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Genetic counseling is conceptualized as having both "teaching" and "counseling" functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pre-test counseling to simulated clients (SCs). One hundred and seventy-seven GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. One hundred and fifty-two videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor's affective demeanor, and the counselor's use of non-verbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction, affective demeanor, and nonverbal effectiveness.

Effective communication skills are a professional competency, yet are often overlooked during training. Providing immediate and constructive feedback is imperative to assist students in developing better communication skills. We sought to evaluate the educational value of using a university-developed application, Rapid Feedback, to provide feedback following students' oral presentations over two years. An online survey comprising of eight 5-point Likert scale items and one open-ended question was conducted in 114 (response rate = 86.5%) students. Students either strongly agreed or agreed that the feedback delivered was timely (98%), relevant (96%), high quality (90%), and specific to enhance their learning (87%). The feedback obtained has helped to identify strengths and weaknesses (87%). Students commented that feedback received will improve their communication skills (90%). The report was also shown to supplement verbal feedback (95%). Overall, students expressed that the feedback report was valuable, allowing for critical self-reflection and future retention. Staff have also found the application easy to use and administer. In a time-and resource-constrained teaching environment, educators constantly explore technology to support student learning and teaching outcomes. We have implemented an application that is user-friendly to staff, efficient, and has provided effective feedback that is well-received and valued by students.

Brief provider communication training had a positive impact on parent mental health symptoms and reduced minority children's impairment across a range of problems.

Genetic information presents challenges to all patients, but particularly those with low and marginal literacy. The goal of the study was to create a rapid estimate of adult literacy in genetics (REAL-G) tool, with established validity, for use with patients receiving genetics services. Patterned after the widely used rapid estimate of adult literacy in medicine (REALM), a three-stage method was used in tool development. This included derivation of terms from transcripts of visits conducted by over 150 prenatal and cancer genetic counselors. Concurrent validity was estimated by administration of both the REAL-G and the REALM to 203 participants. Predictive validity was estimated by relating participants' REAL-G scores to scores on a learning task that involved viewing a videotaped genetic counseling session and answering related questions. The REAL-G measure was strongly correlated with the REALM (Pearson correlation = 0.83; P < 0.0001), indicating substantial concurrent validity in a population of potential genetic counseling patients. Using the REALM as the gold standard, REAL-G scores identified readers at the sixth grade level or below (95.4% sensitivity and 88.5% specificity). Further analysis identified an eight-item subset of words that has strong concurrent validity when compared to longer instruments and even greater predictive power in relation to information recall. Subjects scoring below the sixth grade level on the eight-item REAL-G scored significantly lower than others on knowledge tests after viewing genetic counseling visits. The REAL-G represents a screening tool that can be used to quickly identify low literate patients in the clinical genetics context or to quantify context-specific literacy within a research setting.