Agnc Sub Group Meeting 10Th October 2002

Accreditation of Mlevel Degrees in Genetic Counselling for the Purposes of Preparing Genetic Counsellors for Registration

Adapted on behalf of the Genetic Counsellor Registration Board UK by

Anna Middleton, Heather Skirton, Gillian Scott

Based on original document by

Liz Baines, Maggie Kirk, Diana Scotcher, Sally Watson

Introduction

The aim of the Genetic Counsellor Registration Board (GCRB) is to assess and maintain standards of competence within the genetic counselling profession in the UK and the Republic of Ireland. One of the recognised routes into the profession is via the completion of an MSc course in Genetic Counselling. Graduates from such programmes need to have specific skills that enable them to enter the genetic counselling profession as a ‘trainee genetic counsellor’. After completion of a training period of at least two years full time, candidates can apply for GCRB registration. In order for the programmes in genetic counselling to be recognised as producing graduates who are eligible for entry as a ‘trainee genetic counsellor’, they must be formally accredited through a process of validation; the GCRB oversees this process.

This document lists the requirements of the GCRB for Masters Level (MLevel) genetic counselling courses (called programmes from herein).

Academic Standards

Programmes of education for genetic counsellors must reach standards required for level 4 (Masters) and must be affiliated to a Higher Education Institution (HEI) and one or more recognised Genetics Training Centres (Barnes et al 2008). There must be clearly identified learning outcomes and mechanisms in place for assuring quality and standards. Therefore HEIs should follow the guidelines of the UK Quality Assurance Agency for Higher Education (QAA) to assure quality and standards. These include programme evaluation, recruitment, collaborative provision, external examining, assessment, programme approval, monitoring and review.

Applicants for entry onto the register as a genetic counsellor with a qualification from a non-accredited programme would be required to demonstrate that the learning outcomes had been met in full. Comprehensive evidence of both the theoretical and vocational elements (including appropriate clinical placements) would be required, including the quality standards applied in both settings. Each application would be considered on an individual basis.

Recommendations Regarding the Admission Criteria for Mlevel Courses in Genetic Counselling

In view of the academic requirements and the vocational nature of the training, it is recommended that applicants for recognised programmes are graduates with a relevant Level 3 (Bachelor’s) degree, preferably in biological sciences, genetics, nursing, psychology, social sciences or education. In addition it is preferable that applicants will have also gained substantial experience of working in a caring role through either paid or voluntary work in health, social or educational settings, or through a previous professional qualification (e.g. nursing or social work).

Programme Design

Higher Education institutions considering programme development are strongly advised and encouraged to make early contact with the GCRB for informal discussions prior to programme planning. It is expected that at least one Registered Genetic Counsellor is significantly involved in all states of design and delivery of the programme, including planning of programme structure and content, delivery of teaching and overseeing the course as Programme Lead (or Co-Director).

It would be expected that the duration of the MSc programme is equivalent to 2 years full-time study, combining both theoretical work and vocational experience. Theoretical components of the programme should equal a total of 180 credit points at HE Level 4 (Master’s level) consisting of approximately 1800 hours of student effort. On average over the 2 years at least 35%, but no more than 55%, of the programme time should be taken up by vocational experience. Therefore at least 45% of the programme time is taken up with theoretical study.

Vocational experience

This experience should be achieved by fieldwork placements in:

1. appropriate care settings
2. genetic counselling settings

1. An ‘appropriate care setting’ should give the student an opportunity to understand the impact of disability on individuals and their families. This could be provided in health, social care or education, for example, a school for children with special needs, a child development centre, a day centre for adults with disabilities or a hospice. Placements will vary depending upon each student’s previous background and experience but students must spend a minimum of 200 hours (e.g. 2 days per week over a 13 week period) in one or more care settings.

1. The ‘genetic counselling setting’ must be a genetics centre that has been approved by the GCRB as a Genetic Counsellor Training Centre (Barnes et al 2008). During the clinical placement, the student should gain a wide range of clinical experience. This should include prenatal counselling, diagnostic consultations involving both adults and children, carrier testing and counselling individuals at risk of a genetic disorder. The student should progress from initially observing a variety of clinics to managing their own cases and being the primary genetic counsellor in at least 2 consultations. All clinical contact should be under the supervision of a named genetic counsellor (who is registered or eligible for registration) and assessment of the student’s practice by the supervisor should follow clear guidelines. Clinical placement(s) must be for a minimum of 72 days (e.g. 3 days a week for 6 months) and can be shared between different approved Genetic Training Centres. Students seeing patients must have access to genetic counselling supervision as described in the AGNC Supervision Guidelines (AGNC Supervision Working Group 2007).

In order to facilitate the development of students’ skills it is imperative that theoretical and practical vocational experiences are integrated so that theory informs practice and vice versa. Therefore placements need to be in term time or between academic modules (and consequently not at the end of the final academic year) so that there is a specific opportunity to allow students to revisit and critically evaluate their clinical placement experience in an academic setting.

Programme Content

The programme syllabus must describe learning objectives and competencies to be achieved for each module of the programme. The overall objectives of the programme need to reflect genetic counselling standards for the profession (Skirton et al 2003), however it must be recognised that students graduating from an MSc programme will not be expected to achieve all the competencies expected of a Registered Genetic Counsellor. On completion of the programme, the students must show evidence of achievement in the following learning outcomes:

A) Knowledge and Understanding

The student will be able to:

• Demonstrate knowledge of human genetics including Mendelian inheritance patterns, molecular genetics, cytogenetics, biochemistry, embryology
• Demonstrate knowledge of Clinical Genetics including dysmorphology, inherited and multifactorial disorders, cancer genetics, genetic testing and screening including prenatal diagnosis
• Utilise and critically appraise information and evidence for the purposes of accurate and appropriate genetic counselling
• Appreciate and critically discuss the philosophical, legal and ethical issues that arise in genetic counselling and understand the implications for practice
• Show an awareness of the wider impact of disability on individuals and families and the services available for these people
• Demonstrate knowledge of the psychosocial aspects of genetics including theories of counselling, cultural awareness and family dynamics
• Demonstrate knowledge of psychological responses to the diagnosis of a genetic condition or termination of pregnancy including grief/bereavement theories
• Demonstrate understanding of relevant counselling theory and current evidence for the practice of effective genetic counselling
• Understand the role and development of the Clinical Genetics service within the NHS

B) Intellectual Skills

The student will be able to:

• Understand the role of probability and statistics
• Identify relevant medical and genetic information for use in genetic counselling
• Make appropriate and accurate genetic risk assessment
• Demonstrate proficient IT skills e.g. using a database
• Apply research methodology appropriately, both qualitative and quantitative methods
• Demonstrate critical appraisal skills
• Formulate and carry out a research project relevant to the practice of genetic counselling

C) Professional Issues, Clinical Issues and Vocational Skills

The student will be able to:

• Demonstrate effective and safe counselling skills
• Establish an appropriate relationship with the client & elicit their concerns
• Elicit and interpret appropriate medical, family and psychosocial history
• Convey clinical and genetic information to clients appropriate to their individual clinical needs
• Explain the options available to the client, including risks, benefits and limitations
• Develop self-awareness in different counselling scenarios
• Make a psychosocial assessment of client’s needs and resources and discuss referral to other agencies with supervisor as appropriate
• Facilitate client’s adjustment and decision-making
• Communicate effectively with patients and other colleagues about genetic issues
• Appreciate the importance of confidentiality
• Appreciate the importance of good record keeping
• Present opportunities for clients to participate in research projects in a manner that facilitates informed choice
• Maintain good inter-professional relationships
• Recognise and maintain professional boundaries
• The student must recognise his/her own limitations in knowledge and capabilities and discuss with colleagues or refer clients when necessary
• Identify and support clients’ access to local, regional and national resources and services
• Practice effective genetic counselling, adhering to the AGNC Code of Ethics (see
• Demonstrate reflective practice
• Give presentations on relevant aspects of genetic counselling

Learning and teaching methods

It is expected that a range of teaching and learning methods are utilised, including:

• Didactic lectures
• Group discussion and debate
• Case study presentations
• Role-plays and workshops
• Clinical exposure
• Independent study
• Appropriate care setting placements
• Reflective journals

Assessment of Students

Assessment of students’ work to demonstrate that stated outcomes of the programme have been achieved will be necessary. Students must demonstrate adequate achievement in the above learning outcomes. Evidence of these assessments will also be required. The method of assessment used will be at the discretion of the HEI.

Resources

Programme Management Team

Each programme should have a Director (or Programme Lead) and a management team who meet at least every term or semester, and who meet the external examiner annually. The Course Director (or at least one Co-Director) or the Programme Lead must be a Registered Genetic Counsellor with at least 5 years clinical experience as a genetic counsellor. After accreditation is granted, it is the responsibility of the Director to ensure that the programme complies with the requirements of the GCRB.

Ideally, the management team should include the following:

• Registered genetic counsellors
• Clinical geneticists
• Researchers of genetic counselling
• Clinical scientists
• Psychologist/Psychotherapeutic counsellor

The genetic counsellors should be educated to Level 4 or above. If not employed as academics, the named members of the team should have protected time available for academic duties e.g. preparation of teaching materials, marking, assessment, supervision and mentoring of students.

Staffing

The students should have access to Registered Genetic Counsellors able to provide sufficient time to supervise students on placements, for supervision of dissertations, and to lecture or teach seminars in areas of particular expertise. There must be an appropriate number of genetic counsellors who are registered for the number of students (one Registered Genetic Counsellor per three students) in each Genetic Centre providing placements. The staff must have allocated time and training to supervise students and there should be a demonstrable leadership and management structure.

There should be evidence of staff development. Professional and personal review would be essential as well as evidence of continued professional development (e.g. attendance at conferences, publishing, research etc,) and participation in both clinical and genetic counselling supervision (AGNC Supervision Working Group 2007).

Genetic counselling staff supervising clinical placements need to have access to genetic counselling supervision. Genetic counselling staff teaching on the course do not need to have access to genetic counselling supervision (unless, they are also working clinically).

Material resources

There should be appropriate teaching facilities, access to a library including the relevant genetic journals, computers and office space to accommodate the student numbers.

The Genetic Centres used for clinical placements should be approved by the GCRB as meeting the requirements of a Genetic Counsellor Training Centre (Barnes et al 2008).

The Accreditation Process

To become accredited, the Director or Programme Lead must submit an application to the GCRB, using the Application Form. Current programme documentation, including University validation documents, should accompany the application. Full details are included on the Application Form.

To be accredited the programme must meet the guidelines issued by the Quality Assurance Agency and evidence to this effect should also be provided.

The Accreditation fee will be set by the GCRB; the 2009 fee will be £400 per year. Appeals will be considered by the Genetic Counsellor Registration Board Accreditation Appeals Committee. If requirements are met, accreditation will be valid for a period of 3 years.

Overseas Programmes and Applicants

Programmes from outside the UK would be required to demonstrate that QAA equivalent quality standards are applied, along with the required clinical standards, and each would be considered on an individual basis (Middleton et al 2008).

Failure to Reach the Standards for Accreditation

Directors of programmes that do not reach the standards required for GCRB accreditation will receive feedback and will have up to one year (from the date of the decision letter) to submit a revised application showing how they have addressed the areas that have been highlighted by the GCRB as unsatisfactory. Depending upon the circumstances of the failure of the application, the programme may be given approval for one year, pending a resubmission.

If a programme fails to reach the standards required for accreditation after resubmission, or a resubmission is not made, accreditation will not be granted. In this case, students who are currently taking the course may not have the required qualifications to meet the eligibility criteria to apply for GCRB registration. Such students may need to do additional training and this will be determined on an individual basis by the GCRB, depending on the circumstances for accreditation failure of the programme they completed.

References

AGNC Supervision Working Group (2007) Report from the UK and Eire Association of Genetic Nurses and Counsellors (AGNC) Supervision Working Group on Genetic Counselling Supervision. Authors: Clarke A, Middleton A, Cowley L, Guilbert P, Macleod R, Clarke A, Tran V. Journal of Genetic Counseling 16(2) p127-142.

Barnes C, Kerzin-Storrar L, Skirton H, Tocher J (2008) Information Pack

for Approved Training Centres. Training Post Panel, Education Sub-Committee

Association of Genetic Nurses and Counsellors (AGNC). Latest update 01/10/08. In house publication for the AGNC,

Middleton A, Kerzin-Storrar L, Arnold A, Gaff C, Wiggins J, Benjamin C (2008) Report on UK Registration of Overseas Genetic Counsellors. Written by the UK Registration of Overseas Genetic Counsellors Working Group, on behalf of the Genetic Counsellor Registration Board UK and Eire and the Association of Genetic Nurses and Counsellors UK and Eire Committee. Latest update 04/02/08. In house publication for the AGNC,

Skirton H et al (2003) Genetic counsellors - a registration system to assure

competence in practice in the United Kingdom. Community Genetics

6(3):182-183.

Application Form

NOTES

Please attach relevant documents including:

Course specification documents

Course programme

Validation documents

Student handbook

Copies of student feedback or course evaluation

External examiner’s report.

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