The Medical Genetics and Genomics Milestone Project A Joint Initiative of The Accreditation Council for Graduate Medical Education and The American Board of Medical Genetics and Genomics
October 2015
The Medical Genetics and Genomics Milestone Project The milestones are designed only for use in evaluation of resident physicians in the context of their participation in ACGME-accredited residency or fellowship programs. The milestones provide a framework for assessment of the development of the resident physician in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context.
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Medical Genetics and Genomics Milestones Chair: Bruce Korf, MD Working Group
Advisory Group
Joseph Biggio, MD Laurie A. Demmer, MD Laura Edgar, EdD, CAE Mira Irons, MD Shawn McCandless, MD Kate Nathanson, MD, FACMG, FACP Cynthia Powell, MD Reid Sutton, MD Linda Thorsen, MA Darrel Waggoner, MD Dave Wargowski, MD Audrey Woerner, MD, MPH
Miriam G. Blitzer, PhD, FACMG Timothy Brigham, MDiv, PhD Sue Gross, MD, FRCS(C), FACOG, FACMG Louis Ling, MD Edward R. B. McCabe, MD, PhD Robert Nussbaum, MD Reed E. Pyeritz, MD, PhD Dave Rimoin, MD, PhD*
The Medical Genetics and Genomics Working Group would like to acknowledge the American College of Medical Genetics and Genomics and their report “Competencies for the Physician Medical Geneticist in the 21st Century”. This document was beneficial to the development of the Medical Genetics and Genomics Milestones.
*Acknowledgements: The Advisory Group and the ACGME would like to honor Dr. Dave Rimoin for his contribution to the milestones. He will be greatly missed.
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Milestone Reporting This document presents milestones designed for programs to use in semi-annual review of resident performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for resident performance as a resident moves from entry into residency through graduation. In the initial years of implementation, the Review Committee will examine milestone performance data for each program’s residents as one element in the Next Accreditation System (NAS) to determine whether residents overall are progressing. For each period, review and reporting will involve selecting milestone levels that best describe a resident’s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert. These levels do not correspond with post-graduate year of education. Selection of a level implies that the resident substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v). Level 1: The resident demonstrates milestones expected of an incoming resident. Level 2: The resident is advancing and demonstrates additional milestones, but is not yet performing at a mid-residency level. Level 3: The resident continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for residency. Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency. This level is designed as the graduation target. Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this level.
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Additional Notes Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the residency program director. Study of milestone performance data will be required before the ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the developmental framework, and whether milestone data are of sufficient quality to be used for high-stakes decisions. Some milestone descriptions include statements about performing independently. These activities must conform to ACGME supervision guidelines, as well as institutional and program policies. For example, a resident who performs a procedure independently must, at a minimum, be supervised through oversight. Examples are provided with some milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element. Answers to Frequently Asked Questions about Milestones are available on the Milestones web page: http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.
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The diagram below presents an example set of milestones for one sub-competency in the same format as the milestone report worksheet. For each reporting period, a resident’s performance on the milestones for each sub-competency will be indicated by: • selecting the level of milestones that best describes that resident’s performance in relation to the milestones or • for Patient Care and Medical Knowledge milestones, selecting the option that says the resident has “Not yet rotated” or • for Interpersonal and Communication Skills, Practice-based Learning and Improvement, Professionalism, and Systems-based Practice milestones, selecting the option that says the resident has “Not yet achieved Level 1”
Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated.
Selecting a response box on the line in between levels indicates that milestones in lower levels have been substantially demonstrated as well as some milestones in the higher level(s).
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Medical Genetics and Genomics Milestones, ACGME Report Worksheet
Obtain and interpret medical, social, and family histories, as well as physical exam findings necessary for the evaluation of patients with or atrisk for genetic disorders — Patient Care Level 1 Level 2 Level 3 Level 4 Level 5 • Obtains general • Obtains and interprets • Obtains and interprets • Independently obtains • Makes a nationally medical and social a genetics-focused a genetics-focused and interprets a recognized history family, medical, and family, medical, and genetics-focused contribution by social history with social history with family, medical, and discovering a new • Constructs pedigrees substantial guidance minimal guidance social history genetic or congenital and recognizes simple entity or mechanism patterns of inheritance • Performs a genetics• Performs a genetics• Independently focused physical focused physical performs a genetics• Makes a nationally • Performs general examination with examination with focused physical recognized medical examination substantial guidance minimal guidance examination contribution by for children and adults developing • Synthesizes findings • Synthesizes findings • Independently educational materials from history and from history and synthesizes findings for patients and/or physical exam to make physical exam to make from history and providers a diagnosis with a diagnosis with physical exam to make substantial guidance minimal guidance a diagnosis • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines
Comments:
Not yet rotated
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Incorporate genetic tests into patient management — Patient Care Level 1 Level 2 Level 3 • Distinguishes different • Selects and prioritizes • Selects and prioritizes types of genetic tests tests with substantial tests with minimal guidance guidance • Recognizes different types of genetic • Describes analytical • Describes analytical variants techniques used in techniques used in genetic testing with genetic testing with • Recognizes the substantial guidance minimal guidance distinction between analytical validity, • Interprets laboratory • Interprets laboratory clinical validity, and reports with reports with minimal clinical utility substantial guidance guidance • Recognizes the ethical, • Utilizes tools to assess • Utilizes tools to assess legal, social, and variant of uncertain VUS with minimal economic issues significance (VUS) with guidance associated with substantial guidance • Provides pre- and genetic tests • Provides pre- and post-test counseling post-test counseling with minimal guidance with substantial guidance
Comments:
Level 4 • Independently selects and prioritizes tests • Independently describes analytical techniques used in genetic testing • Independently interprets laboratory reports • Independently utilizes tools to assess VUS • Independently provides pre- and post-test counseling
Level 5 • Makes a nationally recognized contribution by discovering a new genetic or congenital entity or mechanism • Makes a nationally recognized contribution by developing educational materials for patients and/or providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines
Not yet rotated
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Incorporate whole genome or exome tests into patient management — Patient Care Level 1 Level 2 Level 3 • Explains differences • Identifies clinical • Identifies clinical between genetic and situations where situations where genomic analysis genomic testing is genomic testing is appropriate with appropriate with substantial guidance minimal guidance • Provides pre- and • Provides pre- and post-test counseling post-test counseling with substantial with minimal guidance guidance • Interprets and applies • Interprets and applies the information the information obtained from obtained from genomic testing with minimal guidance genomic testing with substantial guidance
Comments:
Level 4 • Independently identifies clinical situations where genomic testing is appropriate • Independently provides pre- and post-test counseling • Independently interprets and applies the information obtained from genomic testing
Level 5 • Makes a nationally recognized contribution by discovering a new genetic or congenital entity or mechanism • Makes a nationally recognized contribution by developing educational materials for patients and/or providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines
Not yet rotated
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Diagnose and manage patients with inborn errors of metabolism — Patient Care Level 1 Level 2 Level 3 • Demonstrates ability • Identifies signs and • Identifies signs and to manage critically-ill symptoms of inborn symptoms of inborn patients errors of metabolism errors of metabolism with substantial with minimal guidance • Recognizes basic guidance abnormalities seen on • Formulates a • Formulates a metabolic testing differential diagnosis differential diagnosis and orders and orders appropriate tests with appropriate tests with minimal guidance substantial guidance • Recognizes normal • Recognizes normal variants and complex variants and complex patterns of patterns of metabolites with metabolites with minimal guidance substantial guidance • Manages acute • Manages acute metabolic crises with metabolic crises with minimal guidance substantial guidance • Provides chronic management with • Provides chronic minimal guidance management with substantial guidance Comments:
Level 4 • Independently identifies signs and symptoms of inborn errors of metabolism • Independently formulates a differential diagnosis and orders appropriate tests • Independently recognizes normal variants and complex patterns of metabolites • Independently manages acute metabolic crises • Independently provides chronic management
Level 5 • Makes a nationally recognized contribution by discovering a new genetic or congenital entity or mechanism • Makes a nationally recognized contribution by developing educational materials for patients and/or providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines
Not yet rotated
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Evaluates infants with abnormal newborn screens in a cost-effective and sensitive manner and educates community providers — Patient Care Level 1 Level 2 Level 3 Level 4 Level 5 • Describes goals and • With substantial • With minimal • Independently • Makes a nationally principles underlying guidance interprets guidance interprets interprets NBS results recognized newborn screening NBS results NBS results contribution by • Independently (NBS) discovering a new collaborates with the • With substantial • With minimal genetic or congenital primary provider to guidance collaborates guidance collaborates entity or mechanism act upon results in a with the primary with the primary timely manner provider to act upon provider to act upon • Makes a nationally results in a timely results in a timely recognized • Independently manner manner contribution by develops a differential developing diagnosis and orders • With substantial • With minimal educational materials appropriate guidance develops a guidance develops a for patients and/or confirmatory testing differential diagnosis differential diagnosis providers and orders and orders • Independently appropriate appropriate communicates results • Makes a nationally confirmatory testing confirmatory testing recognized to families contribution by • With substantial • With minimal participating in the guidance guidance development of communicates results communicates results clinical practice to families to families guidelines Comments:
Not yet rotated
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Develop proficiency in cancer genetics — Patient Care Level 1 Level 2 • Recognizes that cancer • With substantial is the accumulation of guidance assesses and genetic changes, some manages genetic risk of which can be of common cancers inherited • With substantial • Recognizes the use of guidance diagnoses germ line and somatic and manages inherited genetic changes in risk cancer susceptibility assessment and syndromes management of • With substantial cancer guidance manages • Identifies potential developmental high-risk genetic disorders associated pedigrees for common with increased risk of malignancies cancers • With substantial guidance evaluates the results of somatic genetic and genomic testing, and incorporates them into the management plan Comments:
Level 3 • With minimal guidance assesses and manages genetic risk of common cancers • With minimal guidance diagnoses and manages inherited cancer susceptibility syndromes • With minimal guidance manages developmental disorders associated with increased risk of cancers • With minimal guidance evaluates the results of somatic genetic and genomic testing, and incorporates them into the management plan
Level 4 • Independently assesses and manages genetic risk of common cancers • Independently diagnoses and manages inherited cancer susceptibility syndromes • Independently manages developmental disorders associated with increased risk of cancers • Independently evaluates the results of somatic genetic and genomic testing, and incorporates them into the management plan
Level 5 • Makes a nationally recognized contribution by discovering a new genetic or congenital entity or mechanism • Makes a nationally recognized contribution by developing educational materials for patients and/or providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines
Not yet rotated
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Evaluate and manage patients with single malformations, multiple congenital anomalies, developmental disabilities, and growth abnormalities by utilizing knowledge of embryology, teratology, developmental pathways, pathophysiology, and etiologic mechanisms — Patient Care Level 1 Level 2 Level 3 Level 4 Level 5 • Recognizes normal • Performs assessment • Performs assessment • Independently • Makes a nationally physical findings and incorporating physical incorporating physical performs assessment recognized patterns of growth findings and patterns findings and patterns incorporating physical contribution by and development of growth and of growth and findings and patterns discovering a new development to development to of growth and genetic or congenital • Accurately defines establish diagnoses establish diagnoses development to entity or mechanism categories of birth with substantial with minimal guidance establish diagnoses defects utilizing • Makes a nationally guidance principles of recognized • Implements a • Independently embryology contribution by management plan implements a • Implements a developing with minimal guidance management plan management plan educational materials with substantial for patients and/or guidance providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines Comments:
Not yet rotated
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Develop proficiency in prenatal risk assessment, screening, diagnosis, and counseling — Patient Care Level 1 Level 2 Level 3 Level 4 • Demonstrates • Performs risk • Performs risk • Independently knowledge of normal assessment and assessment and performs risk embryological provides pre-test provides pre-test assessment and development counseling with counseling with provides pre-test substantial guidance minimal guidance counseling • Recognizes the • Interprets prenatal • Interprets prenatal • Independently importance of family screening results with screening results with interprets prenatal history, ethnicity, substantial guidance minimal guidance screening results parental age, aneuploidy screening, • Collaborates with • Collaborates with • Independently teratogen exposure, obstetric provider to obstetric provider to collaborates with and ultrasound act upon results in a act upon results in a obstetric provider to findings in the timely manner with timely manner with act upon results in a assessment of fetal substantial guidance minimal guidance timely manner risk • Develops a differential • Develops a differential • Independently • Describes goals and diagnosis and diagnosis and develops a differential principles underlying recommends a recommends a diagnosis and prenatal screening diagnostic approach diagnostic approach recommends a with substantial with minimal guidance diagnostic approach guidance • Provides post-test • Independently counseling with provides post-test • Provides post-test minimal guidance counseling counseling with substantial guidance Comments:
Level 5 • Makes a nationally recognized contribution by discovering a new genetic or congenital entity or mechanism • Makes a nationally recognized contribution by developing educational materials for patients and/or providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines
Not yet rotated
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Provide longitudinal management and reproductive counseling in pregnancies with known or suspected genetic conditions in the mother or fetus — Patient Care Level 1 Level 2 Level 3 Level 4 Level 5 • Recognizes the • Collaborates with the • Collaborates with the • Independently • Makes a nationally importance of obstetric provider to obstetric provider to collaborates with the recognized counseling during the develop a develop a obstetric provider to contribution by transition of care from management plan for management plan for develop a discovers a new prenatal to postnatal pregnant women with pregnant women with management plan for genetic or congenital life genetic disorders with genetic disorders with pregnant women with entity or mechanism substantial guidance minimal guidance genetic disorders • Recognizes the • Makes a nationally importance of a postrecognized • Collaborates with the • Collaborates with the • Independently pregnancy contribution by multidisciplinary team multidisciplinary team collaborates with the management plan developing to develop a to develop a multidisciplinary team upon establishment of educational materials management plan for management plan for to develop a a diagnosis for patients and/or pregnant women with pregnant women with management plan for providers fetuses with genetic fetuses with genetic pregnant women with • Recognizes the disorders with disorders with minimal fetuses with genetic implications of • Makes a nationally substantial guidance guidance disorders maternal genetic recognized disease for pregnancy • Provides postcontribution by • Provides post• Independently management participating in the pregnancy counseling pregnancy counseling provides postdevelopment of and discussion of and discussion of pregnancy counseling clinical practice future reproductive future reproductive and discussion of guidelines options with options with minimal future reproductive substantial guidance guidance options Comments:
Not yet rotated
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Apply knowledge of anatomy, development, pathophysiology, natural history, clinical history, and inheritance to provide counseling, anticipatory guidance, and longitudinal management to patients with multisystem genetic disorders — Medical Knowledge Level 1 Level 2 Level 3 Level 4 Level 5 • Formulates a care plan • Formulates and • Formulates and • Independently • Makes a nationally that is incomplete prioritizes a care plan prioritizes a care plan formulates and recognized with substantial with minimal guidance prioritizes a care plan contribution by • Recognizes the uses guidance discovering a new and limitations of • Applies practice • Independently applies genetic or congenital practice guidelines guidelines based upon practice guidelines • Applies practice entity or mechanism patient’s needs, based upon patient’s guidelines based upon genotype, and family needs, genotype, and patient’s needs, • Makes a nationally history with minimal family history genotype, and family recognized guidance history with contribution by substantial guidance developing educational materials for patients and/or providers • Makes a nationally recognized contribution by participating in the development of clinical practice guidelines Comments:
Not yet rotated
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Assess and participate in a clinical or translational research study or clinical trial involving patients with or at-risk for a genetic disorder — Medical Knowledge Level 1 Level 2 Level 3 Level 4 Level 5 • Completes training in • Identifies research • Identifies research • Independently • Makes a nationally protection of human studies or clinical trials studies or clinical trials identifies research recognized subjects appropriate for appropriate for studies or clinical trials contribution by management with management with appropriate for conducting a clinical • Demonstrates substantial guidance minimal guidance management research study or knowledge of the clinical trial principles of research • Facilitates enrollment • Facilitates enrollment • Independently studies and clinical of patients in research of patients in research facilitates enrollment trials studies with studies with minimal of patients in research substantial guidance guidance studies • Addresses the ethical • Addresses the ethical • Independently issues that are specific issues that are specific addresses the ethical to genetic and to genetic and issues that are specific genomic studies and genomic studies and to genetic and clinical trials with clinical trials with genomic studies and substantial guidance minimal guidance clinical trials Comments:
Not yet rotated
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Function effectively within the larger context of health care systems, and practice cost-effective medicine — Systems-based Practice Level 1 Level 2 Level 3 Level 4 Level 5 • Recognizes how health • Functions effectively • Functions effectively • Independently • Leads systems change care systems influence within different within different functions effectively individual practice and systems with systems with minimal within different patient care substantial guidance guidance systems • Sensitive to cost• Incorporates and • Incorporates and • Independently effectiveness of care advocates for genetics advocates for genetics incorporates and services to enhance services to enhance advocates for genetics • Recognizes that cost-effectiveness of cost-effectiveness of services to enhance diagnosis and care with substantial care with minimal cost-effectiveness of management have guidance guidance care implications for care at home and in the • Recognizes and • Recognizes and • Independently community across the manages the variation manages the variation recognizes and lifespan of the patient in access to genetic in access to genetic manages the variation testing with testing with minimal in access to genetic substantial guidance guidance testing • Facilitates • Facilitates • Independently management and management and facilitates transitions of care transitions of care management and teams as the patient teams as the patient transitions of care ages with substantial ages with minimal teams as the patient guidance guidance ages • Participates in • Participates in • Independently identifying system identifying system participates in errors and errors and identifying system implementing implementing errors and potential system potential system implementing solutions with solutions with minimal potential system substantial guidance guidance solutions Comments:
Not yet achieved Level 1
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Use technology to accomplish safe health care delivery — Systems-based Practice Level 1 Level 2 Level 3 • Utilizes the Electronic • Documents essential • Documents essential Health Record (EHR) elements of genetics elements of genetics and Computerized encounters to encounters to Physician Order Entry enhance the transfer enhance the transfer (CPOE) in prevention of information and of information and of medical errors patient safety with patient safety with substantial guidance minimal guidance • Recognizes the risk added by copy/paste • Utilizes decision • Utilizes decision strategies to create support tools with support tools with notes substantial guidance substantial guidance Comments:
Level 4 • Independently documents essential elements of genetics encounters to enhance the transfer of information and patient safety • Independently utilizes decision support tools
Level 5 • Develops new technologies to improve health care in genetics
Not yet achieved Level 1
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Self-Directed Learning — Practice-based Learning and Improvement 1. Identify strengths, deficiencies, and limits in one’s knowledge and expertise 2. Set learning and improvement goals by seeking and incorporating feedback 3. Identify and perform appropriate learning activities 4. Use information technology to optimize learning 5. Critically read and interpret scientific literature Level 1 Level 2 Level 3 Level 4 • Acknowledges gaps in • Assesses self• Assesses self• Independently personal knowledge performance and performance and assesses selfand expertise develops a learning develops a learning performance and plan with substantial plan with minimal develops a learning • Demonstrates guidance guidance plan computer literacy and basic computer skills • Critically evaluates and • Critically evaluates and • Independently utilizes information utilizes information critically evaluates and from diverse sources from diverse sources utilizes information with substantial with minimal guidance from diverse sources guidance Comments:
Level 5 • Develops nationally recognized materials and approaches for education of others
Not yet achieved Level 1
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Implement a quality improvement project — Practice-based Learning and Improvement Level 1 Level 2 Level 3 Level 4 • Recognizes the value • Describes elements of • Identifies areas for • Participates in a of quality a quality improvement improvement in quality improvement improvement project individual practice project Comments:
Level 5 • Designs and leads quality improvement project
Not yet achieved Level 1
Is sensitive and responsive to diverse patient populations with respect to gender, age, culture, race, religion, disabilities, and sexual orientation — Professionalism Level 1 Level 2 Level 3 Level 4 Level 5 • Understands the • Demonstrates caring, • Demonstrates caring, • Demonstrates caring, • Demonstrates importance of caring, honest, and sensitive honest, and sensitive honest, and sensitive leadership and honest, and sensitive behavior in common behavior in complex behavior in all mentoring regarding behavior and uncomplicated situations relationships and these principles situations situations Comments:
Not yet achieved Level 1
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Adhere to the ethical principles relevant to the practice of medicine — Professionalism Level 1 Level 2 Level 3 Level 4 • Is aware of basic • Effectively manages • Effectively manages • Independently bioethical principles personal beliefs to personal beliefs to effectively manages and their importance avoid any negative avoid any negative personal beliefs to in patient care impact on patient care impact on patient care avoid any negative with substantial with minimal guidance impact on patient care • Demonstrates respect guidance • Recognizes and • Independently for patient privacy and manages ethical issues recognizes and • Recognizes and autonomy in genetics practice manages ethical issues manages ethical issues with minimal guidance in genetics practice in genetics practice with substantial guidance
Comments:
Level 5 • Makes a nationally recognized contribution develops educational materials for patients and/or providers • Makes a nationally recognized contribution participates in the development of clinical practice guidelines
Not yet achieved Level 1
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Demonstrate personal responsibility to maintain emotional, physical, and mental health and accountability to patients, society, and the profession — Professionalism Level 1 Level 2 Level 3 Level 4 Level 5 • Recognizes the • Demonstrates • Identifies and • Identifies and • Develops institutional importance of adequate manages situations in manages situations in and organizational maintaining personal management of which maintaining which maintaining strategies to improve emotional, physical, personal, emotional, personal emotional, personal emotional, physician performance and mental health physical, and mental physical, and mental physical, and mental health health is challenged by health is challenged by • Maintains professional common and typical complicated and less appearance • Effectively manages clinical care situations frequent clinical care the issues related to • Is aware of the issues situations fatigue and sleep related to fatigue and deprivation • Recognizes signs of sleep deprivation physician impairment • Recognizes limits of and demonstrates knowledge and asks appropriate steps to for assistance address impairment in • Completes colleagues professional responsibilities in a timely manner Comments:
Not yet achieved Level 1
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Relationship building, teamwork, and conflict management — Interpersonal and Communication Skills Level 1 Level 2 Level 3 Level 4 • Develops a positive • Develops and sustains • Develops and sustains • Independently relationship based on relationships with relationships with develops and sustains mutual trust with families and health families and health relationships with patients/families in care team members care team members families and health uncomplicated with substantial with minimal guidance care team members situations guidance • Manages conflicts with • Independently patients/families and manages conflicts with • Recognizes conflicts, • Manages conflicts with within the health care patients/families and especially those that patients/families and team with minimal within the health care pertain to patient care within the health care guidance team team with substantial guidance • Participates in team• Independently based care with participates in team• Participates in teamminimal guidance based care based care with substantial guidance • Participates in regional and national • Joins professional organizations organizations Comments:
Level 5 • Develops models/approaches to managing difficult communications • Assumes leadership roles within professional organizations
Not yet achieved Level 1
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Information gathering and sharing — Interpersonal and Communication Skills Level 1 Level 2 Level 3 • Actively seeks and • Communicates general • Communicates general understands the and sensitive and sensitive patient’s/family’s information with information with perspective awareness of the social awareness of the social context with context with minimal • Is aware of factors substantial guidance guidance that affect • Demonstrates • Demonstrates communication knowledge of and knowledge of and sensitivity to cultural sensitivity to cultural values in values in communicating genetic communicating genetic information with information with substantial guidance minimal guidance • Provides information • Provides information and resources with and resources with substantial guidance minimal guidance • Utilizes multiple sources and genetic counselors to obtain information with substantial guidance Comments:
Level 4 • Independently communicates general and sensitive information with awareness of the social context • Independently demonstrates knowledge of and sensitivity to cultural values in communicating genetic information • Independently provides information and resources
Level 5 • Makes a nationally recognized contribution by developing educational materials for patients and/or providers
Not yet achieved Level 1
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