Advanced Counselling and Ethical Practice for Genetic Counsellors —
Training activity: 14

Details

In trainee led consultations, address the unique medical and counselling considerations for patients from different marginalised groups or identities, using clinical and 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.

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 measures a patient may need to fully benefit from care in the clinical genetics setting.
• Consider how you can sensitively address or account for access needs and inequities, utilising appropriate skills and resources.
• Discuss with your training officer to understand how to adapt your approach and get support with unfamiliar situations.

What is your prior experience of this activity?

• Consider possible challenges you might face during the activity, such as anticipating individual patient barriers or understanding different perspectives.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, for example if suitable guidelines or resources do not exist for your patient.
• Acknowledge how you feel about discussing sensitive issues around difference and marginalisation, including how this impacts your approach.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as identifying barriers or access needs for your patient and finding ways to tackle them.
• Identify the specific insights you hope to gain around working respectfully and effectively with patients who may need a tailored approach to benefit from equitable care.

What additional considerations do you need to make?

• Consider how prior experiences of an inequitable health system might affect people trusting or engaging with services.
• Consider what information, language or resources you need to confidently support individual patients.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst identifying or working with patients who belong to a marginalised group?
• Are you encountering situations such as:
  • Finding that the pattern of communication is different, e.g. differences in body language, verbal expression or speaking primarily through a device/partner/relative.
  • Finding that there aren’t adequate resources for your patient, e.g. a lack of patient literature in your patient’s language / accessible format.
  • Finding that forms or standard guidelines don’t meet their needs.

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you able to seek guidance from colleagues to determine a personalised approach to care. Are you able to acknowledge the situation and discuss solutions with your patient in a collaborative and respectful manner?
• Consider the steps you are taking in the moment, such as asking appropriate, open questions about their experience and needs so that you can adapt your approach.
• How are you feeling in that moment? For instance, do you feel anxious about using the wrong terms, or find yourself avoiding a topic for fear of being intrusive? Are you feeling conscious of the difference between your experience and your patient’s?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to identify what might help your patient and navigate this with them? Would you benefit from support to ensure you can meet their clinical, informational or counselling needs?
• What are you learning as a result of the unexpected development? For example, are you becoming more aware of sources of marginalisation within health and social care? Are you gaining skill in sensitively responding to difference and adapting your approach to be more inclusive?

On action

What happened?

• Begin by summarising the key steps you took when identifying the unique needs of your patient.
• Consider specific events, actions, or interactions which felt important, such as a patient not benefitting from a standard approach, or the impact of acknowledging this inequality, e.g., when explaining relative test sensitives for a couple who are from different ethnic backgrounds; explaining to a transgender patient why you need to confirm their ASAB to complete their genomic request form; or, working with a patient who has a poorly understood or stigmatised condition.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, pausing the clinical explanation to ask respectful, open questions about personal experiences, identity or access needs.
• How did you feel during this experience, e.g., did these conversations feel challenging? Did they ultimately enhance trust and rapport between you and your patient?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding supporting inclusive care. What strengths did you demonstrate, e.g., demonstrating openness and respect while acknowledging lived experience?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with a specific cultural context, resources or terminology?
• Compare this experience against previous activities; has your practice improved in tackling sensitive topics or identifying sources of 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.
• What will you do differently next time you approach a consultation, for instance, by seeking out specific practical resources or assistance from an LD and ND team, learning about the experiences of specific people, or exploring your own bias and feelings about these topics in supervision?
• Do you need to practise any aspect of the activity further, such as strategies to proactively identify and address inequality? Are there topics that still feel hard to broach, that might benefit from role play practice or discussion with colleagues?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of delivering inclusive care led you to revisit your initial approach? For example, has a subsequent consultation prompted you to examine a blind spot or unconscious bias?
• How have you subsequently improved or developed your approach? For example, engaging with resources or literature to learn more about the needs of specific groups, or spending time with a service supporting them.
• Has discussing inclusive care 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 experiences influenced your overall confidence and ability in providing sensitive, evidenced care to individual patients?
• 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?

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.
# 2	Outcome Employ counselling skills to facilitate complex decision making during genetic and genomic counselling consultations.
# 3	Outcome Apply communication skills to provide complex genomic test results in an empathic manner.
# 4	Outcome Use counselling supervision and multidisciplinary meetings to work through ethical and cultural issues in genomic counselling practice.