abgc logbook requirements - university of north...

CLINICAL TRAINING

UNCG LOGBOOK REQUIREMENTS

CLASS OF 2 0 1 5

SERVICE TYPES

Fetal Risk Assessment

Prenatal Cases

Diagnosis and Management

Pediatric

Adult

Genetic Risk Assessment

Preconception

Cancer

Predictive Testing

Carrier screening

Family History Concerns

SERVICE TYPE: FETAL RISK ASSESSMENT ~

OBJECTIVES

Gain knowledge and experience discussing the various

options for prenatal diagnostic and screening tests

Be able to manage a case when there are time

constraints

Provide options and supportive counseling to families

who are found to have an affected fetus

Have experience working with families who are dealing

with the unique emotional issues surrounding prenatal

diagnosis

FETAL RISK ASSESSMENT

Clients whose primary concerns involve issues related

to prenatal testing or fetal health in a current pregnancy.

Includes individuals seen for maternal or paternal age,

serum marker screening, non-invasive prenatal testing,

fetal ultrasound anomalies or other abnormal prenatal

test results, and teratogen issues

Includes “previous child with genetic condition or birth

defect” if patient is pregnant and the focus is on prenatal

diagnosis and availability of testing

FETAL RISK ASSESSMENT

Patients included in this category must be pregnant

Primary indication or focus of session is the health of the

fetus

If patient referred for AMA, and a family history concern

is identified –case should be coded for primary

indication

Include all cases involving prenatal diagnosis, positive

maternal serum screening and/or non-invasive prenatal

testing, teratogenic exposure and abnormal ultrasound

evaluation

SERVICE TYPE: DIAGNOSIS AND MANAGEMENT ~

OBJECTIVES

Become familiar with clinical features and natural history

of a broad range of genetic conditions, birth defects and

syndromes of unknown etiology

Gain an understanding of the diagnostic process,

including dysmorphology, syndromology, physical

assessment, and genetically-based laboratory testing

Have experience working with individuals and families

who are dealing with the medical and psychosocial

issues related to living with genetic (or potentially

genetic condition).

DIAGNOSTIC EVALUATION / MANAGEMENT

Patients who are seen for diagnosis and/or

management of a genetic condition or possible genetic

condition, multiple congenital anomalies and/or birth

defects.

This session might include a physical examination

(performed by an M.D.), genetic testing, and discussion

of the diagnosis with the patient/ family.

For previously diagnosed individuals, this includes

individuals who return for medical management,

additional evaluation, or consultation.

SERVICE TYPE: GENETIC RISK ASSESSMENT ~

OBJECTIVES

Become familiar with determining risks based on

pedigree analysis, knowledge of inheritance patterns,

genetic epidemiological data, quantitative genetic

principles and computer based programs.

Be familiar with the range of genetic and other tests that

can be offered to either better refine a risk statistic or

determine an individual’s gene status

GENETIC RISK ASSESSMENT ~

OBJECTIVES

Gain experience communicating risk information and

various etiologies to individuals and families

Understand how individuals and families incorporate risk

statistics and biologically based etiological explanations

into their coping mechanisms

Have experience working with individuals and families

dealing with genetically derived personal health or

reproductive risks.


TYPES OF CASES

Clients whose primary concerns involve issues related

to genetic risks for themselves (predisposition/ pre-

symptomatic evaluation), their offspring (preconception),

or relatives. This includes:

Clients who are themselves at risk for a genetic

condition but who are not currently symptomatic.

Individuals seen for genetic counseling regarding a

known or suspected genetic cancer syndrome, or a

late onset common complex disorder.


PRECONCEPTION COUNSELING

Cases include family history concerns and previously

affected children

Clients seen for carrier screening, reproductive loss,

familial chromosome rearrangements, consanguinity,

and other family history concerns are included in this

category

Patients who request preconception counseling for

advanced maternal age are also included in this

category


CANCER COUNSELING

All cancer risk assessments cases are included in this

category

Include type of cancer as primary indication

Note a personal and/or family history of cancer as

secondary indication


PREGNANT PATIENTS

Pregnant patients may be included, if the focus of the

session is NOT the health of the current pregnancy.

Examples:

A pregnant woman may seek counseling regarding a

family history of breast cancer

A pregnant woman referred for counseling regarding

family history of CF and possible CF carrier

– might include discussion of options for

prenatal diagnosis


ESTABLISHED DIAGNOSES

Patients with established diagnoses (for example seen

in multidisciplinary clinics) where the focus of the

genetic intervention is carrier testing/ family screening,

recurrence risk and prenatal options counseling

?

Service Type

# Core

Cases

# unique

indications/

diagnoses Specialty Examples

Fetal Risk

Assessment20 4 Prenatal

AMA, PSDS [1st,2nd

trimester, NIPD],

ultrasound anomaly,

teratogen

Diagnosis/

Management or

Genetic Risk

Assessment

13 4 Pediatric

4 unique

syndromes/disorders

[evaluation, testing, r/o]

5 2 Adult

2 unique

syndromes/indications;

includes family history

concerns

Genetic Risk

Assessment12 3 Cancer

Breast, ovarian, colon,

cancer syndromes

[affected, at risk]

Distribution of 50 Minimum Core Cases

UNIQUE INDICATIONS ~ EXAMPLES

Fetal Risk Assessment (20 cases - 4 unique indications)

Positive Screen for DS

Serum screening/ non-invasive testing

Advanced Maternal Age

Ultrasound abnormality (specify)

Previous child with ---

Each case must be coded with a primary indication

Secondary indications should be added to help identify the cases


Diagnosis/ Management

( 13 Pediatric Cases- 4 unique indications

5 Adult Cases - 2 unique indications)

Known genetic syndromes (affected)

Known genetic syndromes (r/o or suspected)

Unexplained developmental, growth problems

Birth defects

Each case must be coded with a primary indication

Secondary indications should be added to help identify the cases



Cancer risk assessment (12 cases - 3 unique indications)

Breast and/or ovarian

Colon cancer (FAP, HNPCC)

Other cancers/ cancer syndromes

Note:

• When designating the primary indication for cancer cases, you

may consider a personal history of cancer as unique from a family

history of cancer.

• You may also consider a mutation positive case as a separate

indication.



Non-cancer cases ( No minimum number of cases – these can be

included as unique indications in your Pediatric and Adult cases)

Consanguinity

Carrier testing

Family history concerns

Predictive testing

• Susceptibility

• Pre-symptomatic

Reproductive loss – recurrent miscarriages

Translocation carrier

LOGBOOK-ELIGIBLE CASES:

FUNDAMENTAL COUNSELING ROLES

To be considered a “logbook- eligible case”:

the clinical interaction must occur face-to-face

active student participation in at least 1 role in each of

the 3 categories of Fundamental Counseling Roles

(Management, Education, and Counseling) must be

documented.

MANAGEMENT ROLES

Case preparation

Collection/documentation of medical,

developmental and/or pregnancy history

Collection/documentation of family history/pedigree

Risk assessment

Evaluation/coordination of genetic

Clinical documentation (clinic notes, letters)

Other follow-up (calls, referrals)

EDUCATION ROLES

Develop counseling plan/agenda that includes pertinent

education issues to address

Inheritance patterns

Risk counseling

Diagnosis/prognosis/natural

Medical management/prevention/treatment

Genetic and/or prenatal testing options and possible

results/benefits/limitations

Results disclosure

Research options /consenting

COUNSELING ROLES

Establishing rapport/contracting

Psychosocial assessment

Psychosocial support/counseling

Resource identification/referral

Case processing/self-assessment/self-reflection

UNCG LOGBOOK CASES ~ SUPERVISION

All 50 cases that are included in your UNCG Logbook must be supervised by certified genetic counselors, ABMG or CCMG certified genetics professionals

At least 35 of these should be supervised by certified genetic counselors; others can be supervised by certified geneticists.

Some cases may be supervised by board-eligible, but not yet certified, genetic counselors

You can enter these as “logbook-eligible in your database, but you may not include them in your final UNCG Logbook of 50 cases.

UNCG LOGBOOK CASES ~ FUNDAMENTAL ROLES

All 50 cases that are included in your UNCG Logbook must meet “Core Cases” requirements

You should strive to use each of the 26 fundamental roles at least 3-4 times – more is better.

We know that there are fewer opportunities to perform some roles (i.e. presenting research options) – you should actively seek opportunities to perform these roles.

TRACKING YOUR CASES ~

UNCG LOGBOOK PROGRAM

Site name and number

Supervisor

Type of Case

Prenatal

Pediatric

Cancer

Adult

Primary Type of Service

Fetal Risk Assessment

Diagnosis/ Management

Risk Assessment

TRACKING YOUR CASES ~

UNCG LOGBOOK PROGRAM

Information about client

Pregnant?

Child or Adult?

Clinically affected?

Family Session?

Fundamental Counseling Roles

Management Roles

Education Roles

Counseling Roles

Logbook Eligible?

OTHER ACTIVITIES ~

NON-TRADITIONAL CLINICAL CASES

Non-face-to-face cases (e.g., phone genetic counseling and telemedicine cases)

Clinical experiences supervised by non-genetic providers (physicians, nurse practitioners, etc.)

Cases included in this category (optional) should demonstrate comprehensiveness of patient care in a non-face-to-face encounter.

This does not include observation-only cases

This does not include pedigree-only cases

Student and supervisor should work together to develop an appropriate plan of care

NON-TRADITIONAL CASES ~ EXAMPLES

oTeratogen hotline counseling

oTelemedicine

Quick telephone calls with callers seeking general

information about genetic issues or triage to traditional

clinic-based appointments do not qualify as

nontraditional clinical cases

NON-CLINICAL ACTIVITIES

Remember to continue using your Electronic Portfolio

to keep track of non-clinical activities such as:

Support groups or other community activities

Laboratory experiences

Community outreach/ educational programs

Health Fairs

Educational meetings (e.g. NCMGA)

Journal Club and/or Case Conferences at Clinical

Rotation sites

abgc logbook requirements - university of north...

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