Student Rotation: Utilization Management at UPMC

Before I started my rotation with UPMC’s Utilization Management team, I was nervous. This was my first clinical rotation, and there’s always the fear of the unknown when doing something new. Looking back, I was initially worried that I wouldn’t do a good job, or I’d be unable to answer questions about a condition or testing technique in front of the counselor. After completing this rotation, I can confidently say that I did not need to be so anxious about the start of this rotation.

A few days before my rotation began, I was paired with a genetic counselor “buddy” who would guide me through everything from reviewing patient charts, assessing how appropriate specific testing is for a given patient, and to generally being my point of contact for the entire rotation. As soon as I met my “buddy,” I knew this rotation would be a great experience. On day one, I was able to view patient charts to gain a better understanding as to why one particular patient would receive one specific genetic test while another patient would receive a different genetic test even if they came in with the same concerns. As time went on, I became more confident in my abilities to analyze records and understand why a particular test was offered. Eventually, I met more genetic counselors who work in the Genetic Testing Clinic and are on the Utilization Management team. I was able to observe telemedicine cases, result disclosures, and even participate in cases by taking family histories.

I expected to see times where a testing review came in, where genetic testing wasn’t warranted or appropriate, and consequently, the UM team would have to tell a patient or provider that they couldn’t or shouldn’t have testing based on what’s seen in the patient’s chart. However, that was never really the case. More often, when a situation came up where the UM team thought that the testing ordered was not appropriate, we were able to have a discussion with the physician to talk about why he/she would like to order that specific test, or if a different testing option had been considered. The UM team wasn’t created to tell people “no,” it was created to help determine if the most appropriate test is ordered so that the patient receives the best treatment. In addition to reviewing testing requests, the UM team also helps educate physicians, nurses, and other healthcare professionals on why testing is being ordered, and what specific tests are the most appropriate for their patients, among other things. I developed a new appreciation for all the different things UM genetic counselors do on a daily basis.

I appreciated the flexible nature of the rotation and the variety of activities available to me. A great aspect of this rotation was that the counselors were fantastic about asking if I wanted to join in on a case with them. Additionally, I enjoyed getting to talk through example situations with the genetic counselors. They would ask questions like “so what would your next steps be?” or “and what if that test came back negative?” which really made me think through my responses. I knew that there was rarely a right or wrong answer to their questions, but I always appreciated their feedback.

This UM rotation was a great first-step into clinical rotations because you end up seeing a little bit of everything. In this rotation, you have to think critically about many different aspects of testing, and sometimes come up with creative solutions to best help the patient, but you have an excellent team of GC mentors who help you along the way. The only thing that could have made this rotation better would be if it were longer!

Michael Gosky, class of 2021