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

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 board certification exam. As most people can imagine, and some people can attest to, not passing the board exam is heartbreaking, discouraging, and disappointing. On a basic level, the board exam is the culmination of our genetic counseling education. However, as a recent graduate struggling to build my confidence I also saw the test as a proving ground: if I passed I was a good genetic counselor. I only entertained the idea of failing in hushed jokes with friends, but this seemed unlikely because I was studying hard and I didn’t actually know of anyone who had failed before. In retrospect it is clear that I was setting myself up for disaster with this mentality. No matter your confidence level walking out of the test, opening that envelope bearing the ABGC insignia at the end of October is truly terrifying. Seeing that I had not scored above the cut-off mark was dumbfounding. In that moment it felt like the worst thing in the world. How could this happen? Panicked, I threw the offending piece of paper in a drawer, unable to look at it further. I felt like I was going to be sick as I paced my apartment. I called a friend who listened and then talked to fill the silence while I cried. S. Bradley (*) Maimonides Cancer Center, 6300 8th Ave, Brooklyn, NY 11220, USA e-mail: [email protected] S. Bradley 204 Wren St, Scotia, NY 12302, USA

That evening emails began popping up from my wellintentioned classmates, checking in to see how our group had faired. I told them about my result in a terse message. It was several days before I could bring myself to tell anyone else, including my closest family and friends. I felt like a colossal failure. I had never failed at anything in my whole life, and I had screwed up on the biggest (and most expensive) test I’d ever taken. I couldn’t face my wellmeaning family, friends or co-workers because I was embarrassed and ashamed. I felt miserable and alone, despite encouraging words from my supportive classmates. I worried I was becoming like the Saturday Night Live character, Debbie Downer, perpetually spoiling the good moods of my friends during what should have been a celebratory time. My grief over the exam quickly turned to anger. After years of working to better define the role of a genetic counselor, the ABGC redesigned the certification exam to reflect the findings of their Practice Analysis. Therefore, the test offered in 2009 was different from that offered in 2007 and every other cycle before that. In the days and weeks after learning I failed, I railed against the ABGC to my classmates: We were not adequately informed about what to expect 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 Cancer Center’s genetics program and my self-confidence as a genetic counselor. However, to me the board exam was the final piece of the puzzle to officially become a genetic counselor. Failing the test called all of my early successes and development into question, and I found myself facing a professional identity crisis. Was I a good, competent genetic counselor?

176

For the next several weeks I reflected on this question. I had finally confided in my friends and family, and they tried to assure me that failing was not a reflection of my abilities. I wasn’t convinced. In sharing my failure with a close circle of other genetic counselors, I learned that a few that I respected deeply had also failed their exams on the first try. These were clearly skilled, knowledgeable genetic counselors—that they had failed to pass their board exam on the first attempt didn’t change that, and perhaps it wouldn’t for me, either. They advised me to focus on my successes rather than my failure. I felt confident that I did my job well and had genuinely helped my patients, and wasn’t that most important? I finally decided that I was a good genetic counselor, despite what my test result might indicate. I resolved to redouble my efforts, take the exam again the following year, and pass it. I created a virtual study group for board exam “re-takers,” and found many others in the same situation voicing similar thoughts and feelings. We compared study strategies and resources, and supported each other in the long months leading up to the 2010 exam window. With the backing of new friends and old, I began to think that I would pass this time around. I made peace with the ABGC when I attended their business meeting at the 2009 Annual Education Conference and saw a room full of earnest colleagues. I also read carefully through the ABGC’s website and published materials, and finally acknowledged that they were not my enemy. In administering the board certification exam, the ABGC was furthering the genetic counseling profession’s acceptance by the medical field. During my work hours I strived to rebuild my selfconfidence. I prepared case reports, and my presentations at

Bradley

our Cancer Center’s Hem/Onc Grand Rounds were wellreceived. I established meaningful relationships with my patients, following them past their result disclosure and throughout their treatment course. I delivered successful outreach talks in the community and developed a fruitful collaboration with my local library system to promote genetics literacy. One year after slinking around the AEC feeling embarrassed and self-conscious about failing, I presented to a plenary session at the 2010 AEC to report on my community outreach efforts and accepted the Best Full Member Abstract Award. In these endeavors I not only cultivated confidence in my capabilities as a genetic counselor, but I also developed deep pride in my work. To anyone who finds herself or himself in this situation I say this: Failing is hard, but it’s not even close to being the worst thing in the world, even though it might feel that way at first. Focus on the love and support from your family and friends. Find others in the same situation, because you are definitely not alone. Focus on the little successes you achieve in your work on a daily basis, and build on those. Before you know it your confidence will come back, just as it did for me. Over a year after learning I failed my board exam I feel more self-assured in my role and confident in my profession than I ever was before. After returning from Dallas this year I received another envelope from the ABGC. This time when I cried, it was happy tears. I’m proud to claim the letters “CGC,” but the satisfaction comes from seeing my hard work rewarded, not from justifying myself as a professional. It wasn’t an easy lesson, but in the last year I learned that certification does not define me as a genetic counselor, I define myself.