"Magic Computer in the Sky" - Participant Perspectives on Control and the Genetic Counseling Admissions Match

Since the 2018 admissions cycle, genetic counseling graduate programs in North America have utilized the Genetic Counseling Admissions Match (GCAM), a Match algorithm to place applicants. While a study prior to implementation found that most students were uninterested in a Match due to concerns of control, there has been no investigation into matched applicants’ experiences since its inception. A mixed-methods study explored the experiences and perceptions of control of genetic counselors and genetic counseling (GC) students who entered a program following the GCAM. An anonymous survey documenting GCAM experience and a validated measure for locus of control (LOC) was disseminated through national GC organizations and individual training programs, collecting data from 412 participants. Data was analyzed to assess significant factors associated with GCAM experience. Further, semi-structured interviews were conducted with ten survey participants randomly selected overall, as well as an additional eight randomly selected within factors including gender, Match result, and experience prior to Match implementation. Inductive conventional content analysis was used to code transcripts to identify emergent domains and themes. The median grade assigned to the GCAM was 80/100 (IQR: 65-90), indicating a positive experience, and linear regression modeling found that internal LOC and matching into one’s top two programs were predictive of a better experience (p < 0.001). Qualitative domains that “it all works out” (n = 13), validation (n = 10), and use of positive emotions post-Match (80.8% of coded emotions) reflect this positive regard. However, there is room for improvement, shown by qualitative themes of comparison to applicants and classmates (n = 13) and lack of control (n = 18), and 81.1% of during-GCAM emotions being negative. These results indicate that while GCAM overall is a good experience, genetic counseling educators should improve applicant education to clarify points of control and reduce anxiety; efforts to address cohort dynamics may also be beneficial long-term.