Training activity information
Details
Take three-generation family histories and interpret the medical, family and psychological history provided
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
- Active listening skills to elicit information
- Knowledge of genetic conditions and medical information to interpret family history information provided
- Obstetric history where relevant
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?
- Discuss with your training officer to gain clarity of what is expected of you, particularly regarding pedigree drawing conventions and the appropriate depth of history required for complex family structures in different contexts.
What is your prior experience of this activity?
- Think about what you already know about taking family histories, interpreting medical information, or understanding psychological history.
- Consider possible challenges you might face during the activity, such as obtaining accurate information, dealing with complex family structures, different communication needs, or addressing sensitive psychological factors (e.g., non-paternity or undisclosed diagnoses), and think about how you might handle them.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as pedigree drawing conventions, using appropriate questioning techniques, or interpreting different types of medical reports, drawing upon previous experiences.
- Identify the specific insights you hope to gain from engaging with the activity, such as how family communication patterns or psychological factors influence the history provided.
What additional considerations do you need to make?
- Identify important information you need to consider before embarking on the activity, such as specific conditions relevant to the family, potential inheritance patterns, or typical psychological responses in genetic contexts.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst actively taking and interpreting the family history during the consultation?
- Are you encountering situations such as:
- The family structure turns out to be more complex or different from what you expected?
- You encounter unexpected medical information or a diagnosis you were unfamiliar with?
- The patient or family members have a strong emotional reaction to discussing certain aspects of their history?
- There is difficulty recalling information or discrepancies in the history provided?
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 drawing the pedigree or asking questions to accommodate the complexity or unexpected information?
- Consider the steps you are taking in the moment, such as immediately adapting your approach to questioning specific sensitive details or responding appropriately to emotional distress expressed by the patient or family.
- How are you feeling in that moment? For instance, are you finding it difficult to gather all the necessary information or interpret the history accurately in the moment? Is it affecting your confidence in your history-taking skills?
What is the conclusion or outcome?
- Were you able to complete a reasonably accurate and comprehensive three-generation pedigree and gather the relevant medical, family, and psychological history? If not, did you obtain sufficient information appropriate to the situation in that consultation?
- What are you learning as a result of the unexpected development? For example, are you learning about adapting your history-taking technique when faced with unexpected family complexity or strong emotional responses?
On action
What happened?
- Begin by summarising the key steps you took when structuring the history taking and accurately drawing the three-generation pedigree.
- Consider specific events, actions, or interactions which felt important, such as the moment you encountered a complex family structure (e.g., consanguinity or adoption) or sensitive medical history (e.g., undisclosed non-paternity).
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adapting your method of recording the pedigree to handle unexpected complex family dynamics while maintaining the flow of conversation.
- How did you feel during this experience, e.g., did you feel focused on accurately interpreting the complex historical details but stressed by the unexpected emotional disclosures?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding eliciting and interpreting multi-dimensional history. What strengths did you demonstrate, e.g., systematic application of pedigree conventions?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with interpreting the psychological history associated with a rare genetic condition?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in correlating the medical, family, and psychological histories gathered?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the need for specialist psychological referral due to the patient’s reaction to discussing family history, 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 the interpretation and documentation of ambiguous or sensitive psychological history information.
- What will you do differently next time you approach taking a three-generation family history, for instance, by proactively allocating specific time within the interview to explore sensitive psychological history details?
- Do you need to practise any aspect of the activity further, such as specific questioning techniques for eliciting complex medical history or key learning outcomes related to interpreting history?
- Are there any ways you can simplify or streamline your questioning where it is not always appropriate or suitable to take an in-depth family history?
Beyond action
Have you revisited the experiences?
- Considering what you understand about pedigree conventions and sensitive history elicitation 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 history taking and interpretation technique based on further learning and experiences?
- Has discussing ambiguous family history details or the impact of an incomplete history with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent family history and interpretation experiences, contributed to your overall confidence and ability in systematic history taking?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to taking and interpreting family histories?
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. |