The future of genetic counselling - your questions answered
As UTS Genetic Counselling prepare for the first cohort of students, we asked course contributors some questions our future students have about a career as a genetic counsellor. Here’s what they had to say.
We enjoyed interviewing for our first cohort of Master of Genetic Counselling students.. During the interviews, we were impressed with some of the great questions the candidates asked us about the profession. Their questions got us thinking about how our colleagues might have answered. We therefore posed some of these questions to our Curriculum Advisory Committee who have worked with us to develop the program over the last year. This committee includes experienced clinical and laboratory genetic counsellors, as well as two recent graduates of genetic counselling programs, a clinical psychologist, an ethicist, a learning designer, a university administrator, a specialist in Indigenous health and a clinical geneticist.
The future of the profession- it’s an exciting time for genetic counsellors
We asked the Committee about the evolution and future of the genetic counselling profession. There is likely to be an increasing need for genetic counsellors as testing is integrated into mainstream care, resulting in genetic counsellors working in diverse health related services and situations. Genetic counsellors are already diverging from the traditional clinical roles, with new opportunities emerging in areas of research, academia, policy development, leadership, private practice and specialist streams. This demand is leading to a workforce shortage of genetic counsellors, and a drive towards independent practice and recognition.
The recent shift in genetic counselling roles has alerted potential students to the fact that as new graduates, they may be applying for unique and highly specialised genetic counselling roles. What does this mean for students? How will they be prepared for the changes in the profession and will the diversity of clinical placements offered during the course provide important exposure to the breadth of these new genetic counsellor positions? Whereever possible, students may experience genetic counselling in settings such as laboratories and commercial companies. However, placement opportunities are limited by availability and the low number of certified genetic counsellors working in these areas and able to provide supervision. The current certification process is clinically focussed making it difficult for genetic counsellors working in roles such as research, education and laboratory roles to achieve certification. Within the profession, further discussion is exploring the impact of these new and emerging roles on the genetic counsellor certification process.
As a relatively new profession, genetic counselling is going through a phase of evolution and growth, and it is helpful to draw on the experiences of more established allied health professions who have undergone similar changes. One of the questions arising from the interviews was whether genetic counsellors are underselling their skill set by training other health professionals to deliver genetic counselling. A parallel was made with clinical psychology which has seen a growth in training about cognitive behavioural therapy (CBT) amongst mental health nurses, particularly in the UK. Rather than reducing the demand for clinical psychologists, this initiative has raised awareness around mental health and enabled clinical psychologists to apply their skills to complex cases and specialist areas. A similar situation is expected with genetic counselling. As the complexity of cases grows and awareness is raised by other health professionals taking on more of the delivery of genetic healthcare, the demand for the specialist skills of genetic counsellors and clinical geneticists is likely to increase. This growth in demand is already evident in the new model of mainstreaming genetics which has already increased the workload for genetic counsellors, and utilised their expertise around managing individuals and families with a pathogenic or uncertain variant.
Challenges faced by genetic counsellors
When asked about the most challenging aspects of the genetic counsellors’ role, there were several responses. Lack of awareness amongst other health professionals about what genetic counsellors do was one of many of the reported challenges of being a genetic counsellor.
It is important for genetic counsellors to act as advocates and take the lead in educating other health professionals about their roles and their skills. Genetic counsellors need to articulate their unique competencies, such as family communication of genetic disease to help others to understand how we contribute to the multidisciplinary team approach to caring for a patient and their family.
A new graduate talked about feeling challenged each time she delivers tricky or unexpected results – a feeling echoed by more experienced genetic counsellors who pointed out that you can never predict how someone is going to react to difficult news. Yet, this aspect of our work was also viewed as rewarding, as continuous learning around how individuals and families react to and make decisions about genetic information provides the opportunity to reflect on and improve one’s practice. Other challenges highlighted by the genetic counsellors on the committee included finding a balance between how much information client’s really need to know about the rapidly evolving genetic and genomic technology in the family context, and how to provide equal access to genetic testing within services that are often limited by funding budgets. The perceived challenges by the non-genetic counsellors on the committee focused on time pressures and constraints due to increased workloads and workforce shortage, which were acknowledged as valid obstacles by the genetic counsellors.
Finally, when asked why our colleagues had agreed to be involved in the curriculum development for the new UTS course, we received responses ranging from altruistic reasons, such as contributing to the evolution of the profession through the education of new graduates and to be part of shaping a forward thinking curriculum, to identifying possible knowledge gaps during past student supervision or by reflecting on recent training experiences. Our non-genetic counsellor colleagues described more global reasons for being involved. The reasons given included valuing the process of developing and implementing new courses and helping to map out the evolution of the students from entry to graduation and beyond, a passion for incorporating theoretical ideas into practice and seeing how this can make a difference in the real world. This discussion in response to the candidates’ questions highlighted a keen interest in the genetic counselling profession and a desire to design a relevant and stimulating course curriculum during a time of rapid and exciting change.
We are very grateful for the generosity of our establishment curriculum committee in sharing their experience, wisdom, enthusiasm and support with us during 2018.