Good morning, good afternoon, good evening, wherever you are, I hope that everyone is healthy and active and staying as positive as we can. I am Steve Moore, and I'm here to chat with you today about clinical laboratory-based career paths, and I wanted to thank the organizers for giving me this opportunity. I'm an Associate Professor of Molecular and Medical Genetics in the Department of Molecular and Medical Genetics, and the Medical Director for Cytogenetics and Molecular Genetics in the Knight Diagnostic Laboratories, all at Oregon Health and Science University in Portland. I've circled a couple of the letters up here, because I think that they're important to spell out for you. So the DABMGG is a Diplomate of the American Board of Medical Genetics and Genomics, and FACMG is a Fellow of the American College of Medical Genetics and Genomics. So the DABMGG requires that one matriculate in an approved training program, and at the end of the training program, take a board's exam, actually two board's exams, including a general exam, a general medical genetics exam, and then also a specialty exam. And for laboratory-based career paths, that would be the Laboratory Genetics and Genomics exam, and the FACMG is really not important in the talk right now. So nothing to disclose. We're going to get into what the path from the Doctoral Degree to Clinical Lab Director looks like, and I just wanted to show you where the DABMGG fellowships sit. They are recognized by the American Board of Medical Specialties, and so it's right here. If we expand that out, you'll see this is a specialty here, and the primary specialty certificates include Clinical Biochemical Genetics, this is a laboratory-based, also Clinical Genetics and Genomics, and this is for clinicians, and then Laboratory Genetics and Genomics, and this is my focus, and so I'll have most experience here and be able to chat with you about that today, and then some specialties within those, and then I've just put the Family Medicine specialty here for comparison. So the path includes, to the Clinical Lab Director, includes this training, and the training can either be Clinical Biochemical Genetics or Laboratory Genetics and Genomics, as I mentioned, but my focus is on the LGG. So a diplomate certified in Laboratory Genetics and Genomics demonstrates competence in directing and interpreting both clinical cytogenetics and molecular genetics analyses relevant to the diagnosis and management of human genetic disease. This specialist also acts as a consultant in laboratory diagnoses for a broad range of molecular and chromosomal-based disorders, including both inherited and acquired conditions. So generally speaking, individuals that apply to our fellowship program have some postdoctoral experience. It's not required, but it's certainly helpful to have had some additional experience beyond the research training that most people are getting in their graduate studies. The clinical background is also a plus, and so some folks actually do some clinical work in a more clinical lab after they've come out of graduate school or during graduate school or even as an undergraduate if you've been a tech in a lab or something like that. It's just really helpful because there is a real difference between the research environment and the clinical environment. A focus on genetics in graduate school can be really helpful as well, certainly in terms of what courses you might be required to take, but also just having that foundation is quite helpful during the fellowship. So the Laboratory Genetics and Genomics Fellowship is a two-year training program, and in some places it's a three-year program. But we're really moving toward having everyone be a two-year program. Previously it was separated out into the clinical cytogenetics and molecular genetics paths where they were two years each or three years combined. But those separate paths no longer exist, and now there's just a single unified path called the BLGT, and it's been phased in over the last five years. So at our own institution, I failed to mention I'm the program director here for our fellowship and then also the technical director for our fellowship training program. So to fulfill all the requirements of the fellowship, we've put together a schedule, and I'm just going to give you a flavor of what it looks like for a fellow, kind of a day in the life for a fellow. So initially they would come into the lab July 1st, and they have two weeks of orientation. And then they'll spend three and a half months in the cytogenetics lab doing chromosomal microarray prenatal, including prenatal, and then also high-resolution chromosomes, moving into oncology after that, which also includes microarray bone marrow chromosome analysis of fish for three months, and then into the molecular lab where they'll do heme and next generation sequencing and qPCR for 15-17 translocation or PMRR fusion, BCR-ABO, et cetera. And then NGS exome analysis and panels, and this is for constitutional disorders. And so that really comprises their first year and brings them all the way out to the end of June, and they've been in the lab. And also there's opportunities and really requirements that they spend time in the clinic. And so this is supervised clinic time where they actually have opportunities to interface not only with the clinicians, but with patients. And that tends to be a really popular and a really special time for the fellows. And then at the end of training in week 20, there's actually a four-month period that's left for concentration. And this allows the fellow to go back and revisit any areas where they feel like they may need a little more work or areas where they really want to focus. There's also a didactic portion throughout, and it includes lab meetings and grand rounds, and then actually some courses that are taught by the faculty here, in addition to some other things. Case logs are a requirement, but any more case logs just tend to be a really useful tool to make sure that the fellows are getting the best experience and that the lab is having the opportunity to provide the fellow a very broad and expansive experience. And so they get to sort of touch all different types of tests. And their role in those tests really run the gamut from seeing the test into the lab all the way through the sign out. And so I think it's a really good opportunity and a really good tool to fill that out and to make sure that the fellow is getting a really rich experience. So what do I do, and others like me, I guess, on a daily basis? A lot of what we do is review laboratory data and write medical reports. So these are the reports that end up in the patient records. And we have results from, say, chromosome studies that have had additional fish and maybe microarray studies, and we synthesize all that data together and then produce a report within the context of the clinical findings of the patient, and then hopefully that's something that can be actionable or helps. And then that leads us sort of to the next piece. We respond to inquiries about our results and the testing modalities. And there it's been a real wonderful experience to have the interface that we do with our clinician colleagues and really be a part of the clinical team. And they call us up about reports that we've written, maybe what the next step is for that particular patient in terms of testing, what other types of tests could we do next time in lieu of the tests that we've run, et cetera. And I put down what our mix of cases were here. We're 70% oncology, 30% prenatal, but we've trained numerous fellows over the years, and they still get what they need even with a mix like this. So if you're looking at joining a lab for a fellowship and they happen to be heavy in oncology and not as much in prenatal, say, or the other way around, you'll still be able to get to the mix. And again, that's what the logbook really helps guide. So in addition to having this consultant role, we also teach. We're all faculty at the institution here. And then we train, and we train graduate students. But more often, we're training residents and fellows, pathology residents and fellows in the lab. And this is a lot of fun. We develop new tests. And so we're always bringing up new tests. We're validating new tests. We're searching the literature for what might be the next new modality to use or the next way that we can develop something that allows us to very specifically treat a particular patient's cancer. Within that context, we're also creating budgets for FTE, budgets for lab equipment, budgets around new tests that we're developing, and we do have to be responsible for generating return on investment types of information around developing new tests. And then finally, last but not least here, is managing laboratory staff. And this is certainly one of the joys of the job, is that you get to work with a ton of really smart, dedicated, creative, kind people that are very interested in quality patient care. So to work within that group and to manage that group moving forward, especially with some of the uncertainty that we have now around genetic testing in general and the way genetics testing is going, it's a very interesting, unique time to be a part of this field. And frankly, it's a lot of fun. So I'm going to leave off there so I don't take all of your time. And the organizers have my contact details. I'm sure they're listed in the program. And so please shoot me any questions you have, and I will respond ASAP. And I look forward to seeing you all in person at the next meeting. But I really do appreciate you taking the time to listen to me yammer on today about something I really enjoy, and that is what I do. So thanks again, and I hope everyone stays well and stays healthy, stays positive. Goodbye.

clinical laboratory-based career paths

certifications

Laboratory Genetics and Genomics exam

Clinical Lab Director

genetic testing