BEING DIFFERENT AND BELONGING - Alejandra Bernal

“Everybody says it is going to be so difficult! Will I be able to keep up with homework? What if I don’t make any friends? It is a big place; I am worried that I will get lost….”.

“It will be fine, pequeña mía, it is normal to be anxious before starting middle school. I am also feeling a little nervous.” As I tried to reassure my daughter, I wondered how I would fit in as a new genetic counseling student at Pitt. Would I be able to achieve schoolwork- family balance? What challenges would I face as a non-traditional applicant and the only parent in my cohort? How many candles should I offer to all holy saints, so nobody gets sick for 2 years?

Starting the summer before classes, I began to know and connect with my new tribe. Some are simultaneously enrolled in Genetic Counseling and Public Health programs, a few live with their partners, and many hold part time jobs. We all seem to have different priorities and backgrounds: but I can relate to each one at some level. Our values and aspirations bridge our differences. Whether juggling multiple responsibilities or facing the anticipation of clinical rotations, we have found solidarity in our shared journey. Anyone can ask for help, and one of us will take the time to explain a concept or post that hard-to-find article. We don’t always agree or hang out together, but we celebrate birthdays, enjoy some activities outside campus (like apple picking, playing Secret Santa or getting boba tea), work hard, and try to keep a positive attitude. My assigned “buddy” and the other second years have provided invaluable guidance, while virtual peer groups for minority students offer insights and motivation.

The faculty has been very welcoming from the beginning. When I mentioned I had a disability, the program director encouraged me to apply to the Disability Resources and Services office (DRS). I followed her advice, the university quickly processed the application, and the requested accommodations have been fulfilled. All professors have been very understanding, providing support and confidentiality. I chose to write about my experiences, hoping to remind prospective and current GC students with disabilities to seek the services they need. Just a recommendation: start collecting the necessary documentation to apply as soon as you can. Getting an official diagnosis can take time.

Grad school is difficult, as was predicted. There are never enough hours to do everything that you would like to do. It requires a lot of planning and flexibility, and often, things don’t go as you expected (we all got COVID in January, where were those saints?). Having less time to spend with my family has been hard, but they help as much as they can. For example, explaining genetic concepts at a 6th grade level is easier when you can practice with an actual middle schooler. My teenage son is now my personal IT helpline, and my husband has discovered the fun of cooking for picky eaters. When I need to stay home, because the kids are sick or their schools are closed, I am able to attend most classes virtually. It is also helpful that the majority of lectures at Pitt are recorded, classmates share notes (they are the best!), and professors are always willing to answer questions. Studying while being a parent is not easy, I am lucky to have the support of the program, family and friends.

I did get lost during the first weeks of the semester, even more times than my child did at her new school (parking in Oakland is an adventure). However, the warmth and help I receive from my classmates and the faculty has eased my initial worries. Yes, I am not your average GC student, but I am not defined by a single aspect of my identity. Every facet and intersection shapes who I am, gives me grit, creativity, keeps me grounded when things get hectic and adds to the professional I want to be. I can connect and belong to this cohort of unique individuals with their own experiences, strengths, and perspectives. I also feel that I belong to this program, that is trying to promote equal access and opportunities.
To all students, regardless of where you match, I hope you also find a sense of belonging.

Learning to Cope with the Inevitable: Imposter Syndrome - Jennifer Reif

It’s 1 am, the William and Mary library is deserted. I have been staring at genetic counseling student bios for hours and my eyes are exhausted, but I can’t stop reading, comparing, trying to convince myself I have a chance. I remember turning to my best friend and whispering “these people are incredible, why am I even applying?”

When I got my first interview, I was shocked. I kept telling myself, “If I get in, then I will believe I deserve this.” Two months later, I matched to Pitt, but guess what? I felt just as undeserving as ever. 

This undeserving feeling is known as imposter syndrome. It is the anxiety and insecurity that you are out of place, the sinking feeling that you don’t belong. It absolutely sucks, and even when deep down you know it isn’t true, the fear and shame can be exhausting and overwhelming.

Unfortunately, the very system we use to enter genetic counseling can breed insecurity and imposter syndrome. It is only understandable that such a competitive system would provoke anxiety and self-doubt. BUT, you deserve your spot. You worked hard to be here, and your program leadership and the rest of your cohort fully believe in you. You should believe in yourself too.

Trust me, I know these feelings can be heavy and, consequently, it is important to learn to combat them. In reality, it wasn’t until actually coming to Pitt that I began to feel power over my imposter syndrome, and let's be honest, it is still something I am working on. Even though I am still on my journey towards self-acceptance, I thought it may be helpful to share some of the things I have learned along the way, with the people I have learned it with.

1. Distract Yourself/Try Something New (this is a great school coping skill in general):

Some fun things I have found to do in Pittsburgh during the school year –

Fall: baseball games, Barcadia, Friendsgiving

Winter: Secret Santa, Putt Shack (mini golf), ice skating downtown

Spring: exploring the restaurants in Pittsburgh (Rita’s, City Kitchen, Mercurio’s

2. Remind yourself that you believe everyone else in your cohort deserves to be here: they actually think the same thing about you!

Picture of everyone who deserves to be here:

3. Give yourself grace: you have put in immense effort to be here:

(or in our cohort: give yourself time with Grace - featured below)

4. SELF CARE, SELF CARE, SELF CARE

Self-care looks different for everyone but is a crucial means to build a positive relationship with yourself.  Shower, nap, go to the gym, listen to music, grab a snack: try giving yourself some peace and love to combat the anxious thoughts.

5. Go to your cohort for support: they know what you are going through better than anyone else :) Love you guys!

10 Lessons I’ve Learned So Far in Graduate School - Gabrielle Gauldin

Starting graduate school can introduce a whirlwind of emotions, including nervousness, excitement, fear, and everything in between. It signifies a significant milestone of achievement and personal growth. Leading up to the start of grad school, we often form expectations about what our journey may look like, and here, I share ten things that I’ve learned since starting in the genetic counseling program in the fall.

1. Your cohort will become family

○    Leaving home might feel challenging, but the people you expected to be mere classmates will quickly become your #1 support system. This unique bond we formed as a cohort not only eased the transition moving to a new state and starting graduate school but has made it truly special.

2. Your perspectives will be challenged, and this is a good thing.

○  Your perspectives will undoubtedly be challenged in this time of change, and that's healthy. Genetic counseling is a field that is constantly evolving. Embrace the opportunity to learn from peers, professors, and patients, knowing that your views will grow along the way.

3. Time management may look different.

○  Effective time management is a crucial skill in graduate school, and it's never too late to develop good habits. Graduate school may require a different approach than undergrad, with added responsibilities both in and out of the classroom. Learning to prioritize according to your needs and lifestyle is key. It’s equally as important to recognize when to step back and take a break.

4. Experiencing a sense of identity loss may happen.

○  During my undergraduate years, I had multiple outlets and activities that helped to shape my identity. However, upon transitioning to grad school, I felt disconnected from that sense of self I had created over the previous four years. It's important to take the time to rediscover what brings fulfillment and restores that sense of identity for you.

5. A positive attitude is essential.

○  While every day might not be easy, knowing you're actively pursuing your goals can be a powerful motivator. Remember, you’re one step closer to becoming a genetic counselor.

6. It’s a time to collaborate.

○  You're no longer competing for spots in the program; instead, you're working alongside future colleagues. Grad school is a time to embrace the opportunity to learn from and support each other.

7. Listen to advice, but don’t forget to trust yourself.

○  While guidance from others can be helpful, remember that ultimately, you know what's best for you.   

8. Just because you’re a grad student doesn’t mean you can’t get involved in campus life.

○  When applying to genetic counseling programs, I really valued schools that had a vibrant undergraduate community. Being a grad student doesn't mean you have to miss out on the campus life. Whether it's through work positions, attending events, or joining activities, there are plenty of opportunities to connect with students in different disciplines.

9. It’s time to let go of being perfectionists when it comes to grades.

○  Hearing from program leadership that grades don’t matter can be a difficult thing to convince yourself of. Focus on learning for the sake of helping future patients, rather than fixating on what score you’ll earn.

10. Everyone’s journey to genetic counseling school looks different, and it should be celebrated.

○  In our genetic counseling program, every student’s journey leading up to grad school is uniquely their own, which brings a variety of experiences and perspectives to our cohort. By embracing our differences, we create a positive learning environment where we can all learn from each other's strengths and grow together.

The Grad School Rollercoaster: Navigating Rejections and Celebrating Success - Courtney McGuire

If you’ve gone through the application process for GC school, you’ll know the rollercoaster of stress and emotions that everyone experiences. From gaining advocacy experience and checking off pre-req’s, to putting the final touches on your application materials, it can feel like you’re running a marathon for months on end. As someone who applied multiple cycles, I can share I did not find the process any less exhausting the second time even though I had a better idea of what to expect and how to prepare.

After not matching the first cycle I applied, I was devastated. I had spent so much time and energy applying to schools, connecting with program leadership and current students, and writing and re-writing my personal statements and CV. I had been assured by numerous professionals in my life I had developed a strong application which made it that much harder to accept I hadn’t matched.

I have always been a problem-solver and tend to push my feelings to the back burner. While my initial instinct was to formulate a plan for the next application cycle, I also recognized I would have to deal with my disappointment before it grew into additional anxiety about the next application cycle.

Taking the year between application cycles to get as much exposure to genetic counseling as possible allowed me to better articulate how sure I was (and still am) that this is the best career path for me. I was more confident writing my personal statement and answering application questions the second time around. I was more collected in interviews, feeling I was better able to express my personality and desires to program leadership. I was definitely still nervous about matching, but I was much more confident than the first cycle I applied.

When Match Day came and I learned I had matched at Pitt, I cried. I called my husband, my mom, and ran around my dad’s shop letting everyone know. I was ecstatic, even if a bit overwhelmed. After almost two years of preparation, I would get to go to school for my dream career.

There’s no way around it - getting rejected sucks… But there’s always something to learn. Knowing my classmates as well as I do now, I believe these are the people I was meant to go on this journey with, and as hard as not matching was the first time around, I could not be more grateful to be here now.

For me, navigating rejection is broken down into a few steps. Take the time to experience your feelings - it’s ok to be upset, sad, and even angry. Just don’t stop there; let your feelings fuel your desire to move on, however you choose to. Whether it’s applying a second time, taking a gap year to relax and explore, or moving on to something else, there’s always something to take away from a failure. Remind yourself why you’re doing this. Don’t be afraid to ask for help, especially from the people who know you best. You are important and skilled and worthy; you just have to figure out how to showcase that to others. Enjoy the journey - it makes the success that much sweeter.

AI's Rare Disease Odyssey - Swathi Balaji

Note: The author utilized Midjourney, a generative AI program, to generate the above image from natural language descriptions.

In honor of Rare Disease Day (February 29, 2024) this month, welcome to the rollercoaster of medical mysteries, where patients embark on a journey fraught with uncertainty—the "diagnostic odyssey." For those facing rare diseases, the road to an accurate diagnosis can be a years-long saga, filled with countless doctor visits, unnecessary tests, and, unfortunately, often a misdiagnosis. This protracted timeline not only results in ineffective care but also leads to irreversible damage as the disease progresses. It's like a medical scavenger hunt, but the stakes are far from trivial.

 

Navigating Uncharted Territories

In the United States, diseases affecting less than 200,000 Americans are classified as rare, encompassing over 6,000 conditions worldwide (Cohen & Felix, 2014). These diseases, often chronic and disabling, pose a significant public health challenge. According to the National Organization of Rare Diseases (NORD), the average diagnostic journey for rare diseases spans 5-7 years (NORD Undiagnosed Rare Diseases Registry | NORD, 2022). This prolonged process not only delays treatment initiation but also inflicts considerable psychological distress on patients and their families. Living with a rare disease often subjects the patient to a lifetime of complex care, profoundly affecting their education, physical mobility, and financial stability.

Patients often find themselves on a "diagnostic odyssey," a term reflecting the feeling that no single practitioner comprehensively considers their condition. The current workflow for providers is to take a medical/family history, perform a physical exam, order laboratory tests, conduct imaging tests if needed, and then refer the patient to a specialist. The similarity of rare diseases to other conditions, combined with the no one-size-fits-all approach to diagnosing rare diseases, contributes to diagnostic delays or misdiagnosis. Even good doctors fail to recognize conditions that are right in front of them. The consequence of an early or late diagnosis can lead to worsened symptoms along with the development of other health problems, ultimately resulting in a decline in patient well‐being. These challenges not only affect more than 350 million people worldwide but also create a substantial economic burden on the healthcare system. The overarching need for a solution is clear: a way to streamline the rare disease diagnostic odyssey and support healthcare providers in their quest for accurate and timely diagnoses.

 

Is Artificial Intelligence a Buzzword?

Genomic technologies are technologies used to manipulate and analyze genetic information. The diagnostic landscape has evolved from using cytogenetic techniques using FISH and Karyotype, gene sequencing, and DNA microarrays which are still used in today’s practice. These are powerful tools that providers such as genetic counselors use to convey accurate diagnosis for patients and their families. This could help patients take the best medications and treatments for their disease indications.

While genetic research has come a long way since its original discovery, there is still room for more advancements and developments. However, focusing solely on genetic tools isn't enough if providers across different healthcare systems or countries cannot standardize rare disease findings. The collaborative sharing of sequencing data among clinicians, patients, and organizations is essential to build a robust worldwide network and raise awareness about rare diseases. For providers to practice at the top of their scope and avoid timely case-prep, it is vital to have a searchable or conversational platform to streamline the diagnosis process.

GeneMatcher is a freely accessible web site developed with support from the Baylor-Hopkins Center for Mendelian Genomics as part of the Centers for Mendelian Genomics network. It was designed to connect patients, their families, clinicians and researchers from around the world who share an interest in similar genes. The goal for making GeneMatcher available was to help solve “unsolved” exomes (Sobreira et al., 2015). This is done through cases from research and clinical sources.

While this platform has made significant strides in connecting patients, providers, and researchers worldwide, there is still room for improvement to make the process of searching for relevant information more streamlined. Artificial intelligence (AI) enables machines to perform operations requiring human intelligence, encompassing learning, while analyzing vast amounts of information to identify trends and make decisions with unprecedented speed and precision, emulating human intelligence (Wojtara et al., 2023). AI has the potential to revolutionize the diagnostic process by enabling doctors to analyze extensive datasets, including medical images, genetic data, and electronic health records, identifying intricate patterns difficult for humans to discern, ultimately offering an efficient solution for providers and shortening the diagnostic journey for patients.

Leveraging AI opens the door for healthcare providers to crowdsource crucial differentials specific to rare diseases, encompassing phenotypic characterization, specific biomarkers, historical data, pathology reports, and other factors, considering the inherent heterogeneity in the presentation of these conditions. Within the realm of AI, machine learning (ML) serves as a subset that aids diagnosis through various algorithms, including pattern identification and classification based on past examples. Given that 80% of rare diseases are genetic, AI holds significant potential in analyzing data to provide accurate diagnoses (Rare Genetic Diseases, n.d.). By constructing an ML algorithm, individual cases become puzzle pieces systematically pooled to create a comprehensive population-based dataset. AI then meticulously analyzes patterns within populations that share similar differentials, offering guidance to decode the diagnostic puzzle of rare diseases. An additional asset of AI, natural language processing (NLP), adds predictive analysis capabilities, particularly beneficial when extracting critical data from electronic health records (Wojtara et al., 2023). The overarching objective of using AI in genetic healthcare is to decode the diagnostic journey for individuals grappling with rare diseases, ultimately delivering the sought-after answers to patients through the systematic utilization of crowdsourced data and advanced AI analysis.

 

It's Only The Beginning

Embracing the transformative potential of AI in the rare disease diagnostic landscape not only enhances diagnostic efficiency for providers and offers hope to patients on their diagnostic odysseys but also symbolizes a significant journey for AI itself— an odyssey into the uncharted territories of rare diseases. The fusion of technology and compassion emerges as a powerful catalyst capable of positively reshaping the trajectory of medical diagnoses for rare diseases. The collaborative synergy of AI and crowdsourced data not only enriches our comprehension of individual rare diseases but also unfurls avenues for discerning shared patterns across diverse populations. This data-driven approach holds the key to decoding the diagnostic odyssey for individuals grappling with the complexities of rare diseases, providing a much-needed ray of hope for more accurate and timely diagnoses.

References

Cohen, J. P., & Felix, A. (2014). Are payers treating orphan drugs differently? Journal of Market Access & Health Policy, 2(1), 23513. https://doi.org/10.3402/jmahp.v2.23513

NORD Undiagnosed Rare Diseases Registry | NORD. (2022, August 5). https://rarediseases.org/living-with-a-rare-disease/nord-undiagnosed-rare-diseases-registry/

Rare Genetic Diseases. (n.d.). Retrieved January 30, 2024, from https://www.genome.gov/dna-day/15-ways/rare-genetic-diseases

Sobreira, N., Schiettecatte, F., Valle, D., & Hamosh, A. (2015). GeneMatcher: A matching tool for connecting investigators with an interest in the same gene. Human Mutation, 36(10), 928–930. https://doi.org/10.1002/humu.22844

Wojtara, M., Rana, E., Rahman, T., Khanna, P., & Singh, H. (2023). Artificial intelligence in rare disease diagnosis and treatment. Clinical and Translational Science, 16(11), 2106–2111. https://doi.org/10.1111/cts.13619

Show, Don't Tell: Empathy in Practice - Alex Stauff

Many of the skills I learned as a resident assistant (RA) have been helpful so far in grad school. A lesson that has really stuck with me came from a three minute video (link below) we watched during one of our summer training sessions. It was an animated short on empathy, with delightful anthropomorphic animals and a voiceover by Brené Brown.

In her words, “Rarely can a response make something better. What makes something better is connection.”

This little clip assuaged so much of the anxiety I had about supporting students through a difficult time. Fears like—what if I say the wrong thing? What if the other person can’t tell that I genuinely care?  

Words certainly matter, especially in a field like genetic counseling, where precision in language is critical. But without connection, words roll off like rain. There’s nothing anchoring them.

To me, connection means first and foremost: presence. This feels like an achievable starting point, requiring nothing more than focusing on the person in front of you. No matter how a conversation unfolds, I can be present.

Dr. Vellody, director of the Down Syndrome Center of Western PA, gave a really beautiful example of emotionally responsive communication in a lecture to first year students last semester.

We asked for advice about disclosing a Down syndrome diagnosis in the prenatal setting. I think many of my classmates and I were getting hung up on choosing the right words.

But Dr. Vellody’s focus didn’t start with the words. He said, provide the diagnosis, and then wait for an emotion to come up. Validate it. Wait for another emotion … validate it …. And keep doing this until a person is ready to talk about anything other than how they feel.

When I started my position as a GCA at Magee-Womens Hospital, I was able to sit in on weekly case conferences. This was a really helpful way to “peek behind the curtain” and start getting a feel for clinical and psychosocial considerations before I applied to school. I remember one particular situation a student shared, and the advice she got …

This student and her supervisor recently saw a patient who was newly diagnosed with breast cancer. The patient was extremely upset throughout the session and finally burst out at the student, “Have YOU ever had cancer?! Has anyone in your family even had cancer? Then, how can you have ANY idea what you’re talking about?” The student was distraught and had been at a loss for what to say – she posed the question to the group.

Truthfully, I was glad to be a fly on the wall during the discussion. It feels awful when someone’s anger feels—fairly or unfairly – directed at us. It can be so easy to slip into deflections and defensiveness.     

A seasoned nurse navigator gave advice that immediately reminded me of that short video I love so much.

She said, “You’re young, but I bet you’ve felt fear, or grief. And if you haven’t – you will. Those are likely some of the emotions underlying this woman’s anger. Acknowledge them and connect to those.”

I’m planning to keep that invitation to vulnerability and openness at the front of my mind as I prepare for patient simulations later this semester, and oh-so-quickly approaching rotations this summer.

Video: https://www.youtube.com/watch?v=1Evwgu369Jw

Dr. Colleen Campbell Leadership Seminar Reflections

Dr. Colleen Campbell, a genetic counselor with the University of Iowa Hospitals and Clinics and assistant director at the Iowa Institute of Human Genetics, spoke to our students and Pitt Public Health faculty on December 1, 2023, as part of our Genetic Counseling Leadership Seminar Series. Below are some student reflections on her presentation:

After Dr Colleen Campbell’s insightful presentation, it became apparent that the perceived shortage of genetic counselors in the United States is intricately linked to the uneven distribution of these professionals across states. Dr Campbell pointed out that the total number of genetic counselors may be sufficient, but the geographic dispersion exposes a significant imbalance that poses challenges to health equity. Compared to other patients who enjoy more convenient proximity, the discrepancies become palpable when considering the considerable distances some patients must travel, which can exceed 200 miles, to access crucial care. Dr Campbell’s discussion prompts a deeper reflection on the strategic allocation of genetic counselors across diverse regions. Her emphasis on initiatives like "Charting the Genetic Counseling Landscape: Shaping Public Policy and Advocating for the Future of Genomic Healthcare" underscores the need for collaborative efforts to address and rectify these challenges. After Dr Campbell’s thought-provoking presentation, it becomes crucial to carefully explore strategies ensuring fair access to genetic counseling services. This contemplation seamlessly fits into the wider objectives of advancing genomic healthcare. Dr Campbell’s discussion not only sparked meaningful conversations but also propels future genetic counselors like me to take concrete actions in cultivating a more evenly distributed and accessible framework for genetic counseling services. As I continue my education and enter the workforce, I am inspired to keep this imperative at the forefront of my professional endeavors, advocating for equitable access and contributing to the transformative journey of genomic healthcare. Dr Campbell’s talk has instilled in me a commitment to actively participate in addressing these challenges and working towards a more inclusive and accessible genetic counseling landscape. – Swathi Balaji

The Pitt Public Health students were incredibly lucky to have had the opportunity to hear from Dr. Colleen Campbell at our annual GC leadership seminar. I loved learning about how the field of genetic counseling is influenced by politics and legislation, and Dr. Campbell's advocacy work is truly inspiring. She also offered interesting perspectives about healthcare equity in rural areas and steps that GCs can take to address these inequities. This was an incredibly engaging and thought-provoking conversation, and it has certainly left a lasting impression on myself and my classmates. – Emily Hrach

Listening to Dr. Campbells presentation was inspiring: she is making huge contributions to the field of Genetic Counseling, not only with her advocacy work, but also modeling how GC skills can be used outside of the clinical care environment to empower professionals and improve access to health care. With the growing need of genomic testing interpretation and patient centered genetic services, there is urgency in updating the licensure, professional status, and reimbursement frameworks for genetic counseling. Dr. Campbell provided a vision to move forward and showed us that if there are limited paths to follow, we can always create new opportunities for change. There is so much work needed to overcome the political hurdles that interfere with more equitable access to genomic healthcare in our country. To start, I signed up to meet with my district’s Representative. I believe that we all can participate in building a better future. – Alejandra Bernal

Our training as genetic counselors prepares us to work with patients in various clinical settings. While we regularly discuss aspects of care such as research and clinical trials, empathy, and multidisciplinary care, I did not previously reflect deep into how our counseling skills transfer to public policy. Dr. Campbell elegantly laid out how we can utilize our training in collaborating with lobbyists and legislators to advocate for patients on a larger scale. I am grateful to have had the opportunity to chat with Dr. Campbell. Her advice and positive outlook make me excited to start my journey as a genetic counselor. – Megan Zieber

Whenever someone asks me “what is genetic counseling?” I always describe it as a combination between a doctor, a teacher, and a counselor for genetic conditions. However, Dr. Colleen Campbell's talk emphasized a crucial fourth role that a genetic counselor can take on: an advocate. Furthermore, Dr. Campbell shared how genetic counselors are not only amazing political advocates because of their deep understanding of genetics and patient psychosocial experiences, but also because many of the skills developed as a genetic counselor are important in political advocacy. After hearing her talk I feel I have a deeper understanding of the potential roles and applications of genetic counseling and am even interested in taking part in advocacy myself after I graduate. Thank you, Dr. Campbell, for your inspiring work and presentation! – Jennifer Reif

Dr. Campbell was so personable and knowledgeable. I hadn’t spent much time considering the legislation that impacts our practice as GCs, so I appreciated getting a glimpse into this. I’m excited to help pick next year’s speaker! – Alex Stauff

Listening to Dr. Colleen Campbell's lecture titled "Charting the Genetic Counseling Landscape: Shaping Public Policy and Advocating for the Future of Genomic Healthcare" shed light on the essential partnerships and interdisciplinary efforts required to broaden access to genomic medicine. While I've always been drawn to the field of genetic counseling due to its collaborative nature, Dr. Campbell's insights expanded my understanding. I had previously recognized the importance of partnerships with patients, healthcare providers, and fellow genetics professionals. Yet, I was genuinely intrigued to discover the advocacy work at both the State and Federal levels, particularly regarding the licensure and passage of the Access to Genetic Counselor Services Act. Dr. Campbell's recounting of her journey in securing licensure in Iowa vividly showcased that our envisioned paths often differ from the realities we encounter. As I progress in my training and embark on my professional journey, I am inspired by the lessons of resilience and adaptability she shared, and I intend to carry these invaluable insights forward. – Jerome Doerger