CASE INFORMATION

Case ID: CONTRA-2025-02
Case Name: Emily Dawson
Age: 22
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: W11 (Oral Contraceptive), W10 (Postcoital Contraception), W50 (Other Contraception)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages effectively in a sensitive discussion about contraception 1.3 Explains risks, benefits, and alternatives clearly 1.5 Uses shared decision-making
2. Clinical Information Gathering and Interpretation	2.1 Conducts a detailed sexual and reproductive health history 2.3 Assesses medical eligibility for contraception using appropriate guidelines
3. Diagnosis, Decision-Making and Reasoning	3.1 Identifies appropriate contraceptive options based on patient preference and medical history 3.4 Considers potential contraindications
4. Clinical Management and Therapeutic Reasoning	4.1 Provides safe and effective contraception counselling 4.4 Prescribes contraception in line with national guidelines
5. Preventive and Population Health	5.1 Provides STI screening and prevention advice 5.3 Encourages preventive health activities such as cervical screening
6. Professionalism	6.1 Ensures a non-judgmental, patient-centred approach
7. General Practice Systems and Regulatory Requirements	7.1 Prescribes contraception according to PBS guidelines 7.2 Documents consent and counselling appropriately
9. Managing Uncertainty	9.1 Addresses patient concerns about side effects and efficacy
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises situations where specialist referral is required (e.g., complex medical history, contraindications)

CASE FEATURES

Young female requesting contraception for the first time.
History of migraines with aura, making combined oral contraceptives unsuitable.
Has a new partner and is concerned about STI prevention.
Uncertain about long-term contraceptive options.
Has irregular periods and wants a method that will regulate her cycle.

INSTRUCTIONS

Review the following patient record summary and scenario.
Your examiner will ask you a series of questions based on this information.

You have 15 minutes to complete this case.

The time for each question will be managed by the examiner.
The time allocation for each question is roughly as follows:

Question 1 – 3 minutes
Question 2 – 3 minutes
Question 3 – 3 minutes
Question 4 – 3 minutes
Question 5 – 3 minutes

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Dawson
Age: 22
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

None currently

Past History

Migraines with aura since age 16
No history of thrombosis, hypertension, or significant medical conditions

Social History

University student
New monogamous partner
No history of pregnancy

Family History

Mother has hypertension
No family history of thromboembolism

Smoking

Non-smoker

Alcohol

Occasional social drinking

Vaccination and Preventative Activities

HPV vaccination completed
No recent STI screening
Cervical screening not yet performed

SCENARIO

Emily Dawson, a 22-year-old university student, presents for advice on contraception. She has recently entered a new relationship and wants a reliable, long-term contraceptive method. She is also concerned about STIs and would like to discuss dual protection strategies.

Emily has a history of migraines with aura, which she experiences about once a month. She has never used hormonal contraception before but wants a method that will also regulate her irregular periods.

She expresses concerns about weight gain, acne, and mood changes with hormonal contraceptives and is unsure whether to consider an intrauterine device (IUD), progestogen-only pill, or an implant.

She is open to discussing all options but wants a method that minimises side effects and is low maintenance.

EXAMINATION FINDINGS

General Appearance: Well-groomed, no distress
Temperature: 36.7°C
Blood Pressure: 120/75 mmHg
Heart Rate: 72 bpm, regular
BMI: 22 kg/m²

INVESTIGATION FINDINGS

Pregnancy Test: Negative
STI Screening: Not yet done
Cervical Screening: Not yet due, but recommended

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What key aspects of history and risk factors should you assess before prescribing contraception?

Prompt: What medical conditions or lifestyle factors influence contraceptive choice?
Prompt: What additional information would you gather?

Q2. What are the safest and most effective contraceptive options for Emily?

Prompt: Which methods are contraindicated due to her migraines?
Prompt: How would you counsel her about long-acting reversible contraceptives (LARCs)?

Q3. How would you address Emily’s concerns about side effects?

Prompt: What strategies can be used to manage concerns about weight gain, mood, and acne?
Prompt: How would you compare the hormonal and non-hormonal options?

Q4. What additional preventive health measures would you recommend?

Prompt: What is the role of dual contraception (STI prevention)?
Prompt: What preventive health screenings are relevant?

Q5. How would you ensure Emily has adequate follow-up and support?

Prompt: When should she return for a review?
Prompt: What resources or referrals might be beneficial?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What key aspects of history and risk factors should you assess before prescribing contraception?

Before prescribing contraception, a comprehensive history is crucial to determine the safest and most effective method for Emily. Key areas to explore include:

1. Medical History

Migraines with aura: Combined oral contraceptives (COCs) are contraindicated due to the increased risk of stroke.
Hypertension or thromboembolic disorders: Family history of hypertension necessitates blood pressure monitoring.
Menstrual history: Assess cycle regularity, dysmenorrhoea, and heavy bleeding, which may guide contraceptive choice.
Gynaecological history: Previous STIs, pelvic infections, or abnormal Pap smears may influence IUD suitability.
Endocrine or metabolic conditions: Conditions such as PCOS or diabetes impact contraceptive selection.

2. Lifestyle and Social Factors

Smoking status: Though Emily is a non-smoker, smoking and age impact contraceptive safety.
Sexual history: Assess number of partners, STI risk, past contraceptive use, and adherence concerns.
Future pregnancy plans: Determine if she prefers a reversible or long-term method.

3. Contraceptive Preferences and Concerns

Efficacy and convenience: Emily seeks a low-maintenance method.
Side effects: Address concerns about weight gain, acne, and mood changes.
STI prevention: Emphasise the importance of barrier methods in addition to hormonal contraception.

4. Screening and Investigations

Blood pressure measurement: Essential due to the risk of hypertension with some hormonal methods.
STI screening: Recommended given a new partner.
Pregnancy test: To rule out pregnancy before initiating contraception.

By conducting a structured history, the GP ensures the contraception prescribed aligns with Emily’s medical profile, lifestyle, and personal preferences.

SUMMARY OF A COMPETENT ANSWER

Identifies contraindications (migraines with aura, hypertension risk).
Explores menstrual and gynaecological history to tailor contraceptive options.
Assesses STI risk and reinforces dual protection (contraception + STI prevention).
Addresses patient preferences and concerns regarding side effects and convenience.
Orders relevant screening tests (BP check, STI screen, pregnancy test).

PITFALLS

Failing to identify migraines with aura as a contraindication for COCs.
Not addressing patient concerns about side effects and long-term suitability.
Overlooking the importance of STI screening and barrier methods.
Prescribing without assessing blood pressure in a patient with a family history of hypertension.

REFERENCES

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

2. Clinical Information Gathering and Interpretation

2.1 Conducts a detailed sexual and reproductive health history.
2.3 Assesses medical eligibility for contraception using appropriate guidelines.

Competency at Fellowship Level

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