Show, Don't Tell: Empathy in Practice - Alex Stauff

Many of the skills I learned as a resident assistant (RA) have been helpful so far in grad school. A lesson that has really stuck with me came from a three minute video (link below) we watched during one of our summer training sessions. It was an animated short on empathy, with delightful anthropomorphic animals and a voiceover by Brené Brown.

In her words, “Rarely can a response make something better. What makes something better is connection.”

This little clip assuaged so much of the anxiety I had about supporting students through a difficult time. Fears like—what if I say the wrong thing? What if the other person can’t tell that I genuinely care?  

Words certainly matter, especially in a field like genetic counseling, where precision in language is critical. But without connection, words roll off like rain. There’s nothing anchoring them.

To me, connection means first and foremost: presence. This feels like an achievable starting point, requiring nothing more than focusing on the person in front of you. No matter how a conversation unfolds, I can be present.

Dr. Vellody, director of the Down Syndrome Center of Western PA, gave a really beautiful example of emotionally responsive communication in a lecture to first year students last semester.

We asked for advice about disclosing a Down syndrome diagnosis in the prenatal setting. I think many of my classmates and I were getting hung up on choosing the right words.

But Dr. Vellody’s focus didn’t start with the words. He said, provide the diagnosis, and then wait for an emotion to come up. Validate it. Wait for another emotion … validate it …. And keep doing this until a person is ready to talk about anything other than how they feel.

When I started my position as a GCA at Magee-Womens Hospital, I was able to sit in on weekly case conferences. This was a really helpful way to “peek behind the curtain” and start getting a feel for clinical and psychosocial considerations before I applied to school. I remember one particular situation a student shared, and the advice she got …

This student and her supervisor recently saw a patient who was newly diagnosed with breast cancer. The patient was extremely upset throughout the session and finally burst out at the student, “Have YOU ever had cancer?! Has anyone in your family even had cancer? Then, how can you have ANY idea what you’re talking about?” The student was distraught and had been at a loss for what to say – she posed the question to the group.

Truthfully, I was glad to be a fly on the wall during the discussion. It feels awful when someone’s anger feels—fairly or unfairly – directed at us. It can be so easy to slip into deflections and defensiveness.     

A seasoned nurse navigator gave advice that immediately reminded me of that short video I love so much.

She said, “You’re young, but I bet you’ve felt fear, or grief. And if you haven’t – you will. Those are likely some of the emotions underlying this woman’s anger. Acknowledge them and connect to those.”

I’m planning to keep that invitation to vulnerability and openness at the front of my mind as I prepare for patient simulations later this semester, and oh-so-quickly approaching rotations this summer.

Video: https://www.youtube.com/watch?v=1Evwgu369Jw

Dr. Colleen Campbell Leadership Seminar Reflections

Dr. Colleen Campbell, a genetic counselor with the University of Iowa Hospitals and Clinics and assistant director at the Iowa Institute of Human Genetics, spoke to our students and Pitt Public Health faculty on December 1, 2023, as part of our Genetic Counseling Leadership Seminar Series. Below are some student reflections on her presentation:

After Dr Colleen Campbell’s insightful presentation, it became apparent that the perceived shortage of genetic counselors in the United States is intricately linked to the uneven distribution of these professionals across states. Dr Campbell pointed out that the total number of genetic counselors may be sufficient, but the geographic dispersion exposes a significant imbalance that poses challenges to health equity. Compared to other patients who enjoy more convenient proximity, the discrepancies become palpable when considering the considerable distances some patients must travel, which can exceed 200 miles, to access crucial care. Dr Campbell’s discussion prompts a deeper reflection on the strategic allocation of genetic counselors across diverse regions. Her emphasis on initiatives like "Charting the Genetic Counseling Landscape: Shaping Public Policy and Advocating for the Future of Genomic Healthcare" underscores the need for collaborative efforts to address and rectify these challenges. After Dr Campbell’s thought-provoking presentation, it becomes crucial to carefully explore strategies ensuring fair access to genetic counseling services. This contemplation seamlessly fits into the wider objectives of advancing genomic healthcare. Dr Campbell’s discussion not only sparked meaningful conversations but also propels future genetic counselors like me to take concrete actions in cultivating a more evenly distributed and accessible framework for genetic counseling services. As I continue my education and enter the workforce, I am inspired to keep this imperative at the forefront of my professional endeavors, advocating for equitable access and contributing to the transformative journey of genomic healthcare. Dr Campbell’s talk has instilled in me a commitment to actively participate in addressing these challenges and working towards a more inclusive and accessible genetic counseling landscape. – Swathi Balaji

The Pitt Public Health students were incredibly lucky to have had the opportunity to hear from Dr. Colleen Campbell at our annual GC leadership seminar. I loved learning about how the field of genetic counseling is influenced by politics and legislation, and Dr. Campbell's advocacy work is truly inspiring. She also offered interesting perspectives about healthcare equity in rural areas and steps that GCs can take to address these inequities. This was an incredibly engaging and thought-provoking conversation, and it has certainly left a lasting impression on myself and my classmates. – Emily Hrach

Listening to Dr. Campbells presentation was inspiring: she is making huge contributions to the field of Genetic Counseling, not only with her advocacy work, but also modeling how GC skills can be used outside of the clinical care environment to empower professionals and improve access to health care. With the growing need of genomic testing interpretation and patient centered genetic services, there is urgency in updating the licensure, professional status, and reimbursement frameworks for genetic counseling. Dr. Campbell provided a vision to move forward and showed us that if there are limited paths to follow, we can always create new opportunities for change. There is so much work needed to overcome the political hurdles that interfere with more equitable access to genomic healthcare in our country. To start, I signed up to meet with my district’s Representative. I believe that we all can participate in building a better future. – Alejandra Bernal

Our training as genetic counselors prepares us to work with patients in various clinical settings. While we regularly discuss aspects of care such as research and clinical trials, empathy, and multidisciplinary care, I did not previously reflect deep into how our counseling skills transfer to public policy. Dr. Campbell elegantly laid out how we can utilize our training in collaborating with lobbyists and legislators to advocate for patients on a larger scale. I am grateful to have had the opportunity to chat with Dr. Campbell. Her advice and positive outlook make me excited to start my journey as a genetic counselor. – Megan Zieber

Whenever someone asks me “what is genetic counseling?” I always describe it as a combination between a doctor, a teacher, and a counselor for genetic conditions. However, Dr. Colleen Campbell's talk emphasized a crucial fourth role that a genetic counselor can take on: an advocate. Furthermore, Dr. Campbell shared how genetic counselors are not only amazing political advocates because of their deep understanding of genetics and patient psychosocial experiences, but also because many of the skills developed as a genetic counselor are important in political advocacy. After hearing her talk I feel I have a deeper understanding of the potential roles and applications of genetic counseling and am even interested in taking part in advocacy myself after I graduate. Thank you, Dr. Campbell, for your inspiring work and presentation! – Jennifer Reif

Dr. Campbell was so personable and knowledgeable. I hadn’t spent much time considering the legislation that impacts our practice as GCs, so I appreciated getting a glimpse into this. I’m excited to help pick next year’s speaker! – Alex Stauff

Listening to Dr. Colleen Campbell's lecture titled "Charting the Genetic Counseling Landscape: Shaping Public Policy and Advocating for the Future of Genomic Healthcare" shed light on the essential partnerships and interdisciplinary efforts required to broaden access to genomic medicine. While I've always been drawn to the field of genetic counseling due to its collaborative nature, Dr. Campbell's insights expanded my understanding. I had previously recognized the importance of partnerships with patients, healthcare providers, and fellow genetics professionals. Yet, I was genuinely intrigued to discover the advocacy work at both the State and Federal levels, particularly regarding the licensure and passage of the Access to Genetic Counselor Services Act. Dr. Campbell's recounting of her journey in securing licensure in Iowa vividly showcased that our envisioned paths often differ from the realities we encounter. As I progress in my training and embark on my professional journey, I am inspired by the lessons of resilience and adaptability she shared, and I intend to carry these invaluable insights forward. – Jerome Doerger

Three Generations of Genetic Counseling Club

The Pitt Genetic Counseling Club was established in 2016. The club aims to educate students on genetic counseling as a career, as well as assist with applications for those already decided on the career. The GC Club meets twice a month, with periodic workshops and volunteer opportunities.  Jodie Vento serves as the faculty mentor for the group.  Hear from three past and current members about their experiences in the Pitt Genetic Counseling Club!

Gopika  Jan 2019-April 2022

I first heard about genetic counseling during spring semester my freshman year, and joined Pitt’s genetic counseling club shortly after that. Through attending club meetings, I was able to learn more about the genetic counseling field and confirm that this was the career I wanted to pursue. One of my favorite parts of the genetic counseling club was being a part of the communications committee, a small group of club members that put together a newsletter discussing different topics related to genetic counseling. We wrote articles about various genetic conditions, current challenges in the genetic counseling field, tips for grad school applications, and interviewed current genetic counselors (GCs) and GC students. Writing and editing articles for the newsletter helped me educate myself on the current state of the genetic counseling field. For example, following the initial outbreak of the COVID-19 pandemic in March 2020, there was an increase in the use of telemedicine. We decided to focus our next newsletter on telegenetics, writing articles about the benefits and challenges of telemedicine and interviewing a GC who provided services solely via telemedicine. Conducting research for articles and speaking with GCs was definitely beneficial for growing my understanding of the field, and preparing for grad school applications. I’m so thankful for my time in the genetic counseling club and I hope it continues to be a wonderful resource for future prospective GC students.

 

Grace  August 2019-April 2023

My time within Pitt’s genetic counseling club is something I will never forget. Much of my understanding of the field was garnered at club meetings where we would speak with practicing GCs, have genetics related ethical debates, learn about various genetic disorders, hear from current students, and evaluate the process of applying to graduate schools. It was inspiring to find a community of people who shared my passions and be able to learn and grow together. One of the biggest blessings of being in the club was having a supportive and noncompetitive community when applying to programs. On several occasions, those applying would get together to discuss their CVs and personal statements, and even practice for interviews. It tremendously helped to make me feel less alone when going through a very stressful process. Overall, my time within Pitt’s genetic counseling club bolstered my love for the profession, helped me develop key skills, and provided me with life-long friendships.

 

Alyssa  August 2020-Present

I first joined as a member of the Genetic Counseling Club at Pitt during the Fall 2020 semester—my very first semester of undergrad. Coming into college with an interest and some previous knowledge about the field of genetic counseling, I was beyond excited to join a club dedicated to the field. I attended online club meetings every two weeks since my freshman year of college was completely online (due to the COVID-19 pandemic). Between navigating the nerves and uncertainty of my first year of college, acclimating to online classes, and attempting to make friends in a time of such overwhelming isolation, I found support in the Genetic Counseling Club - every other week I had something to look forward to. In addition to the club meetings, I was able to write for the club’s student-led newsletter. I appreciated the opportunity to focus and really dive into different topics and discussions in the field, and I enjoyed being able to collaborate with peers to produce an engaging resource. The genetic counseling club allowed me the opportunity to get to know my fellow peers who shared similar aspirations and a passion for pursuing a career in GC—and I am forever grateful to have met such a supportive and encouraging group of friends!

 

For more information on the Genetic Counseling Club including meeting dates/times, visit their webpage, email gccatpitt@gmail.com or follow @gcc_upgh on Instagram.

Nutritional Genomics: A New Landscape for Genetic Counseling? - Victoria Kostour

 

During my time as an undergraduate, I had many different interests that I was not sure I could integrate into one career. However, genetic counseling continued to appeal to me because of the opportunity to create new roles in a variety of healthcare areas. Although most are familiar with the few core specialties (prenatal, cancer, and pediatrics), I was surprised to learn about opportunities in disciplines like cardiology, neurology, industry, and ophthalmology. Something that particularly caught my attention was the development of nutritional genomics.

Nutritional genomics has two main branches: nutrigenetics and nutrigenomics. Nutrigenetics is a field that explores how our bodies respond to what we consume. Understanding these genetic impacts may help practitioners recommend specific workouts and supplements to clients. On the other hand, nutrigenomics describes how what we consume impacts gene expression. During my undergraduate career, I participated in nutrigenomic research that investigated how dietary bioactives can impact gene expression that play important roles in various metabolism pathways. I was fascinated by how the food we consume has the potential to change our genetic ecosystem.

In a NSGC Genetic Counselors and You Podcast episode titled “My Nutrition, My Genes,” registered dietician nutritionist Jill West described her experiences using genetic testing to adjust diet and maximize prevention strategies. For example, she shared that genetic testing can be used to understand how patients metabolize caffeine and sodium. If someone’s genetic testing reveals they are a slow metabolizer of these compounds, they may want to limit their consumption, as it poses a larger risk for heart disease for this individual as compared to someone who doesn’t have a genetically based sensitivity.

More recently, the DNA Today podcast hosted an episode with Dr. Yael Joffe, the founder of the company 3X4 Genetics. Her company allows healthcare providers to access genetic testing to inform diet and exercise plans for their patients. Dr. Joffe is passionate about educating practitioners about genetics so they could integrate testing and polygenic risk scores to work with individuals to change their daily lives. In this episode, she clarifies how her company differs from traditional medical genetics by studying “common gene changes … [that] do not cause disease. [These changes] interact with the choices we make in our life: the food we eat, the exercise we do, and therefore give us some control on how our genes express themselves for our lives.” She emphasized how, to get the most value from genes, there needs to be a population of healthcare providers trained in interpreting genetics.

More than 26 million individuals have done direct-to-consumer genetic testing (DTC-GT). According to research by Roosan et al. (2023), there are currently eighteen commercial laboratories in the United States and Europe offering DTC-GT. These companies promise information about personalized recommendations from diets, exercise performance, and fertility optimization. Some DTC-GT can be physician-mediated, meaning practitioners order testing kits from these companies for patients in their practice. While some DTC-GT base their results on monogenic gene changes, others base their results on RNA studies or polygenic risk scores. However, it can sometimes be difficult to know exactly where companies are extracting evidence from to provide health information.

There are many studies that show associations between specific genetic changes and different metabolism effects in individuals. Yet, the main question continues to be whether genetic testing can truly be a catalyst for individuals’ behavior change in relation to health. The hope is that if individuals learn more about their own bodies and get more personalized recommendations, then they will be willing to comply in the long-term with health-promoting behaviors. Even though there is an increased consumer interest in pursuing genetic testing for personalized recommendations, there is still no consensus on the evidence of nutritional genomic testing.

The Academy of Nutrition and Dietetics performed a two-part systematic review in 2021 (Robinson et al.). They looked at 10 articles describing randomized, controlled trials that looked at the impacts of using genetic testing for nutrition counseling. These trials analyzed a variety of nutritional measures from macronutrient distribution to fruit and vegetable intake. The only significant changes were seen with high-risk variant carriers, who were more likely than low-risk gene variant carriers to reduce their intake of sodium and alcohol in response to genetic results (Hendershot et al., Nielsen et al.). In all other studies, there were no significant differences in dietary intake of those that received nutrition-based genetic counseling compared to a control group. Therefore, the Academy concluded that there is insufficient evidence to suggest significant effects of nutrition-based genetic testing and it is not yet ready to be routinely incorporated into dietetics practices. Previous studies also found no changes in behavioral modifications in response to DTC-GT results of condition susceptibility (Bloss et al., Gray et al.).

It’s important to keep in mind that there are many lifestyle changes that people can make to improve health with genetic testing. Genetic advice may help motivate some but may only be more significant than common advice for sub-populations of people who respond to environmental factors uniquely. However, we can also appreciate that this field is very young and gene-lifestyle interactions for polygenic traits need to be further investigated so we can determine if nutrition-based genetic testing can be translated into clinical recommendations and public health initiatives.

From a quick Google search, you can find PhD programs in Nutrigenomics from institutions like University of the Balearic Islands and University of Cape Town. Besides these specialized programs, many dietetic programs do not have coursework in genetics. While individuals, like Dr. Yael Joffe, have tried to respond to these gaps in genetic education, I am interested if there is also a space for genetic counselors. Roosan et al. (2023), conducted a systematic literature review on nutrigenomics counseling and identified that interested practitioners report lacking genetic counseling skills and opportunities to integrate them in clinical practice. Genetic counselors may be best trained to interpret nutritional genetic testing results and help clients adopt personalized plans. Genetic counselors already have roles with psychiatric genetic counseling, which similarly conveys information about multifactorial conditions and potential management strategies.

It’s exciting to me to think that genetic counselors can continue to have new roles within and beyond the healthcare system. While the effectiveness of clinically used nutritional-based genetic testing still seems uncertain, we cannot deny that this field has a future. Genetic tests have already been used by healthcare providers to inform health interventions. The question remains to what extent this service will be beneficial to public health and clinical practice. Do you feel nutrigenomics has a basis for growth? Do genetic counselors have a responsibility to support and be involved in the development of this field?

Resources:

Dineen, K. (Host). (2022, May). #185 Nutrigenomics with Yael Joffe. [Audio podcast]. Retrieved from https://www.youtube.com/watch?v=7SABJeGUwVQ

Guasch-Ferré, M., Dashti, H. S., & Merino, J. (2018). Nutritional Genomics and Direct-to-Consumer Genetic Testing: An Overview. Advances in nutrition (Bethesda, Md.), 9(2), 128–135. https://doi.org/10.1093/advances/nmy001

Hendershot, C. S., Otto, J. M., Collins, S. E., Liang, T., & Wall, T. L. (2010). Evaluation of a brief web-based genetic feedback intervention for reducing alcohol-related health risks associated with ALDH2. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 40(1), 77–88. https://doi.org/10.1007/s12160-010-9207-3

Nielsen, D. E., & El-Sohemy, A. (2014). Disclosure of genetic information and change in dietary intake: a randomized controlled trial. PloS one, 9(11), e112665. https://doi.org/10.1371/journal.pone.0112665

Regalado A. More than 26 million people have taken an at-home ancestry test. MIT Technology Review. https://www. technologyreview.com/s/612880/morethan-26-million-people-have-taken-an-athome-ancestry-test/. Published February 11, 2019. Accessed July 10, 2023.

Robinson, K., Rozga, M., Braakhuis, A., Ellis, A., Monnard, C. R., Sinley, R., Wanner, A., & Vargas, A. J. (2021). Effect of Incorporating Genetic Testing Results into Nutrition Counseling and Care on Dietary Intake: An Evidence Analysis Center Systematic Review-Part I. Journal of the Academy of Nutrition and Dietetics, 121(3), 553–581.e3. https://doi.org/10.1016/j.jand.2020.04.001

Roosan, D., Wu, Y., Tran, M., Huang, Y., Baskys, A., & Roosan, M. R. (2023). Opportunities to integrate nutrigenomics into clinical practice and patient counseling. European journal of clinical nutrition, 77(1), 36–44. https://doi.org/10.1038/s41430-022-01146-x

Wong, K. (Host). My Nutrition, My Genes. [Audio podcast]. Retrieved from https://open.spotify.com/episode/2dx96ucyQtT0e9evVyENmD?si=50b9eb41866746f2

One Size Doesn't Fit All: A Discussion on Strategies to Improve Mental Health in the Graduate School Population - Elian Buchi

November 14, 2014 - this is a day that will forever be ingrained in my mind. You see, this day was when my parents, two brothers and I flew from our war-torn homeland in Syria as refugees, to our new home in Pennsylvania. Waving goodbye to everything that had been familiar to me, and hugging everyone that I had known and loved was overwhelming to say the least. I remember that as the airplane tires touched down at Pittsburgh International Airport and we taxied to our gate, I began to have that sensation of a pit in my stomach. I had so much fear of all the new and unknown things coming my way. Leaving the comfort of the stone buildings and working in my family’s restaurant in Syria, driving to our new home, and seeing these large trees, residential neighborhoods was a stark change in my reality. This theme of change was inevitable at that point in my life. Looking back now, I am immensely grateful for the opportunity to be where I am today, yet I would be lying if this did not come with challenges. I would call this the “snow season” of my life because it honestly was a blur. Like the snow screen on a television, I was trying to assimilate into a new culture, a home, and a largely unfamiliar language. In some respects, I think my journey in graduate school can be applied to this. We are constantly learning about the culture of empathic patient centered care, doing so at our new home (The University of Pittsburgh, Go Panthers!) and yes, even learning all new diseases and genetic concepts that can feel like a new language. Through all of these changes, I continued to reflect on myself, finding that I had that pit in my stomach similar to when that plane landed at PIT. Did I know what this sensation of a pit in my stomach was…no. It took intense self-reflection to realize that I was anxious and in fact, burnout as these new expectations that were set before. I truly felt mentally exhausted and overwhelmed, as if one more task would be too much to bear. Trying to master the numerous PowerPoints, understand the brand new concepts, all while building consistent and empathic patient interviewing skills, this took its toll on me both mentally and physically. I found myself sitting in front of my cherrywood desk in my apartment, staring at my computer screen asking myself if this was all worth it?
With my negative self-talk and the toll that this was taking on my health, I knew it was unacceptable, yet I did not know how to fix this myself. As I continue to reflect, I first realized that I did not know what exactly mental health was. Additionally, I did not know how to articulate exactly how I was feeling. Yes, mental health is a term that we all have heard multiple times in presentations and trendy online posts about improving this, but what does it boil down to? What is and isn’t anxiety, burnout, and depression? More importantly, what can I do to help myself get to a state in which I can healthfully operate? In my view, this is not a one size fits all solution. Someone won’t come around, wave their magic wand and deem me cured. I realized that this is going to take work and support from others. What I am going to share is my own personal reflection, and my hope is that this will inspire you to take stock in what is your own mental health with ideas on how to improve this.
As I continue along my period of lifelong self-discovery of my own mental health, I have found that it is important to realize that the solution to positive mental health is not a straight line. There are many hills and valleys that have culminated into my inner strength and desire to rebuild my positivity and confidence to help get to where I am today. Much like a recipe takes multiple ingredients, trial runs and yes even multiple taste tests before it comes together, I would like to share some of the ingredients that have helped me have a more positive outlook on my own mental health. When I started graduate school, I found myself overwhelmed by the sheer volume of new things. If I am being completely honest with myself and my viewers, I let the fear of the unknown consume me. There would be times that I would sit at my same cherry wood desk with my laptop open, asking myself, “Am I capable of doing this?” This negative self-talk went on for several weeks until my loved ones (mainly my amazing fiancée) realized that I needed help. Through some self-discovery, I decided that I was going to establish boundaries that work for me, so that I am able to set time aside for myself to help achieve a fulfilling life outside of graduate school. I decided that each day, I was going to do something small for myself, something that I personally enjoy and brings a positive point of enjoyment to the day. For me, these include cooking and exercising, as I strongly believe that physical and mental health are interconnected in the intricate web that have helped me get through those hills and valleys. Setting aside forty-five minutes daily to go on a run or taking a walk with my friends, helps me clear my headspace and promote my overall wellness. In regard to my schoolwork, I decided that I would make a manageable to-do list for each day. I also have the expectation that yes, life gets in the way and it is okay not to complete every item, as tomorrow’s to-do list can absorb today’s. Taking the tasks of my day in chewable bites is something that has positively improved my outlook on graduate school overall. Outside of my personal resources, I found it important to look outside of myself for inspiration. I looked at my peers and mentors to lean on during the especially trying times. Having those frank conversations with my cohort and going through the same experiences provides a unique opportunity to support and learn from each other.
In closing, a big picture thought that has helped me on the journey through graduate school has been always reflecting back on my reason “Why?”. Why did I choose to pursue becoming a genetic counselor? In short, I became a genetic counselor to help patients and their families through what will be one of the most difficult and uncertain times in their lives. I have the immense opportunity to be in this country, in a graduate program in a field that I love surrounded by supportive friends and family. I am incredibly grateful for the inner strength that my story has given me. I want to be that person who can sit with a patient and their family to help them truly understand what condition they are diagnosed with and what options there are available. In life, when we are given circumstances that are challenging, I choose to now look at these as opportunities. My reason “Why?” can translate seamlessly into my opportunity for improvement in my own mental health and the health of those around me. The strategies I listed above are the tip of the iceberg, and I hope that they give you inspiration to take stock in how you can improve your own mental and physical health. I encourage each of you to facilitate more discussion that can bring about positive, meaningful change to improve mental health services and reduce the stigma for all. In fact, I urge you to continue fighting the stigma surrounding mental health concerns. In our profession, it is vital that, as genetic counselors, we are best equipped to help our patients and their families find the best solution to an oftentimes challenging diagnosis. To do this with the highest efficacy and empathy, we must first take care of ourselves. After all, the field of medicine is not a one size fits all domain, so our own mental and physical health shouldn’t be either.

With A Little Help From My Friends: My Interdisciplinary Student Experience at Pitt - Saad Akhtar

One of my favorite aspects of being a genetic counseling student here at Pitt is being under the umbrella of the School of Public Health and getting to interact with students and professors in the many other programs offered here. As I started my time at Pitt as an MPH student and later transitioning into the dual degree program, I had no idea how invaluable having this access to other disciplines would be. It has not only broadened my perspective of different health issues that affect patients beyond the clinic but has also made me appreciate the different roles that other students and professionals have in ensuring the best health outcomes for patients. I know this will be especially important as I begin my rotations, as I have seen from my prior support roles how often genetic counselors interact with other medical professionals in our profession and how vital it is to learn to work with others outside of our field.

As a dual degree student, how our work as genetic counselors falls into the broader scope of Public Health is constantly on my mind. In my first year at Pitt prior to officially joining the genetic counseling program, I had the benefit of taking several classes that focused on aspects of health outside the clinical and research spaces we tend to associate it with. Two of these courses, Social and Behavioral Sciences in Public Health and Introduction to Community Health, particularly have had an impact on me and my time here as a student. Social and Behavioral Health Sciences focused on issues of health equity and access, which have always been a passion of mine. But, it also taught me about the importance of qualitative research and how the experiences of people and patients can be just as vital as the statistics and numbers that can represent them in studies. This is extremely relevant to genetic counseling, as the psychosocial aspect of genetic testing and the implications it can have on our patients' lives is the basis of our field. Community Health taught me how to build trust in communities as a medical professional and to think about how health issues can affect people in various ways on a local scale and beyond. In both of these courses, I had a chance to work with public health students studying areas such as Epidemiology, Health Policy and Management, and Behavioral and Community Health Sciences, just to name a few. It opened my eyes to the various ways people in different fields could approach tackling issues we talked about in class and how by working together, we could each bring something unique to the table.

My work in these classes also influenced my practicum experience as part of Bridging the Gaps, which is an internship provided by Pitt. In Bridging the Gaps, students from different fields work together over the summer to join various organizations across the city working to help underserved individuals and communities. As part of my work, I had the pleasure of working with a nursing student at an anti-violence summer camp program for the community of Beltzhoover. Though neither of us had much experience directly working with children or underserved communities, by the end of the summer we both felt like we had learned a lot about working with these individuals, not only from each other but from members of the community of Beltzhoover as well. It is one thing to learn about the social determinants of health in class, but it’s an entirely different experience to see how they affect actual people in communities just twenty minutes from where we study. Besides my own work in Bridging the Gaps, we also got a chance to work with other students studying things such as Social Work, Dentistry, Nursing, and Pharmacy, as well as meet with leaders from organizations doing vital work across the city of Pittsburgh. Many of the people I worked with had very little understanding of genetic counseling as a field, so I had the opportunity to teach others about the work we do in my role while learning from them as well. Through this experience, I have become aware of so many resources and organizations that work to help those in need that I had no knowledge of prior, and I know this knowledge will be useful as a genetic counselor. Part of our job is to be able to direct our patients to resources they need, and as medical professionals, it's our duty to be advocates for our patients. I truly believe our role in our patients’ lives does not begin and end during our time in the clinic with them. Through my experiences, I have a much better idea of how I can address their needs beyond the clinic in the future.

In thinking about interdisciplinary work, I also want to highlight my experience being part of the department of Human Genetics. One thing I love about our department is how, even though our individual focuses can differ from program to program, there is a strong sense of community and uplifting each other’s work. We, of course, have students, professors, and other professionals in our department who primarily focus on genetics research, but we have individuals studying bioinformatics, public health genetics, and of course, genetic counseling as well. As part of our curriculum, we take many of the same courses and get to learn from individuals who are experts in their particular fields. As a result, the way we think about genetics is unique and we see how our work can affect individuals on every level, from a societal perspective all the way down to the molecules that make us who we are.

From my own experience, I can say that making friends in other programs has benefited me enormously as a student. Forming a study group with students in the MS/PhD programs in our Molecular Basis class in my first semester helped me so much as I adjusted to coming back to academia after a long time off. In our statistical methods and bioinformatics courses, having classmates who had prior experience in those fields who I could rely on for help if I needed it was invaluable as well. Some of those classmates have become some of my closest friends here in Pittsburgh and it’s been a true pleasure getting to know them both in and outside the classroom.

If I can end this post with some advice, to any future incoming students or applicants thinking about joining our program, take some inspiration from the Pittsburgh legend Fred Rogers and learn to be a “good neighbor” to those around you. The interdisciplinary community we have developed at Pitt can be your biggest asset in your time here if you’re willing to take advantage of it. Nearly everyone I have had the opportunity to interact with has positively impacted my time here, and I’m deeply grateful to be part of a program that emphasizes collaboration with individuals both in and outside our field.

"If You Knew Everything, You Wouldn't Be Here" - Nicole Weise

Going into graduate school, I knew there was a lot I didn’t know about genetic counseling, and I was eager to get started on my training. Our first semester was inundated with information about Hardy-Weinberg equilibrium, lysosomal storage disorders, and risk assessment (who knew Bayes would not be the hardest part about genetic counseling?). As we finished out the spring semester, the amount of information we’ve absorbed on hereditary cancer predisposition syndromes, genetic testing methodologies, and psychosocial interventions is enough to make one’s head spin. Some days it’s hard to keep up with everything, and even still, I know there is so much more to take in. This is not surprising: we signed up to be lifelong learners.

Despite knowing so little about the actual genetics behind genetic counseling, I thought I had a very good understanding of the basic principles of genetic counseling going into graduate school. Patient autonomy. Non-directiveness. Unconditional positive regard. Self-explanatory, no nuance. Alas, I should have known – it could never be that simple.

On Thursday afternoons from 1:00 – 1:50pm, we had the opportunity to take Ethical Issues in Clinical and Public Health Genetics, taught by Drs. Robin Grubs and Michael Deem. This class challenged my understanding of what I knew to be the basic tenets of genetic counseling. One of our first, and most impactful, lectures was on non-directiveness. Non-directiveness is perhaps one of the main defining features of genetic counseling, born out of the renunciation of eugenics. I had always thought non-directiveness was straightforward: genetic counselors have a duty to provide patients with clear and unbiased information so that patients can make fully informed decisions, free from coercion. As a result, non-directiveness on the part of the genetic counselor promotes patient autonomy and self-directiveness. But in talking about non-directiveness in practice, we were asked: can we take a truly non-directive approach in all situations? If a family does not provide a child with PKU a diet free from phenylalanine, can we remain non-directive? If cascade testing can identify a germline pathogenic variant that increases a person’s cancer risk but the proband does not want to communicate their results to their family, can we remain non-directive? At what point, if ever, should the genetic counselor step in and be even a little bit directive?

In addition to non-directiveness, this course provided us the forum to discuss relevant ethical topics in genetic counseling such as informed consent, duty to disclose, secondary and incidental findings, and consumer-driven genetic testing. I was pleased that we also discussed ethical issues raised by non-invasive prenatal screening (NIPS), a topic that is of personal interest for me. Given the non-invasive nature of NIPS, it may be increasingly seen as a standard part of prenatal care. Some, however, argue that this may diminish the informed consent process and even stigmatize a person’s choice not to pursue NIPS. Additionally, greater access to NIPS raises the possibility that it may result in fewer individuals being born with genetic conditions, and subsequently, fewer resources being invested in their health and equity in society. NIPS, therefore, has the potential to further widen disparities between abled and disabled individuals. How can we as future genetic counselors provide the best care possible for our patients when these ethical implications arise? How can we incorporate our understanding of ethical challenges into practice while maintaining a commitment towards patient autonomy and choice?

The truth is, there is not always a one-size-fits-all answer to such ethical questions. Ethics has a way of challenging our perceptions of what we ought to do, and what we ought not to do. The value of studying ethics is that we consider viewpoints that are not our own and that we recognize that not every dilemma has a right answer. It allows us to set our rigid views of the world aside and consider that things are not always as straightforward as they seem. The study of ethics has a critical role in our training: the field of genetic counseling is rapidly evolving, and we should expect ethical issues to arise and be prepared to face them head on.