Progenity, Inc., a commercial genetic testing laboratory specializing in women's health, employed several adaptations to navigate the disruptions of the COVID-19 pandemic in 2020. Operational changes included implementation of novel genetic counseling services, converting field/sales support to remote means, and facilitating remote genetic counseling graduate student rotations. Additionally, there was a marked rise in participation in Progenity's internal continuing education program from the genetic counseling team. The paradigm shift necessitated by the pandemic spurred creative problem-solving and led to increased connections with patients, healthcare providers, peers, and students. The unanticipated benefits of virtual communication with each of these four groups are summarized below.

Early in the pandemic, there was an increase in requests from OB/GYN healthcare providers for existing services such as mobile phlebotomy and there were unique challenges with reaching providers due to modified staffing and hours in response to the COVID-19 pandemic. We sought to assist healthcare providers by increasing patient access to pre-test information, as the omission or delay of early pregnancy visits could interfere with communication regarding prenatal testing options. Prior to the COVID-19 pandemic, genetic counseling services included post-test positive results disclosure and counseling if requested by the ordering provider. However, in response to the COVID-19 pandemic, healthcare providers were given the opportunity to enroll in the new enhanced genetic counseling services, whereby a Progenity laboratory genetic counselor contacts patients to provide information about testing ordered by their provider prior to testing. A Progenity genetic counselor also calls the patient to communicate their positive or negative results and answer their questions. The successful contact rate for the new enhanced genetic counseling services program is ~93%, and the average time to complete patient contact is ~1.5 business days. This facilitates the offering of appropriate education to patients about the tests their physician orders. Furthermore, clinics can prioritize visits that cannot be performed virtually, while simultaneously reducing potential patient and clinician exposure to COVID-19. The process also expands patient access to a genetic counselor, thereby offering pre- and post-test counseling which increases patient autonomy in decision-making about genetic testing and follow-up options.

Meetings between field genetic counselors and healthcare providers also transitioned to a virtual format. Initial uptake by providers was limited. However, as COVID-19 cases continued to rise Progenity genetic counselors recognized the need for alternative ways to have important clinician education sessions while necessitating less in-person interaction for safety reasons. Within about six weeks from the initial shutdowns, these virtual education sessions were increasingly embraced, and positive feedback was received from both genetic counselors and providers. Progenity's field genetic counselors report the focused nature of the virtual meeting led to more meaningful and less distracted clinical conversations. In addition to one-on-one interactions, field genetic counselors established a series of brief educational webinars designed to address key concerns and frequently asked questions about genetic testing. Prior to the COVID-19 pandemic, interactions would typically be between a field genetic counselor and single provider group. In contrast, these webinars reach multiple providers within a geographical region simultaneously. This created efficient professional development opportunities while also encouraging provider-to-provider dialogue among professionals who do not routinely interact with each other.

Scientific meeting attendance changed drastically in 2020, affecting the way our genetic counselors obtained continuing education units (CEUs). Progenity has an existing Case Conference and Journal Club series that is approved for Category 1 CEUs by the National Society of Genetic Counselors (NSGC). Having this program available allows our genetic counselors to access CEUs in a convenient format and obtain the credits needed for national certification and state licensure maintenance. There was a significant increase in the number of contact hours obtained by each attendee, with the average number of hours rising from 11.0 out of 18.0 available hours claimed in 2019 to 14.1 out of 16.5 available hours in 2020 (p <.01). Increased participation in the program facilitated interaction and fostered dialogue among our peers. Having more of our genetic counselors gain exposure to, and benefit from, this program in 2020, we anticipate this will continue in future years.

Finally, the Progenity genetic counselor team and affiliated genetic counseling graduate training programs have experienced multiple benefits of transitioning to virtual student rotations. The pandemic created an increase in requests for Progenity to accommodate student rotations from programs across the United States, which led to the implementation of a virtual rotation experience. The conversion of student rotation activities to a virtual format allows for scalability—both in the number of students and the participating graduate training programs. In 2019, eleven students from three programs participated in Progenity's industry rotation; this increased to twenty-one students from five programs in 2020. For 2021, two additional programs have requested a virtual industry rotation experience for their students. The virtual format has diversified the educational opportunities available to student trainees as well. For example, the transition of field genetic counselor interactions with clients to remote formats allowed for student involvement in these meetings. We are also able to provide student interaction with professionals in multiple departments, including laboratory directors, marketing, variant classification, and operations. Progenity has confirmed its commitment to genetic counselor education by doubling the number of genetic counselors who coordinate student rotations, meaning we are facilitating more student interactions, with a more varied group of genetic counselors. This novel rotation environment provided experiences as an introduction to a remote working environment including phone counseling, setting up video calls with supervisors in different time zones, and accessing online content. These skills are in demand given the COVID-19 pandemic and may continue to be in demand in a post-COVID world. Indeed, the 2021 NSGC Professional Status Survey reported 91% of respondents worked remotely in some capacity, compared with 40% the previous year. Creation of these virtual rotations and associated materials will be an asset for future years and will allow Progenity to maintain its commitment to genetic counseling graduate student engagement.

In response to the COVID-19 pandemic, Progenity has instituted multiple adaptations to facilitate enhanced support for patients, healthcare providers, peers, and students while adhering to state and federal restrictions and safety measures. In particular, Progenity used virtual methods for patient counseling, healthcare provider education, genetic counselor continuing education, and student training. Of these adaptations, the most likely to be permanent are increased student training capacity and the use of virtual provider meetings, as the benefits for our team and the groups supported appear to be substantial enough to continue beyond the COVID-19 pandemic. Areas of future investigation include studying the efficacy of virtual methods for clinical genetic counseling, student education and rotations, educational conferences, and genetic counseling continuing education.

Progenity, Inc. 是一家专门从事女性健康的商业基因检测实验室，采用了多种调整措施来应对 2020 年 COVID-19 大流行的破坏。运营变化包括实施新型遗传咨询服务、将现场/销售支持转换为远程方式、并促进远程遗传咨询研究生轮换。此外，遗传咨询团队参与 Progenity 内部继续教育计划的人数显着增加。大流行所必需的范式转变激发了创造性的问题解决方案，并导致与患者、医疗保健提供者、同龄人和学生的联系增加。下面总结了与这四个群体中的每一个群体进行虚拟通信的意想不到的好处。

在大流行初期，妇产科/妇产科医疗保健提供者对现有服务（例如移动静脉切开术）的要求有所增加，并且由于应对 COVID-19 大流行而调整了人员配备和工作时间，因此在接触提供者方面遇到了独特的挑战。我们试图通过增加患者对预检信息的访问来协助医疗保健提供者，因为遗漏或延迟早孕就诊可能会干扰有关产前检测选项的沟通。在 COVID-19 大流行之前，遗传咨询服务包括测试后阳性结果披露和咨询，如果订购提供者要求。但是，为了应对 COVID-19 大流行，医疗保健提供者有机会加入新的增强型遗传咨询服务，其中 Progenity 实验室遗传咨询师与患者联系，以提供有关其提供者在测试前订购的测试的信息。Progenity 遗传咨询师还会打电话给患者，告知他们的阳性或阴性结果并回答他们的问题。新的增强型遗传咨询服务计划的成功联系率为 ~93%，完成患者联系的平均时间为 ~1.5 个工作日。这有助于向患者提供有关其医生命令的测试的适当教育。此外，诊所可以优先考虑无法虚拟进行的就诊，同时减少潜在的患者和临床医生接触 COVID-19。该过程还扩大了患者获得遗传咨询师的机会，

现场遗传顾问和医疗保健提供者之间的会议也转变为虚拟形式。供应商的最初采用是有限的。然而，随着 COVID-19 病例的不断增加，Progenity 遗传咨询师认识到需要以其他方式进行重要的临床医生教育课程，同时出于安全原因需要减少面对面的互动。在最初关闭后的大约六周内，这些虚拟教育课程越来越受到欢迎，遗传咨询师和提供者都收到了积极的反馈。Progenity 的现场遗传顾问报告说，虚拟会议的重点性质导致了更有意义和更少分心的临床对话。除了一对一的互动，现场遗传顾问建立了一系列简短的教育网络研讨会，旨在解决有关基因检测的关键问题和常见问题。在 COVID-19 大流行之前，互动通常是在现场遗传顾问和单一提供者群体之间进行。相比之下，这些网络研讨会同时覆盖一个地理区域内的多个提供商。这创造了有效的专业发展机会，同时也鼓励了不经常相互交流的专业人士之间的提供商之间的对话。

2020 年科学会议出席人数发生了巨大变化，影响了我们的遗传顾问获得继续教育单元 (CEU) 的方式。Progenity 现有的案例会议和期刊俱乐部系列已被美国国家遗传咨询师协会 (NSGC) 批准为 1 类 CEU。有了这个计划，我们的遗传顾问就可以方便地访问 CEU，并获得国家认证和国家执照维护所需的学分。每位与会者获得的联系小时数显着增加，平均小时数从 2019 年声称的 18.0 可用小时中的 11.0 小时上升到 2020 年 16.5 可用小时中的 14.1 小时（p <.01）。对计划的更多参与促进了我们同行之间的互动并促进了对话。让更多的遗传顾问在 2020 年接触到该计划并从中受益，我们预计这种情况将在未来几年继续下去。

最后，Progenity 遗传咨询师团队和附属遗传咨询研究生培训项目已经体验到过渡到虚拟学生轮换的多重好处。大流行导致对 Progenity 的要求增加，以适应美国各地项目的学生轮换，这导致了虚拟轮换体验的实施。将学生轮换活动转换为虚拟形式可以实现可扩展性——无论是在学生数量还是参与研究生培训计划方面。2019年，3个项目11名学生参加了Progenity的行业轮换；这从 2020 年的五个项目增加到 21 名学生。 2021 年，另外两个项目要求为其学生提供虚拟行业轮换体验。虚拟形式也为学员提供了多样化的教育机会。例如，现场遗传顾问与客户的互动转变为远程形式，允许学生参与这些会议。我们还能够让学生与多个部门的专业人士进行互动，包括实验室主任、市场营销、变异分类和运营。Progenity 通过将协调学生轮换的遗传顾问的数量增加一倍，确认了其对遗传顾问教育的承诺，这意味着我们正在促进更多的学生互动，以及更多种类的遗传顾问。这种新颖的轮换环境提供了体验，作为对远程工作环境的介绍，包括电话咨询、与不同时区的主管建立视频通话，并访问在线内容。鉴于 COVID-19 大流行，这些技能很受欢迎，并且在 COVID-19 后的世界中可能会继续需要。的确，2021 年NSGC 专业地位调查报告称，91% 的受访者以某种身份远程工作，而前一年这一比例为 40%。这些虚拟轮换和相关材料的创建将成为未来几年的资产，并使 Progenity 能够保持其对遗传咨询研究生参与的承诺。

为应对 COVID-19 大流行，Progenity 进行了多项调整，以在遵守州和联邦限制和安全措施的同时加强对患者、医疗保健提供者、同伴和学生的支持。特别是，Progenity 使用虚拟方法进行患者咨询、医疗保健提供者教育、遗传咨询师继续教育和学生培训。在这些调整中，最有可能是永久性的是提高学生培训能力和使用虚拟供应商会议，因为我们的团队和支持的团体的好处似乎足以在 COVID-19 大流行之后继续下去。未来调查的领域包括研究虚拟方法在临床遗传咨询、学生教育和轮换、教育会议、