Genetic Counseling Practice
The shape of practice questions
Practice-domain items test judgment, not recall of a single fact. Expect scenarios built around the counseling relationship: informed consent, confidentiality and its limits, nondirectiveness, duty to warn versus the patient's privacy, documentation, billing and insurance disclosures, and coordination with laboratories and specialists. Know the difference between clinical duties (accurate risk assessment, appropriate test selection) and professional duties (scope of practice, supervision of students, referral when outside competence).
Traps to watch
A frequent trap is the answer that is clinically clever but procedurally wrong: ordering a broad panel before confirming informed consent, or disclosing results to a relative without the patient's permission. Another is conflating confidentiality with absolute secrecy - confidentiality has recognized exceptions (imminent harm, legal mandate, court order) and questions often hinge on whether the exception genuinely applies. Watch for answers that promise a specific outcome ("this test will tell you whether you will get cancer") rather than describing probabilities and limitations. Also distinguish counseling from directive advice: offering resources and decision support is appropriate; steering toward a particular reproductive choice is not.
Rule of thumb
When two answers both seem reasonable, choose the one that (1) preserves patient autonomy, (2) stays within scope and consent, and (3) documents the reasoning. If an answer requires acting on someone else's behalf without authorization, it is almost always wrong. Worked example: a patient's sibling asks for the patient's BRCA result. The best response is not to disclose and not to refuse coldly, but to explain the limits of confidentiality, offer to discuss what the patient is willing to share, and provide general information about the sibling's own testing options.
Preparation
Practice writing short justifications for each option you reject; exam rationales reward the why, and rehearsing the reasoning builds the discrimination these items require.