Applied Genetics and Genomics in Clinical Care —
Training activity: 4

Details

Deliver, under supervision, genetic consultations for a range of less complex clinical situations applying clinical skills appropriate to the situation, ensuring patient-centred care, to include:

• Reproductive cases
• Adult cases
• Cancer cases

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

• Constructing an agenda for the consultation
• Prioritising information according to individual’s needs
• Devising a clinical action plan and appropriate follow-up
• Genetic risk assessment and possible options to manage identified risk based on best evidence and clinical judgement
• Risk, benefits and limitation of interventions
• Informed consent
• Scope of practice

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 delivering a supervised consultation in a range of less complex clinical situations, ensuring patient-centred care.
• Consider how the learning outcomes apply, specifically in relation to applying counselling skills, facilitating decision-making, identifying opportunities for referral, and using counselling supervision and reflection.
• Discuss what is expected of you in relation to the specific clinical and communication skills your supervisor expects you to demonstrate in these scenarios.

What is your prior experience of this activity?

• Think about what you already know about trainee-led consultations, especially in reproductive, adult, or cancer cases.
• Consider possible challenges you might face during the activity, such as managing the consultation flow, applying your knowledge, or maintaining patient-centredness under supervision.
• 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 less complex situation unexpectedly reveals significant psychosocial challenges or a highly complex family dynamic.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as consultation delivery, knowledge application, communication, or working within a team/scope of practice (drawing upon previous experiences of the activity).
• Identify the specific insights you hope to gain into managing different types of consultations or applying theoretical knowledge in practice.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of consultations or related activities.
• Identify important information you need to consider before embarking on the activity, such as specific information about the patient, family history, and clinical context and how to ensure your supervisor is also adequately briefed.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst delivering the consultation under supervision?
• Are you encountering situations such as:
  • An unexpected question from the patient or a strong emotional response?
  • An unexpected turn in the conversation flow?
  • The supervisor intervenes in a way that shifts the direction of 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 consultation structure or line of questioning in that moment?
• Consider the steps you are taking in the moment, such as immediately adapting your line of questioning, employing clarification techniques, or seeking immediate guidance from your supervisor.
• How are you feeling in that moment? For instance, are you finding it difficult to feel equipped to be intuitive and responsive? Is it affecting your confidence in guiding the consultation independently?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to manage the interaction and maintain patient-centred care for the duration of the consultation? Or are you needing support because the unexpected emotional response requires specialised psychological input outside the scope of a routine consultation?
• What are you learning as a result of the unexpected development? For example, are you learning about managing unexpected events during a consultation while being supervised?

On action

What happened?

• Begin by summarising the key steps you took when leading the consultation under supervision.
• Consider specific events, actions, or interactions which felt important, such as a key interaction where you successfully applied a specific counselling skill or where the supervisor intervened.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pivoting the consultation focus away from technical details when the patient showed signs of confusion or anxiety, maintaining patient-centred care.
• How did you feel during this experience, e.g., did you feel focused on managing consultation flow or stressed by the diagnostic uncertainty?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding delivering consultations. What strengths did you demonstrate, e.g., effective application of consultation structure?
• What skills and/or knowledge gaps were evident, e.g., difficulty managing the timing of the consultation or responding adequately to unexpected psychosocial factors?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying counselling skills under supervision?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding an unexpectedly complex family dynamic requiring advanced counselling skills, 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 recognition of subtle psychosocial cues during the consultation.
• What will you do differently next time you approach delivering a supervised consultation, for instance, by proactively including a structured moment of silence to gauge patient response before moving to the next topic?
• Do you need to practise any aspect of the activity further, such as applying specific counselling techniques under observed conditions or key learning outcomes related to facilitating decision-making?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of delivering supervised consultations across different case types (reproductive, adult, cancer) since completing this specific training activity led you to revisit your initial approach or decisions during that activity? Considering what you understand about clinical skills application, patient-centred care, and integrated communication 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 consultation management technique based on further learning and experiences? For example, how you proactively integrated specific techniques for managing consultation flow and timekeeping based on continuous feedback from supervision, demonstrating you have adapted improvements based on further learning.
• Has discussing challenging consultation flow or the impact of unexpected psychosocial factors or the impact of lapses in patient-centred care on therapeutic alliance 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 supervised consultation experiences, contributed to your overall confidence and ability in integrated clinical skills delivery?
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to applying clinical skills and ensuring patient-centred care? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation?

Relevant learning outcomes

#	Outcome
# 1	Outcome Plan, structure, deliver and appropriately document Genetic Counsellor consultations.
# 3	Outcome Critically analyse the literature and evidence base to compile information on the aetiology and clinical presentation of a range of genetic and genomic disorders.
# 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.