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Vocational Training
Clinical
Genetics - Australia
Supervising Committee
Specialist Advisory Committee (SAC) in Clinical Genetics.
The SAC in Australia will supervise trainees in both
Australia and New Zealand.
Definition
of Specialty
A clinical geneticist is a medical practitioner trained
in the application of the principles of human genetics, including laboratory findings,
to the diagnosis and management of genetic disorders and supervision of the counselling
of patients and their families.
General Principles
- Advanced training should be for the equivalent of 3 years full time.
- The
proposed training program for each year of training must be submitted in advance
and be approved by the SAC in Clinical Genetics of the RACP.
- It is recommended
that training be obtained in more than one genetics centre.
- All subspecialty
paediatric trainees must complete the community and child health requirements
for paediatric training.
Note that the guidelines differ
between Australia
and New Zealand.
Components of Training
Core Training- psychosocial aspects of counselling, including supervision
by an accredited counsellor; with particular emphasis on coping skills and defense
mechanisms, risk communication, bereavement counselling and the giving of distressing
news;
- genetic diagnosis including dysmorphology, interpretation of laboratory
studies, use of computer programs such as CYRILLIC and LINKAGE, computer databases
including OMIM, Medline, POSSUM, London Dysmorphology and Neurology Databases;
- attendance
at cytogenetics, molecular genetics, newborn and prenatal
screening laboratory results meetings, in order to acquire competence in the
interpretation
of results of laboratory testing;
- awareness of ethical and legal issues
arising from clinical genetic practice including informed consent, confidentiality,
prenatal and preimplantation testing, termination of pregnancy and presymptomatic
testing;
- management of genetic service programs including budget preparation,
management of outreach program, liaison with human resources department, medical
record keeping;
- for the majority of the training period the trainee should
be working in the field of medical genetics, and supervised by specialists in
this field.
At least one year of full time equivalent training is
to be exclusively in general clinical genetics, including:- 3 clinics per
week, which could include:
- general clinical genetics
- prenatal diagnosis
clinic
- other clinics, e.g. following up old patients or specialty clinics
such as cancer, ophthalmological genetics;
- one
journal club per week or (in New Zealand) when available;
- one review session
per week, e.g. review of clinical cases seen, discussion of dysmorphology slides,
counselling issues;
- one liaison laboratory meeting per week, for equivalent
of 3 months in the following fields:
- laboratory: cytogenetic, molecular
(required), serum/prenatal screening (elective)
- inborn errors of metabolism/biochemical
genetics (required), neonatal screening (elective).
During
the 3 years of training, core experience should include:- cancer genetics:
hereditary breast and bowel cancer;
- neurogenetics/presymptomatic diagnosis:
Huntington disease and other adult-onset conditions;
- clinical cytogenetic
problems including at least trisomy, reciprocal and Robertsonian translocation,
inversion, sex chromosome variations, mosaicism;
- prenatal diagnosis including
advanced maternal age, cystic fibrosis, Duchenne muscular dystrophy, fetal problem
detected on routine ultrasound, unexpected chromosome variation detected in fetus,
e.g. less frequent trisomies, confined placental mosaicism, trisomy rescue;
- diagnosis
and management of inborn errors of metabolism;
- examination of stillborn/miscarried
fetuses, follow-up of couples who terminate pregnancy;
- at least a week
experience in a cytogenetics diagnostic laboratory, a week in a diagnostic
molecular laboratory and a week in a biochemical genetics laboratory;
- diagnosis of syndromes including
multiple congenital anomaly syndromes and skeletal dysplasias: morphological assessment
and diagnostic investigations.
.
Subspecialty/Non
Core Training
Trainees intending to subspecialise in areas such as cancer
genetics or neurogenetics should spend at least a year training
in general genetics and at least two years in the subspecialty area.
New guidelines commencing 2008
Trainees intending to subspecialise in areas such as cancer genetics, genetic
metabolic medicine or neurogenetics should spend at least a year training in
general genetics and at least 2 years in the subspecialty area.
Up to 6 months of advanced training may be spent in a related field, other than
clinical genetics or subspeciality genetics. This could include up to 6 months
of full time research or clinical training. Appropriate fields of clinical training
may include, but are not restricted to, neurology, developmental paediatrics
and endocrinology. Trainees wishing to do an elective period in a field other
than genetics must obtain prospective approval from the SAC. Approval would not
be automatic even for training in the areas listed above - the specifics of the
6 month period would be important and it is possible that some neurology rotations
(for example) would not be suitable. This means that it is important to discuss
plans to do an elective term with the Coordinator of Advanced Training well in
advance of
the proposed start date.
Completion of Developmental and Psychosocial component of paediatric
training by Clinical Genetics trainees
The Developmental & Psychosocial component can also be satisfied bycompleting
all the requirements of advanced training in clinical genetics under the supervision
of the SAC in Clinical Genetics. Genetics
trainees will continue to be required to have their mandatory training
program approved prospectively and on an individual basis. Undertaking
part of the training program, or a short period of training in Clinical
Genetics, would not satisfy the requirement.
Clinical
Cancer Genetics
Two years of prospectively approved supervised advanced
training in cancer genetics will be accredited by the SAC if undertaken:-
in a centre with access to a clinical genetics service;
- with continuing
involvement in a clinical genetics training program;
- with joint supervision
by a clinical geneticist.
A detailed curriculum for cancer genetics' training is available from the Training
Section of the College office in Australia.
 Subspecialty
training requirements in Clinical Cancer Genetics
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