Training activity information
Details
Provide appropriate follow up care following genetic counselling consultations
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
- Assessing follow appropriate for individual patient care
- Follow-up methods
- Exploring individuals’ psychological needs in genetic counselling consultations
- Identifying individual patients at psychological risk for early intervention and/or referral to other agencies as appropriate
- Referral pathways for appropriate agencies, such as mental health services
- Supporting disclosure of genetic information to family members using direct and indirect methods
- Departmental or international guidelines
- Knowledge of genetic condition and medical information to interpret family history information provided
- Genetic risk assessment and options to manage identified risk based on best evidence and clinical judgement
- The effect of genetic test results on patient care and the care pathway for different genetic conditions
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 what is expected of you in relation to the standard procedures for follow-up in your service and what constitutes ‘appropriate’ follow-up care for different consultation outcomes.
What is your prior experience of this activity?
- Think about what you already know about planning or implementing follow-up actions after a consultation.
- Consider possible challenges you might face during the activity, such as identifying appropriate follow-up needs, coordinating with other services, or communicating the follow-up plan to the patient.
- 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, for example if the required follow-up involves complex coordination between external services or the patient’s psychological needs escalate after the consultation.
- Acknowledge how you feel about managing the post-consultation phase of patient care.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as planning structured care, applying communication skills in different formats (e.g., phone calls, letters), or collaborating with others (drawing upon previous experiences of the activity).
- Identify the specific insights you hope to gain into ensuring continuity of care and addressing long-term patient needs.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of consultations regarding follow-up planning.
- Identify important information you need to consider before embarking on the activity, such as the outcome of the initial consultation, agreed actions or referrals, and the preferred method of contact or follow-up for the patient.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst providing follow up care?
- Are you encountering situations such as:
- An unexpected report from the patient regarding symptoms or test results?
- Difficulty contacting the patient or an unanticipated need to coordinate with another healthcare service?
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 adjusting the planned follow-up steps or responding to the new information?
- Consider the steps you are taking in the moment, such as: Immediately documenting the unexpected report and seeking urgent supervision to determine the next steps or adapting the coordination strategy to contact the required healthcare service.
- How are you feeling in that moment? For instance, are you finding it difficult to manage the situation, particularly if it was complex or required immediate action? Is it affecting your confidence in adapting follow-up procedures?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, was the patient’s need met or the problem resolved effectively, and were subsequent actions clearly documented? Or are you needing support because the unexpected report suggests a rapid clinical change that requires immediate medical consultation or referral?
- What are you learning as a result of the unexpected development? For example, are you learning in that moment about adapting follow-up procedures when unexpected clinical information arises?
On action
What happened?
- Begin by summarising the key steps you took when providing the scheduled follow-up care.
- Consider specific events, actions, or interactions which felt important, such as the patient providing an urgent, unexpected clinical update during a routine call or difficulty coordinating care with a remote specialist service.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately escalating the case when the patient reported an urgent, unexpected clinical development (e.g., new onset symptoms) during a routine follow-up call.
- How did you feel during this experience, e.g., did you feel organised in implementing the follow-up plan but challenged by the need for quick problem-solving?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding follow-up care. What strengths did you demonstrate, e.g., organised documentation of follow-up actions and clear communication with the patient?
- What skills and/or knowledge gaps were evident, e.g., anticipating complex care coordination needs with remote services?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in ensuring continuity of care?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding standardised inter-service communication protocols for care coordination, 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 inter-professional communication to ensure seamless care coordination.
- What will you do differently next time you approach providing follow-up care, for instance, by proactively creating a comprehensive, timeline-based follow-up plan immediately after the consultation?
- Do you need to practise any aspect of the activity further, such as refining inter-professional communication skills to ensure seamless care coordination or key learning outcomes related to identifying opportunities to make referrals?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of determining and delivering appropriate follow-up care 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 complex coordination with remote specialist services during follow-up forced you to re-evaluate the robustness of your initial follow-up plan and communication coordination protocols during your first attempt at this training activity.
- Considering what you understand about continuity of care, care coordination, and managing long-term patient needs 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 follow-up process based on further learning and experiences? For example, how you documented patient status updates and planned subsequent actions during follow-up calls, demonstrating you have adapted improvements based on further learning.
- Has discussing cases where follow-up was missed or ineffective due to poor communication or the impact of inappropriate follow-up frequency on patient anxiety with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how a patient who was lost to follow-up due to unclear communication of next steps refined your understanding of the critical nature of meticulous planning and transparent communication in long-term patient support.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent follow-up care experiences, contributed to your overall confidence and ability in managing ongoing patient relationships and ensuring continuity of care? For example, how your accumulated ability in planning and coordinating follow-up now enables you to confidently manage long-term patient pathways.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to determining and delivering appropriate follow-up care? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately when a patient’s condition rapidly deteriorates during the follow-up period, recognising this requires immediate clinical escalation protocols.
- Looking holistically at your training journey, how has this initial follow-up care experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying counselling skills and using counselling supervision? For example, how this foundational experience has supported your development in meeting subsequent learning outcomes focused on comprehensive care coordination.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Plan, structure, deliver and appropriately document Genetic Counsellor consultations. |
| # 4 |
Outcome
Apply communication skills and knowledge to provide genetic information to individuals and their families across a range of clinical situations being sensitive to patient information needs and the psychosocial and cultural context of the situation. |
| # 5 |
Outcome
Use a multidisciplinary approach, including clinical supervision and teamwork to support the diagnosis and management of genetic and genomic disease, referral of patients and appreciate the context of genetic and genomic conditions within wider healthcare management of patients. |