Student Experiences with Telemedicine

Telemedicine allows patients to have visits with providers from a different physical location, often using video technology through a computer. While telemedicine was already being used by some genetic counselors, it has suddenly become the preferred method in the wake of the COVID-19 pandemic. Many of our second-year students gained some experience with telemedicine this past year during their clinical rotations; we are fortunate to have this opportunity. In this blog, some of our students write about their experiences with telemedicine.

I had the opportunity to participate in telegenetics counseling sessions during my cancer rotation at UPMC Magee-Womens Hospital.  Magee provides counseling to patients at several different telemedicine sites, and each of them have unique features, so it was beneficial for me as a student to see what worked well in some clinics and didn’t work so well in others.  These sessions were facilitated by a specially trained nurse that would call the patients to obtain their family history and then forward it to the counselor and student to prepare relevant risk assessment and counseling materials.  This nurse was also present in-person with the patient during the counseling session, and assisted the counselor by facilitating the use of visual aids.  As a student, I learned that even though we are counseling via video, a genetic counselor can provide active listening skills and empathy to the patient.  

-Lauren Winter

I was grateful for the opportunity to participate in telemedicine cases during multiple clinical rotations, and I felt that these particular cases allowed to me to improve my counseling skills. Not seeing a patient in person means that you need to be ready to be attentive to patient cues and needs that might present a bit differently than what you’re used to experiencing in person. Telemedicine was important in learning how to modify some of my explanations and counseling interventions in order to support patients via telemedicine in some of the same ways I can in person. With increasing use and availability of different telemedicine technology, I think that telemedicine will continue to be used in many aspects of healthcare, and we will all likely use telemedicine at some point in our future careers. Telemedicine can be an efficient way to see patients, and importantly, to increase access to services for patients who may live in remote areas or cannot travel to an in-person location for their appointment.   

-Alyson Evans

I think the past few weeks have shown us all that telemedicine is an important and effective way to deliver services to people when meeting in person just isn’t possible. Going into my first telemedicine session, I was both nervous and excited. I was excited because it was a new type of counseling for me that I have no doubt I will use in my career, and I had the opportunity to try it out with supervisors who routinely use telemedicine. I was nervous because I wasn’t sure about how I would need to change my counseling to fit the telemedicine setting, or if I would miss psychosocial cues from my patients. The transition between in-person counseling and telemedicine was much smoother than I expected. The patients seemed comfortable meeting this way and some mentioned that it was a relief to not have to make the hours-long drive to be seen in-person. Telemedicine will be an important public health tool in expanding access to care and removing barriers to genetic counseling. I’m  glad I had these experiences during my training. 

-Vickie Bacon

I’ve been fortunate to participate in telegenetic counseling sessions during my training at Pitt in prenatal, pediatric, and cancer settings. While learning to use technology to counsel patients required some getting used to for both me and the patients, the benefits of telemedicine are clear. This technology increases access to genetic counseling and allows counselors to provide expertise to remote or underserviced areas. Access is an important consideration now more than ever as recent global events have illustrated. Telemedicine allows for the continued care of our patients during a time where physical distancing is required.

-Rose Venier

I counseled patients via telemedicine during my cancer rotation, and am grateful for the experience; I think as we work to increase access to genetics services, telemedicine will only become more important. The process was much smoother than I anticipated, mostly because the counselor I was working with had many tips and tricks. For instance, she set the computer at the ideal angle so that when I looked at the screen, the patient felt I was looking directly at them. There was an experienced nurse on the other end sitting with the patient, who showed them our visuals in person and was an immense help. Because there is a shortage of geneticists and genetic counselors, many patients end up traveling several hours to their nearest city to have a genetics visit. That kind of travel is especially difficult for someone undergoing cancer treatment, having a tough pregnancy, or raising a child with special needs. I imagine telemedicine will only become more widely used after this pandemic is over.

-Claire McDonald

Student Work Position: NYMAC Regional Genetics Network Graduate Student Worker

One of the big draws for me, as an applicant to Pitt’s Genetic Counseling Program, was the possibility of a student work position. My job at Pitt not only helps me pay my rent, it also has given me valuable experience working in the field of public health genetics.

I am a student worker for the New York-Mid Atlantic Regional Genetics Network (NYMAC), which is the regional genetics network that Pennsylvania belongs to, along with New York, New Jersey, Delaware, Virginia, West Virginia, Maryland, and Washington, D.C. The regional genetics networks are responsible for coordinating regional public health efforts relating to genetics, such as access to services, increasing telegenetics and programs related to newborn screening.

One of NYMAC’s goals has been to improve the availability of genetics resources to everyone within the region, with a particular focus on improving access for people who live in underserved areas. As part of that effort, NYMAC launched a Genetic Services Referral Phone Line. This is where my job comes in: when someone calls the phone line, I answer it. I help callers find a genetics clinic near them, a telegenetics service they can contact, or another resource to help answer their questions.

The trouble is, very few people call this phone line. This is public health in practice – sometimes an intervention doesn’t work the way it was intended, and needs to be re-evaluated. Alyson Evans, a second year genetic counseling student working for NYMAC, is focusing her thesis research project to explore the reasons the phone line might not have been utilized as hoped, as well as other tools that might be more useful for connecting people to genetics services.

In the meantime, we focus our efforts on developing other tools that might help reach the same goals. Alyson and I have written Red Flags fact sheets, answering doctors’ questions about things like when they might consider referring a patient to genetics services.

We have also been working with the American College of Medical Genetics and Genomics (ACMG) to update their Find a Genetics Clinic tool. This involves going through the internal directory of genetics providers within the NYMAC region, and making sure that they are all appropriately updated on the ACMG website. This tool allows people to search for genetics clinics by location and specialty type, to help connect them to appropriate services.

As we approach the beginning of the new grant cycle, we will be developing new ways to adjust our efforts. This spring, I will be attending the Innovations in Genetic Service Delivery Learning Forum in Washington, D.C. This forum was organized by the NYMAC team, gathering stakeholders from throughout the region to discuss how different delivery strategies might help improve access to genetics services.

Through my work with NYMAC, I have gained an appreciation of public health in practice, the chance to work with professionals in the field of public health genetics, and experience implementing public health interventions. I look forward to learning and experiencing more throughout this next year and a half.

Madeline Reding, class of 2021

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Student Work Position: Graduate Research Assistant with the Center for Craniofacial and Dental Genetics

During my time at Pitt Public Health, I have been a Graduate Student Research Assistant with the Center for Craniofacial and Dental Genetics, specifically on their longitudinal studies looking at the development of childhood cavities. These studies are both under the Center for Oral Health Research in Appalachia, with one focusing on a cohort of Caucasian women and their children (COHRA2) and the other focusing on African American women and their children (COHRA Smile). In both of these studies, women are recruited when they are pregnant, with the goal of maintaining their study participation until their child's 10th birthday. Throughout this process, participants have annual in-person visits at the Center and quarterly phone calls where we can collect data on the mother-child pair regarding both the genetic and environmental factors that might be related to the development of cavities during childhood. These environmental factors include the child's diet, the family's

socioeconomic status, oral metabolomics and microbiome, and more. 

Even as a student worker on these studies, I do much of the same work as the full time research assistants. I am responsible for a sub-set of our participants, making sure that they complete their in-person visits and phone calls in a timely manner whenever possible. As part of this, I contact the participants so they can complete their shorter, bi-annual phone calls with me.  It is during these calls that I help to collect much of the environmental data, with a large focus on the child's diet. I am also  involved in the in-person visits, where I am paired with a trained dental hygienist. During these visits, the dental hygienist will take a series of saliva and soft plaque deposit samples. As the assistant, I am responsible for ensuring each sample is placed in the proper tube and for documenting from which teeth the plaque samples were taken. After each visit, I am responsible for logging and storing the samples properly. Outside of phone calls and visits, I also contribute to COHRA’s efforts by preparing the paperwork that is necessary for completing visits, verifying sample shipments to ensure that there are no missing or undocumented samples, mailing welcome materials to new participants, and tracking GPS information associated with where our participants get their water. This wide variety of duties requires me to practice my organizational and time management skills. The main aspect of my job that is different from the full-time staff is the flexibility of my work schedule. As an hourly student worker, I am able to easily adjust my work schedule as needed, as my supervisor understands that academics must come first. This has been extremely helpful for my peace of mind during weeks where I have an exam to take and/or projects to submit.

As a dual degree student, I love how well the work I do at COHRA marries public health and genetic counseling. From a public health perspective, COHRA is trying to better understand why the Appalachian region has one of the highest rates of childhood cavities. In this regard, the data we are collecting could be helpful in designing future public health initiatives to improve oral health in the region. By collecting data on different cohorts of participants (African American and Caucasian, rural and urban), we may also be able to highlight key health disparities impacting oral health. With regards to genetic counseling, even though dentistry and oral health is not an area we currently focus on, I still feel that the work I am doing with COHRA translates into genetic counseling practice in a general way. As genetic counselors, we are expected to explain complex concepts in a way that the average person, including children and adults without a full high school education, can understand.  At COHRA, I often find myself explaining to curious moms (and sometimes curious children) the purpose of the many tubes in which we collect saliva. I also often explain to participating moms what to expect during future visits or phone calls, similar to what we may do in contracting when we lay out what our session will look like or what other appointments need to be scheduled.  In these ways, I am able to practice communicating to people of highly varied backgrounds in a clear manner.

Although my thesis project will not be based on data collected through the COHRA studies, that is not because there is not an opportunity to do so. (My interest just happens to lie in metabolic, not dental genetics, so my thesis will be about PKU). The student before me did choose to do her thesis here, and had a successful experience! She wrote a blog about her experiences with COHRA back in June of 2019, so please read it if you want to know more about how she incorporated her work into her thesis. Her blog also provides another viewpoint of the experiences of working with COHRA in general. 

Overall, my work with COHRA has been a valuable experience. Through it, I have had the opportunity to work with some amazing people - both co-workers and participants - and hone my communication, time management, and organizational skills. I have also been immersed in an interdisciplinary team of people with a mix of dental health, research and genetics backgrounds. Combined, I believe these experiences will make me a genetic counselor with a well-rounded background.

Trinity Sprague, Class of 2021