Hello readers! It’s been awhile since we’ve posted, but thank you for being patient. With the 38th National Society of Genetic Counselors (NSGC) Annual Conference wrapping up last week in Salt Lake City, attendees celebrated the 40th anniversary of NSGC – a proud accomplishment in our young profession! There were inspiring speakers, panelists, and GCs galore! Among the various engaging talks, there was discussion on how to best provide support to genetic counselors, especially in the role of support staff. With that being said, we have Moriah and Lauren, who are/were genetic counseling assistants (GCAs) that wrote a two-part guest post on their experiences and how they support genetic counselors and other staff in both the lab and clinic.
Do you have experience as a GCA or are interested in learning more about how to become one? Please let us know your questions/thoughts in the comments below. You can also join us on Twitter with our handle, @mapsandgenes!
Hey all, this is the first in a two-part series about what it’s like to work as a genetic counseling assistant, also known as GCA. My name is Moriah, and I have worked as a laboratory GCA at GeneDx in Maryland since August of 2018. My lovely counterpart, Lauren, will also be sharing her experience as a clinical genetic counseling assistant in the next installment! While we have very different duties, we each play an important role in patient care.
Our goals are to communicate to you—potential applicants and prospective students—what it’s like to hold this position as we ready ourselves for a genetic counseling program. We will both address the main duties of our positions and the benefits that our roles have imparted to us. Both of us are reapplicants—Lauren is a matriculating student for the class of 2021, and I am a prospective student for the Class of 2022. Each of our positions has given us a unique experience which will not only strengthen our applications, but also provide us with a foundation of skills that we will utilize throughout our careers, including effective communication with patients, providers, insurance companies, and labs; patient advocacy; and patient and professional education. We hope that this will be an informative series for you and that it opens up possibilities as you embark on the journey to a genetic counseling program with us.
My job revolves around test utilization management with the primary responsibility of approving test orders before testing is started. The GCAs at GeneDx spend a good part of their day reviewing every single test order, to verify we have sufficient information to complete testing and that the order is clinically appropriate (we get hundreds of orders every day!). There are about 30 GCAs who are all split into different programs based on medical specialties or test methodologies— including cardiology, neurology, rare diseases, microarray tests, and exome sequencing—who screen and monitor the tests of each particular program. A typical day might look like this:
- Review list of orders that arrived
- Approve orders that can be started, or hold orders that are problematic
- Communicate with providers about orders that were held, and resolve issues
- Attend various meetings, trainings, and/or presentations
- Work on individual rotating duties and projects
When there are errors in the way testing was ordered, we are responsible for communicating with the clinicians about the issue and working with them to resolve any problem so that appropriate testing can be started. For example: A provider who has rarely or never ordered genetic testing may order multiple tests to be run concurrently, but some of the tests are overlapping panels that evaluate the same genes and therefore are redundant. As GCAs, we call the provider to explain the issue, ask some basic questions about conditions that they’re most suspicious for, and with the help of our lab GCs, we work to help the provider choose the most clinically relevant testing. We also may discuss with the provider the order in which testing is run. For example, we may suggest that tests be run one at a time—reflexively—rather than all at once, especially if there are existing clinical guidelines recommending this approach. If one of the early panels provides a molecular diagnosis, then later tests can be cancelled and excess testing is avoided. This is a win for the patient, because the overall cost of testing is reduced. And when the patient wins, we all win! Scenarios like this show that labs have valuable partnerships with providers—they give us their expertise on their patients, and we give them our expertise in how to best utilize our testing for the patient’s benefit.
Through my experience as a GCA I have learned that ordering testing can be very complex! Some providers may not be as familiar with varying testing methodologies or what information a particular test can or cannot provide. Even experts in the field may need guidance; every lab structures their testing options differently, and it can be challenging to figure out which tests will give them the information they need. Add in layers of complexity for appropriate familial testing, billing concerns, and lab logistics, and you can see how there are so many pieces of the puzzle when trying to achieve the right test and an accurate result for each patient. Between the lab GCs and the GCAs, we bear a large responsibility for client education in this regard, and we help them navigate the ins and outs of how to effectively use our tests so that the patient gets the absolute best care.
I have found there are a few important qualities which make someone a successful laboratory GCA at GeneDx. Firstly, having basic genetics knowledge is a huge benefit. Different GCAs have different educational/professional backgrounds and varying levels of interest in becoming GCs, but already having a foundational knowledge of genetics certainly makes learning our testing system much easier. Detection of different conditions is often test-dependent; for example, Duchenne Muscular Dystrophy is unlike other disorders in that most pathogenic variants arise from large deletions or duplications in the DMD gene. Therefore, we initially recommend DMD deletion and duplication analysis first, with a reflex to DMD sequencing. For many other disorders, we would typically recommend starting with sequencing and then proceeding to del/dup testing. Therefore, a background in molecular genetics helps us understand the technology available in our lab and the “why” behind testing recommendations.
Secondly, attention to detail is crucial. We consider each sample that comes to us to be our own patient, so being able to gather all the details to ensure proper testing is being completed is very important to us. We don’t like having to hold up tests because of a small mistake, but fixing those issues can be vital for patient care! Can you imagine if we completed targeted carrier testing for the wrong genetic variant? A typo could lead in an incorrect result for the patient and an inappropriate follow-up. Many of our calls to providers are to ensure that we have the all the right info before proceeding to testing as we try to minimize this risk.
Thirdly, having a communicative and team-oriented attitude will help you thrive in this position. Although each GCA has their own workload, they also have a team of other GCAs and GCs willing to support them. We are able to refer to our team when we have a problematic case, an unclear policy, or general genetics questions that relate to our tests. We all know that good coworkers can make or break a job experience, and I love my team because they are hardworking and dependable. Additionally, we can give and take constructive feedback on the quality of our work. For example, it’s important that we let each other know if we’ve made errors, because we want to avoid anything that may impact test turnaround time or patient care in the long run.
As a reapplicant, the sheer number of things that I’ve learned while working in a diagnostic genetic testing lab in the past year makes me feel much more prepared for the next application cycle. Firstly, I’ve developed critical skills in science communication. To be an effective GCA, it is necessary to be competent in succinctly explaining test methodology, panel options, and lab logistics. As we all know, providers’ time is valuable, and they need concise and quality information from us to make decisions about how to care for their patients. This skill is valuable between teams, too. For example, GCAs from different educational backgrounds and with expertise in different departments exchange knowledge all the time about how different tests are run, what clinical information is needed about patients, and why. This skill will be helpful when communicating and educating patients, families, and other professionals in clinic, and is something to highlight when applying to genetic counseling programs.
Secondly, I work closely with our lab genetic counselors, and as a result, I am now familiar with the role of lab GCs, their scope of practice, and have gotten exposure to their genetics knowledge. We have some genetic counselors who primarily write our reports, and some who work specifically to provide customer service to providers. Many genetic counselors and others also act as experts on particular genes and conditions, and GCAs are afforded opportunities to attend various presentations and get a taste of report writing and variant classification. Needless to say, the educational value in this position is amazing. Everyone here has so much to contribute, and I am always so impressed at the scope of the knowledge that is contained in this one building—GCs are just a few of the many hands that it takes to keep this place running. To name a few, we have accessioners who process our incoming samples, review analysts who identify genetic variants from the sample data, lab directors who keep our lab operations running, and clinical directors who provide molecular and clinical expertise. Working closely with this staff provides a lot of opportunities to forge professional relationships and the possibility for mentorship. As a secondary benefit, many of my current fellow GCAs will someday be genetic counselors with their own special knowledge. Fostering good relationships now will allow us to continue to learn from and draw on each other in the future.
Lastly, I have developed a lot of “soft skills” that will be important in my future career. Besides the pure genetics-related knowledge that I have banked, having this work experience has helped me develop good leadership, multitasking, and problem-solving skills. I’ve taken initiative on various duties and projects that involve monitoring and coordinating multiple cases at once and providing proper case management. These skills are used beyond special projects, though; we all practice them as a team, whether it’s reminding each other to cover time-sensitive duties or pursuing testing solutions for cases with complex inheritance or complex family dynamics. These experiences have improved the quality of my communication skills—in science communication, yes, but also in the way that I communicate with my various co-workers. Since each employee has his or her own priorities and expertise, I need tailored communication for each person. I don’t use the same language for a lab director or an analyst who may be an expert in a particular gene or test when I’m talking to a sales representative who may not be as familiar with it. I also use different language to provide information to a patient compared to when I speak with a provider who is more familiar with genetics. Personally, this increased self-awareness of and improvement in how I communicate has showed growth; some of the feedback I’ve received from programs and other job interviews in the past has been about being able to more confidently and clearly tell them why I belong there. Where I lacked experience and examples in a prior application cycle, I now have enough experience under my belt to showcase that I have a strong knowledge base and concrete examples, that I’ve begun to learn the language of the field, and that I can be flexible and versatile.
Although I didn’t know what to initially expect from a genetic counseling assistant position, it has become much more valuable to me than I could have anticipated. As a prospective student, having exposure to different aspects of genetic counseling is highly sought after. Through GeneDx, I have gained experience in a lab, obtained knowledge and developed skill sets that are important for effective genetic counseling, and have found multiple valuable opportunities like volunteering and telegenetic shadowing. As genetic counseling programs become more competitive and as genetic counselors are voicing their need for administrative help, the number of GCA positions are continuing to increase. If you want or need to take time between college and grad school, this is an excellent position to consider.