Introduction

Mentorship plays a pivotal role in facilitating personal and professional development at all stages of healthcare training. Mentorship describes a relationship in which a more experienced individual acts as a guide to someone with less experience (Fulton 2013), as compared to peer support, in which two individuals with similar experience are matched to provide support to each other. In medicine and nursing, mentorship is recognized as an important facilitator of professional satisfaction, recruitment, and retention (Minor and Bonnin 2022; Mijares and Radovich 2020; Price 2009). For similar reasons, a growing number of mentorship programs have been established within the genetic counseling (GC) field to support prospective students (Watson et al. 2023; Prospective GC Guidance Program 2023; Mann 2020; Clover Genetics 2022). These programs typically include individualized mentorship and feedback on graduate school application documents, as well as group activities (Watson et al. 2023; Fasaye et al. 2022). Although data are limited, in the existing literature, mentees report a high level of satisfaction with their mentors and mentorship program experiences (Watson et al. 2023). In the context of our mentorship program and this paper, we discuss “international GC applicants”, who are citizens of countries other than the United States (U.S.) and can have different educational, professional, and sociocultural experiences compared to domestic applicants. International GC applicants include those from Canada. While exact statistics are not available for just U.S.-based programs (as available data group together the U.S. and Canada), between 2018 and 2023 7–9% of applicants who completed the admissions process were located outside of the U.S. and Canada (Galada et al. 2024).

International GC applicants and students have unique needs and may benefit from dedicated resources and mentorship efforts (Nassef et al. 2021; Akgumus et al. 2016). Past studies suggest that international GC applicants may have limited familiarity with the U.S-specific graduate admissions and training process, different expectations regarding cultural and professional norms, difficulty adjusting to life in the U.S., and/or specific informational and supportive needs pertaining to immigration (Klopfenstein 2023; Nassef et al. 2021; Akgumus et al. 2016; Sabbadini et al. 2013). These challenges may arise from several factors that vary across countries, including diverse sociocultural influences, distinct educational systems, and differing healthcare processes or infrastructure. While these challenges are also reported by international students in medicine and nursing (Marin and Aghagoli 2022; McKitterick et al. 2021), a compounding factor for international GC applicants is that the GC profession is relatively new in most parts of the world, and as a result, international GC applicants often have extremely limited opportunities to interact with practicing genetic counselors (Neogi et al. 2020; Abacan et al. 2019; Ormond et al. 2018). These opportunities are crucial for gaining exposure to the role of genetic counselors, developing a comprehensive understanding of the required skill set, and receiving insight or guidance on navigating the application, training, and/or employment processes, and are valued in the admissions process by GC graduate programs (Association of Genetic Counseling Program Directors 2023). Galada et al. (2024) further highlighted that international applicants may face unique difficulties in presenting themselves due to differing cultural expectations and suggested that mentorship can help international applicants showcase their qualifications and passion for GC.

International applicants may be the only person in their family or community to apply to a U.S.-based graduate program. Joseph et al. (2021) found that first-generation and international applicants often felt a lack of information and support when navigating the application system. Mentorship and role-modeling were key resources to address questions about the application process. Galada et al. (2024) identified a need among international GC applicants for more concrete information about admissions, including details about transcript requirements, volunteer opportunities, financial aid and student loan options for international students, English-proficiency tests, and science, technology, engineering, and mathematics optional practical training (STEM-OPT) designation (which allows international students who are graduates of eligible programs to extend their student visa to begin working in the U.S. following GC graduate school). These, and others, are unique considerations for international applicants that are not readily addressed by GC graduate programs.

Through interpersonal discussions, we found that genetic counselors (including the authors) had been individually providing mentorship and guidance to international applicants over the years informally, operating in silos without a formal program or support group. The support provided to international GC applicants included advice on topics including, but not limited to, program choice, application materials, pre-requisites, cost and financial assistance options, interview preparation, program selection, international relocation, housing, visas, and job opportunities. Guidance ranged from one-off questions to mentorship relationships, in which an experienced genetic counselor supported a prospective student in multiple ways, including maintaining a relationship through (and beyond) the GC graduate program admissions process. In order to formalize and expand mentorship opportunities, volunteer genetic counselors from the International Special Interest Group (ISIG) of the National Society of Genetic Counselors (NSGC) held informal virtual meetings with prospective, current, and past international students between 2019–2021 to learn about their specific needs and the available resources. Literature review also contributed to program development. Alvarado-Wing et al. (2021) interviewed current and recent GC students in the U.S. who identified as racial or ethnic minorities, finding that mentorship was a positive “touchpoint” during the application and interview processes. This positive impact was perceived as even stronger when the mentee and mentor shared a minority status and speaks to the potential importance of common backgrounds and experiences within the mentorship relationship. In addition, a needs assessment survey of U.S. and Canada-based program directors revealed the need for mentorship and resources tailored for international applicants (Nassef et al. 2021). Subsequently, a mentorship program called the “International Genetic Counseling Mentorship Program’’ (IGCMP) was launched in September 2021 to consolidate, streamline, and expand existing mentorship efforts. The IGCMP is the first and only mentorship program dedicated to international GC applicants seeking admission to U.S.-based GC graduate programs. The IGCMP focused on candidates applying to U.S.-based programs as all available mentors had graduated from U.S.-based programs. Below, we highlight the structure of this mentorship program and provide results from program surveys distributed to collect feedback for program improvement purposes.

Program development

The IGCMP was designed after considering the requirements and typical timeline of a GC graduate program application as well as based on the previously mentioned virtual meetings with prospective, current, and past international GC students and literature review. The main components offered through the program included individual meetings with a primary mentor and feedback on application documents (resume/CV, statement of purpose, and other application materials as required by individual programs). The one-on-one meeting component was intended to facilitate introduction between the mentor and the mentee, facilitate discussion of mentee goals and background for personalized review and feedback, and to set expectations for the mentorship relationship. A resume/CV and statement of purpose are required and important components of U.S.-based GC program applications and their review by a mentor was considered a crucial component for inclusion in the IGCMP. Mock interviews were offered only to mentees who received an interview invitation and were intended to assist with interview preparation. All of these components were also designed keeping in mind that some international applicants may be unfamiliar with resume/CV, statement of purpose, and interview expectations for a U.S.-based program. The timeline for establishing the mentorship relationship and completion of the various components was determined by accounting for the amount of time that may be required for a mentor to provide feedback in a timely manner and to enable mentees to submit their applications by the application deadline. Optional components offered to mentees on an ad-hoc basis included educational webinars tailored to international applicants and informal networking opportunities (“social hours”) with other mentors and mentees. Social hours were designed to facilitate discussion with multiple members of the mentorship program, including other mentors and prospective students, which allowed for conversation regarding mentee experiences and concerns, sharing of perspectives, as well as to answer common questions. Mentees could also engage with additional mentors for informational interviews or to receive feedback on their application documents. All mentor and mentee participants could choose whether to participate in specific tasks (e.g., resume/CV review only, mock interviews only) or to be involved in mentorship program activities for continuous support through the entire application process. The mentorship program was intentionally designed to be semi-structured and mentee-driven, maximizing flexibility for both mentor and mentee participants.

Program eligibility

Mentees were eligible for the program if they were (a) international applicants (i.e., needing a student visa to attend a U.S.-based GC graduate program), and (b) applying to a U.S.-based GC graduate program accredited by the Accreditation Council for Genetic Counseling (ACGC) in the upcoming application cycle. Members of the NSGC ISIG with personal experience as international students were specifically solicited as mentors, but there were no formal mentor eligibility criteria, and anyone interested was able to sign up as a mentor.

Onboarding

Mentees and mentors were paired based on time zones, when possible, to allow for easier scheduling of meetings. Other characteristics considered included country of origin, however, the majority of time it was not possible to match mentees and mentors with the same country of origin due to the relatively small mentor pool. Mentees could also be paired with mentors based on the components of the mentorship program they were interested in and what components specific mentors volunteered to complete (i.e. some mentors only had availability to complete review of application materials but not for one-on-one meetings or mock interviews). Mentees were introduced to their primary mentors via email from the program leaders and encouraged to proactively establish their introductory calls and follow-up meetings. Together, mentors and mentees outlined their goals, strategies, and timeline for working together. All mentees were provided a written mentee program guide and a video overview to familiarize them with the program. Additional resources tailored for international students offered through the ISIG included a Frequently Asked Questions document for international applicants, sample resumes from international GCs, and a Decision Aid considering topics including, but not limited to, housing, transportation, job opportunities, and summer rotations (including financial/cost considerations for each of these items). Mentors were provided a mentor guide outlining expectations for the overall program as well as individual program components, and an interview guide for mock interviews which included community-sourced common admissions interview questions for international applicants, best practices on interview behavior, and a rubric for evaluating the mock interview. Mentors primarily relied on individual experiences (i.e. personal experience applying and/or as admissions committee members) to inform their review of application materials. Mentors could also contact other mentors as a resource if additional input was needed on these items or if they required assistance in addressing a mentee’s specific questions or needs.

Methods

This research was deemed non-regulated after IRB review (HUM00234001).

Participants

Individuals eligible for the first survey (“Sign-Up Form”) were mentees that registered for the IGCMP between September 2021 and November 2023. Individuals eligible for the second survey (“Assessment Form”) were mentees that participated in the IGCMP and applied to GC graduate programs in 2021 and 2022.

Procedures

Both surveys were created using Google Forms and gathered anonymous responses. The Sign-Up Form was distributed through social media and listservs of the Minority Genetics Professionals Network (MGPN) and the ISIG. The Assessment Form was distributed via email to eligible mentees 1–3 weeks after the admissions process concluded and mentees had been told if they obtained a spot in a graduate program that cycle. A reminder email was sent 1–2 weeks after initial Assessment Form distribution.

Instrumentation

The Sign-Up Form included open-ended and multiple-choice questions about the mentee’s educational background, GC program application history, geographic location, and interest in various IGCMP components. The Assessment Form was not modeled after other program evaluation surveys; it was developed with the goal of assessing the usefulness and satisfaction levels of mentees with the components of the IGCMP they participated in. The Assessment Form included multiple-choice questions about application and mentorship history, as well as 5-point Likert scale questions on mentees’ experience with their mentors, their satisfaction with specific components of the IGCMP as well as the program overall, and the utility (“helpfulness”) of different program components. Open-ended questions requesting feedback on what worked well and suggestions for improvement were also included, providing mentees the opportunity to provide comments to assist with improvement of the IGCMP. The most recent versions of these forms are available as Supplementary Material (S1).

Data analysis

Descriptive statistics were used when applicable. Frequencies were reported as percentages for categorical variables.

Results

Fifty-two potential mentees from 19 countries expressed interest in mentorship. Forty-seven of these 52 (90.4%) were eligible for IGCMP participation across three years. Seventeen completed the mentorship program in 2021 and 2022 and applied to at least one U.S.-based graduate program. Of these 17 individuals, 12 (70.6%) completed an IGCMP Assessment Form. A summary of respondents is shown in Fig. 1.

Fig. 1
figure 1

Numbers of program participants and survey respondents

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Sign-up form

Key trends in responses from the Sign-Up Form are described here with additional information available in Supplemental Information (S2). Over half of the participants who responded to the Sign-Up Form (59.5%, n = 28/47) were from India, and the remaining respondents were from Canada (3), Republic of Korea (2), Taiwan (2), Singapore (2), Brazil (1), Egypt (1), Haiti (1), Hong Kong S.A.R. (1), Iran (1), Jordan (1), Lebanon (1), Nigeria (1), Pakistan (1), and Saudi Arabia (1). A few respondents (19.1%, n = 9/47) reported that they worked as a genetic counselor in a country other than the U.S. (Fig. 2a); most of them (77.8%, n = 7/9) had an advanced degree. About one-third of the respondents (34.0%, n = 16/47) had completed or were in the process of completing an advanced degree (Fig. 2b).

About one-third of respondents (31.9%, n = 15/47) had applied to GC programs previously, whereas 68.1% (n = 31/47) were applying for the first time. When asked to select the components of the mentorship program they were most interested in, respondents were generally interested in all the components offered by the program (Fig. 2c), with most respondents interested in one-on-one virtual meetings with practicing international GCs in the U.S. (87.2%, n = 41/47), followed by webinars tailored to international students (80.9%, n = 38/47), and resume/CV feedback (78.7%, n = 37/47).

Fig. 2
figure 2

Mentee responses were collected on a sign-up form. (a) Most respondents had not worked as a genetic counselor previously. (b) One-third of the respondents had completed or were in the process of completing an advanced degree. (c) Most respondents were interested in meeting with international genetic counselors practicing in the U.S., webinars tailored to international students, and resume/CV feedback

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Assessment form

Twenty mentees completed the mentorship program across two cycles; eight in 2021 and 12 in 2022. Of these, 17 applied to graduate school and were eligible to complete the feedback survey. Three decided to apply to graduate school in a future cycle. The response rate for the feedback survey was 70.6% (n = 12/17); eight responses were from 2021 and four were from 2022.

For satisfaction ratings, 83.3% of respondents (n = 10/12) stated they were extremely satisfied with their experience with individual mentor(s) (Fig. 3a), and 83.3% (n = 10/12) were also satisfied or extremely satisfied with the overall program itself (Fig. 3b).

For helpfulness ratings, 75.0% of respondents (n = 9/12) thought that the IGCMP overall was helpful or extremely helpful for their application and interview experience. Considering specific program components, 75.0% of respondents (n = 9/12) found the one-on-one meeting with an international genetic counselor mentor to be helpful or extremely helpful in the application process (Fig. 3c). Additionally, 75.0% of respondents (n = 9/12) indicated that the IGCMP was more helpful than other mentorship or support received previously for GC program applications and interviews.

Fig. 3
figure 3

Mentee feedback on the program was solicited. (a) The majority of mentees were extremely satisfied with their experience with individual mentor(s). (b) Most mentees were also satisfied or extremely satisfied with the overall program itself. (c) The one-on-one meeting with an international genetic counselor mentor was reported as helpful or extremely helpful by most respondents

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All respondents (100.0%, n = 12/12) indicated that they would be interested in continuing their mentor-mentee connection through graduate school, and all respondents (100.0%, n = 12/12) would recommend the mentorship program to another international applicant.

Two open-ended questions asked respondents to comment on what worked well and what could be improved moving forward. Eight respondents provided feedback about what worked well in their experience, highlighting the feeling of being supported by mentors (n = 4) and the ease of connecting with mentors (n = 3). Respondents also appreciated the mock interviews (n = 4) and feedback received (n = 4). One respondent stated:

“The flexibility. I was able to check-in with my mentor when I thought it was best to receive my mentor’s feedback or recommendations. Other mentoring programs I’ve been participated [sic] in (as a mentee) had too many check-ins and it was distracting from the overall goals and my specific needs. For example, I felt comfortable with my search for schools that interested me in the U.S. but I was looking for some guidance in preparing my resume/[statement of purpose]. The targeted help for resume/[statement of purpose] review, mock interviews and debriefing sessions were particularly helpful! Having an open line of communication with my mentor was also very beneficial.”

Only four respondents had suggestions for program improvement: two suggested additional group events such as networking opportunities and webinars/workshops, one suggested implementing a structured timeline with scheduled dates for meetings and task deadlines, and one desired a more intensive mentorship process including additional meetings with mentor(s) over a longer time period, more detailed feedback on application materials, and opportunities to connect with genetic counselors that attended programs of interest to the mentee.

Discussion

Here, we present demographics and findings from a unique mentorship program for international candidates applying to U.S.-based GC programs. The IGCMP program formalized prior decentralized efforts to address the unique needs and concerns of international applicants. Over its first three years, the IGCMP reached applicants from 19 different countries and received positive feedback from mentees, with ease of connecting with mentors, high engagement from mentors, availability of mock interview sessions, and flexibility around participation highlighted as strengths of the program. Mentees highlighted one-on-one meetings with an international GC and resume and statement of purpose review as the most helpful aspects of the program.

When signing up for the IGCMP, the majority of mentees indicated interest in connecting with practicing international genetic counselors, and correspondingly, these meetings were considered extremely helpful in their application process by most mentees. Considering this interest and feedback, and acknowledging the scarcity of genetic counselors in countries outside the U.S., graduate programs receiving interest from international applicants could consider facilitating connections with the IGCMP. Alternatively, linking applicants with the program’s international students, alumni, or faculty members who can offer relevant perspectives could be very helpful. Collaboration between international genetic counselors in the U.S. and professional organizations for genetic counselors in different countries could also benefit mentorship efforts and contribute to the overall growth of the profession.

While a couple of mentees suggested a more defined timeline for mentor-mentee meetings and group events as well as specific deadlines for program tasks, many mentees highlighted the flexibility of the program as one of its strengths. These findings reinforce the importance of personalized goal setting at the start of the mentorship experience. Interestingly, while IGCMP seeks to match pairs based on time zones none of the mentees commented on this as a potential benefit (for those matched with a mentor in a similar time zone) or a weakness (for those matched with a mentor with a time difference). However, time zones were challenging to navigate when scheduling group events such as social hours and webinars, and attendance for these events was low compared to the expressed level of interest. It has been shown that pairing mentors and mentees with shared minority status enhances the mentee experience. While the IGCMP does not specifically match mentors and mentees based on country or origin or other demographics, all mentors are associated with the ISIG and have a personal connection to international GC. Additionally, mentees can be connected with additional mentors for specific concerns or questions in the event that their designated mentor does not have direct relevant experience on a certain topic.

Challenges faced by international applicants include limited familiarity with cultural norms regarding applications materials and interviews, uncertainty around topics including program requirements, relocation, financial considerations, and many other topics. They may also have unique concerns in the interview process, with mentees sharing discomfort with interview questions specific to the potential challenges of being an international student. Examples include questions about being far from family, having English as a second language, and intended country of practice after graduate school. Mentorship can provide tailored, practical information that may not be readily available from GC graduate programs and assist in preparing students to address challenging interview questions. The IGCMP brings together a group of experienced GCs who have navigated these unique challenges and can provide anticipatory guidance to mentees.

Future directions

Based on mentee feedback, future additions to the program could include workshops with information about visas, housing, and finances, more group events for mentors and mentees, and opportunities to meet with current international students. These events could be hosted in collaboration with international offices of graduate schools as well as professional organizations for genetic counselors in other countries to ensure up-to-date and relevant information is being provided.

Every mentee that completed the assessment form expressed interest in maintaining their mentor-mentee relationship throughout their graduate school journey. Additionally, there was a surge in the number of mentees during the third cycle. While all mentees have been successfully paired with mentors thus far, there were challenges in pairing as there was not a corresponding rise in the number of available mentors. Identification of additional mentors is imperative to ensure that all interested mentees can be paired with a mentor. Recruitment of new mentors is planned via social media posts and networking with colleagues. Expanding the mentor pool would allow the IGCMP to explore the possibility of mentorship engagement through graduate school without over-extending existing mentors. It may also allow for matching of mentors and mentees on more specific characteristics, such as country of origin, language(s) spoken, educational background, programs of interest, or other items.

Limitations

Program sign-up was advertised via social media and the MGPN and ISIG listservs, making this information more likely to reach prospective students who already have some connection to the GC community. Therefore, IGCMP mentees may not be reflective of the international GC graduate program applicant pool as a whole. Certain topics important to international applicants were out of scope for the mentorship program surveys and thus are not reported on here. These include how changes to admissions policies and ability to obtain visas in response to the COVID-19 pandemic affected international students, which has been described elsewhere (Galada et al. 2024), and the international student experience as a member of an under-represented minority after relocating to the U.S. While these topics were likely discussed during mentee-mentor interactions, the IGCMP survey questions did not capture the content of mentor-mentee interactions and we did not track or analyze the content of these meetings. Therefore, we were not able to determine how factors such as the COVID-19 pandemic, which was ongoing at the time of program initiation, influenced program participation. Additionally, we did not query how the program impacted applicants from different countries. For example, Canadian applicants may share more similarities with U.S.-based applicants and may have different primary concerns and challenges to other international applicants. Our small sample size prevented us from comparing findings from mentees with different countries of origin and limited us to reporting descriptive statistics. To maintain anonymity of mentee responses, survey findings were analyzed in aggregate and did not allow for identification of specific mentees. Detailed demographic data were also not collected; any demographic data received (for example, country of origin) was not reported for the program assessment survey to maintain confidentiality in instances where there may only be one mentee from a certain country. The mentor experience and specific information about mentor demographics and attributes were not evaluated as part of our work, but are currently being examined as a separate study,

Conclusions

Mentorship remains a critical strategy for supporting prospective students and fostering a more diverse and culturally competent GC workforce. Mentorship initiatives offer more than just a collective benefit to the profession; they support candidates on an individual level, providing tailored guidance beneficial for their success. Specifically for international applicants, individual mentorship offers multifaceted advantages by bridging informational and experiential gaps and providing insights into essential skills, expectations, and professional norms specific to the GC field in the U.S.