SCA practice case · Telephone consultation
“I’d like to have a coil fitted — which one should I have?”
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Priya Nair · 34 years · female
Setting
Telephone pre-fit counselling call before an intrauterine contraception appointment.
Past history
- Para 2 — both spontaneous vaginal deliveries; second delivery 7 months ago complicated by third-degree perineal tear (repaired in theatre)
- Combined pill age 22 — stopped due to low mood
- No history of VTE, migraine or hypertension
Medication
- Desogestrel 75 micrograms daily (since 6 weeks postpartum)
Allergies
NKDA
Recent notes
Postnatal check (GP, 6 weeks): BP 118/74; BMI 25; mood good (PHQ-2 negative); perineum healing; “very anxious during speculum examination, examination abandoned”. Antenatal booking bloods: chlamydia NAAT negative; Hb 124 g/L. Booked: IUC fitting with practice nurse next Thursday (20-minute slot) — device not yet chosen.
Reason for contact
Telephone pre-fit counselling call.
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Pre-fit counselling for intrauterine contraception covers the woman’s priorities, UKMEC eligibility, a comparison of devices, risks with numbers, STI and pregnancy risk, and the fitting itself. Both the copper IUD and the 52 mg LNG-IUS are UKMEC 1 from 4 weeks postpartum, including while breastfeeding. The copper IUD is hormone-free, effective immediately, lasts up to 10 years, and can make periods heavier and more painful; the LNG-IUS usually reduces bleeding (first-line for heavy menstrual bleeding), needs 7 days of additional cover unless fitted early in the cycle (or continue the current method), and the 52 mg device is licensed for contraception for up to 8 years. Risks: perforation about 1–2 per 1000 insertions, about six times higher when breastfeeding; expulsion about 1 in 20; pelvic infection is uncommon and mostly in the first 20 days. Ask about previous examinations and birth trauma: trauma-informed adjustments and the explicit right to stop make fitting safer and more acceptable.
The guidance behind it
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