SCA practice case · Video consultation
“Can I get the pill without my mum finding out?”
Video consultation
Young person patient
Hard
Children & young peopleGender, reproductive & sexual healthProfessional & ethical dilemmas
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
Kiera O’Brien · 15 years · female
Setting
Video consultation with a 15-year-old, alone in her bedroom.
Past history
- Asthma as a child — no inhaler for 3 years
- No previous sexual health consultations at the practice
Medication
- None
Allergies
NKDA
Recent notes
Booked online by patient herself at 15:50 for a video slot: “Want to talk about something private.” Registered with mother; no safeguarding alerts on record. Last contact: 2 years ago, sprained ankle.
Reason for contact
Video consultation — patient alone.
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)
Young people under 16 can consent to contraception if they are competent (Gillick) and the Fraser guidelines are met; confidentiality applies, with limits where there is a risk of serious harm. Every under-16 sexual health consultation needs a safeguarding screen — partner age and power imbalance, coercion, alcohol or drugs, gifts, older contacts, online images — and sex under 13 is always a child protection matter. Always ask about recent unprotected sex: a condom failure turns a contraception request into an emergency contraception consultation. The copper IUD is the most effective emergency contraception (up to 5 days after unprotected sex or up to 5 days after the earliest expected ovulation). Ulipristal acetate is more effective than levonorgestrel near ovulation; after ulipristal, wait 5 days before starting hormonal contraception and use condoms. Offer LARC, condoms for STIs, STI testing (2 weeks after exposure for chlamydia and gonorrhoea) and a pregnancy test 3 weeks after the episode. On video, confirm identity and privacy first.
The guidance behind it
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