About

Ian MacFarlane, PhD, is a Research Assistant Professor affiliated with the Department of Genetics, Cell Biology and Development at the University of Minnesota Medical School. The provided page does not include specific details about his research focus, background, or key contributions.

Research topics

• Medicine
• Family medicine
• Psychology
• Computer Science
• Biology
• Political Science
• Clinical psychology
• Genetics
• Medical education
• Internal medicine
• Pedagogy
• Pathology
• Nursing
• Environmental health
• Demography
• Virology

Selected publications

• Navigating identity and professional life: A qualitative study of <scp>LGBTQ</scp> + genetic counselors' workplace experiences

  Journal of Genetic Counseling · 2026-01-30

  articleOpen accessSenior authorCorresponding

  Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) healthcare professionals frequently navigate complex dynamics related to their professional identities, including disclosure, advocacy, and experiences of minority stress. This qualitative study explored how LGBTQ+ genetic counselors manage their professional identities, including decisions about disclosure, advocacy and representation, and encounters with discrimination, within workplace and broader sociopolitical contexts. Twelve LGBTQ+ genetic counselors practicing in the United States participated in semi-structured interviews about their workplace experiences and identity management processes. Using a constructivist framework and reflexive thematic analysis, we conceptualized three overarching themes: (1) Navigating disclosure-Environmental signals and professional outness; (2) The burden and opportunity of being "The LGBTQ+ Expert"; (3) Enduring microaggressions and workplace disillusionment. Participants described ongoing assessments of risk and benefit in disclosure decisions, balancing authenticity with professionalism, and navigating institutional and sociopolitical pressures. They reported that advocacy and visibility often brought both pride and additional labor, and that microaggressions and performative inclusivity contributed to chronic disillusionment. These findings underscored the importance of understanding disclosure dynamics and implementing strategies to promote inclusion, belonging, and equity for LGBTQ+ professionals in genetic counseling.

  PublisherOA PDFDOI

• Examining aspects of job satisfaction associated with burnout and factors related to turnover intention in genetic counselors

  Journal of Genetic Counseling · 2026-03-02

  articleOpen access

  Burnout arises from prolonged work-related stress, leading to a chronic state of exhaustion, cynicism, and diminished professional efficacy. Previous studies have shown that ~50% of genetic counselors (GCs) experience burnout. This has negative implications for the GCs themselves, their employers, and patient care. Research in other healthcare professions has found a negative correlation between burnout and job satisfaction and a positive correlation between burnout and turnover intention. To investigate aspects of job satisfaction associated with burnout and aspects of burnout associated with turnover intention, a cross-sectional survey was administered via the listservs of three genetic counseling professional organizations. The survey included demographic questions, validated measures of burnout (the Maslach Burnout Inventory - General Survey) and job satisfaction (the Job Satisfaction Survey and select scales from the Job Satisfaction Questionnaire), a binary question assessing turnover intention, and two optional open-ended questions eliciting opinions on ways to improve job satisfaction. Of 228 respondents, 70 (30.7%) indicated that they were considering leaving their current job due to burnout. Logistic multiple regression analysis (n = 224) including subscales of burnout revealed that Exhaustion (p = 0.0004) and Cynicism (p < 0.0001) significantly predicted turnover intention. Linear multiple regression analyses (n = 206-207) including subscales of job satisfaction revealed that satisfaction with Nature of Work was a significant predictor of Exhaustion, Cynicism, and reduced Professional Efficacy (p < 0.0001). Significant predictors of Exhaustion included satisfaction with Operating Conditions (p = 0.02), Working Hours (p = 0.02), and Working Conditions (p = 0.01), while satisfaction with Empowerment and Participation (p = 0.03) was a significant predictor of Cynicism. Responses to the open-ended questions (147/228, 64.5%) revealed additional areas of job dissatisfaction. We propose several strategies to improve job satisfaction and ameliorate GC burnout at the organizational level. These strategies may increase the effectiveness of GCs in their jobs, improve patient care, promote professional longevity, and ultimately save organizations money by reducing turnover.

  PublisherDOI

• Barriers and facilitators to genetic counseling service availability in the Arab world: A genetic counselors' perspective

  Journal of Genetic Counseling · 2026-05-20

  articleOpen accessSenior author

  Despite the global growth of the genetic counseling field, many Arab countries either lack genetic services or have limited resources restricted to specific specialties. This qualitative study is among the first to explore genetic counselors' (GCs) perspectives on challenges and facilitators to the field in Arab countries. Eight GCs recruited through social media and professional platforms participated in semi-structured interviews exploring their experiences in their country of practice. Consensual qualitative research methods were applied to inductively analyze interview transcripts. Six domains and 17 categories were extracted from interview transcripts. Despite the observed growth in most Arab countries, participants emphasized the growing need for GCs. Major barriers to service availability included a shortage of training programs and specialized GCs and a scarcity of genomic databases for Arab populations. Factors facilitating practice were also highlighted (e.g., government support, established licensure process). Responses were largely consistent with the existing literature describing structural barriers to the availability of genetic services, while providing novel insights from the perspective of GCs in the region. As one of the first studies to examine service availability through this lens, participants identified challenges and facilitators minimally explored in the literature. Keeping in mind the uniqueness of cultures and attitudes of different Arab countries, this study provides a framework for future efforts to improve the availability of genetic services in the region. Future studies exploring country-specific barriers and facilitators and strategies to tackle identified factors to support the growth of the field can be considered.

  PublisherDOI

• An introduction to Delphi studies and consensus methods for genetic counselors

  Journal of Genetic Counseling · 2025-11-17 · 1 citations

  articleOpen access1st author

  Delphi studies, a type of consensus method, are instrumental in healthcare research for gathering expert perspectives, especially when conclusive evidence is not available. Developed in the 1950s, Delphi methodology is characterized by anonymity, iteration, controlled feedback, and statistical group response. The traditional Delphi method, along with its subforms, policy and decision, has been widely used across various fields, including genetic counseling. In genetic counseling, Delphi studies have been used for guideline development, curriculum design, clinical competency selection, and establishing quality metrics. The overall goal of this research methodology article is to explain the potential benefit of using a Delphi method in the field of genetic counseling and differentiate the Delphi method from other consensus methods available. Educational applications include creating curricula for Master's programs and defining competencies for clinical supervision. Delphi studies have also been used to develop core outcome sets and standardize outcome reporting measures in genetic counseling research. Quality assessment in genetic services has also been studied using Delphi studies. In addition to summarizing Delphi studies in genetic counseling, we provide an overview of the major questions to consider when constructing a Delphi protocol. We discuss common design and provide practical tips for implementation such as: who counts as an expert, how to decide how many rounds to do, how to set up the questionnaire, and how to report findings of a Delphi study. Researchers should thoughtfully consider these many points and the impacts these choices may have on their overall study results.

  PublisherOA PDFDOI

• Representation of skin tone: The use of medical imagery in the genetic counseling profession

  Journal of Genetic Counseling · 2025-12-01

  articleOpen access

  Abstract The utilization of medical imagery featuring human bodies is a common practice in educational settings and patient interactions. However, these images predominantly depict white bodies and lighter skin tones, raising questions about their inclusivity and representation. This cross‐sectional quantitative study addressed this gap by assessing the diversity of medical imagery in the genetic counseling field. Participants ( n = 103) completed a 43‐item survey where they responded to prompts about their experiences with medical imagery, depicting Black, Indigenous, People of Color (BIPOC) bodies and white bodies within their genetic counseling (GC) role, their genetic counseling program instructor role, and during their time as genetic counseling students. In their GC role, participants were significantly more likely to see ( p &lt; 0.001) and use ( p = 0.02) white imagery compared to BIPOC imagery. In both their GC and instructor roles, participants found it more difficult to find BIPOC imagery ( p &lt; 0.001) and had to put more effort into finding it ( p GC &lt; 0.001; p instructor = 0.001). As students, participants were more likely to have seen white imagery in their curriculum ( p &lt; 0.001). When looking for diverse imagery, participants often resorted to Google searches ( n = 44) and used search terms that encompass both the medical condition and the desired race ( n = 16). The most common barrier participants encountered when looking for diverse imagery was the general lack of diversity in stock photo resources ( n = 61). This study sheds light on the lack of diversity in medical imagery within the genetic counseling field and emphasizes the urgent need for inclusive representation. By enhancing providers' knowledge of how conditions manifest across diverse racial and ethnic groups, diverse medical imagery can contribute to mitigating health inequalities among patients of color. Bringing attention to the resources used to educate others on human health is critical for the future development of inclusive resources, such as medical imagery.

  PublisherOA PDFDOI

• Transgender and Gender-Diverse Patient Perspectives on Hereditary Breast Cancer Risk Assessment in Gender-Affirming Top Surgeries

  JCO Precision Oncology · 2025-10-01

  articleOpen accessSenior author

  PURPOSE: Transgender and gender-diverse (TGD) people have increased cancer morbidity and mortality relative to cisgender individuals. Existing breast cancer prevention guidelines fail to adequately address gender-affirming care implications, especially in the context of gender-affirming mastectomies (top surgery). Evaluation of familial and germline genetic risk before top surgery is recommended by some transgender health guidelines. This evaluation can facilitate shared surgical decision making regarding breast tissue resection extent. In this study, we use in-depth interviews with TGD people planning or having recently undergone top surgery. We aimed to understand barriers and facilitators to pre- and post-top surgery breast cancer risk assessment and screening, and the perceived utility and acceptability of presurgical genetic evaluation. METHODS: We conducted qualitative community-engaged research through interviews with 16 TGD adults who had or were considering top surgery. Through a social constructivist lens, we used reflexive thematic analysis to generate themes. RESULTS: We conceptualized six key themes: (1) post-top surgery cancer screening uncertainty, (2) lack of provider knowledge hindering appropriate care, (3) the experience of breast health spaces as heavily feminized, (4) the balance of aesthetic goals with cancer risk reduction, (5) increased comfort with postsurgical screening because of reduced dysphoria and greater body confidence, and (6) the desire for cancer genetics integration with top surgery care navigation. CONCLUSION: From these themes, we derived actionable guidance to address breast cancer health equity in this population. Enhancing patient education, increasing provider awareness, and developing inclusive clinical practice guidelines are crucial steps in effectively addressing breast cancer risk in individuals receiving surgery. It is vital to degender health spaces to promote inclusion and accessibility of breast cancer prevention. Integrating genetics professionals and cancer risk assessment into transgender health clinics and the top surgery process is paramount for delivering personalized care and facilitating informed surgical decision making.

  PublisherOA PDFDOI

• Genetic counseling program director competencies as proposed by the program leadership development subcommittee of the Genetic Counselor Educators Association

  Journal of Genetic Counseling · 2025-05-06 · 1 citations

  articleOpen access

  The growth and maintenance of a highly qualified genetic counselor workforce necessitates the cultivation of competent leaders of accredited genetic counseling graduate programs. This study aimed to identify essential competencies for Genetic Counseling Program Directors (GCPDs) using a modified Delphi approach. The study was facilitated by the Program Leadership Development Subcommittee of the Association of Genetic Counseling Program Directors (now the Genetic Counselor Educators Association) and included experienced program directors and associate directors from accredited programs in North America. The process began with a literature review identifying key leadership competencies in medical education, allied health, and other fields resulting in an initial list of 127 potential competencies across nine domains. Graduate program leaders participated in an initial survey, rating the importance of each competency. Subsequent rounds of ranking and feedback enabled prioritization, refinement, and consolidation of critical competencies. The process achieved consensus among the subcommittee on 34 foundational competencies, classified into four domains: Leadership, Relationships, Operations, and Education, with Leadership positioned at the core due to its integral role. A key addition that had not been identified in the literature review or survey responses was a competency related to applying the principles of equity, diversity, inclusion, and justice throughout the program, bringing the final number of competencies to 35. This framework of competencies provides a scaffolding for designing targeted professional development and educational opportunities, which will, in turn, help create a robust and effective GCPD leadership pipeline and inform the evaluation of GCPDs.

  PublisherOA PDFDOI

• Patient care practices for LGBTQ+ individuals in clinical genetics: A scoping review.

  PubMed · 2025-06-01 · 1 citations

  articleOpen accessSenior author

  Individuals who are LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and/or have a sexual orientations and/or gender identity beyond cisheteronormative conceptions) face systemic barriers to healthcare, leading to significant health inequities. To address these challenges, genetic providers must better understand and inclusively address LGBTQ+ patient needs. This scoping review aims to map the current landscape of genetic care practices and their inclusivity toward LGBTQ+ individuals. We conducted a systematic search of databases, including Ovid MEDLINE, PsycINFO, and Web of Science, identifying 65 relevant articles focused on LGBTQ+ patient experiences and care practices within genetic healthcare services. Our thematic analysis of the articles highlights three major themes: exclusionary clinical environments and tools, provider biases and educational needs, and patient-reported barriers in accessing genetic services. Many articles underscored the importance of inclusive language and criticized the conflation of sex, sex chromosomes, and gender. A significant focus was on cancer care for transgender and gender-diverse individuals, revealing a need for more data on the effects of gender-affirming care on cancer risk assessment. Moreover, genetic counselors often report insufficient training in LGBTQ+ health needs, contributing to biases and knowledge gaps. Despite increased awareness among providers of the need for inclusive care, LGBTQ+ patients encounter substantial barriers, including medical distrust and limited family health history, which may deter them from disclosing their identities due to the risk of discrimination. This review calls for standardized data collection practices regarding sex-related variables, gender modality, and sexual orientation, alongside specialized training programs for providers. By emphasizing critical areas for research, policy changes, and education, we aim to promote equitable, patient-centered genetic services for LGBTQ+ communities.

  PublisherOA PDFDOI

• Exploration of support for Black, Indigenous, and people of color students in genetic counseling programs

  Journal of Genetic Counseling · 2024-01-22 · 5 citations

  articleOpen access

  Students in higher education who identify as Black, Indigenous, and people of color (BIPOC) experience racism, discrimination, and microaggressions through tokenization, hypervisibility, invisibility, and marginalization. The experiences of BIPOC genetic counseling students with curriculum, clinical training, and sense of belonging also differ. Therefore, there is a large need for understanding how support is defined by BIPOC genetic counseling students, and then how to integrate specific aspects of training into a practical framework for programs to address racism and the resulting emotional implications. This study aimed to define current practices of support and identify gaps in genetic counseling programs as described by BIPOC students. BIPOC genetic counseling students (N = 40) were recruited through Listserv, social media, and Slack channels to complete an online survey eliciting demographic data, perspectives on support, and available support resources. The online survey consisted of 22 open- and closed-ended questions. Data were collected over a 5-week period. Open-ended responses were coded by thematic analysis and audited. The top three supports were as follows: (1) presence of other BIPOC students; (2) presence of BIPOC faculty; and (3) financial funding. Participants' individual definitions of support indicated that each student defined support in a unique way. Most participants defined understanding and empathy stemming from peers, supervisors, and faculty within the program setting as important aspects of overall support. The majority of participants felt somewhat or strongly supported in areas of training. The area with the least support was within rotation/fieldwork experiences. Programs should consider social- and program-level support combined with emotional support. Individualized support for every student is needed while avoiding assumptions about their identity and support needs. Training programs may consider a balance of efforts to prioritize recruiting more BIPOC faculty and students and providing the outlined support and funding resources for their students.

  PublisherOA PDFDOI

• Inconvenient sampling: Community‐engaged and restorative justice approaches to genetic counseling student research

  Journal of Genetic Counseling · 2024-02-13 · 8 citations

  articleOpen access

  Genetic counseling research requires a comprehensive approach since it frequently serves as the foundation for clinical care practice. Genetic counseling students play a pivotal role in advancing the profession, as they contribute a significant proportion of the research conducted within the genetic counseling community. However, a prevailing trend of convenience sampling of genetic counselors has limited the diversity of perspectives in student research projects. This article promotes a strategy for greater inclusivity and equity in research by emphasizing community-engaged and empowered research through the perspective of restorative justice. Reflecting on the shadow of the harmful ideologies of eugenics in our profession underscores the need to amplify patients' voices and diverse experiences. Community-engaged research-in collaboration with individuals, families, and communities directly impacted by genetic counseling-transcends traditional research paradigms, empowering patients and addressing systemic inequities. Incorporating community-engaged research into genetic counseling student projects aims to empower future professionals to better understand patient perspectives and needs while working toward addressing historical injustices. This article explores the potential benefits and pathways of incorporating community-engaged research and restorative justice principles into genetic counseling scholarly work, promoting empathy, cultural responsiveness, and ultimately, a more patient-centered approach to research and clinical care. By embracing this collective journey toward authentic partnership in the production of high-quality evidence in genetic counseling student research and more broadly, genetic counseling can become a more just and inclusive practice.

  PublisherOA PDFDOI

Frequent coauthors

• Bonnie S. LeRoy

  36 shared

• Patricia McCarthy Veach

  34 shared

• Patricia McCarthy Veach

  University of Minnesota

  18 shared

• Heather Zierhut

  University of Minnesota

  15 shared

• Krista Redlinger‐Grosse

  University of Minnesota

  14 shared

• Pat McCarthy Veach

  University of Minnesota

  4 shared

• Kimberly W. Zahm

  University of Delaware

  4 shared

• Crystal Y. Lumpkins

  University of Utah

  4 shared

Education

• Ph.D. in Counseling Psychology, Educational Psychology

  University of Minnesota

  2013

• M.A. in Counseling & Student Personnel Psychology, Educational Psychology

  University of Minnesota

  2008

• B.A. in Psychology, Minor in Family Violence Prevention, Psychology

  University of Minnesota

  2006