Transitioning from Student to Genetic Counselor

During the spring semester of my second year of graduate training, I accepted a position at the University of Iowa Holden Comprehensive Cancer Center (UIHC) as a cancer genetic counselor. From the time I first interviewed it was evident that a number of exciting things were on the horizon for genetic counseling at UIHC. I was recruited along with five other new genetic counseling hires for various positions across the hospital, breaking a national recorded for the most new clinical genetic counseling hires at an academic medical center institution.

Since starting my job just over seven months ago, I have had the opportunity to attend the National Society of Genetic Counselors Annual Education Conference in Seattle and the Iowa Cancer Consortium in Des Moines, as well as give a number of presentations at tumor boards, other specialty meetings, and conferences. The most memorable activity I have participated in, to date, was on my third day when we took part in one of the official satellites for former Vice President Biden’s  Cancer Moonshot. The Cancer Moonshot was a call to action for all those involved in cancer care and research to help end cancer as we know it. During the event we heard from a local panel including physicians, researchers, and patients as well as a moving and powerful speech from Vice President Biden as he shared the story of his son, Bo.

One of the most significant changes I noticed when starting my genetic counseling career was that I was now in charge. I was the expert in the room and had to be prepared to answer any question the patients may have. I was also seen as the expert in tumor boards, often fielding questions about appropriate referrals to our clinic. This was both exhilarating and overwhelming. Fortunately, I quickly overcame these feelings and became an integrated part of the patient care team. I found it important to remember that I may not know everything, but I am still the genetics expert. It is okay to say you do not know the answer, but you will look into the question to find the answer. I also found myself using the counseling strategies my supervisors used in clinical rotations, whether that is to get a patient to open up more, facilitate decision-making, or to help refocus a patient to get the session back on track.

Pitt did a wonderful job preparing us for our genetic counseling careers.  The only thing I was probably not prepared for is not being around the 10 wonderful classmates I spent so much time with for two years! This was a significant adjustment but luckily we keep in touch and are available to each other to discuss ideas and provide support after having a difficult case. We also make plans for class trips so we can see each other stress-free. Although it has been hard not seeing these wonderful friends every day, there is a great group of genetic counselors across UIHC who help provide support. I was hired at the same time as other new graduates and we areable to support each other and studied together for the ABGC certification examination.  I was thrilled to pass the exam!

At my job, we have a social chair who plans monthly activities for genetic counselors to get together, which helps foster a strong relationship and friendship with the other genetic counselors at our institution. There is a monthly book club that includes genetic counselors as well as other cancer center staff. I also have the opportunity to work with two (soon to be three) wonderful genetic counselors in the cancer center, that we endearingly refer to as “the dream team”.

With all the changes that are coming to the UIHC and the excellent training I received at Pitt, I know I will be able to take my career down whatever path I choose, whether that be teaching, research, or clinical work. Coming to UIHC has been a wonderful transition into the workforce that provides me with endless opportunity to grow.

-Kristin Gambin, Class of 2016

Thoughts for Interviewees from Current Students

1. Congratulations!

You have an interview! Take a moment to celebrate this achievement. Applications take significant time and effort – writing personal statements, getting recommendations, and sending out copies of your transcripts. All that work has paid off and has resulted in an interview, make sure to enjoy it before tackling the next steps.

2. Come with questions

The interviews are a way for you to learn more about the program than you can read from the website. You are interviewing the program just as much as they are interviewing you. Are any of your interviewers alumni? Ask them why they chose the program, how it has changed, and where they see it going. Some of our favorite questions were:

• What makes the program unique?
• How can I personalize my learning experience?
• How many cases do students typically see?

3. Talk to current students

Current students can give you an important perspective of what life in the program would be like including activities outside of classes and rotations. Find out what’s everyone’s favorite hangout spot. Where do students live? How affordable is the area? Do students work? In addition, it’s fun to meet future colleagues!

4. Explore the city

Especially near campus. You’re going to spend at least two years wherever you decide to go. Are there interesting things to do? Is it easy to get around? Try out some of the public transportation. Check out some of the local parks and unique sites.

5. Keep a list 

And update it as you complete your interviews. It’s handy to have a priority list before Decision Day arrives.  You can keep in mind factors that are important to you when making a decision.

Our biggest advice would be to just breathe, be yourself, and have fun!

Best of luck,

Classes of 2017 and 2018

Mulling Over Ethics as Genetic Counseling Students

I find that one of the unique aspects of the Pitt Genetic Counseling Program is the strong focus on ethical principles in the curriculum.  For example, students participate in a course entitled, “Ethical Issues in Clinical and Public Health Genetics,” in their first and second year. The purpose of the course is to discuss genomics and genetic counseling topics within an ethical framework.

For the course, each week, a first and second-year student pair up to present a topic on which they lead the class discussion. The topics that I have had the pleasure of discussing have been equally intriguing and challenging; they are always pertinent to current issues in the field as well as conundrums that may be faced in the future, especially as genomic technology advances so rapidly. Some examples of topics from my favorite discussions include: post-mortem genetic testing, language barriers and the use of interpreters, prenatal whole exome sequencing, the addition of diseases to newborn screening, and population screening for BRAC1/2 mutations.

Although we touch on ethical principles in many of our classes throughout the program, this course is different due to our instructors. We are lucky to have Dr. Lisa Parker co-lead the class with our program director, Dr. Robin Grubs. Dr. Parker is a philosopher-bioethicist whose research focuses on genetic research, genetic counseling, and pharmacogenomics. She brings a nuanced ethical insight to every class and can play a perfect “devil’s advocate”, which allows us to see a situation from multiple perspectives. I feel that her background and expertise help to encourage us to grapple with the ethical quandaries that we tend to find ourselves in during these discussions.

Overall, I find the ethics course extremely beneficial as a genetic counseling student. As a first-year student, I was fascinated by the insight of our second-year students. It was amazing to see how much they had learned from their rotations and how personal experiences with patients gave them unique insights into certain ethical situations. Now, as a second year, I feel that the ethics discussions allow me to think critically about my patient interactions and to learn from the experiences of my classmates. It doesn’t matter how much I think I know about a topic prior to the discussion, I always come away with a more refined view.

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 -Emily Griffenkranz, Class of 2017

Pitt's Genetic Counseling Club off to a Good Start

A passion for science combined with a desire to understand people fosters unique character. It cultivates a person with empathy and strength, focus and balance. This person is a genetic counselor.

Unfortunately, this isn’t a career typically found on a high school aptitude test…

Thus, like many students in their final years of high school, I found myself trying to decide where to go to college with no real understanding of myself or my professional calling. I knew I didn’t want to be submerged in medicine, but also didn’t want a job that focused on working with people without a science component. When I asked my high school biology teacher if any jobs existed somewhere in the middle, he asked:

“Have you ever heard of genetic counseling?”

This question sparked my curiosity and fueled what is now my burning passion. Though my teacher didn’t know much more about this oddly balanced profession, I ventured out on my own to find more information.

In my searches, I realized that genetic counseling was not just something I wanted to do, but a profession that I was made to do. Throughout high school, I was involved in many theater and music programs, but also enjoyed going home to a date night with my biology book. I started looking for colleges, and happily landed at the University of Pittsburgh, where I decided to pursue a Biological Sciences Major and take as many classes focusing on genetics and the human body as possible. In addition, I decided to pursue a Music Minor and an American Sign Language Certificate to balance the scientific and psychosocial aspects of my education. Ultimately, I considered this a stepping stone to a graduate program in genetic counseling.

Throughout my undergraduate career, I found myself having to do a lot of independent research on how to get into a genetic counseling graduate program. I had to research which classes constituted as prerequisites and which activities would help prepare for a career in genetic counseling. The many times I had questions, I didn’t have anyone else to ask or even someone to compare notes with. By no fault of theirs, career offices and professors had limited answers because genetic counseling is such a niche field. Additionally, I didn’t feel comfortable contacting the head of the Pitt program as a young college student, worried that if I applied to Pitt, they would remember me as unknowledgeable!  (Note from program directors at Pitt: This is not the case! We welcome contact from students at any stage in finding out about genetic counseling to contact us!)

Fast forward to my senior year; the Assistant Director of Pitt’s genetic counseling program, Andrea Durst, approached me about starting a genetic counseling club at the undergraduate level. Although I had decided to take a gap year before going on to graduate school, I realized that I wanted to serve as a mentor for those sitting in the same position I had four years ago. My fellow officers and I hope this club will be able to not only serve as support system for those who know they want to become genetic counselors, but also to inspire and educate those who have only heard whispers of this great profession.

Thus far, the club has had two meetings, elected a new Volunteer Coordinator, and gained over 20 members to its roster. We are looking forward to having many students and genetic counselors attend to share their experiences, tips and tricks, and open a line of communication for anybody who wants to learn. If you have any questions, or would like to be added to our email list (you do not have to be an undergrad at Pitt!), please feel free to email PittGeneticCounselingClub@gmail.com. 

-Jessica Feldman, President of the Pitt Genetic Counseling Club

Educational Opportunities

The Pitt genetic counseling students have the opportunity to participate in a number of educational experiences that enhance their training including educating high school and undergraduate students about the genetic counseling profession. Read on to learn about some of our students’ experiences educating others about genetic counseling.

“I really value my experience leading small group discussions with some AP Psychology high school students. We worked through a genetic counseling session together as a group and discussed complex ethical issues surrounding genetic testing. I was very struck by how thoughtful they were in their answers. They were all very interested in genetics and compassionate regarding how it could have a major impact on people’s lives. As the leader of this discussion, it was the first time I was in an ‘expert’ role in regards to genetic knowledge, and having such a positive interaction early in my educational experience gave me great insight into the role of a genetic counselor in a session before I entered into rotations.” - Emily Griffenkranz, Class of 2017

“I had the opportunity to speak to the Tri Beta biology honors society about genetic counseling this semester, and I really enjoyed the experience. I ultimately decided to become a genetic counselor after listening to some graduate students talk about their program, so after speaking to the undergrads about my program I felt as though I had come full circle. I can only hope that our discussion inspired one of the students in the audience in the same way that I was inspired by genetic counseling students when I was in college” - Julia Stone, Class of 2018

“I also had the opportunity to give a presentation to college students in Grove City, PA introducing them to the field of genetic counseling. I enjoyed the teaching experience and was glad I could help increase knowledge about genetics, as it is such an important public health goal.” - Claire Leifeste, Class of 2018

“I spoke to some students in Grove City, PA about genetic counseling and my experiences in Pitt’s program thus far. Although most students in the room were on the pre-med track, I still think it was important information to pass on to future medical professionals so they can better direct people to genetics services in the future. I believe educating people about what genetic counselors can do is a major component of growing the profession and expanding personalized medicine throughout our healthcare system.” - Meg Hager, Class of 2018

“Educational experiences at the University of Pittsburgh allowed me to share my passion for public health and genetic counseling with high school students who were part of the Health Career Scholars Academy. I was able to first introduce careers in public health and then specifically genetic counseling and its applications to public health to these students. The students were then divided into groups and I was able to go through a genetic counseling scenario and discuss public health and ethical implications. It was really amazing to not only share my passion, but to also hear the thoughts of my future fellow public health professionals.” - Brooke Hornak, Class of 2017

“I spent a day last year getting to talk with some amazing teenagers affiliated with the Huntington’s Disease Society of America’s National Youth Alliance at their annual conference.  These teenagers and young adults are personally affected by Huntington’s disease, and wanted to learn more about genetic testing options available for them in the future.  To facilitate a thoughtful discussion, we broke up into small groups and role-played scenarios involving individuals trying to decide when and how to get tested for Huntington’s disease.  The teens were amazing; right away they understood the emotional complexities that come with testing, and were wonderfully gracious in sharing their own personal experiences with me.  It’s always a wonderful experience to help educate others about genetics, but this particular group was a pleasure to work with, and I was so grateful that they allowed me to listen to their own journeys and struggles with Huntington’s.” - Emily Massiello, Class of 2017

Developing a Thesis: A Journey

At the University of Pittsburgh Genetic Counseling Program, students often have the opportunity to pursue a research project at their work positions. My position as a genetic counseling student worker in the Division of Gastroenterology, Hepatology & Nutrition has enabled me to develop a research study that will ultimately culminate in my Master’s thesis. The development of my own thesis project is an ongoing journey that has cultivated not only my research and management skills, but which has also refined my critical thinking and adaptability.

The Hereditary GI Tumor Program encompasses a diverse medical team that specializes in cancer genetics and research. My work with the team has provided me with the opportunity to participate in the development of a new study entitled “Hereditary GI Tumor Project and Patient Engagement Study.” This year-long pilot study aims to analyze outcomes among high-risk cancer patients participating in genetic counseling. This study is important in furthering the understanding of patient engagement in their health. Patient engagement has been associated with higher patient satisfaction, better health outcomes, and overall decreased cost to the healthcare system. Studying the changes in patient engagement before and after undergoing genetic counseling aims to identify improved means of engaging patients, promoting risk-reducing behavior changes, and ultimately, improving both cost effectiveness and patient satisfaction in the healthcare system.

Finalizing my thesis study however, required ample time and multiple revisions. The contributions of both members within and outside of our team were essential at every phase of the process. Our team worked alongside both the UPMC Health Plan and various University of Pittsburgh faculty members in order to define and refine the current project. The protocol, specific aims, and even the hypothesis were all adjusted many times. Changes were made to deliver the best possible data available.

 Embracing changes was not always easy, and solutions were sometimes difficult to find. During the progression of the project, it was important to balance the goal of the research project, while also remaining flexible. However, having a team available for support drove progress and provided alternative methods of improvement. It was therefore imperative throughout the process of developing my thesis to engage in active communication. Email updates and conference calls on a regular basis allowed for various input, shared experience, and proposed solutions.

As my thesis progresses, my responsibilities have shifted from developing protocols and writing IRB applications, to enrolling subjects and analyzing data. New and different analytic concerns have likewise surfaced, yet with each challenge my project becomes more definite. The evolution of my thesis project is a testament to the time and work shared by myself and the entire team. Not only has my work empowered me to grow as a student, but also has provided me with the foundation necessary to design future investigations. In the months to come, I look forward to finalizing my project as a cohesive thesis presentation that will reflect the time, effort, and the development of communication and flexibility skills that I have learned in throughout the process.

- Anna Zakas, Class of 2017