Objectives To train laywomen to become professional patients in order to teach medical students speculum and bimanual examination, to assess their effectiveness in this role, and to incorporate this method of teaching into the undergraduate curriculum of a medical school in the United Kingdom. Design Comparative study. Setting Guy's, King's, and St Thomas's School of Medicine, London. Participants 44 medical students trained by gynaecology teaching associates; 48 control students. Main outcome measure Skills in pelvic examination. Results Six laywomen were recruited and all successfully graduated to become gynaecology teaching associates. At assessment 1, in the third week of the reproductive and sexual health block, the mean score achieved by students trained by gynaecology teaching associates was 155, compared with 104 for control group students (difference in mean scores 51 (95% confidence interval 41 to 61), P < 0.001). Similar results were obtained at assessment 2, at the end of the attachment-the mean score for trained students was 148, compared with a mean score of 114 for control group students (difference in mean scores 34 (21 to 46), P < 0.001). Conclusions Laywomen can be trained to teach pelvic examination to medical students in the United Kingdom. Students who receive this training have better skills than students who receive the traditional training alone.

A 29-year-old woman with an Implanon ® contraceptive device in situ presented with persistent and prolonged vaginal bleeding. The implant had been inserted 2 years previously; the patient had been happy with it and had been mainly amenorrhoeic with the occasional light period. She was concerned that the implant had broken during a game of 'rough and tumble'with her son in August 2000. Since the trauma to her arm her bleeding pattern had changed, and she began bleeding heavily for 3 weeks every month. The rod was removed and found to be fractured halfway across its width. A new Implanon ® device was inserted and the bleeding settled. Case report This patient was fitted with an Implanon ® contraceptive device in December 1999, in her right (non-dominant) arm, using the standard technique and without complications. When she was reviewed 5 weeks later she reported no problems, although she felt that the implant had moved. She had had no bleeding per vagina since insertion of the device. Upon review 6 months later she mentioned that she had had an infection around the Implanon ® site, which had settled. On inspection the site was healthy, the rod was straight and easily palpable subdermally. She occasionally had light periods but was otherwise amenorrhoeic. She was seen again in January 2001, 6 months after her previous checkup. She had bled heavily for 4 weeks in October 2000, and reported that she thought the Implanon ® rod had snapped during a game of 'rough and tumble' with her 7-year-old son. She had seen her general practitioner (GP) who agreed with her. The patient and the family planning consultant, from whom the GP had sought advice (LB), contacted the manufacturer's helpline and were given the same information. They were advised that it was very unlikely that the device had snapped and that contraceptive cover would not be lost in this situation. The patient was reassured. The patient attended again for a checkup a year later in January 2002. She complained of prolonged heavy bleeding lasting 3 weeks every month for the previous 5 months which she found unacceptable She was otherwise asymptomatic. She had had a stressful year and had been diagnosed as having an eating disorder (her weight had dropped from 64 to 51 kg), for which she was receiving outpatient treatment. She requested that the Implanon ® rod be changed as she was sure it had snapped, was not working, and was the cause of prolonged heavy bleeding. This was discussed in the clinic and other causes for the bleeding explored. The patient was up-to-date with her smears and was in a stable, mutually monogamous relationship for

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Prescribing oral contraceptives is atypical because it involves prescribing to clients who are generally fit, healthy and not complaining of symptoms requiring relief. It is likely that a large number of nurse prescribers will be called on to prescribe or offer advice on these drugs. This article facilitates clear understanding of the differences between various types of ‘the Pill’ that are essential to appreciate before prescribing.