A Dual Degree with an MPH in Public Health Genetics

The dual degree in Genetic Counseling and Public Health Genetics bridges the focus on individuals and on populations so that graduates are poised to bring the patient perspective to the development of legislative policies, guidelines and screening programs. 

Programs like newborn screening and cancer screening are public health programs, and as genetics becomes more ubiquitous in medicine, these types of population level programs are likely to become more plentiful and genetic counselors (GCs) can play a big role in their design and implementation.  

The dual degree program at Pitt can be completed in 2 years of full time study with a couple summer classes or in 3 years when a student starts in the Public Health Genetics program rather than the Genetic Counseling Program.  There is a great deal of flexibility in how the program is organized, and there is room to take some electives as well. Even if completed in 2 years, the courses are spread out in a way that the extra workload is very manageable.  In fact, it can be a nice change of pace to attend lectures on subjects outside of the genetic counseling field. 

In addition to a thesis project for the Master’s degree in Genetic Counseling, an essay must be completed on a practicum in Public Health Genetics for the MPH.  Often the thesis and practicum can be combined into the same project. Almost any project relevant for a genetic counseling master’s thesis could be extrapolated to the population level so doing the dual degree shouldn't limit the choice of project. Many people can even add a chapter to their thesis to discuss public health applications rather than writing a separate essay. An MPH is not necessarily required to work in public health genetics, but it may make graduates more competitive and create exciting, new opportunities for genetic counselors. 

-Bess Wayburn, class of 2016

My Thesis Experience

Recent studies have examined the feasibility and psychosocial implications of a population screening approach to test for mutations in genes associated with hereditary cancer syndromes.  I have a personal interest in the field of cancer genetics, and wanted to have a thesis project that related to recent research in this field.   For my thesis project, I worked with my committee to develop a survey to elicit the interest of people in the general population in accessing a genetic test that analyzes genes related to hereditary cancer syndromes.  The survey also asks questions related to the psychosocial implications of this type of genetic testing, and how people would react to possible results. 

Prior to conducting my research, I needed approval from the Institutional Review Board (IRB).  I had never written an application for the IRB before, and it was a great learning experience to see how it is necessary to have the logistics of the study thought through before IRB approval will be granted. Designing a research study and submitting an IRB application can be quite challenging, but also rewarding.  I now have the knowledge of setting up a research project and can use this experience in my future career as a genetic counselor.

One of my favorite parts of my thesis project so far has been submitting an abstract for the American Society of Human Genetics (ASHG) conference in October.  Using the preliminary results of 240 responses to the survey, I wrote an abstract, which was accepted for a poster presentation at the ASHG conference.  Throughout the process, I had the support and assistance of my research mentor, Dr. Dietrich Stephan, and our program directors, Dr. Robin Grubs and Dr. Andrea Durst.   I look forward to the opportunity to present the results of my thesis at the conference in Baltimore!

-Laura Cross, class of 2016

Favorite Things To Do In Pittsburgh

The class of 2016 share some of their favorite activities in Pittsburgh that they like to engage in while taking a break from their studies.

“My favorite thing to do is train for Pittsburgh races (The Great Race, Half marathon) by running through our eclectic neighborhoods and Moraine State Park…And grabbing a craft beer at Church Brew Works. I also get a season pass to musicals that come through town which is $150-200 for 7 shows throughout the year!” –Amy B.

“I love going to movies and shows in the area. Local festivals are always a good time, and there are a ton of them, like Little Italy and Picklesburgh! There’s plenty of pretty unique things to choose from in the city” –Laura

“I enjoy biking Pittsburgh! There are 4 large parks within a 15 minute ride of my house, bike lanes on most roads, and trails along the river that take you to the stadiums. Grad students also get discounts to sporting events, so I have season tickets to Pitt football!” –Kerrianne

“I love hanging out in the Strip District on the weekends. Lots of ethnic markets, street food, outdoor vegetable stands and a great place to grab brunch while people watching.” –Bess

“I love kayaking along the Pittsburgh rivers! It is the best blend of the great outdoors and the city life Pittsburgh has to offer! I also love all the charming, quirky things Pittsburgh has to offer, such as Cinema in the Park, where every Saturday and Wednesday night during the summer there is a movie playing in parks across the city!” –Kelly

“Pittsburgh is all about its sports teams! The city is filled with super fans and it’s fun to go and be a part of one of the city's passions. Not to mention the awesome fireworks at the Pirate's games.” –Erin

“I like that there is always some sort of festival or activity going on in the city, especially during the summer. There is really something for everyone from free concert series like Jam on Walnut in support of the CF Foundation to more unique things like Picklesburgh and the Three Rivers Arts Festival. I also enjoy keeping track of how the Pens are doing and I hope to make it to a game or two in the next year.” –Kristin

“My favorite place to visit is definitely Randyland!! Closely followed by going up the incline and watching the sun go down on the skyline. That's followed closely by getting lost in the trails of Frick Park. I also went to Book of Mormon last fall, and the theater was beautiful and the show was amazing, so that's definitely on the list.” –Becca

“My favorite non-food related thing to do is probably the museums. Especially the Andy Warhol museum. It always has a featured exhibit from an outside artist that’s usually pretty cool.” –Tricia

“My favorite thing to do to take a break from the program is to get out of the city. There are national and state parks close enough to Pittsburgh to take a day trip: you can hike, bike, kayak, raft, etc. Ohiopyle is a favorite of mine, its trails are part of the Great Allegheny Passage which can take you all the way to Washington D.C.! The towns along the way are so charming and often have roadside farm stands, local treats and really great antiquing.” 

-Nikki

“I enjoy going to the cultural district in downtown Pittsburgh, and attending musicals, operas, the ballet, or the symphony. Downtown is very accessible by bus, and grad students get really good rates on theatre tickets.” –Amy D.

-Some of our second year students at Mad Mex, voted as one of the top restaurants in “The Best of the ‘Burgh 2015”.

CABS Clinic Optional Rotation

For my optional rotation, I spent three weeks in the Children and Adolescent Bipolar Spectrum Services (CABS) clinic. This clinic is staffed by psychiatrists, social workers, and nurses who help to diagnose children and adolescents with Bipolar Disorder in order to provide them with appropriate care and early intervention. The CABs clinic offers both inpatient and outpatient treatments, and is involved with a number of different research studies. The BIOS Family Study is one such research study that is investigating the recurrence risk of Bipolar Disorder in children of individuals with Bipolar Disorder.

Throughout my rotation, I was able to acquire a greater understanding about psychiatry and observe different family dynamics. It was often difficult to appreciate everything that was going on with a family during a short appointment visit, and information gained overtime from multiple sessions was very helpful to best understand patients’ mood patterns. Assessing how the parent was doing during a follow-up session was a good indicator of how a child had been doing at home.

In many instances, it was beneficial to speak separately with different family members to learn more about how the child was doing based on different perspectives. I had the opportunity to observe the varying strategies that clinic staff used to facilitate conversations between family members and to engage everyone in a counseling session.

Like any medical condition, patients with supportive parents or family members seemed to do better with managing stressors, and learning different problem solving and coping strategies. When multiple family members, such as a parent and child, were affected with Bipolar Disorder or another mental health condition, it was often more difficult for the child to manage their symptoms. The importance of assessing the health and well-being of a care giver is essential in all areas of health-care, including genetic counseling.

This rotation gave me the opportunity to observe different assessment and counseling techniques that are transferable to genetic counseling. At the end of my rotation, I gave a presentation to the clinic staff where we discussed psychiatric genetic counseling as well as risk communication with patients. This rotation was a great experience, and I would like to say a big thank you to all of the wonderful staff at the CABS Clinic!

To learn more about the CABS Clinic in Pittsburgh, which is one of the first clinics of its kind in North America, visit http://www.pediatricbipolar.pitt.edu/

-Amy Davis, class of 2016

Clinical Rotations - Reflections from a Pitt GC student

Doing anything for the first time can be a challenge, and for many of us (especially novice genetic counselors) it can be difficult to allow yourself to make mistakes. At the end of April my classmates and I prepared to begin rotations. At Pitt we spend our first year in the classroom, and at the start of May through the following March we spend the vast majority of our time in rotations.  What this means for those of you who are perfectionists with high personal expectations, like me, is this: even armed with all of that new knowledge, you will not be an expert counselor when you walk through the door of your first or even your second rotation.

I spent a lot of time fretting over this concept, worrying and rehearsing what I would say (the rehearsing part is actually very helpful!). I went into my first rotation nervous and a little afraid; I wondered often: what if I say the wrong thing? What if I scare the patient? Or worse, what if I make them cry? My first day counseling patients was definitely frightening, and I certainly was not an expert. I stumbled through my first explanation of chromosomes, and my explanation of how a patients’ family history can contribute to their risk is still evolving. What I did learn is that we all have to start somewhere, and if you are afraid to be a beginner you can’t learn anything new either. I also found that the counselors are there to help, and I have felt this from each counselor I have come across. They give excellent feedback and are sincerely invested in our success. They often helped me craft a better way to explain things when I got stuck; they were also open and willing to share their own struggles as a student.

In short, I survived and so did all of my patients. In the process I also learned quite a bit about how to counsel patients, tears and all. Even more importantly, I found that when I didn’t take on something new I felt a little stuck and uncertain. Trying new ways to explain concepts helped to boost my confidence, and I was excited to see the next patient so I could try out my new skill. Many of us enter this field because we want to share what we know with others to help them make decisions, but the trick is that we have to allow ourselves to be new, to accept that we do not know everything, and that if all else fails, the counselor is there as a safety net.

-Nikki Walano, class of 2016 

NYMAC Summit 2015

I was very fortunate to attend the New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC) Summit 2015 from May 28-29 in Baltimore, MD. NYMAC is one of seven regional collaboratives within the United States that aims to improve access to genetic services for families affected by heritable disorders.

More than 30 speakers including parents, genetic counselors, geneticists, physicians and other health-care providers, policy makers, and additional stakeholders such as public health professionals and LEND faculty presented a wide range of topics that focused on overcoming barriers that prevent individuals and families from receiving genetic services.

Some of the themes that emerged from the conference included improving interdisciplinary care for patients through better communication between providers, addressing language and cultural barriers that may prevent individuals from accessing genetic services, evaluating different educational resources available for families to improve their quality of care, implementing distance strategies such as telemedicine models, and using genetic technologies on a population-based scale.

I especially enjoyed hearing about family perspectives from parents who have a child with a genetic condition. These individuals have become extraordinary advocates for children with special health care needs and their families, and have been involved in creating resources and programs to help other parents and families. When designing new policies to improve patient care, it is essential to understand parental perspectives because parents are the main healthcare provider in their child’s “medical home”.

During the breakout sessions, I attended the Primary Care and Linkages Workgroup session regarding interdisciplinary care. We discussed inclusion and diversity, and the importance of self-perception when providers consider the definition of “cultural humility”. Faculty from the University of Pittsburgh discussed the LEND program as an example of how to incorporate genetic education and the concept of family-centered care into a training program for future health-care providers.

Lastly, it was impressive to see the collaboration between numerous different stakeholders, and the different roles that genetic counselors can have within this multi-disciplinary public health team.

My participation in the NYMAC 2015 Summit was made possible by the NYMAC-Genetics Public Health Fellowship program. This program provides graduate level education to genetic counseling and LEND students, in order to create future leaders in genetics, and improve advocacy for the translation of genetic information and services in the public health realm.

For more information about the NYMAC-GPH Fellowship Program, please email Kunal Sanghavi at ksangha1@jhmi.edu

 -Amy Davis, class of 2016

Utilization Review Optional Rotation

I have had the unique opportunity of being the first University of Pittsburgh student to complete an optional genetic counseling rotation block in the Utilization Review Program within the laboratory at Children’s Hospital of Pittsburgh. Essentially, the genetic counselors working in utilization review are a bridge between physicians requesting inpatient genetic testing, and the hospital which absorbs the cost of uncompensated care. The utilization review team has taken up the complex task of working with physicians to ensure if requested genetic testing is 1) appropriate for the patient, 2) medically actionable in the inpatient setting, and 3) if not medically actionable, then to question whether testing could be deferred to the outpatient setting. This effort has saved the hospital approximately $100,000 in the program’s first year alone, allowing the savings to be redirected to fund other projects. 

This non-traditional rotation has highlighted the multifaceted political and psychosocial dynamics at play between medical and business stakeholders of genetic testing. Utilization review has truly demonstrated the delicate balance that must be maintained between what is best for our patients, what is the best use of our resources, what is medically necessary, and our desire to provide genetic answers to each patient. This opportunity has challenged and taught me, specifically in a way that has given me a new perspective on both the cost and utility of genetic testing. My optional rotation has allowed me to experience a rapidly growing branch of genetic counseling and will truly benefit me as I enter the work force.

-Kelly Johnson, class of 2016