Training activity information
Details
Provide genetic and genomic counselling, using a shared decision-making approach in a supportive manner, in a case where pre-conceptual choices are being discussed with an individual or couple at increased risk of having a pregnancy affected with a genetic condition
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
- Reproductive options
- Counselling strategies to facilitate the couple’s decision making
- Counselling strategies to facilitate the couple’s adjustment to this decision
- Counselling skills including:
- Active listening skills
- Clarification skills
- Reflection and summary skills
- Appropriate use of empathic statements
- Ability to establish a good rapport with the individual/family
- Professional standards, including:
- AGNC cde 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?
- Review the relevant learning outcomes, focusing on applying counselling skills, facilitating decision-making, and applying communication skills.
- Discuss with your training officer to gain clarity of what is expected of you, particularly concerning applying ethical principles and managing the discussion of complex reproductive options (e.g., PGT, prenatal diagnosis) such as presenting balanced information about the benefits and limitations of testing and exploring complex motivations for proceeding.
What is your prior experience of this activity?
- Think about what you already know about pre-conceptual genetic counselling, shared decision-making models, or supporting individuals/couples in making reproductive choices.
- Consider possible challenges you might face during the activity, such as communicating complex risk information, navigating differing views within a couple, or managing anxiety, 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, potentially including making referrals to other support agencies or psychological services.
- Acknowledge how you feel about providing genetic and genomic counselling in this context. How prepared do you feel to undertake this activity sensitively and professionally?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as risk communication, exploring patient values and beliefs, or facilitating discussion of complex reproductive options, drawing upon previous experiences.
- Identify the specific insights you hope to gain from engaging with the activity, such as how individuals/couples process genetic risk in a reproductive context or how different counselling approaches support shared decision-making.
What additional considerations do you need to make?
- Consult actions identified following previous experience of similar counselling sessions or observed practice.
- Identify important information you need to consider before embarking on the activity, such as the specific genetic condition, available reproductive options (e.g., PGT, prenatal diagnosis, donor gametes), and relevant support organisations.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst actively facilitating shared decision-making about pre-conceptual choices during the consultation?
- Are you encountering situations such as:
- The individual or couple expresses conflicting views or preferences you didn’t anticipate?
- They introduce external factors or pressures influencing their decision-making that you weren’t aware of?
- They ask questions or raise concerns about the options that you hadn’t prepared for?
- Their emotional state makes engaging in rational discussion about choices difficult?
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 presenting the options or exploring their values and preferences to maintain a balanced discussion?
- Consider the steps you are taking in the moment, such as: Immediately using non-directive counselling skills to explore the basis of conflicting views or managing any interpersonal dynamics or emotional reactions that arose.
- How are you feeling in that moment? For instance, are you finding it difficult to facilitate a balanced discussion of the pros and cons of each option? Is it affecting your confidence in maintaining a shared decision-making approach?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to support the individual or couple in discussing their pre-conceptual choices using a shared decision-making approach? Or are you needing support because the complexity of the conflict requires referral or mediation by a specialist?
- What are you learning as a result of the unexpected development? For example, are you learning in the moment about the complexities of facilitating decision-making in the context of high-stakes reproductive choices?
On action
What happened?
- Begin by summarising the key steps you took when presenting pre-conceptual choices and facilitating the shared decision-making process.
- Consider specific events, actions, or interactions which felt important, such as the moment you managed a fundamental disagreement between a couple regarding the perceived ethical burden of a specific reproductive option.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately applying non-directive counselling skills and focusing on exploring underlying values when the patient expressed resistance to the most medically feasible option.
- How did you feel during this experience, e.g., did you feel confident in explaining the options but challenged by the ethical complexity of facilitating their decision?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding facilitating shared decision-making. What strengths did you demonstrate, e.g., balanced presentation of reproductive options and effective application of facilitating decision-making?
- What skills and/or knowledge gaps were evident, e.g., difficulty applying specific ethical frameworks to address unanticipated patient conflicts?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in managing sensitive discussions related to pre-conceptual choices?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the management of highly conflicting views between a couple, 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 enhancing my skill in non-directive support when discussing high-stakes reproductive decisions.
- What will you do differently next time you approach facilitating shared decision-making for pre-conceptual choices, for instance, by proactively using visual aids to map out patient values against reproductive options?
- Do you need to practise any aspect of the activity further, such as reviewing counselling theories relevant to couple dynamics or key learning outcomes related to facilitating decision-making?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of counselling individuals for reproductive decisions since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent case requiring discussion of PGT (Pre-implantation Genetic Testing) forced you to re-evaluate the depth of ethical consideration applied during the presentation of options during your first attempt at this training activity.
- Considering what you understand about non-directive support, shared decision-making models, and reproductive ethics 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 facilitation of pre-conceptual decision-making based on further learning and experiences? For example, how you proactively reviewed and integrated counselling theories relevant to couple dynamics (e.g., family systems approaches) to better manage conflict.
- Has discussing cases involving severe conflict between a couple or the impact of unmanaged emotional distress on reproductive choices 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 shared decision-making experiences, contributed to your overall confidence and ability in facilitating complex, values-based decisions?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to providing counselling for pre-conceptual choices? 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 pre-conceptual decision-making experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to facilitating decision-making and applying communication skills?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Apply counselling skills within genetic and genomic counselling consultations. |
| # 3 |
Outcome
Employ counselling skills to facilitate individual/couple and family decision-making. |
| # 4 |
Outcome
Identify opportunities to make referrals for individuals and/or families to other support agencies. |
| # 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. |