Genetic Counseling Assistant Experience - Grace Waldow

I work as a genetic counseling assistant (GCA) at the Children’s Hospital of Pittsburgh, and I think this experience has been one of the most formative in my decision to pursue genetic counseling. I went to the University of Pittsburgh for my undergraduate degree and graduated in 2022, and then began my time as a student in the genetic counseling program here at Pitt the same year. I have worked as a GCA since October 2020 and have had many different roles within my position, as it has evolved with the needs of the clinic I work for. 

Originally, my responsibilities were very similar to that of a traditional GCA role. The clinic included five genetic counselors, and so I helped them call patients about insurance authorization, obtain medical records, mail letters and scripts, and track test results. In addition, the genetic counselors also had a utilization management role. Utilization management involves working with providers and genetic testing labs to ensure that appropriate genetic tests are ordered and that these tests are cost and time efficient. As a GCA, this means that a critical part of my role includes managing a database of genetic testing ordered in the hospital, and tracking certain types of tests for results and subsequent disclosures. Over time, the clinic has been restructured and now primarily has a laboratory role. Since I mostly work with the genetic testing database, I am able to be a part of several different research projects through the clinic. For example, I researched hearing loss panels ordered through the clinic and presented these findings with a genetic counselor to the Audiology department at the hospital. Currently, I am helping in a project that looks at the utility of whole exome sequencing in an inpatient setting. I hope to continue my work in the utilization management space, and am planning to pursue a related project for my thesis. 

I have learned a lot and gained many skills from my time as a GCA. Before working at the Children’s Hospital, I had limited experience interacting with patients or genetic counselors. However, I have now had the opportunity to talk to hundreds of patients and shadow several genetic counselors in different types of appointments. In addition, I have learned a lot about genetic testing methods and have become familiar with genetic tests that are commonly ordered in a pediatric setting. Working as a GCA is also interesting because I am able to see and experience parts of a genetic counselor’s job outside of direct patient care – and there are a lot! For example, genetic counselors work with insurance companies to get testing approved for their patients, coordinate genetic testing with providers, work through challenging cases with their fellow genetic counselors, and lead research projects about genetic testing. 

Although having a work position as a student is a considerable time commitment, it is an invaluable addition to the process of becoming a genetic counselor. My time as a GCA has allowed me to gain confidence in talking to patients, learn how to navigate clinical information, and nicely complements my coursework where I learn about genetics and genetic counseling. I am excited to continue in this position, and would recommend the experience to anyone interested in the field!

Entering Grad School with Different Work and Education Background - Gabi Slizewska

 

Applying to graduate genetic counseling programs can be incredibly overwhelming. It is a very lengthy, expensive, and stressful process. Unfortunately, spots are limited and many qualified candidates are unable to secure a spot. With all this in mind, it’s easy to understand why many prospective students focus on perfecting their resume. I remember scouring the internet for the best resources and hounding current genetic counseling students for advice. However, my resume was far from perfect, and I couldn’t help but worry that I was never going to match with a program. Now, as a first year student, I am finally starting to realize that a good candidate does not have to fit a certain mold.

We all need to meet certain academic requirements to qualify for a program, but you don’t need to have all A’s. In fact, it’s even okay if you failed a class or two the first time around. I did! Just because you struggle with a certain class, doesn’t mean you’re not intelligent enough or cut out for this field. STEM courses are difficult for many of us, and life can sometimes make academic success even more challenging.

I also remember focusing on checking off the boxes in terms of experiences; getting the right job, the same opportunities, and the same experiences as everyone else. One example of this is research. The truth is, I came into this program with no research experience. I was very open about this during interviews, and during the start of the program. The program leadership has been very understanding about this, and I’ve received a ton of support and guidance as I began brainstorming ideas for my thesis project.

Another area where I struggled was in obtaining counseling experience. Unfortunately, with the onset of the pandemic, many in-person opportunities became scarce and online opportunities became over-saturated with volunteers. There are a few organizations that are particularly popular with applicants, but they became exceedingly difficult to get in touch with. It is perfectly fine to look for other options and to explore opportunities that are local to you! Having unique experiences may even make you stand out more against other applicants!

Lastly, I spent a lot of time searching for a GCA position. It seemed that just about every current student I talked to had one. I was very anxious about the fact that I did not have this experience on my resume. What I learned is that a GCA position is a very good experience to have on your resume, but it is absolutely not necessary. There aren’t a lot of these positions available, and even fewer in rural areas. Program leadership knows this! There are lots of other ways to learn more about the field. Talk to genetic counselors, talk to current students, talk to program leadership, and look into online resources. There are also plenty of other job opportunities that relate to patient care, counseling, or education. Not to mention, it is perfectly okay to work in an unrelated field, as long as you can learn something applicable to genetic counseling. This can even be something like leadership or communication skills!

What I want to convey is that it really does not matter if your resume looks just like mine or any other genetic counseling student’s. Focus on doing things that you are passionate about, and make sure that passion comes through in your personal statement and during interviews. I was so happy to meet my cohort and learn that they all came from different backgrounds and with many unique experiences. We all have our own strengths and weaknesses, but what we discovered is that we all complement each other. There really is some sort of magic involved when this program’s leadership makes their choices during the match process!

Faculty Spotlight: Christine Munro

Christine serves as the Director of Recruitment and Admissions at the Pitt Genetic Counseling Program and as a genetic counselor with the UPMC Primary Care Precision Medicine Clinic.  We asked her some questions about her and her role, and here are her responses.

1. How did you find out about genetic counseling?

During my undergraduate degree, genetic counseling was briefly brought up in a genetics class. After doing some research on my own it truly felt like the perfect merge of my interests but I had always thought I would apply for a public health degree as my next step. When I learned of  the University of Pittsburgh’s dual degree option in Public Health Genetics and Genetic Counseling, I could not have been more excited and knew that is where I wanted to land.

2. What does your current role in the program entail?

My current role is Director of Recruitment and Admissions for the Genetic Counseling program. I lead the holistic applicant review process with the program’s admissions committee and develop recruitment strategies. I am also involved with students through research mentorship and I work as a clinical site supervisor in our Primary Care Precision Medicine rotation.

3. What made you decide to work to develop the Primary Care Precision Medicine Clinic?  What is the mission of this clinic?

The Primary Care Precision Medicine clinic was created to bridge a current gap in genetic service delivery. There is an increasing awareness and uptake of genetic testing and Primary Care clinics find themselves at the forefront of genetic risk assessment and appropriate triage but physicians have expressed a lack of confidence in their genetics knowledge. Genetic counselors (GC) embedded in primary care is one potential solution to scale genetic services. When we take a look at the services that primary care physicians (PCP) provide in areas like preventative care, prescription management, routine screenings, prenatal care, newborn care, and chronic disease management, there is a great deal of overlap and connection with subspecialty genetic services such as risk assessment, pharmacogenomics, cancer risk assessment, prenatal carrier screening and testing, newborn screening, and polygenic risk scores. This highlights the potential for a complimentary relationship between PCPs and GCs. Additionally, individuals will have genetic needs throughout their lives and a single genetics visit is unlikely to be enough. There are multiple points where an individual might require genetics care and this unique clinic model allows for that follow-up loop. Lastly, we know there are barriers to appointments and disparities in referral practices. This clinic model has the potential to decrease logistical barriers, meet patient’s where they are at, ensure appropriate referrals for all, decrease wait times for specialty clinics and reduce costs for specialty appointments. The goal of this clinic is not only to scale genetic services but to improve equitable access to these services. I am very proud to work with such an amazing and innovative team. I am also so happy our genetic counseling students get an opportunity to rotate with us in this unique space.

4. What does your role in clinic look like?

In my clinical role, I work with a multidisciplinary team seeing patients for a variety of indications. We also work on research projects and genetics education initiatives for physicians.

5. What is your favorite part of your job?

It is really difficult to choose one “favorite” thing about my job so I will list a few: the field of genetics is constantly evolving which is stimulating,  the ability to mentor students and witness their progress and contributions is so rewarding, and lastly the opportunity to guide and advocate for patients and families during a difficult time is extremely fulfilling work.

Michelle Takemoto Leadership Seminar Reflections

Michelle Takemoto, a genetic counselor with the Hawaii Department of Health and MGPN coordinator, spoke to our students on November 4 about a broad range of topics as part of our Leadership Seminar Series.  Our students reflected on her talk:

I am thankful that I had the opportunity to meet Michelle and listen to her phenomenal presentation about public health genetics. It was great to learn about her own personal journey to genetic counseling and how she became a leader in the field. From working on projects that increase accessibility to genetic services for underserved populations to starting the Minority Genetic Professionals Network, I am incredibly appreciative of all the work she has put in to advocate for marginalized identities. From one member of MGPN to another, thank you for providing me with a community of shared experiences and a sense of belonging in the profession! - Leann To

I am so grateful that we all got to meet Michelle for our leadership seminar! It was interesting to hear how her work ties in both genetic counseling and public health, and learn more about the genetics services in Hawaii. As a member of the Minority Genetics Professional Network, I was excited to learn more about her role in the creation of the organization and how she envisions its future. It was inspiring to see how passionate she is about serving underserved populations and advocating for underrepresented minorities in genetic counseling. I feel very lucky to have had the opportunity to talk to one of the leaders in the field, and I am looking forward to hearing her speak at NSGC! - Impana Shetty

It was so awesome to hear from Michelle for our leadership seminar! She really brought forth a lot of barriers that need to be addressed in the field of genetic counseling, but also talked a lot about the intersection between public health and genetic counseling. It was wonderful to hear from a GC who plays a role in her local public health initiatives, which as a dual degree student was so inspiring because she is doing the dream that so many dual degree students want to accomplish. She was so real with us about our goals and I honestly loved her advice of making space for ourselves in these public health spaces, because GC’s are needed there. It was fantastic to have Michelle come speak with us and I cannot wait to hear her talk at NSGC. – Samantha Runa

Meeting Michelle has been one of the biggest highlights of my graduate career thus far. She shared not only her immensely important perspectives on inspiring and growing inclusivity within the field, but also connected with us all on the importance of the interplay between public health and genetics (specifically, the importance of building relationships). This talk could not have come at a better time in my journey to becoming a genetic counselor. I felt like I learned so much about how to better expand my own opportunities as well as how to become involved in making the field more equitable. Her talk at NSGC is going to be incredible, and I’m so thankful to have gotten to know her on a more personal level. - Ariel Breeze

What a refreshing experience. I appreciated the straightforward and genuine presentation given by Michelle, having firmly planted feet in both public health and genetic counseling worlds. It was a privilege to speak with her about inequities in healthcare, and it has lit a fire in myself to do my part. I am looking into the Minority Genetics Professional Network to connect with other professionals and hopefully make a difference. Thank you, and I look forward to seeing you at NSGC! - Daniel Brennsteiner

I appreciated hearing the perspective of a genetic counselor outside the "bubble" of Pittsburgh.  Hearing about Michelle’s journey to genetic counseling and her passion for the field was energizing.  She touched on the intersection between public health and genetic counseling, which is helpful and inspiring to a dual degree student like myself.  Newborn screening processes and accessibility of testing sites/clinics are things we may take for granted in places like Pittsburgh.  Working on an island like Hawaii, Michelle has had to be flexible and advocate for patients and counselors alike.  Hearing first-hand how I can be a leader in the field using both my degrees adds focus to a world of opportunity. - Megan Zieber

Michelle gave a wonderful talk in Leadership Seminar that included her role in MGPN and the incredible work they do to connect underrepresented minorities in the genetic counseling profession to each other.  She addressed some important barriers that genetics services in Hawaii face and described some ways to move forward.  I appreciated the time she took to speak with us at different points throughout the day.  She was so down-to-earth, and I cannot wait to hear her speak at NSGC!  - Rebecca Oberschmidt

It was wonderful having Michelle as our Leadership Seminar speaker. Her talk was compelling and motivating. I enjoyed hearing about her roles with MGPN and Regional Genetics Networks. Most interesting to me was her work in telegenetics training and increasing access to genetic services. Michelle and I had a conversation after her talk about some of the many barriers to genetic services, including the ways in which telegenetics is not always the answer. Looking forward to hearing more from Michelle at NSGC and in the future! - Madalyn Charnego 

Student Spotlight - Daniel Brennsteiner

Returning to school as a graduate student? Feeling a little rusty? Perhaps you have fresh notecards kept safe and pristine in a location you forgot all about. Locate your supplies and gather your courage. Strap yourself in because grad school is a long rollercoaster ride with many bumps, turns, and fancy new inversions. This blog post contains pieces of advice for incoming genetic counseling students who share similar concerns of transitioning to grad school after having gap years.

For context purposes, I am currently a dual degree-seeking student, projected to graduate this year with both an MS in Genetic Counseling degree and an MPH with a specialization in Genetics degree. I took five years off after undergrad due to various reasons, one including a profession change. That story, however, is for an entirely separate blog post.

First off, you are not alone. Feeling nervous about returning to school with or without gap years is perfectly normal. Though genetic counseling programs tend to be smaller, ranging between 3 and 30 students, someone in your cohort will relate to you on some level. The field of genetic counseling is filled with professionals that would readily hear your trepidations. Debrief with them. I would recommend reaching out to your fellow genetic counseling students and leadership. Allow them to listen and share with you their own perspectives and advice surrounding this major lifestyle adjustment.

Those preserved notecards will come in handy, be sure of it. However, be prepared to adapt to your graduate level courses and adjust accordingly. What do I mean by that? Times have most likely changed since you walked across the stage dressed in your cap and gown. Studying methods from previous undergraduate courses may not be as effective now. Anecdotally, I can remember holding on to my archaic handwritten notetaking ways throughout my first year as a grad student, exhaustively attempting to keep up with energetic genetic professors and boundless PowerPoint presentations. Let go of your pride and adapt your studying techniques to best fit each class and do this early. The sooner you adapt, the easier your life will be. Second-year genetic counseling students will have their own thoughts on which methods worked best.

Adapting to the workload of a graduate student is just as important, and time management is key. You have an advantage. After undergrad, you most likely entered the work force bright eyed and bushy tailed. Treat genetic counseling school like a 9AM-5PM job. You know what it’s like to wake up, make breakfast, work, eat lunch, work through the tryptophan, and head home. Going back to sporadic college schedules might include having odd breaks throughout the days and evenings. Temptations to nap throughout these days and putting work off will be thrust upon you. Sticking to that workday mindset can help maintain healthy sleep schedules and sanity while managing your workload and life balance as a genetic counseling student.

Lastly, imposter syndrome exists, and it exists in everyone. That feeling of doubting your own abilities can overtake your mind and consume. Knowing that others in your cohort experience similar thoughts can help normalize your own. Share your thoughts and feelings, you are in safe company. Remember, getting into the genetic counseling program is proof enough that you are fully capable of succeeding in your program and afterwards as a practicing genetic counselor. Hold on to that achievement - you can do this!

Inpatient Genetic Counseling - Glenna Noska

When I first learned about genetic counseling during my last semester of nursing school, I was only aware of the three core outpatient specialty areas within the profession: prenatal, pediatrics, and cancer. It wasn’t until entering genetic counseling graduate school that I learned of the many subspecialty areas in the field. I wasn’t aware, for example, that inpatient genetic counseling even existed, let alone the possibility that I may really enjoy it. But after having the opportunity to spend time in inpatient during my pediatric clinical rotation, that’s exactly what happened.

According to an article published in the Journal of Genetic Counseling in 2021, Characterization of Genetic Counselor practices in inpatient care settings, over 130 genetic counselors (GCs) provide care in the inpatient setting. However, the exact number of inpatient GCs is unknown (Magness et al., 2021). For comparison, according to the National Society of Genetic Counselors 2022 professional status survey, the number of certified genetic counselors in the United States as of April 2021 is 5,629 (National Society of Genetic Counselors, 2022). But despite the relatively small number of GCs working in inpatient, there is no denying how valuable of a role they play as part of the patient care team. Among the many roles they provide, having inpatient GCs increases patients' access to genetic services and testing and provides patients at the bedside with valuable support and continuity of care. Their genetic knowledge and expertise also guide healthcare providers and helps ensure the most appropriate genetic tests are being ordered. Having inpatient genetic counselors’ benefits patients and their families and the healthcare system as a whole.

As genetic counseling students at Pitt, we have 9-week clinical rotations in prenatal, cancer, and pediatrics, which includes two weeks with the inpatient pediatric GCs at the Children’s Hospital of Pittsburgh (CHP). During my pediatric rotation, I observed inpatient clinical rounds with the Geneticist and was given the opportunity to provide patients with pre/post-test counseling, genetics education, result disclosures, and psychosocial counseling.

I found my time in inpatient to be challenging, given the reduced preparation time as compared to outpatient, but also incredibly rewarding for its fast pace and multidisciplinary approach. I enjoyed having to think quickly on my feet and loved the opportunity to provide one-on-one counseling to patients at the bedside.

Still, my experience inpatient was only two weeks. For more insight into what it means to be an inpatient GC, I spoke to two from CHP who have been at it much longer than I have: Leslie Cyprych, LCGC, and Linford Williams, LCGC. Here’s what they had to say about inpatient genetic counseling:

What is an average day like for you as an inpatient genetic counselor?

Linford: Day to day on inpatient varies so much. Often it includes seeing around 1-2 new consults or new patients (on average), checking in on some patients you've seen earlier who are still admitted to discuss their thoughts on the recommended genetic testing, speaking to families about genetic testing results.

Throughout every day we're communicating with various other hospital teams as well such as ICU teams (ex – NICU, PICU), specialty teams (ex – cardiology, neurology) or general pediatrics teams.

Leslie: The genetic inpatient genetic counselors are the "first call" for genetics from 8a-4pm, so we carry a pager and a cell phone and triage calls throughout the day. Whenever a team in the hospital thinks their patient could have a genetic condition they page us, we prep the chart, and go see the patient. From there, it's pretty similar to an outpatient genetics appointment… you're just usually standing up at a patient's bedside rather than sitting across a table from them. We work alongside our geneticists to make sure the patient gets appropriate testing and counseling for whatever the concern is that has them admitted to the hospital.

We also field calls from all sorts of other folks who might be paging the Genetics service… Pediatricians and other doctors who have questions, labs with urgent results (like an abnormal newborn screen), and families who need to speak with a geneticist immediately.

In any time that I'm not actively seeing a new patient or handling incoming calls, I follow up on patients who have left the hospital by doing results disclosures, writing notes, and helping to get them established with our outpatient team for follow-up.

What is your favorite part of being an inpatient genetic counselor?

Linford: There are two aspects of this role which I enjoy a lot. One is the flexibility in terms of time you get to spend with a patient/their family. Unlike outpatient, we're not necessarily bound by any schedule, so we're able to meet with families for as long as or as many times as they need to fully process our discussions. There are many families that I've met several times to talk through their thoughts on genetic testing or any abnormal results for their child. I often find that I'm able to build much more rapport and meaningful relationships with inpatient families because of this.

Second is the variety. Every day on inpatient is different from the next. By nature of the position, you get exposed to numerous patient indications, diagnoses (common and rare), and different situations that families are in. It both keeps you engaged and grows your skillset quickly.

Leslie: I love the teamwork aspect of inpatient care. I interact daily with so many different specialists, nurses, dieticians, social workers, and more. I have learned so much in this position and have made so many wonderful professional connections.

I also really appreciate the opportunity to work with this specific patient population. It's a real privilege to be able to support families during such a vulnerable experience.

What is the most challenging aspect of being an inpatient genetic counselor?

Linford: The most challenging part is balancing all the demands on busy days and determining what can and can't be done in a day. Triaging each family's needs can be difficult because every patient and family we see is in some level of crisis that they haven't necessarily been in before. It's natural to be empathetic to each situation and hard to sometimes not try and do it all to not overwork yourself.

Leslie: Time management for sure! Since the inpatient genetic counselors are the first ones who get calls throughout the day, it's our job to triage a lot of the workflow for the day. For example, if you get more than one consult in a day, you need to be able to decide which one you're going to work up and see first. All while your pager keeps going off! It's one big rolling to-do list!

What advice would you give to students wishing to pursue a career in inpatient genetic counseling?

Linford: Inpatient genetic counseling is an evolving field and looks different across each institution and specialty. Sometimes the breadth of the role is also determined based on the administrative support of the institution.

The newly formed inpatient SIG is a great place to start getting some information about the ins and outs of inpatient genetic counseling across the specialties. Otherwise, I would advise purposefully seeking out positions which have some aspect of inpatient in the job description or advocate for that role when interviewing.

Finally, although you can never be fully prepared for what inpatient can throw at you, I would also advise starting with outpatient as a new grad (at least some of the time) to have a good foundation. Inpatient often involves quickly applying a knowledge base of genetic conditions as well as some of the ins and outs of the hospital you're working at to be the most successful, both of which come with some work experience. In an outpatient setting, this knowledge can be gained in a less time-sensitive manner.

Leslie: Try to get exposure to the specialty. We are very lucky at Pitt that inpatient experience is built into the pediatric rotation. I'm not sure I would have ever known this was a possibility if I hadn't had been part of Pitt's training program.

Other ways to get exposure would be to seek out inpatient counselors (ex: on the NSGC website), and joining the inpatient special interest group (SIG) within NSGC. The inpatient SIG is fairly new, but it has been a wonderful connection to other inpatient GCs so that we can share experiences and grow the specialty. The SIG also has a lecture series, which is great!

According to Magness et al. (2021), of the genetic counselors who work in the inpatient setting, 50% had not had exposure to inpatient genetic counseling during their graduate education. Gaining exposure to inpatient genetic counseling introduced me to a specialty area I didn't know existed, and it is a specialty I can see myself pursuing. Without this opportunity, I don't think I would have known that, and I am incredibly grateful that, as a student at Pitt, I had this unique opportunity.

I want to thank the Pitt GC program and the CHP pediatric genetics department staff, including the genetic counselors and physicians. I also want to thank Linford and Leslie for their willingness to provide their time and insight into this unique specialty.

Link to Inpatient Genetic Counseling SIG for more information:

https://www.nsgc.org/Members/Special-Interest-Groups-SIGs/Inpatient-SIG

References:

Magness, E., Magoulas, P., Moscarello, T., Ma, D., Helm, B. M., & Mizerik, E. (2021). Characterization of genetic counselor practices in inpatient care settings. Journal of Genetic Counseling. https://doi.org/10.1002/jgc4.1401

National Society of Genetic Counselors. (2022). NSGC > Policy, Research and Publications > Professional Status Survey. Www.nsgc.org. https://www.nsgc.org/Policy-Research-and-Publications/Professional-Status-Survey

Student Spotlight - Kate Cioffi

After a year of coursework, my classmates and I were eager to begin our clinical rotations. My first rotation block was in cancer genetics, a specialty that is particularly dear to me as I am a Genetic Counseling Assistant at the UPMC Hereditary GI Tumor Program. Although there is always a level of anxiety that comes with starting something new (the transition from didactics to clinicals is certainly a significant one!), I learned an incredible amount in just nine weeks.

During the rotation, students split their time between the UPMC hospital system and Allegheny Health Network. This serves to enrich the student experience as it enables us to be exposed to a variety of counseling styles, patient populations, and indications. It’s also valuable to observe how processes and workflows differ between health systems, especially given the fact that students will likely be spread throughout the country after graduation.

Students start small by initially taking on certain parts of the session and working their way up to complete the entire session by their fifth week. Though this may sound fast, with the support and feedback from supervising genetic counselors, this goal is more than attainable. In my nine weeks on the rotation, I saw patients with a variety of indications beyond those that are considered more typical for a cancer genetics clinic, like Hereditary Breast and Ovarian cancer. I counseled patients with suspected conditions ranging from Gorlin syndrome to Von Hippel Lindau disease. Students also spend three days in the Hereditary GI Tumor Program, gaining additional experience with hereditary GI cancer syndromes like familial adenomatous polyposis. There, we also observe the physician, Dr. Randall Brand, work with patients to gain a broader perspective of these patients’ clinical care.

Another important aspect of the rotation are the weekly clinical case reviews, wherein counselors and students present their upcoming cases. We discuss plans for each patient and get input from the team regarding differentials, testing approaches, and more. I found this helpful in improving the way I communicate with other providers and learning to identify the most critical parts of a case for review.

In all, I really enjoyed my time on the rotation. I appreciated being able to work with many different genetic counselors and glean bits of wisdom from each. It was rewarding to be able to work with so many different patients, who all had different stories and motivations for coming in to see us. Though I consider cancer genetics to be a bit of a “safe space” for me given my background, I’m excited to begin my rotations in other specialties and learn everything I can from the amazing genetic counselors we have in Pittsburgh!