meet and Draft 6 Sets
- Drafts Revised & Combined – Email & Conference Call
- March 2001 – Team Leaders Meet – Edit & Cut – Format
- April 2001 – Outside Review by 60+ Associates of Team 	Members
- May 2001 – Comments Combined – Team Leaders Review 	by Email
- June 2001 – Document Released on OGDP Web Site

***Team Leaders & Members Kept Involved***
***Ownership***

**Notes:**
Here I would outline the process.  The key message is that we did our best to keep the Team leaders and members involved in the whole process.  This was not one of those times that a group met and then months later a document was produced.  This was a joint process the entire way.

The result was that the members could OWN this project and feel comfortable supporting it in the future.

## Current Design

- May 2001 – Team Leaders Decide
- Combine Similar Competencies
- Concentrate on Doable – 5 year plan

- Three Categories / Eight Lists
- I. All Public Health Workers
- II. Over-Arching for Professional Positions
- III. Six Specific to Specialty - Concentration

**Notes:**
Two points here – first how we decided to combine competencies and cut to the essential.  There was originally a much longer list, but the group wanted a list that was possible and realistic.  This is the list for now.  It will change in the future as some things become incorporated and new discoveries are made.

Second – the format of a very short list for everyone from the receptionist up.  A list for anyone with professional training.  And then a list specific to some ones primary job responsibility.

A laboratory director would need to incorporate the short list, the professional list and the laboratory list.

## Working Web Site for Project

- Home
- History
- Staff
- Teams
- Resources
- Work in Progress

## How To Use This ToolNot a “Gold” Standard

- Discussion Point
- As
- Position Specific
- Competencies Written or Reviewed

**Notes:**
The goal of the group was not to tell others what to do, but to provide a list that could be incorporated over time.  This is a place to begin the discussion as academic, training, and practice programs begin to create and edit their competencies, program and individual goals, and evaluation process.

## Three Basic for All Public Health

- Demonstrate basic **knowledge **of the **role **that **genomics **has in the development of **disease**
- Identify the **limits **of his/her **genomic expertise**
- Make appropriate **referrals **to those with **more genomic expertise**

**Notes:**
This list is for every one in public health.  The key words are in bold.  In reality every one should meet these goals now.

## Eight for All Professionals

- Apply the basic public health sciences ... utilizing the 	**genomic vocabulary** ...
- Identify **ethical **and **medical limitations **...
- Maintain **knowledge **on the **development **of **genetic ****	****advances**
- Identify the **role **of cultural, social, behavioral, 	environmental and **genetic **factors in ... **disease**
- Participate in **strategic policy planning** ...
**Collaborate **... **to **solve **genomic **related **problems**
- Participate in the **evaluation **of ... **genomic services ****	**in public health
- Develop **protocols **to insure **informed consent **and 	.. **protection**

**Notes:**
Depending on time, I would quickly show these and then concentrate on the lab slides to follow.

## List For Each Specialty

- Leaders / Administrators – 9
- Clinicians – 5
- Epidemiology / Data Management – 9
- Health Educators – 7
- Laboratory – 7
- Environmental - 6

**Notes:**
I would highlight the range of difference for the different groups.  Also talk about the reality that many people in public health wear more than one hat.  As lab director you are also an administrator.

## Where We Go From Here!

- Convert competencies to curricula and then to multiple training modalities
- Continue to get buy-in from public health community
- Assist others in creating competencies
- Work with professional organizations to incorporate genomic competencies

## Genomic Competencieson the Webwww.cdc.gov/genetics/default.htm

- Questions / Comments
- Andy Faucett
- _[aif3@cdc.gov](mailto:aif3@cdc.gov)_