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. 2025 Aug 5;34(4):e70091. doi: 10.1002/jgc4.70091

An escape room increases interest and knowledge of the genetic counseling career among diverse students

Katherine Sleckman 1,1,✉, Katie Church 1,2, Gerald McGwin 2, Jessica Johnson Denton 1,3
PMCID: PMC12323292  PMID: 40762298

Abstract

Despite significant growth of the genetic counseling field, there is still a lack of racial and ethnic diversity among the genetic counseling workforce. Increasing diversity in the genetic counseling profession can only happen if underrepresented groups are informed about careers in genetic counseling. This cross‐sectional pre‐ and post‐survey‐based study implemented an interactive educational program utilizing an escape room to educate diverse students about the field of genetic counseling. The study assessed factors that influence career choice and pre‐ and post‐surveys to determine how interest in and knowledge of the genetic counseling field changed after learning about the profession. Of the 90 participants, 85.56% identified as Asian, Black, Hispanic, Middle Eastern, or multiple races. Participants indicated that the most important factor when selecting a career is personal satisfaction and the least important is research opportunities. Men valued prestige significantly more than women (p = 0.0091), women valued helping others significantly more than men (p = 0.015), and participants in the BIPOC (Black, Indigenous, and People of Color) group valued flexible location significantly more than White participants (p = 0.019). Undergraduates were more certain about their career path than high schoolers (p < 0.001). After the educational program, familiarity with, interest in, consideration of applying to, and knowledge of the genetic counseling profession increased significantly overall (p < 0.0001, p = 0.0001, p = 0.0004, and p < 0.0001, respectively). When analyzing changes in outcomes within each demographic group, nearly all groups showed a significant increase in each factor. However, knowledge among White participants (p = 0.065) and consideration of applying among male participants (p = 0.09) were exceptions and had no significant increase. This interactive educational program is one example of an effective method to increase knowledge and interest in the field, specifically among individuals of diverse racial and ethnic groups. Future efforts should continue to explore how and when individuals make career choices to better recruitment efforts of diverse individuals.

Keywords: career choice, diversity, escape room, familiarity, genetic counseling, interest, knowledge, underrepresented students

What is known about this topic

Previous studies have found that individuals from diverse racial and ethnic backgrounds are significantly less aware of the genetic counseling profession; however, when informed, they express interest in pursuing genetic counseling as a career path.

What this paper adds to the topic

Escape rooms are an effective way to increase interest in and knowledge of genetic counseling among students from diverse racial backgrounds. Differences in what individuals from diverse backgrounds value in a career may be important to consider when presenting career options such as genetic counseling to prospective students.

1. INTRODUCTION

Over the past 25 years, access and utilization of genetic testing has grown, resulting in an increased demand for genetic counselors. The growth in number of genetic counselors is rising to meet this demand with an estimated 6985 genetic counselors currently practicing in the United States compared to 1410 in 1999 (2024 Professional Status Survey, 2024; Haga & Boughman, 2003). However, despite the increased number of genetic counselors, there is still a lack of racial and ethnic diversity in the genetic counseling profession. Of the respondents to the 2024 National Society of Genetic Counselors (NSGC) Professional Status Survey, only 18% identified as a Person of Color, which is defined as non‐White racial and ethnic groups, and only 6% identified as men (2024 Professional Status Survey, 2024; Bias‐Free Language, 2023).

Given that 44% of individuals in the United States are People of Color (U.S. Census Bureau, 2023), a genetic counseling workforce with counselors from diverse racial and ethnic backgrounds would better serve patient populations. A systematic evaluation of research surrounding diversity in health professions concluded patients receive better interpersonal care from healthcare professionals of their same race or ethnicity (Gilliss et al., 2010; White et al., 2014). Furthermore, individuals of diverse racial and ethnic groups receiving genetic counseling have noted a lack of culturally sensitive care and difficulty building rapport (Atkin et al., 2009; Ford et al., 2007; Sussner et al., 2009). For these reasons, having a diverse genetic counseling workforce is important to foster support and connection for patients.

A diverse genetic counseling workforce would also offer better support for genetic counseling students. Genetic counseling students from underrepresented racial and ethnic backgrounds have reported a lack of understanding of racial issues from their classmates, feelings of isolation, supervisor cultural insensitivity, and culture shock due to the predominance of individuals who identify as White in the field (Carmichael et al., 2021, 2024). Prospective genetic counseling students from diverse backgrounds reported multiple barriers to applying to graduate programs, including but not limited to a lack of diversity in the workforce, financial concerns, and a lack of shadowing opportunities (Schoonveld et al., 2007). These studies indicate a need for racial and ethnic diversity within the genetic counseling profession; however, increasing diversity is only possible if prospective students from these underrepresented populations are aware of genetic counseling as a career choice.

Given the genetic counseling field's homogenous demographics, it may be assumed that individuals who identify as members of an underrepresented racial or ethnic group are not interested in the career. However, the root cause seems to be limited awareness of the profession rather than a lack of interest. Individuals who identify as White were significantly more likely to know about genetic counseling as a profession compared to individuals of underrepresented racial and ethnic groups (Alvarado‐Wing et al., 2021; Pasca et al., 2022; Wolfe Schneider et al., 2009). One study found that 88% of high school students from underrepresented racial and ethnic backgrounds had not heard of the profession, but 100% were interested upon hearing more about the field (Urli et al., 2020). After students hear about the existence of genetic counseling, they need additional exposure to genetic counseling as a career. A study of mostly non‐Hispanic White undergraduate students found that of those who had previously heard of the genetic counseling profession, 41.6% still reported being unfamiliar with the career (Gerard et al., 2018).

Students often learn about potential future careers from their teachers, and the introduction of careers in high school has increased students' likelihood to take advanced placement exams, graduate high school, and enroll in college (Visher et al., 2004). Although much of career exploration occurs in high school, studies have shown that starting this exploration in younger adolescence allows individuals to explore careers more in depth, resulting in increased certainty when they do choose their career path (Porfeli & Lee, 2012; Skorikov & Patton, 2007). Despite this research, when it comes to the genetic counseling career, educators report a lack of knowledge about the profession and have limited class time to discuss the field in depth, which creates barriers to students learning about the profession beyond a basic description (Atkin et al., 2009; Owens et al., 2009; Sveden et al., 2023).

Information about genetic counseling as a career could be provided to those with access to prospective student populations not represented in the current genetic counseling workforce; however, understanding career decision‐making is key to effective student recruitment. Previous research has shown that professionals of diverse racial and ethnic groups report valuing mentorship, personal satisfaction, helping others, job security, level of stress, and giving back to their community in their future careers (Hahn et al., 2021; Nivet, 2010; Wolfe Schneider et al., 2009). Another study comparing White and Black professionals showed White professionals value intrinsic rewards such as job accomplishments, while Black professionals value extrinsic rewards like competitive pay and other work benefits such as paid time off, insurance perks, and retirement plans (Kashefi, 2011). Career motivations also vary across gender, such as women valuing work‐life balance, altruistic relationships, and helping others, while men value salary, power, and prestige (Abele & Spurk, 2011; Di Dio et al., 1996; Eccles, 2011; Eccles & Wang, 2016; Schwartz & Rubel, 2005). Understanding what modern‐day youth value in a career and how it may differ between demographic groups can inform what aspects of the genetic counseling career are highlighted in educational materials to pique the interest of specific prospective students.

Educating young future professionals about the genetic counseling field using engaging and easily accessible learning strategies could increase knowledge of the profession. A scoping review of the learning styles and preferences of Generation Z found they value collaboration and active learning principles via innovative education models, interactive games, role playing, and group activities (Shorey et al., 2021). Altering in‐person learning experiences to be more engaging than traditional didactic lectures is one approach that could be successful for prospective students to learn about genetic counseling. One way to do this is utilizing escape rooms, a type of serious gaming where participants are given sequential puzzles to solve in a time‐limited situation (Healy, 2019). Gamification, a technique that integrates gaming elements into nongame contexts, has been used in the past, but serious gaming takes it a step further to make the activity itself captivating rather than relying on motivators such as prizes to incentivize participation (Cheng & Ebrahimi, 2023). Serious gaming has been shown to decrease stress, improve knowledge retention, and increase engagement (Popil & Dillard‐Thompson, 2015). Studies using escape rooms to educate students in health professional degree programs have found that students feel more knowledgeable, score higher on examinations, and enjoy learning more with escape rooms compared to traditional didactic learning (Hu et al., 2024; Molina‐Torres et al., 2022; Reiser, 2023). However, escape rooms have not been well tested for educating prospective pre‐health or pre‐genetic counseling students.

The purpose of this study was to create and implement an interactive educational program including an escape room to introduce a group of high school and undergraduate students from diverse racial and ethnic backgrounds to the field of genetic counseling. The study assessed factors that influence career choice and how interest in and knowledge of the genetic counseling career among these groups of prospective students changed after learning about the profession.

2. METHODS

This cross‐sectional survey‐based study was conducted at the University of Alabama at Birmingham (UAB). Approval was obtained from the Institutional Review Board at UAB (IRB‐300012376).

2.1. Participants

This study was conducted as part of the programming for the Center for Community Development and Outreach Summer Science Institute (CORD‐SSI) and the Summer Health Professions Education Program (SHPEP) at UAB. These summer programs are designed to recruit students from underrepresented and socioeconomically disadvantaged backgrounds to help decrease racial and gender disparity in science, math, and engineering. Participants included two groups of high school students from the CORD‐SSI and two groups of undergraduate students from the SHPEP. All students were required to participate in the escape room activity, but the pre‐ and post‐surveys associated with the study were voluntary. Each participant was given a pre‐survey before the activity with a description of the research component of the activity. This description was also read aloud. Following the educational program, each participant was given a post‐survey. Students were instructed to leave the surveys blank if they did not want to participate in the research component.

2.2. Educational program

One of the study authors attended a workshop session at the NSGC annual conference titled “Escape the PowerPoint: Immersive Experiences to Engage Gen Z Learners”. This session focused on the use of escape rooms in genetic counseling education which inspired the authors to brainstorm a way to incorporate this into their educational practices. Ultimately, the authors decided to create an escape room targeted to prospective students as multiple authors have various opportunities to educate prospective students throughout the year in their role as university faculty members and had noted lack of engagement of some of these preprofessional audiences during previous presentations. A single 90‐min educational presentation, including the escape room activities, was designed to educate both high school and undergraduate students about the genetic counseling profession. The presentation began by discussing what genetic counseling is and where genetic counselors work for approximately 5 min using a PowerPoint. Students then engaged in three 15‐min escape room activities about prenatal, cancer, and pediatric genetic counseling. After each escape room there was approximately 10 min to debrief about that case and its psychosocial implications. Upon completion of the escape rooms, how to become a genetic counselor was discussed for approximately 10 min.

The educational program, including the presentation and escape rooms, was designed, created, and led by the study authors and funded by the UAB Genetic Counseling Training Program (Appendix S1). The escape rooms aimed to provide participants with a typical case scenario highlighting genetic counseling skills/roles in each main clinical specialty that would not require any prior genetics knowledge from participants. Study authors brainstormed common indications seen in each specialty and puzzles that could be incorporated in a stepwise fashion to simulate the typical progression of a case from pre‐ to post‐test to create the final escape rooms.

2.3. Surveys

The surveys (Appendix S2) were adapted from surveys used by Gerard et al. (2018) and Maio et al. (2013) with permission from the first and last authors, respectively. Items from the aforementioned surveys were reviewed and adjusted to fit the goals of the current study. The pre‐survey consisted of 16 questions for high school students and 17 questions for college students and collected information on demographics, factors valued in a career, and future career aspirations. The post‐survey included nine questions for both groups of students, including questions about participant satisfaction with the educational activity. Both surveys assessed interest in and knowledge of the genetic counseling profession and had two additional questions used to create a unique code to link the pre‐ and post‐survey responses for each participant.

Knowledge of the genetic counseling profession was measured using 12 true/false statements about job responsibilities of a genetic counselor. Participants were instructed to select “I don't know” if they were unsure rather than guessing. Interest in the profession was measured by a question that asked if they would apply to a graduate training program and a Likert scale question about interest in exploring genetic counseling as a career choice. Additional questions were asked regarding familiarity with the genetic counseling career. Career aspiration questions included what resources participants use to learn about a career and what they value when choosing a future career path.

Data collection occurred on July 10, 11, and 15, 2024. All surveys were distributed on paper. Responses were entered into REDCap (Research Electronic Data Capture), an electronic data capture tool hosted at The University of Alabama at Birmingham, by the primary investigator (KS) for analysis (Harris et al., 2009, 2019).

2.4. Data analysis

Demographic groups with less than five participants were either combined with another group or excluded from statistical analysis. For race and ethnicity, two comparison groups were created: Black or African American, American Indian, Alaska Native, Latine or Hispanic, and Middle Eastern combined into one “Black, Indigenous, and People of Color (BIPOC)” group and a second group of participants who identified as only White. Some individuals reported multiple races or ethnicities. If both White and another race or ethnicity was reported, they were included in the BIPOC group and not the White group. Familiarity with the genetic counseling profession was combined into two groups, “familiar” as either very familiar or somewhat familiar and “unfamiliar” as either never heard of genetic counseling or have heard of genetic counseling but not familiar. For interest in the genetic counseling profession, somewhat and very interested were combined into an “interested” group and neither interested or uninterested, somewhat and very uninterested, and have not heard of genetic counseling were combined into a “not interested” group. For the questions asking if participants would consider applying to genetic counseling school, no and unsure were combined into a “no” group.

Paired t‐tests were used to compare knowledge test scores before and after the educational program. Unpaired t‐tests were used to compare career choice factors between demographic groups. McNemar‐Bowker tests were performed to compare differences in career aspirations and differences in both interest in and familiarity with the genetic counseling profession before and after the educational program. Chi‐square tests were used to compare familiarity with and interest in the genetic counseling profession between demographic groups. Statistical analyses were conducted with SAS version 9.4 and Excel. A p‐value of < 0.05 (two sided) was considered statistically significant.

3. RESULTS

3.1. Participant characteristics

A summary of participant demographics can be found in Table 1. Ninety responses to the pre‐survey and 78 responses to the post‐survey were received. Most participants identified as BIPOC (86%, n = 77) and women (71%, n = 64) with an average age of 18 years (range 15–25 years). Sixty percent (n = 54) of participants were undergraduates and 40% (n = 36) were high school students.

TABLE 1.

Participant characteristics (N = 90).

n %
Race and ethnicity
Black or African American 42 46.67
Asian 24 26.67
White 13 14.44
Hispanic or Latine 5 5.56
More than one race or ethnicity a 5 5.56
Middle Eastern 1 1.11
Gender identity
Woman 64 71.11
Man 24 26.67
Nonbinary 1 1.11
Prefer not to answer 1 1.11
Rising school grade
High school junior 30 33.33
High school senior 6 6.67
College sophomore 27 30.00
College junior 27 30.00
Parental education
None went to college 10 11.11
One went to college 12 13.33
Both went to college 67 74.44
Prefer not to answer 1 1.11
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a

Two participants identified as Black or African American and White, one participant identified as American Indian or Alaska Native, Black or African American, and Hispanic or Latine, one participant identified as Asian and White, and one participant identified as Black or African American, Hispanic or Latine, and White.

3.2. Exploring careers

On average, participants indicated that the most important factor when selecting a career is personal satisfaction and the least important is research opportunities (Figure 1a). Upon comparison of each career choice factor across genders, the only significant differences in rankings were for helping others (women ranked higher than men [p = 0.015]) and prestige (men ranked higher than women [p = 0.0091]) (Figure 1b). When comparing career choice factors by race/ethnicity, personal satisfaction was the highest ranked factor for both racial/ethnic groups. White participants had the amount of postgraduate education ranked lowest, while participants in the BIPOC group had research opportunities ranked lowest. When comparing each career choice factor across race and ethnicity groups, the only significant difference in ranking was for flexible location (participants in the BIPOC group ranked higher than White participants [p = 0.019]) (Figure 1c). After the educational program, there were no significant differences identified when comparing each career choice factor between participants who were interested in the genetic counseling profession and those who were not interested.

FIGURE 1.

FIGURE 1

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Average ranking of factors that influenced participants' choices in a future career path (a) overall, (b) by gender, and (c) by race and ethnicity. For ranking, 1 indicates least important and 11 indicates most important. * indicates p < 0.05, ** indicates p < 0.01.

Participants' interest in a healthcare‐related career path did not change significantly overall, with 86% (n = 77) of participants interested before and 82% (n = 64) of participants being interested after (p = 0.1718). No significant difference was observed in certainty about career paths before (90% of participants certain, n = 79) and after (87% of participants certain, n = 68) the educational program (p = 0.9952). Undergraduate students came into the educational program significantly more certain about their career path than high school students (p < 0.001). Participants reported that the three most useful resources when exploring careers are shadowing people in the field (84%, n = 76), having a part‐time job in the field (69%, n = 62), and social media (36%, n = 32).

3.3. Familiarity with and interest in the genetic counseling profession

When asked specifically about familiarity with the genetic counseling profession, 25% (n = 22) of individuals had never heard of the profession before the educational program, 43% (n = 38) had heard of genetic counseling but were not familiar, 31% (n = 27) were somewhat familiar, and 1% (n = 1) of individuals were very familiar. Of the individuals who had heard about the genetic counseling profession in some way (n = 66), most of them heard about it from a high school class (26%, n = 17), an extracurricular activity (20%, n = 13), or online (14%, n = 9). Of the 66 participants who had heard about the career of genetic counseling, 86% (n = 57) had not done research about the profession outside of their initial introduction to the career. High school students were significantly more familiar with the genetic counseling profession before the educational program than undergraduate students (p = 0.001).

After the educational program, 96% (n = 75) of participants were familiar with the profession, which was significantly higher than the 32% (n = 28) of participants who were somewhat familiar or very familiar before (p < 0.0001). The proportion of participants that reported they were interested in genetic counseling as a career choice increased significantly from 17% (n = 15) before the educational program to 42% (n = 32) after (p = 0.0001). The number of participants that reported they would consider applying to genetic counseling school also increased significantly from 3% (n = 3) before to 19% (n = 15) after the educational program (p = 0.0004). Interest, familiarity, and consideration of applying to a GC program were analyzed within each demographic group (Table S1). Interest increased significantly for men (p = 0.0005), women (p = 0.015), White participants (p = 0.013), and participants in the BIPOC group (p = 0.004). Familiarity increased significantly for men (p < 0.0001), women (p < 0.0001), White participants (p = 0.002), and participants in the BIPOC group (p < 0.0001). Consideration of applying increased significantly for women (p = 0.004), White participants (p = 0.02), and participants in the BIPOC group (p = 0.005).

We investigated if familiarity with and interest in the genetic counseling profession varied among participants based on demographic factors before and after the intervention. On average, familiarity with and interest in the genetic counseling career increased for all participants. No significant differences in familiarity with and interest in the genetic counseling profession were identified when comparing men to women before or after the educational program (Figure 2a,c,e). Likewise, no significant differences in familiarity with and interest in the genetic counseling profession were identified when comparing participants in the BIPOC group to White participants before or after the educational program (Figure 2b,d,f).

FIGURE 2.

FIGURE 2

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No significant differences in familiarity or interest were identified between gender groups (a, c, and e) or race/ethnicity groups (b, d, and f) before and after the educational program. p‐values are as follows: (a) before, p = 0.68 and after, p = 0.51; (b) before, p = 0.23 and after, p = 0.43; (c) before, p = 0.17 and after, p = 0.076; (d) before, p = 0.079 and after, p = 0.26; (e) before, p = 0.12 and after, p = 0.31; (f) before, p = 0.47 and after, p = 0.70.

3.4. Knowledge of the genetic counseling profession

The average knowledge score before the educational program was 55.68%. Participants who had heard of the field of genetic counseling previously had an average knowledge score higher than 50% regardless of the source of previous exposure. Conversely, participants who had never heard of genetic counseling had an average knowledge score of 30% before the educational program. Participants who were interested in the genetic counseling profession scored significantly higher on the pre‐survey knowledge test than participants who were not interested in the profession before the educational program (Figure 3, p = 0.049). The average knowledge score after the educational program was 73.9%, which was a significant increase (p < 0.0001) from before the educational program. The percent of participants who answered each question correctly on the knowledge test before and after the educational program is reported in Table S2. When analyzing within group changes in knowledge, there was a significant increase in average knowledge score after the educational program among men (p = 0.0007), women (p = 0.0006), and participants in the BIPOC group (p < 0.0001) (Table S1). After the educational program, there was no significant difference in knowledge test scores between participants who were interested in the genetic counseling career and those who were not (Figure 3, p = 0.45).

FIGURE 3.

FIGURE 3

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Average knowledge score before and after the educational program between participants interested in the genetic counseling profession and not interested in the genetic counseling profession. * indicates p = 0.049.

No significant difference in knowledge was observed between men and women before (p = 0.21) or after (p = 0.41) the educational program (Figure 4a). Similarly, there was no significant difference in knowledge between individuals in the BIPOC group compared to their White counterparts before (p = 0.26) or after (p = 0.17) the educational program (Figure 4b).

FIGURE 4.

FIGURE 4

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Knowledge of the genetic counseling profession before and after the educational program by (a) gender and (b) race/ethnicity.

3.5. Educational program feedback

Participants were asked to evaluate the educational program with Likert scale questions. The average score across all feedback measures was 4.45 (1 = very dissatisfied/strongly disagree, 5 = very satisfied/strongly agree). Free response feedback was overall positive, including emphasis on the escape room being enjoyable, engaging, and educational. Some constructive feedback included making the escape rooms more challenging and the didactic presentation portion of the educational program more engaging and detailed.

4. DISCUSSION

The purpose of this study was to learn more about what diverse students value in a career and to investigate their familiarity, interest in, and knowledge of the genetic counseling profession before and after an interactive educational program describing the field. In general, the educational program increased familiarity, interest in, and knowledge of genetic counseling in the study population.

4.1. Career values and resource preferences among participants

When searching for a career, there are many aspects individuals consider to determine the best fit for a future profession. The current study identified personal satisfaction as the most important and research opportunities as the least important factor of a future career for participants. The degree to which participants valued each career quality factor was not significantly different between participants interested in pursuing the genetic counseling profession and those who were not interested; however, none of the quality factors were specific to genetic counseling. The most and least important factors did not change when compared by gender. However, men valued prestige whereas women valued helping others, which is consistent with previous studies evaluating differences in career choice factors between men and women (Abele & Spurk, 2011; Di Dio et al., 1996; Eccles, 2011; Eccles & Wang, 2016). White participants and participants in the BIPOC group reported the most important factor of a future career was personal satisfaction. Participants in the BIPOC group valued a flexible location significantly more than White participants. In previous studies, factors such as mentorship, personal satisfaction, extrinsic rewards, and helping others, have been rated as being important in making a career choice while geographic location was rated as not important by racial/ethnic minorities (Hahn et al., 2021; Kashefi, 2011; Nivet, 2010; Wolfe Schneider et al., 2009). Personal satisfaction and helping others were measured in the current study and may not have been identified as significantly different between racial/ethnic groups due to small sample size or White participants equally valuing these factors. Although there is an underrepresentation of men and racial/ethnic minorities in the genetic counseling workforce, the career emulates many qualities that these individuals value, including mentorship, helping others, personal satisfaction, and flexible location (2024 Professional Status Survey, 2024; Finley et al., 2016; McCuaig et al., 2023; Zierhut et al., 2018). Presentations about genetic counseling as a career should consider highlighting these reported factors to better pique an interest in the profession for individuals from these underrepresented groups.

While it is important to consider the content used to educate prospective students about future careers, it is equally important to consider the timing of such education. Over 80% of the participants in this study were interested in a healthcare career, which is not surprising given their attendance at a healthcare‐focused summer camp. However, 90% of participants were certain about their career path before the educational program, and undergraduate students were significantly more certain than high school students. This timeline emphasizes the importance of career exploration programs during high school that was highlighted in a previous study (Visher et al., 2004). Furthermore, since high school participants in the current study reported high certainty of future career paths, this points to the potential importance of introducing students to the genetic counseling profession prior to high school, which has been emphasized by previous research on the timing of career development efforts (Porfeli & Lee, 2012; Skorikov & Patton, 2007). However, it could be assumed that middle school teachers and counselors may not be equipped with the necessary information regarding genetic counseling as a career choice, given that high school educators report such a lack of knowledge (Atkin et al., 2009; Owens et al., 2009; Sveden et al., 2023). The current dearth of knowledge of the genetic counseling profession in educators and prospective students found in previous studies highlights the importance of educational materials and/or tools developed to engage such young audiences from a variety of backgrounds to fill this knowledge gap (Alvarado‐Wing et al., 2021; Pasca et al., 2022; Urli et al., 2020; Wolfe Schneider et al., 2009).

4.2. Familiarization with and interest in the genetic counseling profession

One of the first steps to broadening representation in a profession is ensuring individuals are aware of what the profession entails. In our study, of individuals who were familiar with the genetic counseling profession prior to our educational program, most were exposed to the field through a high school class and/or an extracurricular activity. This is consistent with previous research on undergraduate awareness of the genetic counseling profession, where 75% of individuals had heard of genetic counseling, and the majority of the exposures were in high school (Gerard et al., 2018). However, in both this study and a previous study (Gerard et al., 2018) of participants who were previously aware of the genetic counseling profession, most had never explored the career further. Data was not collected as to why additional information was not sought by participants, but participants in this study and in previous research (Gerard et al., 2018) preferred to learn about future careers through shadowing and part‐time employment. Shadowing and preprofessional jobs are difficult to obtain in genetic counseling due to the increase in non‐patient‐facing roles, the limited number of genetics clinics, and the lack of accessibility due to geographic limitations and the need to take time off work (Agre et al., 2021; Gerard et al., 2018; Muncan et al., 2016; Zahavich & Babul‐Hirji, 2023). Additionally, participants in our study indicated social media was another preferred way to learn about a career. Although social media utilization has been evaluated for patient outreach, more research is needed on its use for prospective student recruitment (Gallagher et al., 2016; Moore et al., 2018).

This study expands on previous findings that show students from underrepresented groups are interested in the genetic counseling profession if they are exposed to the profession (Urli et al., 2020). Our study found that familiarity with genetic counseling increased overall after the educational program and within each demographic group. Although White participants were more familiar than those in the BIPOC group, these differences between groups were not statistically significant at any point. Interest in the genetic counseling profession increased overall and within each demographic group. Men were the only demographic group that did not have a significant increase in consideration of applying to genetic counseling school. These findings are consistent with previous research that showed increased interest in the genetic counseling profession among women and those with Asian and Hispanic ethnicity after learning about the profession (Gerard et al., 2018).

Although the majority of genetic counselors are currently White women, individuals of other demographic groups are interested in the field once they become familiar with it. Our findings may be a product of the sample population already being interested in healthcare careers; however, they also point to previous research that education about the genetic counseling profession increases interest in populations not represented in the current genetic counseling workforce (Alvarado‐Wing et al., 2021; Urli et al., 2020; Wolfe Schneider et al., 2009). Although interest is increased with awareness of the profession, education about genetic counseling is not commonplace in high school curriculum. High school teachers report both limited knowledge of the genetic counseling profession and a lack of available class time for presentation (Owens et al., 2009; Sveden et al., 2023). Despite previous research citing a lack of education about the genetic counseling profession in high school, this study found that before the educational program, high school students were significantly more familiar with the genetic counseling profession than undergraduate students. This may be due to the fact that some of the high school participants had previously attended a summer camp that included education about the career of genetic counseling. With proper education of the profession, individuals who are not currently well represented in the genetic counseling profession express interest, which demonstrates a benefit of early high school education of the genetic counseling profession for prospective students.

4.3. Knowledge of the genetic counseling profession

Our study demonstrates that reported awareness of the profession correlates with a higher knowledge of that profession. The individuals who had prior exposure to and interest in the genetic counseling profession had higher average knowledge scores before the educational program. There was a significant increase in average knowledge score after the educational program, with no differences in knowledge based on interest. All demographic groups except White participants showed a significant increase in knowledge after the educational intervention, which may be attributed to the awareness of the profession typically being greater in that demographic group. Knowledge scores did not differ by gender or race/ethnicity before or after the educational program. Like previous studies, these results indicate that being aware of the profession, regardless of where this information came from, can increase knowledge of the genetic counseling profession in individuals from diverse racial and ethnic backgrounds (Alvarado‐Wing et al., 2021; Pasca et al., 2022; Urli et al., 2020; Wolfe Schneider et al., 2009). Aside from educating the participants about the genetic counseling profession, participants in the current study reported overwhelmingly positive feedback about the escape room. Based on previous research of individuals in the same generation as the current study participants, this positive response is not surprising, as Generation Z values learning through innovative education models, interactive games, role playing, and group activities (Shorey et al., 2021). As expected, the interactive nature of the escape room added a level of interaction, which increased engagement and also improved short‐term knowledge retention in our study, as similar educational approaches have been shown to do in previous studies (Popil & Dillard‐Thompson, 2015). Our study adds to the literature demonstrating that science‐focused escape rooms, including ones used to educate genetic counseling students, not only promote knowledge acquisition but also engage participants (Cheng & Ebrahimi, 2023; Healy, 2019; Hu et al., 2024; Molina‐Torres et al., 2022; Reiser, 2023).

Increasing knowledge of the genetic counseling career in young students is clearly important, and partnerships with educators who work with students every day would be beneficial to reach this population. Escape rooms designed by genetic counselors and distributed to educators could help address the previously mentioned educator‐reported barriers to integrating lessons about the genetic counseling field (Owens et al., 2009; Sveden et al., 2023). Such escape rooms could both increase educator and student knowledge of the profession if educators could be provided with instructions on implementing these escape room activities in their own classrooms.

4.4. Strengths and limitations

To our knowledge, this is the first study using an educational program that incorporates an escape room to educate individuals about the genetic counseling profession and measure changes in interest in and knowledge of the profession. This type of interactive education is growing in popularity and is beneficial when trying to captivate an audience's attention. Furthermore, this study is the first of its kind to have the majority of participants identify as members of an underrepresented group. The sample population included a variety of ethnic and racial backgrounds and genders, which was imperative for our study and contributions to the literature on this topic. The study population also included both high school and undergraduate students.

Study limitations should be considered when interpreting the results. Participants were recruited from two summer camps for students interested in healthcare‐related fields; therefore, participants were biased to being interested in healthcare careers. The sample size was also small, so some comparison statistics were not possible when the test involved categorizing participants into multiple groups. Moreover, a small sample size limits generalizability to the larger population. A comparison group using a traditional didactic lecture would have been beneficial to confirm that the interactive educational model was preferred by participants and if it increased interest and knowledge in the genetic counseling profession more than traditional lecture methods. Lastly, the survey used to measure interest and knowledge regarding the genetic counseling profession was not validated, though it was adapted from previous research that investigated interest in the genetic counseling profession among undergraduate students.

4.5. Research recommendations

The current study includes many preliminary findings that would benefit from future studies. Implementing this escape room activity in larger populations of students, including those who do not have healthcare‐related careers in mind, would be beneficial. A larger population would allow for more comparison groups in the data analysis, including being able to compare between individual racial and ethnic groups rather than having to condense the participants into more generalized groups. Although this study included participants from diverse racial and ethnic backgrounds, in the future, expanding this study into diverse religious, gender, and socioeconomic groups would provide more data and information on how to further diversify the demographics of the genetic counseling workforce. If this study expands to additional populations, a survey that is validated to measure interest in and knowledge of the field would be essential for future studies in this area. This validated survey should use a developmental psychology framework and include questions focused on exploration of career choice to further evaluate how students are choosing careers and how this impacts the genetic counseling workforce. It should also include a more in‐depth investigation of other factors that impact interest and engagement in the genetic counseling profession outside of an interactive educational program. Further research could expand the use of an escape room to inform more than just prospective students about the genetic counseling profession, including other healthcare providers, teachers, and high school counselors. Future efforts to educate individuals about the genetic counseling career could utilize social media accounts, an online version of the escape room, and simulated shadowing experiences for students to further explore the career through their preferred methods. Genetic counselors could ensure these educational tools are accurate, engaging, and cover aspects of the genetic counseling career that individuals who are currently underrepresented in the genetic counseling workforce value. Findings from this study regarding how individuals learn about careers and what they value in a career could be used by genetic counseling programs and professional societies to further explore genetic counseling recruitment strategies.

5. CONCLUSIONS

The genetic counseling profession lacks gender and racial/ethnic diversity, which can impact patient care and affect interest in the profession among students who also identify as a member of an underrepresented population. The current study found an escape room to be a successful way to educate a group of high school and undergraduate students from diverse racial and ethnic backgrounds about the genetic counseling profession. Various studies, including the current study, demonstrated that when educated about the genetic counseling profession, individuals from underrepresented backgrounds are interested in the profession.

AUTHOR CONTRIBUTIONS

Katherine Sleckman: conceptualization; methodology; data acquisition; data curation; formal analysis; investigation; project administration; visualization; writing – original draft; writing – editing. Katie Church: conceptualization; methodology; data acquisition; formal analysis; investigation; project administration; supervision; visualization; writing – review and editing. Gerald McGwin: data curation; data analysis. Jessica Johnson Denton: conceptualization; methodology; formal analysis; investigation; supervision; project administration; visualization; writing – review and editing. All authors provided final approval for the version to be published and agree to be accountable for all aspects of the work.

FUNDING INFORMATION

Funding for this study was provided by the UAB Genetic Counseling Training Program.

CONFLICT OF INTEREST STATEMENT

The authors declare they have no conflicts of interest.

ETHICS STATEMENT

Human studies and informed consent: All study materials were approved by the University of Alabama at Birmingham IRB review. The study conforms to the Declaration of Helsinki and the US Federal Policy for the Protection of Human Subjects.

Animal studies: No animal studies were carried out by the authors for this article.

Supporting information

Data S1:

JGC4-34-0-s001.docx (33.4KB, docx)

ACKNOWLEDGMENTS

The authors would like to thank Carmel McNicholas‐Bevensee, PhD, Program Director of the UAB Summer Health Professions Education Program (SHPEP) funded by the Robert Wood Johnson Foundation, and Kevin Jarrett, MS, Program Manager at The Center for Community Outreach and Development (CORD), for allowing access to their summer camp attendees to participate in this study. This research was performed with the support of the Genetic Counseling Program at the University of Alabama at Birmingham as partial fulfillment of the first author's M.S. degree requirement. Thank you to Ashley Cannon, PhD, MS, UAB Research Project Coordinator, for her continued support throughout this research project and manuscript writing process. This work has been supported financially by the Genetic Counseling Program at the University of Alabama at Birmingham School of Health Professions.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Data S1:

JGC4-34-0-s001.docx (33.4KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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