Survey of the training needs of genetic assistants supports the creation of genetic assistant training programs

Abstract

Despite the increasing numbers of genetic assistants (GAs) in the genomics workforce, their training needs and how to best prepare GAs for their role have not been well defined. We sought to identify the current educational status of GAs, opinions on their training needs, and attitudes about GA training programs (GATPs). Survey links were emailed to NSGC members, 17 state genetic counseling (GC) professional organizations, and genomic medicine researchers. Respondents (n=411) included GCs (n=231) and GAs (n=136). Like other studies, we found that the GA position is filled by a range of education levels and career aspirations. Most respondents supported the creation of GATPs, with 63% endorsing that GATPs would be helpful and half endorsing a short-term (3 months or less) program. Most believed GATPs should focus on general knowledge, with almost all practical skills learned on-the-job. If more GATPs are created, our survey provides evidence that graduates would be hired. Indeed, of those whose work setting required a bachelor’s degree, the number of respondents who favored keeping that requirement was similar to the number who favored hiring a GA without a degree if they attended a GATP. However, there were concerns about GATPs. Many (44%) believed creating GATPs could discourage candidates from becoming GAs. We observed that there are two types of GAs: entry-level and bachelor’s-level, with the entry-level being those who do not have and are not working to obtain a bachelor’s degree and the bachelor’s-level being those who do/are. GATPs could focus on the education of entry-level GAs, while gaps in the knowledge base of bachelor’s-level GAs could be addressed by augmenting bachelor’s curriculum or providing additional training after hire. Further research on the training needs of GAs and hiring practices of institutions will be vital to understanding their training needs and designing and implementing effective GATPs.

1. INTRODUCTION

In response to the genetic counselor (GC) workforce shortage and the overwhelming demand for genetic counseling services, genetics clinics have started to include genetic assistants (GAs) on their staffs who are commonly referred to as genetic counseling assistants (Hallquist et al., 2020; Hnatiuk, Noss, Mitchell, & Matthews, 2019; Hoskovec et al., 2018; Krutish, Liu, Kelly, Chin, & Hartley, 2023; Pirzadeh-Miller, Robinson, Read, & Ross, 2017). While GAs typically support GCs, they may provide support to other staff, such as clinical geneticists (Krutish, Balshaw, Jiang, & Hartley, 2022). And, GAs may be hired in work settings where there is no GC. (Melvill, Fitzpatrick, & Rosenblatt, 2023). GAs are clinical support staff trained to assume the less specialized tasks traditionally assigned to GCs (Hallquist et al., 2020; Pirzadeh-Miller et al., 2017). 42% of GCs report that they have GAs on their support staff (NSGC, 2022b). Inclusion of GAs in the genetics workforce has a positive impact on GC efficiency (Cohen, Nixon, & Lichtenberg, 2023; Hallquist et al., 2020; Krutish et al., 2022; Pirzadeh-Miller et al., 2017). Despite the increasing number of GAs, their training needs and how to best prepare GAs for their role have not been well defined.

GAs typically focus on administrative tasks, data entry, collecting patient records, and completing portions of test requisition forms, while leaving tasks such as clinical interpretation and counseling to GCs (Hnatiuk et al., 2019; Krutish et al., 2023; Pirzadeh-Miller et al., 2017). A majority of GAs have a bachelor’s degree or higher and are aspiring to become GCs (Hnatiuk et al., 2019; Krutish et al., 2023; Melvill et al., 2023; Pirzadeh-Miller et al., 2017). Most GAs have been in the position for two or fewer years; however, 14% of GAs in the United States have been in the position for two or more years (Krutish et al., 2023).

Two educational programs in the United States have been developed for those seeking to become GAs (Melvill et al., 2023). Johns Hopkins University’s Genetic Assistant Training Program is an online program with no specific educational prerequisites and is intended for students considering a career as a GA or similar position (Johns Hopkins University). The University of Connecticut’s Clinical Genetics and Genomics Online Graduate Certificate is an online program with a baccalaureate degree as a prerequisite and is intended to give health care professionals an understanding of genetics (University of Connecticut). Credits earned in the Connecticut program can be transferred to their Health Care Genetics or Genetic Counseling master’s degree programs. There are also on-the-job training programs for those who aspire to become GCs and are intended to help them get experience prior to applying to GC programs, such as Geisinger’s Genetic Counseling Assistant program, which is an in-person, full time position (Geisinger).

It is unknown what level of education adequately prepares GAs for their position or if there are further training needs. While there is one study that surveyed GAs and reported that all GAs in their sample felt their on-the-job training and supervision were adequate to prepare them for their job, it was a small study (N=14), limited to two academic cancer genetics centers, only included GAs with undergraduate degrees, and did not explore if there were alternative ways to train their GAs (Pirzadeh-Miller et al., 2017). A larger study (N=134) reported that 13.7% of clinical GAs and 14.1% of laboratory GAs reported that they were given responsibilities for which they did not feel qualified (Gagne, Geiser, Danylchuk, Jin, & McWalter, 2023). The GAs in that study cited specific tasks that they felt unprepared to do, such as working with billing and insurance, talking about family history, and calling out normal results for non-genetic tests. However, it is not known why some felt prepared and other did not or what would have made them feel prepared. Another study asked respondents what is keeping GAs from performing additional roles (Hnatiuk et al., 2019). Some cited a lack of experience and training among GAs, but due to the qualitative nature of the study, it is impossible to determine how pervasive this barrier is. To fill the gap in knowledge on the training needs of GAs, we report results of a national survey that captured GAs who assist GCs and other genetic providers such as medical geneticists, clinical geneticists, and genetic nurses. The objectives of this study were to identify the roles and work settings of current GAs, characterize their training needs, and determine the views of respondents on the need for and usefulness of GA training programs (GATPs).

2. METHODS

2.1. Participants and Recruitment

We administered a web-based survey through SurveyMonkey between May 18 and June 18, 2021. To include as many opinions as possible, we did not limit who could take the survey and it was open to anyone working in genetic/genomic healthcare who was 18 years of age or older. Because some institutions may use titles other than genetic counseling assistant and may use the staff in these positions to support non-GCs, we used the term genetic assistant on our survey, which we defined as a “family of support staff who assist with duties that are specific to genetics, such as coordinating ordering of genetic tests or collecting family histories.” We sent a paid advertisement through the National Society of Genetic Counselors (NSGC) to their members asking for their participation. We also sent email requests to 20 state professional genetic counseling organizations and 17 agreed to forward our advertisement to their membership. Finally, we forwarded our advertisement to the members of several clinical research consortia of the National Human Genome Research Institute (NHGRI), such as the Electronic Medical Records and Genomics (eMERGE) Network.

We used snowball sampling and asked, in all advertisements and at the end of our survey, that respondents forward the link to the survey to their GAs and other professionals working in genetics.

2.2. Instrumentation

The survey contained 20 multiple-choice questions in three sections: demographics and work setting (11 questions), opinions regarding GATPs (6 questions), and opinions on GA workforce issues (3 questions); one free-response text box was also provided. We gave participants the option to identify the institution at which they were employed to aggregate survey responses by facility. A PDF version of the survey is available in supplemental materials.

Our survey was developed after a review of previous literature. To develop the list of general knowledge and skills that was presented in question 17, we reviewed the literature describing the tasks and activities assigned to GAs (Hallquist et al., 2020; Hnatiuk et al., 2019; Pirzadeh-Miller et al., 2017). Skills were specific work activities, while general knowledge items were types of information that might be useful to GAs in performing these activities. We also got input on the content of the survey through discussions with the NHGRI Extramural Training Team on the types of information that would be useful in determining appropriateness of proposed training. Finally, we spoke with practicing GCs to determine what questions they had about training GAs.

Our survey was initially developed by the authors RR and TAM. All authors then provided feedback and revisions. The survey was then piloted with four clinical GCs, two laboratory GCs, two clinical GAs, a laboratory GA, an oncologist who works with GCs, and a nurse practitioner who works with GCs. Responses received to these pilot surveys were then used to refine the final survey. For example, responses that were entered in the “other” response option were considered for inclusion in the survey.

2.3. Data Analysis

2.3.1. Quantitative Data

We used Stata/BE, Release 17 to generate descriptive statistics, including means and percentages, to assess responses to the multiple-choice questions.

For continuous variables, we used t-tests or Mann-Whitney U tests for comparisons as appropriate. For categorical variables, we used chi-square or Fisher’s exact tests for comparisons as appropriate. We considered p-values less than 0.05 significant.

We analyzed all responses. We then compared responses by work setting (clinical centers vs laboratories) and profession of the respondent (GCs vs GAs). Other work settings and professions of the respondents were too rare for comparison. Additionally, survey responses from the three clinical centers and three laboratories with the most respondents were analyzed separately to assess the level of agreement among respondents within each institution, i.e., intra-institution variability. Answers to three questions were analyzed as part of the intra-institution variability analysis: “Do you think educational programs that train GAs would be helpful,” “Would you prefer that your work setting hire GAs who have completed a GA training program,” and “Do any of the following statements reflect your feelings/beliefs toward GA training programs.” On the third question, for those who reported that their work setting currently requires a bachelor’s degree, we looked at the number endorsing “I would be in favor of hiring GAs without a bachelor’s if they have attended a GA training program” versus “I would be in favor of continuing to require a bachelor’s degree, even if an applicant without a bachelor’s degree had completed a GA training program.”

2.3.2. Qualitative Data

Our survey included an open-ended question, question 21, “Please tell us about any suggestions or concerns you have about GA training programs that are not addressed elsewhere in the survey.” Respondents also used the “other” option on question 13, “Do any of the following statements reflect your feelings/beliefs toward GA training programs” to expand on their thoughts about GATPs.

The qualitative data were analyzed using qualitative content analysis (Bengtsson, 2016; Erlingsson & Brysiewicz, 2017). Using the process described by Erlingsson, the first author (RR) read all the open-ended responses to become familiar with the data. Second, the responses were divided into smaller units of text and condensed until each unit of text had only one meaning. For example, sentences that had multiple opinions about GATPs were divided until each unit of text only had one opinion. Then, codes were developed for each unit of text using an inductive approach (Elo & Kyngas, 2008). A codebook was created to document the meaning of each code. Because qualitative content analysis is an iterative cycle, as new codes were created, the units of text were reread and recoded as needed. Once the codebook and codes for each unit of text was established, an independent coder coded 12% of the open-ended responses as a check for internal validity. Then, similar codes were placed in categories and themes were developed. When we developed categories and themes, the responses to questions 13 and 21 were looked at individually and collectively.

3. RESULTS

We received 411 responses to our survey. Not all respondents answered all questions and some questions allowed multiple responses; thus, the total number of responses for each question varied. 369 respondents answered all questions, 31 respondents skipped one question, 7 skipped two questions, and 1 each skipped six, twelve, and thirteen questions. All responses from individuals who chose to identify their employer were employed in the United States.

245 respondents identified their employer. Of those, there were 120 unique employers, and most (110) were identified by fewer than 5 respondents. The three clinical centers with the most self-identified respondents provided 9, 7, and 7 responses. The three laboratory employers with the most self-identified respondents provided 12, 9, and 8 responses. Thus, no single institution had more than 12 respondents to the survey, which translates to any institution accounting for less than 5% of the survey responses.

3.1. Respondent and Work Setting Demographics

89% of responses were from GCs and GAs (Table 1). 72% of responses came from those primarily working in clinical centers, 22% came from those working in laboratories, and 6% came from other work settings, such as pharmaceutical, research, and telehealth companies or from respondents who split their time between types of work settings.

TABLE 1.

Respondent and work setting demographics

	All Responses		Clinical Centersa		Laboratories		Other
	n	%	n	%	n	%	n	%
Respondent’s Position	(N=409)		(N=293)		(N=90)		(N=23)
Genetic Counselor	231	56%	158	54%	54	60%	16	70%
Clinical Geneticistb	8	2%	8	3%	0	0%	0	0%
Molecular Geneticistc	8	2%	1	0%	6	7%	1	4%
Genetic Assistantd	136	33%	103	35%	30	33%	3	13%
Student/Traineee	9	2%	8	3%	0	0%	1	4%
Other	17	4%	15	5%	0	0%	2	9%
Work setting employs GAs	(N=409)		(N=292)		(N=90)		(N=23)
No	86	21%	68	23%	9	10%	7	43%
Yes	323	79%	224	77%	81	90%	16	70%
Staff that GAs support f	(N=349)		(N=243)		(N=87)		(N=16)
Genetic Counselor	339	97%	234	96%	86	99%	16	100%
Genetic Counselor only	157	45%	102	42%	44	51%	11	69%
Clinical Geneticist	119	34%	94	39%	21	24%	3	19%
Molecular Geneticist	42	12%	8	3%	32	37%	2	13%
Physicians, non-genetic	64	18%	46	19%	15	17%	2	13%
Other	64	18%	43	18%	18	21%	1	6%
Non-Genetic Counselor only	9	3%	9	4%	0	0%	0	0%
Title of Gas	(N=350)		(N=243)		(N=88)		(N=16)
Genetic Counseling Assistant	241	69%	172	71%	59	67%	8	50%
Genetic Assistant	34	10%	27	11%	6	7%	1	6%
Genomic Assistant	1	0%	0	0%	1	1%	0	0%
Other	74	21%	44	18%	22	25%	7	44%

Note: Not all respondents answered all questions; thus, the N for each question varied.

^aE.g., medical centers, hospitals, private practices

^bMD or equivalent

^cPhD or equivalent

^dGenetic Assistants (GAs) who are career GAs and those who are using the position to gain experience to advance to other positions

^eStudents and trainees in genetic/genomic health professions (e.g., student genetic counselor, medical genetics fellow)

^fRespondents were asked to select answers that applied to at least one of their GAs and were able to select multiple answers; thus, totals equal more than 100%

Nearly 80% reported that their work setting employed GAs. Almost all work settings with GAs had their GAs supporting GCs. Some of those work settings also had their GAs support clinical geneticists, molecular geneticists, non-genetic physicians such as oncologists or neurologists, and other staff. The other staff that GAs supported included dieticians, medical assistants, nurses (e.g., genetic nurses, nurse practitioners, advance practice registered nurses), physician associates/assistants, laboratory personnel, and administrative staff such as the insurance team, client services, financial services, scheduling, and clinic coordinators. Of the 3% of work settings whose GAs did not support GCs, all reported that their GAs supported only one type of provider, which included clinical geneticists, molecular geneticists, non-genetic physicians, nurse practitioners, and a clinical trial coordinator.

Most work settings use the title genetic counseling assistant for their GAs. The titles most commonly listed by respondents who chose the “other” response option were genetic counselor support specialist, clinical assistant, administrative assistant, genetic navigator, medical assistant, intern/genetic counseling intern, and genetic coordinator. None of the titles listed were for medical providers, such as dieticians or nurses.

For the work settings that employ GAs, they had a mean of 3.9 GAs (interquartile range: 1–4). GAs each supported a mean of 10.8 staff (interquartile range: 4–14). Less than 2% of respondents reported they have unpaid GAs, with about 90% having at least one full-time GA and 20% having at least one part-time GA.

3.2. GA Experience and Education

A little more than half of respondents (54%) reported that their work setting had at least one GA with prior work experience in the medical field as a medical assistant, nursing assistant, medical scheduler, research coordinator, or laboratory technologist (Table 2). Some (32%) had at least one GA with experience in other positions such as customer service, teachers, office assistants, and patient service representatives, while others had at least one GA with no work experience (36%). Most (87%) had at least one GA with a bachelor’s degree and some (15%) had at least one GA whose highest level of education was a high school diploma, GED, certificate, or associate’s degree. Most (81%) had at least one GA who was working toward a career as a GC; 21% had at least one GA who was working toward a non-GC career, and 19% had at least one GA who was not working toward another career.

TABLE 2.

Work experience and training status of current GAs

	n	%	[95% CI]
GA prior work experience	(N=293)
Medical experience*	158	54%	[48–60]
Medical Assistant	31	11%	[8–15]
Nursing Assistant	6	2%	[1–4]
Medical Scheduler	46	16%	[12–20]
Research Coordinator	46	16%	[12–20]
Laboratory Technologist	78	27%	[22–32]
Experience in other field	95	32%	[27–38]
No work experience	106	36%	[31–42]
GA highest level of education	(N=338)
Doctoral Degree	4	1%	[0–3]
Master’s Degree	35	10%	[8–14]
Bachelor’s Degree	294	87%	[83–90]
Education at pre-bachelor’s level*	51	15%	[11–19]
Associate Degree	23	7%	[5–10]
Certificate, Genetic Assistant	10	3%	[2–5]
Certificate, Medical Assistant	8	2%	[1–5]
Certificate, Nursing Assistant	4	1%	[0–3]
High School Diploma/GED	19	6%	[4–9]
Other	8	2%	[1–5]
GA use of position	(N=339)
Working toward GC career	274	81%	[76–85]
Working toward non-GC career	71	21%	[17–26]
Not working toward another career	63	19%	[15–23]

Note: Not all respondents answered all questions; thus, the N for each question varied. Respondents were asked to select answers that applied to at least one of their GAs and were able to select multiple answers; thus, totals equal more than 100%

^*Category created post hoc by combining the answers listed directly below it.

3.3. Opinions Regarding GATPs

Over half of respondents (63%) thought GATPs would be helpful, with most endorsing a short-term (3 months or less) program (Figure 1a). About half endorsed the idea that GATP students should at least be enrolled in a bachelor’s degree program, with about a quarter endorsing an associate’s degree or high school/GED, and < 3% favoring no educational prerequisite (Figure 1b). Some (12%) stated that multiple programs with different prerequisites are needed.

FIGURE 1.

Opinions regarding creation of GA training programs

General knowledge topics were more likely to be rated as best taught in GATPs, while skills were more likely to be rated as best taught on-the-job or not needed (Figure 2). Most respondents rated eight of the 10 general knowledge topics as best taught in GATPs. However, only two of the 23 skills (constructing pedigrees and family histories) were rated as best taught in a GATP by most of respondents. Skills were much more likely to be rated as not needed with 15 skills being rated as not needed by at least 20% of respondents. Only two general knowledge topics (insurance/billing and roles of team members) were rated as not needed by at least 20% of respondents.

FIGURE 2.

Opinions on where GAs should learn general knowledge and skills

Purple shading indicates that most respondents felt the topic should be taught in GATPs, blue that it should be taught on the job; and orange that it isn’t needed by GAs at the respondent’s work setting. Dark shading indicates majority; light shading indicates plurality.

For each topic, N varied from 401 to 407.

About half endorsed the idea that GAs who completed GATPs would be able to help with more tasks than those who had not, and 45% believed that GAs who completed GATPs would need less training than those who had not (Table 3). However, there were some reservations. 60% of respondents believed that each institution does things slightly differently and GAs would best be trained locally. Some (44%) worried that needing to complete a GATP before being hired would be a burden that discourages candidates from becoming GAs. Of those whose work setting required a bachelor’s degree, the number of respondents who favored keeping that requirement was similar to the number who favored hiring a GA without a degree if they attended a GATP.

TABLE 3.

Attitudes toward genetic assistant training programs

	n	%	[95% CI]
Do any of the following statements reflect your feelings/beliefs toward GATPs?	(N=406)
Each institution does things slightly differently. GAs are best trained at each institution.	244	60%	[55–65]
New GAs who completed GATPs would be able to help with more tasks than those who have not.	209	51%	[47–56]
New GAs who completed GATPs would need less training than those who have not.	181	45%	[40–49]
GAs who have completed GATPs could command higher salaries.	179	44%	[39–49]
Completing GATP prior to hiring would be a burden that discourages candidates from becoming GAs.	177	44%	[39–48]
Requiring GAs to complete GA training programs would make it harder to hire GAs at my work setting.	155	38%	[34–43]
We currently require a bachelor’s; in favor of continuing, regardless of GATP participation.	95	23%	[20–28]
We currently require a bachelor’s; in favor of hiring GAs without if they attended GATP.	85	21%	[17–25]
GATPs would likely teach more than is needed in my work setting.	72	18%	[14–22]
We already require formal education (like enrollment in a bachelor’s); no further formal training is needed.	63	16%	[12–19]
Requiring GAs to complete GA training programs would make it easier to hire GAs at my work setting.	27	7%	[5–10]
Would you prefer that your work setting hire GAs who have completed a GATP?	(N=408)
Strongly prefer a GA who has completed a GATP	26	6%	[4–9]
Prefer a GA who has completed a GATP	118	29%	[25–34]
Neutral; have no preference	234	57%	[52–62]
Prefer a GA who has not completed a GATP	19	5%	[3–7]
Strongly prefer a GA who has not completed a GATP	11	3%	[1–5]

Note: Not all respondents answered all questions; thus, the N for each question varied.

3.4. Opinions on GA Workforce Issues

41% of respondents thought the genetics community should develop professional standards, competencies, and/or a scope of practice for GAs, while 24% answered no and 35% were unsure. Nearly two-thirds (62%) of respondents felt that certification/licensure was not needed, while 18% felt that certification through coursework or a national exam was needed.

In general, there was little concern about the impact of GAs on GC job security; 50% of respondents believed GAs will have a positive impact, 36% believed there will not be an impact, and 3% believed that there will be a negative impact.

3.5. Differences by Work Setting and Profession

Regardless of work setting (clinical centers vs laboratories), most GAs provided direct support to GCs (96% vs 99%; p=0.23). GAs in clinical centers were more likely to support clinical geneticists (39% vs 24%; p=0.02), while GAs in laboratories were more likely to support molecular geneticists (3% vs 37%; p<0.01) (Table S1). While most provided support to the clinical or molecular geneticists in addition to GCs, 4 GAs in clinical centers provided support only to a clinical geneticist and 1 GA in a laboratory provided support to only a molecular geneticist. Clinical centers were more likely to have part-time GAs (26% vs 8%; p<0.01) and GAs with no previous work experience (42% vs 21%; p<0.01). Laboratories were more likely to have GAs with previous experience in a medical field (47% vs 74%; p<0.01) and five times more likely to have GAs who were previously laboratory technologists (13% vs 63%; p<0.01).

Respondents from clinical centers reported employing fewer GAs than laboratories (median: 2 vs 5; interquartile range: 1–3 vs 2–10; p<0.01). Likewise, GAs in clinical centers supported fewer staff members than those in laboratories (median: 6 vs 20; interquartile range: 4–10 vs 7.5–30; p<0.01).

3.5.1. Opinions regarding GATPs

Respondents working in clinical centers were more likely than those working in laboratories to think that GATPs would be helpful (67% vs 52%; p<0.01) (Figure S1a). Those in clinical centers were also more likely to endorse the idea that there are differences between institutions and therefore GAs are best trained at each institution (57% vs 70%; p=0.04) (Table S2). Respondents in clinical centers were more likely to endorse the idea that GAs who completed GATPs would need less training than those who had not (50% vs 28%; p<0.01) and more likely to prefer or strongly prefer hiring a GA who had completed a GATP (40% vs 22%; p=0.04).

GCs were less likely to endorse the idea that there are differences between institutions and therefore GAs are best trained at each institution than GAs (54% vs 76%; p<0.01) and more likely to endorse the idea that GAs who completed GATPs would need less training than those who had not (49% vs 34%; p=0.01) (Table S2). GCs were more likely to endorse the idea that needing to complete a GATP before being hired would discourage candidates from becoming GAs (51% vs 37%; p=0.01). GCs were twice as likely to prefer or strongly prefer hiring a GA who had completed a GATP than GAs (42% vs 21%; p<0.01).

3.5.2. Opinions regarding how GAs are educated

While opinions about where general knowledge topics should be taught were similar among those in clinical centers and laboratories, there were differences in opinions regarding where specific skills should be taught, with disagreements on 10 of the 23 skills (Table S3). In each case, more respondents in clinical centers rated the skill as something that should be taught on-the-job, while those in laboratories rated it as something that was not needed by their GAs.

Opinions about where general knowledge topics should be taught generally agreed between GCs and GAs (Table S3). However, GCs were more likely to think HIPAA/privacy regulations and diversity, inclusion, and sensitivity training were best taught in GATP while GAs felt those should be taught on-the-job (61% vs 36%; p<0.01; 55% vs 37%; p<0.01). There was even greater disagreement between GCs and GAs on skills, with a majority of GCs recommending that two of the 23 skills should be taught in a GATP, while a majority of GAs didn’t recommend that any of the 23 be taught in a GATP. A majority of GCs thought that seven of the 23 skills were not needed by their GAs, while a majority of GAs thought that two were not needed.

3.5.3. Opinions on GA workforce issue

Those in clinical centers were more likely to respond that the genetics community should develop professional standards, competencies, and/or a scope of practice for GAs than those in laboratories (45% vs 29%, p<0.01).

GCs were less likely to believe that the genetics community should develop professional standards, competencies, and/or a scope of practice for GAs than GAs (37% vs 46%, p=0.02).

3.6. Intra-Institution Variability

Survey responses within the institutions varied (Table S4). For example, at the three clinical centers with the highest number of individual respondents, the percentage of respondents picking the same answer ranged from 11% to 57%. At the three laboratories with the most respondents, the percentage of respondents picking the same answer ranged from 11% to 78%.

3.7. Qualitative Data

132 respondents answered at least one of our open-ended response options. Our primary and secondary coders had good agreement on the codes assigned. After initially coding the data, we noted that the same themes were emerging from the “other” option of question 13 and the open-ended question 21. For example, the four most common codes to be assigned to question 13 were among the six most common codes to be assigned to question 21. Once the codes were categorized, the most common codes for both questions belonged to the same themes. Thus, we chose to do the final synthesis of the qualitative information of these two questions together. Three major themes emerged from the thematic analysis: GA workforce issues, barriers that GATPs could create, and the construction of GATPs.

3.7.1. GA workforce issues

Many of the open-ended responses addressed the long-term goals of becoming a GA, specifically that these positions are temporary and a step on a career ladder to another position, most often to becoming a GC: “Many GAs use the job experience to prepare themselves for a GC program…” Comments also surrounded the educational levels of GAs, which was most often assumed to be a bachelor’s: “I don’t see someone without basic undergraduate science coursework as being successful as a GCA.”

3.7.2. Barriers that GATPs could create

Respondents identified several potential barriers that GATPs could create: financial burdens, time commitments, and access difficulties, such as the location of the program being inconvenient. These potential barriers were discussed both as barriers to getting into a GATP and barriers to the longer-term career goals of the students, such as becoming a GC. “Requiring a GA training program would limit the diversity in applicants. People from rural communities or without as much money in savings may not be able to afford or take time off of work to complete a training program before applying to a position.” Some hypothesized that these barriers could ultimately impact diversity in the field of genetics, particularly among GCs. “[A]dding training requirements creates barriers to those striving to become a genetics professional (most likely a genetic counselor). The genetic counseling profession already suffers from significant diversity issues and layering on this training (whether a requirement or expectation) will add additional barriers.”

3.7.3. Construction of GATPs

A common theme that emerged surrounded suggestions on how to best construct a GATP. A common suggestion was that GATPs be offered to GAs after they are hired. “Instead, offer GA training programs to individuals once they are hired as GAs, for example as online modules. This would be a big help to clinics, saving them from developing so much of their own training materials.” Other ideas included that GATPs could be virtual, low-cost, or optional. Concerns were raised that the education in GATPs would be duplicative of prior education. “I feel as though much of this information is learned through courses that students are taking for graduation requirements and the remainder can be learned on-the-job.” Some suggested that training programs be only for entry-level GAs. “A training program may be more helpful for folks without a college degree…”

3.8. Sample Representativeness

There were 231 respondents who identified themselves as GCs. In April 2021, there were 5,629 certified GCs in the United States and about 4700 were members of NSGC (NSGC, 2022a). Thus, our sample represents approximately 4.1% of certified GCs and 4.9% of GCs in NSGC. If we extrapolate these numbers using the fact that 42% of GCs report that they work with GAs (NSGC, 2022b) and that we received responses from 172 GCs who said that they work with GAs, our sample represents approximately 7.3% of certified GCs and 8.7% of GCs in NSGC who work with GAs. Similar calculations cannot be done for GAs as there are no reliable sources for the total number of GAs.

4. DISCUSSION

Our study shows that GAs are common, with 80% of respondents having at least one GA in their work setting, which included clinical centers, laboratories, and other settings such as pharmaceutical, research, and telehealth companies. Most respondents believe that GATPs would be helpful and most agree that GATPs should focus on teaching general knowledge, rather than specific skills. While GCs were twice as likely to prefer or strongly prefer hiring a GA who had completed a GATP, they were more likely to endorse the idea that needing to complete a GATP before being hired would discourage candidates from becoming GAs.

We attempted to capture information on all GAs in the genetic workforce – those working with GCs and those who do not. In our sample, only 3% of work settings had GAs who did not work with GCs. It is unknown if this is because there are few GAs who do not work with GCs or our survey failed to capture them. Thus, the results of our survey are informative for GAs who work with GCs, most commonly called genetic counseling assistants. However, our study suggests that more than half of work settings have GAs who support GCs and non-GCs. Due to our study design, it is impossible to know if those work settings have individual GAs who support multiple provider types or if they have different GAs assigned to each provider type. It is important to note that respondents at these work settings did not report multiple job titles. Because not all work settings use the title genetic counseling assistant and more than half of work settings have their GAs support staff other than GCs, we chose to use the term genetic assistant in this manuscript.

We found that the GA position is filled by a range of education levels – from high school diploma/GEDs to doctoral degrees. 15% of work settings had at least one GA who had not earned a bachelor’s, which supports findings of another study that found that 9% of GAs had a high school diploma/GED or an associate’s degree (Hnatiuk et al., 2019). Most work settings have at least one GA with bachelor’s degree (87%) and were working towards becoming a GC (81%). Based on this information, we observed that there are two types of GAs: entry-level and bachelor’s-level. We define the entry-level GA as those who have not completed and are not working towards a bachelor’s degree, while the bachelor’s-level are those who are in or have completed bachelor’s programs.

We suggest that GATPs focus on the entry-level GA, rather than the bachelor’s-level GA. Some of the general knowledge topics identified by our survey can already be found in bachelor’s curriculum. For example, introductory genetics classes contain information on basic genetic concepts, such as DNA, genes, and chromosomes and genetic contributions to disease, such as multifactorial inheritance. If there are gaps in the knowledge base of bachelor’s-level GAs, they can be addressed by augmenting bachelor’s curriculum or having employers provide additional training after hire rather than through GATPs. For example, GINA and its protections could be taught in introductory genetics classes or through an online module supplied by the employer.

Additionally, the focus on entry-level GATPs could minimize concerns that GATPs could create barriers to the GC career path and reduce diversity in a field already lacking in diversity (NSGC, 2022a). Indeed, if GATPs were to focus on recruiting a diverse entry-level student population, GATPs could be utilized to introduce a more diverse group of students to the field of genetics in general. By providing exposure to genetics at the entry-level, we may encourage some to stay in the field and explore careers in genetics.

While some may question the advisability of focusing on the entry-level GA as they are currently a relatively small portion of the GA workforce, we do not know if this segment of the workforce is increasing, decreasing, or remaining stable. The GA position is still growing and changing as the field figures out how to best utilize it. Our study indicates that if GATPs are introduced at the entry-level there is interest in hiring the graduates. This demand, along with the benefits of having entry-level GAs who can remain in their positions for longer than GAs who are working towards becoming GCs, could cause this segment to grow. Indeed, Krutish speculated that their finding of higher rates of long-term GAs in Canada compared to the United States may be due to the earlier introduction of the position in Canada (Krutish et al., 2023). If true, this would indicate that the portion of long-term GAs in the United States may increase over time. Continued evaluation of the entry-level GA position is warranted.

Of course, the benefits of creating GATPs at the entry-level assumes that they could be created in ways that are affordable and accessible and that students would enroll, complete the programs, and subsequently obtain jobs as GAs. There is evidence that entry-level programs for healthcare are in demand and economically feasible. In general, entry-level healthcare positions, such as home health aides or medical, dental, occupational therapy and physical therapy assistants, are among the fastest growing positions in the United States workforce (Snyder, Dahal, & Frogner, 2018).

While this study showed the potential of GATPs, it also recognized the need for on-the-job training. Due to variation among institutions, certain skills were identified as being best learned on-the-job, such as finding information in medical charts. While there are variations in how this task is done, there are likely elements that are the same in many institutions, such as the kinds of information to look for or how to search in the different electronic record systems. Individual trainings could be created on each of these common elements so that institutions could customize a training for their GAs after hire.

Our survey asked about the need for professional standards, competencies, scope of practice, and licensure/certification because the need for these will impact training. We found that most respondents do not feel that certification/licensure is needed for GAs. However, most respondents felt that the genetics community should develop professional standards, competencies, and/or a scope of practice for GAs. Ideally, these types of standards should be in place before designing GATPs, or at minimum, should be developed in conjunction with creating GATPs.

While the differences in opinions between respondents in clinical centers and laboratories are statistically significant, they are not large enough to suggest that any topic should be taught only to one group and not the other. Thus, while interesting, these differences lack utility. Likewise, the differences of opinion between GCs and GAs also lacked utility.

Because there was significant intra-institution variability, our study provides little insight into how hiring institutions would respond to the creation of GATPs. Thus, we would recommend that those who are thinking about creating a GATP explore this topic more thoroughly with the institutions where their students would likely be hired.

4.1. Study Limitations

Our study had some limitations. There were very few respondents who were medical or molecular geneticists, other non-GC providers, or GAs that did not work directly with GCs. Our questions did not separate opinions on entry- and bachelor’s-level GAs. Our study collected data at the work setting level and not the individual level. For example, while we found that many work settings had GAs who support both GCs and non-GCs, it is impossible to know if each GA at the work setting supports more than one provider type or if they have separate GAs supporting each provider type. Likewise, our study was not designed to extrapolate data to the entire GA workforce. For example, while we found that 15% of work settings have a GA without a bachelor’s degree, it is impossible to know how many GAs in the workforce don’t have a bachelor’s degree. Additionally, our study represents individual preferences and opinions that may not be reflective of the hiring practices of that work setting, as evidenced by the intra-institution variability.

4.2. Future Research Directions

Future research on GAs should examine the separate demographics, roles, assigned tasks, responsibilities, and training needs of entry- and bachelor’s-level GAs. While the educational backgrounds of these two types of GAs are different, we currently do not know if these differences result in variations in the tasks they are assigned, how they are trained on-the-job, or their training needs that could be addressed in GATPs. We would also recommend that research be done at the institutional level, where data gathered represents the policies of employers, rather than the personal opinions of employees. While our survey focused on a national sample, individual GATPs may need to focus on the locality where their students are most likely to obtain positions. Additionally, our study showed that many respondents are concerned about the need for professional standards and certification/licensure. More information is needed to determine if this concern represents a lack of education regarding the necessity of these, or if GAs are doing tasks that would require these formal requirements.

5. CONCLUSIONS

There was enthusiasm for the creation of GATPs. Our study and others show that a sizable portion of GAs are entry-level, meaning they do not have and are not working to obtain a bachelor’s degree. Thus, this segment of the genomics workforce needs to be considered when addressing training needs. Because there are concerns that GATPs at the bachelor’s-level could create barriers to the GC career path and reduce diversity in a field already lacking in diversity and most of the general knowledge topics identified by our survey can already be found in bachelor’s curriculum, we suggest that GATPs be focused on the practical knowledge needed by entry-level GAs. GATPs could teach general knowledge with almost all skills learned on-the-job. Anyone creating a GATP should be aware of the barriers identified by our survey and find ways to lessen them. They should also consider doing further research on the hiring needs of local employers where their students are most likely to obtain positions.

What is known about this topic

More than half of genetic assistants (GAs) aspire to become genetic counselors (GCs) and have bachelor’s degrees. It is unclear what training best prepares GAs for their position. While one study reported that GAs feel prepared for their jobs, another reported that some GCs believe that a lack of experience and training are keeping GAs from performing additional roles that they are capable of. Some GAs report that they were given responsibilities for which they did not feel qualified. There are currently two educational programs in the United States that prepare students to become GAs.

What this paper adds to this topic

This paper reports quantitative and qualitative data from a United States-based survey about the training needs of GAs who assist GCs and other genetic providers such as medical geneticists, clinical geneticists, and genetic nurses. The survey identified the roles and work settings of current GAs, characterized their training needs, and determined the views of respondents on the need for, usefulness of, and potential content of GA training programs.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request. The survey used to gather data for this study is available as supplemental materials.