Training activity information
Details
Communicate complex genetic test results appropriately in trainee-led 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
- Implications of the genetic test results for diagnosis/prognosis and reproductive options
- Communicating genetic test results in an empathic manner
- Communicating genetic test results with clarity about the boundaries of certain/uncertain information
- Communicating genetic test results taking into account patients’ current concerns, health literacy and cognitive ability
- Different modes of communication, including: verbal, letter, phone, video etc
- Emerging genomic technologies, potential outcomes, implications and uncertainties
- Single gene, panel, targeted or open whole genome approaches in these settings
- Incidental findings
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 how you will communicate the results and how you will assess whether the individual has understood the implications.
- Consider how the learning outcomes apply, specifically in relation to ensuring the information is conveyed in an empathic, clear, and appropriate manner, even when the results are complex.
- Discuss with your training officer what is expected of you in relation to the level of simplification appropriate for maintaining accuracy when communicating complex genetic concepts.
What is your prior experience of this activity?
- Think about what you already know about communicating complex medical or scientific information to a lay audience.
- Consider possible challenges you might face during the activity, such as ensuring understanding when discussing complex genetic concepts or results.
- 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 patient raises highly technical questions about methodology, interpretation (e.g., dealing with a complex variant of uncertain significance, VUS) or management that requires immediate senior clarification.
- Acknowledge how you feel about leading a consultation where you must explain complex genetic test results independently.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as specific techniques to use to simplify complex genetic information while maintaining accuracy, drawing upon previous experiences of the activity.
- Identify the specific insights you hope to gain into the most effective ways to explain complex results and address patient questions or confusion.
What additional considerations do you need to make?
- Consider your previous experiences of communicating complex technical results.
- Identify what information you need to consider before embarking on the activity, such as specific details about the patient’s result, laboratory process or family history, and how you will address questions or emotional responses.
- Establish whether there is anyone else you need to speak to to guide the management of this complex result such as an MDT forum, clinical specialist or scientist.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst actively communicating complex genetic test results?
- Are you encountering situations such as:
- The individual’s immediate reaction is one of confusion or disbelief?
- They ask highly detailed questions about methodology or interpretation (e.g., variant classification criteria) that you hadn’t anticipated?
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 complex result by using different analogies or visual aids?
- Consider the steps you are taking in the moment, such as: Immediately pausing to employ the ‘teach-back’ method to check their understanding; or re-explaining the complexity of VUS using simplified, lay-appropriate terminology.
- How are you feeling in that moment? For instance, are you finding it difficult to re-explain the complex information accurately without increasing their confusion? Is it affecting your confidence in communicating the results clearly in an independent setting?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to communicate the complex result and verify understanding using tailored communication techniques? Or are you needing support because the required technical detail exceeds your current knowledge base and necessitates consultation with the laboratory scientist?
- What are you learning as a result of the unexpected development? For example, are you mastering specific communication strategies for conveying complex genomic uncertainty or gaining insight into patient comprehension barriers?
On action
What happened?
- Begin by summarising the key steps you took when structuring the delivery and explanation of complex genetic test results (e.g., VUS, mosaicism, implications for multiple genes).
- Consider specific events, actions, or interactions which felt important, such as the moment the patient expressed confusion, or identified an emotional issue that was influencing their interpretation.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adapting your language and using different analogies to explain the complexity of a VUS or mosaicism result in an understandable way.
- How did you feel during this experience, e.g., did you feel challenged by the complexity of the results but focused on simplifying the information?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding complex results communication. What strengths did you demonstrate, e.g., simplifying information, checking for understanding or empathising with their emotional response?
- What skills and/or knowledge gaps were evident, e.g., difficulty managing the potential emotional responses to complexity?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in effectively communicating complex genetic test results?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding communicating results that were ambiguous and required confirmation from the laboratory scientist, 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 strategies for communicating complex genetic test results.
- What will you do differently next time you approach delivering complex results, for instance, by proactively using visual aids or the teach-back technique to ensure understanding?
- Do you need to practise any aspect of the activity further, such as enhancing knowledge of specific complex result types (e.g., mosaicism) or refining skills for managing emotional responses to uncertainty?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of delivering complex results since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, a subsequent case involving ambiguous findings (e.g., complex VUS or mosaicism) may have prompted you to re-evaluate your strategy for explaining intricate information and assessing patient comprehension during.
- Considering what you understand about assessing patient comprehension, managing uncertainty, and advanced communication techniques now; how, how have you adapted your complex results communication strategy? For example, proactively integrating specific check-back questions and visual aids to ensure accurate understanding of findings and implications.
- Has discussing ambiguous or conflicting complex results or the impact of misinterpretation on subsequent clinical management 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 miscommunication regarding reclassification of a VUS refined your understanding of how expectations, or family stories, can sway influence a patient’s memory of events.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of delivering complex results and managing unexpected findings experiences, contributed to your overall confidence and ability in explaining intricate information and assessing patient understanding?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to communicating complex genetic test results?
- 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 a laboratory scientist before final communication to the patient. Or, how you review previous consultation notes to ensure that you frame the explanation according to the patient’s priorities and history.
- Looking holistically at your training journey, how has this initial complex results communication experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to communication, decision-making, and counselling skills?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply communication skills to provide complex genomic test results in an empathic manner. |