Correction to "The Rise of the Genetic Counseling Profession in China".

The rapid development of genetic and genomic technologies has greatly boosted medical genetic researches and clinical services worldwide. Since last century, genetic counseling in the United States has helped individuals and families understand, accept, and cope with their genetic issues. This fledging profession, which is in essence a branch of social work, emerged in China relatively late but has rapidly grown over the last few years. We believe that genetic counseling will continue to play a pivotal role in building communication channels between medical doctors and their patients, the government and the general public, and social organizations and their customers in China. The growth of genetic counseling aims to enable patients and family members to make informed decision which in turn will lead to the reduction of the birth prevalence of severe congenital anomalies and genetic disorders.

Objective Many Chinese international graduates, having completed graduate-level programs that teach students to provide mental health services to clients (e.g. counselling, psychology, social work) in the United States of America, return to China for professional practice. However, their adaptation process often brings unexpected challenges. This study aimed to develop a process model of how Chinese international graduates from mental health programs adapted to professional practice upon their return to China. Method Using grounded theory, the researchers collected data by interviewing 12 participants who studied in mental health programs in the United States of America and returned to China for professional practice. Results A process model described how returning Chinese international graduates adapted to professional practice in China was developed. The model included the themes of chaos, transition, integration, emotional reactions, and coping strategies. Discussion The Chinese international graduates went through a process of chaos, transition, and integration. They used numerous coping strategies to facilitate the adjustment process. During the process, they experienced various emotions, including both pleasant and unpleasant feelings. The study findings offer valuable insights for returning Chinese international graduates, mental health programs in the United States of America, and the counselling profession in China.

Prospective genetic counseling students face many barriers when seeking to engage with the genetic counseling (GC) profession and applying to graduate programs. These barriers are exacerbated for individuals who identify as part of an underrepresented minority group due to limited access to academic resources, lack of awareness about career options, and absence of role models and mentors. The NSGC Justice, Equity, Diversity, and Inclusion (JEDI) Action Plan was developed to address disparities in the field with a focus on areas such as education and training. The JEDI Action Plan calls for development of resources and partnerships for recruiting and supporting minoritized communities' access to the field. The Genetic Counseling Career Research & Exploration Workshop (GC-CREW) is a 10-week virtual workshop that was created to offer an inclusive, comprehensive experience that introduces its attendees to the foundations of the GC practice with the mission to increase accessibility and promote diversity within the field. This study utilized a quantitative survey sent to attendees of the GC-CREW with the aim to assess the workshop's impact on their engagement with and accessibility to the GC profession. Results showed 87% of respondents identified as female and 29% as an underrepresented racial or ethnic minority. Respondents that participated in the GC Admissions Match reported a 45% match rate, and 90% percent of respondents reported the GC-CREW helped them envision themselves as a genetic counselor. These findings demonstrate the workshop is an effective way for individuals from underrepresented groups to gain exposure and engage with the genetic counseling profession. Eliminating barriers and promoting accessible opportunities for interested individuals to learn more about the field and prepare for the graduate application process is crucial. These actions move the GC profession toward better reflecting the diverse communities it serves, further equipping it to address their unique healthcare needs.

PurposeThe profession of genetic counselors has existed for over 50 years. This article provides an update on the global state of the genetic counseling (GC) profession in 2022 and 2023. MethodsWe used a survey approach to collect data from individuals who were identified as being leaders in GC practice and/or education around the world. ResultsBased on responses provided between October 2023 and January 2024, we estimate that there are over 10,250 genetic counselors in over 45 countries around the world. These numbers have increased significantly in the past 5 years, when there were ∼7000 genetic counselors. Key factors identified as driving the increase in genetic counselors are the number of training programs that have developed (>130 globally, mostly at a master’s degree level) and a growing number of national biobanks and/or population screening programs that require GC as part of the process. There is tremendous variability in how genetic counselors are regulated, with only a few countries holding national statutory regulation processes. There are many commonalities, but the GC profession appears nuanced to their specific country and its wider socio-political context and history. ConclusionWe hope that genetic counselors internationally will come together to assist each other in all aspects: training, statutory regulation, developing the workforce, and establishing GC as an academic discipline. We envision that establishing an international organization for the profession of genetic counselors might maintain such international connections and provide relevant data in future years.

Genetic counseling is “the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease.” Traditionally, this process includes collecting and interpreting the family and medical history, risk assessment, a comprehensive educational process for potential genetic testing, informed consent, and psychosocial assessment and support (National Society of Genetic Counselors' Definition Task Force et al. 2006). While genetic counseling falls within the scope of many health care professionals, clinical geneticists (physicians) and masters level genetic counselors have been working in the United States for more than 40 years, providing genetic counseling primarily for single-gene conditions. Debate about what “genomic counseling” will include and who will practice it has been fueled by the transition from single-gene focused genetic counseling and testing to a full genomic medicine approach. The routine incorporation of genomic medicine will likely induce differences in the scope, approach and process of genetic counseling (Table ​(Table1).1). In this commentary, I will discuss the several areas where practice will likely change as we move toward “genomic” counseling, with a focus on the unique skills and roles that genetic counselors and clinical geneticists provide. Table 1 Changes that will impact the transition to “genomic counseling.”

Introductory Speech for Joan Marks

Awareness of the genetic counseling (GC) profession may influence access to genetic services, yet awareness among the U.S. population is unknown. A survey of U.S. adults was conducted using age- and sex-based quotas. Participants were asked if they had heard of the GC profession and to describe what genetic counselors (GCs) do. After reading a brief description of what GCs do, participants were asked the likelihood they would request to see a genetic counselor if they were concerned about a genetic condition. We used descriptive statistics to characterize the population, logistic regression to determine factors related to awareness of the GC profession, and ordinary least squares regression to identify which factors correlated with likelihood of seeking GC services. Thematic analysis was used to code open-ended responses. Among the final sample of 543, the majority were White individuals (79.7%) with an average age of 46.5 and median income between $60,000 and $69,999. Although 20% indicated they had heard of the GC profession, further analysis of the qualitative follow-up question suggested only 13.4% understood the role of GCs (CI 10.6%-16.3%). Factors positively and significantly correlated with knowledge of the GC profession included identifying as White or female and having higher educational attainment or higher science knowledge after controlling for income, age, and political views. Approximately 45% of respondents indicated they would likely or very likely seek GC if concerned about a genetic condition. Biological sex, age, religious affiliation, science knowledge, and awareness of the GC profession were significantly correlated with likelihood of seeking GC services while controlling for race, income, educational attainment, and political views. Curiosity/interest, the perception of benefits, and trust in GCs were all major themes that emerged to explain reasons for seeking an appointment with GCs. Lack of awareness, lack of perceived benefit, and lack of trust in GCs or greater trust in other healthcare providers were reasons for not wanting a GC appointment. Despite the 50-year existence of the GC profession, awareness remains low and negative attitudes exist.

Remembered: F. Clarke Fraser

The genetic counseling profession is 50years 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 50min, 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.

Lack of diversity in the genetic counseling profession has been a concern for over 20years, with the National Society of Genetic Counselors identifying increasing diversity and inclusion as a strategic focus in 2019. Previous research has revealed potential barriers that could explain the low number of diverse applicants to genetic counseling graduate programs. The aims of this pilot study were to test strategies for participation and site recruitment methods for Historically Black Colleges and Universities (HBCUs) and to evaluate the effectiveness of a brief presentation tailored to African American students. Recruitment emails were sent to career services and 124 biology/psychology department chairs from HBCUs and one predominately white institution with over 10% black student population. There was a 16% response rate through career services and a 25% response rate from department chairs. Different sections of a single biology class at one HBCU were randomly assigned to either attend a class presentation by an African American second-year genetic counseling student and given a brochure detailing the same information (presentation group), or receive a brochure only (brochure group). Ninety students participated in the study: 65 in the presentation group and 25 in the brochure group. All students completed a 10-question knowledge test and were given an email address for further student-initiated contact about genetic counseling. In the presentation group, 65% (42/65) completed the knowledge test with a mean score of 7.59/10. Only one student from the brochure group completed the knowledge test. No students initiated contact to receive additional information about genetic counseling. This study highlights the difficulties in reaching African American students, even through HBCUs. Strategies beyond the use of brochures and presentations will be necessary to attract African American students into the genetic counseling profession.

In their timely review of recent important genetic findings in psychiatric disorders—specifically, common and rare copy number variants (CNVs) in bipolar disorder, schizophrenia and autism spectrum disorders—Gershon and Alliey-Rodriguez (1) propose that these findings “must lead to profound changes” in genetic counseling and “propose that genetic counseling is more than risk prediction.” The genetic counseling profession has devoted considerable attention to the process of risk communication (2) and the conceptualization of risk as a complex construct that comprises more than probability alone—for instance, by addressing how a client’s context and subjective perception of the severity of a potential outcome influences perceptions of risk (3). Within this framework, the identification of CNVs that play important roles in the etiology of psychiatric disorders represents a refinement in our ability to predict probabilities of illness, rather than a major paradigm shift in the risk communication process. Similarly, psychological and psychotherapeutic dimensions to genetic counseling, such as attending to experiences of stigma, shame and guilt, have been explored in the genetic counseling literature for several decades (4). We fully agree with the authors that a “psychotherapeutic approach” would best serve patients and families seeking psychiatric genetic counseling for high-impact detectable genetic events such as CNVs, and we would add that such an approach ought to inform all genetic counseling encounters. This is consistent with a growing body of evidence from studies of genetic counseling practice indicating that attending to psychological dimensions of practice, such as the facilitation of understanding, empathic responses and lower levels of verbal dominance, are associated with more positive outcomes (5). We agree with the authors that there is a need for expert counseling for families affected by psychiatric disorders, and propose that there is much to be gained by greater collaboration between the psychiatric genetics community and the genetic counseling profession, in particular with regard to exploring how best to implement testing for CNVs in psychiatric populations in clinical practice, and how to manage the attendant ethical challenges.

Building the Genetic Counsellor Profession in the United Kingdom: Two Decades of Growth and Development

Kit Clark's candid account of the challenges of being pregnant while working in the prenatal setting highlights a number of important professional issues for genetic counselors. As the majority of those in the genetic counseling profession are women, the personal and professional challenges raised when a counselor is pregnant herself can affect both the pregnant counselor as well as her colleagues, particularly in prenatal settings. The issues Clark eloquently introduces in her paper prompt us to contemplate how pregnancy can affect genetic counseling practice, and they provide a paradigm for discussing these phenomena in our graduate training programs. One of the major concepts raised in Clark's reflection is that of self-disclosure. Self-disclosure occurs when a genetic counselor reveals something personal about themselves to their client, most often as a means of engaging with the client. In general, genetic counselors are cautioned about self-disclosure (Kessler 1992; McCarthy Veach et al. 2003; Peters et al. 2004; Weil 2000), a sentiment echoed by medical and psychiatry professions. While self-disclosure can help with rapport building, it can also shift the focus of the session from the client to the counselor (Weil 2000) and influence clients’ decisions (McCarthy Veach et al. 2003). Two types of disclosure are highlighted in Clark's reflection—inadvertent self-disclosure, and intentional self-disclosure. Inadvertent self-disclosure occurs when physical characteristics such as pregnancy or a visible disability make personal disclosure unavoidable. In a study of prenatal genetic counselors’ experiences of pregnancy, participants described feeling they were inadvertently disclosing something about themselves as soon as the client saw their pregnant belly, which made them uncomfortable and in some cases led counselors to attempt to hide their pregnancy (Menezes et al. 2010). In a larger study, the issue of inadvertent self-disclosure was found to be more broadly applicable to other medical and allied health professionals who were working in the prenatal setting while pregnant themselves; with many participants reporting attempts to conceal a visible pregnancy so as to avoid disclosure (Menezes 2010; doctoral dissertation). Similarly, in both of Clark's accounts of her own pregnancies, she describes trying to “hide” her pregnancy so as not to reveal she is pregnant to her clients (Clark 2010, 2011). Equally, in a study of genetic counselors’ use of self-disclosure with their clients, Thomas et al. (2006) found that some counselors elected not to see clients when visibly pregnant themselves, particularly when the client was at risk of a fetal abnormality. The reasons genetic counselors and other health professionals offer for trying to hide their pregnancy or electing not to see clients when they are visibly pregnant are twofold: (1) They are concerned their visible pregnancy will cause further distress to couples who are experiencing the diagnosis of a fetal abnormality; and (2) They are worried clients will ask them personal questions about the type of testing etc. they had during their own pregnancy, potentially influencing client decision-making but also shifting the focus of the session to the health professional's own pregnancy (Menezes et al. 2010; Menezes 2010). Clark raises both of these issues in her discussion of her own pregnancies (Clark 2010, 2011). In particular, she reflects on her decision not to visit a client who had a termination of pregnancy for Trisomy 18 because she was visibly pregnant herself and did not know how the client would react to this (Clark 2011). Her experience calls attention to the issue of whether or not genetic counselors should change their practice when pregnant themselves and counseling clients with fetal abnormalities. One potential solution is for genetic counselors to disclose that they are pregnant to their clients upfront and offer clients the option of seeing another counselor if this is possible. In our study, most genetic counselors reported always disclosing their pregnancy prior to seeing a client, and giving them the opportunity to request another counselor (Menezes et al. 2010). For many, these actions were based on a belief that by being visibly pregnant, they were potentially making clients uncomfortable, and therefore clients should have the choice of requesting another counselor if this was the case. While being counseled by a visibly pregnant genetic counselor may upset some clients, for others seeing someone who is in a similar life stage may actually help with rapport building, as Clark also discusses. Alternatively, clients in crisis may not actually notice or care that the genetic counselor is pregnant: they may just be grateful for the support they are receiving. While it is appropriate that pregnant genetic counselors are sensitive to their clients’ feelings, it may not be practical to offer clients the choice of seeing another counselor. Moreover, offering this choice raises the question of whether it is appropriate to disclose pregnancy prior to seeing a client. While done out of concern for the client, this disclosure could create a bigger issue of the situation than is necessary, potentially shifting the focus of the session to the counselor's pregnancy. Furthermore, in some instances the motivation for disclosure could be an attempt to ease the counselor's own apprehension about how the client may react to the pregnancy. Clients will encounter pregnant women in their day to day life, and it can be argued that it is not feasible to shelter them from this experience. Clark is clearly conflicted about her decision not to visit her client on the ward when she was visibly pregnant herself. Given the lack of empirical evidence about how clients experience being counseled by a visibly pregnant genetic counselor, there are no clear guidelines as to what is appropriate in this situation. Thus, genetic counselors must rely on their professional instincts and do what they feel is appropriate on a case by case basis. Clark made a decision that was right for her and her client at the time. Nevertheless, her situation does raise the question of whether being visibly pregnant poses sufficient harm to clients to necessitate a change in practice. This issue needs to be further reflected on in peer supervision groups and discussed in graduate training programs in order to consider all of the strategies that may be appropriate. There is also a need for further research to provide evidence as to what strategies are most effective in these circumstances. Clark also openly discusses the use of intentional self-disclosure during a genetic counseling session, and the benefits and harms of such disclosure. The author reflects on the disclosure of her own personal experience of unplanned pregnancy with a client whom she felt was going through a similar situation. In this case, Clark describes how sharing her own experience with the client helped to “open up a line of communication” so that the client was able to share her thoughts and feelings (Clark 2011). In a collection of commentaries entitled “Defining Moments: Important Lessons for Genetic Counselors,” several authors comment on their use of self-disclosure in clinical practice (Bennett 2002; Drake 2002; Edwards 2002; Gold 2002; Hagemoser-Platt and Reiser 2002; Hatten 2002; Keilman 2002; Lieber 2002; Morris 2002; Schmerler 2002; Valverde 2002; Vokits Cohen 2002; Woo 2002). However, while “personal experience constitutes a data source that is as valid as any quantitative information derived from empirical research … the challenge is to select the most pertinent and useful portions for a given client” (McCarthy Veach et al. 2002, p. 334). McCarthy Veach et al. caution that genetic counselors must be aware of their own motivations when choosing to disclose personal information to a client (McCarthy Veach et al. 2002; McCarthy Veach et al. 2003) as this disclosure may interfere with the counselling session and be distracting to clients. Counselors’ use of self-disclosure is risky as it can potentially be motivated by countertransference. Thomas et al. (2006) stress that genetic counselors should use self-disclosure judiciously and with a clear purpose. This sentiment is supported by McDaniel et al. (2007) who studied physician self-disclosure, finding no evidence that it had a positive effect with clients. An alternative strategy to self-disclosure is the use of empathy. Empathy is defined as “understanding what another person is experiencing and communicating that understanding to the person. It is the capacity to put yourself in another person's place to understand from her or his frame of reference” (McCarthy Veach et al. 2003, p. 51). Empathy is considered to be a crucial aspect of building relationships with clients and effective service provision (Anfossi and Numico 2004; Figley 2002). Using empathy allows us to reflect back to clients feelings that they may be finding difficult to identify or articulate themselves. Another effective strategy could be to normalize the client's feelings (e.g. “some clients find it difficult …”) which can convey an understanding of their situation without the counselor utilizing personal disclosure. Both of these strategies are less risky than self-disclosure as they maintain focus on the client. Genetic counselling is a complex process which can frequently bring up personal emotional issues. In particular, when genetic counselors are pregnant themselves and working with pregnant clients, issues of countertransference can be present as the counselor is at a similar life stage, and perhaps identifying with pregnant clients in a different way (Menezes et al. 2010). While countertransference can have both positive and negative effects (McCarthy Veach et al. 2003; Weil 2000, 2010) it is important for genetic counselors to recognize when it is occurring so that it does not have unexpected negative effects on the consultation or on the genetic counselor themselves. For example, motivation for self-disclosure could be due to identification with a particular client, and an assumption that they share the same feelings towards a life event, rather than providing the client with useful information. As Kit Clark describes, the use of peer support is essential in these situations as it allows the counselor to debrief while providing the professional perspectives of one's colleagues. The use of regular supervision can also be an effective strategy in helping genetic counselors reflect on the challenges they face in their work, while refining strategies to deal with these challenges more effectively. As genetic counselors may be relating to clients differently when pregnant themselves, discussing the difficulties that can arise in a professional and supportive environment can enable them to recognize and overcome any challenges faced, as well as reflect on the positive aspects of this enhanced connection with clients. Kit Clark's insightful reflection of her own difficulties and strategies utilized when pregnant herself and working with pregnant clients raises important and complex issues for both practicing genetic counselors as well as those in training. This reflection should prompt a more open discussion of the challenges experienced by genetic counselors when pregnant themselves; it provides a useful archetype for exploring these issues in genetic counseling training programs and in peer group supervision. Moreover, as these challenges are also relevant to a range of health professionals working in the prenatal setting, discussing the difficulties that can arise with our medical and allied health colleagues may normalize the impact and allow for a more open discussion.

It is no secret that genetic counselors are predominately Caucasian females. Although aware of this fact, I had not extensively considered the need for diversity in the genetic counseling discipline until I, a Caucasian female genetic counseling student, was the minority. I became interested in issues related to diversity in genetic counseling while participating in a medical mission and research project in January, 2008 in rural Guatemala. I travelled there as part of a research team representing the University of Pittsburgh Oral-Facial Cleft study, led by Dr. Mary Marazita. While attempting to collect family histories, DNA samples and phenotypic data, my colleagues and I struggled with many barriers including language, social and educational differences. I was humbled by the Guatemalan culture that seemed so distant from my middle-class Canadian upbringing. It was not difficult to identify daily struggles of Guatemala's people — the relatively high prevalence of birth defects including cleft lip and palate, the quest for an understanding as to why this might be, the beg for efficient birth control methods and the necessity for basic medical care. I considered how valuable it could be to have more health care providers, including a genetic counselor, in that setting; to be able to not only speak the same language as this wonderful population, but also to really understand where they are coming from, to identify with the values and beliefs of the culture; and so my interest in diversity began. International travel is not required to experience cultural diversity; underrepresented populations can be found on all borders of the United States. In order to connect with underrepresented populations, the genetic counseling community should begin with outreach to inform them of who we are, what we do and where we stand in terms of our professional values. An example of a successful outreach project is the Center for Minority Health (CMH) at the University of Pittsburgh. Members of this outreach team (including genetic counseling students) venture across Pittsburgh to an African American community to collect family histories, give individualized risk estimates for common diseases and promote activity and community involvement amongst its population. Although the CMH does not prioritize promoting the genetic counseling profession, it is clear that the recipients of their services are aware of who genetic counselors are and what their role in the health care team can be. We should consider using projects like the CMH as a model for outreach into underrepresented populations, expanding their exposure to our line of work. We can strive to assist minority groups in overcoming health disparities; providing medical services as well as making the genetic counseling profession known and recognized, with hopes that we gain their trust and inspire interest in our growing field. In addition to community centers and medical missions, outreach can take place in colleges, high schools and local libraries, specifically with the emphasis of providing early awareness to minority populations. Practicing genetic counselors may take part in career days and health fairs, promoting interest in the field, discussing non-traditional roles and distributing information about prospective graduate programs. Informative presentations given to young minority students including discussions with reasons to choose genetic counseling as a profession should be pursued in the college setting. A complicating factor in attracting students from minority populations may be financial adversity. That being said, our professional organizations and training programs must be prepared to provide financial assistance to diverse students at both the undergraduate and graduate levels. Further, genetics centers could offer financial incentives to exceptional high school or college students of minority populations who are interested in summer internships. Genetic counselors that participate in outreach and recruiting events will need to either be willing to volunteer their time, or require the support of their employers. We may have to help employers understand the importance of diversifying our profession in hopes that they will see the clear advantages of taking time to inform and recruit from underrepresented populations. Many North American genetic counseling programs accept applications from international students; however, it is not clear as to how many of our programs make the effort to actively advertise to foreign countries. Genetic counseling training in North America may be widely promoted with websites, pamphlets, online presentations and networking with international faculty. In order to attract and retain student diversity into the field of genetic counseling, it may also be critical to encourage the advancement of diverse genetic counselors in leadership roles. Minority and international students may feel more inclined to apply to genetic counseling programs where those facilitating the training have overcome similar diversity efforts. Therefore, the recruitment of diverse students should include attracting diversity in leadership among our training programs and the NSGC. An important option we must take into account is to further diversify our current population of genetic counselors. This may be achieved by offering second language courses at reduced prices and encouraging the need for genetic counselors serving minority populations within the United States. Second language training could be initiated by the NSGC, providing the opportunity to enhance professional development. Accredited genetic counseling programs should emphasize cultural competencies in their coursework and teach new generations of genetic counselors to be culturally sensitive and appreciative of multicultural experiences. While pursuing my thesis this year, I hope to continue my work with Guatemala; learning of its culture, its people, and working toward the goal of understanding more about the genetic and environmental factors that affect the health of its population. My experiences have broadened my outlook on healthcare and the genetic counseling role. In addition, I plan to soon be the type of practicing genetic counselor that gives outreach talks at the local library once a month and participates in career fairs in high schools and colleges. We should all strive to reach out, in hopes that we might catch the attention of diverse prospective students as well as to expand our own horizons.

As interest in the profession of genetic counseling continues to grow, the number of applications received by accredited genetic counseling graduate programs far outweighs the number of available training positions. In the 2023 application cycle, 46% of applicants who participated in the genetic counseling match went unmatched. There is limited research surrounding the experiences of unmatched candidates. The aims of this qualitative study were to highlight the experience of not matching and reapplying and to identify support resources for the genetic counseling admissions process. We conducted 15 semi-structured interviews with individuals who had previously applied to genetic counseling graduate programs, not matched, and were in the process of reapplying. Through reflexive thematic analysis, five major themes were conceptualized: (1) Emotional navigation through the stages of the match process; (2) external perceptions surrounding going unmatched and disclosure of results; (3) experiencing stagnancy throughout applying and reapplying; (4) advances in knowledge and personal growth; (5) areas for increased supports and resources. This study has shed light on emotional and practical challenges faced by individuals who did not match with genetic counseling graduate programs and chose to reapply. The participants' experiences highlighted the need for enhanced support, especially in terms of emotional assistance and program feedback. They also underscored the importance of standardization and transparency in the application process. This research offers valuable insights for genetic counseling programs and organizations seeking to enhance the reapplicant experience and address the evolving needs of prospective candidates in the genetic counseling profession.