4.15.2020

Graduate School and Graduation during the COVID-19 Crisis

It’s 7:30 on a Tuesday. I hop off the shuttle from the parking garage and make my way to the E building. I’m feeling healthy today, so I take the stairs up to the 5th floor. I badge in and sit down at my desk to respond to a few emails before our 8:00 Advanced Genetic Counseling class.

It’s 7:45. My classmate April walks in. In keeping with our daily routine, she asks if I want to make coffee with her. Of course I do! We grab our respective mugs and K-cups and shuffle over to the break room, catching up on each other’s evenings. Piping hot coffee in hand, we trickle in to our classroom along with our 10 other classmates. We each take our unofficially self-assigned seat around the table. We’re all chatting as though we haven’t seen each other in weeks. (We had class together 15 hours ago and then went to Monday night trivia at MadTree together). Joshua says something funny and/or very Canadian, we all laugh, and eventually Carrie gets started with class. Today’s topic is compassion fatigue and burnout in genetic counseling.

It’s 11:00. I’m heading back to my desk from a meeting with my clinical supervisor. We reviewed the plan for this afternoon’s patients and agreed to meet in clinic at 1:00. In the meantime, I make some revisions to my thesis and schedule a meeting with my research advisor for the following day.

It’s 2:30. Clinic is busy today!

It’s 5:45. I arrive home after a busy day. My dog greets me enthusiastically as I unclip my badge and take off my shoes. A few minutes later, I get a text from my classmate Chloe: “Burgers tonight?” Yes! I put my shoes right back on and head out the door.

It’s 9:30. Dinner was fun! I’m exhausted, but I’m glad I went. I set my alarm and my head hits the pillow, ready to do it all again tomorrow.

The COVID-19 crisis forced a transition from normal life to completely uncharted territory for everyone in a matter of days. We as a program had to quickly adapt to the many challenges that came with this unexpected transition to remote learning and social distancing.
For me, the biggest challenge of being a genetic counseling student during the COVID-19 crisis has been dealing with my own feelings of loss and grief. As a second year student growing more and more eager to add that “MS” to my name, there was no world in which I ever anticipated a cancelled graduation. I could not wait to put on that cap and gown and celebrate all of my class’s accomplishments. I was so excited for my parents to see all of my hard work, meet my classmates and faculty, and enjoy some of my favorite places in Cincinnati with me. My classmates and I have been talking about ideas for our graduation reception for literally almost two years now. This was going to be the culmination of everything we’ve done on our journey to become genetic counselors. And it was just...cancelled. I knew it was coming. Everything else had been cancelled. Businesses were closed. We were ordered to stay in our homes. And yet, graduation was the one thing I was still holding on to. Maybe, just maybe, things would be normal again by April 30th. Up until that point, I had been bottling up all of my grief. Seeing the email pop up in my inbox with the subject line “Spring 2020 Commencement Postponed” was what finally broke me. I knew the university was making the right decision. “It’s not safe to hold a graduation ceremony right now,” I told myself. I sat on the couch and cried anyway.

Over the last two years, my classmates have also become some of my closest friends. As we started accepting jobs around the country throughout our final semester, I was already feeling particularly sentimental about making the most of our last few weeks together. We were going to go to brunch every weekend, go on tons of hikes as the weather got nicer, laugh our way through many wine-filled game nights, spend lazy days at my apartment pool, work separately but together at our desks on E5...and I was ready to cherish every last moment.

But we left for Spring Break and never came back. It has become increasingly clear that I may not see any of them again in person before I move to Chicago.

Our entire program has been flipped completely upside down over the last few weeks. We have had to learn a completely new normal as everyone has been figuring out how to work from home. Technology issues have been frequent, classes and meetings have often been interrupted by partners/pets/kids, and yet, nobody seems to mind. We are all in this together, but apart. Despite the lack of in-person contact during the COVID-19 crisis, we as a program have really worked hard to maintain a sense of community. We hold weekly virtual lunches for everyone in the program to attend. Topics of conversation have included: quarantine baking, unique challenges we each face while working from home, and of course, Tiger King. This 45-minute get-together is something I look forward to every week because there’s something about just hearing and seeing everyone that makes me feel a little less isolated. Our second year class group chat continues to be very active, a constant stream of memes and pictures of our pets. We hold Skype game nights at least once a week and have managed to come up with an arsenal of phone-based games we can play together remotely. More often than not, several of us linger on Skype calls after class a little longer to keep chatting.

Classes, clinical rotations, and research have also required some major adaptations. All classes and thesis defenses were switched to remote. Instead of a triumphant thesis defense photo of me in a sharp blazer in front of my title slide, I’m now presenting from my bedroom with my dog barking in the background. In-person clinical rotations were cancelled, but these experiences were supplemented with an assignment related to our online Case Series as well as telemedicine role-plays with supervisors. My community education experience that got cancelled due to COVID-19 turned into this blog post. Program interviews, which have always been some of the most exciting days of spring semester, were made remote. I imagined how hard it must be for applicants this cycle, many of whom have been unable to visit campuses and meet faculty and current students in person. We typically host an informal meet-and-greet for interviewees and current students called Dessert Night the night before each interview day. I wanted to come up with some sort of remote alternative to give our remote interviewees that same opportunity, and so Bring Your Own Dessert Night was born! A virtual recognition ceremony for the Class of 2020 is in the works as well. We as a program have truly risen to the challenge and adapted to this entirely new normal in just a few short weeks, and I think that’s pretty remarkable. It’s not the same, but I do feel fortunate that we’re living in a world where we have these electronic resources to keep in touch and maintain a sense of community while we’re all stuck in our respective homes. And so, we’ll continue doing what we’re doing. We’ll keep rising to new challenges to adapt to these ever-changing and unprecedented times.

I never factored a global pandemic into my graduate school plans. We talk a lot about grief in the genetic counseling setting, and one of the types of grief that often comes up is a loss of normality. I never quite understood what this meant until now.

I am safe and healthy. I have a roof over my head and plenty to eat. I have supportive friends and family that love me. I’m about to earn my Master’s degree!!!!!

I have so much to be thankful for, and yet, I’m grieving. I’m grieving the loss of my normal and the loss of my plans. The coping process has not been linear, and some days have been harder than others. Despite the grief, I know that my training has prepared me to be a competent and confident genetic counselor, ready to take on the real world as soon as it re-opens. It has truly been an incredible two years, and I got to experience it all with some of the most amazing people I’ve ever known by my side (and/or by Skype).

The finish line wasn’t what I expected, but I sure am lucky to have taken the journey.

Kelly Buh
Class of 2020

3.12.2019

Supporting Students with March Madness

The Madness is upon us, and that means it's time to test your prognostication prowess in the most exciting tournament in sports! 


The University of Cincinnati/Cincinnati Children’s Hospital Medical Center Genetic Counseling Program is hosting an NCAA Men’s Basketball Bracket Challenge. 


All proceeds benefit student scholarships. 

Here's your chance to both support the education of future genetic counselors and test your hoops expertise in the ultimate tournament pool!


To participate online, follow these instructions:



  • You may need to create an account at this link before completing your bracket
  • Make your tax-deductible donation here (or see below for other ways to donate): Donation
  • Complete your bracket once teams are announced on Selection Sunday (March 17th). Brackets must be completed before play begins on Thursday, March 21st.
  • Watch the madness unfold and cheer on your top picks!

If you prefer to donate in person, Alexandra Magnante or Preethi Pillai will be able to accept credit cards, checks, and cash beginning Wednesday, March 6th. Please email GCPMarchMadness@cchmc.org if you have any questions.

We are suggesting a tax-deductible donation of $15 but certainly appreciate any amount you are willing to contribute. Dr. and Mrs. Carl Huether are also currently offering a generous matching 3 to 1 gift so no amount is too small! Please consider forwarding this email to anyone else you think might be interested in participating. 


THANK YOU!

~UC Genetic Counseling Program


1.18.2019

Elective Rotation - Assisted Reproductive Technology

Becky McGowan, 2nd Year Student

One of the opportunities afforded to students in the UC genetic counseling program is the ability to select our own summer rotations.  Having an interest in the area of infertility and preconception genetic counseling, I worked with the program to find two unique rotation opportunities for the summer with genetic counselors at embryo testing laboratories.   In each of these rotations I was able to learn about the types of genetic tests available at the preconception stage, about effective methods for telephone counseling, and about the specific challenges and emotional burdens faced by the preconception patient population.

My first summer rotation was heavily focused on preimplantation genetic testing for single-gene conditions, or PGT-M (monogenic).  This test is available largely to those who know that they have a personal or family history of a condition such as Huntington’s disease, Fragile X, breast cancer, etc. with a known familial mutation already established. Often individuals may not have a family history, but are identified via carrier screening through their fertility clinic as being at risk to have a child with one of the tested genetic conditions.  Couples choosing to screen embryos via PGT-M are often seeking to stop the cycle of disease that has been in their family, or may have lost a child or had a child with a severe presentation and wish to use the technology available to choose to implant an embryo that would not carry the genetic mutation.  Often couples who use PGT-M may not have fertility concerns, but may be going through IVF specifically for this genetic test. 

In my second summer rotation I focused on preimplantation genetic screening for aneuploidy, or PGT-A.  This test screens embryos to see if there are extra or missing chromosomes (aneuploidy).  Having extra or missing chromosomes is the greatest factor in embryo implantation failure and early pregnancy loss. Performing this test increases the chance of establishing a pregnancy during IVF, while also screening for conditions such as Down syndrome, which typically is caused by an additional copy of chromosome 21. 

Since the counseling was performed remotely, I was able to experience a really diverse array of patient interactions. I worked with patients all over the country as well as internationally. I was able to work with same-sex couples, couples using surrogates or gamete donation, single individuals, couples facing male-factor infertility, female-factor infertility, or unexplained infertility.  Patients came to the genetic counseling sessions with different goals and different past experiences on their journey to conception. It was a tremendous opportunity to be a part of that process and allow patients a space to ask questions about genetic testing options. 

Genetic counseling consultations for both of these tests followed a similar structure to the in-person genetic counseling sessions I have been involved in during my other rotations! We started by contracting with the patients and asking what their hopes or goals were of the testing, as well as what information they had coming into the session. In many cases we took a pregnancy history, and for PGT-M cases, where other family members had the condition, we generally took a pedigree and inquired about relatives.  We also reviewed the available test reports and often contacted other laboratories or genetic counselors regarding previous testing or if remaining DNA was available.  The PGT-M cases involved designing a probe with samples of DNA from two generations of family members to track markers that sit above and below the gene of interest. We discussed residual risks, prenatal testing options, and set expectations with patients by discussing the potential outcomes of testing.  In both rotations we worked closely with the laboratory team to determine the best testing approach for each patient.  I also worked on responding to physician inquiries regarding specific patient concerns or testing questions. 

In my second rotation I also had the opportunity to put together and deliver two presentations on another genetic test, endometrial receptivity analysis (ERA).  I spoke about counseling considerations involving this test to staff at a fertility clinic, including nurses, physicians, and lab staff.  I also presented on the test design and the role of the genetic counselor in working with ERA patients for genetic counselors in the special interest group for ART and infertility through the National Society of Genetic Counselors (NSGC).  These experiences allowed me to work on my public speaking skills and educate other providers about the benefit of genetic testing and genetic counseling. 

Overall, my summer rotations were a phenomenal learning experience.  Industry is a rising site for employment of genetic counselors, and it was a great chance to experience work at a for-profit laboratory setting.  Both of my summer sites were heavily involved in research and genetic counselors were encouraged to be involved in research projects.  It was great to see how genetic counselors in these positions are able to move the field forward and improve patient care.   I became very comfortable speaking with patients over the phone and being able to pick up on non-verbal cues to guide psychosocial counseling.  I often felt that patients were more comfortable being emotionally vulnerable over the phone and in the comfort of their own familiar setting, as opposed to in an unfamiliar clinic environment.  It was also very gratifying to be a part of the journey with women and couples who were seeking to build their families.

 - Becky McGowan, Second Year Student

11.16.2018

This Is What I Know. Now What Can We Do? – Racial Diversity in Genetic Counseling

Bryana Rivers, Cincinnati GC Student
The lack of diversity in the field of genetic counseling is an issue that has been present since the start of the profession. However, very few studies have actually been done on the presence of underrepresented minorities (URMs) in the field. A 2008 study by Mittman and Downs about the past, present, and future of diversity in our field explains that, despite efforts to increase diversity, the field of genetic counseling is still composed of over 94% non-Hispanic, white genetic counselors. The article focused on underrepresented racial and ethnic minorities within the field, such as African Americans, Native Americans, and Hispanic Americans, quoting these groups as comprising about 2 to 3% of the profession, but about 33% of the general population. That means that our presence in the field is vastly disproportionate to our presence in the general population.

Increasing diversity in the field is important to allow individuals like me to have colleagues and mentors who look like me and so that our patients can have providers who look like them. As a black female entering the field of genetic counseling, I can only speak about my own experiences, which may not be the same for all genetic counselors who belong to a minority group. Nonetheless, I think that it’s important that I share my experiences and that others have the opportunity to share their experiences as well.

One particular experience that stood out to me occurred during my summer rotation here at Cincinnati Children’s Hospital. My patients were siblings, a black male and a black female, with diagnoses of developmental disabilities and hypotonia. They were accompanied by their mother and their maternal grandmother. Both children previously had extensive genetic testing, including panel testing, single gene testing, and microarrays, which were all either normal or had several variants of uncertain significance (VUSs). For social reasons, variant tracking in the family was not attainable. What we did know, was that one particular VUS of interest was presumed to be paternally inherited.

Our patients’ mother was hoping to get some answers from us so that she could have a definitive diagnosis for her children. Without a diagnosis, she had been struggling to access the necessary resources they needed in school. Unfortunately, for this family, we could only communicate our suspicions of what was causing the developmental disability, but we could not give them a definitive cause, diagnosis, prognosis, or recurrence risk.

At one point during the appointment, the mother had a question for my supervisor and me. She stated that she had an honest question, but that she was unsure of how to ask it without coming across as offensive. We encouraged her to ask the question anyway. She wanted to know if we, as black health care providers, have seen “other people who look like us” with the same variant found in her children. Honestly, I wasn’t sure what to say. I deferred the question to my supervisor who explained that the variant found in her children has not been previously published or described in other patients. She then went on to explain that the mother brought up a great point about VUSs in black patients. Being that we are a less-studied group, VUSs are more commonly seen in minority populations than in white populations. The patients’ mother added that she felt that there are barriers to healthcare and genetic testing in minority populations that also contribute to the lack of data and knowledge of how certain genetic variants affect our health. Afterwards, she told my supervisor and me that we have a responsibility as black women to improve our knowledge of genetic variants in minority populations while making sure that they are not being taken advantage of by the individuals conducting the research.

That was a loaded statement that I have reflected a lot on since I saw that family. In that moment I felt heartbroken for this woman who had worked so hard to obtain the best care for her children, but had so many doors closed in her face while trying to access the necessary resources. However, I also felt thankful that my supervisor and I were the ones who saw these patients because their mother was able to open up about questions she has been holding onto and challenges that she has been facing while advocating for her children.

I cannot stress enough how important it is for patients to feel comfortable, to feel heard, and to know that they will not be ignored or discriminated against by their providers based on the color of their skin. I don’t want to suggest that a genetic counselor who wasn’t black wouldn’t have listened to her, but there are factors outside of what we do and say that can have an impact on our patients. Just the fact that she was able to lower her guard a bit because we share the same racial background as her speaks volumes.

People like seeing themselves represented in their social and professional circles, including their healthcare providers. This is just one example of how increasing diversity in the field of genetic counseling can help our patients. But now the question is: Why have past efforts failed to improve diversity in the field, and what can we do to fix it?

--Bryana Rivers, 2nd Year Genetic Counseling Student

4.18.2018

Qualified Bilingual Staff & Language Access Services


QBS Badge Backer
Growing up, I spoke both English and Urdu – the native language of Pakistan, which is where my parents were from. I never considered my bilingual skills to be anything special until I started my time at the University of Cincinnati/Cincinnati Children’s Genetic Counseling Program. During our orientation week, a member of Cincinnati Children’s Hospital Medical Center’s (CCHMC) Diversity and Inclusion department spoke with us about cultural competency. The presentation included information on Language Access Services, and a program called the “Qualified Bilingual Staff”. In CCHMC, if any staff/employees are bilingual, they can train through the hospital to be able to become a Qualified Bilingual Staff (QBS). A QBS member may
  
1) Provide interpreting to, or speak directly with patients and their families at the hospital outside their appointments in the target language, and/or

2) Provide interpreting to, or speak directly with patients and their families at the hospital during their medical appointments

To become a QBS member, one must first take an assessment in their target language, which in my case was Urdu. Since Urdu is considered a rare language, I took my assessment over the phone rather than in person. The assessment tested my spoken skills in Urdu, progressively becoming more difficult till I could no longer answer the questions being asked. Based on the assessment scoring, one is assigned either a QBS Level I or QBS Level II. 

Falling in the Level I range meant that you could provide interpreting to, or speak directly with patients and their families at the hospital outside their appointments, for example, if a patient is asking for directions in the hospital. Falling in the Level II range meant that you could provide interpreting to, and speak directly with patients and their families in the target language in their medical appointments. Fortunately, I was assigned to be Level II. An additional perk of being Level II is that you can get paid for providing interpreting for medical appointments! 

Before you can be recognized as a QBS member, you must first complete QBS training via CCHMC. I completed my training at the end of my first year in the genetic counseling program, right before I headed out of town to my summer rotation. Since returning to CCHMC for my second year, I have not provided any interpreting for medical appointments (by choice), but rather I have taken on a part time job with the Language Access Services department. At my job, I have worked to create a resource for interpreters whose target languages are rare, like mine. While there are plenty of resources available for interpreters of the more common languages such as Spanish and Arabic, there aren’t many training resources for interpreters who have rare target languages, such as Urdu. In creating this resource, I have also had the opportunity to shadow the CCHMC staff medical interpreters.

The experience of training as a QBS member, and working with Language Access Services has allowed me to appreciate the role of medical interpreters from the perspective of the interpreter. I realized how helpful this experience was when I myself counseled a patient with an Arabic medical interpreter present in the room. I found myself to be much more comfortable with the medical interpreter in the room, and it made the delivery of information to the client much more effective.

I am grateful to have been a part of an institution that has a well-developed Language Access Services department, and provides services every day to numerous patients and families with limited English proficiency. I am passionate about continuing to grow in my cultural competency, and my work with the Language Access Services has helped contribute to that by allowing me to better appreciate the intertwining nature of language and culture.

Fatima Amir, Class of 2018

12.07.2017

Elective Rotation: Informed Consent and Biobanking

Second year students in the UC/CCHMC GCP who are on track to complete their clinical logbook requirements are given the option to develop their own elective rotation. Students choose these rotations based on their interests or skills they would like to obtain. Along with input from program faculty, they develop the learning objectives and outcomes for their rotation. Previous elective rotation posts were about the International Adoption Center, StarshineHospice, Psychiatry, and Bioethics.

How are biobanks regulated? What information are patients provided during the informed consent process for biobank research enrollment? What is discussed when reviewing biobanking research protocols at an IRB meeting?

I learned about biobanking through lectures in Human Genetics and Emerging Topics in Clinical Genomics during my first year of the program. Genetic counselors are often asked to facilitate consent for research protocols involving genomics, as well as for participation in biobanks. Biobanks offer opportunities for researchers to access many patient samples and clinical data to facilitate research into therapeutics, natural history of disease, how genetics may influence disease states, etc. Genetic information is often collected, de-identified, and stored as part of this process. However, there is ongoing debate as to if and how genetic variants found through biobanking should be communicated to study participants.

Through networking with faculty members at the University of Cincinnati and Cincinnati Children’s Hospital, I set up a rotation with Dr. Kelsey Dillehay McKillip, Director, and her team at the University of Cincinnati Biorepository, as well as Dr. Mike Linke, IRB Chair, with the University of Cincinnati Institutional Review Board (IRB). At this time, the UC Biorepository is mostly composed of blood, urine, tumor and paired normal tissue samples from patients with solid cancers. The UC IRB has 20+ members with various professional backgrounds including biobanking, medicine, sociology, etc. The UC IRB meets every week for about two hours. Each IRB meeting was composed of at least eight different IRB members.

During my rotation, I observed the biobanking process from start to finish including screening patients to determine who met eligibility criteria, talking with eligible patients during the informed consent process, collecting and processing blood or tissue samples, and dispensing samples to researchers who have IRB approval for research that utilizes UC Biorepository specimens. I also attended UC IRB meetings where investigator-initiated biobanking protocols were discussed. The UC Biorepository is a core facility that supports basic scientists at UC and CCHMC, however there are also separate investigator initiated research protocols that can involve biobanking as well. Finally, I revised and consolidated multiple informed consent documents for different sample types into a universal consent document. Currently, if patients have different types of cancers, they are asked for their consent to participate in biobanking research for each individual cancer during their clinic visits. Therefore, the ultimate goal was to create a clear and concise consent form that would allow patients to provide consent once and provide multiple sample types for biobanking research in the future. The use of a universal consent form not only facilitates research, but also increases efficiency during patient clinic visits if patients only have to talk with one member of the research team at one time point.

Related to my knowledge in genetics, I was specifically tasked with adding language to the consent about how participants’ genetic information may be handled, as well as specific laws that protect this information (such as GINA: Genetic Information Nondiscrimination Act). Further, I conducted a literature review about how changes in human subjects research policy impacts genetic information and the informed consent process. The majority of biobanks, including the UC Biorepository, do not report genetic research findings to participants. However, there is debate within the research community about the most ethical way to handle and store genetic information and whether it should be communicated to research participants.

My experience with the UC Biorepository team and the UC IRB will allow me to better explain the biobanking process to patients and anticipate questions an IRB may have about a research protocol that involves biospecimen collection. I thank Dr. Kelsey Dillehay and Dr. Mike Linke, as well as the UC Biorepository team members including Matt Koch, Farah Sagin, MS, and Karen Winstead for their time and supervision.

I am thankful that the UC graduate program encourages students to take responsibility for their education and seek opportunities that foster their personal and professional growth. Further, I thank my classmates and program faculty for facilitating my interests into action throughout my graduate career at UC.


--Kristen Fishler, Class of 2018

7.10.2017

NSGC "Prospectives in Genetic Counseling" newsletter

The National Society of Genetic Counselors (NSGC) Student/New Member SIG has put together the third edition of their "Prospectives in Genetic Counseling" newsletter, which is geared toward prospective and new genetic counseling students.  It includes articles by recent alum Sarah Chadwell and current student Stacey Aldrich.  Check it out here:


Prospectives in Genetic Counseling Newsletter

5.25.2017

My Experience as a Second Year Genetic Counseling Student

One of the strengths that I have perceived within the Genetic Counseling Program at Cincinnati Children’s is the wealth of opportunities we have as students here. The first year of the training program is relatively academically heavy with significant coursework, group assignments, research experience, and clinical exposure. The second year of training offers more flexible time and an ability to truly tailor our learning experience. Over the last year, a variety of experiences and opportunities have shaped my professional and personal growth and I wanted to take some time to share that with all of you. Here is a short summary of some of the things I’ve done over the past year and a few pictures as well: https://jmshank.weebly.com

I had the privilege to be a LEND trainee in my second year. LEND stands for Leadership and Education in Neurodevelopmental and related Disabilities. It is a federally funded program which seeks to cultivate leadership skills within clinical and non-clinical members of the disability community. Through LEND I gained an understanding of my own leadership skills and abilities while exploring how those skills fit within the greater context of advocacy and disability policy. The LEND program at Cincinnati Children’s this past year consisted of 24 trainees from 13 different disciplines. Attending classes and working on projects with the other LEND trainees has given me a broad understanding of multiple disciplines and how genetic counseling fits in the greater medical field. LEND afforded me many opportunities to travel for conferences and service trips as well as setting a foundation for lifelong learning and growth through work within the disability community.

Throughout the year I also attended a variety of conferences and experiential learning events. Specific to genetic counseling, I attended the Ohio Genetic Counselor’s conference in Cleveland and the National Society of Genetic Counselor’s conference in Seattle. We also had the chance to attend a bereavement conference in Columbus with other genetic counseling program students from the Midwest area. Related to my work with LEND, I was able to spend a week in Nicaragua working with a developmental pediatrician and a speech team. Our LEND cohort also took a trip to Columbus, the Ohio state capitol, to meet with our legislators for Disability Awareness day. We discussed up and coming bills and developed our own ways to tell our stories and advocate for our patients and their needs.

I also had the opportunity for non-clinical training opportunities. I was able to rotate in our lab at Cincinnati Children’s to gain an understanding of genetic testing technologies and methodologies. I worked with genetic counselors writing reports and interpreting variants in both the molecular and cytogenetic labs. Additionally, I was able to visit Myriad Genetics the summer before my second year which gave me hands-on exposure to industry and oncology genetics.

I am so grateful for my time at Cincinnati Children’s and the experiences I can take with me in my career. You get out of life what you put into it, but it comes back so much fuller. My second year of training has given me confidence in my skills and broadened my perspectives towards genetic counseling and the healthcare field as a whole. With a foundation set in strong clinical, practical, and relational skills as well as the ability to facilitate my own lifelong learning I couldn’t be more excited for my future. 

--Jessica Shank, 2017 graduate

6.06.2016

Traveling to Nicaragua

Hola!

A couple of months ago I embarked on a journey to Managua, Nicaragua with a team from Cincinnati Children's Hospital Medical Center (CCHMC) to help provide different types of services, education, and support for children with disabilities and their families. You might ask how I got here…so let me back up.

As a second year genetic counseling student, I am a trainee in the LEND Program. LEND stands for Leadership Education in Neurodevelopmental and related Disabilities. This program is designed to train culturally competent, family-centered interdisciplinary leaders who will strive to improve the health of infants, children, and adolescents with or at risk for developmental disabilities. Trainees are afforded many opportunities through LEND during the year and traveling to Nicaragua was one opportunity that sparked my interest. I decided to apply, which consisted of an essay submission, and was offered a spot on the team. Ecstatic and terrified all at the same time, I committed and began planning. 

February arrived sooner than I had anticipated. Before I knew it, I was sitting on the plane from Houston to Nicaragua with different thoughts flooding my mind. What should I expect upon arrival? Would I be accepted by the people of Nicaragua? How will the language barrier impact our team’s goals? And most importantly, would I be able to help? Although CCHMC has a longstanding relationship with Tesoros de Dios (http://www.tesorosdedios.org), the organization we worked with, a genetic counseling trainee had never gone on this trip before.


After a long Saturday of traveling, we arrived in Mangua and settled into the guest house. Sunday was well spent exploring Granada, gathering souveniers, and eating a lot of plantains. I remember looking out at the lake and thinking to myself, “This is where I’m supposed to be.”

The next five days were a whirlwind. I was paired with Dr. Susan Wiley, co-director of the Division of Developmental and Behavioral Pediatrics at CCHMC and developmental and behavioral pediatrician. We saw new visits and follow-ups and I even counseled parents of patients while their child was receiving physical or speech therapy. I saw a variety of patients with different genetic conditions, including Rett syndrome, Rubinstein-Taybi syndrome, Trisomy 21, Joubert syndrome, and others. I assessed parents’ perception of disability and offered psychosocial support to patients and families as needed. Due to cultural and social misconceptions about disability, there were often tears when I provided recurrence risk or limited liability.

In addition to the clinical focus, I contributed to a Developmental Disabilities Seminar with Dr. Wiley at University of Nicaragua-Managua. We spoke with professors, healthcare providers, and others in attendance about the field of developmental disabilities and sharing unexpected news with parents. Everyone was very warm, welcoming, and receptive to the information.

One of my goals for this opportunity was to recognize the role genetic counselors can play in the field of international disability and better understand the challenges individuals with disabilities and their families face in other countries. There is a lack of resources in Nicaragua in general, not to mention for those with disabilities. With only one genetic specialist, genetic testing is widely unavailable unless a patient travels to another country for services.

Another one of my goals was to gain more experience with other healthcare providers and specifically in the setting of international disability. I was able to observe psychologists, physical therapists, speech/language pathologists, and others provide services and recommendations to the patients as well as the staff of Tesoros de Dios. I know that the knowledge I gained there can be applied to the patient care that I will provide in the U.S.

The Nicaragua travel opportunity truly provided a basis for understanding international disability challenges, the lack of resources many countries have, and how genetic counselors can potentially play a role in the field. 

--Randa Newman, genetic counseling student



2.08.2016

Elective Rotation: Psychiatry

Attention-deficit/hyperactivity disorder, bipolar disorder, generalized anxiety disorder, major depression, obsessive compulsive disorder, schizophrenia, and substance abuse/dependence.  These are all psychiatric illnesses and are all relatively common.  In fact, if you go through someone’s family history you will more than likely run across at least one family member with a history of mental illness.  But how many of them can be seen running in families and have a known genetic component?  If you said all of them, you are correct.

Most of our training as genetic counseling students is focused on less common diseases with better characterized genetics: cystic fibrosis, Lynch syndrome, neurofibromatosis 1 & 2, sickle cell anemia, etc.  However, we all invariably encounter families containing members with more common diseases, such as cancer, diabetes, heart disease, and, of course, mental illness.  While we do receive training in discussing the genetics of these conditions with patients, we rarely get to see patients for whom these diseases and how they affect their families are a main concern. 

Cincinnati Genetic Counseling Program
As a person whose life has been tremendously impacted by mental illness in many ways, I have been especially interested in learning more about these conditions. I was also interested in learning about the experiences of individuals and families affected by these conditions, including  ways to help people cope with mental illness and decrease the stigma surrounding mental illness.

One of the greatest aspects of the University of Cincinnati’s genetic counseling program is that we have the option to do an elective rotation in our second year.  An even better feature is that we have the opportunity and the support to create a rotation if we have a specific interest.  After discussing my interest in psychiatry with our program faculty, I talked to the director of the Division of Psychiatry at Cincinnati Children’s who was very interested in the idea of an elective rotation and helped me set up a 5-week observational rotation with a few psychiatrists.

During my rotation, I shadowed three psychiatrists in very different settings.  I was in a general pediatric psychiatry setting, the Tuberous Sclerosis clinic, and an inpatient unit for children with both psychiatric diagnoses and developmental disabilities.  I saw a total of 19 patients outside of the inpatient unit with a wide variety of psychiatric diagnoses, averaging three per patient.

I learned quite a bit about different psychiatric illnesses: how they are diagnosed, how they present, and how they are treated.  Along those same lines, I was able to create a resource for myself and others containing a list of commonly prescribed medications and what they are primarily used to treat.  During my rotation, I picked up as many resources as I could find in the form of flyers, newsletters, and pamphlets that are specific to the psychiatric services at Cincinnati Children’s.

I hope that my experience in psychiatry and in setting up the rotation will inspire others to pursue a similar rotation.  As psychiatric genetic counseling becomes more widespread, it will be easier for others to get involved in talking to families about the genetics of mental illness.  For now, though, I think it is important that we start that conversation with psychiatry and really show them our interest in merging the two fields.

- Meghann Reardon, second year student