Training activity information
Details
Identify and work through cultural 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
- Providing genetic counselling to diverse groups
- Providing genetic counselling appropriately to patients from a diversity of social, economic and cultural backgrounds
- Cultural perspectives and contexts in relation to science, genetics and disease
- Influence of beliefs and values in relation to genetic counselling and/or testing and the contribution to delivering better quality genetic counselling the individual
- The role of the Genetic Counsellor and other health professionals, e.g. interpreters in providing genetic counselling appropriately to patients from a diversity of social, economic and cultural backgrounds
- The role of critical reflection in addressing the ethical issues
- Effective use of counselling supervision
- AGNC code of ethics
- GCRB code of conduct
- Good scientific practice
- HCPC standards of proficiency
- Multidisciplinary team working
- Conflicts of confidentiality
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?
- Consider which groups or individuals might be affected by health inequality, and how this might impact on genetics care specifically.
- Consider how different cultural, social, health and identity-based differences can intersect to affect an individual’s experience of the healthcare system.
- Discuss with your training officer to gain clarity of what is expected of you in relation to identifying patient needs and responding in a constructive and sensitive manner.
What is your prior experience of this activity?
- Think about what you already know about health inequality and how it affects care/access for different people.
- Consider the challenges you have witnessed in delivering care for different groups of patients.
- Acknowledge how you feel about discussing inequity and difference in health provision.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as identifying when policies or resources do not meet the needs of all patients, and how to improve this.
- Identify the specific insights you hope to gain, such as appreciating the lived experience of marginalised groups whose experience may differ from yours.
What additional considerations do you need to make?
- Think broadly about the different factors that can impact healthcare access, some will be more obvious than others.
- Consider the impact of systemic factors; these may include IT system design, patient pathways and policies on access.
- Consider the effect of individual factors, including unconscious bias.
- Explore what resources there are to help you understand different experiences and perspectives on health, illness, or genetics.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipated while exploring marginalisation and healthcare?
- Are you encountering situations such as:
- Seeing inequity of access/care for a patient/family who you hadn’t previously thought of as being marginalised?
- Finding that systems or standard resources are unsuitable for some patients, e.g., reduced test sensitivity based on ethnicity, a lack of reference data for your patient, inappropriate options on forms for gender / family structure, exclusion from research or treatment based on personal characteristics?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you able to gather additional information or resources to tailor care to that patient’s circumstances?
- How are you feeling in that moment? For instance, do you notice any areas where your own prior bias, or experiences of marginalisation, intersect with what you have learnt?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to identify the source of inequity and identify improvements or solutions?
- Do you need support or expert advice to achieve this?
- What are you learning as a result of the unexpected development? For example, are you becoming more aware of your own bias and assumptions, or learning how system design creates inequity for some patients?
On action
What happened?
- Begin by summarising the key steps you took when while exploring the issue of marginalisation in genetic healthcare?
- Consider specific events, actions, or interactions which felt important, such as seeing the impact of inequitable care for a patient/family.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, recognising that a test or policy would not work for a patient and adapting your approach.
- How did you feel during this experience, e.g., did you feel concerned by the inequity, or empowered to be able to tailor care?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding inequity and marginalisation. What strengths did you demonstrate, e.g., advocating for equitable care?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with a specific cultural context, lived experience or resource provision. Compare this experience against previous activities. Has learning about inequity helped you to deliver better counselling?
- Identify any challenges you experienced, such as needing to seek advice or support.
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 addressing marginalisation and equity.
- What will you do differently next time you encounter this topic? For example, are there any resources you might utilise?
Beyond action
Have you revisited the experiences?
- Have your subsequent experiences led you to revisit this topic? For example, a subsequent consultation involving a patient who needed a tailored approach to account for their beliefs, access needs or identity.
- How have you adapted your approach? For example, proactively reviewing UK test sensitivities for a patient from a global majority background.
- Has discussing cases involving marginalisation or inequity with colleagues, peers, or supervisors changed how you now view your initial experiences 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 experiences of addressing marginalisation and inequity, contributed to your overall confidence and ability in providing inclusive care?
- Looking holistically at your training journey, how have these initial experiences, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to counselling skills, communication, and supervision? For example, how this foundational experience has supported your development in navigating ethical issues in a multicultural society and ensuring equitable care.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Use counselling supervision and multidisciplinary meetings to work through ethical and cultural issues in genomic counselling practice. |