This article is part of a series by ABGC designed to provide recommendations for additional resources and topics to prepare for the CGC exam. This article covers one exam content category and is meant to provide suggestions based on one genetic counselor’s exam preparation experience. Please note that these are suggestions only and are not meant as an exhaustive guide or exclusive study resource.
When I first made my study plan for the board exam, I spent time reviewing the ABGC Content Outline to ensure that I was covering all the important topics and thinking about the organization of the exam. I used an Excel spreadsheet to organize the domains, subdomains and specific topics. Next, I spent time thinking “what is important to know about each of these topics?” This allowed me to go into my studying with clear targets for what I wanted to review.
My Study Strategies for Domain 4B of the ABGC Board Exam
When studying content associated with counseling and psychosocial topics, I found the textbooks to be very helpful resources. Clinical experiences are filled with robust learning and feedback from supervisors who taught me skills I have brought into my practice. However, I looked at the ABGC Reference List when preparing to study so I was aware of some of the resources referenced when writing the exam. Additionally, I found the book “Genetic Counseling Practice” (Ed: LeRoy, McCarthy Veach, Callanan) to be incredibly helpful! For me, a medley of textbooks and class notes gave me multiple ways to review and frame the same information. Below I shared the major ideas and questions I used to frame my study of the topics in Domain 4B.
1. Adapting Counseling to Modes of Delivery
The first thing I thought about for this item was “what are the main different service delivery models?” I thought of (1) in-person, (2) video visits, (3) telephone visits and (4) group counseling sessions. When studying, I asked myself “what are the benefits and limitations of each service delivery model for (1) providers, (2) patients and (3) the broader system?” I reflected on my own clinical experience, what I learned in class, and information about the patient experience. Big themes were patient accessibility, the provider-patient relationship, and reimbursement implications.
Resources
- Genetic Counseling Practice - Ch. 14: Adapting GC Practice to Different Delivery Models
- Table 14.2 has a great breakdown of the major service delivery types as well as their benefits and limitations
- NSGC Practice Guidelines - Telehealth Education
2. Risk Communication Theories and Models
There is a lot of subjectivity that can come along with risk communication, so it is important to consider how this information is presented to patients. For me, the textbooks were very helpful at reviewing the importance of (1) limiting use of subjective wording like “low risk” and (2) framing risk in different ways like saying “there is a 25% chance of having an affected child and 75% of having an unaffected child.” As providers, it is important that we do not superimpose our thoughts about levels of risk to patients and instead let them add qualitative words based on their feelings. For some patients, a 1% recurrence risk will seem really low, but it might be seen as high for other patients. I used Table 7.1 from “A Guide to Genetic Counseling” as it provides an overview of factors and heuristics that influence how someone perceives risk information. I found it helpful to review major heuristics like “availability, anchoring and representativeness” by coming up with various real-world settings.
Resources
- A Guide to Genetic Counseling - Ch. 7: Risk Communication and Decision-Making
- Genetic Counseling Practice - Ch. 4: Risk Assessment and Communication
- Genetic Counseling Practice - Ch. 9: Supporting Family Communication About Genetic Conditions
- Facilitating the Genetic Counseling Process - Ch. 7.16: Collaborating with Patients
3. Strategies for Working With Interpreters
For this topic, I focused on making a do’s and don’ts of working with interpreters list. I reflected on a lecture with a representative from our language services team, and my clinical experiences. Reviewing the best practices, such as face the patient, use concise language and limit metaphors, is a great starting place. Additionally, I thought about what to do when there is a disconnect between the patient, clinician and interpreter. For example, how do you rebuild rapport with patients? Can you give the interpreter a brief overview of the session in advance? How will you ensure your patient understands what you shared?
Resources
4. Strategies of Results Delivery and Long-Term Follow-Up
I started by reviewing important considerations for results delivery, particularly surrounding difficult news. I had a fantastic lecture in which we learned how to prepare ourselves and patients when delivering difficult news — this centered around the SPIKES model. I linked an article below, but SPIKES helped me think about the components of news delivery beyond the actual information. A key component is the “warning shot,” which involves giving patients a signal that you are about to share something serious. Other considerations are to be concise (you can provide more information later), don’t minimize the result and use easy-to-understand wording. In terms of long-term follow-up, I thought about how this looks in each specialty and our responsibility as genetic counselors. For example, what is our obligation with updating patients about variant reclassifications and new management guidelines?
Resources
- Facilitating the Genetic Counseling Process - Ch. 7.1: Communication Information
- SPIKES Model for delivering bad news (Setting, Perception/Perspective, Invitation, Knowledge, Empathy/Emotion, Summary/Strategy)
5. Impact of Health Literacy
Big considerations of this topic are learning the definitions of health and genetic literacy, reviewing clinical implications of health literacy, and considering factors that impact health literacy. Most medical information is well above the average American’s health literacy level and genetic information is even more complex. Other social determinants of health can be closely tied to health literacy, so it is important to think about how various factors interact to either increase or decrease someone’s access to health care.
Resources
- Genetic Counseling Practice - Ch. 12: Cultural Competency (p. 259)
- Genetic Counseling Practice - Ch. 13: Education in Genetic Counseling
6. Elements of Informed Consent
We talk about informed consent all the time in our field, but what makes consent truly informed? Here, I spent time reviewing the major components of informed consent and their clinical implications. For example, I came across many prenatal patients who received cfDNA screening as the “gender test” without knowing it was looking for chromosomal changes. Would the patient still have elected the test if they were truly informed about what it could tell you? Another topic that came up during my studying was the difference between consent in the clinical setting versus the research setting. Some of this is addressed in Domain 5; however, there is always overlap in studying! Think about what types of research require truly informed consent compared to studies that may just require an informal information sheet. Finally, it is important to review exceptions to informed consent. For example, parents cannot refuse life-saving treatment for a child such as a blood transfusion (A Guide to Genetic Counseling, page 383).
Resources
7. Informed Decision Making
Informed decision making is such a crucial component of our profession. Coupled with this are the ideas of shared decision making and non-directiveness. Here I thought about (1) what does it mean to make an informed decision? (2) why is informed decision making important? and (3) how to promote informed decision making as a genetic counselor? One big takeaway is the importance of presenting all options in a balanced and unbiased way. It is important to think about how you share information with patients and to avoid phrasing options in a way that might sway patients in one direction. However, there are also times when it is important to provide more directive counseling, such as when reviewing management recommendations for a pathogenic variant in a cancer predisposition gene.
Resources
- Genetic Counseling Practice - Ch. 3: Actively Engaging with Patients in Decision-Making
- A Guide to Genetic Counseling - Ch. 7: Risk Communication and Decision-Making
Final Thoughts
If you are starting to study for boards, you are likely nearing the end of your graduate school training. Take a moment to congratulate yourself for everything you have learned in both the classroom and the clinic. Your real-world patient experiences will serve you well while tackling the counseling-focused questions on this exam.
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