CCE-CBD-027

Examiner Only Information

Questions

Q1. What key factors would you consider when prescribing an oral contraceptive for Jessica?

• Prompt: How would you assess her suitability for a combined oral contraceptive pill (COCP)?
• Prompt: What risk factors would make you consider a progestogen-only pill (POP)?

Q2. What counselling would you provide regarding COCP use?

• Prompt: How would you explain how to take the pill correctly?
• Prompt: What common side effects and risks should she be aware of?

Q3. What alternative contraceptive options would you discuss?

• Prompt: If Jessica is unsure about the pill, what other long-acting reversible contraceptives (LARC) could be considered?
• Prompt: How would you compare LARC options to oral contraception?

Q4. How would you address Jessica’s concerns about weight gain and mood changes?

• Prompt: What does the evidence say about COCP and weight gain?
• Prompt: How would you support her if she experiences mood-related side effects?

Q5. What preventive health measures should be discussed alongside contraception?

• Prompt: How would you ensure Jessica is up to date with STI screening and cervical screening?
• Prompt: What lifestyle factors should be discussed?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What key factors would you consider when prescribing an oral contraceptive for Jessica?

The competent candidate should:

• Assess medical history for contraindications to combined oral contraceptive pills (COCP):
  • No history of DVT/PE, hypertension, or migraine with aura (COCP is safe).
  • Mother had a DVT on HRT – this may indicate a mild inherited thrombophilia risk.
• Evaluate risk factors for thromboembolism:
  • Smoking, BMI, immobility, family history.
  • COCP increases clot risk but remains acceptable in low-risk women.
• Consider menstrual symptoms and benefits:
  • COCP can regulate irregular cycles and reduce cramps.
  • Progestogen-only pill (POP) may be preferred if clot risk is a concern.

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Q2: What counselling would you provide regarding COCP use?

The competent candidate should:

• How to take the pill correctly:
  • Take one pill daily at the same time.
  • Seven-day rule: If a pill is missed for more than 24 hours, use backup contraception for seven days.
• Common side effects and risks:
  • Breakthrough bleeding in the first few months.
  • Potential mood changes, nausea, breast tenderness.
  • Slightly increased risk of blood clots (DVT, PE) but rare in healthy women.
• Follow-up and monitoring:
  • Review in three months for side effects and adherence.

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Q3: What alternative contraceptive options would you discuss?

The competent candidate should:

• Long-acting reversible contraception (LARC):
  • Progestogen-only implant (e.g., Implanon) – highly effective for three years.
  • IUDs (hormonal or copper) – effective for 5+ years.
• Comparing LARC vs oral contraception:
  • LARC does not require daily adherence.
  • IUDs can improve heavy periods (Mirena) or be hormone-free (copper).

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Q4: How would you address Jessica’s concerns about weight gain and mood changes?

The competent candidate should:

• Weight gain:
  • No strong evidence that COCP causes significant weight gain.
  • Water retention may cause minor fluctuations.
• Mood changes:
  • Some women report mood swings, but effects vary.
  • Monitor mood for the first few months; alternative pills may help.
• Trial period approach:
  • Review in three months, consider switching if side effects occur.

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Q5: What preventive health measures should be discussed alongside contraception?

The competent candidate should:

• Cervical screening:
  • First CST due at age 26 – encourage testing today or book an appointment.
• STI screening:
  • Consider chlamydia testing, particularly for women <30.
• Lifestyle factors:
  • Smoking cessation (if applicable).
  • Healthy diet and exercise to maintain general health.

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SUMMARY OF A COMPETENT ANSWER

• Evaluates contraindications and risks of COCP use.
• Explains proper COCP use, side effects, and safety considerations.
• Discusses alternative contraception options, including LARC.
• Addresses common concerns about weight and mood changes.
• Incorporates preventive health measures like STI and cervical screening.

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PITFALLS

• Failing to assess thromboembolism risk before prescribing COCP.
• Not explaining proper pill adherence or missed pill rules.
• Overlooking alternative contraception options.
• Not discussing cervical screening and STI prevention.

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REFERENCES

• RACGP Guidelines on Contraception
• Family Planning NSW on Oral Contraceptive Guide
• Therapeutic Guidelines on Contraception

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MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Engages the patient in an informed discussion about contraception options.

2. Clinical Information Gathering and Interpretation

2.1 Identifies risk factors for COCP use.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recommends an appropriate contraceptive method based on history.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides clear guidance on contraceptive use and monitoring.

5. Preventive and Population Health

5.2 Discusses STI screening, cervical screening, and general health.

6. Professionalism

6.3 Provides patient-centred and ethical contraceptive advice.

7. General Practice Systems and Regulatory Requirements

7.2 Documents consent and safe prescribing practices.

9. Managing Uncertainty

9.1 Addresses concerns about side effects and adherence.

10. Identifying and Managing the Patient with Significant Illness

10.3 Recognises contraindications to COCP and offers alternatives.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD