CFP Senior Candidate Exam Preparation

Provide contraceptive counseling, provision, and surveillance to patients and contraceptive consultation to other health care providers

• Engage in person-centered counseling to identify reproductive life goals
• Screen patients for contraceptive coercion
• Implement practices to improve access to contraception (e.g., same-day IUD insertion, quick start)

Demonstrate advanced knowledge of pharmacology (mechanism of action, dosing, route of administration/absorption, contraindications, metabolism, excretion), effectiveness, potential side effects, and complications of all contraceptive methods

• Coitally-dependent
• Short-acting
• Long-acting
• Permanent
• Emergency contraception

Provider care for patients with specialized contraceptive needs (e.g., limited access or medical considerations)

• Adolescent patients
• Perimenopausal patients
• LGBTQIA patients
• Patients with substance and alcohol use disorder
• Patients with disabilities
• Patients experiencing intimate partner violence and sexual assault
• Patients who are incarcerated
• Postpartum or post-abortal patients (including immediate LARC)

Provide contraceptive counseling, provision, and surveillance for patients with pre-existing medical or anatomical conditions

• Evaluate and manage interactions between contraception and medications
• Evaluate and manage interaction between medical conditions and contraception (e.g., HIV infection, renal disease, hepatic disease, hematologic disorders, thromboembolic disorders, cardiac disease, mental health disorders, connective tissue disorders, STIs, PID)
• Provide care for patients with reproductive tract anomalies (e.g., uterine anomalies, leiomyomata)
• Perform complex placement of contraceptive devices [e.g., patients with anatomic challenges (e.g., stenotic cervix, leiomyomata, reproductive tract anomalies) or physical or mental conditions impacting insertion (e.g., contractures, developmental delay)]
• Utilize contraception for non-contraceptive benefits (e.g., management of uterine bleeding, catamenial seizures, perimenopausal)

Evaluate and manage side effects related to contraception

• Evaluate reported side effect(s) with respect for patient autonomy (e.g., modeling non-coercive practice)
• Counsel patients about alternative methods of contraception based on side effect history
• Offer management options for method side effects

Evaluate and manage complications related to contraception

• Identify severe adverse complications and refer for management (e.g., stroke, DVT, myocardial infarction)
• Evaluate and manage if intrauterine pregnancy occurs with contraceptive methods

Evaluate and manage complicated contraceptive removals including malpositioned or broken devices, with use of imaging if needed

• IUD (e.g., missing strings, embedded, uterine perforation)
• Implants (e.g., nonpalpable implants, broken devices)
• Use of hysterectomy and laparoscopy for removal of devices
• Determine when additional expertise and/or facilities are needed (e.g., interventional radiology, other surgical specialties, and specialty laboratories)

Evaluate early pregnancy

• Determine pregnancy location (e.g., intrauterine, extrauterine, cesarean scar, cervical, cornual)
• Evaluate intrauterine pregnancy (e.g., evolution of ultrasonographic landmarks, gestational age, etc.)
• Demonstrate knowledge of ectopic risk factors (e.g., IUD in situ, prior tubal ligation, prior ectopic)

Manage early pregnancy

• Provide pregnancy options counseling
• Provide counseling about options for management of pregnancy of unknown location (PUL), early pregnancy loss (EPL), and ectopic pregnancy (e.g., intrasac injections, laparoscopy, uterine aspiration, multi-model approach)
• Use uterine aspiration for diagnosis and treatment of PUL and EPL
• Use mifepristone and/or misoprostol for PUL
• Use of mifepristone and/or misoprostol for EPL

Manage and surveil gestational trophoblastic disease with other subspecialties

• Procedurally manage gestational trophoblastic disease (e.g., second trimester uterine evacuation)
• Identify the consequences of gestational trophoblastic disease (e.g., thyroid storm and hypertension)
• Provide counseling for and manage contraception after treatment of gestational trophoblastic disease
• Diagnose gestational trophoblastic disease and refer patients

Provide comprehensive counseling to patients about abortion and consultation to other health care providers

• Provide comprehensive options counseling to patients
• Screen patients for interpersonal reproductive coercion
• Facilitate identification of patient-led reproductive goals (e.g., post-abortion contraception, general contraception, reproductive life planning)
• Incorporate comprehensive knowledge of local laws and regulations into counseling
• Describe methods of abortion to patients (e.g., medication, procedure, induction, feticidal, injection, third trimester options)

Provide abortion counseling for patients with special reproductive needs

• Adolescent patients
• LGBTQIA patients
• Patients with substance and/or alcohol use disorder
• Patients experiencing intimate partner violence and/or sexual assault
• Patients who are incarcerated
• Patients with disabilities

Perform a pre-abortion evaluation

• Identify patients at risk for abortion complications (e.g., prior uterine surgery, uterine anomalies, cervical anomalies)
• Identify comorbidities that influence abortion care (e.g., cardiac disease, seizure disorders, renal disorders, coagulopathies, fetal demise)
• Evaluate the results of laboratory studies (e.g., Rh typing, CBC, CMP)
• Perform ultrasound as needed (e.g., to determine pregnancy location, determine gestational age, diagnose uterine anomalies, diagnose multiple gestation, identify placental location, and recognize signs of abnormal placentation)
• Determine the need for additional imaging studies (e.g., MRI, CT scan, ultrasound)
• Determine the need for consultations from other health care specialties (e.g., hematology, cardiology, anesthesiology)
• Determine appropriate location for completion of abortion (e.g., at home, free standing clinic, hospital-based clinic, operating room) based on patient risk factors (e.g., gestational age, comorbidities, fetal demise)
• Determine options for abortion method including feticidal injections
• Counsel patients on available genetic testing options
• Determine need for peri-abortal medications (e.g., Rh immunoglobulin, antibiotics, antiemetics, uterotonics)
• Provide a multimodal plan for pain management during and after an abortion

Provide medication abortion

• Demonstrate advanced knowledge of pharmacology (mechanism of action, dosing, route of administration/absorption, contraindications, metabolism, excretion) for medication abortion at various gestational ages (e.g., mifepristone, misoprostol, methotrexate, oxytocin)
• Counsel regarding risks and benefits of treatment regimen for medication abortion at any gestational age
• Determine medication regimen based on patient factors (e.g., gestational age, prior uterine scar)
• Surveil patients to assess abortion completion (e.g., laboratory, ultrasound, clinical)
• Provide complex labor inductions for second and/or third trimester abortion (e.g., history of cesarean deliveries, leiomyomatous uterus, prolonged induction)

Perform procedural abortion

• Perform abortions for patients for comorbidities (e.g., prior surgery, fibroids, vascular malformations, multi-gestation, emergency uterine evacuation)
• Provide cervical preparation to patients including those with comorbidities (e.g., cervical anomalies, previous uterine surgery, advanced gestational age, urgent uterine evacuation)
• Provide pain management and/or anesthesia (e.g., paracervical block, sedation, non-pharmacological pain management)
• Utilize ultrasound guidance during procedural abortion
• Perform abortion via electric or manual uterine aspiration
• Perform abortion via dilation and evacuation
• Perform abortion via dilation and extraction
• Assess for abortion completion (e.g., tissue examination, laboratory studies, ultrasound

Evaluate, diagnose, and manage abortion complications

• Hemorrhage
• Retained products of conception
• Hematometra
• Uterine perforation and initial management of resulting injuries (e.g., genitourinary, gastrointestinal, vascular)
• Cervical lacerations
• Amniotic fluid embolism (AFE)
• Thrombotic event
• Anesthesia complications
• Undiagnosed placenta site abnormalities
• Infection
• Septic abortion
• Heterotopic pregnancy (initially manage)
• Vasovagal response
• Continuing pregnancy after abortion
• Unplanned delivery prior to scheduled procedure
• Disseminated intravascular coagulopathy
• Uterine rupture

Research

• Demonstrate knowledge of basic research methodology (e.g., study design, sample size)
• Critically analyze published studies
• Determine the proper biostatistical test based on data type and study questions
• Demonstrate knowledge of research ethics (e.g., informed consent, vulnerable populations)

Public health and reproductive health policy

• Understand how reproductive health impacts public health and health policy
• Identify disparities in reproductive health including access, care quality, patient experience, and outcomes
• Identify professional organizations that advocate for and influence policy in reproductive health
• Demonstrate knowledge of social and structural determinants that create reproductive health inequities in marginalized groups

Advocacy

• Engage with stakeholders (e.g., public, other healthcare providers, policy makers) about the role of family planning in public health and health policy
• Engage with the work of professional organizations that advocate for health policy in contraception and abortion
• Demonstrate the knowledge and skills to advocate for equitable access to reproductive health services

Ethics and professionalism

• Systematically engage in practice review to identify health disparities
• When engaged in shared clinical decision making, incorporate patient, family, and cultural considerations in making treatment recommendations
• When providing care for patients, consider psychological, sexual, and social implications of various treatment options

Patient safety

• Systematically analyze the practice for safety improvements (e.g., root cause analysis)
• Systematically engage in practice reviews for safety improvements (e.g., root cause analysis)
• Incorporate the standard use of procedural briefings, "time outs," and debriefings in clinical practice
• Participate in the review of sentinel events, reportable events, and near misses
• Implement universal protocols (e.g., bundles, checklists) to help ensure patient safety

Interpersonal and communication skills

• Communicate to patient and family regarding adverse outcomes and medical errors
• Demonstrate sensitivity and responsiveness when communicating with a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
• Provide comprehensive information when referring patients to other professionals

Systems-based practice

• Incorporate considerations of cost awareness and risk-benefit analysis in patient care
• Provide care with multidisciplinary teams to promote patient safety and optimize patient outcomes

Practice-based learning and improvement

• Design or participate in practice or hospital quality improvement activities

Evidence-based medicine

• Incorporate evidence-based practices and national guidelines to improve practice patterns and outcomes
• Implement evidence-based protocols to enhance recovery after surgery (ERAS)