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West B, Selig JP, Simonson M, Lepard-Tassin T. Factors influencing applicants' rank order in the Genetic Counseling Admissions Match. J Genet Couns 2024; 33:554-565. [PMID: 37528611 DOI: 10.1002/jgc4.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
Previous studies have identified factors that influence genetic counseling applicants' decisions to initially apply to certain schools. However, research on the factors that influence their Genetic Counseling Admissions Match (GCAM) rank order preferences are limited. The purpose of this study was to investigate these factors via an online survey sent to current students and recent graduates who participated in the GCAM. Participants (N = 415) were asked to rank factors within six categories (faculty, students, didactic curriculum, clinical training, cost of attendance, and general program information) on a 7-point Likert scale. Factors related to clinical training were most influential to applicants (M = 5.68), while factors related to didactic training were least influential to applicants (M = 4.63). Several significant differences existed between underrepresented and overrepresented applicants; overrepresented was defined as White, non-Hispanic female. Underrepresented applicants were more influenced by the diversity of program faculty (p = 0.016), students (p ≤ 0.001), and the location/patient population (p = 0.003), while overrepresented applicants are more influenced by program graduation and board pass rates (p = 0.021). The results of our study suggest that GCAM rank preferences are influenced by a large number of factors. Additionally, by demonstrating significant differences in the influence of program diversity on underrepresented applicants, the results of our study suggest that JEDI efforts of genetic counseling training programs should continue to be an area of focus, in order to create a more welcoming environment for all students and to further diversify the genetic counseling profession.
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Affiliation(s)
- Brayden West
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Molecular Genetic Pathology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - James P Selig
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Melinda Simonson
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Hereditary Cancer, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Tiffany Lepard-Tassin
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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2
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Paneque M, O Shea R, Narravula A, Siglen E, Ciuca A, Abulí A, Serra-Juhé C. Thirty-years of genetic counselling education in Europe: a growing professional area. Eur J Hum Genet 2024:10.1038/s41431-024-01552-8. [PMID: 38355960 DOI: 10.1038/s41431-024-01552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Genetic counselling education and training in Europe spans a continuum of 30 years. More master programs are opening due the demand for qualified genetic counselors. This report describes the evolution of training in Europe and the current state of genetic counselling training programs. Directors of master programs in Europe were invited to complete an online survey describing their program, including year of commencement, course duration, number of students and frequency of intake and number graduating. Results of the survey were presented at a closed meeting at the European Society of Human Genetics conference in 2022 along with a facilitated stakeholder engagement session in which 19 professionals participated to understand the challenges in delivering genetic counselling education in Europe. A total of 10 active programs exists in Europe with the first training program starting in 1992. The majority of training programs have a 2-year duration, with just over half of programs having an annual intake of students. Up to May 2022, 710 students have graduated from genetic counseling training programs across Europe. Of these, 670 students graduated from European Board of Medical Genetics-registered programs. Arranging clinical placements, clinical and counseling supervision of students, research collaboration for MSc research projects and incorporating genomics into the curriculum were identified as current challenges for genetic counseling education. Genetic counseling is still a developing profession in Europe and this historical and current view of the European genetic counselor pathways, allows for educational and professional standards to be examined as the profession evolves into the future.
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Affiliation(s)
- M Paneque
- CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - R O Shea
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW, Australia
- Cancer Genetic Service, St. James Hospital, Dublin, Ireland
| | | | - E Siglen
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - A Ciuca
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - A Abulí
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - C Serra-Juhé
- Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
- U705 CIBERER, Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), 28029, Madrid, Spain
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3
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Schwartz L, Mackall MS, Arjunan A, Goodenberger M, Mills R, Ham C, Witherington S. Graduate training, credentialing, and continuing education to prepare genetic counselors for laboratory roles-Results of a national survey. J Genet Couns 2024. [PMID: 38339832 DOI: 10.1002/jgc4.1883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Opportunities for genetic counselors to work in a variety of practice settings have greatly expanded, particularly in the laboratory. This study aimed to assess attitudes of genetic counselors working both within and outside of the laboratory setting regarding (1) the re-wording and/or expansion of key measures of genetic counselors' competency, including practice-based competencies (PBCs) and board examination, to include laboratory roles, (2) preparation and transferability of competencies developed in master's in genetic counseling (MGC) programs to different roles, (3) need of additional training for genetic counselors to practice in laboratory settings, and (4) preferred methods to obtain that training. An e-blast was sent to ABGC diplomats (N = 5458) with a link to a 29-item survey with 12 demographic questions to compare respondents to 2021 NSGC Professional Status Survey (PSS) respondents. Statistical comparisons were made between respondents working in the laboratory versus other settings. Among 399 responses received, there was an oversampling of respondents working in the laboratory (52% vs. 20% in PSS) and in non-direct patient care positions (47% vs. 25% in PSS). Most respondents agreed the PBCs were transferable to their work yet favored making the PBCs less direct patient care-focused, expanding PBCs to align with laboratory roles, adding laboratory-focused questions to the ABGC exam, and adding laboratory-focused training in MGC programs. Most agreed requiring post-MGC training would limit genetic counselors' ability to change jobs. Genetic counselors working in the laboratory reported being significantly less prepared by their MGC program for some roles (p < 0.001) or how the PBCs applied to non-direct patient care positions (p < 0.001). Only 53% of all respondents agreed that NSGC supports their professional needs and others in their practice area, and genetic counselors working in the laboratory were significantly less likely to agree (p = 0.002). These sentiments should be further explored.
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Affiliation(s)
- Lisa Schwartz
- Department of Biomedical Laboratory Sciences, The George Washington University, Ashburn, Virginia, USA
| | - Mia S Mackall
- Clinical Genetic Services, Natera, Inc., Austin, Texas, USA
| | - Aishwarya Arjunan
- Department of Medical Affairs, GRAIL, LLC., Menlo Park, California, USA
| | - McKinsey Goodenberger
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Mills
- MS Genetic Counseling Program, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Chloe Ham
- MD Program, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Witherington
- Oncology Genetic Services, BioReference Health, LLC, Elmwood Park, New Jersey, USA
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4
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Shane-Carson KP, Stone L, Justice K, Mwanda S, Stagg A, Pilditch J, Hiner S, Schwoerer JS, Berry SA, Edick MJ. Perspectives of genetic counseling supervisors regarding genetic counseling students' attainment of practice-based competencies in clinical care through remote supervision. J Genet Couns 2024; 33:86-102. [PMID: 38339846 DOI: 10.1002/jgc4.1872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
There are limited studies regarding the attainment of the Accreditation Council for Genetic Counseling Practice-Based Competencies by genetic counseling students who complete clinical rotations in an in-person setting versus in a remote setting that incudes telephone and/or video patient encounters. This study explored the perceptions of 17 patient-facing genetic counselors who had served as supervisors for genetic counseling students regarding student attainment of practice-based competencies in in-person compared to remote rotations. Participants were recruited through an American Board of Genetic Counseling eblast and were required to have at least 2 years of clinical experience and experience providing genetic counseling supervision for at least one in-person rotation and one remote rotation. Four focus groups were created comprising genetic counselors from various practice disciplines. Discussion focused on potential differences and similarities in supervisor perceptions of student attainment of each clinical practice-based competency, and whether there were any concerns about students being able to attain each competency in remote rotations. Overall, participants discussed that genetic counseling students' attainment of clinical competencies through remote rotations was comparable to in-person rotations; however, 15 themes were identified illustrating differences reported by participants in how they observed these skills being performed by students in in-person versus remote clinical settings. The findings of this study highlight important considerations when developing a remote rotation, as well as ways in which certain clinical skills may be further enhanced through a combination of both in-person and remote clinical experiences. A noted limitation of remote rotations is that students have less of an opportunity to interact with other providers, and so may require other opportunities for interprofessionalism and to understand their role as part of a larger organization. Further study is required to elucidate differences between telephone and video clinics, as well as potential differences pertaining to various specialty areas of practice.
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Affiliation(s)
- Kate P Shane-Carson
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine, Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Loan Stone
- Michigan Public Health Institute, Center for Data Management and Translational Research, Okemos, Michigan, USA
| | - Kaitlin Justice
- Michigan Public Health Institute, Center for Strategic Health Partnerships, Okemos, Michigan, USA
| | - Shannah Mwanda
- Michigan Public Health Institute, Center for Strategic Health Partnerships, Okemos, Michigan, USA
| | - Amy Stagg
- Michigan Public Health Institute, Center for Strategic Health Partnerships, Okemos, Michigan, USA
| | - Jane Pilditch
- Michigan Public Health Institute, Center for Strategic Health Partnerships, Okemos, Michigan, USA
| | - Sally Hiner
- Michigan Public Health Institute, Office of Research and Compliance, Okemos, Michigan, USA
| | - Jessica Scott Schwoerer
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Susan A Berry
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mathew J Edick
- Michigan Public Health Institute, Center for Strategic Health Partnerships, Okemos, Michigan, USA
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Cho MT, Davis C, Lowe C, Flynn M, Jamal L, Bajaj K, Atzinger C, Erby LH. Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies. J Genet Couns 2024; 33:118-123. [PMID: 38351603 PMCID: PMC10922725 DOI: 10.1002/jgc4.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
Educational use of clinical simulation is a way for students to immerse themselves within a realistic yet safe and structured environment as they practice clinical skills. It is widely used in healthcare training and evaluation, and there are best practices for design, implementation, debriefing, and assessment. An increasing number of genetic counseling graduate programs use simulation in various ways, ranging from role-plays to working with professional simulated/standardized patient (SP) actors. At this time, there is very little consistency across programs, research on the approaches, and standards by which simulation is incorporated into training. Simulation is an understudied but promising approach for genetic counselor (GC) education and assessment. After graduation, GCs demonstrate their competence as entry-level providers through American Board of Genetic Counseling (ABGC) multiple-choice examination (MCE), along with their participatory clinical encounters from graduate training. Data from genetic counseling and other professions highlight the limitations and biases of MCEs, suggesting they not only fail to accurately capture competency, but also that they disadvantage underrepresented individuals from entering the field. In addition, MCEs are limited as a tool for assessing nuanced counseling and communication skills, as compared to more quantitative scientific knowledge. We propose that innovative, evidence-based approaches such as simulation have the potential to not only enhance learning, but also to allow GCs to better demonstrate competency during training and in relation to the board examination. Collaborative approaches, research, and funding are needed to further explore the viability of routinely incorporating simulation into GC training and assessment.
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Affiliation(s)
- Megan T. Cho
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda MD
- Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD
| | - Claire Davis
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville NY
| | - Chenery Lowe
- Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD
| | - Maureen Flynn
- Department of Genetic Counseling, MGH Institute of Health Professions, Boston MA
| | - Leila Jamal
- Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda MD
- Department of Bioethics, National Institutes of Health, Bethesda MD
| | - Komal Bajaj
- Office of Quality & Safety, NYC Health + Hospitals/Jacobi/North Central Bronx, New York NY
| | - Carrie Atzinger
- Department of Pediatrics, College of Medicine, University of Cincinnati & Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Lori H. Erby
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda MD
- Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD
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Ahimaz P, Ross M, Foltz J, Sebastin M, Naik K, Kramer T, Bogyo K, Primiano M. Future Frontiers: Exploration of practices, challenges, and educational needs of genetic counselors in emerging subspecialties. J Genet Couns 2023; 32:1238-1248. [PMID: 37975258 DOI: 10.1002/jgc4.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/19/2023]
Abstract
The augmented use of genomic testing across different medical subspecialties has led to increased involvement of genetic counselors (GCs) in specialized areas of medicine. However, the lack of educational infrastructure required for changing scholastic needs of GCs entering new subspecialties lends to the burden of self-directed learning and inconsistent knowledge. We conducted a cross-sectional study surveying GCs with experience in the emerging genetic subspecialties of Immunology, Dermatology, Endocrinology, and Pulmonology (abbreviated as "IDEP") on current practices, clinical challenges, and educational strategies undertaken while working in these settings. We compared knowledge and confidence in skills related to IDEP patient care between GCs who do (experienced cohort) and do not (control cohort) practice in these settings to assess their comfort with working in subspecialties. Participants were recruited from the National Society of Genetic Counselors membership. A total of 304 GCs (178 experienced and 126 control) completed the survey. Most GCs in the experienced cohort saw IDEP patients by themselves (n = 104; 58.4%) or with a geneticist (n = 97; 54.4%) and almost all (n = 176; 99%) cited GeneReviews as a primary informational source for IDEP genetics but half (n = 91; 51.1%) agreed that a dedicated online course would be the best way to learn about a specific subspecialty. The experienced cohort scored higher on confidence in all skills (p < 0.001, z = 7.32) and knowledge (p < 0.001, z = 5.68) related to IDEP genetics than the control cohort. Previous exposure to IDEP through graduate school coursework and rotations positively correlated with better self-confidence in skills (p = 0.02, z = -2.19; p < 0.001, z = -5.25) and genetic knowledge (p = 0.03, z = -2.09; p < 0.001, z = -2.81) related to IDEP patient care. Years of experience working as a GC did not correlate with better confidence in skills (p = 0.53) or better IDEP genetic knowledge (p = 0.15). Our findings show that provision of opportunities for increased exposure to subspecialties could help maximize GCs' ability to work in emerging niche fields.
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Affiliation(s)
- Priyanka Ahimaz
- Division of Molecular Genetics, Department of Pediatrics, Columbia University, New York, New York, USA
| | - Meredith Ross
- Division of Clinical Genetics, Department of Pediatrics, Columbia University, New York, New York, USA
| | - Jennah Foltz
- Genetic Counseling Graduate Program, Columbia University, New York, New York, USA
| | - Monisha Sebastin
- Division of Genetics Medicine, Department of Pediatrics, Montefiore Medical Center, New York, New York, USA
| | - Ketki Naik
- Division of Clinical Genetics, Department of Pediatrics, Columbia University, New York, New York, USA
| | - Tamar Kramer
- Division of Clinical Genetics, Department of Pediatrics, Columbia University, New York, New York, USA
| | - Kelsie Bogyo
- Interdepartmental Genetic Counseling Program, Department of Medicine, Columbia University, New York, New York, USA
| | - Michelle Primiano
- Division of Clinical Genetics, Department of Oncology, Weill Cornell Medical Center, New York, New York, USA
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7
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Kohler JN, Glanton E, Boyd BM, Sillari CH, Marwaha S, Wheeler MT. Genetic counselor roles in the undiagnosed diseases network research study: Clinical care, collaboration, and curation. J Genet Couns 2022; 31:326-337. [PMID: 34374469 PMCID: PMC11305122 DOI: 10.1002/jgc4.1493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022]
Abstract
Genetic counselors (GCs) are increasingly filling important positions on research study teams, but there is limited literature describing the roles of GCs in these settings. GCs on the Undiagnosed Diseases Network (UDN) study team serve in a variety of roles across the research network and provide an opportunity to better understand genetic counselor roles in research. To quantitatively characterize the tasks regularly performed and professional fulfillment derived from these tasks, two surveys were administered to UDN GCs in a stepwise fashion. Responses from the first, free-response survey elicited the scope of tasks which informed development of a second structured, multiple-select survey. In survey 2, respondents were asked to select which roles they performed. Across 19 respondents, roles in survey 2 received a total of 947 selections averaging approximately 10 selections per role. When asked to indicate what roles they performed, respondent selected a mean of 50 roles (range 22-70). Survey 2 data were analyzed via thematic coding of responses and hierarchical cluster analysis to identify patterns in responses. From the thematic analysis, 20 non-overlapping codes emerged in seven categories: clinical interaction and care, communication, curation, leadership, participant management, research, and team management. Three themes emerged from the categories that represented the roles of GCs in the UDN: clinical care, collaboration, and curation. Cluster analyses showed that responses were more similar among individuals at the same institution than between institutions. This study highlights the ways GCs apply their unique skill set in the context of a clinical translational research network. Additionally, findings from this study reinforce the wide applicability of core skills that are part of genetic counseling training. Clinical literacy, genomics expertise and analysis, interpersonal, psychosocial and counseling skills, education, professional practice skills, and an understanding of research processes make genetic counselors well suited for such roles and poised to positively impact research experiences and outcomes for participants.
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Affiliation(s)
- Jennefer N Kohler
- Center for Undiagnosed Diseases, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Emily Glanton
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Color Genomics, Burlingame, CA, USA
| | - Brenna M Boyd
- Department of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Catherine H Sillari
- NIH Undiagnosed Diseases Program, Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - Shruti Marwaha
- Center for Undiagnosed Diseases, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew T Wheeler
- Center for Undiagnosed Diseases, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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8
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Myers MF, Bergner A, Conway L, Duquette D, Durst AL, Yashar BM, Zhang X, Campion M. A report of the AGCPD task force to evaluate associations between select admissions requirements, demographics, and performance on ABGC certification examination. J Genet Couns 2021; 31:302-315. [PMID: 34855258 DOI: 10.1002/jgc4.1537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022]
Abstract
Graduation from a genetic counseling graduate program accredited by the Accreditation Council of Genetic Counseling and certification obtained by passing the American Board of Genetic Counseling (ABGC) certification examination are increasingly required to practice as a genetic counselor in the USA. Despite the ABGC certification examination serving as a gateway to the genetic counseling career, there have been no research studies to date that have examined what variables are associated with examination performance. Therefore, the Association of Genetic Counseling Program Directors established a Task Force to assess whether trainee demographics, Grade point average (GPA) and Graduate Record Exam (GRE®) percentile scores are associated with passing the ABGC certification examination on the first attempt. We surveyed accredited genetic counseling graduate programs in North America and gathered demographic data, admissions variables, and certification examination outcome data for 1,494 trainees from 24 training programs, representing approximately 60.5% of matriculants between 2007 and 2016. Univariable analysis was performed to assess associations between admissions variables and categorical outcome (pass vs. fail) on the certification examination using Wilcoxon rank-sum or Fisher's exact test. Variables significantly associated with the categorical board outcome were then entered in a stepwise model selection procedure. In stepwise logistic regression, trainees with higher GPA (OR = 3.41; 95% CI = 1.99, 5.83), higher verbal (OR = 1.02; 95% CI = 1.01, 1.03) and quantitative (OR = 1.02; 95% CI = 1.01, 1.03) GRE® scores, female trainees (OR = 2.95; 95% CI = 1.70, 5.12), and White trainees (OR 3.37; 95% CI = 2.14, 5.30) had higher odds of passing the certification examination on the first attempt. As programs move to a holistic approach to graduate admissions in order to improve access to the genetic counseling profession, our results may influence programs to provide additional preparation for the certification examination for all trainees. In addition, genetic counseling professional organizations should continue to work together to assess and eliminate outcome disparities in admissions, training, and certification processes.
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Affiliation(s)
- Melanie F Myers
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Amanda Bergner
- Department of Genetics & Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Laura Conway
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debra Duquette
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrea L Durst
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Xue Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - MaryAnn Campion
- Department of Genetics, Stanford University, Stanford, California, USA
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Arjunan A, Sanders M, Chen A, Roscow B, Ray J. Genetic counseling student rotations in industry: How COVID-19 magnified the urgency for virtual learning options in diverse training settings. J Genet Couns 2021; 30:1316-1324. [PMID: 34462997 PMCID: PMC8656352 DOI: 10.1002/jgc4.1500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/12/2022]
Abstract
The COVID-19 pandemic created unprecedented challenges worldwide that required rapid adaptation and transformation across the entire healthcare system. Graduate medical training programs across all specialties have moved to rapidly adjust to the virtual landscape. This created a unique opportunity for genetic counselors who work in industry and within diagnostic laboratories to develop internship and rotation programs that can be offered virtually to meet the needs of genetic counseling training programs. Myriad Genetics, Inc., was contacted by numerous graduate programs in genetic counseling beginning in March 2020 requesting the opportunity for their students to participate in remote laboratory-based rotations. As a result of these requests, a working group of genetic counselors across Myriad came together to adapt existing experiences to fully remote formats and develop new remote-based opportunities for students. We describe our experience of expanding genetic counseling student rotations during the COVID-19 pandemic with the goal of providing examples of remote learning experiences that may be applicable to other diagnostic laboratory industry-based rotations for genetic counseling students. In 2020, a total of 59 second-year genetic counseling students, from 21 different genetic counseling training programs, participated in one of five different virtual experiences. Furthermore, two new rotation experiences were created to increase capacity and highlight diversity of industry roles. Genetic counselors in industry are uniquely positioned to provide both remote training opportunities for genetic counseling students and exposure to the variety of roles that genetic counselors can occupy. Increasing the exposure to these roles is important as the genetic counseling workforce continues to expand and diversify, and it is imperative among all programs to enable access to these opportunities.
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Affiliation(s)
| | | | - Anthony Chen
- Myriad Genetics, Inc., Salt Lake City, Utah, USA
| | | | - Jessica Ray
- Myriad Women' Health, South San Francisco, California, USA
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10
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Pediatric Oncologists' Experiences Returning and Incorporating Genomic Sequencing Results into Cancer Care. J Pers Med 2021; 11:jpm11060570. [PMID: 34207141 PMCID: PMC8235493 DOI: 10.3390/jpm11060570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric oncologists’ perspectives around returning and incorporating tumor and germline genomic sequencing (GS) results into cancer care are not well-described. To inform optimization of cancer genomics communication, we assessed oncologists’ experiences with return of genomic results (ROR), including their preparation/readiness for ROR, collaboration with genetic counselors (GCs) during ROR, and perceived challenges. The BASIC3 study paired pediatric oncologists with GCs to return results to patients’ families. We thematically analyzed 24 interviews with 12 oncologists at two post-ROR time points. Oncologists found pre-ROR meetings with GCs and geneticists essential to interpreting patients’ reports and communicating results to families. Most oncologists took a collaborative ROR approach where they discussed tumor findings and GCs discussed germline findings. Oncologists perceived many roles for GCs during ROR, including answering families’ questions and describing information in lay language. Challenges identified included conveying uncertain information in accessible language, limits of oncologists’ genetics expertise, and navigating families’ emotional responses. Oncologists emphasized how GCs’ and geneticists’ support was essential to ROR, especially for germline findings. GS can be successfully integrated into cancer care, but to account for the GC shortage, alternative ROR models and access to genetics resources will be needed to better support families and avoid burdening oncologists.
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Riddle L, Amendola LM, Gilmore MJ, Guerra C, Biesecker B, Kauffman TL, Anderson K, Rope AF, Leo MC, Caruncho M, Jarvik GP, Wilfond B, Goddard KAB, Joseph G. Development and early implementation of an Accessible, Relational, Inclusive and Actionable approach to genetic counseling: The ARIA model. PATIENT EDUCATION AND COUNSELING 2021; 104:969-978. [PMID: 33549385 PMCID: PMC8881934 DOI: 10.1016/j.pec.2020.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the training and early implementation of the ARIA model of genetic counseling (Accessible, Relational, Inclusive, Actionable). METHODS As part of the Cancer Health Assessments Reaching Many (CHARM) study, an interdisciplinary workgroup developed the ARIA curriculum and trained genetic counselors to return exome sequencing results using the ARIA model. CURRICULUM The ARIA curriculum includes didactic elements, discussion, readings, role plays, and observations of usual care genetic counseling sessions. The ARIA model provides the skills and strategies needed for genetic counseling to be accessible to all patients, regardless of prior knowledge or literacy level; involves appropriate psychological and social counseling without overwhelming the patient with information; and leaves the patient with clear and actionable next steps. CONCLUSION With sufficient training and practice, the ARIA model appears to be feasible, with promise for ensuring that genetic counselors' communication is accessible, relational, inclusive and actionable for the diverse patients participating in genomic medicine. PRACTICE IMPLICATIONS ARIA offers a coherent set of principles and strategies for effective communication with patients of all literacy levels and outlines specific techniques to practice and incorporate these skills into routine practice. The ARIA model could be integrated into genetic counseling training programs and practice, making genetic counseling more accessible and meaningful for all patients.
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Affiliation(s)
- Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, 1705 NE Pacific St. Box 357720, Seattle, WA 98195, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Claudia Guerra
- Department of General Internal Medicine, University of California, San Francisco, 1450 3rd St. Box 0128, San Francisco, CA 94158, USA
| | | | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Katherine Anderson
- Denver Health and Hospital Authority, MC 3150, 777 Bannock, Denver, CO 80204, USA
| | - Alan F Rope
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Mikaella Caruncho
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, 1705 NE Pacific St. Box 357720, Seattle, WA 98195, USA
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, M/S JMB-6, 1900 Ninth Ave., Seattle, WA 98101, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd St., San Francisco, CA 94158, USA
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12
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Amendola LM, Golden-Grant K, Scollon S. Scaling Genetic Counseling in the Genomics Era. Annu Rev Genomics Hum Genet 2021; 22:339-355. [PMID: 33722076 DOI: 10.1146/annurev-genom-110320-121752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The development of massively parallel sequencing-based genomic sequencing tests has increased genetic test availability and access. The field and practice of genetic counseling have adapted in response to this paradigm-shifting technology and the subsequent transition to practicing genomic medicine. While the key elements defining genetic counseling remain relevant, genetic counseling service delivery models and practice settings have evolved. Genetic counselors are addressing the challenges of direct-to-consumer and consumer-driven genetic testing, and genetic counseling training programs are responding to the ongoing increased demand for genetic counseling services across a broadening range of contexts. The need to diversify both the patient and participant groups with access to genetic information, as well as the field of genetic counseling, is at the forefront of research and training program initiatives. Genetic counselors are key stakeholders in the genomics era, and their contributions are essential to effectively and equitably deliver precision medicine.
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Affiliation(s)
- Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle, Washington 98195, USA; ,
| | - Katie Golden-Grant
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle, Washington 98195, USA; ,
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA;
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13
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Szymaniak BM, Facchini LA, Giri VN, Antonarakis ES, Beer TM, Carlo MI, Danila DC, Dhawan M, George D, Graff JN, Gupta S, Heath E, Higano CS, Liu G, Molina AM, Paller CJ, Patnaik A, Petrylak DP, Reichert Z, Rettig MB, Ryan CJ, Taplin ME, Vinson J, Whang YE, Morgans AK, Cheng HH, McKay RR. Practical Considerations and Challenges for Germline Genetic Testing in Patients With Prostate Cancer: Recommendations From the Germline Genetics Working Group of the PCCTC. JCO Oncol Pract 2020; 16:811-819. [PMID: 32986533 PMCID: PMC7735040 DOI: 10.1200/op.20.00431] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Germline genetic testing is now routinely recommended for patients with prostate cancer (PCa) because of expanded guidelines and options for targeted treatments. However, integrating genetic testing into oncology and urology clinical workflows remains a challenge because of the increased number of patients with PCa requiring testing and the limited access to genetics providers. This suggests a critical unmet need for genetic services outside of historical models. This review addresses current guidelines, considerations, and challenges for PCa genetic testing and offers a practical guide for genetic counseling and testing delivery, with solutions to help address potential barriers and challenges for both providers and patients. As genetic and genomic testing become integral to PCa care, developing standardized systems for implementation in the clinic is essential for delivering precision oncology to patients with PCa and realizing the full scope and impact of genetic testing.
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Affiliation(s)
- Brittany M. Szymaniak
- Department of Urology, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | | | | | | | - Tomasz M. Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Maria I. Carlo
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel C. Danila
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mallika Dhawan
- Division of Hematology/Oncology, University of California San Francisco, CA
| | - Daniel George
- Division of Medical Oncology, Department of Medicine, and Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Julie N. Graff
- Division of Hematology and Medical Oncology, VA Portland Health Care System/Oregon Health & Science University Knight Cancer Institute, Portland, OR
| | - Shilpa Gupta
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Elisabeth Heath
- Karmanos Cancer Institute and Department of Oncology, Wayne State University, Detroit, MI
| | - Celestia S. Higano
- Fred Hutchinson Cancer Research Center and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Glenn Liu
- University of Wisconsin, Madison, WI
| | - Ana M. Molina
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Akash Patnaik
- Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL
| | | | - Zachery Reichert
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI; University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Matthew B. Rettig
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Charles J. Ryan
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Jake Vinson
- The Prostate Cancer Clinical Trials Consortium, New York, NY
| | - Young E. Whang
- Department of Medicine, Hematology/Oncology, University of North Carolina Lineberger Cancer Center, Chapel Hill, NC
| | - Alicia K. Morgans
- Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Heather H. Cheng
- Fred Hutchinson Cancer Research Center and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Rana R. McKay
- Department of Medicine, University of California at San Diego Moores Cancer Center, La Jolla, CA
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14
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Khan A, Cohen S, Weir C, Greenberg S. Implementing innovative service delivery models in genetic counseling: a qualitative analysis of facilitators and barriers. J Genet Couns 2020; 30:319-328. [PMID: 32914913 DOI: 10.1002/jgc4.1325] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/02/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
Given the increasing demand for genetic counseling, implementation of innovative service delivery models (SDMs) has been proposed to improve access and increase the efficiency of genetic counseling services. This study investigated the key considerations in genetic counseling practices that impact the decision to implement innovative SDMs, as well as barriers and facilitators to implementation. A cross-sectional, qualitative research design was employed, using focus groups. Genetic counselors (GCs) were recruited from respondents to an online survey about SDMs and by posting an invitation to the National Society of Genetic Counselors (NSGC) listserv. A total of 30 participants participated in either in-person (n = 3) or online (n = 5) focus groups, facilitated by members of the Service Delivery Model subcommittee of the NSGC Access and Service Delivery Committee. Transcribed audio and written notes from the focus groups were coded, utilizing an inductive thematic analysis method. Five overarching themes that impact decisions to implement and use innovative SDMs were identified: (a) Patient volume and efficiency are key motivators in trying innovative SDMs; (b) the decision to change is facilitated by available resources; (c) the implementation of innovative SDMs is multidimensional and complex process; (d) there is concern about the impact on patient-provider relationships with the utilization of innovative SDMs; and (e) measuring outcomes of innovative SDM facilitates acquisition of additional resources and support. Approaches to innovative SDM selection and implementation vary by institution needs, resources, and population as demonstrated by the variety of approaches to similar barriers. Outcomes related to the implementation of innovative SDMs in genetic counseling practice should be measured to demonstrate the value of innovative genetic counseling SDMs, improvement of access to care, and to justify need for additional resources to support implementation of these models.
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Affiliation(s)
- Ambreen Khan
- University of Utah Graduate Program in Genetic Counseling, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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15
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Lee PWC, Bedard AC, Samimi S, Beard VK, Hong Q, Bedard JEJ, Gilks B, Schaeffer DF, Wolber R, Kwon JS, Lim HJ, Sun S, Schrader KA. Evaluating the impact of universal Lynch syndrome screening in a publicly funded healthcare system. Cancer Med 2020; 9:6507-6514. [PMID: 32700475 PMCID: PMC7520344 DOI: 10.1002/cam4.3279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/08/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Referrals for Lynch syndrome (LS) assessment have traditionally been based on personal and family medical history. The introduction of universal screening practices has allowed for referrals based on immunohistochemistry tests for mismatch repair (MMR) protein expression. This study aims to characterize the effect of universal screening in a publicly funded healthcare system with comparison to patients referred by traditional criteria, from January 2012 to March 2017. METHODS Patient files from the time of initiation of universal screening from 2012 to 2017 were reviewed. Patients were sorted into two groups: (a) universally screened and (b) referred by traditional methods. Mutation detection rates, analysis of traditional testing criteria met, and cascade carrier testing were evaluated. RESULTS The mutation detection rate of the universal screening group was higher than the traditionally referred group (45/228 (19.7%) vs 50/390 (12.5%), P = .05), though each were able to identify unique patients. An analysis of testing criteria met by each patient showed that half of referred patients from the universal screening group could not meet any traditional testing criteria. CONCLUSION The implementation of universal screening in a publicly funded system will increase efficiency in detecting patients with LS. The resources available for genetic testing and counseling may be more limited in public systems, thus inclusion of secondary screening with BRAF and MLH1 promoter hypermethylation testing is key to further optimizing efficiency.
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Affiliation(s)
- Petra W C Lee
- Department of Biology, University of the Fraser Valley, Abbotsford, BC, Canada
| | | | - Setareh Samimi
- Hematologie et Oncologie Departement, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Vivienne K Beard
- Department of Biology, University of the Fraser Valley, Abbotsford, BC, Canada
| | - Quan Hong
- BC Cancer, Hereditary Cancer Program, Vancouver, BC, Canada
| | - James E J Bedard
- Department of Biology, University of the Fraser Valley, Abbotsford, BC, Canada
| | - Blake Gilks
- Department of Pathology, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - David F Schaeffer
- Department of Pathology, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Robert Wolber
- Department of Pathology, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Janice S Kwon
- Division of Gynecology Oncology, BC Cancer, Vancouver, BC, Canada
| | - Howard J Lim
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Sophie Sun
- BC Cancer, Hereditary Cancer Program, Vancouver, BC, Canada.,Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- BC Cancer, Hereditary Cancer Program, Vancouver, BC, Canada.,Department of Medical Genetics, The University of British Columbia, Vancouver, BC, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
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16
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Yoshida A, Nakada H, Inaba A, Takahashi M. Ethical and professional challenges encountered by Japanese healthcare professionals who provide genetic counseling services. J Genet Couns 2020; 29:1004-1014. [PMID: 32030851 DOI: 10.1002/jgc4.1225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/09/2022]
Abstract
It is important to identify ethical and professional challenges associated with genetic counseling services and systems to improve these services. In previous studies, specific challenges in genetic counseling were categorized into 16 domains. However, these studies were limited to a few countries, and genetic counseling differs according to national cultures or systems. Thus, additional efforts should be made to collect and analyze challenges in genetic counseling to address these issues. We interviewed 48 genetic counseling professionals in Japan (including 29 clinical geneticists, 17 genetic counselors, and 2 other professionals) about anecdotes that included ethical professional challenges. Thematic analysis was used to code the interview data, and anecdotes were categorized according to the ethical and professional challenges. The anecdotes (n = 333) were classified into the 16 previously identified domains and three unique subcategories: 'lack of understanding about genetic professionals or departments of genetic counseling by other professionals and patients', 'insufficient communication skills to carry out counseling on the part of the genetic counseling professionals', and 'lack of a system for self-improvement'. Many of the anecdotes also noted the emotional responses domain. The challenges experienced by Japanese genetic counseling professionals described herein will improve the quality of the service these professionals provide. Furthermore, the results can assist development of high-quality genetic counseling systems in countries developing these systems.
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Affiliation(s)
- Akiko Yoshida
- Laboratory for Retinal Regeneration, RIKEN, Center for Biosystems Dynamics Research, Kobe, Japan.,Kobe City Eye Hospital, Kobe, Japan
| | - Haruka Nakada
- Division of Bioethics and Healthcare Law, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Akira Inaba
- Laboratory for Retinal Regeneration, RIKEN, Center for Biosystems Dynamics Research, Kobe, Japan.,Kobe City Eye Hospital, Kobe, Japan.,Department of Medical Ethics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayo Takahashi
- Laboratory for Retinal Regeneration, RIKEN, Center for Biosystems Dynamics Research, Kobe, Japan.,Kobe City Eye Hospital, Kobe, Japan
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17
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Hoffman JD, Thompson R, Swenson KB, Dasgupta S. Complexities of Clinical Genetics Consultation: An Interprofessional Clinical Skills Workshop. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10869. [PMID: 32342009 PMCID: PMC7182040 DOI: 10.15766/mep_2374-8265.10869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/04/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Advances in genomic medicine contribute to increased demand for clinical genetics services and require physicians to understand the interprofessional practice of this field. Medical students receive a foundation in genetics during preclinical studies, but variability in clinical experience may limit knowledge of and recruitment into this clinical specialty. In this resource, we describe an approach for simulating exposure to the practice of clinical genetics during the core pediatrics clerkship. METHODS Prior to class, students researched and considered a mock genetics case. In class, each of four small groups discussed two cases demonstrating varied presentations, with facilitation by genetic counseling students. Each case highlighted the variability in presentation, testing, management strategies, and psychosocial issues of a genetics case. Groups reported out to the class, and individuals completed an anonymous evaluation survey. RESULTS Surveys were distributed to nine of 10 pilot sessions (210 of 235 students) with a response rate of 48%. Students frequently reported no previous exposure to seeing patients with genetics professionals, indicated a preference for learning in case discussion format over traditional lectures, and felt the format helped them apply clinical skills and reasoning. Medical students appreciated the opportunity to interact with genetic counseling students in an interdisciplinary setting and desired further educational opportunities regarding delivering complex information to patients and their families. DISCUSSION This session expanded exposure to clinical genetics content and professionals, serving as an important foundation for further development of genetic knowledge during clinical training.
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Affiliation(s)
- Jodi D. Hoffman
- Associate Professor, Department of Pediatrics, Boston University School of Medicine
| | - Rachel Thompson
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
| | - Kathleen B. Swenson
- Assistant Professor, Department of Medical Sciences and Education, Boston University School of Medicine
| | - Shoumita Dasgupta
- Professor, Department of Medicine, Biomedical Genetics Section, Boston University School of Medicine
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18
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Means C, Cirino A, Swenson KB, Austin J. "I am a Genetic Counselor": A qualitative exploration of field leaders' perceptions of the title "genetic counselor". J Genet Couns 2019; 29:97-104. [PMID: 31663200 DOI: 10.1002/jgc4.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/05/2019] [Accepted: 10/09/2019] [Indexed: 11/05/2022]
Abstract
The genetic counseling profession is 50 years old, and is growing and diversifying. Despite this evolving context, no studies have formally explored the continuing relevance or appropriateness of the title "genetic counselor." We used a qualitative research methodology (interpretive description) to explore this concept among thought leaders within the genetic counseling profession. We conducted 12 semi-structured telephone interviews, which ranged in length from 18 to 50 min, and transcribed them verbatim. Analysis and data collection unfolded in parallel. The following themes regarding participants' perceptions of the title "genetic counselor" emerged from the data: (1) others misunderstand "genetic counselor"; (2) the term "counselor" in our title produces complex and conflicting emotions; (3) risks of changing our title outweigh the benefit; and (4) we need to own the narrative surrounding our title. Despite recognition that the title "genetic counselor" may not capture the full range of diverse roles members of the profession play, our data reveal overall support for the continued relevance and appropriateness of the title, for the value of the strength that comes from unity within the profession, and for efforts to highlight that which unites us across roles, disciplines, and specialties.
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Affiliation(s)
- Chandler Means
- Graduate Medical Sciences, Master's Program in Genetic Counseling, Boston University School of Medicine, Boston, MA, USA
| | - Allison Cirino
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathleen B Swenson
- Graduate Medical Sciences, Master's Program in Genetic Counseling, Boston University School of Medicine, Boston, MA, USA
| | - Jehannine Austin
- Departments of Psychiatry and Medical Genetics, University of British Columbia, Vancouver, Canada
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19
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Kostick K, Pereira S, Brannan C, Torgerson L, Lázaro-Muñoz G. Psychiatric genomics researchers' perspectives on best practices for returning results to individual participants. Genet Med 2019; 22:345-352. [PMID: 31477844 PMCID: PMC7000323 DOI: 10.1038/s41436-019-0642-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/13/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Large-scale array-based and sequencing studies have advanced our understanding of the genetic architecture of psychiatric disorders, but also increased the potential to generate an exponentially larger amount of clinically relevant findings. As genomic testing becomes more widespread in psychiatry research, urgency grows to establish best practices for offering return of results (RoR) to individuals at risk or diagnosed with a psychiatric disorder. Methods We interviewed an international sample (n = 39) of psychiatric genetics researchers to examine conceptualizations of “best practices” for RoR to individual research participants. Results While the vast majority of researchers do not offer RoR, most believed medically actionable findings (85%) and clinically valid but non–medically actionable findings (54%) should be offered. Researchers identified three main areas for improvement: interfacing with individual participants; interdisciplinary training, guidance, and integration; and quality planning and resource allocation for returning results. Conclusion There are significant gaps between researchers’ visions for “best” versus “actual” RoR practices. While researchers call for participant-centered practices, including consent practices that consider any special needs of participants with psychiatric disorders, return of individually meaningful results, and effective follow-up and provisions for treatment, the current reality is that consent and RoR practices lack standardized and evidence-based norms.
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Affiliation(s)
- Kristin Kostick
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Pereira
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Cody Brannan
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA.
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21
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Towards Cultural Competence in the Genomic Age: a Review of Current Health Care Provider Educational Trainings and Interventions. CURRENT GENETIC MEDICINE REPORTS 2018. [DOI: 10.1007/s40142-018-0150-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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22
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Bamshad MJ, Magoulas PL, Dent KM. Genetic counselors on the frontline of precision health. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:5-9. [PMID: 29582554 DOI: 10.1002/ajmg.c.31610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/04/2018] [Indexed: 12/16/2022]
Abstract
By enabling precise genetic diagnosis and treatment there is great potential for inexpensive, accurate, and widely accessible genomic information to transform health care and improve the general well-being of virtually every person. To maximize this potential, approaches to genetic counseling and the role of genetic counselors will need to adapt to fit changing clinical and commercial needs worldwide. This will require overcoming multiple challenges including an inadequate workforce; development and implementation of alternate models of service delivery; integration of new technologies to improve, extend, and expand services; and support for equitable education and counseling among all populations. Genetic counselors are aptly poised to take on these challenges. The result will be better informed patients and families more capable of utilizing genetic information appropriately, making autonomous decisions about their care, and modifying their approach to disease risk to actively contribute to their health. The contributors to this issue of Seminars discuss how key areas of genetic counseling need to evolve and how genetic counselors can play a role in shaping the future of precision health.
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Affiliation(s)
- Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington.,Division of Genetic Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Pilar L Magoulas
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas
| | - Karin M Dent
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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