Since the first genetic counseling program (GCP) was established in 1969, there has been a proliferation of growth and demand for genetic counselors. Advances in technology, affordable access to genetic testing, public genomic health initiatives, and diversifying clinical and non-clinical roles comprise a dynamic environment that GCPs must respond to. While there is extensive literature regarding how other health professions adapt their curricula to changing environments, this has yet to be documented and explored for genetic counseling. This study aimed to understand how GCPs evolve their didactic curricula to keep up with the rapidly changing professional landscape. An online survey was used to recruit program leadership of fully accredited GCPs for semi-structured interviews. These interviews explored four critical factors of didactic curricular change, including drivers, implementation, barriers, and mechanisms for evaluation after a change has been made. Interview transcripts were analyzed using reflexive thematic analysis based on iterative discussions with prioritization of excerpts from the codes that had been most commonly applied across multiple transcripts. Multiple factors were identified that program leadership must appropriately weigh when making curricular change decisions. The factors that were considered major influences by all participants included national accreditation standards, program stakeholders, sponsoring institutions and local genetic counseling communities, and the genetic counseling profession as a whole. Our data also demonstrated the extensive role program leadership plays in the adaptation of didactic curricula. With GCP leadership constantly identifying, implementing, and evaluating complex didactic curricular change, there is a need for further exploration of this topic and development of genetic counseling specific resources and tools.