Counselling and Communication Skills for Genetic Counsellors —
Training activity: 1

Details

Identify the patient’s agenda for a range of trainee led genetic counselling consultations taking into account the concerns and priorities for the individual/couple and/or family

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Counselling theory
• Core skills, including: empathy, congruence and warmth
• Advanced skills, including: advanced empathy, concreteness and challenge
• Active listening skills to elicit information
• Establishment of good rapport with the individual/family
• Factors that may influence communication such as age, capacity, language and learning ability
• Professional standards, including:
  • AGNC code of ethics
  • GCRB code of conduct
  • Good scientific practice
  • HCPC standards of proficiency

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• You should identify what is expected of you in relation to identifying the patient’s agenda in a trainee-led consultation in relation to applying counselling skills, interpreting history, facilitating decision-making and practicing in accordance with standards.

What is your prior experience of this activity?

• Think about what you already know about identifying patient agendas.
• Consider possible challenges you might face during the activity, such as a patient having multiple or unstated agendas, and think about how you might handle them.
• Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help and from whom, for instance, consulting your Training Officer if the patient’s priorities conflict strongly with the referral reason.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as active listening or using open questions to elicit the patient’s true priorities, drawing upon previous experiences of similar activities.
• Identify the specific insights you hope to gain from engaging with this activity, such as how patients prioritise their concerns or how different psychological or social factors influence their agenda.

What additional considerations do you need to make?

• Identify important information you need to consider before embarking on the activity, such as information from the referral letter or any prior patient communication detailing the reason for the appointment.
• How do you plan to use the process of establishing the patient’s agenda in directing, reframing or prioritising the appointment?

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst actively working to identify the patient’s agenda during the consultation?
• Are you encountering situations such as:
• The patient expresses a concern or priority that you hadn’t anticipated based on the referral or initial information?
• They disclose something significant (medical, social, or psychological) that shifted your understanding of their agenda in the moment?
• You notice a non-verbal cue that suggested an underlying agenda different from what was being verbalised?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to your line of questioning or your focus to explore the unexpected element?
• Consider the steps you are taking in the moment, such as immediately adapting your line of questioning or exploring the unexpected element using appropriate advanced counselling skills.
• How are you feeling in that moment? For instance, are you finding it difficult to guide the conversation to the core agenda points you had initially planned to cover? Is it affecting your confidence in guiding the conversation to a patient-centred outcome?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to successfully identify the patient’s key concerns and priorities by the end of the initial part of the consultation? Or are you needing support because the unexpected psychosocial factor requires immediate clinical input?
• What are you learning as a result of the unexpected development? For example, are you learning in the moment about recognising and responding effectively to unexpected aspects of a patient’s agenda?
• Were you able to utilise the patient’s agenda as a way of eliciting more information or improving the outcome of the consultation in any way?

On action

What happened?

• Begin by summarising the key steps you took when approaching the initial phase of the consultation to elicit the patient’s agenda.
• Consider specific events, actions, or interactions which felt important, such as a key interaction where the patient disclosed a priority (e.g., anxiety about insurance) that shifted the focus of the consultation.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately shifting from closed questions to open questions to better explore a subtle concern the patient verbalised about a family member’s health.
• How did you feel during this experience, e.g., did you feel focused on active listening but challenged by the patient’s reluctance to state their true priorities?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding identifying a patient’s priorities. What strengths did you demonstrate, e.g., effective rapport building which facilitated the patient’s eventual disclosure of their main concern?
• What skills and/or knowledge gaps were evident, e.g., difficulty distinguishing between the overt agenda (referral reason) and the covert agenda (psychosocial need)?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying counselling skills to navigate the initial stages of the consultation?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to document an unexpected psychosocial factor that emerged during agenda setting, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving recognition and exploration of subtle verbal or non-verbal cues related to the patient’s priorities.
• What will you do differently next time you approach agenda setting, for instance, by proactively incorporating a short summary of the patient’s perceived concerns back to them to ensure clarity?
• Do you need to practise any aspect of the activity further, such as specific questioning techniques to elicit core priorities or key learning outcomes related to applying counselling skills?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of identifying patient priorities in cases since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent case involving conflicting family agendas forced you to re-evaluate the rigidity of your initial questioning technique to explore psychosocial priorities during your first attempt at this training activity.
• Considering what you understand about listening skills, psychosocial factors, and tailoring consultations now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your agenda-setting practice based on further learning and experiences? For example, how you proactively integrated a specific check-back question to confirm the patient’s primary concern based on feedback from a Genetic Counsellor.
• Has discussing ambiguous initial patient agendas or the impact of missing the patient’s underlying concern with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a patient who was initially reluctant to disclose their true fears refined your understanding of the critical nature of active listening and establishing rapport early in the consultation.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent agenda identification and rapport-building experiences, contributed to your overall confidence and ability in establishing a patient-centred focus? How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to identifying the patient’s priorities?
• How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? Looking holistically at your training journey, how has this initial agenda identification experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying counselling skills and practicing in accordance with relevant standards? For example, how this foundational experience has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on facilitating decision-making.

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply counselling skills within genetic and genomic counselling consultations.
# 2	Outcome Interpret and elicit appropriate medical, family and psychological history from patients in a sensitive and culturally appropriate manner.
# 3	Outcome Employ counselling skills to facilitate individual/couple and family decision-making.
# 7	Outcome Practice in accordance with the relevant standards.