PROFESSIONAL ISSUES

Learning to Define Myself

Sarah Bradley

Received: 6 October 2011 /Accepted: 16 November 2011 /Published online: 13 December 2011# National Society of Genetic Counselors, Inc. 2011

Keywords Fail . Board exam . Defining moment

My defining moment came in 2009 when I failed my boardcertification exam. As most people can imagine, and somepeople can attest to, not passing the board exam isheartbreaking, discouraging, and disappointing. On a basiclevel, the board exam is the culmination of our geneticcounseling education. However, as a recent graduatestruggling to build my confidence I also saw the test as aproving ground: if I passed I was a good genetic counselor.I only entertained the idea of failing in hushed jokes withfriends, but this seemed unlikely because I was studyinghard and I didn’t actually know of anyone who had failedbefore. In retrospect it is clear that I was setting myself upfor disaster with this mentality.

No matter your confidence level walking out of the test,opening that envelope bearing the ABGC insignia at theend of October is truly terrifying. Seeing that I had notscored above the cut-off mark was dumbfounding. In thatmoment it felt like the worst thing in the world. How couldthis happen? Panicked, I threw the offending piece of paperin a drawer, unable to look at it further. I felt like I wasgoing to be sick as I paced my apartment. I called a friendwho listened and then talked to fill the silence while I cried.

That evening emails began popping up from my well-intentioned classmates, checking in to see how our grouphad faired. I told them about my result in a terse message.

It was several days before I could bring myself to tellanyone else, including my closest family and friends. I feltlike a colossal failure. I had never failed at anything in mywhole life, and I had screwed up on the biggest (and mostexpensive) test I’d ever taken. I couldn’t face my well-meaning family, friends or co-workers because I wasembarrassed and ashamed. I felt miserable and alone,despite encouraging words from my supportive classmates.I worried I was becoming like the Saturday Night Livecharacter, Debbie Downer, perpetually spoiling the goodmoods of my friends during what should have been acelebratory time.

My grief over the exam quickly turned to anger. Afteryears of working to better define the role of a geneticcounselor, the ABGC redesigned the certification exam toreflect the findings of their Practice Analysis. Therefore, thetest offered in 2009 was different from that offered in 2007and every other cycle before that. In the days and weeksafter learning I failed, I railed against the ABGC to myclassmates: We were not adequately informed about what toexpect on the exam! I was particularly peeved that,according to the exam bulletin, I was not deemed a“minimally competent” genetic counselor. I was insulted.Since graduating, I had worked hard to build my CancerCenter’s genetics program and my self-confidence as agenetic counselor. However, to me the board exam was thefinal piece of the puzzle to officially become a geneticcounselor. Failing the test called all of my early successesand development into question, and I found myself facing aprofessional identity crisis. Was I a good, competent geneticcounselor?

S. Bradley (*)Maimonides Cancer Center,6300 8th Ave,Brooklyn, NY 11220, USAe-mail: sbradley522@gmail.com

S. Bradley204 Wren St,Scotia, NY 12302, USA

J Genet Counsel (2012) 21:175–176DOI 10.1007/s10897-011-9428-z

For the next several weeks I reflected on this question. Ihad finally confided in my friends and family, and theytried to assure me that failing was not a reflection of myabilities. I wasn’t convinced. In sharing my failure with aclose circle of other genetic counselors, I learned that a fewthat I respected deeply had also failed their exams on thefirst try. These were clearly skilled, knowledgeable geneticcounselors—that they had failed to pass their board examon the first attempt didn’t change that, and perhaps itwouldn’t for me, either. They advised me to focus on mysuccesses rather than my failure. I felt confident that I didmy job well and had genuinely helped my patients, andwasn’t that most important? I finally decided that I was agood genetic counselor, despite what my test result mightindicate. I resolved to redouble my efforts, take the examagain the following year, and pass it. I created a virtualstudy group for board exam “re-takers,” and found manyothers in the same situation voicing similar thoughts andfeelings. We compared study strategies and resources, andsupported each other in the long months leading up to the2010 exam window. With the backing of new friends andold, I began to think that I would pass this time around.

I made peace with the ABGC when I attended theirbusiness meeting at the 2009 Annual Education Conferenceand saw a room full of earnest colleagues. I also readcarefully through the ABGC’s website and publishedmaterials, and finally acknowledged that they were notmy enemy. In administering the board certification exam,the ABGC was furthering the genetic counseling profes-sion’s acceptance by the medical field.

During my work hours I strived to rebuild my self-confidence. I prepared case reports, and my presentations at

our Cancer Center’s Hem/Onc Grand Rounds were well-received. I established meaningful relationships with mypatients, following them past their result disclosure andthroughout their treatment course. I delivered successfuloutreach talks in the community and developed a fruitfulcollaboration with my local library system to promotegenetics literacy. One year after slinking around the AECfeeling embarrassed and self-conscious about failing, Ipresented to a plenary session at the 2010 AEC to report onmy community outreach efforts and accepted the Best FullMember Abstract Award. In these endeavors I not onlycultivated confidence in my capabilities as a geneticcounselor, but I also developed deep pride in my work.

To anyone who finds herself or himself in thissituation I say this: Failing is hard, but it’s not evenclose to being the worst thing in the world, even thoughit might feel that way at first. Focus on the love andsupport from your family and friends. Find others in thesame situation, because you are definitely not alone.Focus on the little successes you achieve in your workon a daily basis, and build on those. Before you knowit your confidence will come back, just as it did for me.Over a year after learning I failed my board exam I feelmore self-assured in my role and confident in myprofession than I ever was before. After returning fromDallas this year I received another envelope from theABGC. This time when I cried, it was happy tears. I’m proudto claim the letters “CGC,” but the satisfaction comes fromseeing my hard work rewarded, not from justifying myself asa professional. It wasn’t an easy lesson, but in the last year Ilearned that certification does not define me as a geneticcounselor, I define myself.

176 Bradley