The experiences and support needs of applicants who go unmatched to genetic counseling graduate programs: An exploratory qualitative study

Abstract

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.

What is known about this topic

The rapid growth of the genetic counseling profession has led to a surge in the number of applicants for genetic counseling graduate programs. This has resulted in an increasingly competitive matching process, where many applicants do not secure positions, leading to financial and emotional burdens. Research on unmatched applicants is limited, but studies in other healthcare professions emphasize the necessity for support and a better understanding of how it affects applicants' well‐being and career goals.

What this paper adds to the topic

This study explores the experiences of unmatched genetic counseling program applicants, emphasizing their emotional journeys, challenges, and areas of growth. The research underscores the need for support and resources for unmatched applicants and offers recommendations for genetic counseling programs and organizations to assist these individuals in navigating the emotional and logistical challenges they face during the reapplication process.

1. INTRODUCTION

The profession of genetic counseling has been expanding rapidly in recent years. The 2023 Professional Status Survey disseminated by the National Society of Genetic Counselors (NSGC) states that “the genetic counseling profession has grown by over 100% in the last 10 years and is expected to grow another 100% over the next 10 years” (National Society of Genetic Counselors, 2023, pg. 1). Contributions to this growth include increased access to and demand for genetic and genomic testing as well as a broader availability of genetic counseling positions outside of clinical spaces (Hoskovec et al., 2018). This growth in the profession stimulated an increase in the number of graduate programs and training positions available in such programs (National Matching Service, 2023). To become a genetic counselor, individuals typically complete a 2‐year genetic counseling master's degree in a graduate program accredited by the Accreditation Council for Genetic Counseling. These graduate programs have been receiving a record‐breaking number of applications from interested prospective students (Beasley et al., 2022). In 2018, there were 1328 individuals who entered the application process for 43 accredited genetic counseling graduate programs (National Matching Service, 2018). By 2023, the number of accredited programs increased to 56, a 30% increase, while the number of applicants increased to 2082, a 57% increase, demonstrating how quickly interest in the profession is growing (National Matching Service, 2023).

In 2018 genetic counseling graduate programs transitioned to a match system at the recommendation of the Genetic Counselor Educators Association (GCEA), formerly the Association of Genetic Counseling Program Directors. Prospective genetic counseling students must research any number of the now 58 accredited genetic counseling graduate programs, choose schools to apply to, and hope to be invited to interview after submitting applications (Accreditation Council for Genetic Counseling, 2023; Ivan et al., 2017). With the addition of the match process, all applicants must register for the genetic counseling match through the National Matching Service (NMS). Graduate programs contractually agree to participate in the match and invite only those who are registered with NMS to interview. Many individuals who register with NMS and apply to programs are not offered interviews and therefore are not eligible to enter the match. Eligible individuals may participate in the match process by submitting a rank order list of the schools they interviewed with. Programs also submit a rank order list of the candidates they would consider for their program. Applicants eligible to participate with the match submit an average of 5.3 rankings (National Matching Service, 2023). Applicants who ultimately match submit an average of 6.8 rankings while those who go unmatched submit an average of 3.4. Applicants end the application process by being met with one of two realities: either they were not matched with a program at all, or they matched with one program in a binding agreement. Because of this, applicants face extreme pressure on “Match Day,” which is the day of the year that all prospective students are made aware of the results of the match process (Okoniewska et al., 2020).

About a quarter of all of those who apply to accredited programs and about half of those who are eligible to participate in the match do not match (National Matching Service, 2023). The number of people who went unmatched in applying to genetic counseling graduate programs increased from 369 in 2018 to 496 in 2023 (National Matching Service, 2018, 2023). There continues to be many more applicants than available training positions resulting in a high proportion of individuals going unmatched, a trend that is anticipated to continue in future years (Beasley et al., 2022). In some application years, there may be a post‐match process. This occurs when there is at least one unfilled position within one or more programs. Typically, unmatched applicants are made aware of unfilled positions in the few days after Match Day and have the option to apply to and interview for open positions during the post‐match process.

Research on the experiences of prospective genetic counseling students who do not match with a program is notably scarce. A study by Lee (2021) explored the financial aspects of applying to genetic counseling graduate programs. This research underscores that reapplying after not matching, even in three or more cycles, is a common occurrence and emphasizes the financial burdens associated with multiple rounds of applications (Lee, 2021). These financial aspects encompass expenses like application fees, Graduate Record Examination testing, Graduate Record Examination prep courses, and additional coursework to meet application prerequisites. Though many programs do virtual interviews, there may be interview‐related costs such as airfare, transportation, lodging, and childcare (Lee, 2021). Additionally, missed work days for interviews and unpaid volunteer commitments, like crisis counseling or shadowing genetic counselors, can result in additional costs, including background checks and transportation fees (Alvarado‐Wing et al., 2021; Lee, 2021). Those undergoing multiple application cycles face the financial burden of the process and also the opportunity cost of delayed entry into the genetic counseling profession, potentially impacting their lifetime earnings. Genetic counseling applicants perceive these costs as higher barriers to admission than admissions committee members do (Zahavich & Babul‐Hirji, 2023), aligning with the broader trend of financial barriers discouraging individuals from applying to graduate or professional education programs (Grbic & Brewer Roskovensky, 2012).

There is some research related to other healthcare professions with their matching systems. Research in specialties like orthopedics or urology within the National Residency Matching Program (NRMP) offers insights into support and alternative pathways for unmatched candidates (Lamba et al., 2023; Rivero Ippolito et al., 2016), with similar resources existing for the Canadian Residency Matching Service (CaRMS) (Okoniewska et al., 2020). In psychology, those who go unmatched in the Association of Psychology Postdoctoral and Internship Centers (APPIC) Match have a success rate of two thirds in securing positions within unfilled internship sites during the APPIC Clearinghouse (Chamberlin, 2004). In contrast, the genetic counseling match often does not have any unfilled spots after the initial round. Notably, the NRMP, APPIC Match, and CaRMS, like the genetic counseling admissions match, involve considerations of geographical preferences, program applications, faculty interviews, rank order lists, and the binding nature of matches, each having its post‐match procedures. The programs differ in timing within individuals' careers, with the genetic counseling admissions match marking the start of formal education, while the others come after it. Additionally, the NRMP has significantly more applicants, including a substantial international contingent (Morrissette & Morrissette, 2023).

Research about the match process for residency and the felt experiences of those who went unmatched within the CaRMS has outlined how this process is accompanied by immense stress; every participant interviewed reported a spectrum of negative emotions that ranged from grief, to disbelief, to self‐doubt, to isolation (Okoniewska et al., 2020). Additionally, participants felt that there was a negative stigma attached to not matching. Lastly, participants noted a lack of transparency or information available about not matching, and not enough resources available to help them cope with negative emotions (Okoniewska et al., 2020). For those who were not successful within the APPIC Match, unmatched applicants felt demoralized, judged by others, and left behind by matched peers (Chartier, 2014). Many of these individuals harbored hostility toward the profession of psychology. Within the genetic counseling application process, similar emotions and observations are likely to be felt and noted by those who are unmatched. Still, there are also positive aspects to delaying entry into desired career professions. Every individual within the CaRMS study mentioned that they eventually experienced growth after not matching (Okoniewska et al., 2020). Moreover, Rashid and Kibble (2021) found that individuals who took gap years before attending medical school felt more prepared to navigate the educational and professional landscape of their training due to personal growth and life experiences gained during their gap years.

Given how integral the match process is to becoming a genetic counselor, there is a need for research on how this experience impacts applicants. Investigating the perspectives of unmatched genetic counseling program applicants holds importance in refining the admissions process, aligning the profession with applicants' aspirations, and addressing ethical concerns surrounding equity and access. Additionally, it is important to understand how the profession fosters a sense of “belonging” right from the admissions phase. Furthermore, this exploration sheds light on the emotional and financial consequences that applicants who may eventually matriculate face. The aim of this study was to investigate the impact of not matching with a genetic counseling graduate program on applicants, focusing on emotional aspects, the reapplication experience, and identifying supportive resources during the period of not matching and the subsequent reapplication process. By enhancing support mechanisms, respecting applicants' dignity, and promoting inclusivity, institutions can create a more robust and diverse genetic counseling community.

2. METHODS

In this study, we conducted semi‐structured interviews with reapplicants to genetic counseling graduate programs. Reflexive thematic analysis was used to provide this study with a framework designed to generate themes based on the commonalities of not matching within a genetic counseling application process. This research study was reviewed by the Boston University Medical Campus Institutional Review Board and was granted approval as an exempt study in September 2022 (Protocol H‐42967).

2.1. Participants

Eligible participants for this study included individuals who applied to, interviewed at, and ranked at least one genetic counseling graduate program in the match process between the years of 2018 and 2022, did not match in these previous application cycles, and are choosing to reapply in the 2023 application cycle. This specific population of reapplicants was chosen because they are active in the re‐application process and have a current perspective on their lived experience and resources that may be beneficial. Participants were required to be English‐speaking and have access to Zoom for interview completion.

2.2. Procedures

Recruitment of participants occurred via social media platforms, encompassing the GC Chat Discord, an online forum facilitating discussions among prospective and current students; the Slack channel of the Minority Genetics Professional Network, an organization fostering connections among prospective students, current graduate students, and genetics professionals from diverse racial and ethnic backgrounds; as well as X (formerly Twitter). The recruitment notice detailed the study's objectives, which involved investigating the experiences and support requirements of unmatched applicants, and understanding their ongoing motivation for reapplication. It defined inclusion criteria and provided a link to the qualifying survey.

Interested participants filled out a screening survey administered by Qualtrics (Appendix S1). The survey collected information on inclusion criteria, demographic information, and information about previous application cycles. It asked respondents to consent to being contacted for an interview and included in the study. Individuals who completed the survey were contacted via email by the first author to participate in a 30–60‐min semi‐structured interview via Zoom. Invitations were sent on a weekly basis, and if an invitation went without response, additional prospective participants were contacted. Initially, our intention was to employ purposive sampling within our study sample. However, it became apparent that the survey respondents exhibited nearly identical demographics, leaving limited room for purposeful variation. Consequently, the first 15 individuals to schedule interviews participated in this study. The authors determined data collection's sufficiency in terms of informational power, considering the focused study aim, specific sample population, and high‐quality interview dialogues (Malterud et al., 2016). They observed robust informational power in the study, driven by extensive and diverse data that thoroughly illuminated participants' experiences.

The semi‐structured interview guide (Appendix S2) was created through collaboration of all members of the research team, including two team members who themselves had gone through multiple application cycles for genetic counseling graduate programs. The development of the interview guide drew inspiration from personal experience and the thematic elements identified in Okoniewska et al.'s (2020) work. The interview guide included questions about participants' application process, preparation for Match Day, feelings upon learning that they did not match, resources or supports they used or would have used, coping strategies when not matching, continued motivation to apply again, and influence of not matching on their current application cycle. The interview guide was piloted with two current genetic counseling students, and minor adjustments were made to questions for clarity. All interviews were conducted by the first author, who disclosed her own status as a multi‐cycle applicant at the beginning of interviews. After the interview completion, participants were sent a $20 Amazon e‐gift card as compensation for their time and participation. Interviews were transcribed verbatim from audio recordings by the first author, and identifiers were removed prior to data analysis.

2.3. Data analysis

NVivo, a qualitative data analysis software, was used to organize and manually code the interview transcripts. Given the lack of representation of reapplicants' perspectives in the literature and the reflexive thematic approach to coding, the codebook was developed inductively from interview data by the first and last authors, both of whom have training in qualitative data analysis. Guided by a social constructivist interpretive framework that acknowledges the construction of multiple realities through personal experiences (Creswell & Poth, 2018), the reflexive thematic analysis followed an iterative process, involving data familiarization, initial code creation, application to transcripts, development and reflection on preliminary themes, and iterative refinement (Braun & Clarke, 2006, 2019). Notably, 8 of the 15 transcripts underwent iterative analysis by both HL and KZ, and HL applied the finalized codebook to all transcripts. The generation of themes was a collaborative effort within the research team. Participant quotes selected for this article underwent minimal modification, limited to the removal of filler words such as “like” or “kind of.” Demographic data were aggregated and summarized in Excel.

3. RESULTS

The qualifying survey was completed by 20 eligible participants, and 15 individuals were interviewed. The demographic information of participants is presented in aggregate to protect participant's anonymity (Table 1). Participants' ages ranged from 20 to 29 years old. All participants were cisgender women. All participants identified themselves as white, with two also identifying as East/Southeast Asian. Eight participants had participated in one previous application cycle, six participated in two cycles, and one participated in three cycles.

TABLE 1.

Participant demographic information.

Item	Response	Participants
Age (years) (n = 15)	20–25	12
	25–29	3
Race/ethnicity a (n = 15)	White	15
	East/Southeast Asian	2
Gender (n = 15)	Cisgender Woman	15
Number of completed application cycles (n = 15)	1	8
	2	6
	3	1
Number of applications submitted in first round (n = 15)	1–3	4
	4–6	5
	7–10	3
	11+	3
Number of applications submitted in second round (n = 7)	1–3	1
	4–6	2
	7–10	4
Number of interviews completed in first round (n = 15)	0	5
	1–3	8
	4–6	1
	7–10	1
Number of interviews completed in second round (n = 7)	0	1
	1–3	6
Years after graduating college when first application submitted (n = 15)	0	7
	1	4
	2	2
	3	2

^a Participants were able to select all that apply.

Five major themes were conceptualized from participant responses: (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.

3.1. Theme 1: Emotional navigation through the stages of the match process

Participants felt a range of both negative and positive emotions throughout the process of applying, waiting for Match Day, finding out they had not matched, and reapplying to programs.

3.1.1. Pre‐match

Pre‐match emotions were influenced by participants' confidence in their ability to match, and interview experience heavily impacted confidence levels. Receiving interviews increased participants' confidence: “For me it was a big thing that I had interviews. Half the people who apply don't even get interviews… It was a confidence booster”—Participant 14. In contrast, having a negative interview experience increased feelings of anxiety going into Match Day: “There was a sense of dread going into [Match Day] because I didn't feel amazing about my first interview”—Participant 4. Some participants lost confidence after receiving a low number of interviews in comparison to the number of applications they submitted. Participant 1 described, “Going into the interview, I felt less confident, just because I knew that I wasn't as strong of an applicant as others, otherwise I would have gotten more interviews.” Many participants' emotions were influenced by not being able to properly showcase their personality and abilities during interviews, as noted by Participant 15: “I didn't think that the questions they asked me allowed me to show my full capacity and all of my abilities in a way that I was prepared for…I just felt disappointed from that.” The number and quality of interviews impacted participants' emotions and how they faced the uncertainty of the match process.

During the time between interviews and Match Day, the most common emotion that participants felt was anxiety. Participant 9 shared, “I was definitely feeling very anxious. I wanted it to come faster.” Participants discussed that part of this anxiety comes from the pressure of being met with one of two realities on Match Day and either matching with a school in a binding contract or not matching with any program. The uncertainty of this result was difficult for some participants to consider, as expressed by Participant 10: “I had no idea about what would happen and what I would do if I didn't match because the two outcomes were totally different for my future.” On top of navigating emotional responses to anxiety and pressure, a few participants had physical responses to the stress they were feeling before Match Day: “My anxiety really makes me feel unwell. My stomach hurts all the time whenever I'm anxious about something. I had a stomach ache the whole week.”—Participant 15. As participants waited for Match Day to come, many remember ruminating on their application experience: “There's that long time‐frame between interviews and Match Day as well. That's a huge amount of time just to stew on things”—Participant 7. All applicants likely experience negative emotions during the match process, and those who do not match and then reapply have to endure these emotions multiple times.

3.1.2. Match Day

On Match Day, when the results were unveiled, applicants recalled their initial emotions upon discovering their unmatched status. Many participants expressed first being disappointed about not matching: “I sobbed. The disappointment hits like a brick”—Participant 13. They then recounted the ongoing emotional journey as they navigated the uncertainty surrounding their future plans. Many participants grappled with a sense of shock as they came to terms with the reality that their hopeful plans for the future had not materialized:

I was shocked for a while. Then I had to reread it multiple times as it settled in. And then thinking about what that meant, the implications of what my next year, or hopefully what my future looks like. And then you start grieving that. Participant 1

While processing these challenging feelings, many participants reported the need to take time away from the genetic counseling space for self‐preservation. Participant 4 shared, “I tried to step away from GC for a bit just for my own mental sanity.”

In addition to negative emotions, several participants expressed a sense of relief about not matching and avoiding the challenges that come with moving or starting graduate school:

It was definitely not surprising but disappointing. But I did also feel a sense of relief because then I didn't have to worry about the long list of things that I was going to have to do like finding an apartment, moving, and actually getting back into school. Participant 9

3.1.3. Post‐match

After not matching, a few participants entered the post‐match process. Most of these participants had not applied previously to the school with an open position but were willing to apply during the post‐match process for the continued hope of becoming a genetic counseling student: “I did not fully think it through, I just wanted to take some next steps. I still wanted a shot at going to school this year”—Participant 2. Of those who participated in the post‐match, most shared how this process elongated feelings of uncertainty about their future that are felt throughout the application process. Participant 7 expressed, “Not matching and the follow up of then having that open spot that I applied for then interviewed for just delayed that process of not knowing where I was going to live and what we were going to do.”

A few participants shared how difficult it was to figure out the post‐match process and how this confusion led to too much additional stress for them to consider entering the process:

I didn't really understand how it worked and there wasn't really anywhere that I applied to that had openings. At that point I was like, this has emotionally beaten me, I'm not giving it any of my time right now because I don't think I can. Participant 15

3.1.4. Reapplying

Participants in this study were all individuals who decided to reapply after not matching. Some participants found it challenging to find the motivation to apply again given how difficult initially applying was and how uncertain a successful reapplication is: “Going back out there and making myself vulnerable again in submitting applications to schools. That's been the hardest part so far”—Participant 14. In contrast, some participants were eager to apply what they had learned from their initial application process to a new cycle: “I'm feeling excited to reapply and reflect on some of the new experiences that I've had and how I've grown as a person”—Participant 3.

When reapplying, participants often found themselves reflecting on their emotions from their initial application process with fresh perspectives, having gained better insight into those experiences. Several reflected on the validity of the various emotions felt during the application process. Participant 6 offered, “I would say it's important to really process the results….It's okay to be sad, angry, and upset about the results.” Fortunately, participants commonly shared a sense of being more comfortable with the uncertainty of the process in their subsequent application rounds: “I wasted so much anxiety and energy being so stressed about it. And I am okay where I am right now. I am perfectly fine, I am happy, and I do hope I get in this cycle”—Participant 15.

Various and sometimes simultaneous emotions are experienced throughout the different stages of the application process. The individual ways in which participants processed and contemplated these emotions influenced their subsequent application rounds and the emotions that accompanied their re‐application journeys.

3.2. Theme 2: External perceptions surrounding going unmatched and disclosure of results

Many participants' abilities to process their experiences and emotions were influenced by the external perception they felt from those inside and outside of the genetic counseling profession. The simultaneous participation of many participants in the application process alongside their peers added complexity to their perceptions of facing unmatched status:

I had a few friends who were going through [physician assistant] school, my friend had gotten into all of these schools so they were very excited and it was very difficult to be happy for her but this is what happened to me and I need to process this. Participant 8

With time, participants increasingly grasped the intense competition in matching with a genetic counseling program compared to other graduate programs:

I would definitely tell myself to look into the grad school process a little bit more. You do hear about people who decided they want to go to grad school and get their masters, and just go‐ it's not as competitive. Participant 2

Many participants believed that individuals outside the genetic counseling profession held more negative perceptions of not matching, affecting their desire to share their results:

For people who are not from the field, the process is very different from other graduate programs, so it is really hard to tell people that it is a normal situation not to match. So I felt some negative attitudes about it from other people. Participant 10

Most participant's reasoned this perception may stem from others not understanding the genetic counseling application process and its competitive nature. Participant 8 shared, “A lot of people in my life… they have no idea what the match process is like, they do not understand how competitive it is.” The lack of understanding of the matching process by others, combined with a prevalent negative perception, intensified the challenges faced by unmatched applicants when they had to repeatedly share the news with others: “I have to tell them over and over and over that I didn't get in, and explain all of that, and it's just like you keep reliving it like over and over and over again, and it just hurts more and more each time”—Participant 1. Moreover, because results were released on a specific day for everyone, many participants found themselves under pressure from their support systems, who were eagerly awaiting the outcome: “A bunch of my friends had it in their calendars to ask me. And of course my parents. Almost everyone knew as soon as I did”—Participant 11.

In the social context of the genetic counseling profession, genetic counseling assistants grappled with complex emotions stemming from their proximity to others undergoing the same process. The interplay between relationships with colleagues, the anticipation of Match Day results, and the diverse range of outcomes further complicates the sharing of these results:

[My coworkers] talk about Match Day last year, and just how terrible it was to be at work with everyone‐ all these coworkers that you love, and are supporting. Then half get in, half don't. How do you get excited for people? But also you can't be super excited because the person next to you didn't get in, and they're grieving about it. Participant 1

Some applicants found a sense of support from genetic counselors who understood the nuances of not matching. These individuals, well‐versed in both the profession and the matching process, generally held more optimistic attitudes toward not securing a match. Participant 12 described, “The people who I've interacted with in the genetic counseling field have been very supportive of the fact that I didn't match.” In fact, some participants felt encouragement when individuals within the profession normalized the experience of not matching, resulting in increased comfort among participants when it came to sharing their unmatched status:

I talked with other genetic counselors letting them know that I didn't match. Them lifting me up was definitely helpful. They told me they did not match their first time. A couple are faculty for programs, and they told me there are a lot of people who didn't match their first time. Them normalizing that experience was really helpful. Participant 3

Participants reflected on the difficulty that comes with increased interest in the profession and the discouragement that accompanies genetic counselors' perceptions on how increased competition affects matching success: “I talked to GC's before I applied, the ones that I had shadowed… They mentioned how it has gotten more competitive. One told me ‘If I was applying today, I don't think I would match’”—Participant 2.

3.3. Theme 3: Experiencing stagnancy throughout applying and reapplying

Numerous participants expressed a sense of stagnation during both the application and reapplication phases. This stagnancy is a feeling created by being unable to move forward with intended future plans, being compelled to delay life‐altering decisions contingent on match outcomes, and experiencing personal and professional setbacks due to not matching:

The hardest part was a long waiting period. At first you're waiting for the interviews, then you're waiting for Match Day. It's a very long process. In this period, for several months, you feel very stressed and you don't know your future. Participant 10

Since participants often had to spend several months in anticipation of information that could help them make life decisions, some had to stay in or find intermediate jobs: “I didn't want to completely convince myself that I wasn't in and start looking for different job opportunities or different places to live in the meantime if I didn't match. My life was put on the backburner until Match Day”—Participant 12.

The notion of not being able to make life decisions or progress forward in life due to the uncertainty of match results was shared by many participants:

In terms of life, I'm stuck right now. I'm on hold. This has definitely impacted getting married, moving out. I'm back home with my parents… I've definitely tried to figure out next steps but it's hard because you don't know what is going to happen in April. Participant 13

Participants reflected on how they might be further in their careers if they had pursued a different path. The frustration that accompanies feeling setback compared to peers is evident:

I have friends who are now physicians. It is incredibly frustrating to feel like I am in a perpetual state of limbo. I am always in assistant positions and associate positions…. If 3 years ago I had gone a different route, say OT (occupational therapy) or PT (physical therapy), I would be done now, I could move somewhere, I could buy a house, and I could settle in life. Participant 7

Ultimately, the experience of stagnancy and wanting to make career progress contributed to participants experiencing turmoil in deciding to reapply again. Despite their passion for the profession, avoiding stagnancy was a major motivator for participants in considering whether they wanted re‐apply:

I'll try to spend more time exploring different career paths. And even if there isn't one that I'm as passionate about, I can settle for being happy and okay with that for an extended period of time. It's hard because I really want to be a GC but I don't know if I can do the application process again. Participant 2

For many participants, deciding whether to reapply was the most arduous aspect of their experience with not matching. The extended duration required for the reapplication process, akin to stagnation, compounded the complexity of this decision: “The hardest part about not matching quite honestly is knowing that you're going to have go through another application cycle just because they're so expensive, and time consuming, and stressful”Participant 8.

3.4. Theme 4: Advances in knowledge and personal growth

Participants were able to derive positive life lessons and personal growth through their experience of not matching: “It was a good experience for me, just because before that I didn't have any major failures. Before this match season I was pretty successful at everything I was doing. It's good to experience a failure and overcome that”—Participant 10. The resilience developed by participants was thought to be a valuable asset in their progression through the reapplication process. Upon introspection regarding this personal growth, some participants even acknowledged that they might not have been entirely prepared for graduate school had they matched in the previous cycle. Participant 3 reflected, “Looking back at it, I'm not sure I would have been ready to go to school in the fall.”

To assist in knowing which areas to focus on for improvement, all participants reached out to programs they had interviewed with for feedback. In this process, some participants were given feedback that more life experiences would benefit them as an applicant: “Honestly a lot of the feedback that I got my first year was around getting more experience”—Participant 5. The feedback process proved beneficial for applicants, helping them formulate plans and identify areas where they needed to exhibit skill improvement and personal growth: “I reached out to programs to get feedback because that's always really helpful. Then I made actionable steps towards achieving what they wanted to see more of. I found things that are interesting for me in the field”—Participant 8.

Participants described how they acquired valuable insights into themselves, the genetic counseling profession, and the admissions process during their initial application round. Consequently, some participants reflected on their increased confidence when embarking on a new application cycle: “I definitely feel more confident than last year. I have experience and I know how it works. I know the process and I know the hardships of it”—Participant 10. Some participants viewed their first application cycle just as a learning experience. Participant 1 discussed, “The first time I applied only to one school. I was fairly new to my journey towards genetic counseling, so I just kind of threw an application out there hoping to get some feedback.”

Reapplicants described not only gaining a deeper understanding of the admissions process but also developing a more comprehensive grasp of each program's unique characteristics and distinctions, along with a heightened appreciation for program attributes that aligned with their personal values and objectives. Initially, participants primarily considered program differences based on location, but with increased knowledge, they began to factor in other important aspects:

Location was the number one factor because I didn't really know what else to look for. Now I have a whole list of things I would want in a school that I want to apply to in the future. For that I am glad that I didn't match the first time because now I have an idea of what I'm actually doing and what the differences are between programs. Participant 9

In completing multiple application rounds, participants' knowledge about the genetic counseling profession increased substantially: “Just even in the last 6 months I feel like I have a way better grasp on what genetic counselors actually do”—Participant 9. Upon careful consideration of the pros and cons associated with reapplying, the majority of participants expressed that their unwavering passion for the profession serves as their primary motivation to pursue reapplication: “This is the field for me. As generic as that sounds. I feel really sure that this is what I'm supposed to do”—Participant 5.

3.5. Theme 5: Areas for increased supports and resources

Participants actively sought support at critical junctures, finding value in these resources during the initial application, immediately after Match Day, and when contemplating reapplication. They first encountered challenges while navigating the application process, leading them to seek additional assistance and resources: “There's stuff out there for resources, but it's not readily available, and it's difficult to find. You really have to dig to find and understand”—Participant 1. As part of the application process, most participants found the match system to be convoluted: “The whole match process took me about four videos and three blog articles to learn. It is very confusing. I still don't entirely get it; when people ask me to explain it to them, I don't know how to”—Participant 12. The match process itself emerged as a point of contention, with participants expressing diverse perspectives on its value within the genetic counseling admissions process. Many participants conveyed skepticism about the match and exhibited varying levels of understanding, possibly indicating a lack of comprehensive information about its mechanics: “There could be a better system. Does it really work in our favor?”—Participant 13. Still, many participants appreciated the match system's utility: “The match program is a good idea so that everyone finds out at once and we don't play that sitting on the waitlist game…. Logistically I definitely think it makes sense”—Participant 11.

Navigating the varying application portals and program requirements was another logistical aspect to applying to genetic counseling graduate programs that frustrated participants: “Other programs have one application website or center. Whereas with [genetic counseling], each program has their own different thing”—Participant 4. Participants were especially aware of how difficult this was for the individuals who wrote their letters of recommendation to navigate such logistical challenges: “My poor letters of recommendation writers, having to upload the same letter to XYZ portal. You're sending them dozens of links or something to all of these different websites”—Participant 1. Though navigating program websites and portals is not unique to reapplicants, many participants applied to increasingly more programs in successive application rounds, which requires further navigation. Participant 8 shared, “First cycle I had applied to 3 schools and my second cycle I applied to 8 schools, and this year I'm applying to 20 schools.” In light of these barriers, many participants advocated for a standard or common application: “I wish that there was a common app… That would help with some stress”—Participant 3.

As participants reflected on their increasing knowledge across multiple application rounds, some attributed their initial lack of information about the genetic counseling application process and programs to the absence of advisors or mentors who could offer insights. This deficiency underscores a gap in available supports and resources:

I used to be in a pre‐health space in college, but no one was pre‐genetic counseling. So I felt a sense of isolation that I was in it alone. Finding those people who are on the same path as you is amazing, it's just hard to find them. Participant 4

For some participants who were first‐generation college students, the significance of accessible resources, such as advisors well‐versed in the genetic counseling admissions process, was amplified: “As a first‐generation student these academic circles aren't familiar to me. So I didn't really have those lived experiences or generational advice to go off of”—Participant 11.

Lacking access to individuals knowledgeable about the genetic counseling profession and specific programs, participants considered alternative resources that would benefit anyone applying to genetic counseling graduate programs. Many participants expressed a desire for greater transparency in admissions data for each program and sought additional insights into the criteria program faculty valued when assessing applications. Participant 13 described, “More of each school's individual statistics would be helpful. Because each school might have a little bit of a different GPA (grade point average), background, how many people apply, things like that.” On the topic of data transparency, other participants wanted more data on the number of application cycles students participated in before matching: “I definitely would love to learn more about how many times it takes people because I do feel more alone in the fact that it's taken me more than two tries”—Participant 5.

In the critical time period after not matching, many participants shared the benefit of finding social support and community with other unmatched applicants: “Basically I shared within the Discord group. I learned a lot of advice about self care from there. I decided that I should focus on myself and my well‐being right away”—Participant 6. Individuals relied on such resources to process their experience: “Being able to talk it out in that moment with someone else, whether it's a shared experience with another prospective applicant or with a partner or someone like that‐ processing it with other people was really helpful for me personally”—Participant 3. Engaging with peers, sharing personal stories, and actively listening to the experiences of others proved advantageous for unmatched applicants. Moreover, participants gained valuable information through webinars and panels about the reapplication process: “I attended a genetic counseling prospective student network‐ they had a reapplicant panel. Hearing other people talk about their experiences as reapplicants was nice”—Participant 4.

In the time period following applying and not matching, a few participants struggled with wondering whether they should continue to pursue genetic counseling or consider other careers. Several wished programs would be explicit about affirming reapplicants:

A lot of those programs were very adamant that they really appreciate reapplicants and that reapplicants should talk about it in their personal statement. Them saying that makes me want to apply to them way more. Schools need to be aware of this and make sure that they're making reapplicants feel valued in some way. Participant 15

4. DISCUSSION

This is one of the first studies to explore the experiences of individuals who do not match with a genetic counseling graduate program after going through an application cycle. The results demonstrate the varying emotions that reapplicants can experience through their journey of not matching and reapplying. The results highlight the challenges and stagnancy that reapplicants face in considering their future careers in genetic counseling, as well as the ways in which applicants demonstrate resilience and growth. Taken together, this study's findings shed light on areas where people and organizations within the genetic counseling profession can offer reapplicants more support. Fostering a sense of belonging and reducing stigma from the beginning of the admissions process is crucial, and it is vital for graduate programs to recognize the considerable stress that applicants and reapplicants bring with them into their graduate training.

Common emotions such as anxiety, uncertainty, disappointment, and dread were prevalent among participants. Similar emotions have been documented in a study regarding the Canadian Residency Match (Okoniewska et al., 2020). Moreover, past research has explored the impact of financial burdens on the choice of applying or reapplying to graduate or professional education programs, a contributor mirrored in this study's participants' difficulty in deciding to reapply (Grbic & Brewer Roskovensky, 2012). This study highlights that stagnancy was another major contributor in participants' decisions about reapplying. Stagnancy describes a state of not progressing or remaining inactive. Participants experienced distress in two areas related to stagnancy. First, many participants were in positions in life where they felt they could not progress. Some participants stayed in intermediate jobs that they had hoped to transition out of if they matched with a genetic counseling graduate program, while others decided to live with family to save money for school. Participants were unable to ameliorate this stagnancy due to the uncertainty of where they would be living for graduate school in the future. Second, social comparisons contributed to this feeling of stagnancy as participants saw their peers complete other graduate programs while they have been unsuccessful at entering into one. Observing success in other career paths and wanting to move forward with intended life plans to eliminate feelings of stagnancy were the main reasons why many participants considered not reapplying to genetic counseling programs and instead pursuing other careers.

Highlighting variability in perspectives gained during this process, all participants in this study spoke about experiencing growth, resilience, and hope, as is similarly reported in the literature (Okoniewska et al., 2020). Rashid and Kibble (2021) studied the experiences of individuals who took gap years between undergraduate school and medical school, whether by choice or because they were not accepted to medical school. These participants indicated that their resilience in the face of lack of acceptance or when navigating work‐life challenges during their gap year has rendered them more adaptable to change. Rashid & Kibble's participants also noted a broader conceptualization of themselves as a professional, a better understanding of the world outside the confines of an educational institute, and a deeper understanding of their values and goals (Rashid & Kibble, 2021). These benefits are similarly reflected within this study through participants noting their increased knowledge of themselves, personally and professionally, as well as an increased understanding of genetic counseling.

4.1. Practice recommendations

This study establishes how the rejection and reapplication process is stressful and filled with uncertainty. Ensuring proper support for unmatched candidates is vital given that the proportion of unmatched candidates in future application cycles is projected to increase (Beasley et al., 2022). The two critical timepoints for resources to be offered are when unmatched applicants are processing not matching and while they complete the reapplication process. Many participants expressed how they desired more resources from individual programs themselves; however, relying on this method of disseminating information has the potential to contribute to the decentralization and redundancy of available support. Instead, broader genetic counseling bodies, such as the GCEA, could be responsible for creating and disseminating information on resources. GCEA dictates the information that is shared with unmatched candidates via NMS on Match Day and could be instrumental in helping unmatched applicants find support.

Directly after Match Day participants primarily noted a desire for emotional support in the form of support groups that could offer solidarity and a space to process emotions. Having a community within the genetic counseling space to share experiences with may decrease feelings of isolation, considering participants felt that individuals outside the profession were less understanding of the process. Such resources would have to be offered at different times after Match Day to accommodate individuals involved in the post‐match process and individuals who need space from the genetic counseling community after not matching. NSGC establishes virtual communities through Special Interest Groups (SIGs), including one dedicated to student members. Given the recent experience of many members in the match process, this student‐specific group can offer unmatched applicants a chance to connect with the genetic counseling community of learners. This approach not only supports current participants but also ensures a smooth transition of leadership within the group, promoting sustainability and long‐term continuity.

After processing the initial grief of not matching, participants described the need for resources to assist in deciding whether or not to continue to pursue genetic counseling. For example, panels hosted by successfully matched multiple‐round applicants on the topic of why they chose to keep pursuing the profession would be beneficial. Additionally, it would be beneficial for NMS to add data surrounding the proportion of applicants who are reapplicants and the proportion of accepted students who were reapplicants to the overall match summary statistics. NMS has contact information of unmatched applicants, which has the potential to be used for developing statistics on the different career choices unmatched applicants make.

Participants expressed a significant interest in receiving program feedback to enhance their reapplication to genetic counseling graduate programs. Those who had the opportunity to receive program feedback found it valuable. As part of the program requirements for the genetic counseling match, programs must provide all interviewed applicants an informational flier about the match and post‐match process which discusses how some programs are open to inquiries about reapplying to their institutions (Association of Genetic Counseling Program Directors, 2023). However, it is worth noting that program faculty may face challenges in providing this feedback due to the growing number of applications and their demanding job responsibilities.

With more general communications to reapplicants, the information that programs post on their websites is influential in applicants making decisions about where to apply (Ivan et al., 2017). Additionally, the perceptions that participants felt from others' after not matching influenced their emotions and processing of disappointment. Observing a positive perception of reapplicants from program faculty contributed to feelings of support, encouragement, and normalization. Participants shared that they had an increased motivation to apply to programs that clearly valued reapplicants, as displayed verbally through webinars or through program websites or social media.

In applying to numerous schools, participants expressed challenges navigating different application portals, school requirements, webinars, and websites. Prospective students who had previously applied to genetic counseling programs perceived the time to complete applications and the timing of application deadlines to be a significantly larger barrier to applying than was perceived by admissions committee members (Zahavich & Babul‐Hirji, 2023). Suggestions to ease this burden included a standard application, which is a consideration being researched and should be further explored for feasibility by larger genetic counseling organizations (Beasley et al., 2022). A centralized website of program information and a calendar of information sessions could be another resource of utility.

Furthermore, participant insights highlight the pressing need for transparency in the genetic counseling application process. These recommendations resonate with a wider audience, emphasizing the importance of making application procedures more accessible and comprehensible, regardless of whether they are first‐time applicants or reapplicants. Participants desired clear and comprehensive information on admission criteria, application review procedures, communication protocols, support for reapplicants, and historical data on previous application cycles. Participants also wanted more standardization in programs publishing selectivity data, such as the number of applications they receive or the average GPA of their students, which is something that accreditation standards for programs could consider adding to required data on admissions in the same way that is required for graduate outcomes (Accreditation Council for Genetic Counseling, 2019). If programs become more forthright about their prospective applicant review process, applicants can consider the value of an array of experiences in the application process. Recent research has highlighted the importance of a holistic approach to reviewing application materials in order to consider an applicant's complete experience, rather than disproportionately focusing on any one factor (Zahavich & Babul‐Hirji, 2023). A holistic review for graduate programs has been recommended for healthcare professions as it helps to create a workforce prepared to take care of diverse patient communities. However, at this time, there is no research focused on the similarities and differences across admissions practices for accredited training programs.

The experiences shared by participants in this study underscore the significance of mentors in demystifying both the profession and the application process. As participants described, mentorship plays a pivotal role in applications, offering invaluable support and guidance to both applicants and reapplicants. For first‐generation college students or those lacking familiarity with the academic circles related to genetic counseling, mentorship becomes even more critical, bridging the gap of generational advice and lived experiences (Carmichael et al., 2021). Furthermore, mentors can assist applicants in navigating the maze of diverse program requirements and highlighting what is most important, fostering an environment where they can make informed decisions and increase their chances of success (Alvarado‐Wing et al., 2021). In essence, mentorship may not only impart knowledge but also alleviate the sense of isolation felt by many applicants, making the path to genetic counseling programs more accessible and less daunting (Watson et al., 2023). The clamor for accessible mentors well‐versed in genetic counseling and program admissions processes resonates as a call to address the dearth of these supports.

Finally, not all unmatched genetic counseling students will continue pursuing a career in genetic counseling. Drawing inspiration from the concept of a compassionate off‐ramp in medical education (Bellini et al., 2019), a similar approach could be extended to unmatched applicants in the genetic counseling admission process. Much like struggling medical students, unmatched applicants often experience disappointment and uncertainty. A compassionate off‐ramp for unmatched applicants could encompass personalized guidance, mentorship, and resources to explore alternative paths, skill enhancement opportunities, and psychosocial support. Integrating the concept of academic capital into this compassionate off‐ramp approach could involve assessing and leveraging the accumulated knowledge, skills, and academic achievements of these individuals to facilitate a smooth transition into alternative educational or career paths that align with their strengths and aspirations (Huang, 2021). This approach aims to empower unmatched applicants to navigate their situation with dignity, foster growth, and make informed decisions about their academic and professional futures within and beyond the genetic counseling profession. However, it remains unclear whose responsibility it would be to provide this mentorship and support, highlighting the need for further research in this area.

4.2. Study limitations

This exploratory study has several limitations. Due to the qualitative nature of the study, issues of social desirability bias may have influenced participants' responses. The participants in this study demonstrated limited demographics, with all participants being cisgender women between the ages of 20 and 29, and the majority being white, significantly limiting the transferability of the findings. Although these demographics are fairly consistent with the demographics of the larger genetic counseling profession, being predominantly white, cisgender women under the age of 40 (National Society of Genetic Counselors, 2023), this study is missing the valuable perspectives of people of other ages, races/ethnicities, and genders. Recent research has shown that applicants who are of a visible minority group or have a disability face additional barriers applying to genetic counseling programs (Zahavich & Babul‐Hirji, 2023). Due to our limited demographics, this study does not speak to how various aspects of identity impact the application and reapplication process. Furthermore, this study was advertised through social media, and reapplicants who are less well connected with the social media channels the study used would not have seen the advertising. This study only interviewed unmatched applicants who were going through a new application cycle for genetic counseling graduate programs, therefore omitting the experiences of applicants who decided not to reapply. The timing at which this study took place, in the fall while new applications were being submitted and interviews had not commenced for the year, likely influenced responses of participants.

4.3. Future directions

The results of this study suggest a number of areas for future research directions. Future studies should recruit applicants with diversity in race, ethnicity, gender, and age, as applicants with various social identities are likely to have different experiences in the application process. Future research could explore how reapplicants' experiences shift depending on timing, such as during the interview process or after not matching. Longitudinal explorations of reapplicants' experiences would provide rich data on the experience as a whole. This study explored the experiences of those who decided to reapply to genetic counseling graduate programs, and future research should explore decision making about reapplying and the experiences of those who decided not to go through additional genetic counseling application cycles or decided to pursue alternative careers. Likewise, examining the viewpoints of applicants who initially entered the match but later chose to withdraw their applications would provide valuable insights. This study touched on how reapplicants felt they were perceived by others after not matching, and future research could explore such perceptions from program faculty, genetic counselors, and genetic counseling students in order to identify areas of stigmatization and ways to increase inclusion. Finally, future research should explore how genetic counseling training programs view and weigh different aspects of prospective students' applications throughout the admissions process.

4.4. Conclusions

This qualitative study focused on the experiences of individuals who were unmatched in applying to genetic counseling graduate programs and persevered to apply again. Participants described their emotional journeys and areas of growth and stagnancy that resulted from the application processes. This research underscores the resilience of reapplicants and emphasizes the imperative for ongoing support and tailored resources to alleviate emotional and logistical hurdles, ultimately contributing to a more inclusive and supportive academic environment.

AUTHOR CONTRIBUTIONS

Haley Leishman: Conceptualization; methodology; formal analysis; investigation; data curation; writing – original draft; writing – review and editing; project administration. Kathleen B. Swenson: Conceptualization; methodology; writing – review and editing; supervision; project administration. Kimberly Zayhowski: Conceptualization; methodology; formal analysis; data curation; writing – original draft; writing – review and editing; supervision; project administration.

CONFLICT OF INTEREST STATEMENT

Haley Leishman, Kathleen B. Swenson, and Kimberly Zayhowski declare that they have no conflicts of interest.

ETHICS STATEMENT

Human Studies and Informed Consent: This research study was reviewed by the Boston University Medical Campus Institutional Review Board and was granted approval as an exempt study in September 2022 (Protocol H‐42967). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Verbal informed consent was obtained from all participants prior to their inclusion in this study.

Animal Studies: No non‐human animal studies were carried out by the authors for this article.

Supporting information

Appendix S1

Appendix S2

Leishman, H. , Swenson, K. B. , & Zayhowski, K. (2024). The experiences and support needs of applicants who go unmatched to genetic counseling graduate programs: An exploratory qualitative study. Journal of Genetic Counseling, 33, 1323–1336. 10.1002/jgc4.1864

DATA AVAILABILITY STATEMENT

Research data are not shared due to the remote risk of re‐identifying a participant.