Original Publication
Open Access

Objective Structured Clinical Examination: Non-Directive Pregnancy Options Counseling with Communication and Ethical Challenges

Published: January 10, 2012 | 10.15766/mep_2374-8265.9075

Included in this publication:

  • Counseling Instructor Background.pdf
  • Karen Greene SP final.pdf
  • Lauren Smith SP final.pdf
  • Options Counseling OSCE checklist.pdf
  • Student Checklist.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Recognizing that all primary care doctors, as well as many specialty practitioners, deliver the news of unplanned pregnancy to their patients, the ninth edition of APGO Medical Student Educational Objectives specifies that third-year medical students should attain a “does” level of competency for pregnancy options counseling. Methods of evaluation include standardized patients (SPs), direct observation, and simulation. We could not identify any published SP for evaluation of options counseling skills, so we developed a resource with feedback from colleagues nationwide with extensive experience in family planning education of both medical students and residents. This resource consists of two fully written and developed SPs, the first being married woman in her early 20s and the second an unmarried woman in her late 30s, presenting to an urgent care center with vague gastrointestinal complaints. Both SPs are diagnosed with unexpected early intrauterine pregnancy. Students are tasked with delivering the news of pregnancy after receiving a sign-out with the medical history, physical, and test results, and dispositioning the patient. The patient challenges the student with silence, ambivalence, and the questions, “What should I do?” and “What would you do?” The resource was used to assess the skills of 104 third-year medical students in an obstetrics and gynecology clerkship at the University of Miami Miller School of Medicine. Student responses in a postworkshop survey included the following results related specifically to this resource. Of the 104 students in the clerkship, 98% felt the SP scenario “came across as realistic and believable.” Ninety-six percent thought the instructions they were given “were sufficient to complete the interaction, including disclosing pregnancy results and discussing options with the patient.” One hundred percent agreed that the medical information in the SP scenario instructions “was sufficient to handle the interaction with the assumed diagnosis of pregnancy.” Eighty-eight percent felt that participating in the SP scenario “increased comfort with my skills in nondirective options counseling,” while 80% believed it “increased my moral comfort with nondirective options counseling.”

Educational Objectives

By the end of this standardized patient case, learners will be able to:

  1. Evaluate competency in nondirective options counseling.
  2. Appropriately respond to patient silence and ambivalence.
  3. Deliver bad news/unexpected diagnoses.
  4. Respond to patient requests for moral guidance.

Author Information

  • Carla Shyrl Lupi, MD, FACOG: Florida International University Herbert Wertheim College of Medicine
  • Nicolette Schreiber, MD: Jackson Memorial Hospital
  • Aliye Runyan, MS: University of Miami Miller School of Medicine

Input and feedback were obtained from: Dr. Eve Espey, M.D., University of New Mexico, Dr. Jodi Steinauer, M.D., M.A.S., University of California San Francisco, and Dr. June LaValleur, M.D., F.A.C.O.G., formerly of the University of Minnesota.

None to report.

None to report.


  1. APGO Medical Student Curricular Objectives, 9th Edition. Accessed December 30, 2010 at www.apgo.org.
  2. Lupi CS, Estes CM, et al. Conscientious refusal in reproductive medicine: an educational intervention. Am J Obstet Gynecol. 2009;201(502):e1-e7. http://dx.doi.org/10.1016/j.ajog.2009.05.056


Lupi C, Schreiber N, Runyan A. Objective structured clinical examination: non-directive pregnancy options counseling with communication and ethical challenges. MedEdPORTAL. 2012;8:9075. https://doi.org/10.15766/mep_2374-8265.9075