Abortion care — structured oral station (12 minutes)

Opening prompt — "Talk me through how you'd approach this consult."

Model response: ^[1][4]

• "I'd start with a structured, private conversation — confirming her gestation, her certainty, and screening for reproductive coercion and intimate partner violence, because coercion can sit behind an unwanted pregnancy."
• "I'd counsel the options clearly: medical or surgical abortion, and the alternative of continuing the pregnancy with antenatal care. I'd give her the real numbers — medical abortion completes in roughly 95 percent, surgical in over 99 percent — and describe what each feels like."
• "Then I'd confirm gestation and proceed with the work-up the RANZCOG guideline supports: routine haemoglobin and Rh testing are not required before 10 weeks, and she does not need a confirmatory scan — the VEMA trial showed starting before ultrasound confirmation is non-inferior."^[1][2]

Probe 1 — "She chooses the tablets. Give me the regimen."

• "MS-2 Step: mifepristone 200 mg orally, then 24 to 48 hours later misoprostol 800 micrograms buccal. In Australia that's licensed to 9 weeks or 63 days; in New Zealand it's used to 10 weeks or 70 days."
• "I'd tell her to expect bleeding and cramping after the misoprostol, give written instructions on the warning signs — soaking bleeding, severe pain, fever, fainting — and arrange a low-sensitivity pregnancy test or serum beta-hCG at two to four weeks to confirm completion, where an 80 percent fall is expected."^[1]

Probe 2 — "What about pain, and does she need antibiotics?"

• "For medical abortion, ibuprofen with an antiemetic 30 minutes before the misoprostol is the first-line analgesia; NSAIDs are the backbone, with an opioid as needed."
• "She does not need routine antibiotic prophylaxis for medical abortion up to 14 weeks — the severe infection risk is under 1 percent and over-use drives resistance. That rule is the mirror image of surgical abortion, where every patient gets prophylaxis."
• "If she'd chosen surgical, the analgesia would be a buffered lidocaine paracervical block plus ibuprofen, with sedation or general anaesthesia as needed — and I'd note that oral opioids don't actually reduce procedural pain."^[1][3][5]

Probe 3 — "Her scan shows a sac but no yolk sac. Does that change anything?"

• "No — a small sac without a yolk sac is exactly the early-intrauterine-pregnancy finding VEMA was designed to test. Starting the regimen now is non-inferior to waiting: 95.2 percent complete abortion early-start versus 95.3 percent standard."
• "I'd document the finding, proceed, and keep a low threshold to re-present if pain is unilateral or atypical — ectopic is the diagnosis not to miss, and VEMA still had a 1.3 percent ectopic rate in the early-start group."^[2]

Probe 4 — "She's frightened and asks you to explain it again. Her partner is in the room."

Communication is a scored domain — demonstrate it out loud: ^[1][4]

• Move to her eye level, use her name, and restate plainly: "You take one tablet today, the mifepristone. Tomorrow or the next day you put four tablets against your cheek to dissolve — that's the misoprostol — and within a few hours you'll have bleeding and cramps, like a heavy, clotty period. Most of the pregnancy passes at home."
• "You'll have strong painkillers to take beforehand, a number to call anytime, and a simple test to confirm it's worked. I'll also ask to speak with you alone for a moment, just to make sure you're making this choice freely."
• Offer contraception at this visit — same-day long-acting reversible contraception if she wants it — and confirm a follow-up plan.^[1]

Probe 5 — "What are the things that would make her need to come straight back?"

• Soaking bleeding — for example more than two soaked pads an hour for two hours.
• Severe pain not eased by the analgesia provided.
• Fever, or feeling faint or unwell.
• A positive or invalid follow-up pregnancy test, or ongoing pregnancy symptoms at two weeks.^[1]