The framework
This competency framework identifies the core competencies required to facilitate and consent patients for germline genomic tests. The Genomics Education Programme has developed this framework in collaboration with healthcare professionals from across the health service. Each competency is provided with links to supporting evidence-based educational resources.
Importantly, the individual competencies in this framework should be interpreted in the context in which a healthcare professional is offering genomic testing, considering their scope of practice. Not all competencies, or parts of a competency, will be applicable for all healthcare professionals, or in all clinical situations or settings. This framework has been designed to be a developmental tool to support individuals and organisations. It is not intended to be used as a grading or an assessment tool.
For more information about the framework, how it was developed, and how it can be used, please see the FAQs.
The competencies
The framework identifies eight areas of proficiency for health professionals facilitating and consenting patients to genomic testing. You can also access this handy printable list of the competencies.
General resources
In addition to the links to supporting resources listed for each competency above, there are some general resources that you may find helpful and relevant to gaining competency across many areas of this framework.
Resources for educators
Those delivering healthcare education around facilitating genomic testing may find these two resources helpful, along with the Categories of experience information below.
Categories of experience
The competency framework is designed around four categories of healthcare professionals, based on their training and experience with genomics.
A training needs analysis was conducted by the GEP (via the education and training leads in each Genomic Medicine Centre) in 2016-17 during the delivery of the 100,000 Genomes Project, to identify current and future education and training needs of NHS staff. Results from this analysis have been used to outline four broad categories of healthcare professionals, based on their training and experience with genomics.
Clinical leaders and educators may find it helpful to develop training based on these groups, although individuals within each group will have varying levels of experience. The competency framework mapped to these broad categories can be found here.
| Category | Examples of healthcare professionals | Comments regarding experience |
|---|---|---|
| A. Genetic / genomic specialists | Clinical geneticists, genetic registrars, genetic counsellors, specialist nurses in clinical genetics | Experience of consenting for complex genetic and genomic testing, as well as often for research projects. Also has experience of returning results for patients, which will influence their consent practice. |
| B. Consenters for genomic research projects (eg 100,000 Genomes Project) | Research nurses, bio-bankers, research trials co-ordinators, mainstream clinicians | Familiarity with the process of consent to a genomic test, although varying levels of competence expected depending on the nature of the research study and familiarity with clinical pathways. |
| C. Mainstream clinicians | Specialist consultants and registrars, specialist nurses, midwives, community paediatricians, GPs | Includes diagnostic tests to confirm a clinical diagnosis within area of expertise. Will have experience in consent for genetic/genomic tests, but level of complexity and experience returning results may vary. Overall less extensive training than Category A, and may or may not have been involved in research featuring genomic testing. |
| D. Healthcare professionals who have never consented for a clinical or research genetic / genomic test | Healthcare professionals as listed in C | May have some or no knowledge of genomics and how it relates to their role. |
Case studies
Real-life experiences of healthcare professionals and educators reflecting on how they have used the competency framework in practice.
Identifying learning outcomes for a regional genomics course
Corinne Trim, education and training lead, North Thames Genomic Laboratory Hub
How did you use the framework?
I used the framework to identify learning outcomes for our new course, An introduction to Genetic Counselling Skills in Genomic Medicine, and to help us consider the target audience of the programme and ensure we meet their needs by including the knowledge and skills required.
How did the framework help?
There were challenges in developing our CPD programme, which included its short length, the unknown level of background knowledge and experience of participants, and the vast amount of content to potentially cover. Our aim was to create a programme that would provide an overview and resources for staff who were going to be involved in mainstreaming genomic medicine, so having a competency framework to base the learning on was a useful starting point.
What have you learned?
When setting up a CPD programme linked to categories of experience, there are a wide range of competencies to consider based on participants’ experience or area of specialty. Undertaking a pilot programme and using the framework as a guide helped us to create a tailored programme that meets specific needs, while ensuring a baseline knowledge for all participants.
Do you have any other plans to use the framework?
We have used the categories of experience concept as a tool on our website to signpost users to the resources we have collated. The framework will continue to be used in the development of our CPD programme, which is a series of mainstreaming genetic testing modules.
Developing the topics for a training workshop
Amelogenesis Imperfecta / Dentinogenesis Imperfecta Clinical Excellence Network UK
How did you use the framework?
Access within the NHS in England to the amelogenesis imperfecta (AI) panel test is now freely available. This is a new and unfamiliar area of dental care and upskilling of the paediatric dental workforce is required to meet the expectations of clinicians and patients. A virtual AI consent workshop with roleplay format was delivered to 26 paediatric dentists in May 2021. The workshop was led by members of the Genomics Education Programme and topics were based on the competency consent framework.
How did the framework help?
The framework gave the learning structure required for clinicians new to this area of clinical practice. The workshop was very well received. Confidence in explaining the purposes and process of an AI genomic test to patients and family members increased, from less than 20% attendees feeling confident pre-workshop to 100% post-workshop. Similarly, confidence in clinical skills in obtaining consent and the application of skills to genomic testing increased, from below 40% pre-workshop to almost 90%.
What have you learned?
The framework gives a structured approach and provides useful boundaries. It helped to inform the roleplay, which was well received with attendees learning how to have conversations about genomic testing and explaining inheritance patterns to families. Attendees found the sections that covered reviewing genomic test results along with Q&A opportunities to be useful. There was also discussion on how to manage difficult conversations with families and what support would be appropriate from clinical genetics.
Do you have any other plans to use the framework?
We are developing a local standard operating procedure for use with Leeds Dental Hospital for discussing an AI genomic test and the consent process. It is anticipated that this will be later rolled out UK-wide. The competency framework and associated training has guided the content of this document.
To approach the AI/DI CEN about their use of the framework, you can contact network secretary Joana Monteiro.
Frequently
asked questions
What is the framework?
The framework has been designed as a cross-professional guide for best practice for any clinician offering germline genomic testing, which may include whole genome sequencing, panel, microarray or single gene tests for diagnostic, carrier or predictive testing purposes. Conversations about genomic testing may be led by different individuals depending on the context of the test and clinical pathway. It is therefore imperative that professional judgement based on an individual’s scope of practice is considered when reflecting on these competencies.
How can this framework be used?
This framework has been designed to be a developmental tool to support individuals and organisations. It is not intended to be used as a grading or assessment tool.
It can be used as a guide for individual healthcare professionals to recognise learning needs. For those delivering training, the framework provides a mechanism to identify the training needs of healthcare professional groups, and to structure the development of training such that the consent conversions about genomic testing can be delivered in a consistent manner across specialties. In addition, these competencies can be used as a reference to evaluate how consent is being facilitated in different specialty areas to enhance the delivery of genomic medicine.
How was the framework developed?
The methodology for reaching consensus on this framework is founded on the nominal group technique. An initial framework was developed based on existing literature and experience of the GEP. On 12th February 2019, a one-day expert consensus meeting with healthcare professionals in various disciplines reviewed clinical scenarios in iterative rounds, mapped themes to the framework and voted on areas of inconsistency.
A revised framework was open for consultation with individual healthcare professionals, professional bodies and medical Royal Colleges in April and May 2019. As well, feedback was gained from rare disease and cancer patient communities via Genetic Alliance UK, Macmillan and the 100,000 Genomes Project participant panel, to ensure that the patient narrative was incorporated into discussions about genomic testing.
How can I give feedback on the framework?
The framework will guide the development of future tools and resources developed by the Genomics Education Programme, and it is anticipated that it will be reviewed on a regular basis.
We would be grateful for your feedback on this framework and how you have used it in practice. You can submit your comments via this form.
If you have any questions about the framework and how it was developed, please contact us.
Evaluating the framework
The Genomics Education Programme commissioned a short-term evaluation of this competency framework, carried out by NHS Solutions for Public Health between January and April 2020.
Why did we conduct the evaluation?
The evaluation was conducted to understand how individual healthcare professionals and services are using, or are planning to use, the competency framework, as well as to identify any implementation enablers and barriers.
How was the evaluation carried out?
Three interviews were carried out with regional genomic education leads to highlight key themes and inform the development of an online survey. The online survey was aimed at healthcare professionals in the NHS, and completed by 239 individuals. The evaluation also looked at weekly web usage statistics from when the framework was launched in October 2019 until April 2020.
What were the key findings?
Survey respondents included representation from all seven NHS Genomic Laboratory Hub regions and healthcare professionals with a range of experience with genomic testing. Around 29% (n=60 of 206 respondents) considered themselves specialists with extensive experience, 42% (n=86) had some experience, and 29% (n=60) had no experience with genomic testing.
Around 51% (n=121 of 239 respondents) said that they were not aware of the competency framework prior to learning about it via the survey. Of these, 56% (n=68) felt that it would be useful for several reasons. For example, the framework could be helpful to the nursing and midwifery workforce where certain specialist individuals may be involved in requesting and consenting patients to genomic tests, with the framework being used to evidence competence and support autonomous working in their practice.
Overall, the evaluation concluded that this competency framework meets a genuine and timely need among current and potential users, and provided early insights to support wider engagement with the framework. It identified ways in which promotion and accessibility of the framework can be improved for different healthcare professional groups.
What are the next steps?
The GEP team will be adding and making improvements to the competency framework website to improve access and utility of the framework, such as case studies.
Recently, a series of courses, Facilitating Genomic Testing, has been published to address areas of competence.
We will be continuing our discussions with professional bodies, regional education and training leads, and workforce development groups in the NHS Genomic Medicine Service to further assess the framework, and additional evaluations are planned for the future.
Acknowledgements
We would like to thank NHS Solutions for Public Health for carrying out this evaluation, and to the regional genomic education and training leads for their participation and dissemination of the framework.
