ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

---

Opening Line:

“Hi Doctor, I need to talk about contraception. I read online that the pill might not be safe for me since I smoke. Is that true?”

---

General Information

(Freely Given if Asked Open-Ended Questions):

• Lisa has been on the combined oral contraceptive pill (COCP) for years without any noticeable problems.
• She smokes about 12 cigarettes per day and has done so for over 15 years.
• She has tried to quit several times in the past using nicotine patches and gum but has always relapsed.

---

Specific Information

(Only Given When Asked Targeted Questions):

Background Information

• She is not currently pregnant and has no plans for more children.
• She wants a reliable and effective method of contraception
• She has not had her blood pressure checked in years.

Contraceptive History

• She has always used the pill since she was 22.
• She sometimes forgets to take it on time, especially on weekends.
• She has considered switching to other methods, but she hasn’t known much about her options.

Smoking and Health Risks

• She started smoking in her late teens and has continued since.
• She has tried quitting multiple times, mostly for her children’s sake.
• She knows smoking is bad for her health but struggles with cravings and stress.
• She is not aware that her smoking could increase health risks with the pill.

Medical and Family History

• She has occasional migraines with aura (describes them as seeing flashing lights and blurry vision before the headache starts).
• Her mother had a stroke at 58, but Lisa is not sure if smoking or high blood pressure played a role.
• Her father had high blood pressure in his late 40s and was put on medication.
• She has a stable partner and is not at risk of sexually transmitted infections (STIs).

Concerns About Alternative Contraception Methods

• She has never used long-acting reversible contraception (LARC) before.
• She has never tried an IUD and is worried about the pain of insertion.
• She is hesitant about the implant because she heard it can cause irregular bleeding.
• She likes that the COCP regulates her periods, so she’s afraid of changes.
• She does not like injections and is unsure about the Depo-Provera shot.

---

Emotional Cues & Behaviour

• She appears concerned when discussing the safety of her current contraception.
• She is hesitant and nervous when talking about IUDs, frequently asking for reassurance about pain and side effects.
• She expresses frustration about her failed smoking cessation attempts.
• She seems a bit defensive about her smoking habit but acknowledges its risks when pressed.
• She leans forward with curiosity when discussing contraceptive alternatives, showing engagement in the discussion.

---

Patient Concerns & Questions (Must Be Raised in the Consultation)

1. “Is it true that I can’t take the pill anymore because I smoke?” (She is genuinely worried about this and will express concern if the doctor confirms it is not safe.)
2. “What are my safest options? I don’t want to get pregnant, but I don’t want something that will mess up my body either.”
3. “I heard that the implant can make you bleed all the time. Is that true?”
4. “IUDs sound painful. How bad is it? Would I have to take time off work if I get one?”
5. “Will the mini-pill work as well as the normal pill?” (She will ask this if the progestogen-only pill (POP) is mentioned.)
6. “If I quit smoking, could I go back on the pill later?” (She is interested but skeptical about quitting.)
7. “I’ve tried quitting before, and it didn’t work. What’s different this time?” (If the doctor offers smoking cessation support.)

---

Expected Reactions & Responses to Doctor’s Advice

If Told That COCP Is Unsafe Due to Smoking OR Migraine with Aura

• She will be visibly surprised and slightly anxious.
• She will ask why she wasn’t told this before.
• She might say: “I’ve been on this for years. Why is it suddenly a problem now?”
• If explained that her age and smoking combination increases her risk, she will be concerned but willing to consider alternatives.

If Told That IUDs or Implants Are Good Alternatives

• She will look skeptical and hesitant.
• She will say: “I don’t know about having something put inside me. Doesn’t it hurt?”
• If reassured about pain management, she will be more open to learning more.
• She will need clear explanations on how these methods work and whether they will affect her periods.

If Discussing Smoking Cessation

• She will initially sound doubtful: “I’ve tried quitting before, but it didn’t work.”
• If given new strategies, she will say: “I suppose I could try again, but I don’t want to fail.”
• She will be more interested if given options beyond nicotine patches, such as medications or behavioral support.

If Given Safety-Netting Advice

• She will appreciate the follow-up plan but may ask: “How will I know if this method isn’t right for me?”
• She will want clear guidance on when to come back and what symptoms to look out for.

---

Role-Player Guidelines

• Do not give all information upfront—only provide details when prompted with relevant questions.
• If the candidate fails to ask about smoking, Lisa should not mention it herself until later in the consultation.
• If the candidate does not ask about her migraines, she should still mention them if discussing contraceptive risks.
• If the candidate pressures her into an IUD or implant without proper discussion, she should push back and ask for more reassurance.
• Maintain a realistic mix of curiosity, hesitation, and concern throughout the discussion.

---

Ending the Consultation

Lisa should end with one of the following statements based on how well the consultation goes:

1. If satisfied and reassured:
   “Okay, I feel better about this now. I might try the implant. Thanks for explaining it all.”
2. If still hesitant but considering options:
   “I need to think about it, but at least now I know what’s safe for me.”
3. If still uncertain about IUD/Implant:
   “Can I come back and talk more about this if I have more questions?”