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.

Public Health in the Genetic Counseling Space - Megan Zieber

 

Since beginning my career at Pitt Public Health, my appreciation for external influences on health – accessibility, transportation, and built environment – has grown immensely.  The University of Pittsburgh is one of few schools in the country to offer a dual Master of Public Health (MPH) in Public Health Genetics and Master of Science in Genetic Counseling (MSGC) degree.  The MPH gives me a unique perspective when approaching case preparation and patient interactions.  Working directly with individuals in outpatient clinics as well as underserved communities in the greater Pittsburgh area has highlighted gaps in care and sparked ideas of how, as providers, we can work on transdisciplinary teams to close those gaps.  The MPH also exposed me to more disciplines that I may interface with in my career – social work, physical therapy and occupational therapy, as well as environmental and occupational health, to name a few.

As a student currently in the dual degree program, I recognize some of the benefits of pursuing an MPH in addition to my MSGC degree; however, I think there are some things you can only glean from working in the field.  With the innumerable opportunities available to students in genetic counseling and public health programs, I thought it would be helpful to hear from two currently practicing genetic counselors on how their dual degrees (MPH/MSGC) are serving them in their unique careers. 

I spoke with Kerrianne Fry, MS, MPH, CGC and Aishwarya Arjunan, MS, MPH, CGC, CPH, two Pitt MPH/MSGC alumnae.  Kerrianne attended Shippensburg University of Pennsylvania, where she majored in Biology with a Health Sciences concentration and minored in Psychology.  She then attended the University of Pittsburgh, beginning with her MPH in Public Health Genetics and graduating with a dual degree in 2016.  Aishwarya completed her undergraduate education at Case Western Reserve University, majoring in Biology.  She continued on to the University of Pittsburgh to complete her Master of Public Health degree.  After a year at Pitt, she matriculated into the genetic counseling program, graduating with a dual degree in 2013.  Read on to hear about their journeys with the MPH and what they’ve been up to since graduation.

Why did you decide to pursue a dual degree?

Kerrianne: I kind of tripped and stumbled into the dual degree.  I was accepted into the MPH first.  I had applied for both the MS and MPH, but I wasn’t accepted into the MS program my first application cycle.  I decided to continue on the path of the MPH because I knew genetics was where my passion lied.  I reapplied to get into the MS program the next year and was accepted.  I don’t think I fully appreciated the finer aspects of the MPH until I was into my working career, and I recognized what my passions were.  I realized the MPH strongly aligned with who I am – my core values as a person.  I think it marries what I really enjoy and am passionate about.  I always explain it to people that the MS degree is one-on-one conversation, and the MPH is the bridge between the whole population and getting to the one-on-one conversation – the bridge that builds the gap between the general population and how we get them to that individualized care.  So, I’ve always seen them as one integrated program rather than seeing them as two distinctly defined degrees.  I always looked at how I could pull my knowledge base together.

Aishwarya: I think public health was something I became interested in in college.  I was a biology major, but I also took anthropology classes and some sociology classes in which public health would come up in conversation.  Then at the end of senior year [of college], I decided to apply to public health programs.  [Public health] was something I was really interested in, and Pitt was the only one that had a public health degree in genetics.  I was always looking to be in a healthcare space.  I hadn’t heard about genetic counseling until senior year when I was in a developmental biology lab class.  The post doc teaching the class asked if I’d heard of genetic counseling, so I talked to one of the genetic counseling program directors to learn more.  They told me what prerequisites and extracurriculars I needed, like crisis counseling.  It was already into one semester of senior year, so I thought, ‘I’ve already applied to grad programs.  Maybe this isn’t for me.’  I went to Pitt for my public health degree.  In the Intro to Public Health Genetics class, one of the directors of Pitt’s MPH Public Health Genetics program pulled me aside very early on and said, ‘Have you thought about genetic counseling?’  These are two people that I don’t know very well who are saying this is a career I need to look into, so I set up observations with the genetic counselors in Pitt, and then ended up applying to the Pitt Genetic Counseling program that Fall.  It’s been a blessing because this is not what I had planned for my life, but this has been perfect for me.

Would you share what your GC journey has looked like since graduation?  Where has your career taken you?

Kerrianne: I’ve worked in many different domains as a genetic counselor.  I was previously working in the clinic, where my main passion was newborn screening which has a strong public health component to it.  I was talking to people in one-on-one conversations who have these conditions that were diagnosed from a population health standpoint.  I now work for Myriad in the lab industry, which I think is where my MPH kicked in even more.  My passion as a genetic counselor is lab utilization and optimization.  I really like the behind-the-scenes work.  I love chatting with patients one-on-one and families, but my ultimate goal is working on projects that can improve the physician and patient experience.  ‘What can I do on the back end to make it an even better outcome for both parties, individually and collectively, so that patients can get the best care possible?’  I want to make sure the most appropriate testing is being ordered and ensure providers know what testing exists to help their patient.

Aishwarya: I’m in industry now, but when I graduated, I found a job where I felt like I could really combine the public health and genetic counseling degrees.  Eighty percent of my job was with the Center for Jewish Genetics, which is part of the Jewish Federation in Chicago, and twenty percent of my job was clinical pediatrics at Lurie Children’s Hospital.  My role at the hospital was clinical pediatrics, seeing patients who were coming in and working with the medical geneticists.  My role [at the Center for Jewish Genetics] was to be educating the Chicagoan Jewish community about genetics and genetic testing, primarily carrier screening.  They used to have a program that would happen every other month at local synagogues where people would come in, listen to a presentation about carrier screening and risks, and have their blood drawn to be sent for testing.  When I joined, I switched that program to a virtual format and made it a continuous program that people could sign up whenever they want, watch a series of educational videos, and we would reach out to them once they completed that to answer any questions they might have had.  We would mail a [saliva] kit to their house.  They would get the kits, give their sample, and send it back to the lab; I would get the results and follow up to do the counseling.  It was an opportunity to do a lot of education and public health genetics awareness.  I was at the Center for Jewish Genetics for a little over two years, and then switched to industry [in 2015] to work as a medical science liaison (MSL) at Counsyl.  I was an MSL for a few years, and then I switched over to product.  I was the clinical product manager for the expanded carrier screening.  I joined GRAIL, Inc. in May 2021 as an MSL.

Do you think having the dual degree has helped you in your genetic counseling career?  If so, how?

Kerrianne: The MPH focuses on all the other specialties you can run into – health administration, epidemiology, behavioral health sciences – all the specialties that I would want to refer to or that might refer to me.  The dual degree has made me more cognizant of other key stakeholders and the importance we all play, independently and cohesively.  The MPH, for me, has built the acknowledgement that other teams are equally important to genetics in different ways.  It has broadened my awareness and respect of other practices before I even set foot in a clinic.  I think that’s one of the biggest differences I see between me and a lot of genetic counselors I’ve practiced with in the past.  I’ve always looked at it from a much bigger picture; I recognize I can’t be my best self without the support of different teams of providers. I always thought that I was just a different genetic counselor.  I’ve learned a lot of that is from my MPH training.

Aishwarya: I really think the dual degree helps.  More and more of the general public is getting access to genetic testing and genetic information one way or another.  "Personalized medicine" is the buzz word.  I think there are so many ways that genetics is intertwined into people’s care that they don’t even realize.  I think we need to be doing more; public health genetics is very important and it’s what drives my role.  I strongly believe that if I can help educate or empower one provider to be more comfortable and understand the testing that they’re offering and offer better pre-test counseling, the downstream impact is much larger than I could’ve had seeing patients one-on-one.  I think it would be beneficial for a lot of people to have more of a public health background to really understand how everything fits together.  I think the public health degree is so useful because it gives you more perspective outside of what might be your area of expertise.  With the MPH, I had to take an environmental and health sciences class, as well as health policy and management – additional things that you don’t take as a genetic counseling student.  We need to have as much exposure to things outside of our area because those things have an impact on what we do.  I think it helps us to be more open-minded about how we fit into the picture.

What advice would you give to students thinking about completing an MPH in addition to an MSGC?

Kerrianne: When I first graduated with my MPH, I wasn’t sure why I put myself in one additional year of debt, but when I reflect on my MPH, there were so many classes I loved that taught me how other specialties approached a situation, what types of resolutions they could provide, what gaps there may be, and where genetics or another specialty could fill that space.  A lot of what the MPH taught me is to think about the upstream and downstream factors that could influence the indications bringing individuals into the genetics clinic.  If we’re all willing to state our voices and listen to others to work together, it’s all going to go so much better.

Aishwarya: Just understanding other perspectives, it really helps me be a better genetic counselor.  I have a classmate who got an MPH after we finished grad school and a few years later said, ‘This is really important.’  Genetics is already everywhere, and being able to have the public health lens and understanding will help you think wider than our genetics space.  I don’t think I knew all the possibilities of different roles that I could do when I was graduating.  There’s such a diverse variety of roles that are available for genetic counselors to thrive in.  There are so many ways we can use our genetic counseling skills that we shouldn’t hold ourselves back.  I think our genetic counseling degree gives us a great base and there’s so many things we can grow from, do, and learn.

If I had to pare down what I learned from meeting with these accomplished genetic counselors, I would say, think outside the box and build your network.  Not everything has a genetic cause.  Convergence of environmental factors and genetics can account for more indications than you may expect.  Building your network will open opportunities for mentorship, as well as growth to help ensure a better patient experience.                                           

Thank you to Kerrianne and Aishwarya for taking time out of their busy schedules to provide insight on their unique journeys with the dual degree.

*Responses have been shortened for length purposes.

For more information on Pitt’s dual MPH/MSGC degree, visit: https://www.sph.pitt.edu/hugen/academics/dual-mphms-genetic-counseling

Making Waves in the SEAs of Genetic Counseling - Leann To

My father fled Vietnam since my grandfather, a South Vietnamese Army Officer, was sent to a re-education camp after the Fall of Saigon. He slipped away on a small rickety boat during a quiet night at a South Vietnamese sea port with two of his sisters, even after his youngest brother’s multiple failed attempts had left him imprisoned. At the age of 19, my father stayed at Galang Refugee Camp in Indonesia awaiting sponsorship for US citizenship. 

I am a child of Southeast Asian (SEA) immigrants. My ethnic identity was shaped early on in my Vietnamese home, where I spent most of my time playing with my brother and cousins in a quaint Midwestern town. As I grew up, I became familiar with the role of a translator: from reading bills, writing emails, and explaining my days at school in Vietnamese.

 

However, going to the doctor’s office was often a frustrating experience that proved to be difficult. Due to language and cultural barriers, my mother had difficulty finding a doctor that would listen to her concerns, which caused a significant delay in her diagnosis. My family’s experience with healthcare barriers is just one drop in the ocean of many others in the Asian American (AA) community.

 

According to a systematic review by Young et al., many Asian Americans (which includes SEAs) face various challenges to accessing genetic counseling and genetic testing:

 

1.  Lack of Access and Awareness of Genetic Services: AAs have some of the lowest awareness levels regarding genetic testing services compared to other groups. One study found that AAs have the lowest proportion of knowledge regarding their family history, which in part can be attributed to immigration or forced displacement of certain ethnic groups.

2.  Language Barriers: Patients with limited English proficiency face a significant barrier. Studies have brought up that AAs were reluctant to ask questions during GC sessions due to difficulties formulating questions in English. Differences in language can also create difficulty in conversing with healthcare providers and understanding and interpreting test results.

3.  Cultural Factors: AA patients expected providers to give specific health recommendations. Some patients felt uncomfortable with the nondirective nature of genetic counseling. Family roles in decision-making was also highlighted: one study of East/SEA women showed an emphasis on collective family decisions, rather than an individual decision for a range of prenatal tests.

4.  Aggregation of Asian American Subgroups: Few studies have explicitly compared multiple Asian subgroups. AAs are a heterogenous group composed of various ethnicities with different needs. Lumping various Asian communities into one singular non-specific group with no options to categorize by ethnicity creates inequities and masks meaningful differences in health.

 

To serve the needs of a diverse and culturally rich population and reduce health disparities, our profession must take measures to increase diversity and promote inclusion to train graduates who will promote a society in which all people have equal access to culturally competent healthcare and the resources to make informed health decisions. This ongoing endeavor starts with the recruitment and support of students from backgrounds currently underrepresented in the field.

The NSGC 2022 Professional Status Survey reported that 36 genetic counselors identified as SEA, out of a total of 2,859 completed surveys. To put this in perspective, the US Census Bureau published data from the 2016-2020 5-year ACS stating that there are 5.9 million SEAs living in the US. We do not have enough SEA genetic counselors (or those from any racial/ethnic minority groups for that matter) to provide patient/provider concordance.

The National Match Survey Statistics for 2022 reported that 8% of students who matched identified as East/SEA. There was no increase for the 2023 application cycle. As a minority student in the field, I am excited to be able to be part of the future generation of diverse genetic counselors. Although I feel invigorated to promote DEIJ and improve health outcomes for all, I sometimes feel like a fish out of water in graduate school. To all my fellow minority genetic counseling students, these are the ways I found a sense of belonging and a space of support during graduate school:

 

Find your local community and relationships outside of the profession. Moving away to a foreign place far away from my family was a culture shock. I often felt homesick. If I ever feel like I’m drowning in grad school, I go to my favorite family-run Vietnamese restaurant in Pittsburgh. Being able to see others who looked like me and shared the same language reminded me of the reason why I want to be a GC, and I found people who could be my anchor. Creating your community, whether it be your mail carrier or the person that cuts your hair, can end up being some of the most supportive people outside of school. You never know where support can come from.

 

Connect with other minority students and GCs. I was able to meet other racial/ethnic medical genetic professionals through the Minority Genetics Professional Network. I established a monthly peer support Zoom call for current minority GC students and co-moderate it with another student I met via MGPN. Other places, like #GeneChat on Twitter has also provided me with online platforms where I can belong and relate to shared experiences with other minority GCs and students.

Các cậu hãy nhớ nằng:

Đã từng có một phiên bản trẻ hơn của cậu đã không nghĩ rằng cậu sẽ đến được đây vào ngày hôm nay. Nhưng họ đang theo dõi cậu vô cùng tự hào và đầy lòng biết ơn. Vì vậy hãy tiếp tục phát triển nhé!

Tôi là Tô Liên LeAnn, sinh viên tư vấn di truyền. 

My Favorite Places to Study in Oakland and Shadyside - Gopika Rajanikanth

The Pitt Genetic Counseling uses a confidence building model, so during our first year, we mainly focus on classes. As a result, this past year, my classmates and I have had a lot of assignments to work on and exams to prepare for. Personally, I find it a bit difficult to focus if I am stuck in the same location for a while, so I like to study in different libraries and coffee shops around Oakland and Shadyside. I also went to undergrad at Pitt, so these are some of the places I have really enjoyed studying in over the last few years as a student in Pittsburgh.

Human Genetics Study Rooms

The Human Genetics department, where the genetic counseling program is housed, is located on the 3^rd floor of the Public Health building. On our floor, we have two different study rooms for students to use. Since most of our classes are located in the Public Health building, this is a great study space before, after, or in between classes. The main study room has tables and white boards, which makes it a great place to collaborate on assignments. The room also has a fridge and microwave, so we all tend to eat our lunch in here.

The quiet study room is right next door and is comprised of desks that have dividers, so you can have some quiet and privacy. I have found that this is a good place to sit if I really need to focus on something and do not want any distractions, such as if I am working on an online quiz for class.

Divvy Coffee & Buns 

This coffee shop is located along Forbes Avenue, just a 3-minute walk from the Public Health building. The interior is really cute - they have a massive floral wall, lots of travel themed décor, and lots of tables. This is a good place to go if you do not want to go too far from campus and maybe want to get some food while studying. I actually spent a lot of time here last year writing and revising my personal statement when I was applying to grad school.

Hillman Library

This is Pitt’s main library and is a short walk from the Public Health building. The 3^rd and 4^th floors were renovated a few years ago, and the 1^st and 2^nd floors actually opened again earlier this semester after renovation, so the library looks pretty modern. Something useful about Hillman is that you can book group study rooms which can be useful for collaborating with others or if you just need a quiet space.

Coffee Tree Roasters - Shadyside

This coffee shop is located in Shadyside on Walnut Street and is a favorite of many of my classmates. Since a lot of us live in Shadyside, this is a really convenient place for us to meet up on weekends and get work done. Coffee Tree Roasters is a lot bigger than a lot of the other coffee shops in the area, so it is easier to find a place to sit. Something I really like about Coffee Tree Roasters is that they have a closed off room in the back that is specifically meant for studying, so it is a lot quieter compared to the rest of the available seating.

Carnegie Library of Pittsburgh – Main (Oakland)

The Carnegie Library system is the Pittsburgh public library system, and the main branch is located in Oakland right across the street from the Cathedral of Learning. The inside of the library is really beautiful, and if you go up to the second floor, you will find a large room with plenty of long wooden tables and outlets, perfect for studying. There are also massive windows and lots of natural lighting, which makes it a more pleasant place to study. There is even a coffee shop downstairs if you want to treat yourself to something while you study. The Carnegie Library is honestly one of my favorite places to study, and I have definitely influenced a lot of my cohort to come study here with me. In fact, a few of us have made it a habit to come here every Saturday morning to get some work done because we all feel more productive here. Sometimes after studying, I like wandering around the fiction section downstairs and perhaps checking out a book or two.

My First Genetic Test - Alex Larson

In a high school science club, I isolated my DNA from a saliva sample (or at least I believed I did; there was no confirmatory test done) and the concept of a genetic code firmly gripped my curiosity. How could an invisible molecule in a teensy, tiny tube dictate the construction and function of my body? And humans have the ability to read, predict, and manipulate this code? I was hooked.

Eight years later, I am thoroughly enjoying my first year of genetic counseling training and have a soft spot for a class titled “Genetic Techniques”. In this course, we are treated to lectures detailing different genetic testing methods and other molecular techniques and then get to try our hand at them in lab. Even with a background in bench research, I have learned a lot and gained immense respect for the lab technicians. The professors are thoughtful in explaining the reasoning behind each step in a protocol and are thankfully quite patient as our clumsy hands attempt to execute the experiment. While I likely will not do much pipetting after graduating, it has been incredibly valuable to gain insight into the strengths, weaknesses, and requirements of different genetic tests that I could order for a patient someday.

Additionally, and unexpectedly, the class has offered a glimpse of some psychosocial aspects of genetic testing. Spread across several labs, we isolated our DNA from blood samples, amplified a gene of interest with PCR, and confirmed successful PCR products (my high school self would have exploded with excitement). We sent our products out for Sanger sequencing and when our results returned, we combed through the reads for a single nucleotide change. In the gene ABCC11, we were looking for a variant that, when inherited from both parents, is seen in individuals with dry earwax and mildly smelly sweat as opposed to wet earwax and sweat with a typical odor. I was happy to find that not only was sequencing of my sample successful, but I have the genotype of a dry-earwaxed-and-mildly-smelly individual!

When viewing my sequencing results, I felt…excited? Proud? Why did I feel proud? I had not done anything to achieve this genotype and quite honestly, I still felt just as smelly as anyone else. I felt kind of awkward talking about my genotype with my classmates, as if it may make someone feel bad about not having the same discovery in their results. As I reflected on these silly thoughts about my single nucleotide changes, I recognized that this was my first genetic test. I had peered into my genes and, in a little way, pulled back the curtain between my lived experience and my biological blueprint. If such a goofy, insignificant test could provoke an emotional response in me, what psychosocial cartwheels await someone who has just received results of a disease-related genetic test?

While I previously understood that patient distress can be associated with genetic testing results disclosure, I had acquired a new appreciation for the weight of this information. Even when presented with biological "good news”, people may still wrestle with how to relate to their genetic make-up. As a high schooler I held deep respect for the genetic code, and my genetic counseling training has only reinforced the power of this information. I am grateful for opportunities provided by the program like “Genetic Techniques” to craft myself as a knowledgeable, thoughtful, and sincerely considerate provider.

9 Things I Wish I Knew Going into GC Applications - Emily Hrach

The GC application process is a long and stressful one, and looking back there are a lot of things I wish I could’ve told myself now that I’ve been through it. Here are some of those things:

1. You do not have to be a GCA. When I was applying, I felt like everybody else was a GCA. Being a GCA is a great experience, but the vast majority of my classmates never worked as a GCA- it is not a requirement for graduate programs! These jobs are rare and competitive- I sent in dozens of GCA applications and never got an interview. I ended up getting creative with my gap-year jobs and these ended up being hugely rewarding experiences! If you’re like me and are getting rejection after rejection trying to find a GCA job, don’t sweat. There are a ton of other interesting, unique, and inspiring options out there.

2. You also do not have to work for Crisis Text Line. Crisis Text Line is great, but again, it is not the only option out there. If there is a specific cause or organization that you are passionate about, look into local or national organizations dedicated to the topic (I worked at a local center focused on youth housing and it was an incredible experience). Also, think about if you would prefer a text, phone, or in-person experience. Text is definitely the most convenient and accessible while phone/in-person experiences may help you get used to working with people in real time. I personally found in-person crisis management to be extremely challenging, but I learned a lot from the experience. Before setting your mind to one organization, think about what type of experience is right for you, your goals, and your schedule.

3. Check if the school wants your official or unofficial transcript!! I have a friend who forgot to check and spent a lot of money sending out her official transcripts when she didn’t have to. Don’t do that!!!

4. There is no common app. You probably already picked up on this if you’ve started applications, but if you haven’t, here is your warning: each application is separate, so be prepared to fill out a bunch of applications and ask your recommenders to submit letters to multiple different sites. This will take much longer than college applications, so be sure to plan your schedule accordingly (most of the people in my cohort started in late summer/early fall).

5. Don’t let your personal statement read like a robot wrote a resume, and give yourself lots of time to get it right. I’m speaking from personal experience here- my resume-esque first draft was boring, impersonal, and repetitive (they already had my CV!) Your personal statement is a chance to tell a story (not your whole life story, you only have a few hundred words), illuminate your personality, and show admissions directors why you are going to be an awesome GC. Writing an honest, impactful personal statement takes time, so make sure you give yourself plenty.

6. It’s okay to not be a genetics expert. This is what graduate school is for! It’s okay if you can’t name all the conditions on PA’s newborn screening panel or calculate residual risk after a negative CF carrier screening test. Some interviews have questions about cases, but the goal is for the interviewer to see how you think rather than test you. Don’t study for your interviews, but be prepared to think logically and articulate your thought process. Disclaimer: I obviously did not interview at every school, so I don’t know for a fact that this is true everywhere, but this was my experience and the experience of everyone I have talked to :)

7. Interviewers are really just people. Seriously. I actually had a lot of fun in my interviews. Don’t get me wrong- it was super nerve-racking, but I ended up having a lot of really informative and interesting conversations. Remember that you are talking to real people who do this job, at least in part, because they enjoy talking to students. You talk to people everyday, and interviewers are just more people to talk to. Take a deep breath, you can do it.

8. Have a couple really solid answers to common interview questions prepared- each school will ask different questions, and it’s going to be impossible to predict all of them. Some questions, however, are pretty standard (this is true for job interviews, too!) You’ll probably get questions like “tell me about yourself” and “why genetic counseling”. Take some time to think about these questions and find honest answers. If someone asks why you want to be a GC, you’ll probably want an answer that goes beyond just saying that you like science and helping people- dig deep and figure out why you really want to do GC. I’d recommend practicing your responses to these kinds of questions in advance (Katie Lee CGC on YouTube has some really good videos about this).

9. All the cheesy ones- don’t focus on what other people are doing, take care of your mental health, and remind yourself that this experience does not define you. Think of the things that have helped you get through stressful periods in the past and do those things again. Take deep breaths, prioritize your sleep, don’t be afraid to ask for help from your loved ones and/or a professional. Good luck, you’ve got this!