Revised Standards FAQs
ACGC developed this resource to help provide answers about key areas of the Standards changes to note. Click the plus sign next to the appropriate section below to view the answer. You can also download the Revised Standards FAQs in PDF format.
To ensure the continued valuable contributions medical geneticists can provide program leadership, a medical geneticist was made a required member of the Advisory Board (See Standard C1.4).
B.) Does becoming a program director for the first time refer only to individuals with no program leadership experience (i.e. have never been an Assistant Program Director), or also those who have been an Assistant Program Director, but never a Program Director? The main point of clarification here is that there doesn’t seem to be a path for Assistant Program Directors to rise. Meaning, they need three years of experience, but there isn’t a patient-facing requirement. They also aren’t required to have experience supervising (whereas first time program directors are). A genetic counselor could theoretically qualify to be an APD, hold that role for many years and not be eligible for promotion. It would be helpful for someone to clarify that logic. Of course, this would be simpler if APD experience counts toward program director experience.
B.) Clinical supervision is a major component of a training program and the PD must have experienced providing clinical supervision to genetic counseling students.Candidacy applications may be accepted in which the PD is still acquiring the required qualifications. However, the PD must have met the PD qualifications prior to submission of the New Program application. In the candidacy application programs must submit a detailed plan for the PD to acquire the required qualifications in the time frame needed. Prospective PDs are not allowed to continue to work to meet qualifications in the time before students’ matriculate; the qualifications must be met to be granted Accredited, New Program Status.The PD qualifications listed in A2.2.2 applies to all individuals regardless if previously an APD.
B.) If the person in the additional leadership position is not a CGC, then would this person be able to serve as a designated acting/interim PD in the event of an unexpected LOA of the PD? C.) If the program has a medical director can that be counted as the additional leadership position?
Examples could be supervision workshops, online webinars, mentoring with colleague. Training does not need to be annual, but the program must be able to show that they are supporting and training their supervisors.
B.) The word clinical is not meant to exclude laboratory genetic counselors. This better stated as fieldwork, we will make that change.
C.) same as above, it was not meant to be exclusive.
D.) Yes, as programs may have individuals who are not genetic counselors supervise in some fieldwork experiences, it would seem prudent for programs to know the qualifications of the individuals who are supervising their students. Obtaining CV’s is likely sufficient, but could include current license status, certification, or what-ever might apply for current professional status relative to the supervisor. This is meant to allow students to know who they are being supervised by and for programs to fully document the student experience.
B.) This standard is meant to document the program’s effort to reach out to under-represented populations. The activities that are mentioned would indicate compliance with the standard. The fact that they are held in ‘high minority’ school is an example that provides the necessary information.
B.) A philosophical/rhetorical/language question re: “Client can refer to a simulated or non-simulated patient and/or research participant”. This feels disrespectful that the “real patients” are referred to as the non-simulated patients and are listed after the simulated patients. This language is preferable because it honors the patients we see with health concerns.
B.) Thank you for your thoughtful reading of the Standards. There was no disrespect intended. We agree with the suggestion to change the language. Revised standard B3.1.1: Client can refer to individuals seen in a clinic setting; as standardized patients; or in certain research participant encounters.
A.) Presumably a pregnant client who is herself unaffected but is being seen for indications such as AMA, abnormal NIPT, abnormal U/S or similar prenatal indications counts among the “at least 40” cases, even though the risk being evaluated in these cases is for the fetus to be affected by a genetic condition? We are asking this only because ABGC introduced the “affected” language many years ago, i.e. the requirement that a certain proportion of clients had to be “affected” with a condition/phenotype, specifically to ensure that students were not seeing an overabundance of prenatal cases for their 50 case logbooks, since pregnant clients were typically not affected with anything themselves.
B.) Is teratology risk assessment/counseling included in this?
While CTAT found that the number of cases does not predict competency as defined by board exam performance, stakeholder feedback supported the retention of a minimum threshold for exposure to patients/clients, in diverse practice settings and with a variety of indications.
Moreover, the review of competency-based education literature did not identify an existing tool to assess and determine clinical competency in genetic counseling trainees, and such a tool would be necessary for the implementation of a competency-based approach. CTAT found no viable alternative approaches that would eliminate the need for a minimum number of required cases. CTAT also noted that the profession has a set of well-defined practice-based competencies (PBCs) and that clinical training and all components of a program should support trainees’ development of the PBCs.
A.) At least 40 of the 50 required participatory cases must be with individuals being evaluated for risk of or affected by diverse genetic conditions across the lifespan (i.e., patients; not individuals who are being consented to research; and not standardized patients).
B.) Yes, teratology risk assessment is included.
B.) Some, but not all, of our major specialties utilize telemedicine in addition to face-to-face visits --- as long as students gain telemedicine experience in some of their specialties (e.g. pediatrics and cancer, but not prenatal or adult), does that satisfy this standard?
C.) How is telephone service delivery being defined? Does this mean that the entire session must be conducted via telephone (such as for a teratogen line inquiry) for it to count, or does this mean that some components of the case can be conducted by telephone (e.g. pre-clinic contact by student to clarify understanding of the visit and what to expect, post-clinic telephone call to discuss results of testing), while others are face-to-face?
D.) Re: use of multiple service delivery modes-if student’s complete review of systems, family histories and HPI over the phone is that considered a type of service delivery? The same can be asked about f/u counseling regarding test results. Under prior standards we would not count these in the log roles assumed as they were not face to face.
E.) Does every student need experience in multiple service delivery models? Or as an aggregate?
F.) What is considered a case in settings such as industry/ other?
B.) Yes, it satisfies the Standard. A student does not need to gain experience in every mode of service delivery in every fieldwork experience. This applies across all fieldwork experiences as a total.
C.) Telephone service delivery is not defined as many counselors employ a variety of telephone encounter modalities and deliver a variety of counseling encounters in the various modes. The important aspect of the fieldwork encounter is tying the student’s experience to practice-based competencies. For example, a face-to-face initial visit and a telephone FU would count.
D.) These may be counted as logbook roles as long as the experience is tied to the accomplishment of practice-based competencies within the fieldwork experience framework at your program.
E.) This is an individual student requirement as students need to be prepared to practice in the wide variety of practice settings that now exist.
F.) There are many industry settings, such as commercial lab settings, in which the student may have a consumer encounter. Participatory cases need to involve the student interacting with a “client.” Non-participatory cases may include broader experiential encounters that lead to the development of PBCs, such as variant interpretation or consulting with clinicians regarding laboratory test results.
B.) What does ACGC define as “no one specialty dominating”? E.g. in the current 2013 standards, Prenatal is expected to encompass 40% of the core cases, while Cancer and Pediatrics are expected to encompass 25% each, with Adult 10%. Under the new standard, would 40% be flagged as dominating, as it is certainly quite a bit higher than 25%? Or would dominating be 51% --- or something else? Would it depend on the specialty --- e.g. ACGC would consider it acceptable for Prenatal or Cancer cases to constitute 40-50% (or more) of a students’ participatory cases, but penalize a program if 40-50% of the cases were in Adult or Pediatrics? As currently written, this allows way too much subjectivity by ACGC, when it comes time for rendering reaccreditation decisions.
C.) B3.1.5 RE: cases must represent as being across multiple practice areas with no one specialty area dominating. Can this be clarified? Does “no one specialty dominating” mean that two could dominate, or that there should be an equal distribution across the four specialties? IF a student is really interested in a particular area they may choose an elective credit to do more in that area….this will automatically skew their numbers. How is this accounted for? Or will students need to be denied the extra opportunity or told not to log these cases? It is important to know that this variable interpretation is acceptable.
D.) Please clarify whether only certain categories of research participants fully count or not in the 50 required participatory cases e.g. those who are healthy and not at risk for a certain condition vs. those at risk/affected with.
E.) Do we need separate tracking forms for Field work experiences and clinical rotations if both can count toward participatory cases?
C.) Variable interpretation is acceptable, however at this time training should prepare students to practice in a wide variety of specialty areas using a variety of service delivery methodologies.
D.) A specific type of research participant is not specified. Research participants may be used for participatory cases, if the trainee is providing clinical genetic counseling services to the individual even though within a research protocol.
E.) Fieldwork experiences include clinical rotations.
B.) The list of documentation elements specifies “PBC(s) addressed” --- is the intent that every single PBC that is demonstrated, even in a small way, during each participatory case be formally recorded in some way? If so, is this expected to be at the level of just the 4 Domains, or the 22 PBCs (main PBC, as bolded in the PBC document), or down to an even more discrete level within each PBC (i.e. the lettered examples under each of the 22 PBCs)? Would it suffice to have the PBC’s be the identified learning objectives for clinical fieldwork?
C.) Also, are there repercussions if a category is not checked a certain number of times-if so, is there a certain number of times it must be checked to ‘count’. Some PBC’s are not relevant to clinical care e.g. effectively give a presentation on genetics or demonstrate understanding of the research process.
D.) Lastly, is there any evidence that checking these boxes identifies a better or more robust learning experience, or that the number of times they are checked says something about competence of the learner?
E.) Will the next RCS allow for the inclusion of the broader categories of ‘participatory experiences’? This is an important clarification to make sure we are documenting things appropriately for graduating students.
A2.) Please clarify what would constitute a healthcare provider being a client. If this is intended to be in a laboratory setting where a GC student takes a phone call from an HCP, then are there certain elements of the inquiry/discussion that a student would have to complete for this to “count” as a participatory case, or does a quick/straightforward 1 minute phone call about a lab result count as a case?
B2.) A “healthcare provider” is considered a client here, but was removed from section B3.1.1 in the draft for public comment.
B.) Programs are expected to document to the 22 PBCs. The detail provided in the PBCs are meant to be examples and suggestions as to how one may achieve or demonstrate competency for that PBC. A program could use the PBCs as learning objectives should they choose; however, this is currently not an expectation.
D.) ACGC requests that programs utilize the PBCs because they are currently the best indication of knowledge, skills, and actions that will be required of practicing genetic counselors. The PBCs were developed based on the practice analysis of what genetic counselors are currently doing as service providers in clinical practice. PBCs offer the student some assurance that the competencies that they are working to achieve do have actual relationship to clinical knowledge, skills and actions used by genetic counselors in practice. ACGC recognizes the limitations of the current knowledge base regarding competency-based education and its assessment of relevance to actual practice-based competency. It an area well-deserving of future research for the ongoing development of our professional and educational competencies.
E.) The June 2021 RCS will include this.
A2.) HCP were removed from B3.1.1, participatory cases. CTAT had initially included them in response to stakeholder feedback. This standard outlines what is needed for documentation of a case. Time is not one of them.
B2.) A HCP can be a client for ‘other supplementary’ fieldwork experiences.
B.) RE: representative of across the lifecycle. Can requirements around this be better defined? E.g. If a student is involved in a case involving a child where there is a physical exam for dx purposes and but they counsel parents about recurrence risks of the disorder-is this a pediatric, or pre-conception? Similarly, if they see an adult with a disorder and they describe natural history and recurrence risk is this pre-conception or adult? This may seem a straightforward clarification but if a logbook needs to have an evenly distributed spread across the lifecycle it will lead to variable interpretation.
B.) This Standard refers to an expectation that the genetic counseling student’s education address the issues and diagnoses that are experienced over the lifetime. The way in which students achieve this exposure is likely to vary depending on exactly the factors that you describe. The context of the visit and the variety of patients seen by the trainee may lead to the same encounter being “counted” differently for different students. The Standard does not mention that the experiences must be “evenly” distributed.
If a program falls below this threshold, a remediation process is required as opposed to an automatic revoking of accreditation. This allows the program time to make modifications to its curriculum to address consistent deficiencies in specific categories.
B.) Can we start implementing these changes now, acknowledging that this will be incremental and that we will be operating under the old standards in some areas and under the new standards in others? Also, acknowledging that this could vary between the first- and second-year cohorts…
C.) What are the deadlines for compliance for a developing program that intends to submit a candidacy application this fall and the new program application in May but has already recruited a PD based on previous standards? It appears that according to the compliance dates on the website, the new PD must meet the current standards at the time of the new program application. Is this accurate? Is there any accommodation for the new PD as long as they have a detailed plan to meet qualifications by 5/1/21, which would be prior to matriculation of the first class?
B.) Shifting to the new Standards is acceptable.
C.) It is in the best interest of the program to map out a process as soon as possible for their PD to meet the new Standards and submit that with their Candidacy or to document how their Pd meets the Standard in the New Program application.