You walk into your PLAB 2 station. A 26-year-old woman sits across from you asking for a repeat contraceptive pill prescription. She mentions she's travelling soon and wants to delay her period.
The Challenge: within 8 minutes, you need to gather her contraceptive history, screen for safety concerns, explain period delay options clearly, and ensure she leaves confident about her plan.
Essential Communication Strategies for COCP Counselling Start with Clear Identification and Purpose
Begin every consultation by confirming the patient's identity and understanding why they're here. PLAB 2 examiners score you on initial rapport-building.
Correct approach:
✅ "Hello, I'm Dr. [Name]. Could I confirm your full name and date of birth please? How can I help you today?"
Avoid:
❌ Jumping straight into questions without introducing yourself or confirming identity.
Clarify the Presenting Concern Early
Don't assume you know what the patient wants. Confirm both requests immediately to structure your consultation effectively.
Key phrases:
"You're here for a repeat of your contraceptive pill, and to ask about managing your periods, is that right?"
"Is there a specific reason you'd like to delay your period, like travel or an event?"
Gather Detailed Contraceptive History
You need to know if she is on a 21-day monophasic pill or an everyday (ED) pill, as this determines your advice.
Key questions to ask:
"Which type of contraceptive pill are you currently taking?"
"How do you take your pill? Do you take it for 21 days and then have a break?"
"Are you taking any dummy pills after the active pills?"
"Have you had any issues with the pill so far, like stomach pains, nausea, spotting, or feeling unwell?"
Safety Screening Using PMAFTOSA Framework Why Safety Screening Matters
COCP has contraindications. Missing red flags like previous blood clots or migraines with aura can fail you in the station. Use the PMAFTOSA framework to stay systematic.
Past Medical History
Critical questions:
"Have you ever had any blood clots in your legs or lungs?"
"Any personal history of stroke, heart conditions, or migraines with aura?"
"Have you ever been diagnosed with breast cancer or epilepsy?"
"Any other significant medical conditions?"
Why these matter: COCP increases clotting risk. Patients with personal history of VTE, stroke, or migraine with aura shouldn't take COCP.
Medication, Allergies, Family History
Allergies: "Do you have any known drug allergies?"
Family History: "Has anyone in your immediate family had blood clots or early strokes?" (Family history of VTE under age 45 is a relative contraindication).
Social and Sexual Health
Sexual health: "Are you currently sexually active?"
Usage: "Is your contraception mainly for pregnancy prevention or managing periods too?"
Menstrual history: "Are your periods normally regular when you're off the pill?"
How to Structure Your COCP Counselling Consultation Step 1: Introduction and Rapport (30 seconds)
Greet warmly
Confirm identity
Ask how you can help
Step 2: Clarify Presenting Concern (1 minute)
Confirm she wants repeat prescription
Understand reason for period delay (travel, event)
Ask about current pill type and taking habits
Step 3: Safety Screening (2-3 minutes)
Use PMAFTOSA framework
Focus on VTE risk, cardiovascular history, migraines
Check family history
Step 4: ICE - Brief But Important (30 seconds)
Ideas: "What were you hoping for today?"
Concerns: "Any particular worries about taking the pill continuously?"
Expectations: "Would you like me to explain all your options?"
Step 5: Management Plan (2-3 minutes)
Confirm prescription:
"You've been doing well on your pill, and there are no issues. I'll issue a repeat prescription for three months."
Explain period delay options:
For 21-day monophasic COCP:
"You can safely delay your period by taking two packs of active pills back-to-back, without taking a break or the dummy pills. After finishing two packs, take your usual 7-day break."
For everyday (ED) pill:
"Skip the 7 dummy pills and immediately start the next pack of active pills."
Alternative - Norethisterone (if needed):
"If COCP isn't suitable, we can prescribe norethisterone. Take it three times daily, starting 3-4 days before your expected period. Note: It is not a contraceptive, so you need condoms."
Step 6: Safety Netting (1 minute)
Breakthrough bleeding: "If you notice spotting while taking continuous pills, it's safe."
Warning signs: "If you experience severe headaches, chest pain, leg swelling, or sudden breathlessness, seek urgent medical help."
Missed pills: "If you miss more than two pills, seek advice."
Step 7: Closing (30 seconds)
Summarize plan
Offer patient leaflet
Check for questions
Common Mistakes to Avoid in COCP Stations
- Skipping Safety Screening
Mistake: Going straight to period delay advice without checking contraindications.
Fix: Always screen for VTE history, migraines with aura, and cardiovascular risk factors before continuing or prescribing COCP.
- Using Medical Jargon
Mistake: "You can use norethisterone for luteal phase suppression."
Fix: "There's a hormone tablet called norethisterone that can delay your period."
- Forgetting to Explain Side Effects
Mistake: Not warning about issues with continuous use.
Fix: Warn that taking more than two packs back-to-back can cause breakthrough bleeding, sickness, or bloating.
- Not Confirming Understanding
Mistake: Lecturing the patient.
Fix: Ask, "Does that make sense? Do you have any questions about taking two packs back-to-back?"
Practice This Station on Medi8 Want to test your contraceptive counselling skills in a realistic exam setting?
Medi8 offers virtual patient consultations where you can:
✓ Practice taking focused contraceptive histories ✓ Practice safety screening with AI patients ✓ Receive instant feedback on your explanation skills ✓ Review your performance with audio playback ✓ Access 520+ OSCE scenarios including COCP counselling
Practice COCP Counselling Scenario
Examiner Checklist: What They're Looking For Communication Skills
Did you introduce yourself professionally?
Did you use simple, clear language?
Did you check understanding throughout?
Did you show empathy and warmth?
Data Gathering
Did you take a focused contraceptive history?
Did you screen for COCP contraindications systematically?
Did you ask about the reason for period delay?
Did you explore ICE?
Clinical Management
Did you explain period delay options clearly?
Did you mention side effects and contraindications?
Did you provide appropriate safety netting?
Did you offer written information?
Frequently Asked Questions Q: How long should I spend on safety screening in a PLAB 2 COCP station? A: Allocate 2-3 minutes for PMAFTOSA screening. Focus on VTE history, cardiovascular risk, migraines with aura, and family history. You don't need an exhaustive medical history, but you must cover contraindications.
Q: What if the patient has a contraindication to COCP? A: Explain you can't continue the COCP due to safety concerns. Offer alternatives like progesterone-only pill, implant, or IUD. For period delay, explain norethisterone as an option (if no VTE history).
Q: Do I need to explain how norethisterone works in detail? A: Give a brief, clear explanation: when to start (3-4 days before period), how to take it (three times daily), how long to use it (up to 20 days), when periods return (2-3 days after stopping), and that it's not contraceptive.
Q: Should I offer a physical examination? A: For a routine COCP repeat with no red flags, physical examination isn't needed. Focus on history and counselling. If the patient reports symptoms, acknowledge you'd normally examine but explain your management based on history.
Q: What if I run out of time before explaining everything? A: Prioritize safety screening and the main management plan (continuing COCP back-to-back). If time is short, briefly mention norethisterone as an alternative and offer to provide written information. Always include basic safety netting.
Q: Should I discuss other contraceptive options if she's happy with COCP? A: No need to. She's requesting a repeat and is happy with her current method. Focus on her specific request. Only discuss alternatives if she asks or if there's a new contraindication.
Key Takeaways for PLAB 2 Success Always start with clear introductions - Confirm identity, introduce yourself professionally, and clarify the patient's requests.
Use PMAFTOSA for safety screening - Check VTE history, cardiovascular risk, migraines with aura, and family history before continuing COCP.
Explain period delay clearly - For COCP users, recommend taking two packs back-to-back. Warn about breakthrough bleeding and avoid more than two consecutive packs.
Know your norethisterone facts - Start 3-4 days before period, take three times daily, use for up to 20 days, not contraceptive, periods return 2-3 days after stopping.
Avoid medical jargon - Say "hormone tablet" instead of "progestogen," "blood clots" instead of "VTE," "dummy pills" instead of "placebo."
Always provide safety netting - Warn about severe headaches, chest pain, leg swelling, and breathlessness as reasons to seek urgent help.
Check understanding throughout - Use phrases like "Does that make sense?" and "Do you have any questions?"
Summary COCP repeat and period delay stations test your ability to take focused contraceptive histories, screen systematically for safety concerns, and explain management options in clear, simple language.
Success comes from using structured frameworks like PMAFTOSA, knowing key contraindications and side effects, providing practical advice tailored to the patient's needs, and maintaining a warm, professional manner throughout. Avoid medical jargon, always check understanding, and provide comprehensive safety netting.
Start your PLAB 2 preparation today at https://mymedi8.com