ASHG/NSGC ACTIVITIES RELATED TO EDUCATION The Doctoral Degree in Genetic Counseling: Attitudes of

Transcription

1 Am. J. Hum. Genet. 49: , 1991 ASHG/NSGC ACTIVITIES RELATED TO EDUCATION The Doctoral Degree in Genetic Counseling: Attitudes of Genetic Counselors Katherine M. Gaupman,' Janice G. Edwards, Karen Albiez Brooks, and S. Robert Young HUMAN -MGENETICS HEDUCATION Department of Obstetrics and Gynecology, University of South Carolina, Columbia Summary All 565 full members of the National Society of Genetic Counselors were surveyed in September 1989 to assess their attitudes toward a potential doctoral degree in genetic counseling. The usable return rate was 59.6% (337/565) of the full membership. One hundred eighty (54.4%) respondents indicated a need for a doctoral degree in genetic counseling, 101 (30.5%) were undecided as to the need, and 50 (15.1%) did not see a need for such a degree. One hundred forty-seven (44.3%) respondents indicated their individual interest in pursuing a doctorate in genetic counseling, 109 (32.8%) would not pursue such a degree, and 76 (22.9%) were undecided. Beyond the generally accepted feeling that genetic counseling should expand as a professional field, the reasons cited most often for seeking the Ph.D. in genetic counseling were professional recognition, a desire to specialize in a particular area, and greater depth of knowledge. The study revealed a strongly positive attitude, among full members of the NSGC, toward establishment of a doctoral degree in genetic counseling. Introduction In the 1960s, Dr. Melissa Richter envisioned that a new health-care professional trained at the master'sdegree level in human genetics and genetic counseling could enhance the efficiency and availability of genetic services (Rollnick 1984). The first master's program in genetic counseling was established at Sarah Lawrence College in 1969 (Marks and Richter 1976; Rollnick 1984; Mertens et al. 1986). Currently, there are 18 training programs throughout the United States and Received July 31, 1990; final revision received December 10, Address for correspondence: Janice G. Edwards, M. S., Department of Obstetrics and Gynecology, Two Medical Park, Suite 301, Columbia, SC Present address: Medical Genetics Section, Saint Christopher's Hospital for Children, Philadelphia by The American Society of Human Genetics. All rights reserved /91 / $ Canada and there are over 700 practicing genetic counselors (Marks 1989; Edwards 1990; Walker et al. 1990). Establishment of this new profession has been highlighted by the incorporation of the National Society of Genetic Counselors (NSGC) in 1979 and by the establishment of a professional certification procedure by the American Board of Medical Genetics (ABMG) in 1980 (Heimler 1979; Smith and Heimler 1979; Mertens et al. 1986). The field of genetic counseling has not as yet established a doctoral degree. It was recently proposed (Kloza 1988) that the feasibility of having a Ph.D. degree in genetic counseling be investigated. In addition, one of the major topics addressed at the 1989 Asilomar conference appraising the education of genetic counselors was the potential for post-master's education in genetic counseling (Biesecker 1990; Walker et al. 1990). The purpose of the present study was to assess genetic counselors' attitudes toward a potential doctoral degree in genetic counseling.

2 Human Genetics Education Section Material and Methods The survey was mailed to all 565 full members of the NSGC in September 1989, and completed surveys were collected for 6 wk. Individuals with either an M.A./M.S. in genetic counseling, a nursing degree (R.N. or M.S.N.), or a social work degree (M.S.W.) were included in the study. Individuals with multiple degrees were included if one of their degrees was related to genetic counseling. Those with a Ph.D. were excluded from the study. Information collected from each survey included demographic data, educational and professional background, professional activities, and attitudes toward establishing a doctoral degree in genetic counseling. All statistical analyses were performed using the SAS (Cary, NC) computer-analysis package. Results Demographic and Professional Background Three hundred fifty-three (62.5%) of the surveys were returned and 16 were excluded. The respondents represent 59.6% of the full 1989 membership of the NSGC. Table 1 indicates the demographic charac- 489 teristics of the study population. The majority of (91.7%) of respondents held a master's degree in genetic counseling, were ABMG certified (69.1%), and were currently practicing as genetic counselors (92.9%) (table 2). Of the respondents, 42.6% (143/ 336) had given presentations at national meetings, 68.7% (230/335) had published in the professional literature, 25.6% (86/336) held faculty appointments, 87.8% (294/335) had teaching responsibilities, and 40.0% (154/335) engaged in research. Attitudes toward a Doctoral Degree Fifty-four percent of respondents indicated that they perceived a need for a doctoral degree in genetic counseling, 15.1% did not, and the remaining 30.5% were undecided (table 3). Forty-four percent said that they would be interested in pursuing this degree; 32.8% said that they would not. Reasons cited as most important for having such a degree available were greater professional recognition (43.7%), the ability to specialize in a particular area (21.4%), greater depth of knowledge (17.8%), and improved compensation (10.0%). Reasons that respondents would not seek such a degree included the inability to relocate to a program (35.1%), lack of perception of need for the Table I Demographic Characteristics of Respondents Sex: Female... M ale... Age (years): Over Race: Caucasian... Asian... Hispanic... Black... Other... Geographic location by NSGC region: Region I (CT, MA, ME, NH, RI, VT)... Region II (DC, DE, MD, NJ, NY, PA, VA, WV)... Region III (AL, FL, GA, KY, MS, NC, SC, TN)... Region IV (IA, IL, IN, KS, MI, MN, MO, NE, OH, WI)... Region V (AR, CO, LA, MT, ND, NM, OK, SD, TX, UT, WY)... Region VI (AK, AZ, CA, HI, ID, NV, OR, WA)... Canada (94.7) 18 (5.3) 11 (3.3) 119 (35.3) 90 (26.7) 52 (15.4) 65 (19.3) 323 (96.4) 5 (1.5) 5 (1.5) 1 (.3) 1 (.3) 38 (11.3) 104 (31.0) 34 (10.1) 48 (14.3) 26 (7.7) 84 (25.0) 2 (.6)

3 Table 2 Professional Background of Respondents Highest degree held: Master of arts or science... Master of social work... Nursing (R.N. or M.N.S.)... Multiple degrees... ABMG certification: Certified... Noncertified... Length of employment (years): Current genetic counseling status: Currently practicing.... Not currently practicing... Human Genetics Education Section 309 (91.7) 6 (1.8) 14 (4.2) 8 (2.4) 233 (69.1) 104 (30.9) 95 (28.3) 114 (33.9) 85 (25.3) 29 (8.6) 13 (3.9) 312 (92.9) 24 (7.1) degree (25.6%), satisfaction with current position (13.6%), financial concerns (8.8%), and family responsibilities (6.2%) (table 3). Many respondents provided written comments supporting an advanced degree. The doctorate in genetic counseling was considered a natural progression within the field, which would provide increased professional recognition within the academic community and would further legitimize the profession as a distinct discipline. Other comments suggested examining Table 3 Attitudes toward a Doctoral Degree See need for doctoral program: No... Undecided... Personally interested in pursuing doctorate: Yes... No... Undecided... Major reason for seeking degree: Professional recognition.... Specialization in one area... Greater depth of knowledge... Monetary compensation.... Other... Major reason for not seeking degree: Relocation concerns.... Do not see need... Satisfied with position... Financial concerns... Family responsibilities... Other (54.4) 50 (15.1) 101 (30.5) 147 (44.3) 109 (32.8) 76 (22.9) 135 (43.7) 66 (21.4) 55 (17.8) 31 (10.0) 22 (7.1) 108 (35.1) 79 (25.6) 42 (13.6) 27 (8.8) 19 (6.2) 33 (10.7)

4 Human Genetics Education Section the experience of other health professions, such as nursing and social work, which have developed multiple degree options. Negative comments tended to focus on the possibility that the status of the master's-trained genetic counselor would be devalued. Other comments mentioned the abundance of doctoral programs in related disciplines, which reduced the necessity of this degree. Some comments reflected concern that higher salary expectations among Ph.D. genetic counselors would affect master's-level salaries. Characteristics of a Doctoral Program Table 4 presents respondents' feelings about attributes of potential candidates for the doctoral degree in genetic counseling, and table 5 lists possible characteristics of such a degree program. Seventy-three percent felt that candidates should be master's-trained genetic counselors, 58.8% believed that candidates should be ABMG certified, and 82.5% felt that, prior to pursuing the degree, candidates should already have practiced some years in the field (table 4). Forty-two percent of respondents felt that the institution providing such a program should offer the Ph.D. in medical genetics, and 41. 1% said that it should offer the M.S. in genetic counseling (table 5). Forty-two percent felt that the advanced training should concentrate on genetic counseling versus other areas such as education (18.0%) or administration (13.7%). Most respondents (82.1%) felt that the length of study should be 2-3 years. The majority (68.0%) suggested that requirements include a dissertation and a comprehensive 4, 491 examination (67.7%), whereas a language requirement was not seen as clearly needed (table 5). Discussion The study population represents the full membership of the NSGC, as evidenced by similarity in demographic, educational, and professional characteristics of respondents to the fourth Professional Status Survey of the NSGC (Edwards 1990). The results of the current study indicate a strongly supportive attitude among full members of the NSGC toward establishing a doctoral degree. There is also a sizable pool of potential candidates, as evidenced by individual interest in pursuing the degree. Many respondents may have been considering the issue for the first time, and others may have been unaware of typical requirements in Ph.D. programs, if one can judge by the number of respondents who were "undecided" on questions regarding the need for and nature of a doctoral program. The high survey-return rate and numerous written comments would suggest that individuals who participated in the study felt strongly about a potential doctoral degree in genetic counseling. The recent Asilomar meeting on education in genetic counseling identified potential advantages and disadvantages of the doctorally prepared genetic counselor (Walker et al. (1990). The advantages included (1) greater opportunity in academic settings, leading to increased opportunity for teaching and grant funding for research projects, (2) development of research skills to build upon what is seen by many as a paucity of genetic counseling literature and (3) the potential Table 4 Potential Doctoral Candidates N(%) Should candidate be master's-level genetic counselor: Yes (73.3) No (9.6) Undecided (17.1) Should candidate be ABMG certified Yes (58.8) No (17.0) Undecided (24.2) Should candidate have experience in field No experience (17.5) 1-2 Years (39.0) 3-5 Years (38.7) Over 5 years (4.8)

5 492 Wjj Table 5 Characteristics of Doctoral Program University Setting: Ph.D. in medical genetics... Master's in genetic counseling... Ph.D. in biology... Ph.D. in social work... Ph.D. in education.... Other... Area of specialization: Genetic counseling... Education... A specialized area... Administration... Research... Other... Length of study (years): Over 5... Dissertation requirement: No... Undecided... Comprehensive examination: No... Undecided... Language requirement: No... Undecided... Human Genetics Education Section 128 (42.8) 123 (41.1) 6 (2.0) 6 (2.0) 3 (1.0) 33 (11.0) 123 (40.2) 55 (18.0) 42 (13.7) 41 (13.4) 30 (9.8) 15 (4.9) 256 (82.1) 54 (17.3) 2 (.6) 225 (68.0) 28 (8.5) 78 (23.6) 224 (67.7) 40 (12.1) 68 (20.2) 99 (30.0) 155 (47.0) 76 (23.0) for personal satisfaction and professional recognition. Disadvantages cited included (1) devaluing the master's-level genetic counselor, 2) replacing the master's as the terminal degree for clinical practice, (3) diverting practicing counselors from much needed service provision into doctoral programs, and (4) creating doctorally prepared counselors who lack clinical experience. The Asilomar workshop suggested the examining results from the current study as one method of exploring further the doctorate in genetic counseling (Walker et al. 1990). Many of the advantages/disadvantages of the Ph.D. genetic counselor that were delineated at the Asilomar conference were echoed by survey respondents. Greater professional recognition was the most often cited reason for possibly seeking the degree. The results from this study, as well as those of the 1990 Professional Status Survey, show that, while genetic counselors most often work in university-based genetic centers and have significant teaching and research responsibilities, only one-fourth have faculty appointments and less than 5% have tenure-track positions (Edwards 1990). The doctoral degree would allow access to tenure-track faculty status, usually not available to those with a master's degree. Trained in research, the doctorally prepared counselor would focus on genetic counseling-related research and would have the academic standing to pursue grant funding for projects. It is important to note that the small amount of current research devoted to genetic counseling issues seems to be primarily generated by other disciplines, such as sociology, psychology, and nursing. Sustained growth both in our knowledge of human genetics and in the provision of information and testing to families requires exploration of the impact that genetic counseling has on the individual, the family, and society. Research focused on the process of genetic counseling

6 Human Genetics Education Section 493 is particularly imperative. A Ph.D. genetic counselor, trained in the necessary skills, may be in a better position to address evolving questions. This study suggests that ABMG-certified, master'slevel genetic counselors with significant experience in the field would be the most appropriate candidates for a 2-3-year doctoral program. This would ensure that the Ph.D. genetic counselor would be grounded in clinical reality, prior to focusing on teaching and research. Indeed, many nursing and social work doctoral programs have similar requirements. The study has also indicated that the degree should be focused on genetic counseling research - versus administration or education, for example. Respondents felt that the doctoral program could be associated with a M.S. genetic counselor program or with a Ph.D. medical geneticist program. However, when all of the characteristics of the degree as outlined by this study are considered, an extension of an M.S. program may be most logical. Since most medical genetic centers are housed within academic institutions, the Ph.D. genetic counselor might be employed in a dual role -i.e., to perform counseling and to conduct teaching and research in the traditional academic manner. It is doubtful that the doctoral degree would replace or devalue the master's degree in genetic counseling. Master's-level practitioners have established their niche in genetics service provision. The demand for their services, as evidenced by a current manpower shortage, will continue to parallel the increase of clinically applicable technology (e.g., cystic fibrosis screening). Most likely, Ph.D. genetic counselors would represent a minority of the profession, similar to the situation of doctorate-level nurses or social workers in their professions. Although the interest in the doctoral degree in genetic counseling is evident, further study into its feasibility is required. Other studies might (1) examine the potential role of the Ph.D. genetic counselor and how it would differ from that of the master's-trained counselor, (2) determine the interest of potential employers, (3) identify academic institutions with the appropriate faculty and resources to provide the degree, and (4) define potential content for study. Academic institutions may require resolution of these issues before committing to the development of the doctoral degree in genetic counseling. References Biesecker B (1990) Genetic counseling education into the '90's. Perspect Genet Counseling 12(1):2 EdwardsJ (1990) Professional status survey results. Perspect Genet Counseling 12(2):7-10 Heimler A (1979) From whence we've come: a message from the president. Perspect Genetic Counseling 1(1):1 Kioza E (1988) Corner thoughts. Perspect Genet Counseling 10(3):2 Marks J (1989) Foreward: genetic counseling principles in action: a casework. Birth Defects 25(5):v-vii Marks J, Richter M (1976) The genetic associate: a new health professional. Am J Public Health 66(4): Mertens T, Hendrix J, Kenkel K (1986) The genetic associate: a career option in genetic counseling. J Hered 77(3): Rollnick B (1984) The National Society of Genetic Counselors: a historical perspective. Birth Defects 20(6):3-7 Smith A, Heimler A (1979) American Board of Medical Genetics is established. Perspect Genet Counseling 1(4): 2 Walker AP, Scott JA, Biesecker BB, Conover B, Blake W. Djurdjinovic L (1990) Report of the 1989 Asilomar meeting on education in genetic counseling. Am J Hum Genet 46: