Faculty Highlight: Judith Westman, MD

Judith Westman, MD Judith Westman, MD, is a clinical geneticist and medical director of the Genetic Counseling Graduate Program at The Ohio State University College of Medicine. In addition to being medical director, Dr. Westman also serves as the course director of the program’s Foundations in Medicine course, and as one of students’ fieldwork supervisors in The Ohio State University Wexner Medical Center’s Adult Medical Genetics/Genomics Program clinic.

For this interview, Dr. Westman sat down with Rachel Flocken, program coordinator for the Genetic Counseling Graduate Program, to discuss her work in the graduate program and her impact on its students. This interview has been lightly edited for brevity and clarity.

Thank you so much for joining me today for this interview, Dr. Westman. Could you please tell me a little bit about the Adult Medical Genetics clinic, and how your work there contributes to students’ experience in the graduate program?

For background, my training was different from genetic counseling training. I had four years of undergraduate work, four years of medical school, three years of pediatric residency and two years in a clinical genetics fellowship. I then worked in pediatric and prenatal genetics for nine years.

I moved to cancer genetics at the James Cancer Hospital in the medical center in 1996 and set up the clinical program in cancer genetics. It became evident that we needed to provide additional services in genetics to adults, and because of that, we started seeing non-cancer patients.

From the beginning in pediatric and prenatal genetics, I worked with genetic counselors; these days in medical genetics I primarily work with Dawn Allain, MS, LGC, who is also the program director of the Genetic Counseling Graduate Program. My role is to do a physical exam because there are many genetic issues that require that, but the genetic counselor takes the family history, reviews all the medical information and takes care of the general counseling. While I am capable of doing those things, it is helpful for us to play to our strengths, and we can accomplish more and see more patients that way.

When the Genetic Counseling Graduate Program started, we developed our clinic so it would be particularly useful for the secondyear students. They observe their first time in clinic, start counseling the second time with the certified genetic counselor in the exam room with them, and by their third time in clinic they take direct responsibility for patients. Our clinic gives students a great deal of autonomy in that way, giving them the chance to use basic counseling skills, basic case management and ordering of tests, and calling the patients with test results once they are received.

Something we found though is that there is a lot of prep work with these adult patients because they have frequently had a long diagnostic journey. For many of them, they have seen multiple doctors and specialists and finally get referred to genetics. So we have a lot of medical records to review before every patient, and that is eye opening for students. It is not like when you are in a cancer genetics clinic and everyone has cancer; that narrows the scope of what a student has to review. In our clinic, you could have a metabolic patient, a dysmorphic patient, a neurology patent and maybe a little cancer thrown in on the side. As generalists, we do all of that. So the students — as far as reviewing goes — have more work at the front end.

In general, though, because of the level of independence we expect them to have in the second year of the program, students are happier in the clinic because they have more responsibility and autonomy, which means they are more satisfied even though there is additional work.

Do you have first-year students rotate with you in clinic, and if so, what does that look like?

Very early in the Genetic Counseling Graduate Program curriculum, they start learning how to take family histories in their Foundations in Genetic Counseling class. They start doing this in their observational clinics the first semester as well. For example, in our clinic, Ms. Allain will take the family history and the student will sit next to her following along with a similar sheet of paper while taking their own notes. Once the patient leaves, she and the student will compare. After that happens a couple of times, the student will take the family history while Ms. Allain is in the room. She might chime in with questions that the student might miss, but the student is practicing what they have learned in the classroom.

You mentioned the graduate program’s Foundations in Genetic Counseling course, but I think we should also talk about Foundations in Medicine since you are its course director. Do you feel like Foundations in Medicine is unique to the Ohio State experience for students?

I think Foundations in Medicine is unique because the students get to learn about basic anatomy, embryology, physiology, cell biology and such. It is the “normal” as compared to the “abnormal” aspects you get in the Foundations in Genetics course. Giving students the normal constructs so they have something to compare it to is, I think, fairly unique. We also use that course as a platform to help students develop their communication skills in general and as it relates to health care — both verbal and written — which is unique as well.

What advice would you give to anyone considering genetic counseling as a profession, especially if they are thinking of studying it at Ohio State?

Genetic counselors are frequently leaders in their health care teams since they will generally have more genetic knowledge than anyone else. It is important to learn how to lead a team from within the team because of this. At the Ohio State College of Medicine, our students work with a variety of health professionals and are well positioned to be a strong interprofessional team member upon graduation and entry into the profession.

If you'd like to connect with a student or alumni of the Ohio State Genetic Counseling Graduate Program, please contact our office at OhioStateGCGP@osumc.edu.