Cultural Competency Training in Genetic Counseling Training Programs
By Dina El Achi, MS, CGC
Arguably no one knows the impact of word choice as well as a genetic counselor in a difficult disclosure visit. Pile on to that a language barrier or an unfamiliar cultural background, and you have yourself a stressed-out genetic counselor! Thankfully, we aren’t left without any training. However, this calls for a conversation about what exactly we are teaching genetic counseling students, and whether their cultural competency training (CCT) is sufficient to provide them with the tools they need to work with patients from ethnocultural backgrounds different than their own.
It is often the case that a patient’s cultural beliefs, traditions, and perceptions about medicine are influenced by their ethnocultural background, a term that encompasses a person’s ethnic identity along with the cultural and traditional practices of the groups with which they identify. Within healthcare circles, cultural competence involves recognizing the relevance of social and cultural influences on patients’ healthcare beliefs and finding effective ways to integrate this knowledge effectively into clinical interactions (Betancourt et al., 2003). In light of that, CCT should equip genetic counselors to provide care that is consistent with their patients’ worldviews, while not negatively affecting their rapport or ability to provide appropriate medical care and psychosocial counseling. This is relevant because we know that miscommunication between patients and providers due to differences in their ethnocultural backgrounds may further perpetuate health care inequities and mistrust of the medical system.
This is a topic I spent countless hours in painstaking thought and research over for my master’s thesis for my genetic counseling program. I naively thought this would be an easy enough topic to dissect and that I could just waltz into the offices at the Accreditation Council of Genetic Counseling (ACGC) with a neat little list of recommendations for how to improve CCT in genetic counseling programs (GCPs). However, it didn’t take long for me to piece together just how intricate of an endeavor this would be, as people’s perceptions of what they found helpful or effective couldn’t have been more diverse. My team and I surveyed second-year genetic counseling students (now graduated in 2022) and practicing genetic counselors who graduated from an ACGC-accredited program between 2018 and 2021. Our aim was to assess the perspective of GC students and recent graduates on the focus, type and delivery of the ethnocultural CCT they received through their training program, and how ethnocultural CCT impacted their self-reported levels of preparedness and comfort when interacting with patients of racial or ethnic backgrounds different than their own.
To no one’s surprise, the participant demographics showed that there is significant homogeneity within the field, implying that genetic counselors are likely to provide services to patients from ethnocultural backgrounds different than their own. Most participants reported they received an insufficient amount of ethnocultural CCT through their GCPs. This was further highlighted by various participants in the free-response section of the survey where several ways to improve racial or ethnic CCT were suggested. These included more frequent DEI training, additional discussions/roleplays/practice opportunities, and a semester-long training class on cultural competency. This clearly highlights the need to devote more time to cultural competency training, and additional designated time to practice acquired skills with relevant guidance and feedback (El Achi et al., 2023).
The survey also supported that ethnocultural CCT focused on specific racial or ethnic traditions and practices (covering topics related to eye contact, shaking hands, family structure, guilt and shame), medical considerations (covering topics related to death and dying, grief, organ donation, research…), or systemic disparities in healthcare (covering topics related to historical practices, distrust of medical providers, issues surrounding access to care…) is more effective at increasing GCs’ self-reported levels of preparedness and comfort when interacting with ethnoculturally diverse patients than CCT focused on racial or ethnic stereotypes and generalizations.
The majority of participants reported that their training was their main source of preparedness, which demonstrated that although this training was helpful to participants, additional evaluation of these curricula might be warranted, especially given the weight of their impact on practicing genetic counselors’ self-reported levels of preparedness and comfort. However, the majority (61%) also reported they received an insufficient amount of ethnocultural CCT. This also suggests the need for more consistent and well-outlined guidelines from the ACGC regarding the focus, type, and delivery of ethnocultural CCT provided by GCPs. This should include built-in means for students to evaluate the efficacy of the training and provide feedback to their programs. Moreover, it would be beneficial for GCPs to provide practice avenues for students to apply the knowledge they receive in ways that are effective and promote diversity and inclusion.
Ultimately, the study brought to light the need for ethnocultural CCT that recognizes its target audience and ultimate purpose - it must account for the demographic it is trying to educate and the demographic it is trying to serve.
So, what comes next? I sat with that question for an awfully long time, though arguably not long enough. However, here are some of the suggestions I could piece together. It is critical that GCPs identify consistent and realistic expectations for skills that are expected of their students. We need to diversify GCP cohorts, but also be prepared to meet the need of students who identify as ethnocultural minorities. We must ensure that students and their supervisors are held accountable to apply skills acquired from ethnocultural CCT in the clinical setting. But if nothing else, we need to prepare to be teachable, humble, and willing to engage in conversations about the difficult things.
There is a tremendous amount of work that still needs to be done to continue improving ethnocultural CCT in GCPs and countless alterations and suggestions to be made. However, I left this thesis with one lingering thought. It is only when we recognize the needs of people beyond the generalizations ascribed to their cultural groups, and start answering the person, not just the question, that we will begin to meet patients’ needs in a way that truly serves them best. Until our training curricula intentionally addresses these issues, we will continue to have more work to do to ensure that genetic counselors are serving their communities well.
References:
Betancourt, J. R., Green, A. R., Carrillo, J., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302. https://doi.org/10.1016/s0033-3549(04)50253-4
El Achi, D., Brown, A., Huguenard, S., Khan, S., Streff, H., & Nassef, S. (2023). Perceived impact of ethnocultural competency training on genetic counselors' clinical interactions. Journal of genetic counseling, 10.1002/jgc4.1756. Advance online publication. https://doi.org/10.1002/jgc4.1756