Entering Grad School During a Global Pandemic

Starting graduate school is a challenge in normal circumstances, but the presence of the COVID-19 pandemic has brought unexpected difficulties and changes. Our new first-years discuss their experiences beginning their training while dealing with this new crisis.

"While I could never regret matching with Pitt and beginning my graduate career, it has definitely been anticlimactic and not at all what I was expecting. One of the things I was really looking forward to was having tight-knit bonds with the other students in my class -- going to classes together, studying in the Public Health building together, having all the same experiences as we began becoming genetic counselors. And these things can all still happen in various ways, they just take a little more effort, and there’s a little more distance between us. Spread across the states, we have weekly Zoom meetings to study together or just talk. We meet up for brunch (six feet away in parks). Our group chat is filled with questions about classes, but also jokes, pictures of pets, plans to explore the city. I love reaching out to my classmates and seeing them back out just as eagerly. Though the pandemic is raging on stronger than ever, I still hope that one day we will all be sitting in class together, not having to worry about distancing or masks." -Bailey Sasseville

"Going to graduate school during a pandemic has been very challenging, to say the least. I was a graduate student in the MPH program prior to joining the genetic counseling program, so the contrast between today and a year ago today is especially stark. I traveled to campus, shoulder-to-shoulder, on a cramped bus during the morning and evening rush hours; this reality is now out of the question. When I finally arrived at the GSPH building, it was always so alive with activity – students huddled together for study groups and jovial conversation. I had a chance to visit professor office hours; face-to-face seminars and lectures kept me engaged in the conversation. A morning beverage from my favorite coffee cart kept my head in the game. All in, there were cues, signs, and conversations that kept me attuned to deadlines, exams, and events of interest. All of that was taken away abruptly, and my physical world is now much more still, for better or worse. I got my first taste of these challenges in the spring when COVID-19 emerged in March, grinding much of student life to a halt. I knew that these challenges would persist, invariably, into the present day.

Still, I was so elated to have matched with Pitt’s GC program that nothing could have stopped my advance on this new and exciting opportunity. It was as if I was re-ignited: my motivation to proceed was kicked into high gear. I would not be swayed to put my education on pause, or to worry about what this new “normal” would look like, because the department had demonstrated to me prior its dedication to the best interests of all students. Now, the Human Genetics department has risen to the occasion – just as I knew it would. The amazing faculty has been wholly supportive and accommodating, and acknowledges that this is no ordinary time for any student. Students make effort and time to hold each other up, and emphasize the importance of mental health transparency during these times. I love that my class, and our GC directors, are so open to exploring our questions and concerns, both academic and personal, and that the department as a whole regularly asks students what they can do to help us get through this. Nothing about this is perfect or ideal, but we are making it work over a distance in the best way that we can. The teamwork effort has been my rock as we weather this storm, and I know that the lessons learned will make us all more prepared moving forward." -Frank Swann

"When I heard that I matched with Pitt, I remember staying in for weeks on end afterwards because of my mom’s paranoia of me catching COVID if I so much as stepped foot outside. I would religiously take precautions to protect myself and people I love, but I did not want to worry her - who expressed extreme happiness and concerns that her daughter might move away in the midst of the pandemic. She was disappointed that she could not travel to the U.S. to help me move. It was funny and touching at the same time when she always called me to see me in action, as I cleaned, packed, and sent boxes across states (my hands got excessively dry after the thousand times she reminded me to sanitize). To her satisfaction, I finished a long moving process with “grace” and “intact health.”

The moving’s excitement passed.

Then, seemingly in a whirlwind, class started, though I had been very much looking forward to it. As a huge introvert, I used to overestimate my tolerance of doing everything online (though I have always preferred attending class in person). Big mistake. There are times I daydream with nostalgia about what this pandemic has done to me, my family, my friends. The healthcare workers at the front line. The people who have lost so much probably due to carelessness or, most of the time, just bad luck. There are times I panicked thinking, “What if it does not get better?” Here at Pitt, we take all the classes during our first year and do rotations in our second year - I appreciate that the approach would equip us with tools we need to know, but what if I never get the chance to sit with my classmates in the same classroom? What if it is really harder getting to know each other because it’s purely through a screen? 

So far though, the pandemic has proved me wrong. True kindness is just a call away - when I got into a fender-bender, my program director asked how she could help, and one of my classmates offered to drive me to the ER if I did not feel well. I guess in the grand scheme of things, this pandemic is like a Pittsburgh storm. Sudden, raging, angry - the kind of storm that makes you drive with emergency lights the entire way. The kind that gets you drenched to the bones, that makes you appreciate your luck and car for not giving out on the street midway.

But afterwards, you are greeted with a peaceful night, filled with light sprinkling in your sleep. Or a beautiful sky, bright with sun and shine that welcomes you to a nice day in the park. That’s when I look out the window and remind myself. We are all in this for the long game." -Phuc Thi Hong Do

"When the pandemic began ramping up in early 2020, I started questioning my decision to go to graduate school. I was expecting grad school to be difficult, but I wasn’t expecting to have to deal with a global pandemic while adjusting to my new program. I decided to continue on my path because I was incredibly excited about my future as a genetic counselor, and didn’t want anything to delay that end goal. This adjustment has been difficult in many ways. I have always defined myself as a “people person” so the lack of in-person interaction with my classmates has made the experience more isolating. In addition, my class has missed out on some wonderful bonding experiences, like the Human Genetics department retreat that generally occurs in September. Given that we are currently doing everything remotely, I’ve been dealing with the sadness that comes with losing certain experiences that you thought were guaranteed, but overall I’m so happy to be here. I think that out of any grad program to start during a pandemic, a Master’s in Genetic Counseling is the way to go! In my experience, it seems that this field attracts people who are thoughtful, supportive, and passionate. This is absolutely holding true. My classmates have been putting in extra effort to get to know each other and support each other, even if it is through a computer screen or from six feet away. I’m grateful to be going through this experience with such outstanding people, but of course am hoping that we can all experience a more “normal” version of grad school soon. I know we’ll all be thrilled to actually see each other during class instead of just watching each other pop up on the Zoom screen!" -Savannah Binion

"These past few months have been full of surprises. I was so excited when I found out I was accepted into Pitt’s Genetic Counseling Program. One of the perks of genetic counseling programs is the small class sizes which allow students to form close friendships, but the pandemic has altered how students are interacting with each other. Previous classes describe spending most of the day together, attending classes, studying, and getting to know each other. My class is having to overcome the obstacle of not being able to have classes in person. But when one door closes another one opens. My classmates and I are able to connect via Zoom for study sessions and are able to participate in socially distant activities. Remote learning has given us the opportunity to explore outdoor spaces like Arsenal Park and the Pitt Campus. Students also have more flexibility with their work schedules because of remote learning. For example, students can attend remote classes while staying at the hospital or lab instead of having to travel back and forth. While starting grad school during a pandemic is not ideal, we are fortunate to be able to continue our education and make lifelong friendships." -Haley Soller

Psychosocial Counseling Challenges During the Pandemic

The COVID-19 pandemic has created many obstacles for genetic counselors to overcome, including a unique set of psychosocial challenges. In this blog, some of our second-year students share their experiences and challenges with counseling during the pandemic. 

 

 

“Though I’m glad our clinical rotation sites are taking all necessary precautions, I’ve found that reading psychosocial cues from clients is so much harder when everyone is wearing masks. I’ve been more likely to ask direct questions about how a client is feeling rather than reflecting their emotions with statements like “It seems like you’re feeling…” because I can’t tell how they’re feeling at all! During my previous cancer rotation, I wore a face shield during sessions and could barely see the pedigree as I was taking it, which made for some messy pedigrees and lots of white out. On the flip side, I’ve built some great rapport with clients over our shared frustrations with our newly masked lives!” -Kaylee Williams

“I am definitely thankful for our clinical rotations to return to the in-person setting, but it has certainly come with some difficulties. To reduce the chances of spreading COVID at the Children’s Hospital of Pittsburgh, everyone is required to wear a mask, and the genetic counseling students, such as myself, are only scheduled to come in once or twice a week. This brings about some unique challenges. For one, asking classmates or supervisors questions takes more effort because you aren’t all together like how it was before COVID. Secondly, trying to read people’s facial expressions is nearly impossible when they are wearing a mask, so I find myself trying to listen to the tone of their voice as an indicator as to how they feel. But on the other hand, I still feel like I can make a connection with the people I meet, the conversations just might revolve around masks a little more now!” - Michael Gosky

 

“COVID has definitely thrown a wrench into our training and into everybody’s lives. I’ve taken to asking all of my patients directly how they’re feeling about the current pandemic. It’s a good way to get a feel of what I need to think about when I’m counseling. Some of the questions I think about: Are they extremely stressed or handling things relatively well? Are they feeling isolated from their support systems? What challenges are they facing with healthcare services? Knowing the answer to some of these questions helps me figure out what I can do for the patient.” -Chelsey Walsh

“The pandemic has created many challenges for everyone and in my training as a genetic counselor. Although I am thankful that we were able connect with patients through telemedicine during the summer months, I found that telemedicine comes with a unique set of psychosocial challenges. Many of my telemedicine patients did not have a quiet space in which to attend appointments and were distracted in our sessions by other family members and various activities taking place at home. I worried about how much information the patients were hearing and retaining throughout the session, so I was frequently asking patients about their understanding and using the teach-back method. Since returning to in-person rotations, I have encountered other challenges with everyone wearing masks and social distancing during sessions. Although necessary, masks make it harder to interpret patient facial expressions and for me to offer minimal encouragers to patients. In addition, social distancing with patients in the office changes the dynamic of the session to feel less personal initially. I find that contracting and building rapport are especially important during the pandemic to overcome the awkwardness of being physically separated in appointments.” -Kaitlyn Scola

Student Work Position: Genetic Counseling Assistant for UPMC Hereditary GI Tumor Program

I work as a Genetic Counseling Assistant (GCA) for the Hereditary Gastrointestinal (GI) Tumor Program at Shadyside Hospital. Part of the responsibilities of my job focus on tasks that we will also be performing in clinical rotations. These tasks include completing patient intake forms prior to appointments, requesting pathology reports, and calling patients for a family history intake. My job also involves entering patient pedigrees into progeny and documenting genetic testing results in patient records and research study databases. I have additional responsibilities in several research studies, and for this part of my work I review consent forms, ask research survey questions, document patient records in research study databases, and research participant follow-up. Lastly, I have the opportunity to provide information and training to incoming students in clinical rotations and the GCA position.

My thesis for the genetic counseling program is related to my position. It is based on our research study that evaluates in-person genetic counseling vs. a pre-recorded video of the information covered in a genetic counseling session for patients newly diagnosed with pancreatic cancer. My thesis project will assess patient satisfaction and knowledge outcomes based on the service delivery model in which they were presented genetic testing information for pancreatic cancer. As part of the project, I attend the multidisciplinary pancreatic cancer clinic at UPMC Hillman and Presbyterian to recruit patients into my thesis study.

Working as a GCA for the Hereditary GI Tumor Program has allowed me to gain extra clinical experience that is valuable in my training as a genetic counselor. Throughout my first year in the genetic counseling program, my work position provided me an opportunity to translate counseling skills discussed in the classroom into practice and as a result, I felt confident going into second-year rotations. In addition, my experience has helped me gain important research and professional skills that will be vital in my career.

Mariele Anneling, Class of 2021

 

Student Rotation: UPMC Ophthalmology Clinic

    As a second-year genetic counseling student, I would have started clinical rotations over the summer but due to COVID-19 concerns, we had remote rotation opportunities. My remote opportunity was a virtual 3-week experience at the UPMC Ophthalmology Clinic. The rotation consisted of two retinal dystrophy clinic days per week (attended remotely), one journal club, one variant case conference, and one genetic testing clinic day, and these opportunities provided a great learning experience. To gain knowledge of retinal dystrophies and relevant genetics regarding the eye, the video recorded lectures and journal articles were excellent literature tools. The videos were well organized and provided ample pictures of the retina representing different retinal diseases. One assignment that I completed was to fill in blank spaces that corresponded to different anatomical areas of the eye and retina. This assignment allowed me to gain a general understanding of eye and retina anatomy. As a result, I could gauge how a mutation in a gene responsible for a specific retina area could cause disease symptoms. If I had any questions, my genetic counselor supervisor, Michelle, would provide me with the answers and relevant information.

    I was able to observe patients virtually during the clinic days. Even though I could not interact with the patients due to the pandemic, I was able to see and hear clearly. During the clinic, Michelle and I would discuss each case and go through medical images of the eye, specifically of the retina. She would have me look at the literature for specific conditions when a patient was coming in with a syndromic condition, such as Usher syndrome, and then we would talk through what I learned. During the discussion, Michelle would ask me my thoughts and challenge me to think creatively and critically. This allowed me to consider how I would handle the session and understand which testing methodology (i.e. panel vs. single site) to choose for each patient.  I also had the opportunity to outline a genetic counseling session for the retinal dystrophy clinic. I went through my outline and Michelle helped me tweak my outline to show how a clinic session was different than a general genetic counseling session. It allowed me to tailor my thinking and how to adapt a general session to a more focused clinical setting. Going through the genetic testing results and interpretation was also helpful in understanding genotype-phenotype relationships. For example, Michelle and I discussed whether the result could or could not explain the patient’s phenotype.  In the genetic testing clinic, I was able to observe Michelle doing pretest counseling. I was able to see her modify her pretest counseling based on the client's needs and knowledge of genetics concepts.

    Another aspect of the rotation that I liked was the journal club and the variant case conference. The journal club helped with my professional development and presentation skills. Giving presentations are not my forte so being able to practice enhanced my confidence in this area. The variant case conference focused on challenging results, and this strengthened my interpretation skills. It was helpful for Michelle and Hannah to go through how to evaluate a variant when the lab did not provide an in-depth interpretation.

     I liked all aspects of this rotation. Given the pandemic, our rotation schedule had to be adjusted and I thought the opportunities available were great. The virtual aspect went smoothly, and Michelle and I maintained strong communication with each other. Overall, I enjoyed my time in the Ophthalmology clinic and learning about the genetics of the eye. I will use the constructive feedback provided by Michelle in my future rotations.

Haley Kulas, Class of 2021

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

Coping with COVID-19

Navigating life in the midst of the global COVID-19 pandemic comes with many challenges. Our current students share some strategies they have used to cope with social distancing during the pandemic.

"I really miss being with my family and friends so social distancing has been a struggle. I’ve been watching lots of comedies (Bob’s Burgers, The League, Avatar: The Last Airbender) to lift my spirits. I added a Couch 2 5K app to motivate me to go jogging (update: I have not stuck with it). Every day I try to read and do a puzzle. The brightest part of this time is snuggling with my cat Anastasia and connecting virtually with my friends."

-Chelsey

Ana is a hide and seek expert

I had just opened this puzzle and it was missing a piece!

"The silver-lining of COVID-19 for me is the amount of time I’ve been able to spend with my family. All of us are back home and work during the day, but we get to spend a lot of time together during the evenings. Board games are making a comeback! Zooming with my classmates regularly has also helped to brighten my days, whether we are doing homework together, working out, or having a happy hour. This has all definitely made me appreciate the little things!"

-Megan

"It’s difficult to work at home, and especially to see others so infrequently - I’ve been joking lately that the dripping sink and humming refrigerator have become the background noise in my brain. Outside-time has been my major coping strategy: at the end of the day, my partner and I go for a walk in the neighborhood (I’ve developed some major garden envy!) or drive to a regional park for a longer hike. I’ve also been appreciating weekly trivia over Zoom, with my friends in Minnesota and Japan. As before quarantine, Friday night take-out pizza from Pastoli’s is the highlight of the week."

-Madeline

"I’ve been keeping myself busy within my home. I watch movies, read books, watch tv shows, and work on schoolwork. Keeping my mind busy allows my mind not to go into the “What Ifs” of the current situation. I also walk around my neighborhood with my mom to get fresh air and sunlight." 

-Haley

"It has been a difficult past few months, but we’re all doing the best that we can. Frequent phone calls and video chats with friends and family have kept me grounded. I have focused on physical activity as a way of alleviating stress. I came across a book a few months ago called “60 Hikes within 60 miles of Pittsburgh”. It has been a lifesaver - anytime I am feeling uncertain of what to do, I simply get in my car and drive to the next hike on the list. I’ll have to figure out what to do with myself once I finish the list; it’s only June and I’m more than halfway through!"

-Ravella

Slippery Rock Creek

I also started a small windowsill garden with herbs and other plants (and some colorful painted rocks for fun).

My partner and I replaced the exhaust system in our car.
It took a while, but now it’s shiny and new!

Student Rotation: Agnes Ginges Centre for Molecular Cardiology at Centenary Institute in Sydney, Australia

Since beginning the process of researching and applying to genetic counseling programs several years ago, I knew that I was interested in a rotation experience abroad. With so many genetics professionals and teams working around the world to better understand genetic conditions and how to best care for individuals and families impacted by these conditions, I was very eager for an opportunity to learn more about how clinical and research aspects of genetics are approached outside of the United States. 

With a particular interest in cardiovascular genetics and research, I had the opportunity to spend two weeks with the team at the Agnes Ginges Centre for Molecular Cardiology at Centenary Institute in Sydney, Australia for my optional rotation. 

Centenary Institute in Sydney, Australia is devoted to cardiovascular, cancer, and inflammation research.

The Molecular Cardiology team is made up of genetic counselors, physicians, and researchers devoted to gaining a better understanding of the mechanisms, psychosocial implications, and management of inherited heart disease. During my time in Sydney, I worked closely with the team and learned about the variety of projects they are working on – from the laboratory, clinic, and psychosocial angles. I was able to attend many meetings and participate in discussions about current and future projects.

One of the main goals of my optional rotation was to learn more about genetic counselor roles in a research setting. The genetic counselors at Centenary are responsible for seeing patients in the inherited heart disease clinics, as well as research coordination. While I was unable to attend a clinic prior to leaving Sydney, over the two weeks I was there, I was able to speak with the genetic counselors and learn more about the Australian healthcare system, which differs in a number of ways from what I have experienced in the United States, as well as their clinic procedures, patients, and genetic testing processes.  

A good portion of my time was spent learning about variant curation. With a variety of research projects and registries available to patients and research participants with inherited heart disease, the Molecular Cardiology team coordinates many types of genetic testing and sequencing and is responsible for determining pathogenicity of variants identified through research endeavors. During my rotation, I was responsible for helping to classify research variants by using a variety of population databases, published literature, and ACMG variant classification criteria to determine if the genetic change(s) identified in an individual could be considered disease-causing and related to their clinical presentation. Throughout my training at Pitt, most of my experience with genetic variants has been in a clinical setting, explaining different types of result classifications to patients. This experience with variant interpretation was very valuable to my training and helped me better understand the effort that goes into determining pathogenicity of a variant prior to disclosing a genetic test result to a patient or research participant.

While at Centenary, I also had the opportunity to attend a genetic counseling clinical supervision meeting. Genetic counselors from multiple practice areas meet monthly to discuss difficult cases and provide peer support as part of a requirement for maintaining genetic counselor certification in Australia. In addition, I was able to meet genetic counseling students from the local training program in Sydney who were at Centenary as part of their clinical rotations. It was interesting to learn more about training programs in Australia and how they differ from our program at Pitt and other programs in the United States.

While I was focused on learning the most I could during my time in Australia, I also made sure to take some personal time to explore the wonderful city of Sydney. I was able to visit the harbor and the Sydney Opera House, the beautiful Blue Mountains National Park, and yes, I even met a koala!

Despite having to cut my rotation short due to concerns surrounding COVID-19, overall, I had a wonderful experience. I learned a great deal about the genetics of inherited heart disease, and was able to get some insight into the seemingly endless possibilities for genetic counselor involvement in a research setting. My newly acquired variant interpretation skills are a nice addition to my genetic counselor toolkit for the future.  This rotation served as an excellent finish to my rotation training and a nice transition into my new position as a clinical and research genetic counselor.

My sincerest thanks to genetic counselors Laura Yeates and Jodie Ingles, as well as all of “Team Cardio” at Centenary Institute, for welcoming me to Sydney and facilitating a fantastic learning experience!

Alyson Evans, Class of 2020