Perceived social support: A study of genetic counseling graduate students in the United States (US) and Canada
Abstract
Social support is described as having positive psychological and physical outcomes and offers some protective benefits against mental illness. However, research has not addressed social support for genetic counseling graduate students, although this population is prone to elevated levels of stress in addition to field-specific phenomena like compassion fatigue and burnout. Therefore, an online survey was distributed to genetic counseling students in accredited programs in the United States and Canada to synthesize information about (1) demographic information, (2) self-identified sources of support, and (3) the availability of a strong support network. In total, 238 responses were included in the analysis, yielding a mean social support score of 3.84 on a 5-point scale, where higher scores indicate increased social support. The identification of friends or classmates as forms of social support significantly increased social support scores (p < 0.001; p = 0.006, respectively). There was also a positive correlation between increased social support scores and the number of social support outlets (p = 0.01). Subgroup analysis focused on potential differences in social support for racially/ethnically underrepresented participants (comprising less than 22% of respondents), revealing that this population identified friends as a form of social support significantly less often than their White counterparts; and mean social support scores were also significantly lower. Our study underscores the importance of classmates as a source of social support for genetic counseling graduate students while uncovering discrepancies that exist in social support sources between White and underrepresented students. Ultimately, stakeholders in genetic counseling student success should foster a community and culture of support within a training program (whether traditionally in-person or online) to encourage success among all students.
What is known about this topic
Social support is described as having positive psychological and physical outcomes and offers some protective benefits against mental illness. Social support available to genetic counseling graduate students has not been previously evaluated.
What this paper adds to the topic
Our study identifies social support sources for genetic counseling graduate students. Specifically, it underscores the importance of classmates as a key source of social support while uncovering discrepancies that exist in social support sources between White and underrepresented students.
1 INTRODUCTION
Positive social support has protective benefits against mental illness, decreases the consequences of disorders induced by trauma (such as posttraumatic stress disorder), reduces morbidity and mortality of many other medical conditions, promotes resilience to stress, and helps protect against developing other psychopathologies resulting from trauma (Ozbay et al., 2007; Southwick et al., 2005). Historically, research has focused on social support among postgraduate students in health sciences including medical, public health, physical therapy, and physician assistant student populations (Bíró et al., 2011; Gold et al., 2019; Hojat et al., 2015; Thompson et al., 2016). Similar to research findings in the general population, one such study indicated a positive correlation between postgraduate student mental health and social support (Bíró et al., 2011), while another revealed that decreased postgraduate social support from family and friends is associated with a significantly greater risk for depression (Thompson et al., 2016). Gold et al. (2019) identified that implementing age-matched peer social support groups for medical students led to improved well-being, enhanced self-awareness, increased ability to empathize, and promoted social connection. Among these studies, the association between increased social support and positive outcomes for students was recurrent. Despite its significance in other postgraduate fields and its association with positive and/or protective outcomes, to our knowledge research has not addressed social support for genetic counseling postgraduate students.
Previous work measuring perceived social support as a variable for student success is described by William Sedlacek, whose work focuses on improving success for nontraditional student populations; this is defined by Sedlacek as a diverse group including students of color, international students, LGBTQ students, and women (2017). According to Sedlacek, availability of a strong support person represents one of eight measurable noncognitive variables. These noncognitive variables “include personal and social dimensions, adjustment, motivation, and student perceptions” instead of relying on assessments measured by standardized tests (2017). Sedlacek posits that traditional measures of student success (e.g., grades or test scores) may overlook qualified candidates for admission, while noncognitive variables have been associated with academic success for students of all races, genders, cultures, and backgrounds. This is important as it captures alternative indications of academic success.
Sedlacek's findings regarding social support indicate that individuals with identified social support typically perform better in school, as measured by GPA, enrollment status, and graduation rate. This is true for both US and international graduate students (Curtin et al., 2013), where the source of social support can be a family member, friend, or someone in the education system (Sedlacek, 2017). Moreover, a separate study found that support from family, friends, or faculty was related to success in terms of grades and graduation rates (Fauria & Zellner, 2015). Accordingly, Sedlacek (2017) uses his described measure of social support, where he “assesses the [student's] availability of a strong support network, help, and encouragement and the degree to which he or she relies solely on his or her own resources.” Sedlacek's work serves as the foundation of this study as it provides a tool for measuring the availability of social support for students of all backgrounds. The definition of social support has been adapted from Sedlacek's previous work to meet the objectives of this study. Therefore, the authors define social support as a source of encouragement, comfort, and/or emotional connection.
It is widely accepted that postgraduate students are likely to experience elevated levels of stress that negatively impact physical health, mental well-being, and academic performance (Melaku et al., 2015). A study of genetic counseling students revealed stress levels comparable to those of outpatients diagnosed with obsessive–compulsive disorder; furthermore, trait anxiety scores for genetic counseling students were significantly higher compared to those of adult women and medical students (Jungbluth et al., 2011). However, research has not addressed whether social support moderated these outcomes.
Genetic counselors are prone to experiencing burnout and compassion fatigue from repeated and/or overwhelming empathetic engagement with clients in distress (Benoit et al., 2007). Burnout disrupts the counselor's relationship with their work and can negatively impact work quality, satisfaction, and retention. Burnout can manifest as mental exhaustion where the counselor questions self-efficacy and value to the patient (McCarthy Veach et al., 2018). Because these clinical experiences extend to genetic counseling students during graduate training, these unique susceptibilities in the field further emphasize the significance of personal social support for genetic counseling students as they are exposed to patient situations that may further drive negative outcomes.
Evaluating the current landscape of perceived social support for genetic counseling trainees may be of value to genetic counseling program directors and administrators. While the results of previous quantitative demographic studies of genetic counseling students may enable inferences regarding available support, a focused assessment of perceived social support among genetic counseling trainees would address this topic appropriately. Describing the state of perceived social support for genetic counseling students is the first step to create a framework for future studies to evaluate its association with positive and/or protective mental health outcomes. To our knowledge, this is the first study to explore the state of social support among genetic counseling students. Our aim is to describe the state of social support available to genetic counseling students in graduate programs across the US and Canada. Understanding such support for genetic counseling students will lay the groundwork for future studies to address the potential correlation with positive genetic counseling student outcomes.
2 METHODS
2.1 Participants
This study included genetic counseling students enrolled in the 51 training programs accredited by the Accreditation Council for Genetic Counseling (ACGC) at the time of the study: 47 in the United States and four in Canada. Training program sizes ranged from four to 30 students. Both first- and second-year students were invited to participate. To reduce recall bias, recent graduates were not included in this study. A survey was sent electronically through the Association of Genetic Counseling Program Directors (AGCPD) listserv. Program directors were invited to share the survey with students enrolled in their respective training programs. According to the AGCPD, 464 students were matched to programs for the 2019–2020 academic year, and 492 students were matched for the 2020–2021 academic year (GC Admissions Match Statistics, 2020). Given these enrollment statistics, an estimated 956 genetic counseling students were eligible to participate in this study.
2.2 Procedures
Study data were collected and managed using the REDCap electronic data capture tools (Harris et al, 2009, 2019) hosted at the University of Nebraska Medical Center. Service and support were provided by the Research Information Technology Office (RITO), which is funded by the Vice Chancellor for Research. The survey included three sections: (1) demographics; (2) self-identified sources of social support; (3) assessment of a strong social support network. The demographic section of the survey was adapted from a previous study of genetic counseling students designed to describe certain demographic features of future genetic counselors entering the workforce (Lega et al., 2005; Supplemental file). Amendments were made to be more inclusive and included questions about age, gender identity, number of roommates, and other variables outlined in Table 1. Gathering this demographic information allowed comparisons between our survey population and data previously collected by Lega et al. No personal identifying information was collected.
| Variable | Number of respondents (n = 238) | % |
|---|---|---|
| Age (mean: 24.80; range: 21–40; SD: 3.03) | 236 | |
| Gender identity | ||
| Female | 227 | 95.38 |
| Male | 10 | 4.20 |
| Self-described: agender | 1 | 0.42 |
| Race/Ethnicity | ||
| African-American/Black | 6 | 2.52 |
| Latinx-Hispanic | 11 | 4.62 |
| Native American/Alaska Native/First Nations | 1 | 0.42 |
| Native Hawaiian/Pacific Islander | 0 | 0.00 |
| East/Southeast Asian | 21 | 8.82 |
| South Asian | 10 | 4.20 |
| Middle Eastern/North African/West Asian | 2 | 0.84 |
| White | 211 | 88.66 |
| Prefer to self-describe | 0 | 0.00 |
| Relationship status | ||
| Single | 149 | 62.61 |
| Married | 28 | 11.76 |
| Engaged | 17 | 7.14 |
| Domestic partnership | 26 | 10.92 |
| Separated/divorced | 0 | 0.00 |
| Other | 18 | 7.56 |
| Part of disability community | ||
| Yes | 10 | 4.20 |
| No | 228 | 95.80 |
| Roommate | ||
| Yes | 195 | 81.93 |
| No | 43 | 18.07 |
| Online graduate school program | ||
| Yes | 98 | 41.18 |
| No | 140 | 58.82 |
| Year in program | ||
| 1st Year | 129 | 54.20 |
| 2nd Year | 109 | 45.80 |
| # Parents/Guardians Reported | ||
| 0 | 18 | 7.56 |
| 1 | 22 | 9.24 |
| 2 | 198 | 83.19 |
| Parent/Guardian combined annual income | ||
| <20,000 | 4 | 1.82 |
| 20,001–40,000 | 8 | 3.64 |
| 40,001–60,000 | 19 | 8.64 |
| 60,001–80,000 | 21 | 9.55 |
| 80,001–100,000 | 24 | 10.91 |
| 100,001–120,000 | 26 | 11.82 |
| 120,001–140,000 | 22 | 10.00 |
| 140,001–160,000 | 12 | 5.45 |
| >160,000 | 48 | 21.82 |
| Unsure | 36 | 16.36 |
In the second section of the survey, the participants were asked to self-identify areas of support by selecting one or more of the following: parents/family members, spouse/partner, teacher/professor, community mentor, faith/spirituality/religion, pets, hobbies, classmates, friends, or other. Once selected, additional questions assessed the nature of the identified support, including frequency of interaction and method of interaction. If “other” was selected, participants were given an open-ended response option to further describe their source of support. This portion of the survey was developed based on support described by Sedlacek (2017), informal discussions with colleagues familiar with sources of support, and personal/lived experiences of the primary investigator.
The final section of the survey included 15 statements adapted from a previous study and was meant to assess the availability of a strong social support network (Sedlacek, 2017). Respondents were asked to indicate their level of agreement with each statement, measured by a 5-point Likert scale (1 = strongly agree; 5 = strongly disagree). Six statements were framed in a positive manner, and nine were framed in a negative manner. The nine negative statements were designated to be reverse-coded upon data analysis.
Survey responses were collected from September 16, 2020, through November 23, 2020. Survey reminder prompts went to the AGCPD listserv on October 2 and October 15. This protocol was deemed exempt by the Internal Review Board of the University of Nebraska Medical Center (IRB #481-20-EX).
2.3 Data analysis
Descriptive statistics were used to summarize data from the first and second sections of the survey (demographic information and self-identified sources of social support). All 15 questions from the social support tool were then adjusted so that higher scores were associated with increased availability of social support. Associations with average social support were assessed using Spearman correlations for count data and independent samples t-tests for dichotomous data (except in the case when subgroup sizes were small (<30), in which case Wilcoxon Rank Sum test p-values were reported alongside means and standard deviations). Subgroup associations between two categorical variables were assessed using Chi-Square tests or Fisher's exact test when expected cell counts were low. All analyses were performed using SAS software version 9.4 (SAS Institute Inc.).
3 RESULTS
This study captured 253 student responses. The estimated response rate is 26.5%, which assumes all program directors shared the survey with their students. Of these, 15 respondents did not complete the survey, and, therefore, the authors excluded those responses leaving 238 participant responses for data analysis (24.9%).
3.1 Demographic characteristics of genetic counseling students
Table 1 summarizes student demographic data. Students ranged in age from 21–40 years old (mean = 24.80 years, SD = 3.03 years) with the majority of respondents identifying as female (95.38%), while others identified as male (4.20%) or agender (0.42%). The majority of participants identified as White (88.66%). Participants also reported the following: East/Southeast Asian (8.82%); Latinx-Hispanic (4.62%); South Asian (4.20%); African-American/Black (2.52%); Middle Eastern/North African/West Asian (0.84%); Native American/Alaska Native/First Nations (0.42%). Additionally, 22 respondents identified two ethnicities (9.24%), and one respondent identified three ethnicities (0.42%).
Ten respondents identified as part of the disability community (4.2%). Regarding relationship status, a majority of respondents identified themselves as single (62.61%); 28 respondents identified as married (11.76%); 26 reported a domestic partnership (10.92%); 17 were engaged (7.14%); and 18 identified “other” (7.56%) and were invited to self-describe. Next, nearly 82% of respondents indicated living with a roommate. Of those who did, 85.64% reported one to two roommates while the remaining 14.35% reported living with three to six roommates. Of those who reported one or more roommates, 36.92% reported that a roommate was another genetic counseling student (comprising 30.25% of all respondents).
Considering the COVID-19 pandemic, the definition of an online genetic counseling program was expanded to capture those students in programs typically in-person but where instruction moved online because of the public health crisis. For this reason, this study defines an online genetic counseling program as (1) a program typically offered online; (2) a program that pivoted to completely online coursework with no or few (<4) in-person campus visits throughout the 2020–2021 academic year. Given this provisional definition, 41.18% of students indicated enrollment in an online program, and 58.82% reported enrollment in an in-person program. Just over half of the participants were in the first year of their program, leaving just under half in the second and final year of their program.
3.2 Parent and/or Guardian characteristics of genetic counseling students
Twenty-two students (9.24%) reported having one parent/guardian, and 198 (83.19%) reported having two parents and/or guardians. Combined annual income data revealed 49.09% of students reporting an annual income for their parent(s)/guardian(s) of $100,000 or more. Of the remaining respondents, 34.56% reported an annual parent/guardian income below $100,000. Finally, 16.36% were unsure of parental/guardian annual income. Detailed parental/guardian data is in Table 1.
3.3 Self-Identified sources of social support
For this study, the operational definition of social support adopted was a source of encouragement, comfort, and/or an emotional connection. When asked to identify all sources of social support that applied, more than half of respondents selected parents/family, friends, classmates, and spouse/partner, while fewer students selected hobbies, teacher/professor, pets, faith/spirituality/religion, community mentor, and others. When respondents selected “other,” the survey prompted them to self-describe. Responses included therapist, counselor, extended family, the local queer community, and a fitness instructor as sources of alternative support. The median number of support types identified by respondents was 5.0 (IQR: 4.0, 6.0).
The majority of respondents identified parents/family members, friends, classmates, and/or a spouse/partner as sources of support. Individuals who selected parents/family as a source of support were most likely to interact with this support through phone calls and text messaging (93.42%). Respondents were most likely to see their parents/family once per semester (44.30%) and interact with them from a distance (e.g., phone calls, video chat, texts, emails, letters, etc.) at least once per week (55.26%).
Participants who selected friends as a source of support were most likely to interact with friends in some capacity at least once a week (42.4%), in person on a monthly basis (32.11%), and from a distance at least once a week (46.33%).
Participants who selected classmates as a source of support were most likely to interact with classmates in some capacity at least once a week (48.06%), in person at least once a week (41.75%), and from a distance daily (52.43%).
Meanwhile, those who selected a spouse/partner as a source of support were most likely to interact with them in person (92.0%) and through text messaging (88.67%). The majority of respondents saw their spouse/partner daily (54.0%) and interacted with them from a distance daily as well (76.0%).
Fewer participants identified sources of support in hobbies, teacher/professor, pets, faith/spirituality/religion, community mentor, or others. For respondents who identified hobbies as a source of support, the median number of hobbies was two, and the median time spent per week engaging in a hobby was 6 h (IQR: 5.0, 10.0).
Participants who selected a teacher/professor as a source of support were most likely to interact with them by email (88.46%) followed by video chat (75.0%). Respondents were most likely to interact with a teacher/professor in person on a weekly basis (50.96%) and from a distance on a weekly basis as well (72.12%).
For respondents who identified pets as a source of support, 83.67% interacted with them daily. Those who identified faith/spirituality/religion as a support source were most likely to interact with this support on a weekly basis (55.88%).
Participants who selected a community mentor as a source of support were most likely to interact with them by phone call (45.15%). Most respondents who reported a community mentor as a source of social support identified never interacting with them in person (46.15%) but interacting with them from a distance on a monthly basis (53.85%).
3.4 Availability of a strong social support network
Assessment of the availability of a strong social support network showed the mean social support score was 3.84 on a 5-point Likert scale with a standard deviation of 0.37. Detailed data is in Table 2.
| Question number | Raw mean social support score (n = 238) | Reverse-coded mean social support score | SD |
|---|---|---|---|
| Question 1* | 3.65 | 2.35 | 1.04 |
| When I have a problem in my life, I like to handle it myself. | |||
| Question 2 | 3.89 | 0.79 | |
| When I have a problem in my life, I like to seek advice on how to handle it. | |||
| Question 3 | 4.58 | 0.60 | |
| I have someone in my life that I have turned to when I need advice. | |||
| Question 4 | 4.05 | 0.86 | |
| I have had a teacher who has given me good advice. | |||
| Question 5* | 2.53 | 3.47 | 1.16 |
| No one in my family can give me good advice on academic issues. | |||
| Question 6* | 1.92 | 4.08 | 0.92 |
| No one in my family can give me good advice on personal issues. | |||
| Question 7* | 2.01 | 3.99 | 0.85 |
| It is best to keep your problems to yourself. | |||
| Question 8* | 1.80 | 4.20 | 0.72 |
| I do not have problems I need help with. | |||
| Question 9* | 2.03 | 3.97 | 0.72 |
| Usually, the advice you get from others is not good. | |||
| Question 10* | 2.12 | 3.88 | 0.71 |
| I do not like to listen to others on handling issues. | |||
| Question 11 | 4.82 | 0.39 | |
| Everyone needs help sometimes. | |||
| Question 12* | 2.02 | 3.98 | 0.75 |
| Most people are too involved with their own issues to give good advice. | |||
| Question 13 | 4.20 | 0.68 | |
| When I am not sure of something, I have someone I check it out with. | |||
| Question 14* | 4.02 | 1.98 | 0.67 |
| I am good at figuring things out for myself. | |||
| Question 15 | 4.10 | 0.84 | |
| When things are tough, I know where to go. |
- Note: Asterisks denote negatively worded questions. Raw mean scores are provided for these questions as well as adjusted mean scores (raw mean score subtracted from 6).
Second-year students were more likely to have higher average social support scores (mean = 3.89, SD = 0.37) than first-year students (mean = 3.79, SD = 0.37), though the difference did not reach statistical significance (t(236) = −1.89, p = 0.06). The more support types a respondent self-identified, the higher their average social support score (rho(238) = 0.18, p = 0.01; Table 3). Respondents also had significantly higher average social support scores if they indicated friends as a source of support (mean = 3.87, SD = 0.36) than if they did not (mean = 3.52, SD = 0.42; z = −3.48, p < 0.001). The identification of classmates as a source of social support was associated with significantly higher average social support scores (mean = 3.86, SD = 0.36) than for those who did not identify classmates as a support source (mean = 3.67, SD = 0.42; t(236) = −2.78, p = 0.006). Similar to the results of social support for second-year students compared to first-year students, those who identified faith/spirituality/religion as a support source (mean = 3.93, SD = 0.28) tended to have higher social support scores than those who did not (mean = 3.82, SD = 0.38), but not to any degree of statistical significance (t(55.4) = −1.90, p = 0.06).
| Support variable | n | Mean social support score | SD | p-value |
|---|---|---|---|---|
| Year in graduate school | ||||
| First Year | 129 | 3.79 | 0.37 | 0.06 |
| Second Year | 109 | 3.89 | 0.37 | |
| # of roommates (Spearman Correlation) | Rho = −0.04 | 0.62 | ||
| Sum of support types (Spearman Correlation) | Rho = 0.18 | 0.01 | ||
| Support from parents/family members | ||||
| Yes | 228 | 3.84 | 0.37 | 0.18a |
| No | 10 | 3.65 | 0.43 | |
| Support from spouse/partner | ||||
| Yes | 150 | 3.85 | 0.38 | 0.41 |
| No | 88 | 3.81 | 0.37 | |
| Support from teacher/professor | ||||
| Yes | 104 | 3.88 | 0.37 | 0.09 |
| No | 134 | 3.80 | 0.37 | |
| Support from community mentor | ||||
| Yes | 13 | 3.86 | 0.39 | 0.82a |
| No | 225 | 3.84 | 0.37 | |
| Support from Faith/Spirituality/Religion | ||||
| Yes | 34 | 3.93 | 0.28 | 0.06 |
| No | 204 | 3.82 | 0.38 | |
| Support from pets | ||||
| Yes | 98 | 3.86 | 0.36 | 0.35 |
| No | 140 | 3.82 | 0.38 | |
| Support from hobbies | ||||
| Yes | 111 | 3.84 | 0.36 | 0.80 |
| No | 127 | 3.83 | 0.39 | |
| Support from classmates | ||||
| Yes | 206 | 3.86 | 0.36 | 0.006 |
| No | 32 | 3.67 | 0.42 | |
| Support from friends | ||||
| Yes | 218 | 3.87 | 0.36 | <0.001a |
| No | 20 | 3.52 | 0.42 | |
| Support from other | ||||
| Yes | 8 | 3.80 | 0.39 | 0.87a |
| No | 230 | 3.84 | 0.37 | |
- Note: p-values were derived from independent samples t-tests unless otherwise noted.
- a Wilcoxon Rank Sum test was used due to low subgroup size.
Among respondents who identified at least one roommate, there was no significant association between the number of roommates and average social support response (rho(195) = −0.04, p = 0.62). Similarly, respondents who identified parents/family members as a source of support did not have significantly different social support scores relative to those who did not. The same was true of the following support sources: spouse/partner, teacher/professor, community mentor, pets, hobbies, and other sources of support. Social support outcomes are in Table 3.
A subgroup analysis of individuals identifying as White compared to those who did not was run to assess potential disparities in perceived social support among genetic counseling students. A significantly higher proportion of students who identified as White reported receiving support from friends (93.36%) than students who did not identify as White (77.78%; p = 0.02, Fisher's Exact test). Furthermore, students who identified as White had higher average social support responses (mean = 3.86, SD = 0.37) than students who did not identify as White (mean = 3.69, SD = 0.37), (z = −2.58, p = 0.01). There were no other statistically significant differences between the two groups.
4 DISCUSSION
This study explores genetic counseling students' perceptions of available social support as they progress through training programs in the United States and Canada. We obtained demographic information and asked participants to self-identify sources of support. We then assessed the availability of a strong social support network using a tool previously outlined by Sedlacek (2017). The authors define social support as a source of encouragement, comfort, and/or an emotional connection. Our results indicate a positive correlation between increased social support scores and the number of social support outlets. While previous studies have demonstrated the importance of social support, this study reveals that social support in the form of friends or classmates was associated with significantly increased social support scores among genetic counseling students. These findings suggest that community among classmates is an important part of a genetic counseling student's support system. Program directors and stakeholders in genetic counseling student success are encouraged to acknowledge the impact of support from classmates, as it has the potential to be a mitigating factor for burnout and compassion fatigue, both known phenomena in the field of genetic counseling.
4.1 Student demographics
The majority of respondents identified themselves as single, White females in their mid-20s, on average. This is similar to demographic data from previous demographic studies of genetic counseling students (Lega et al., 2005; Stoddard et al., 2021). Diversity in gender identity (10 males and one agender respondent) and racial-ethnic diversity (25 respondents) was noted in the survey data. Also, 10 individuals identified as part of the disability community. Comparatively, the current study revealed higher percentages of respondents for most non-White racial/ethnic groups than the demographics of the Professional Status Survey (PSS) released by the National Society of Genetic Counselors (NSGC, 2020) at the time of the study. While the authors are hopeful that the increased diversity of the student respondents is the result of diversity and equity initiatives, it is unclear whether these findings represent a shift in the race/ethnicity of emerging genetic counseling professionals or if these results reflect the study population only.
Furthermore, annual income for students' parents was largely comparable to the Stoddard et al. (2021) study and the Lega et al. (2005) study, where slight differences are evident among the data sets, but general patterns are consistent. Because of the similarities, the findings from this study may be generalizable.
Participants identified their enrollment in an online or an in-person training program. In light of the COVID-19 pandemic, the authors expanded the definition of an online genetic counseling program to capture those students in genetic counseling programs that are typically in-person but where instruction has moved online because of the public health crisis. While the majority of students still reported learning from an in-person program, the provisional definition of an online school revealed just over 40% of students learning in an online program. This is greater than would be expected in non-COVID times, as only two genetic counseling programs in the United States and Canada were online programs previously. Thus, this provisional definition of an online program may have affected the findings of this study. Furthermore, the pandemic and the subsequent shift to online learning may have affected how students interacted with their reported social support sources and the frequency of those interactions. This potential impact is especially important when considering interaction with classmates, as previous research has shown that interaction with classmates is an essential factor in effective online learning (Swan, 2002). Aside from classmates, other social supports (e.g., parents/family members and friends) may also have been affected. It is important to keep in mind the effects of the pandemic when considering the findings of this study.
4.2 Self-identified support sources
Most participants identified parents/family members, friends, classmates, and/or a spouse/partner as sources of support. Fewer participants identified sources of support in hobbies, teacher/professor, pets, faith/spirituality/religion, community mentor, or other.
Participants were most likely to interact with a spouse/partner daily, both in person and remotely. This was the highest rate of interaction compared with any other support. The next-highest rate of interaction was with classmates followed by teacher/professor. On the contrary, community mentors were interacted with the least, suggesting this may not be a primary support source for this population of genetic counseling students. However, researchers must also consider the likely decrease in interaction with community mentors due to the impact of the pandemic.
4.3 Support variables related to social support scores
The mean social support score for participants was 3.84 on a 5-point scale, where higher scores are associated with increased social support. The identification of friends or classmates as support sources was associated with significantly increased social support scores despite not being the most frequently interacted-with support sources. On the contrary, while spouse/partner was the most frequently interacted-with source of support, it was not associated with significantly increased social support scores. These findings suggest that the frequency of interaction with a source of support does not necessarily increase perceived social support. Increased numbers of support sources were also associated with significantly increased social support scores. This finding suggests that the quantity of sources is indeed important in terms of social support. Increased opportunities for involvement and connection for graduate students may facilitate increased social support sources and in turn, social support scores. Potential strategies for facilitating support may include implementing a program-wide student mentorship/buddy program; connecting students with a university-wide peer mentorship program; identifying genetic counseling and community mentors; planning program-wide and/or class-wide social events (including events that do and do not involve program leadership, professors, and supervisors); or generally fostering connections among students when possible.
Social support scores for second-year students were higher than for first-year students, though not significant at the 0.05 alpha level. This difference is likely due to the nature of second-year students having had more time to become established in their role as graduate students. The process of establishing oneself in this role allows an individual to develop relationships with support sources like teachers/professors and especially classmates. It also allows for exposure to opportunities to augment existing support sources and/or develop new ones.
While an increased number of social support sources was associated with significantly increased social support scores, an increased number of roommates was not. This finding may be explainable by considering that increased numbers of roommates may not necessarily indicate supportive relationships therewith. In this case, the quality of roommate relationships may be more indicative of increased support than the quantity of roommates. Interestingly, the identification of parents/family members as a source of support was also not associated with significantly increased social support scores despite its being the most frequently selected source of support. It is difficult to hypothesize why this might be, as myriad reasons are possible, all of which may be compounded by the effects of the pandemic on students' interactions with their parents/family members. Nevertheless, this finding supports the notion that the commonality of a specific support source among participants does not necessarily inform perceptions of social support.
According to Sedlacek (2011), students who have a strong, influential support source who can provide advice in crisis situations typically do well in school. The source of this support may vary, whether it is in the education system itself or the immediate family. Sedlacek's research further reveals that underrepresented individuals may not have these same sources of support available and instead find support in a community member or other source. Underrepresented students who have developed supportive relationships typically do better in academic settings than those who have not. To this point, subgroup analysis focused on differences in self-identified social support sources and overall social support scores for racially/ethnically underrepresented respondents to promote an emphasis on diversity and inclusion. A significantly lower proportion of underrepresented students reported receiving support from friends than did students who identified as White. Underrepresented participants also had significantly lower overall mean social support scores than White participants. These results suggest program leaders should focus efforts on facilitating social support for underrepresented students. Providing opportunities for this support may include connecting the student with the Minority Genetics Professional Network (Mann, 2020), a mentor through the university's academic affairs program, a university-wide peer mentorship program, or sharing information for counseling available through the university's student support center. Furthermore, Carmichael et al. (2021) discovered that genetic counseling students who identify as a racial or ethnic minority at times prefer support from someone who shares their minority identity; therefore, appropriate support for underrepresented individuals may also include diverse faculty and staff. To promote diversity in this field, it is necessary that underrepresented individuals have sufficient sources of support as this correlates with their success in training programs. It is imperative that the genetic counseling workforce represents the diverse population it serves.
4.4 Limitations
Several limitations of the study present; for example, the estimated response rate of 24.9% assumes all program directors shared the survey invitation email with their students. The true response rate may be higher as there was no way to confirm that all program directors shared the survey with their students.
Another limitation is related to how the survey captured individual identities. The survey provided an inclusive list of race and ethnic identities recognizing individuals can have more than one racial and ethnic identity. Participants who identified as being White and being in an underrepresented group were included in the analysis for White participants only. Future studies can utilize a formal categorization system to address this issue and capture the varied experiences of underrepresented genetic counseling students.
Furthermore, the underrepresented group of respondents included many racial/ethnic identities. By grouping all these identities into one underrepresented group, the data does not truly represent the individual experiences of all respondents in that group. This could result in non-significant results because the average of the individual responses from the underrepresented group may have masked differences for the specific race/ethnicity. The average could be similar to those responses from the group of White respondents and fail to highlight specific points to consider for individuals within the underrepresented group (among other potential issues). Furthermore, the small sample size for underrepresented participants means statistical significance was difficult to achieve. Another limiting factor of the study was the necessary provisional definition of an online training program given the global health crisis. This expanded definition may have skewed social support findings associated with traditionally online or in-person programs. Last, we did not capture qualitative data concerning perceived social support. The highly individualized manner in which we each exist in relationships and the ways in which the COVID-19 pandemic impacted how we communicated and interacted with each other cannot, for example, be captured via quantitative survey items.
4.5 Future areas of research
The authors are hopeful that diversity in genetic counseling will continue to increase in the future. Future studies can include research on the impact of social support among individuals who identify from an underrepresented group in genetic counseling. Specifically, this study suggests a need to identify sources of social support for underrepresented genetic counseling students, and this is an area of limited knowledge. Social support outcomes of traditionally in-person programs versus online programs represent another direction for future study. This study also provides a framework for future studies to address predictors, mediators, and moderators of potential relationships among perceived social support and positive genetic counseling student outcomes.
5 CONCLUSION
Social support is an important factor for genetic counseling students progressing through training programs, and students in this study identified a diverse range of social support sources. The central findings of the study are that friends, classmates, and/or an increased number of varied support sources were the main variables associated with increased social support scores. Stakeholders in genetic counseling student success may appreciate these findings for their application in facilitating or encouraging social support for graduate students. Specific to the genetic counseling training program, this study underscores the importance of classmates as a source of social support and its potential to mitigate compassion fatigue and burnout. Therefore, training programs should consider fostering a community and culture of support for students. There are a number of ways for students, program leadership, faculty, and staff to facilitate such a culture of support. Future research could assess student outcomes with interventions designed to enhance social support in this setting.
AUTHOR CONTRIBUTIONS
Authors Sierra Clark and Kaeli Samson confirm that they had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All of the authors gave final approval of this version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
ACKNOWLEDGMENTS
The research presented in this paper was conducted while the first author was in a genetic counseling training program.
CONFLICT OF INTEREST STATEMENT
Authors Sierra Clark, Victoria Kennel, Kaeli Samson, and Holly Zimmerman declare that they have no conflicts of interest. Author Sarah McBrien was serving a three-year term on the Accreditation Council for Genetic Counseling Board of Directors (2020–2023) at the time of the study.
HUMAN STUDIES AND INFORMED CONSENT
This study was reviewed and granted an exemption by the Internal Review Board of the University of Nebraska Medical Center (IRB #481-20-EX). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Implied informed consent was obtained for individuals who voluntarily completed the online survey and submitted their responses.
ANIMAL STUDIES
No non-human animal studies were carried out by the authors of this article.
Open Research
DATA AVAILABILITY STATEMENT
Data for this study are not available publicly to avoid compromising ethical standards.
