Counselling and Communication Skills for Genetic Counsellors —
Training activity: 10

Details

Deliver result for positive and negative test outcomes, under direct supervision by a registered Genetic Counsellor

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

• SPIKES framework: The six-step protocol for delivering bad news
• Responses to loss associated with genetic diagnosis or risk
• Professional standards, including:
  • AGNC code of ethics
  • GCRB code of conduct
  • Good scientific practice
  • HCPC standards of proficiency
• Counselling techniques for discussing adverse test results
• Clinical context of test results and impact on patient care

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 delivering genetic test results, both positive and negative, in a sensitive and clear manner under direct supervision.
• Review the relevant learning outcomes, focusing on applying counselling and communication skills.
• Discuss with your training officer to gain clarity of what is expected of you. Specifically related to the level of supervision required and your role in managing the discussion of potential emotional reactions to positive or negative test outcomes, potentially utilising communication frameworks like SPIKES

What is your prior experience of this activity?

• Think about what you already know about delivering test results, communicating sensitive or potentially upsetting information, or managing emotional responses in a clinical setting. You may have observed ‘bad news’ result consultations and reflected on frameworks like SPIKES.
• Consider possible challenges you might face during the activity, such as managing strong patient emotional reactions, clearly explaining complex results, or dealing with unexpected questions, and think about how you might handle them, including seeking immediate support from your supervisor.
• 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. You will need to seek advice when required if the patient exhibits a complex grief response.
• Acknowledge how you feel about embarking on this training activity and the responsibility of delivering sensitive information.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as structuring the delivery of results, using clear and accessible language, or providing appropriate support and follow-up information, drawing upon previous experiences or observations.
• Identify the specific insights you hope to gain from engaging with the activity, such as how individuals react differently to positive versus negative results, the immediate impact of a diagnosis, or the dynamics of delivering results in the presence of a supervisor.

What additional considerations do you need to make?

• Consult actions identified following previous experience of similar communications or from reflecting on observed result sessions (e.g., reviewing frameworks like SPIKES).
• Identify important information you need to consider before embarking on the activity, such as confirming the test results, understanding the specific implications of the result for the patient and family, and knowing what immediate support and follow-up is available.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst actively delivering the test result under supervision?
• Are you encountering situations such as:
  • The patient has an emotional reaction that was different (more or less intense, or different in nature) from what you expected for that specific result (positive or negative)?
  • The patient asks a question about the results or implications that you hadn’t anticipated or weren’t immediately sure how to answer?
  • The supervising Genetic Counsellor intervenes in a way you didn’t expect?
  • Practical issues (e.g., technological problems, interruptions) arise during the consultation?

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 communication style or pace to address the patient’s reaction or unexpected question?
• Consider the steps you are taking in the moment, such as: Immediately adapting your communication style or pace to address the patient’s reaction or effectively using your communication and counselling skills to manage the unexpected element.
• How are you feeling in that moment? For instance, are you finding it difficult to deliver the result clearly and compassionately despite the unexpected event? Is it affecting your confidence in managing the emotional response while knowing you are under supervision?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, was the test result successfully delivered and the immediate implications discussed with the patient? Or are you needing support because the unexpected question requires immediate clarification from the supervisor due to its clinical complexity?
• What are you learning as a result of the unexpected development? For example, are you learning in the moment about managing unexpected emotional reactions or complex questions during the sensitive process of results delivery?

On action

What happened?

• Begin by summarising the key steps you took when delivering the positive or negative test outcome under direct supervision.
• Consider specific events, actions, or interactions which felt important, such as the moment the patient’s reaction of denial or excessive reassurance differed significantly from the expected emotional response.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the delivery and using silence to allow the patient to process the information, or observing the supervisor intervene to manage the patient’s acute grief response.
• How did you feel during this experience, e.g., did you feel confident in conveying the factual results but stressed by the unexpected intensity of the patient’s reaction while being supervised?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding communicating sensitive results. What strengths did you demonstrate, e.g., clarity in presenting technical information related to the result?
• What skills and/or knowledge gaps were evident, e.g., difficulty using communication skills to tailor the response to unexpected manifestations of grief or loss?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding when the supervisor should intervene to manage an acute emotional reaction, 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 preparation for handling the potential range of responses when delivering results.
• What will you do differently next time you approach delivering sensitive test outcomes, for instance, by proactively using a standardised communication framework (e.g., similar to SPIKES) to structure the conversation?
• Do you need to practise any aspect of the activity further, such as role-playing managing complex responses or key learning outcomes related to applying communication skills?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of delivering sensitive information (e.g., new diagnosis, adverse results) since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
• Considering what you understand about grief models, empathic communication, and managing acute distress 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 results delivery technique based on further learning and experiences? For example, how you proactively reviewed and integrated specific communication skills to tailor your emotional response to unexpected responses.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent sensitive communication experiences, contributed to your overall confidence and ability in managing conversations and patient emotion? For example, how your accumulated ability in maintaining composure while providing empathic support now enables you to confidently deliver a bad news result.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to delivering test outcomes?
• Looking holistically at your training journey, how has this initial results delivery experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying communication skills and practicing in accordance with relevant standards?

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply counselling skills within genetic and genomic counselling consultations.
# 6	Outcome Apply communication skills within genetic and genomic counselling consultations, tailoring the method and style of communication to facilitate understanding of complex information.
# 7	Outcome Practice in accordance with the relevant standards.