Counselling · Intermediate · O&G

Abnormal Cervical Smear Result Notification

Practise this PLAB 2 counselling station on Cervical Dyskaryosis. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Mrs Mumtaz Rana, a 42-year-old woman, has come for an appointment following receipt of her cervical smear result. Her result shows dyskaryosis (abnormal cells). Please discuss the result with her, explain what dyskaryosis means, outline the next steps including colposcopy, and address her concerns and anxieties.

Background notes: PMH: Generally healthy

What this station tests

  • Dyskaryosis is NOT cancer: precancerous changes that can be treated before cancer develops
  • Colposcopy explanation: what it involves, what happens during, and that treatment can be done at the same visit
  • HPV normalisation: 80% of adults will have HPV, it does not imply infidelity
  • LLETZ as the treatment: excision of abnormal area under local anaesthetic as outpatient
  • Screening success: finding and treating changes before cancer develops is exactly what screening is designed to do

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Explaining an abnormal smear result requires correcting the immediate 'I have cancer' assumption while communicating the need for colposcopy. Mrs Rana is 42, received a letter showing high-grade dyskaryosis. She thinks she has cancer. Open with: 'Mrs Rana, I know the letter was worrying. Before I explain the result, can you tell me what you understood from it?'

Core approach

Correct the cancer misconception immediately. 'Dyskaryosis means abnormal cells were found on your smear. These are NOT cancer cells. They are cells that have changed and, if left untreated over many years, could potentially develop into cancer. That is exactly why we screen: to find and treat these changes before cancer ever develops.'

Explain the grading. High-grade dyskaryosis means the changes are more significant and need investigation. She will be referred for colposcopy (examination of the cervix with a magnifying instrument). If abnormal areas are seen, a biopsy will be taken. Treatment (LLETZ, excision of the abnormal area) can often be done at the same appointment.

HPV context. The screening programme now tests for HPV first. HPV is extremely common (80% of sexually active adults will have it at some point). Having HPV does not imply infidelity. It can be dormant for years. She may be worried about this.

Closing and safety netting

Explain colposcopy practically. 'It is similar to a smear but takes a bit longer. They apply a solution to your cervix and look at it through a magnifying camera. If they see an abnormal area, they may treat it there and then with a small procedure under local anaesthetic.' Mild discomfort, not painful.

Reassure about outcomes. 'The vast majority of women with dyskaryosis are treated successfully with a simple outpatient procedure and go on to have normal smears afterwards.' Safety net: 'If you develop unusual bleeding, discharge, or pelvic pain before your colposcopy, come back.' Follow-up after colposcopy result. Jo's Cervical Cancer Trust for support.

How examiners mark this station

Examiners will assess your ability to explain cervical dyskaryosis and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1 (Supporting)

Scores well: Understanding of her current knowledge assessed. Cervical screening history checked. HPV status noted. Symptoms checked.

Costs marks: Not checking her understanding. Not asking about symptoms.

Domain 2 (Primary focus)

Scores well: Dyskaryosis explained accurately (not cancer). Colposcopy referral. LLETZ explained. HPV context provided. Jo's Trust signposted.

Costs marks: Not explaining dyskaryosis. Not explaining colposcopy. Not mentioning HPV.

Domain 3 (Primary focus)

Scores well: Correcting cancer fear immediately. Normalising HPV. Explaining colposcopy to reduce anxiety. Providing hope about outcomes.

Costs marks: Leaving cancer fear unaddressed. Implying infidelity. Not explaining the procedure.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Not correcting the cancer assumption immediately: she thinks she has cancer and every minute of delay increases her distress
  2. Implying HPV means infidelity: HPV can be dormant for years, and 80% of adults carry it
  3. Not explaining colposcopy practically: fear of the unknown procedure adds to her anxiety

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

What is the best way to structure this cervical dyskaryosis counselling consultation?

Explaining an abnormal smear result requires correcting the immediate 'I have cancer' assumption while communicating the need for colposcopy. Mrs Rana is 42, received a letter showing high-grade dyskaryosis. She thinks she has cancer.

Where are marks won and lost in this cervical dyskaryosis station?

Examiners reward: Understanding of her current knowledge assessed. Cervical screening history checked. HPV status noted. Symptoms checked. Candidates are penalised for: Not checking her understanding. Not asking about symptoms.

Where do candidates most often go wrong in this station?

Not correcting the cancer assumption immediately: she thinks she has cancer and every minute of delay increases her distress.

Can I do well in this station without real-world experience of cervical dyskaryosis?

Structure beats experience here. Focus on colposcopy explanation: what it involves, what happens during, and that treatment can be done at the same visit. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

Related cases