2026 Theses Master's

From Applicant to Genetic Counselor: A Qualitative Comparison of Domestic and International Graduates' Journeys

Daumeyer, Henry; Ahimaz, Priyanka Rebecca; Brush, Eden R.; Gallagher, Katie; Sebastin, Monisha

Introduction: As the genetic counseling profession expands, enrollment in genetic counseling graduate programs in the United States (US) has been increasing. However, despite shifting national population demographics, the representation of individuals from international backgrounds in these programs remains limited. Furthermore, while there is a growing emphasis on diversity and inclusion in the genetic counseling field, there has been little longitudinal research on the lived experiences of international individuals progressing from applicant to practicing genetic counselor (GC) and how they differ from their domestic counterparts.

Purpose: This qualitative study aimed to comparatively examine the lived experience of domestic and international graduates of US-based genetic counseling programs across the continuum from application through early professional practice. To help cultivate diversity and inclusivity in genetic counseling education and practice, this study intended to identify universal or divergent challenges and facilitators based on citizenship status that individuals may face in the process of becoming a practicing GC.

Methods: Using purposive sampling, seventeen GCs who graduated from an accredited program in the US after 2020 were recruited to participate in semi-structured virtual interviews. Based on their status at time of application, participants were categorized as domestic (US citizens/permanent residents; n=7) or international (non-US citizens; n=10). Interview questions were designed to explore how participant identities and backgrounds impacted their experiences and were grouped into three domains: 1) day-to-day lifestyle/cultural adaptation, 2) graduate education and training, and 3) transition to professional practice. Interviews were conducted via Zoom video conferencing platform and recorded, transcribed, and analyzed using inductive thematic analysis. Two study team members independently coded transcripts and reconciled discrepancies to develop a consensus codebook and overarching themes.

Results: Participants described a range of barriers in the journey from applicant to practicing GC. Across both domestic and international cohorts, common key themes noted throughout every stage of the journey were financial challenges and families/partners as important support sources. Universal challenges during different stages included inconsistent application prerequisites, adaptation to rigor of education, long commutes for rotations, limited support from overextended faculty during graduate school, a dearth of employment opportunities, and difficulty understanding the US healthcare system. International GCs noted additional challenges and barriers to adaptation, including limited educational and employment opportunities due to visa constraints, grappling with issues related to personal identity, difficulty accessing key support systems, and unfamiliarity with US systems, cultural norms, and society.

Conclusions: This study highlights that the pathway from applicant to practicing GC is marked by a variety of challenges that, while shared by many GCs, are compounded for international GCs. These findings underscore the structural and systemic inequities embedded in US society and institutions, including higher education, and illustrate the need for targeted structural interventions at the program level. Addressing these disparities may help improve accessibility and inclusivity within genetic counseling education in the US and, in turn, nurture a more diverse workforce that better represents the US patient population.