Counselling · Intermediate · O&G

Contraceptive Counselling and Options

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

Clinical scenario

You are an FY2 doctor in a sexual health clinic. Miss Ruth Gould, a 27-year-old woman, has come for contraceptive counselling. She is in a stable relationship but unsure about which contraceptive method would suit her best. Please discuss the various options available, their effectiveness, advantages and disadvantages, and help her make an informed choice.

Background notes: PMH: Nil significant

What this station tests

  • Establishing patient priorities before presenting options: convenience, reliability, reversibility
  • LARC as the most effective category: removes human error that reduces pill effectiveness
  • IUS versus implant versus IUD: comparative counselling based on individual priorities
  • Depo-Provera delayed fertility return: less suitable for women planning pregnancy within 2-3 years
  • Continuing current method until new one is fitted: no gap in contraception

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

Contraceptive counselling tests shared decision-making: the candidate must present options based on the patient's priorities, not prescribe their preferred method. Miss Gould is 27, wants to switch from the pill because she forgets doses and travels frequently. Open with: 'Ruth, tell me what you are looking for in a contraceptive method. What matters most to you?'

Core approach

Establish her priorities before presenting options. She wants: reliability (tired of missed pills), convenience (no daily action), and reversibility (wants children in 2 to 3 years). She does not want something permanent or that takes a long time to return to fertility.

Present LARC (long-acting reversible contraception) options tailored to her priorities. IUS (Mirena): lasts 5 years, very effective (>99%), periods lighter or absent, fertility returns quickly on removal. Implant (Nexplanon): lasts 3 years, >99% effective, no daily action, but may cause irregular bleeding. IUD (copper coil): non-hormonal, lasts 5 to 10 years, periods may be heavier, fertility returns immediately. Injection (Depo-Provera): every 12 weeks, but delayed return to fertility (up to 12 months) makes it less suitable given her 2 to 3 year plan.

Address common concerns. IUS/IUD insertion: brief discomfort, done in clinic, takes 10 minutes. Implant: small rod under skin of upper arm, local anaesthetic. Explain that LARC is the most effective contraception category because it removes the human error factor that makes the pill less reliable in practice.

Closing and safety netting

Shared decision: let her choose. If she leans toward IUS: explain the advantages (lightest periods, most effective, quick fertility return). If implant: explain bleeding patterns. Do not push one method. 'Take time to think about it and come back when you are ready to have it fitted.'

Practical: continue the pill until the new method is in place to avoid a gap in contraception. STI protection: 'LARC protects against pregnancy but not STIs. Condoms are still recommended with new partners.' Safety net: 'If you have any problems after fitting, come back.' Follow-up for fitting.

How examiners mark this station

Examiners will assess your ability to explain contraceptive counselling 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: Priorities established. Sexual health and reproductive history taken. Current method reviewed. Medical contraindications checked (UKMEC).

Costs marks: Not exploring priorities. Not checking contraindications.

Domain 2 (Primary focus)

Scores well: LARC options presented with comparison. Fertility return discussed. Correct method comparison. STI protection mentioned. Continuation of current method.

Costs marks: Only pill alternatives. Not comparing methods. Missing fertility discussion.

Domain 3 (Primary focus)

Scores well: Patient-led decision. Not pushing one method. Addressing concerns about insertion. Allowing time to decide.

Costs marks: Being directive. Dismissing concerns about IUD insertion. Pressuring a decision.

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. Prescribing a method without exploring her priorities: shared decision-making is the core skill
  2. Not mentioning LARC: candidates who only discuss pill alternatives miss the most effective options
  3. Not addressing return to fertility: she wants children in 2-3 years, this affects which methods are suitable

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

How do I open and run a contraceptive counselling counselling station in PLAB 2?

Contraceptive counselling tests shared decision-making: the candidate must present options based on the patient's priorities, not prescribe their preferred method. Miss Gould is 27, wants to switch from the pill because she forgets doses and travels frequently. Open with: 'Ruth, tell me what you are looking for in a contraceptive method.

What does a strong performance look like to the examiner in this station?

Strong performances show: Priorities established. Sexual health and reproductive history taken. Current method reviewed. Medical contraindications checked (UKMEC). Weak performances: Not exploring priorities. Not checking contraindications.

What is the biggest pitfall in this contraceptive counselling station?

Prescribing a method without exploring her priorities: shared decision-making is the core skill. Another frequent error: Not mentioning LARC: candidates who only discuss pill alternatives miss the most effective options.

How should I prepare for contraceptive counselling if I have never seen it in practice?

Structure beats experience here. Focus on lARC as the most effective category: removes human error that reduces pill effectiveness. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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