Effects of Anxiety on Novice Genetic Counseling Students’ Experience of Supervised Clinical Rotations

Abstract

Supervised clinical experiences with patients comprise a critical component of genetic counseling student education. Previous research has found genetic counseling students tend to be more anxiety prone than the general population, and anxiety related to supervision has been found in genetic counseling and related fields. The present study investigated how anxiety affects the experience of supervision for genetic counseling students. Second year genetic counseling students were invited to participate through email invitations distributed via training directors of the 33 programs accredited at the time of the study by the American Board of Genetic Counseling. An initial online survey contained the trait scale of the State-Trait Anxiety Inventory to estimate anxiety proneness in this population and an invitation to participate in a 45-minute semi-structured phone interview focusing on students' experiences of supervision during their clinical rotations. High and low trait anxiety groups were created using STAI scores, and the groups' interview responses were compared using consensual qualitative research methodology (CQR; Hill 2012). The high anxiety group was more likely to describe problematic supervisory relationships, appreciate the supervisor's ability to help them when they get stuck in sessions, and feel their anxiety had a negative effect on their performance in general and in supervision. Common themes included supervisors' balancing support and guidance, the importance of feedback, ego-centric responses, and supervisors as focal points. The results of the present study are largely consistent with current literature. Further research findings and research, practice, and training recommendations are provided.

Supervision in genetic counselor training in North America: A systematic review

“…The plurality of papers in the GC supervision field are surrounding some of these difficulties. These six papers included the following: compassion fatigue/burnout from being a supervisor (Allsbrook et al, ), boundary issues (Gu, McCarthy Veach, Eubanks, LeRoy, & Callanan, ), multiculturalism/competence (Kyung Lee, McCarthy Veach, & LeRoy, ), anxiety (MacFarlane, McCarthy Veach, Grier, Meister, & LeRoy, ), games (McIntosh, Dircks, Fitzpatrick, & Shuman, ), and language issues (Vanneste et al, ). Each of these papers explored difficult aspects of the GC supervisor/student relationship, but all either suggest increasing the supervision working alliance or working with the GC program to identify ways to leverage existing resources to provide supervision training.…”

“…Specifically, the supervisor can attempt to build rapport, create a bond, or otherwise get to know the student to build the supervisory relationship (Suguitan et al, ). The supervisory relationship is important because, when strong, students feel less stress (Caldwell, Wusik, He, Yager, & Atzinger, ; Gnilka, Chang, & Dew, ), less role conflict or role ambiguity (Ladany & Friedlander, ), are more able to cope, are more willing to trust the supervisors’ feedback, and feel less anxious while with patients and the supervisor (MacFarlane et al, ). The working alliance is integral to GC student supervision (Wherley et al, ), but this relationship is not always addressed in a rotation.…”

“…Previous lowly rated competencies or issues included: I can respond to a student's thoughts regarding their clinical skills in a manner that enhances the supervision process and I can elicit a student's feelings regarding their clinical skills ; I can use the ABGC practice‐based competencies to set goals; and I can identify learning needs of a student at various levels of experience (Finley et al, ). Supervisor struggles, including difficult student personalities (Hendrickson et al, ; Venne & Coleman, ) Disagreement on student skill level (Atzinger et al, ). Working with novice versus advanced students in clinical rotations (Eubanks Higgins et al, ) Evaluation and supervision methods (Eubanks Higgins et al, ) Discuss the supervisory working alliance and strategies to strengthen the relationship between GC supervisor and student (Berg et al, ; Caldwell et al, ; Eubanks Higgins et al, ; MacFarlane et al, ; Suguitan et al, ). Discuss creative ways to reduce the amount of time genetic counselors need to spend in supervision (Berg et al, ). This can include discussion of other methods of supervision besides live supervision, such as listening to recordings at 1.5× speed or student self‐report, depending on the developmental level of the student (Hendrickson et al, ; MacFarlane et al, ; Masunga et al, ; McCarthy & LeRoy, ). Include information about the particular GC program. Supervisors may not know background information, such as total number of cases that are usually seen per student during the program or remediation policies (Berg et al, ; Lindh et al, ).…”

“…Supervisors may not know background information, such as total number of cases that are usually seen per student during the program or remediation policies (Berg et al, ; Lindh et al, ). Not having this information could lead to barriers to becoming supervisors. Include information about and solutions to previously identified Difficulties in Supervision: Increase supervisors' confidence and provide resources to address compassion fatigue and trait anxiety, ways to recognize these and seek help (Allsbrook et al, ). Boundary issues and resolution (e.g., through an informed consent document; Gu et al, ). Include cultural competency in the rotation (e.g., drawing attention to when sessions are tailored to the cultural identity of the patient/family/student; Kyung Lee et al, ). Recognize student anxiety is normal, how to use the SWA to decrease anxiety, and how to provide useful feedback (MacFarlane et al, ). Define supervision and student “games,” examples from each side, and how to spot and stop a game from continuing (McIntosh et al, ). Raise awareness of the needs of multilingual GC students and possible issues GC students and supervisors might face when another language is involved in supervision and training (Vanneste et al, ). …”

Genetic counseling supervisor strategies: An elaboration of the Reciprocal‐Engagement Model of Supervision

“…They also are consistent with a major domain of supervisor competencies identified by Eubanks Higgins et al (). When done effectively, feedback can contribute to effective supervision processes and outcomes (Hendrickson, McCarthy Veach, & LeRoy, ; MacFarlane et al, ). Opportunities for skill practice are also evident in the strategies identified in the current study.…”