Medical Genetics and Genomics Residency Program

Resident education is a priority for the University of Miami/Jackson Health System Graduate Medical Education Program. During the Medical Genetics and Genomics Residency, Thursday mornings are protected education time for residents. The morning starts with metabolic rounds at 8 a.m., followed by didactics or board review at 8:30 a.m. At 9:30 a.m. we have post-clinic rounds and discussion of potential candidates for the Undiagnosed Diseases Network clinic until 11:30 a.m. Residents are relieved of all clinical duties in order to attend and actively participate in these activities. In addition, the faculty provides smaller group didactic sessions on a daily/weekly basis depending on the rotation and specialty. Daily one-on-one teaching is also stressed, especially when on call.

Grand rounds occur four times a year and case conferences occur once a month with postgraduate students from the Master of Science in Genomic Medicine Program. The department enjoys a very active visiting professor lecture program, with many prominent speakers featured throughout the year. We are lucky to have basic scientists and a well-rounded research center.

In each genetics rotation, the resident observes faculty members and genetic counselors during patient evaluations. These include observing the history, physical examination, presentation of diagnosis, communicating impression and plan-of-care to the family, and reviewing written documentation detailing the clinical visit. At the discretion of the attending physician, the resident is encouraged to perform the history and physical examination on their own, directly present their findings to the attending who helps formulate the proposed diagnostic and management plans and re-examine the patient and share counseling information with the family. Based on direct observation by the attending physician, the resident is encouraged to see more patients independently. The residents are also encouraged to see a few patients with the genetic counselor to learn how to obtain detailed family history and to observe counseling skills. With increasing experience, the resident is expected to play a more active role in presenting appropriate differential diagnosis, a diagnostic plan to the attending and to provide genetic counseling for the family, with the faculty member in attendance. Although residents assume a progressively more central role in patient evaluations over time, an attending geneticist directly supervises the trainee, evaluating every patient and signing the clinic note.

For an inpatient consultation, early in training, the resident typically observes the attending perform patient assessment and family counseling. As the resident gains increasing competence in diagnosis and counseling, the attending faculty member allows the resident greater independence, though they will continue to directly supervise all aspects of the consultation. In the case of a metabolic patient who becomes critically ill, the resident and attending work closely together. The on-call physician carries a cellphone to ensure direct supervision and provide immediate availability and involvement in every case. In the case that the on-call physician cannot be reached, the residents know to call the program director or associate program director.

With increasing experience, the resident is expected to play a more active role in presenting appropriate differential diagnosis and diagnostic plans to the attending and to provide genetic counseling for the family, with the faculty member in attendance. By the second half of the second year, residents will be expected to examine and evaluate both inpatients and outpatients with minimal input from attending physicians. The attending will review cases with residents and will check key findings, but the resident will essentially serve as the consultant, including communicating with the referring physician. Although residents assume a progressively more central role in patient evaluations over time, an attending geneticist directly supervises the trainee, evaluating every patient and signing the clinic note.