Thirty years after the first course for genetic counsellors’ education, genetic counselling is still a developing profession in Europe [17] and the educational backgrounds and clinical practices of professionals vary significantly between countries [6, 18]. To our knowledge, this is the first historical review of the European education for becoming a genetic counsellor. However, we only included courses at the Masters level, as this is the gold standard for training of genetic counsellors as recommended by the EBMG (See website www.ebmg.eu for more information) and other boards around the world including the American Board of Genetic Counseling (See website www.abgc.org for more information)
Establishing such a standard for education and training is now of more relevance than ever as genetic technologies and professional standards evolve constantly, and with the increasing mobility of genetic counsellors worldwide [18] and the growing need for professionals trained in this field. As a profession, genetic counselling has been predicted to be one of the fastest growing professions in the USA, with the Bureau of Labor Statistics predicting a 21% growth rate in genetic counselling jobs from 2019 to 2029; much faster than the average for all occupations [19].
Accordingly, our short report described a doubling of the number of training programs in the past fifteen years. Although not included here, this number is even higher if we consider the Scientist Training Program started in 2017, a three-year program of work-based learning, supported by a university accredited Master's degree in the UK [20].
Among the active Master's programs in Europe, all are accredited by the EBMG, with the exception of the Norwegian program. Each country has one Master's program, except for the UK, which has three concurrent Master's programs. Most training programs follow a two-year Master’s degree approach and, accordingly, the number of ECTS (the European Credit Transfer and Accumulation System) are quite similar.
Overall, the number of students per intake is small in most programs. This is likely due to several factors such as the limited number of trained professionals in countries where the genetic counselling profession is new or previously non-existent; difficulties for programs and students to identify clinical rotation training sites; and the lack of sufficient job openings for genetic counsellors since these are clinical Masters programs whose primary goal is to train GCs to take on professional roles within the healthcare system as opposed to purely academic MSc programs.
In spite of the push for standardization at the European level, alternative pathways and trainings for genetic counsellors different from the previously mentioned Masters programs and Scientific Training Program pathways still exist or previously existed. Hence professional groups of genetic counsellors practice in countries such as The Netherlands, Belgium, or Sweden.
Key topics discussed at the closed meeting as main challenges in GC education
During the meeting, common challenges were identified among the different training programs in genetic counselling in Europe. Some of them were related to the rapid evolution of the field of genetics and genomics, while others were related to the complexity of establishing a specific training for a new profession.
Due to the exponential evolution of genomics in recent years, the complexity of genetic test result interpretation has increased [21]. It has also resulted in difficulties in managing the large amounts of generated data. As an example, Boland et al [22] states that by 2015 only 53,4% of genetic consellors in their study had counselled a patient for an NGS result. Addittionally data published by many genetic counsellors also perceived deficiencies in their understanding of NGS testing, including clinically relevant aspects. More recent evidence, published in 2020, also described a need for training in genomics as > 70% of respondents deemed knowledge of genomic technologies as important for successful job performance [23]. However, 55% responded that additional job training was needed for them to successfully perform their work tasks, and only 28% considered their graduate training in genomic technologies was sufficient [23].
To keep up with this development, training programs in genetic counselling have to be regularly updated and include the basic knowledge and skills required to safely practice the profession. For this reason, the Masters programs in genetic counselling have had to enhance their genomics section of the curriculum over the last years. This was one of the challenges clearly identified by the program directors.
Another challenge identified were the limitations regarding opportunities for clinical placements where students also have proper access to clinical and counselling supervision. This is related to the fact that when a master program in genetic counselling is established in a country for the first time, the number of trained professionals in the country is usually very low or non-existent. This makes it difficult to supervise and train students on very specific aspects of the profession, such as clinical placements or counselling supervision. Usually, the first students are supervised by clinical geneticists who, of course, share a substantial amount of skills, tasks and knowledge with genetic counsellors. To help overcome this challenge, one of the strategies that has been followed is to strongly support the supervisors from the Masters programs have specific training requirements and previous experience of clinical placements or research projects. Another commonly used strategy is to foster new graduates to be trained as supervisors for the next batch of students. Another interesting initiative used in some of the Master programs is to include genetic counsellors trained in other countries where genetic counselling is already established as a profession as teachers, although this suggestion might be useful for specific sessions, lessons or workshops it might not help with clinical placements or thesis supervision.
Counselling supervision was identified as a big challenge for the majority of the Masters programs, but also for genetic counsellors. This particularly applies to genetic counsellors trained in countries where genetic counselling is a new profession [17] as the concept of counselling supervision is novel and innovative in many countries, or they lack a tradition of caring for the emotional well-being of healthcare professionals. Again, one of the strategies for the Masters programs to make students familiar with counselling supervision is to include professionals with work experience in countries where counselling supervision is more established as teachers for this area. Another approach is to explore other professional fields different from genetics, to find the support required, such as psychologists and psychotherapists.
The evolution of educational programs has seen the introduction of genomics and the practical component as part of the training. Standards of accreditation for graduate programs in genetic counselling such as the one promoted by the Accreditation Council for Genetic Counseling [5, 24] and the European Board of Medical Genetics [25] has had an important role in promoting appropriate training for genetic counsellors by comparing the course delivery methods and content of each program with the core competences for genetic counsellors and the curriculum developed by the European Board of Medical Genetics [26, 27].