Canadian certification exam pass rates are impacted by genetic counseling program location: A review of Canadian Board of Genetic Counselling data from 2007 to 2025

Despite significant growth of the genetic counseling profession worldwide, there are differences between genetic counseling training programs (GCPs), professional standards, and professional regulation. Certification of genetic counselors (GCs) in Canada was previously managed by the Certification Board of the Canadian Association of Genetic Counsellors and is now the responsibility of the Canadian Board of Genetic Counselling - Conseil Canadien de Conseil Génétique (CBGC). Since 2007, individuals who attended a Master's level GCP, irrespective of location, have been eligible to sit for the Canadian certification exam. However, the CBGC Board of Directors has observed lower exam pass rates for candidates who attended GCPs outside North America compared to candidates who attended GCPs accredited by the Accreditation Council of Genetic Counseling (ACGC). Anonymized line-level data for candidates who first applied to write the Canadian certification exam between 2007 and 2025 were extracted from the CBGC records. Pass rates were significantly higher for first-time test-takers who attended ACGC-accredited GCPs (227/246, 92.3%) than those who attended GCPs outside North America (18/37, 48.6%) (p < 0.001). However, pass rates were not significantly different between candidates who attended an ACGC-accredited GCP in Canada and those who attended an ACGC-accredited GCP in the United States (p = 0.48). A variety of factors, including differences in training program content and developmental endpoints, differences in GC roles and scope, and cultural, religious, and societal influences, may underlie the difference in pass rates observed here. Given its dedication to diversity, equity, inclusion, and justice efforts, as well as development of the genetic counseling profession worldwide, the CBGC will endeavor to develop resources that support exam performance for all candidates, including those who trained at international GCPs. However, the CBGC must balance these efforts with its ultimate purpose to protect the Canadian public by upholding certification standards for Canadian GCs.