BIPOC genetic counselors' experiences with the professional certification exam: Insights from a longitudinal qualitative study.

The genetic counseling certification exam, or "oard exam," is a four-hour, 200-question multiple-choice exam. Recently reported first-time pass rates were 80% (August 2024) and 54% (February 2025). The purpose of our study was to explore the experiences of Black, Indigenous, and People of Color (BIPOC) Board exam candidates during these two exam cycles. In 2022, we enrolled 25 BIPOC genetic counseling students in a longitudinal constructivist grounded theory study. Here, we report the results of interviews conducted with this cohort before and after they took the August 2024 (n = 16) and/or the February 2025 (n = 13) Board exam. Interviews were transcribed and analyzed using a constant comparative approach. Among our participants, pass rates were 11/16 (69%) in August 2024, and 5/9 (56%) for first-time and 2/4 (50%) for repeat test-takers in February 2025. We constructed five themes and an overarching theory. Theme 1: The Board exam does not reflect real-world practice, where genetic counselors work with limited time and resources, and emphasizes memorization of information that is readily available online. Theme 2: The likelihood of passing the Board exam is influenced by socioeconomic disparities, particularly in the challenging 2024 job market. Theme 3: Anxiety negatively impacted exam performance. Theme 4: Testing accommodations, such as extended time, were challenging to access. Theme 5: Participants perceived that Board exam outcomes were influenced by luck, because the lack of a detailed content outline forces candidates to self-direct study across hundreds of topics. We theorize that the Board exam is a poor measure of readiness for entry-level genetic counseling as it fails to reflect real-world practice and is influenced by factors unrelated to competence, such as socioeconomic status, mental health, ability to access accommodations, and luck. We recommend changes to the exam format and the provision of official study materials to reduce inequities.