Precision medicine enables more effective preventive, diagnostic and therapeutic health actions. But, like any incorporation of new knowledge and technological innovations, it brings with it great challenges that fall on health workers, the field of professional training being one of the most prominent. Just a month ago, the extraordinary plenary session of the Interterritorial Council of the National Health System (SNS) agreed to the distribution of 40 million euros among all the autonomies to consolidate precision medicine. This measure is part of the 5-P Plan (Personalized, Predictive, Preventive, Participatory and Population) and the intention of the department headed by Carolina Darias is to update and expand the infrastructure of health centers to consolidate a type of medicine that seeks to promote the genetic diagnosis of hereditary diseases and the genomic diagnosis of cancer.
The situation that the country is going through in this matter can be summed up in the lack of professional training of health workers. The root of the problem arises in medical schools, where future professionals are faced with a situation in which they are not provided with the appropriate instruments in training tasks. The current study plans are divided by subjects and departments, which, in the words of the experts, are still “very traditional”. “In Spain, clinics are mini specialties. There are no clinics based on the needs of a general practitioner who has to do a specialty,” explains Milagros García Barbero, outgoing president of SEDEM (Spanish Society of Medical Education).
Faced with this problem, many professionals are forced to resort to individual initiatives and self-training tasks. “At the moment, to have knowledge of precision medicine, the professional has to train on their own or in the hospitals that are practicing the services that have incorporated it. But it is still at a very incipient level because it requires a large investment in infrastructures and personnel. Honestly, I believe that there is neither political nor academic will to change the situation”, affirms García Barbero.
One of the three pillars of the plan is the promotion of the genetic diagnosis of hereditary diseases. However, Spain is the only country in Europe that does not recognize the subject of clinical genetics in the faculties. Faced with this situation, Spanish geneticists have been forced to complement their training in other ways, which is why they are currently biologists specialized in genetics, pharmacists or even doctors.
Another of the questions that arise among specialists has to do with what is going to be done with the professionals who are already working. What is going to be done with the training of professionals in the field of digital health is another question, since technological management is one of the most important pillars of precision medicine. Therefore, institutions need to develop strategies in genomics, digital health and bioethics so that the medicine of the future is implemented in the health system, while health professionals need tools to help them in the data translation process. .
Oncology is the area where precision medicine is most deployed, since it is where there are more options and more medical knowledge. However, its use can also be extended to other scenarios, such as neuroscience. “We are attacking the problem from different fronts at the same time. The portfolio of services is open, but the professional who is going to receive this information has to interpret it and connect it with a clinical decision. If we are still not clear about what we are going to do, we should not “We can know if that is going to be enough or not. Are we going to aspire to all professionals in all specialties or are we going to start with those where it has the greatest impact? If we want this money to be efficient, we need a teaching program,” explains Adrián Llenera, president of the Spanish Society of Pharmacogenetics and Pharmacogenomics (SEFF).
Barely six months ago, the Roche Institute Foundation presented a document prepared by a multidisciplinary group of experts that analyzes in depth the skills that health professionals should acquire in the context of new scientific advances. The actions have been carried out in two work phases: the first one seeks to identify the key elements and the training needs of professionals in this field; while phase two would seek to define their competencies and level of training. As this medium has learned, different actors from the Administration have contacted the Roche Institute Foundation to find out more details about the plan.
In said document, they have identified and defined six professional profiles to which this proposal of competences is directed, depending on the field where they carry out their professional activity: care, laboratory, digital health, community health, research and management and planning. In addition, a classification by progressive levels of training is proposed that it would be advisable to acquire for each competence according to the professional profile.
Training is a fundamental pillar to implement progress, so a continuous learning environment must be created and adapted to the current and future context to respond to the demands of the population. “The training process is something very progressive that requires time. Therefore, it is a difficult process because it means a change of mentality. There is new information, new skills and a change of attitudes. The first thing we need is the tools and the first problem “What we have is to make the implementation reach the health service. We have had it at the research level, but it has to reach the service in a different way,” explains Llerena.
Situation by CCAA
Another of the challenges that precision medicine will have to face will be to see what the needs of each of the different CCAAs are. Catalonia already presented its Precision Medicine Program for the area of oncology at the end of 2021, which places it as the most advanced Spanish territory in this matter. Other autonomies, such as Valencia, Andalusia, Madrid, Castilla y León or Cantabria have already established a strategic plan to promote precision medicine and in the Canary Islands, they have recently launched a training plan for their professionals. Other territories such as Aragon are developing their plan, while the Basque Country has a personalized medicine department.
“You have to see what the needs of each CCAA are and the point at which they are. They are all mobilizing and have some initiative. The most mature is Catalonia because they already have a financing plan for two years. This budget will It will help progress and now they will be more ambitious”, emphasizes Teresa Ramos, head of Personalized Medicine at Roche Farma in Spain.
In the opinion of the experts in this matter, at the regional level precision medicine will have to pursue the achievement of an equitable plan between the different autonomies because, in the event that this objective is not pursued, it may happen that in some hospitals some biomarkers and in others not. “We need an implementation plan so as not to fall into the situation that each CCAA decides its own training, since we are talking about standardized knowledge worldwide. If this is not done in this way, it can lead to inequity in the National Health System “We need a training plan. I am more interested in what is going to be done with that money than the amount of money itself. There has to be a professional training plan to change and be able to advance”, concludes Llerena.