Introduction

Pharmacy is a healthcare profession that deals with all aspects of medicines, including the manufacture, supply and management of drug therapy for patients. The primary aim of the pharmacy course at the National University of Singapore (NUS) is to provide students with relevant knowledge and skills required for entry into the profession. The course focuses on laying a strong foundation in topics related to pharmaceutical sciences and pharmacy practice so that graduates can readily apply these fundamental and important principles to their future practice, be it in the community, hospital, healthcare, pharmaceutical industry or research.

Current concepts in drug therapy often attempt drug treatment of large patient populations as groups, irrespective of the potential for individual, genetically based differences in drug response (Evans & Relling, 1999). It is well recognised that most medications exhibit wide inter-patient variability in their efficacy and toxicity. Pharmacogenetics, the study of how the genetic variations affect drug response in individual patients (Evans & McLeod, 2003), emphasises the identification of the network of genes that governs drug response in individual patients using genome-wide approaches (Evans & Johnson, 2001). All of these will lead to novel approaches in drug discovery, individualised medication dosage and new insights into disease susceptibility and prevention (Milos & Seymour, 2004). Pharmacogenetics and pharmacogenomics, both interchangeable, may help focus effective therapy on smaller patient sub-populations which, despite demonstrating the same disease phenotype, are characterised by distinct genetic profiles.

Due to the importance of pharmacogenetics, the great potential application of pharmacogenetics in future medicine and the vital role of pharmacists in healthcare, pharmacy students must be educated with adequate knowledge in pharmacogenetics (Frueh & Gurwitz, 2004). In NUS, pharmacogenetics is incorporated into other modules (e.g. pharmacokinetics and toxicokinetics). In this paper, I will highlight my experience teaching pharamacogenetics at NUS, emphasising on teaching topics, approaches, evaluation, emerging problems and possible solutions.

My teaching of pharmacogenetics for pharmacy students at NUS

In AY 2004/2005, pharmacogenetics is incorporated into three modules, namely, PR3106 “Pharmacokinetics and Drug Disposition”, PR4207 “Applied Pharmacokinetics and Toxicokinetics” and PR5113 “Clinical Pharmacokinetics and Therapeutic Drug Monitoring”, to cater to students at both the undergraduate and postgraduate levels with a basic knowledge in human genetics and pharmacology.

Teaching approaches involved for pharmacogenetics

The application and combination of the major teaching methods I use may vary depending on the module and students (Table 1). An IVLE website is also set up for each module and a forum is used for discussion on pharmacogenetic topics. The lecturer will monitor the forum and provide proper guidance regularly.

Table 1. Major teaching methods for pharmacogenetics.

In addition, I have also provided a number of useful websites, journals and books to students. Many key points in my lecture notes are extracted from these materials and students are encouraged to read them thoroughly if time allows.

Problems and possible solutions in my teaching of pharmacogenetics

Efficiency of my teaching methods

Choosing the proper teaching methods for a complex subject like pharmacogenetics is important. Student feedback indicate that the methods I used (Table 1) are basically and technically efficient, although there are some concerns (Table 2).

Table 2. Major teaching methods for pharmacogenetics.

There is debate about what the various complexities and implications of teaching pharmacogenetics are. On the one hand, pharmacogenetics contains multiple fundamental scientific concepts that are really complex, but its education for pharmacists must focus on the application of such complex science in clinical settings. On the other hand, gaining key pharmacogenetic knowledge in pharmacists will benefit patients to some extent by turning this knowledge into practice and eventually the well-being of patients.

There is a growing expansion of pharmacogenetic knowledge with the advent of Human Genome Project. Thus, there is a need to incorporate this increasingly complex body of knowledge to the standard curriculum of pharmacy schools. Some additional topics in pharmacogenetics are of importance, but, due to time constraints, not included in my classes. These important topics should be included if a new module on pharmacogenetics is launched for pharmacy students at NUS.

However, there is still considerable space for me to improve and a flexible attitude and mindset are needed to better my teaching. I will also need to consider how my classes need to be dovetailed with other relevant topics such as pharmacotherapy and toxicology.

Problems facing the teaching of pharmacogenetics in the faculty

In pharmacy education, pharmacogenetics may receive less attention due to several reasons (Sansgiry, 2004) including a) genetics and relevant disciplines are not considered as a priority for pharmacists; b) pharmacogenetics is a complex and large teaching area with uncertain coverage and teaching outcomes; c) long timescales will be required for both teachers and students; d) students may lack interest in this subject; e) there is already overcrowding of the curriculum; and f) shortage of adequately-trained teaching faculty. The last issue may be resolved when faculty members integrate pharmacogenetics into other courses, provided that they understand the relationship and relevance of pharmacogenetics to the subject in question.

Pharmacogenetics is becoming a core subject in some countries (Brock, Faulkner, Williams & Smith, 2002) where pharmacists who play a key role in drug therapy and patient care (Sansgiry, 2004) are greatly valued. I suggest that an independent module on pharmacogenetics for pharmacy students be set up in the near future to help students construct comprehensive knowledge needed to achieve safe and optimal drug therapy in their future careers. For working pharmacists in Singapore and other East-South Asian countries, a continuing education or a special programme in pharmacogenetics may be set up to assist them in updating their pharmacogenetic knowledge.

References

Brock, T.P., Faulkner, C.M., Williams, D.M. & Smith, S.R. (2002). ‘Continuing-education Programs in Pharmacogenomics for Pharmacists’, Am J Health Sys Pharm. Vol. 59, pp. 722–5.

Evans, W.E. & Johnson, J.A. (2001). ‘Pharmacogenomics: the Inherited Basis for Interindividual Differences in Drug Response’, Annu Rev Genom Human Genet. Vol. 2, pp. 9–39.

Evans, W.E. & McLeod, H.L. (2003). ‘Pharmacogenomics—Drug Disposition, Drug Targets, and Side Effects’, N Engl J Med. Vol. 348, pp. 538–549.

Evans, W.E. & Relling, M.V. (1999). ‘Pharmacogenomics: Translating Functional Genomics into Rational Therapeutics’, Science. Vol. 286, No. 5439, pp. 487–491.

Frueh, F.W. & Gurwitz, D. (2004). ‘From Pharmacogenetics to Personalized Medicine: a Vital Need for Educating Health Professionals and the Community’, Pharmacogenomics. Vol. 5, pp. 571–9.

Milos, P.M. & Seymour, A.B. (2004). ‘Emerging Strategies and Applications of Pharmacogenomics’, Hum Genomics. Vol. 1, pp. 444–55.

Sansgiry, S.S. (2004). ‘The Future of Pharmacy Education: Back to Which Basics?’ Pharmacotherapy. Vol. 4, pp. 688–9; 691–3.