Adolescent sexual health and contraception — branching viva

Stem

The examiner will test whether you can run a confidential, youth-centred contraceptive consult under pressure. [3]

Branch 1 — Visit structure

Examiner: A 16-year-old wants the pill; her mother won't leave. How do you start? [8]

Strong answer: Greet the young person first, set a joint agenda, explain private time as standard youth care, and create confidential time. Do not take the full sexual history with the parent answering. [3] [8]

Examiner: Give your confidentiality line. [3]

Strong answer: Conditional confidentiality — private unless serious harm to self/others, abuse or exploitation, or a legal duty; plan any override with the young person as far as possible. [3]

Branch 2 — The 5 Ps

Examiner: Take the sexual history. What are the 5 Ps? [3]

Strong answer: Partners, Practices, Protection, Past STI, Pregnancy intention — with a direct question about coercion. Match STI testing to the practices disclosed. [3] [6]

Branch 3 — Method choice

Examiner: Which method do you recommend and why? [1]

Strong answer: LARC first — implant or IUD — because typical-use failure is under one per cent and continuation is highest, closing the user-dependency gap. The CHOICE Project shows adolescents accept LARC when barriers are removed. IUDs are not contraindicated by age or nulliparity; Medical Eligibility Criteria categories guide safety. [1] [2] [4]

Examiner: She picks the pill. [7]

Strong answer: Support her choice, counsel perfect vs typical use honestly, add condoms for dual protection, quick-start if reasonably certain not pregnant, and arrange close follow-up. [7]

Branch 4 — Emergency contraception

Examiner: Unprotected sex 36 hours ago — options? [5]

Strong answer: Earlier is more effective. Levonorgestrel and ulipristal acetate are oral options; ulipristal extends the window; a copper IUD is most effective and can be placed within the locally permitted window. Confirm exact regimen and window from local protocol; rule out pregnancy before an ongoing method and offer quick-start. [5]

Branch 5 — Disclosure and follow-up

Examiner: She says her boyfriend is controlling and older. [3]

Strong answer: Ask directly about coercion, age and power imbalance, and safety. This may meet a confidentiality override and mandatory-reporting threshold. Involve safeguarding, share the minimum necessary with her knowledge, and do not discharge into danger. [3] [8]

Examiner: How do you close the visit? [3]

Strong answer: A shared plan the young person owns — method, dual protection, an emergency contraception plan, after-hours contact, and a named follow-up for continuation. [3]

Examiner extras

• A pill request is an opening, not a transaction. [3]
• No hormonal or intrauterine method prevents STI — dual method is mandatory counselling. [7]
• Portals, bills and parent letters can leak confidentiality and stop re-attendance. [8]