The Accreditation Council for Genetic Counseling’s response to COVID‐19 impact on genetic counseling programs

This manuscript is a commentary outlining the response of the Accreditation Council for Genetic Counseling (ACGC) to the restrictions imposed by the COVID-19 pandemic and the disruption that presented for genetic counseling graduate programs. This commentary makes transparent the process and procedures used by the ACGC Board of Directors to develop guidance and offer flexibility for students, faculty, and graduate program leadership that addressed safety, learning options, fieldwork placements, and matriculation. In addition, this manuscript outlines changes that granted programs greater flexibility in compliance with the Standards of Accreditation and to meet required accreditation activities including program reports, program review, and re-accreditation. The first recognized diagnoses of Coronavirus infection in the United States and Canada occurred on January 21 and January 25, 2020, respectively. Named COVID-19 on February 11, 2020, the full pandemic implications of the SARS-CoV-2 viral infection would not be officially recognized until March 11, 2020. By April 11, 2020, the death toll in the US was 20,000 and 84 in Canada. As such, many states and provinces issued stay-at-home orders. An article in the Washington Post documented the shutdown of most institutions including schools, leading to telework and distance learning as the only option available (Anderson et al., 2020, March 13). These efforts to contain the spread of Coronavirus infections led to striking healthcare delivery restrictions, with a significant impact on graduate education for healthcare professionals. Specifically, genetic counseling graduate programs found themselves needing to pivot both the delivery of in-classroom education and in-person fieldwork training (Bergstrom et al., 2020; Greenberg et al., 2020). As a result, genetic counseling graduate programs implemented novel strategies to address the pressing needs presented by COVID-19 restrictions while looking to the Accreditation Council for Genetic Counseling (ACGC) Board of Directors (BOD) for permission to make these changes. Herein, we present a summary of the actions taken by the ACGC BOD relative to these programmatic changes and their implications for program compliance related to current accreditation standards. We review the COVID-19 impact on genetic counseling graduate programs, the ACGC accreditation activities, the timeline of communication, a survey of program leadership to quickly assess the impact of COVID-19, and the allowances granted to programs to remain in compliance with accreditation standards. This review serves as transparent documentation of the decisions and decision-making process assumed by the ACGC BOD during the onset of COVID-19, and as a summary of modifications to accreditation standards that may guide future decision-making during a pandemic or stay-at-home orders. The ACGC BOD began to receive inquiries from graduate programs related to their ability to remain compliant with the ACGC Standards of Accreditation (Standards) in late March and early April of 2020. The pandemic was impacting genetic counseling graduate programs in many areas including admissions and thesis project work, however, three main areas of concern surfaced related to the Standards that addressed teaching delivery models, fieldwork placements, and the development of resources and support services for remote learners and faculty. Table 1 provides an overview of the concerns identified by genetic counseling graduate program leadership together with the ACGC response and potential ongoing significance beyond COVID-19 implications. Given that social distancing was required to help prevent the spread of the virus, in-person classroom instruction ceased at universities and colleges across North America, necessitating quick conversion to online platforms for the delivery of remote teaching. While some genetic counseling graduate programs in North America utilized some educational content asynchronously or utilized web- or telephone-based communication platforms for class prior to the COVID-19 pandemic, the majority of programs had little to no experience teaching learners with these systems (Berg et al.,2018; Hilgart et al., 2012; Greenberg et al., 2020; Zierhut et al., 2018). Typical in-person classroom case-based discussions, small group learning, didactic lectures, and role-plays were now being carried out online. Programs also had to determine how to appropriately assess learners’ acquisition of knowledge and skills remotely, leading to remote proctoring of course examinations and implementation of online clinical skill Standardized Patient (SP) encounters. In order to effectively teach and assess learners through online synchronous and/or asynchronous methods, programs had to quickly adapt course learning objectives and lesson plans for the remaining spring semester, as well as the subsequent summer and fall semesters. Teaching delivery models Fieldwork Placements Allowed programs greater flexibility to use 2014 and/or 2019 Standards through the ‘20/’21 academic calendar related to Programs will be required to be in compliance with 2019 Standards as of June 15, 2021 Programs that continue any changes implemented during COVID−19, will need to submit a substantive change request after COVID−19 resolves If COVID−19 restrictions continue past May 2021, ACGC will issue appropriate guidance Will need to have in-person follow-up site visit after COVID−19 restrictions are lifted All 2021 site visits are expected to be in-person. While programs were transitioning didactic learning to virtual platforms, the rise of COVID-19 infections affected staffing for inpatient and outpatient clinical services in healthcare institutions (Bergstrom et al., 2020). In the acute early phase of the initial shutdown, many hospitals ceased all non-COVID-19 related healthcare services, including the provision of ambulatory genetic services. Additionally, given the highly contagious nature of the virus and limited PPE supplies, concerns were raised that students would not only be at risk for contracting the virus but also transmitting the virus to clients and other healthcare providers (Dewitt, 2020). These factors resulted in the removal of genetic counseling graduate students, as well as many other healthcare learners, from clinical environments, resulting in immediate cessation of onsite fieldwork placement opportunities for genetic counseling students. Over time, healthcare institutions began converting outpatient services to telephone and/or telemedicine appointments, which allowed genetic providers and clinics to resume clinical operations (Norman et al., 2020; Pereira, 2020; Chad et al., 2020). Despite the implementation of telemedicine genetic counseling services at healthcare institutions, many graduate programs continued to have limited fieldwork experience opportunities for students due to ongoing bans on student involvement in healthcare settings, or lack of available fieldwork supervisors because of furloughs and/or redeployment of genetic counselor supervisors. Additionally, there was a notable increase in burnout and fatigue due to the impact of the COVID-19 pandemic on healthcare providers’ work and personal lives, causing some genetic counselor supervisors to decline supervision of students, regardless of whether the institution allowed placements to resume (Bergstrom et al., 2020; Norman et al., 2020; Pereira et al., 2020; Chad et al., 2020). The switch to online learning and decreased availability of fieldwork placements required programs to proactively address the mental health and physical wellbeing of their faculty and learners. The requirement to shelter in place quickly resulted in the reduced social engagement of learners within their cohorts, among friends and family, as well as with their academic faculty mentors and advisors (Huckins et al., 2020; Son et al., 2020). Faculty also lost the in-person support they received from colleagues related to teaching, supervision, and clinical challenges. The ability to balance and maintain boundaries between work/school and home life demands (e.g., schooling of their own children, worrying and/or caring for family members who were infected with COVID-19, staying safe) was difficult (Zamarro & Prados, 2021). Additionally, altered communication and meeting patterns led to increased reliance on email correspondence and virtual meetings that required a novel skill set as compared to in-person meetings. While all universities had various student and faculty support services pre-pandemic, these services were typically delivered in person. Due to the pandemic, university offices that provided these support services also had to adjust to providing online support to their faculty and student constituents. Overall, the demand for counseling and support services was higher than the pre-COVID-19 era making it harder for graduate students and faculty to access these resources (Lederer et al., 2021). As the impact of the COVID-19 restrictions was recognized, the ACGC BOD began to regularly consult the guidance published by other accrediting agencies, the United States Department of Education (USDE), and the Council on Higher Education Accreditation (CHEA) to inform and support the guidance that ACGC would offer to graduate programs (American Psychological Association, 2020; Long et al., 2020; Luke et al., 2020; Luke, 2020; United States Department of Education, 2020). It became clear that accrediting agencies faced two different exigencies as a result of the pandemic. The first involved the ongoing oversight of graduate programs relative to compliance with Standards, and the second involved the agencies' ability to complete normal accreditation activities associated with review and assignment of accreditation status. Of the two exigencies, the most immediate for ACGC involved the programmatic issues caused by restrictions placed on in-person and/or on-campus classroom attendance and fieldwork placements. Based on ACGC experience with accreditation reviews, most genetic counseling graduate programs report in-person didactic curriculum and in-person training sites for the acquisition of clinical skills. COVID-19 restrictions upended these traditional modalities. Guidance from the USDE related to COVID-19 gave permission for accrediting agencies to forego routine review requirements and approval processes for distance learning, thereby enabling institutions to quickly transition to distance learning modalities (USDE, 2020, March 17). The ACGC utilized existing scheduled monthly board meetings and emergency meetings of the executive committee to develop guidance around COVID-19 restrictions that impacted genetic counseling graduate program functions. A variety of methods over time were employed to communicate with genetic counseling program leadership as is seen in Figure 1, which provides dates for key COVID-19 milestones and a timeline of ACGC communication which consisted of eblasts and webinars directed to program leadership. On April 7, 2020, the ACGC BOD distributed by email and posted to the ACGC website its first COVID-19-related guidance to programs regarding flexibility to remain in compliance with the ACGC Standards. Table 2 lists the specific Standards which ACGC referenced when addressing program COVID-19 related concerns. The initial guidance focused on Standards related to fieldwork experiences, fieldwork supervision, and documentation of student records. It is important to note that during this time ACGC was with two of the Standards published in 2014 and the 2019 Standards, compliance by June 15, As such, the ACGC BOD was to both of Standards in order to programs with the of flexibility in If the program related to and in to of the the program is expected to these and make available to faculty. The graduate institution is the institution that for This institution for the it with other institutions that are for providing or program The graduate institution is Fieldwork A of from a variety of clinical and delivery models are and clinical on the development of the clinical counseling as in are or that meet the in student have at but the ACGC no on the of be a the clinical and student in at in of the three of Counseling Education, and be The be by an or and/or an genetic counselor Programs are expected to use a and supervision the of supervision is with documented skills and to a variety of genetic issues the life students for the in the clinical training current in the Programs to the most for a of the of the across different this as a it is the of the to that all students have and involvement in a of clinical in an to that by the most The student not have an majority of in any to with a that support the development of the to seen in a as or in encounters. a of required of the required be with being for risk of or affected by genetic across the not who are being to and not The required be by an genetic Programs that and other are across including and other in a variety of that may and/or other and than delivery as and/or Programs opportunities that students are to in of the main and All the required be distributed across and other with no The ACGC program to determine how its clinical will be (e.g., a traditional The of these provides a complete of acquisition of skills and over time, as well as the and of or clinical training of clinical be with the and the of the clinical any These be available for review during site visits as of the accreditation review Programs maintain documentation of all student fieldwork ACGC program to determine how fieldwork training will be (e.g., a traditional This documentation a complete of fieldwork training of fieldwork training be within and the of the fieldwork These be available for review during site visits as of the accreditation review process Due to the of in-person fieldwork placement the concern among many programs was that students would not have the ability to the required of fieldwork to the 2014 and 2019 Standards that all students a of fieldwork in a clinical Table The 2014 ACGC required that be from a variety of clinical and delivery only in-person clinical be as and it was that these be by an or and/or an genetic In the Standards required that the be by an genetic counselor with than 1 of the use of all delivery models, that the are across and in a variety of settings, and that at of these be with being for risk of or affected by genetic across the not who are being to and not In order to that students an appropriate of required the ACGC COVID-19-related guidance to programs allowed students in the of and 2021 to virtual healthcare delivery models as well as the Standards. Additionally, ACGC allowed all of the required for the students in the class of to be by a genetic counselor or including with than of provided the was by a the 2014 Standards Programs that not student acquisition of the required had to students with access to learning to develop skills related to and acquisition of the The would be most for the of students expected to graduate in 2021, as it was that the impact of the pandemic would the of the remaining time in graduate ACGC programs that they the Standards, that all telemedicine and be their required Additionally, all of fieldwork placements and/or other and delivery models for students to develop the skills to the for students in the class of 2021, ACGC expected programs to to all other requirements set in the 2019 ACGC The ACGC BOD that they would a of remote supervision for students to and COVID-19 restrictions are any change implemented by a program would of a substantive change to ACGC the appropriate implementation of a recognized online as well as for student and in ongoing clinical genetic counseling The ACGC also addressed COVID-19 guidance for the use of that who were not with a educational program receive appropriate The ACGC also that genetic counseling students not be used as Additionally, ACGC required that the used for the would be with learning objectives and for student prior to the The ACGC BOD programs to or fieldwork placement changes due to COVID-19 2019 The ACGC this documentation the and for a specific changes impact on remaining work during this as well as documentation of program of changes with students. the of the spring and after initial guidance was ACGC a survey through to the program leadership of all North genetic counseling programs to assess program and to COVID-19 The survey was of related to student concerns the program staffing fieldwork placement site and two in which the ACGC BOD support programs. An was to assess the of programs to submit their report of current a that ACGC on an of on the 2019 Standards or 2014 Standards. A of genetic counseling graduate programs to the across program The first involved a of faced by program leadership regarding many areas of program including in-person distance learning requirements related to the academic the of genetic counseling and potential implications of due to the shutdown of outpatient The second involved the need to on telemedicine and remote supervision to students with fieldwork continued to concerns their ability to meet compliance with Standards, Standards that acquisition requirements given the significant restrictions placed on fieldwork Based survey the ACGC BOD published guidance for the academic This guidance focused on fieldwork training and supervision, but also addressed student safety, Standards related to of and curriculum and to Standards 2019 2019 ACGC provided guidance related to COVID-19 and PPE availability for communication of and of student and faculty and of the need for and access to health and mental health services. and found at the website by for and provided the ACGC BOD with and relative to COVID-19 directed at and et al., 2020, June of the guide and for programs to use to to student wellbeing and for student of educational to curriculum and ACGC that changes in course delivery (e.g., distance or distance for the academic were and not programs to the ACGC The ACGC also guidance related to fieldwork and that telemedicine and/or telephone counseling be the only delivery used by students. programs were that for the of ACGC expected programs to with the 2019 Standards and If programs that they would not be to maintain compliance with these three standards for the of ACGC required of a which the for The most significant impact of COVID-19 for genetic counseling graduate programs related to the in clinical opportunities and variety of fieldwork to meet compliance with Standards. As in the majority of to the May program clinical fieldwork sites were Specifically, the impact of the pandemic led to some genetic being being within the healthcare some were and a lost their In this led to a of fieldwork sites with genetic counselor supervisors. In the ACGC BOD from and Standards to guidance that allowed for genetic to students, and remote supervision, greater flexibility in fieldwork and settings, increased the use of and allowed for in Despite the with these Standards, the ACGC BOD continued to that student was required to acquisition of the prior to In to the published guidance on the survey in June 2020, the ACGC presented this to the of Genetic Counseling Directors in 2020. While some accrediting agencies, Accreditation on Education for the and the Psychological on Accreditation the that some students not graduate on time due to a lack of clinical training 2020; Luke, ACGC the that due to lack of clinical opportunities was not a for the class of 2020. The for was on from ACGC program that the majority of genetic counseling graduate students have the of required by ACGC to and of clinical In addition, normal it is the of programs to assess and determine whether a student the in order to As such, ACGC that programs would appropriate as placement or in a student required time to The ACGC also programs that the BOD required of or disruption or changes in the expected dates of or dates for students. Given the increased programs were while to the impact of COVID-19, ACGC The report of current due on June 15, was to 15, to programs time to complete the Additionally, all programs were the option to of their to 1, than 1, 2020. programs and program accreditation review, the would have for ACGC a pandemic. program review and a site visit and is a for the program and Given that COVID-19 restrictions not for in-person site guidance from the USDE allowed accrediting agencies to make and allowed for virtual site however, agencies follow-up with an in-person follow-up site visit by appropriate health and The ability to virtual site given the and required ACGC to review and the in-person visit ACGC had its program review and site visit processes to increase These processes themselves to a virtual site visit a As of the of 2020, ACGC had of the site visits and Based on to executive programs to be with the virtual review process The required of distance learning by genetic counseling graduate programs that a virtual curriculum be it in programs that had not for distance learning will need to be An response to this implementation would be to the process and of the various different change methods and The genetic counseling may a were to develop and a however, most programs on from program have and to out the of the pandemic programs will need to their ongoing education is to remain in some for many programs that had not used this in the as a delivery was prior to the pandemic but a increase due to in-person restrictions et al., 2020; Hilgart et al., 2012; Zierhut et al., 2018). Due to the pandemic restrictions, programs that students the majority of their fieldwork through telemedicine modalities remote As the pandemic some students may not have any in-person or some students may not any in-person their This important the impact this may have on the of genetic counseling student education related to both the of and the provision of remote ACGC and programs will assess and address the in distance learning and telemedicine modalities for education and training genetic to be this the development of appropriate standards that be to programs remote supervision and distance learning In with this ACGC a delivery models may continue to greater on telemedicine a of the COVID-19 experience will be that the current of genetic counseling may be than to meet this in healthcare a of the to distance learning and telemedicine delivery is the to increase the of genetic This is for learners who are limited by who be to through remote supervision as well as for who at a distance from the of healthcare services. In addition, clinical to have and for time thereby impacting the of across Based on program that on in-person as and may continue to be available for student In the 2019 Standards, ACGC the need to have specific of for a of fieldwork The will be to determine it is to have an of at the of a student graduate with only or with only the many remain to be regarding the of within that are to determine genetic counseling skills across fieldwork whether students need to be in to be have led to an that the ACGC BOD to In how an accrediting instruction and student at while the of COVID-19 restrictions and The ACGC BOD to and to accreditation standards be training that in the of genetic While it is that the to may be the ACGC had to adapt and the COVID-19 pandemic, these By to greater flexibility for programs to to their students with the opportunities to the acquisition of the ACGC will continue to student through the of the pandemic. The impact of the COVID-19 related changes may be by the published student that Based on reports, it is to note that the Board of Genetic Counseling not change in the it be that the who the would have only had of their graduate training impacted by the pandemic. In the class of 2021 will have had over of graduate training impacted by the pandemic. it will be important for ACGC to the for the The pandemic led to but changes in graduate program of the changes that learning modalities as online learning and remote supervision be they may be after the COVID-19 telemedicine genetic counseling visits and remote supervision support many supervision opportunities which in support graduate program to distance learning accreditation and for both didactic curriculum and fieldwork placements, will be important for ACGC to meet the changes that are to result from the COVID-19 pandemic. The ACGC BOD will also continue to with the by COVID-19 that around is for students to be and to prior to that had full access to all the in the and for the of the and the of the All of the gave approval of this to be published and to be for all of the work in that related to the or of any of the work are appropriately and The would to the ACGC executive and of who provided this time We also and current Board Directors and Directors and for their to the guidance provided to genetic counseling programs. All no of This manuscript is a commentary on process and procedures used by the Accreditation Council for Genetic review board was for the work presented in this manuscript as no was were carried out by the for this