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.
To make my study plan, I reviewed the ABGC Content Outline to ensure that I was covering all the important topics and thinking about the organization of the exam. I used a spreadsheet to organize the domains, subdomains and specific topics. Next, I spent time thinking, “What is important to know about each of these topics?” and, “What resources will I use?” This allowed me to go into my studying with clear targets for what I wanted to review and a list of resources.
My Study Strategies for Domain 5D of the ABGC Board Exam
When studying professional frameworks, I found NSGC resources and textbooks from the ABGC Reference List to be very helpful. Several task list items from this domain are based on documents that can be accessed through the NSGC website. Below, I shared the seven major ideas and questions I used to frame my study of the topics in Domain 5D.
1. Code of Ethics:
You can find the code of ethics on the NSGC website (see link below). The code is composed of four overarching sections: (1) Genetic Counselors Themselves, (2) Genetic Counselors and Their Clients, (3) Genetic Counselors and Their Colleagues and (4) Genetic Counselors and Society. When studying the code of ethics, familiarize yourself with the major components of these four sections. Additionally, it is helpful to think about how the code of ethics relates to the guiding ethical principles. For example, genetic counselors “enable their clients to make informed decisions” as a way to promote patient autonomy. You can also find information about the code of ethics in multiple textbooks.
Resources
- Facilitating the Genetic Counseling Process Appendix B: NSGC Code of Ethics
- Facilitating the Genetic Counseling Process — Ch. 13.3: Guiding Ethical Principles for Health Professionals
- A Guide to Genetic Counseling — Ch. 12: Ethical and Legal Issues (beginning page 372)
2. Ethical Decision Making:
This topic has some overlap with Domain 4B. A great starting place is to review the guiding ethical principles of (1) autonomy — respecting the client’s right to make their own decisions; (2) nonmaleficence — avoiding doing harm; (3) beneficence — acting in the client’s best interest; and (4) justice — treating clients equitably. Understanding these principles and how they apply to genetic counseling practice form a key foundation for ethical decision making. When studying, I practiced identifying which ethical principles were displayed in clinical scenarios or practice questions. Next, I focused on how these principles are considered when addressing ethical dilemmas. There are times when these ethical principles will conflict with one another. The “Facilitating a Genetic Counseling” textbook provides the example of a patient with familial adenomatous polyposis who refuses to disclose their diagnosis to their children. In this scenario, the GC might be concerned that the children will not get the necessary cancer screening. However, you must consider the other principles of patient autonomy and privacy. It is important to know who to go to — and when — once you encounter such ethical dilemmas (e.g., discussing among colleagues vs. going to your hospital ethics board). The MORAL decision-making model described in Chapter 13.4 of “Facilitating the Genetic Counseling Process” is another framework you can use to practice working through different ethical scenarios.
Resources
- A Guide to Genetic Counseling — Ch. 12: Ethical and Legal Issues
- Facilitating the Genetic Counseling Process — Ch. 13: Professionalism: Ethically Based Reflective Practice
3. Evidence-based Practice:
We talk about “evidence-based” practice a lot throughout our training because it is a key element of genetic counseling, with the goal of improving patient outcomes and consistency in care. For this topic, I briefly reviewed some of the “NSGC Practice Based Guidelines” — such as “pedigree nomenclature,” “expanded carrier screening,” “telehealth genetic counseling” and “congenital heart disease.” When reviewing these guidelines, I recommend focusing on the key components and summaries versus studying the small details. For example, “chromosomal microarray analysis is recommended as the first-tier test for individuals with congenital anomalies” and “carrier screening should be offered to all who are currently pregnant, considering pregnancy or might otherwise biologically contribute to pregnancy”.
Resources
- Facilitating the Genetic Counseling Process — Ch. 13: Professionalism: Ethically Based Reflective Practice
4. Conflict of Interest:
Similar to the code of ethics, the NSGC policy page is a great resource for reviewing conflict of interest (COI). Through the link below, you will find the NSGC conflict of interest policy and several resources. Specifically, I found that the “NSGC Reference Sheet for Genetic Counselors” and “NSGC COI Guiding Questions” documents provided a great foundation. When studying COIs, it is important to think about (1) situations in which COIs might occur, (2) how to mitigate COIs and (3) how to manage COIs.
Resources
5. Clinical Supervision of Students:
During your clinical training, you experienced supervision from the student side. As you move into your career, you will likely have the opportunity to take on the role of supervisor. There is a lot of information about the student-supervisor relationship and key components of fostering student growth. One key thing to study is the four types of supervisor roles: (1) consultation, (2) teaching, (3) counseling and (4) evaluation. These roles all have a place within the supervisor-student relationship and can evolve throughout student training. Chapter 13 of “A Guide to Genetic Counseling” has several examples of each role, which can help contextualize their application. After studying these definitions, I came up with additional examples from my own training to form memory palaces of these roles. For this topic, I also focused on common supervision challenges, described at the end of the same chapter.
Resource
- A Guide to Genetic Counseling — Ch. 13: Student Supervision
6. Scope of Practice: Where does our role as a genetic counselor end? Knowing what is within our scope of practice and what is overstepping our bounds is crucial to provide excellent patient care. You can find the genetic counselor scope of practice in “A Guide to Genetic Counseling.” It is important to recall the three roles of genetic counselors as they pertain to this document: (1) to provide expertise in clinical genetics, (2) to counsel and communicate with patients on matters of clinical genetics and (3) to provide genetic counseling services in accordance with professional ethics and values. Second, remember that scope of practice may be determined by the state and institution in which you practice. For example, do you practice in a state with licensure? Can genetic counselors order testing at your institution? Additionally, it is important to know when something is outside our scope as a genetic counselor and refer patients to the most appropriate professional or resource (e.g., refer to social work if your patient needs additional mental health resources).
Resource
- A Guide to Genetic Counseling — Ch. 1: The Practice of Genetic Counseling (pages 30-32)
7. Professional and Public Education:
When considering the role of genetic counselors in education, we need to consider our audience. I considered key factors for educating (1) other health care professionals and (2) educating the public or other laypeople. Regardless of the audience, it is important to present the information in a clear way that considers the goals of our education. For example, we might educate health care workers on the role of a GC so they can be more aware of our services and know when to refer. When talking with individuals without a genetics background, word choice is important to ensure clear communication and understanding. “A Guide to Genetic Counseling” has a great breakdown of considerations for educating specific groups to help contextualize this information.
Resource
- A Guide to Genetic Counseling — Ch. 16: Genetic Counselors as Educators
Final Thoughts
You are transitioning into the professional world and the information in this domain pertains to your daily practice and growth. As you study for boards, make sure you take time for yourself to relax and recharge. Finding balance and taking time for self-reflection are other important aspects of developing your professional identity.