Student Spotlight: Natalie Tri

 

Everyone who is interested in the field of genetic counseling knows how competitive the graduate programs are. Over the years, it has been increasingly more difficult to apply and get into grad school directly out of undergrad. Many applicants are having to find work related to the field for a couple years after school to help build their applications up. I was one of those students who had attempted to apply to grad school straight out of undergrad and did not even get so much as an interview at any of the schools I applied to.

Afterwards, I started to look for work in the field and learned about a genetic counseling assistant position at Allegheny Health Network. I started as a GCA in July of 2018 and learned that I was the first GCA the program had ever had. This was a really cool experience to be a part of because not only did I get to grow my own skill set and learn more about the world of genetic counseling, but I got to shape the future of the genetic counseling assistant position. With a second GCA who joined, I supported six genetic counselors. As a GCA I got to learn more about the full experience of being a genetic counselor. Genetic counselors are not only responsible for seeing patients, but there is a whole host of additional responsibilities including putting in genetic testing orders, verifying insurance claims and getting insurance authorization, and tracking down old patient and family records. This work is what many students who shadow a genetic counselor are unaware of. My position allowed me to see the inner workings of the job that I hoped to do one day.

As a new GCA, I also got to help build the future of the jobs. Many of the counselors had never worked with a GCA before, which was a good experience for the counselors as well. I got to be there for them and show them that a GCA was capable of putting in test orders, getting insurance authorization and tracking down patient records. These were all things that the genetic counselors had been doing for themselves. I was also thankful to be able to have opportunities as a genetic counseling assistant that I would not have had in another position. I was able to help the counselors with various research projects and ended up getting three posters at national genetic counseling conferences over the two years I worked as a GCA. I also was fortunate enough to collaborate on a published paper with a physician at AHN as well.

Overall, my experience as a GCA gave me valuable insight into the field as a whole and allowed me to have numerous opportunities that furthered my career as a GCA and boosted my applications for grad school. I am so thankful to be able to have had the opportunities I did and the experiences I had the ability to work with genetic counselors and make connections with individuals in the field who would eventually become my colleagues. For anyone who is considering applying to grad school for genetic counseling, I would strongly recommend considering working as a GCA for a year or two. This experience is an invaluable one and can really help strengthen your future application.

-Natalie Tri

Student Spotlight: Experiences Beginning Clinical Rotations

Here at the University of Pittsburgh, genetic counseling students begin their clinical rotations the summer after their first year. Students start out in a variety of settings and specialties, so each student has a unique experience. Read more about how we've adapted to these new steps in becoming a genetic counselor! 

I think clinical rotations are a part of the program we all look forward to as soon as we’re matched to a program, especially because at Pitt we spend the summer before second year, and the entire second year, focused mainly on rotations. I was really excited to get started but I was having some self doubt that I was actually ready. We’ve learned so much over the first year but at least for me, I still felt “Was this enough for me to work with patients?” Now that we’re a few months into rotations, the answer is yes. Of course you’re never going to know everything and you’re going to learn so much while actually rotating, but it’s so important to have confidence in the material you do know. Give yourself the credit you deserve and trust yourself because as soon as you do, your sessions will start to have more of a flow.

-Julia Knapo

 

 

 

Starting clinical rotations this summer was incredibly exciting, but also quite nerve-wracking. I was worried that I wouldn’t know what to do when I got into a real session with a patient. Though there was definitely a learning curve, it didn’t take me as long as I expected to start feeling comfortable. My first rotation was cancer, which is the rotation where we spend three weeks at the AHN clinic site and six weeks at the UPMC clinic site. The counselors at each site worked with me to make sure that I felt prepared before taking on new roles in the sessions. This gradual buildup of responsibilities helped me feel more capable and confident. I was able to become comfortable doing each part of the session before taking on the responsibility of doing a full session. Overall, although there were a lot of nerves along the way, I was surprised by how much I was able to do in that first rotation. I feel so grateful for the exposure we got to such a wide variety of patients in this rotation. I can’t believe we’re done with our first rotation block already, time really does fly!

-Savannah Binion

 

 

 

Admittedly, I was a little nervous about starting clinical rotations because COVID-19 really limited students’ ability to observe and “get in the zone” prior to starting. However, supervisors throughout my first rotation at UPMC Magee-Womens for the past nine weeks have been so supportive and understanding of student experiences that I have felt confident and adventurous in my ability to take on new parts of the counseling session. Of course, there have been challenging sessions - the most cringe-worthy coming to mind is when I case-prepped for the wrong indication based on some confusion in the contact notes (and for a telehealth visit, no less)! I was a complete ball of nerves, but the supervisor working with me that day did such a great job of normalizing feelings about a rocky session. She also reminded me that every session is a new chance to improve and restart feelings about an emotional or difficult case. I was able to pick up the pieces and keep moving with my head held high throughout the rest of the day! All of this is to say: lean on your supervisors. This is one of many scenarios when the counselors around me gave me wholesome, realistic advice about how to improve my counseling style. Find one, two, three people you can come to when you are feeling overwhelmed or need additional guidance. Without question, invested mentors are a large part of the reason I made it through my first rotation feeling good about my techniques so far and eager to improve!

-Frank Swann

 

 

Beginning clinical rotations was an exciting time for myself, as I felt like we had prepared all year in classes for this time. I started my rotation in the cancer genetics department which was a benefit for me, as I had worked in cancer genetics as a GCA for the two years prior to school starting. Jumping into rotations was a big learning curve, but I learned that the rotations documents provided coupled with a planner are my new best friends. For the incoming class, I would highly recommend knowing what you need to do before each rotation starts and making sure to complete the assignments as far in advance as you can, as that really saves you from unnecessary stresses further into the rotation block.

-Natalie Tri

 

 

After finishing the spring semester, I knew clinical rotations were the next step, and I remember feeling excited but also still slightly unsure of myself. Would I be able to adjust and handle the demands of clinic life? These feelings were dismissed once I started my rotation and met all of the wonderful supervisors that would be guiding me through this process. My first rotation was in pediatrics at the UPMC Children’s Hospital of Pittsburgh. This rotation was certainly a lot of work, especially in prepping for patients. I think it is important to be organized and reach out to the supervising GC in a timely manner to be sure you are prepared for the case. Overall, it has been quite empowering to take everything I have learned over the last year and begin to apply it in the clinic setting. There is certainly an adjustment when starting rotations, but I think it is important to trust yourself and be confident in the knowledge you have been building throughout the program.

-Maria Rhine

 

 

 

Starting clinical rotations was exciting and nerve wracking! I knew that the courses taught in the first year prepared me to start rotations, but I was still nervous. I started my rotations in pediatrics at UPMC Children’s Hospital of Pittsburgh. Starting in pediatrics was definitely a challenge and a lot of work outside of the clinic to prepare for your cases. This rotation allowed me to slowly build my skill set and all of the Genetic Counselors were very supportive with their feedback. One of the biggest things I am taking away from my pediatric rotation is that I need to be confident in myself and the material we have learned over the past year.

-Kristen D’Aquila

 

 

I was excited and nervous to enter my second year and to start clinical rotation. My rotations began with specialty rotation, thesis block, and primary care & precision medicine (PCPM). I was glad to be eased into rotation with observation since we had little to no observational experience in our first year due to COVID-19. During the thesis block, it definitely felt like I was falling behind from everyone else for not having as many counseling experiences. However, the primary care rotation became one of the huge learning curves for me to start catching up. It is important not to compare your progress and improvement with your peers as each one of us will have unique schedules and learning experiences.

-Aika Miikeda

 

 

My first rotations included three weeks of Specialty, Primary Care/Genetic Testing Clinic, followed by three weeks on thesis. I was nervous going into the Primary Care rotation because unlike Specialty rotation (which was mostly observational), Pricary Care engaged students’ participation quite early because we only had three weeks in this block. I got a little overwhelmed during my first week but started to get more comfortable once I went through the process of thinking things through when articulating genetic concepts to patients, facilitating decision-making, and especially analyzing different elements of cases to come up with a plan. I was grateful for specific feedback from my Genetic Counselor Advisors, who wanted to help us learn and always responded enthusiastically to my eagerness in learning. One takeaway for me after the Primary Care rotation is that open-mindedness and not being afraid to jump into or try new things will help me make the most out of the learning experience, and I will try to keep up such spirit in the upcoming rotations.

-Phuc Do

 

 

Starting rotations can be a challenging time because you’re trying to find a new routine. I started my rotations at West Penn prenatal, which I would say is one of the easier rotations. I would recommend keeping a log of the assignments that are due for each rotation. Also be flexible, try not to jam pack your weekly schedule. Sometimes patients no-show or you see a procedure, so you’ll want to make sure you leave room to make up patients if needed. Rotations are a great time to learn and apply your classroom knowledge in a clinical setting. Remember to have fun and be open to feedback. Also, don’t forget to talk to your classmates and second year buddies for support!

-Haley Soller

 

 

Like my classmates, I was excited and nervous to start clinical rotations! Having just completed my first rotation at Magee, I can reflect on how much I’ve been able to learn, build new skills, and apply coursework in a clinical setting. I also felt like the rotation process has taught me a lot about myself and what I want to accomplish as a genetic counselor. Though this experience is challenging, I try to remind myself that this is part of the process of becoming a genetic counselor, and as I continue to learn and take more roles in sessions, my confidence grows. I also find it helpful to remind myself that every GC has been in the same position we are as rotating students. I’m so grateful to our program leadership, clinical supervisors, and classmates who are there to support us every step of the way. 

-Lauren Garcia

 

 

 

Starting rotations this summer was exciting, especially after a whole year of everything being virtual. It has been so nice to step out from behind the computer screen and start applying the knowledge and skills we spent so much time building during the first year of classes. That being said, it has also been a very challenging experience. My first rotation was with the pediatric genetics clinic at UPMC Children’s Hospital of Pittsburgh. This rotation is incredibly busy and definitely a lot of work. Preparation for these cases is very involved and there are many assignments to keep track of. I have found staying organized to be extremely important. Pediatrics also tends to have a higher rate of no-shows, so I recommend trying to be flexible with your schedule since you may need to make-up cases. Remember that your classmates, supervisors, and program leadership are there to help you succeed!

-Elizabeth Bombal

 

 

One thing I really liked about Pitt’s program when I was applying was the confidence-building model, where our first year is primarily coursework and our second year is primarily rotations. This also means that entering my first rotation was a complete change of pace and a huge learning curve! Despite some of the bumps in the road, I’ve had a lot of incredible experiences and I’ve grown so much just over the course of one rotation. Learning to be a real genetic counselor and put all this didactic learning into practice has been challenging and very rewarding, and makes me more certain than ever that this is the field I’m meant to go into.

-Bailey Sasseville

Student Spotlight: Specialty Rotation

 

Phuc Do

    Unlike most of my classmates, I hit the ground running with clinical rotations in specialty – a unique, largely observation-based rotation that provided me with opportunities to see a wide array of clinics in which genetic counselors work. The first look at the schedule made me a little overwhelmed and excited with each and every clinic day varied in its title and often locations. With this being my first rotation, I was also thinking about how to organize such a variety of information/clinic settings and get the most out of observing. I did not yet experience what a “traditional” structured genetic counseling session should be (aside from stimulated patients), and here I was, already preparing to be exposed to the non-traditional, specialized sessions. Excitement grew inside me with the anticipation that every clinic day is a unique learning environment, where I could meet different experienced GCs and learn from them in specialized fields. A few names of my clinic days include ophthalmology, pediatric oncology, adult Down syndrome, and cardiogenetics.

    One thing I was glad that I started early on was to reach out to the GCs in each clinic a week or more before the clinic day. Each clinic has a different set of expectations for which a GC intern should prepare in advance, along with prior or follow-up assignments that consolidate the student’s takeaways. Every week, I also chose a memorable case on which to write chart notes and create my own outline. To systematize our observations, I was also provided with an “Active observation form” from the program to do brief case prep and fill out sessions’ information. 

    Although the specialty rotation is considered not as intense relative to others, initially I was a little overwhelmed with such a variety of information. Furthermore, with all the clinics being very specialized, I found myself not being able to come up with specific testing options or strategies. Despite spending a whole year in the classroom, observing the functioning of specialized clinics had actualized in me the gap between classroom and practice, with the recognition that a genetic counselor’s roles are fluid and flexible within a hospital or even a specialty. An example would be the Muscular Dystrophy Association (MDA) clinic, where Kelsey Bohnert, my GC supervisor, took turns with other providers in the multidisciplinary team to see patients. This streamlining approach is to enable the muscular dystrophy patient’s convenience in their new, follow-up, or routine appointments to see all the specialists at once, including Dr. Hoda, the director neurologist, the PA, the physical therapist, the rehab doctor, and the genetic counselor. It was eye-opening to see how Kelsey counseled patients with needed contents conveyed and proper informed consent achieved but in a very time-efficient manner, allowing time for other specialists and for a constant clinic flow. Fresh from the classroom with the idea of a 30–40-minute session, I felt the need to learn the ability to greatly customize sessions. It seemed like a daunting task, but it was necessary to incorporate genetics into patient’s care.

    Slowly, I practiced seeing that gap as the room to grow. It was exciting to realize that as long as I kept the growth mindset, I could mold my professional development to focus on a deeply specialized sub-specialty or condition I am interested in. Such appreciation came from the great support I had from clinics’ supervisor. I had felt the eagerness to help me learn from every genetic counselor, doctor, and coordinator I came across, who wrote helpful summaries or handouts, provided me with recommended readings, and always gave me time for debrief and Q&A. I found clarity and interesting stories when asking questions from cases, clinics, testing options, patients’ programs, to career paths of how my supervisors came to participate in such unique clinics. For example, it was a wise search for a fast-paced, specialized practice setting that helped Michelle Alabek to land her job at the eye clinic, where she served as both a genetic counselor and a coordinator. After the patient saw the optometrists and had ocular imaging, the attending physician, Dr. Sahel, would see the patient to review medications and testing options, for which Michele would counsel. The eye clinic at UPMC housed cutting-edge technologies and clinical strategies especially for inherited retinal degenerations. Dr Sahel, the director, is a worldwide-renowned expert for development of vision restoration techniques. Michelle remarked on her experience seeing impressive bench-to-bedside approaches utilized to benefit the patients. When asked about her journey, she guided me with helpful tips and questions to ask in job interviews such as the position’s role, peers’ interaction, and past experience working with GCs, in order to tailor job search and form your development. 

    There are many other unique, by no means less interesting learning experiences in the specialty rotation to fit into one blog spot, so I will leave it here to not spoil all the excitement. I ended this rotation with a great appreciation for my mentors, the exposures, and the hope of experiencing more of such a variety and expansion of GCs roles in the future. I hope that my experience leaves you, the readers, some sneak peeks into this one-of-a-kind rotation, as I prepared myself for another unique one that Pitt has to offer – the primary care/genetic testing rotation.

Best of luck to everyone this summer!

Phuc Do

 

 

Student Spotlight: GCAs at the UPMC Hereditary GI Tumor Program

 

Lauren Garcia (left) and Aika Miikeda

We work at the UPMC Hereditary GI Tumor Program as Genetic Counseling Assistants (GCAs). The majority of patients come to our clinic for hereditary GI cancer risk assessment or management, including Lynch Syndrome, Familial Adenomatous Polyposis (FAP), Hereditary Diffuse Gastric Cancer (HDGC), Familial Pancreatic Cancer (FPC), and more. The team consists of a gastroenterologist specializing in hereditary GI predispositions, two genetic counselors, Beth and Eve, and several research coordinators who enroll and coordinate patient participation in various research studies. Typically, we see about 10 new patients per week. Patients with known familial variants may choose to have single-site testing, and others may be tested using multigene panels that include many cancer predisposition syndromes. One of our roles as GCAs is to collect relevant past/current medical histories and family history information before these appointments. Other tasks include entering pedigrees and genetic test results and inputting patient information into the research registry. Both of us have the same roles and are assigned to each genetic counselor in the clinic.

 

What’s it like to work at the clinic? 

Working at the GI Tumor Clinic continues to be a unique and rewarding experience. Both of us feel that it's been valuable in our development as future genetic counselors. It has been especially helpful in applying core genetic counseling skills, like constructing pedigrees and interpreting genetic test results. During the beginning of the pandemic, the office set up remote options for the previous GCAs, which allowed us to have a lot of flexibility when we took our positions. Both of us had periods where we worked out of the state or out of the country because we had access to everything we needed from home. Even with loosening restrictions, we are still mostly remote, which has been helpful during busy rotation schedules. Each of us stops by the office about once a week to drop off or pick up paperwork. Typically, the GI clinic has one GCA per class, but when we entered the program, they decided to hire two GCAs. Having two GCAs allows us more flexibility and the opportunity to learn and discuss questions with one another, especially in the current remote nature of our job.

 

Why did we choose this position?

Lauren: Before grad school, I had a strong interest in cancer genetics and worked as a researcher in a cancer laboratory, mainly focusing on breast and ovarian cancer. I knew that I wanted to continue working in this space and was excited to apply for this position, as it seemed like a great fit. In addition, I liked that I would be able to actively apply what I was learning in class, such as constructing pedigrees, reading test results, and becoming more familiar with GI cancers and the many roles of a genetic counselor in this environment.

Aika: I have always been interested in GI cancer predisposition syndromes, and I wanted to do my thesis on this topic when I got into a GC program. When the GI Tumor Program work position became available, I was very excited to apply and learn more from my work position. We are also provided an opportunity to do a thesis with them, and I am on board with exploring my thesis in the clinic. I am very thankful for being able to explore my interest in the cancer genetics field as a GCA.

 

 

Prospective Applicant Experiences

 As we finish one application cycle and prepare to enter another, many individuals are wondering how they can improve their applications to have the best chance of matching with a genetic counseling program. It’s important to have experiences that prepare someone for entering graduate school as well as the field of genetic counseling. Shadowing genetic counselors is a classic example of this, but there are actually many more potential experiences individuals can consider.

 

If you want to become a genetic counselor, the most important thing you need is exposure to the field -- essentially, learning what it means to be a genetic counselor to ensure that it’s what you really want to do. Shadowing is the most hands-on way to do this, but finding opportunities can be difficult. There aren’t many genetic counselors compared to other healthcare providers, and they tend to cluster in larger cities, making it harder for individuals in rural areas. Healthcare systems also might place restrictions on whether individuals are allowed to shadow genetic counselors during sessions with patients, even when we’re not in the midst of a pandemic. If you can get shadowing experience, great! If not, here are some other resources!

 

Talk to genetic counselors -- by phone, by email, by whatever means you can. At www.nsgc.org, you can search for genetic counselors who are open to being contacted by individuals interested in the profession. Asking questions of genetic counselors practicing in a variety of settings is a great way to learn about genetic counseling straight from the source. This will help give you an idea of their day-to-day life, their favorite and least favorite parts about their job, and whatever else you’re interested in. Genetic counselors love helping prospective applicants, so don’t be afraid to reach out!

 

Educate yourself. There’s a whole host of media out there for you -- podcasts, books, seminars, webinars and more. These can teach you not only about what the field of genetic counseling is like in general, but also about specific genetic syndromes, legal debates, issues within the profession, and more. Use these resources to round out your understanding of the field.

 

This isn’t a comprehensive list of ways to get exposure to the field, but it’s a good starting place if you’re feeling a little lost. Anything that helps you learn about genetic counseling counts! Just remember to list it somewhere in your application -- if you don’t, how will programs know all the work you did?

A Day in the Life: First-Year Students

One of the most common questions prospective students ask is, “What is it like to be a student in your program?” We hope to answer that, at least from the perspective of a first-year student at the University of Pittsburgh. Both inside and outside of the curriculum, each student has a unique daily experience. Here’s a brief look at that variety! 

This year has taught me that I need a routine in my life more than I originally thought I did! The majority of our semester has been online, which means I spend the majority of my day in my apartment. In the beginning of the year it was difficult to find the best way to organize my time outside of classes. I was so used to the routine of getting up and going to class (in undergrad) or work (before starting GC school) that without a specific routine of where I needed to be, I found myself spending the time between or after classes in ways that probably weren’t helpful to getting my work done. Once I forced myself to set a schedule of when I would be in class, when I would work on schoolwork, and when I would work my part-time job, I had a much easier time with the semesters. Now that I’ve made myself more of a schedule, I find myself spending the day going to class, studying, and/or working as a part-time genetic counselor assistant at Children’s Hospital, and even finding time to hangout with my classmates, work out, or catch up on episodes of RuPaul’s Drag Race and 90 Day Fiancé. Grad school in a pandemic is definitely strange, but it’s a unique experience and I’m happy to have such a great group of people to do it with. 
-Julia Knapo

Throughout my first two semesters in the Pitt program I’ve spent most of my time in classes and at my part-time job! We do the majority of our classes within the first year, and then do mostly clinical work during our second year. Almost all of our classes have been remote this year so I’ve been spending most of my class time in my apartment here in Pittsburgh. We did get to have a few classes in-person when cases in the city were low, which was a really great experience! Aside from classes I’ve also been spending time working a part-time job at Magee-Womens Hospital as a genetic counselor assistant. It can be tough to balance working a job with my school work, but I really value the time that I spend working in the clinic at Magee. Whenever I have free time, I generally like to try and explore Pittsburgh or spend time with my classmates! The pandemic has definitely made that more difficult, but we’ve been able to spend time with each other in socially distant ways which has still been such a fun time!

-Savannah Binion

It’s hard to sum up what “a day in the life” of a first-year student is, because each day feels totally different from the last, and each student has a different day. From the outside, it looks like I spend most of my time in my apartment, attending classes via Zoom while my classmates do the same from their apartments. While that’s true, our classes progress quickly, so it feels like every day I’m a bit more of a genetic counselor than the last, and it never gets boring. Our knowledge base builds upon itself and enables us to take on new assignments and tackle new parts of the genetic counseling process. We are full-time students, so this learning takes up the majority of my day or my week, but it still leaves plenty of time for other pursuits! I have a part-time work position as the student worker for the first-year class, and I love the flexibility of being able to choose my own schedule for that. I find time to explore the city, go on walks around nearby parks, and bake enough bread to feed a family. And we all find time to meet up for socially distant get-togethers!

-Bailey Sasseville

Reflection on the Leadership Seminar with Aishwarya Arjunan

Each year, the Pitt genetic counseling students invite a leader in the genetics field to speak with current students and give a seminar that addresses leadership for the department. This year, the class of 2021 invited Aishwarya Arjunan, MS, MPH, CGC, CPH. Aishwarya graduated from the University of Pittsburgh’s Graduate School of Public Health with a dual degree in Public Health and Genetic Counseling, as well as a certificate of Global Health. After graduating, she practiced as a clinical genetic counselor in Chicago for 2 years at the Ann and Robert H. Lurie Children’s Hospital and the Center for Jewish Genetics. Aishwarya has since then transitioned into industry, now serving as a Senior Clinical Product Manager for carrier screening with Myriad Genetics. She is a tireless advocate for medical and patient communities, constantly voicing the inequities of race-based medicine and the importance of expanded carrier screening in reducing healthcare disparities. In her talk, Aishwarya shared her experiences as a minority genetic counselor and her thoughts regarding where the field of genetic counseling stands today. In this blog, some of our student’s share their thoughts after Aishwarya’s presentation.

 

To view Aishwarya’s presentation, please visit: https://pitt.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=0671db55-98c4-4a2f-ba43-acbf0139df07

 

I really enjoyed Aishwarya’s presentation! It was clear from her talk that we have come a long way as a field in terms of providing opportunities for inclusion for individuals with a minority background, however we still have a long way to go. It was really interesting hearing Aishwarya’s own story of how she became so involved in the field and now acts as an advocate for change and inclusion. I truly appreciate that Aishwarya took the time to give a presentation to the Human Genetics department and then meet with the GC students afterward.

Michael Gosky, Class of 2021

 

I met Aishwarya during our virtual rotation with Myriad Women’s Health over the summer, and her knowledge and passion for her work was inspiring. I was so happy that she was able to speak at our Leadership Seminar and talk about her experiences. The utility of expanded carrier screening was a hot topic at NSGC this past year, so I was grateful to hear her perspective on it, both as a minority genetic counselor and as a product manager at Myriad. She is an excellent role model and mentor!

Megan Czekalski, Class of 2021

 

I appreciated Aishwarya taking the time to meet with us! It was a timely reminder of how many opportunities we have as genetics professionals to make healthcare more equitable. I also was grateful that she discussed provider burnout and how to make sure we don’t overextend ourselves.

Chelsey Walsh, Class of 2021