Training activity information
Details
Make appropriate and accurate genetic risk assessment and communicate this risk in a trainee led consultation
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
- Risk assessment methods such as pedigree analysis, computer models and Bayes theorem
- Application in different clinical situations e.g. genetic risk, personal risk, recurrence risk and risk to family members
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?
- Identify what is expected of you in relation to making appropriate and accurate genetic risk assessment and communicating this risk in a trainee led consultation.
- Discuss what is expected of you in relation to the key elements expected in a successful risk assessment and communication.
What is your prior experience of this activity?
- Think about what you already know about calculating or interpreting different types of genetic risks.
- Consider possible challenges you might face during the activity, such as calculating or explaining risk accurately and sensitively, as well as how risk calculations and figures are adjusted for different populations
- 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 from your Training Officer when required, for example if the inheritance pattern is atypical or the risk calculation involves highly complex statistical data outside routine assessment.
- Acknowledge how you feel about taking the lead on risk assessment and communication in a consultation.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as risk calculation, interpretation, and communication (drawing upon previous experiences of the activity).
- Identify the specific insights you hope to gain into tailoring risk information to individual patient needs and understanding.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of your risk assessment or communication skills.
- Identify important information you need to consider before embarking on the activity, such as information about the specific condition, inheritance pattern, and family history crucial for making the assessment, including tools or resources you might need access to.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst making the risk assessment or communicating it during the consultation?
- Are you encountering situations such as:
- A new piece of family history emerges that alters plan?
- The patient reacts unexpectedly or strongly to the risk information?
- You have difficulty accurately calculating the risk in the moment due to complexity or unforeseen data?
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 explanation of the risk to address the patient’s reaction?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, was the risk ultimately communicated accurately despite the unexpected event? Or are you needing support because the new piece of family history significantly alters clinical picture?
- What are you learning as a result of the unexpected development? For example, are you learning in the moment about managing unexpected information or patient responses during risk communication?
On action
What happened?
- Begin by summarising the key steps you took when calculating the risk assessment and conveying this risk in the consultation.
- Consider specific events, actions, or interactions which felt important, such as how the patient reacted to the risk figures or the moment unexpected family history emerged that altered the calculation.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adapting your explanation of the risk calculation when the patient expressed unexpected distress or using simpler ratios when the mathematical concept proved confusing.
- How did you feel during this experience, e.g., did you feel stressed by patient distress or confident in the accuracy of the risk figure?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding risk communication. What strengths did you demonstrate, e.g., clear articulation of risk statistics or systematic verification of family history?
- What skills and/or knowledge gaps were evident, e.g., managing patient distress associated with risk figures or handling complex exceptions to Mendelian inheritance?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in communicating complex information effectively?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding unexpected disclosure of non-paternity that complicated the risk calculation, 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 methods for verifying complex family history details.
- What will you do differently next time you approach risk communication, for instance, by proactively preparing tiered explanations of risk (e.g., simple fractions, percentages, and recurrence concepts)?
- Do you need to practise any aspect of the activity further, such as role-playing managing acute emotional responses to risk figures or key learning outcomes related to applying counselling skills?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of making and communicating genetic risk assessments since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent patient exhibited unexpected emotional distress in response to specific risk figures (e.g., 50% chance) forced you to re-evaluate the emotional sensitivity and clarity of your initial risk communication approach during your first attempt at this training activity.
- Considering what you understand about risk perception, communication clarity, and managing patient anxiety associated with uncertainty 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 risk communication practice based on further learning and experiences? For example, how you proactively reviewed and integrated specific communication skills to tailor responses to patient distress associated with risk figures, demonstrating you have adapted improvements based on further learning.
- Has discussing ambiguous risk calculations or patient denial/misunderstanding of risk or the impact of inappropriate risk grading on subsequent clinical decisions with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how a misclassification due to overlooked family history detail refined your understanding of the critical nature of meticulous data verification prior to risk calculation.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent risk assessment experiences, contributed to your overall confidence and ability in communicating complex risk information? For example, how your accumulated ability in clearly articulating complex risk statistics now enables you to confidently manage discussions about recurrence risk.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to risk assessment and communication? 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 risk calculation involves novel, non-standard inheritance patterns or rare exceptions to Mendelian laws, recognising this falls outside routine risk assessment scope.
- Looking holistically at your training journey, how has this initial risk assessment experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying counselling skills and making referrals? For example, how this foundational experience has supported your development in meeting subsequent learning outcomes focused on managing uncertainty in decision-making.
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. |