Training activity information
Details
Identify and discuss ethical issues raised in trainee led or observed consultations, use clinical or counselling supervision where appropriate
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
- Ethical issues that may be raised within the context of a genetic counselling appointment
- Ethical theory vs ethical governance
- Frameworks for thinking about ethics
- AGNC code of ethics
- GCRB code of conduct
- Good scientific practice
- HCPC standards of proficiency
- The role of critical reflection in addressing the ethical issues
- Conflicts of confidentiality
- Multidisciplinary team working
- Safeguarding concerns
- Effective use of counselling supervision
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 ensuring you are able to identify potential ethical issues as they arise in a consultation.
- Consider how the learning outcomes apply, specifically in relation to effectively discussing ethical issues, either within the consultation or later in supervision.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the level of ethical analysis expected for different types of dilemmas and the procedures for rapid escalation of urgent ethical issues.
What is your prior experience of this activity?
- Think about what you already know about ethical principles and frameworks relevant to genetic counselling.
- Consider possible challenges you might face during the activity, such as recognising or articulating ethical concerns in clinical practice.
- 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 ethical issue involves a conflict with institutional policy or legal mandates (e.g., non-paternity disclosure outside consent).
- Acknowledge how you feel about raising and discussing ethical issues with a supervisor or within a clinical team.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as identifying and exploring specific ethical dilemmas or types of issues, drawing upon previous experiences of the activity.
- Identify the specific insights you hope to gain into applying ethical frameworks or seeking appropriate supervision for ethical challenges.
What additional considerations do you need to make?
- Consider your previous experiences of ethical analysis or supervision regarding difficult cases.
- Identify important information you need to consider before embarking on the activity, such as which professional codes of conduct or guidelines are most relevant to the types of consultations you anticipate, and the process for accessing clinical or counselling supervision to discuss ethical issues.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst identifying or discussing an ethical issue?
- Are you encountering situations such as:
- A patient raises a significant ethical conflict (e.g., duty to warn vs. confidentiality) that you hadn’t anticipated or studied?
- A seemingly simple clinical decision unexpectedly presents a complex ethical challenge (e.g., related to capacity or autonomy)?
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 the conversation to safely bracket the ethical issue for later supervision?
- Consider the steps you are taking in the moment, such as: Immediately acknowledging the complexity of the issue; or making an internal note of the ethical dilemma for immediate post-consultation discussion with a supervisor.
- How are you feeling in that moment? For instance, are you finding it difficult to remain objective while grappling with the moral weight of the dilemma? Is it affecting your confidence in recognising the ethical issue as it unfolds in real-time?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to identify the ethical issue and continue the consultation without making an immediate, unsupported decision? Or are you needing support because the ethical issue relates to legal mandates (e.g., duty to warn) and requires immediate senior consultation before clinical action can proceed?
- What are you learning as a result of the unexpected development? For example, are you mastering the skill of identifying complex ethical issues in action or gaining insight into the need for immediate consultation when faced with ethical ambiguity?
On action
What happened?
- Begin by summarising the key steps you took when identifying and addressing an ethical issue.
- Consider specific events, actions, or interactions which felt important, such as a patient raising a significant ethical conflict (e.g., duty to warn vs. confidentiality) that you had not anticipated.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately documenting the ethical dilemma for immediate post-consultation supervision, while maintaining professional neutrality.
- How did you feel during this experience, e.g., did you feel focused on patient care but challenged by the moral weight of the dilemma?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding ethical issues. What strengths did you demonstrate, e.g., recognising the ethical dimensions of the case as it unfolded?
- What skills and/or knowledge gaps were evident, e.g., applying specific ethical frameworks to address the conflict or the need for clarification on professional codes of conduct?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in utilising clinical or counselling supervision to work through the ethical issue?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the need to escalate a conflict related to legal mandates (e.g., duty to warn), 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 ability to recognise ethical issues proactively.
- What will you do differently next time you approach an ethical dilemma, for instance, by proactively reviewing relevant professional codes of conduct and ethical guidelines?
- Do you need to practise any aspect of the activity further, such as using specific ethical frameworks to guide your thinking or ensuring appropriate discussion of ethical concerns with patients?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of identifying and discussing ethical issues since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent case involving complex consent issues or capacity ambiguity may have prompted you to re-evaluate your ability to apply ethical frameworks and justify your approach during your first attempt at this training activity.
- Considering what you understand about ethical frameworks, supervision protocols, and professional codes of conduct now, how have you adapted your ethical issue management technique? For example, how you proactively reviewed and integrated strategies for using supervision for ethical issues to inform your confidence in navigating complex cases.
- Has discussing complex conflicts (e.g., duty to warn vs. confidentiality) or the impact of ethical ambiguity on clinical decision-making with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, hearing a senior colleague talk about about a dilemma requiring consultation with an ethics committee refined your understanding of the critical nature of recognising and escalating ethical dimensions.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of identifying and discussing ethical issues and utilising supervision experiences, contributed to your overall confidence and ability in recognising ethical dimensions and applying ethical frameworks? For example, how your accumulated ability in recognising ethical dimensions and applying ethical frameworks now enables you to present and justify a decision on a complex ethical dilemma.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to identifying and discussing ethical issues?
- 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 from your Training Officer immediately when an ethical conflict relates to legal mandates (e.g., duty to warn) or requires clarification on institutional policy that falls outside routine clinical scope.
- Looking holistically at your training journey, how has this initial ethical experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to supervision and ethical practice? For example, how this foundational experience has supported your development in justifying your approach in complex cases.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Lead on establishing the patient agenda and psychosocial needs in complex genetic and genomic counselling consultations, under the supervision of a GCRB registered Genetic Counsellor. |
| # 4 |
Outcome
Use counselling supervision and multidisciplinary meetings to work through ethical and cultural issues in genomic counselling practice. |