Module information
Module details
- Title
- Advanced Counselling and Ethical Practice for Genetic Counsellors
- Type
- Specialist
- Module code
- S-GC-S3
- Credits
- 15
- Phase
- 3
- Requirement
- Compulsory
Aim of this module
This module will provide the trainee with opportunities to critically evaluate theories of advanced counselling and develop their communication skills to support the delivery of high quality, compassionate and patient-centred genetic and genomic counselling. This module builds on the knowledge and skills acquired in the counselling and communication skills module, to enable trainees to develop their skills of critical reflection, including the impact of their actions on the patient and the patient’s family. It will also enable the trainee to explore a range of ethical issues that arise in genetic and genomic counselling practice, e.g. around issues of confidentiality of genetic and genomic information in the family context and the ways in which these may be approached and managed.
The majority of clinical practice should be undertaken by the trainee under indirect supervision (excluding neuropsychiatric presymptomatic testing and prenatal testing which will be more closely supervised).
Work-based content
Training activities
| # | Learning outcome | Training activity | Type | Action |
|---|---|---|---|---|
| # 1 | Learning outcome 1 |
Training activities
Communicate and negotiate effectively with an individual about what is to be achieved in genetic counselling consultations, taking into account the concerns and priorities of the individual/couple/family, as well as what can realistically be delivered |
Type ETA | Action View |
| # 2 | Learning outcome 1,2,3,4 |
Training activities
Assess individuals psychological state and their social support and mental health needs and refer appropriately |
Type ETA | Action View |
| # 3 | Learning outcome 1,2 |
Training activities
Provide information regarding genetic testing options and elicit the individual’s preference for testing in independent consultations |
Type ETA | Action View |
| # 4 | Learning outcome 1,2,3 |
Training activities
Prepare individuals for the potential outcomes of diagnostic genetic tests in trainee led consultations |
Type ETA | Action View |
| # 5 | Learning outcome 1,2,3 |
Training activities
Prepare individuals for the potential outcomes of prenatal genetic tests in trainee led consultations |
Type ETA | Action View |
| # 6 | Learning outcome 1,2,3 |
Training activities
Prepare individuals for the potential outcomes of cancer and non-cancer predictive/pre-symptomatic genetic tests in trainee led consultations |
Type ETA | Action View |
| # 7 | Learning outcome 3 |
Training activities
Communicate complex genetic test results appropriately in trainee-led consultations |
Type ETA | Action View |
| # 8 | Learning outcome 3 |
Training activities
Deliver bad news results following predictive and/or prenatal tests, reflect on the family context and circumstances under supervision |
Type ETA | Action View |
| # 9 | Learning outcome 1,3 |
Training activities
Facilitate and support disclosure of genetic information to family members in a trainee led consultation |
Type ETA | Action View |
| # 10 | Learning outcome 1,2,3,4 |
Training activities
Reflect on how a patient’s beliefs and values have influenced their response to genetic counselling and testing and how you responded to these in trainee led consultations |
Type DTA | Action View |
| # 11 | Learning outcome 1,4 |
Training activities
Identify and discuss ethical issues raised in trainee led or observed consultations, use clinical or counselling supervision where appropriate |
Type ETA | Action View |
| # 12 | Learning outcome 4 |
Training activities
Identify and work through cultural issues raised in trainee led or observed consultations, use clinical or counselling supervision where appropriate |
Type ETA | Action View |
| # 13 | Learning outcome 4 |
Training activities
In trainee led consultations, address ethical issues raised, and take steps with the patient to find a resolution where possible |
Type DTA | Action View |
| # 14 | Learning outcome 4 |
Training activities
Identify and work through counselling issues raised in trainee led consultations using counselling supervision |
Type ETA | Action View |
| # 15 | Learning outcome 2,3,4 |
Training activities
Reflect on a range of communication and counselling skills used in independent counselling sessions with a counselling supervisor through audio and/or video recording |
Type DTA | Action View |
Assessments
Complete 3 Case-Based Discussions
Complete 3 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Explain to a patient the potential outcomes of a genetic test to identify the underlying cause for a general genetic condition.
- Provide genetic counselling appropriately to a patient who does not speak English.
- Provide genetic counselling appropriately to a patient with visual or hearing impairment.
Observed Clinical Event Titles
- Explain to a patient the potential outcomes of a genetic test to identify the underlying cause for hereditary cancer.
- Explain reproductive options available to a patient with an at-risk pregnancy taking account of the patients concerns and personal circumstances and uncertainties associated with the available options.
- Elicit individual preferences for cancer risk management options.
- Communicate bad news from a predictive genetic test results in an empathic manner.
- Facilitate and support disclosure of genetic information to family members in a trainee led consultation.
- Explore with a patient their anticipated response to the potential outcomes of a pre-symptomatic genetic test.
- Present an ethical case at a multidisciplinary team meeting.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | 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 | Employ counselling skills to facilitate complex decision making during genetic and genomic counselling consultations. |
| 3 | Apply communication skills to provide complex genomic test results in an empathic manner. |
| 4 | Use counselling supervision and multidisciplinary meetings to work through ethical and cultural issues in genomic counselling practice. |
Clinical experiences
Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.
Activities
- Attend multidisciplinary clinical meetings where the trainees’ patients are discussed.
- Attend a meeting specialising in ethical discussion such as Genetics or a Trust Ethics Committee.
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Critically appraise current counselling theories and discuss how these can be applied to genetic and genomic counselling practice.
- Apply suitable frameworks for the assessment and resolution of ethical and psychosocial dilemmas in clinical genetics practice.
- Discuss the potential ethical and psychosocial impact of genetic test results, synthesising the published evidence base of patient and family experiences.
- Critically evaluate the strategies professionals can use to provide support and facilitate ethical decision making in partnership with the patient/family.
- Critically evaluate theoretical frameworks to help explain family functioning and their relevance to practice in supporting families around a genetic diagnosis or genetic test result.
- Describe and critically evaluate current best practice guidelines for genetic and genomic testing.
- Argue and defend specific ethical position(s) in relation to issues arising in genetic counselling practice.
- Justify the role of counselling supervision in managing ethically contentious cases.
Indicative content
In a safe learning environment, e.g. an HEI clinical skills centre, trainees will:
- Practice applying advanced skills for counselling, showing a positive regard for the patient and family members with respect to their autonomy. They will use a range of counselling skills to develop further skills in supporting patients and their families to adjust to their genetic risk or status
- Practice the use of a range of more advanced counselling skills to support patients in decision making in relation to genetic testing and to address ethical issues raised by genetic counselling
- Practice applying counselling theory in hypothetical scenarios to enhance understanding of individual people’s responses and develop competent and safe patient practice
- Critically reflect upon own professional strengths and limitations
Counselling theory and skills
- Theories of psychosocial adjustment
- Responses to loss (bereavement, loss of imagined future)
- Responses to uncertainty
- Assessment of psychological status including screening questions/diagnostic criteria for clinical anxiety and depression
- Family impact, family systems theory and fostering resilience
- Application of counselling skills and theory for delivery of genetic testing
- Psychology and theory of decision-making
Ethical principles and frameworks
- Why ethics is important in clinical genetics and genetic counselling
- Ethics as theory vs ethics as governance
- Frameworks for thinking about ethics (e.g. normative ethics, consequentialism, deontology and bioethics)
- Ethical issues in a multicultural society, including: providing genetic counselling to diverse groups, and cultural perspectives and contexts in relation to science, genetics and disease
- Ethical issues surrounding the reporting of incidental findings using examples from a pre-natal, childhood and adult setting
- Ethical issues raised by NIPT (e.g. incidental cancer diagnosis picked up in the mother via the pre-natal test) and the ‘prenatal exome/genome’
Professional codes of conduct and legislation
- Professional codes of conduct, e.g. Association of Genetic Nurses and Counsellors (AGNC) Code of Ethics, The Genetic Counsellor Registration Board (GCRB) Code of Conduct, HCPC and their standards of proficiency for clinical practice
- Latest relevant policy on ethics and genomics, e.g. from the British Society of Genetic Medicine (in particular on consent and confidentiality best practice) and the Nuffield Council on Bioethics (on the ethical issues surrounding genomic data sharing)
- Latest information about legislation, codes of practice, Caldicott guardian and information commissioner (e.g. to cover Data Protection Act, Mental Capacity Act, Human Tissue Act, Human Fertilisation and Embryology Act, and Equality Act (formally the Disability Discrimination Act)
- Privacy, confidentiality and (non) disclosure
Consent for genetic and genomic testing and data sharing
- Genetic testing: consent and competence (adults and children)
- Consent models used in a health setting (to include ‘broad consent’ used prior to sequencing and dynamic consent as a model for research)
- Prenatal diagnosis, screening and disability issues
- Opportunistic genomic screening for additional information (in addition to the diagnosis) searched for via genomic sequencing technologies
- Patient identifiable data and information, relationship between data and information
- Information system risks to patient safety, electronic and paper copies, safe havens, encryption, secondary uses of data, audit and research
- Secure information exchange between professionals
- ‘Citizen science’ and the return of data to patients (e.g. raw sequence data)
- Handling requests for information about patients /clients
Patient support
- Use of resources (including online) for psychological support and referral pathways
- Assessing psychological status to ascertain patients who may benefit from referral
- Critical reflective practice – including how to apply to work-based learning