Student Experience: Clinical Observations

The first year of the Pitt genetic counseling program is centered around coursework to help prepare us for clinical rotations in the second year; we attend lectures, take exams, and complete a variety of assignments. While the comprehensive classes in the Human Genetics Department are a huge strength of the Pitt Genetic Counseling Program, ultimately we have chosen this field because we want to work with patients. When faced with five final exams in one week, it’s easy to forget why we spend so much time in the classroom. During our first year of training, clinical observations serve as a much-needed reminder that we won’t be taking tests forever.

Clinical observations give first-year students a chance to shadow genetic counselors, familiarize themselves with the clinics where they will see patients during their second year, and to interact with patients. My classmates and I observed the three main specialties of genetic counseling (cancer, pediatrics, and prenatal), as well as two specialty clinics (cystic fibrosis and muscular dystrophy).

Although we only observe in these clinics, there was plenty of opportunity for lovely interactions with patients. An adorable toddler hugged me in pediatrics. I bonded with a young girl in muscular dystrophy clinic over the dresses we were each wearing, which looked similar. She was just as happy as I was that it was finally warm enough outside to wear a dress. Several prenatal and cancer patients asked me about my experiences in graduate school and how I became interested in genetic counseling.

Shadowing in clinic reminded me how important the learning in the classroom is. I sat down with one of the genetic counselors to look up a patient’s variant in ClinVar (an online database for genetic variants) so we could explain the significance to the family. A pediatric patient had been diagnosed with a de novo variant that caused an autosomal dominant condition, but no one had ever explained to the family these test results and how they might impact reproductive decisions. The parents had been asked questions for years about the inheritance pattern of this condition and how it is passed down through families. They had no idea how to answer these questions. The genetic counselor made a slide set and took the time to sit down with them; they were grateful to have someone take the time to focus on their situation and explain everything. By the end of the session, I felt confident they could answer inheritance questions from friends and family.

Clinical observations also reminded me that genetic counselors have a wealth of information available at their fingertips. Although I memorize small details before taking an exam, in clinic I will have access to the internet. For example, a couple was seen in prenatal clinic because a relative was diagnosed with a rare condition. The genetic counselor had never heard of the condition, but immediately researched it and learned that the condition is autosomal dominant and usually de novo. Although no definitive statement could be made without genetic testing results for the relative, the research provided the information for the genetic counselor to determine that this couple’s risk of having a child with the same condition was most likely close to zero.

Finally, spending time in clinic gave us the opportunity to become familiar with our future training sites. As someone who struggles with directions, I rarely remember where everything is the first time around. But seeing where the bathrooms and the cafeteria are, or learning that the office suite is one giant circle, increases the chances that I will find my way next time.

Ultimately, we have chosen genetic counseling because we want some amount of patient interaction. Clinical observations provided me with the opportunity to engage with patients and reminded me that my coursework was preparing me for the start of the main clinical rotations.

 Claire McDonald, class of 2020