What to Expect When You're Expecting to Take the Board Exam
By Jordan Zeiger, MS, CGC & Erin Atkinson, PhD, MS, CGC
“I cried in my car after my exam. After hitting “submit” and clicking through the “how did we do?” questions; after seeing for the first time my score, signing out with the proctor, taking the key given in exchange for my belongings, and walking to my car; after waiting the eternity for my phone to turn on, and checking my email to obtain proof that the result I’d seen on my screen in the testing room was true… I cried.” (March 2024 test-taker).
Everyone who has taken the American Board of Genetic Counseling (ABGC) genetic counseling board examination (“boards”) knows that stress. They know the hours of studying, the immense anxiety during the exam, and the questions that race through your mind. Did I remember the inheritance of this condition? Did I miscalculate Bayes? Do I know how to be an empathetic human in the way this question wants me to answer? For the last two exam cycles, test-takers have experienced additional stressors related to substantial changes in the exam without adequate study resources, and issues with testing facilities. These growing pains associated with the updated exam have compounded the already immense stress of taking ABGC boards for hundreds of new genetic counselors (GCs).
Here we provide a summary of perspectives from multiple test-takers who took boards in August 2023 and/or March 2024. As two cis white women with similar board experiences, we recognize that our limited background provides a limited perspective. So, first, we gathered anonymous reflections from multiple recent test-takers. This diversity of perspectives includes first-time and repeat test takers, different academic backgrounds, in-person and virtual test taking, with and without accommodations, age, and ethnicity. We hope to provide context for instructors and supervisors training the next generation of GCs, and updated perspectives for anyone who plans to take ABGC boards in the coming years.
The Exam
At the end of 2022, content changes were implemented for boards starting with the August 2023 exam. The burning question has been, “What is the new exam like?” Overall, the consensus was that the subject matter and questions felt appropriate for a practicing GC. Regarding difficulty level, most describe it as a difficult-but-doable exam. Some felt that it was easier than expected, although this was possibly due to pessimistic expectations resulting from horror stories of past exam experiences. The questions did not feel like they were written to trap you or to test whether you could recall a singular detail of an obscure disease that is rarely seen in clinical practice. While recalling rare phenotypes is an impressive party trick, it is not the measure of a competent GC. Instead, questions focused on critical clinical thinking about scenarios, conditions, and testing strategies.
However, many test-takers said they felt surprised at the types of questions on the exam. With the launch of the new exam, ABGC took the practice exam down from their website, sending the message to test-takers, whether accurate or not, that these old study materials were no longer appropriate benchmarks for the new exam. Unfortunately, no new practice exam appeared to take its place, though one is expected to be released, for a cost, on June 1st Right up until we walked into the exam room, it still felt like it was a guess as to whether we had studied the correct information.
The lack of updated study materials meant that many people felt they were not able to prepare for the style of test. This led to a difficult exam experience because so much time had been spent studying old study materials and outdated quizzes whose structure was not similar to boards in that they focused on recalling singular facts.. This was a complaint of people who had taken the old version of the exam as well. While a good test should limit the amount of “testing to the test” required, any standardized test requires some understanding of the test structure. With the removal of the official practice exam, people felt they did not have a way to practice the style of questions that were found on the exam.
Study Tips
Everyone’s study process is different, and knowing how you study best is key. Two resources were mentioned frequently: the Genetic Counseling Complete Study Guide by Etsy user GCGeniusGuides ($119 through Etsy), and the StudyRare course ($399 early bird registration or $499 if registering after June 1). The Etsy study guide helped provide a starting place for studying that could then be expanded with GeneReviews, lecture notes, study groups, webinars, and Quizlet flashcards from current and prior test-takers. The StudyRare course was specifically revamped for the new ABGC exam. Those who enrolled in this course felt it was well designed to address the newer material on the exam, such as insurance questions. The StudyRare course was also unique in that it provided practice questions in a similar style to the exam. However, the StudyRare course comes with a significant price tag. An ABGC practice exam is still needed since basic knowledge of the exam format should not be reserved for those who can pay for it.
Experience with New Testing Facility: Prometric
After the many logistical nightmares experienced with the old testing company, the switch to Prometric as the host of the exam this March was a welcome one. The experiences with Prometric were satisfactory, especially in juxtaposition to what the August 2023 test-takers went through including an inability to access exams and delayed scoring. From our personal experiences and those of individuals who took the exam through both PSI and through Prometric, we can anecdotally share that Prometric scheduling and test-taking was a much smoother process. Even the software used to take the test seemed more up-to-date and user-friendly. In-person testing dates can fill up quickly, but virtual exam dates are more flexible. Those who took the exam at home expressed it was also a pretty smooth process and, for some, being at home minimized their test anxiety. Virtual test takers had an online version of scratch paper that was essentially a Microsoft Word document, which makes drawing pedigrees a challenge. However, this was not a deal breaker for taking the test virtually for the people we spoke to.
Words of Wisdom
We know how stressful it is to take a career competency exam that costs $675 for first-time test-takers and years of your life to work up to. It makes sense to have any range of emotions: it is stressful! Many talented GCs have needed to take the exam multiple times. You are not your job, you are not how well you do on exams. Whether you pass your first time or your fifth time, you are a capable and empathetic human who would not have gotten as far as taking boards if that were not the case!
Takeaways
We believe lessons have been learned that may be incorporated into the roll-out of any future changes to boards. In the future, new or changed credentialing criteria should be announced two years prior to implementation of the exam. This timing would allow programs to incorporate anticipated changes into their curriculum. Additionally, an official practice exam should be available through ABGC as a free resource several months prior to an updated exam. Information and resources need to be provided so that in the future, any tears shed after the test are happy tears or tears of having tried our best. Not tears in frustration and surprise at the questions on the screen.
Jordan Zeiger, MS, CGC, is a genetic counselor and clinical instructor for the Division of Medical Genetics in the Department of Pediatrics at UTHealth McGovern Medical School. In addition to providing genetic counseling for families in general genetics at UT, Jordan assists the lysosomal storage disorders (LSD) specialty clinic at UT, and provides clinical coordination and genetic counseling for the genetics clinic at the Harris Health C.E. Odom Pediatric and Adolescent Health Center. Jordan graduated from the University of Missouri, Columbia in 2013 with BAs in Sociology and Anthropology. In 2023, she completed her MS in genetic counseling at the University of Texas MD Anderson Cancer Center Graduate School of Biomedical Sciences. She took her ABGC boards examination in March 2024.
Erin Atkinson, PhD, MS, CGC is a prenatal and preconception genetic counselor in the Department of Human and Molecular Genetics at Baylor College of Medicine. Erin received her undergraduate degrees in Biology and Spanish from the University of Texas at Austin and her PhD in Genetics and Epigenetics from the University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences. In 2023, she completed her MS in genetic counseling at the same institution. She took the ABGC board exam in March 2024.