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Scenarios

Basic Medication Counselling 1

By Leya Luhar • May 01, 2026 • Last reviewed: 2026-05-01 •

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Summary Beginner

In this scenario, the student counsels a patient who has been newly prescribed levothyroxine for hypothyroidism. This scenario is aimed at students who are in first year or new to medication counselling.

Please ensure that this scenario and mark scheme align with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this scenario.

Revision Topics

Be aware, this may reveal any answers!

Levothyroxine

Hypothyroidism

Medication cousselling

Student Instructions

You are a pharmacist working in a community pharmacy. A patient has come to collect a new prescription. You have been asked to counsel them on their medication.

You have 6 minutes.

You have access to the BNF

The following labelled item is available at the station:

28 x Levothyroxine 50 micrograms tablets

Take ONE tablet ONCE daily

Take on an empty stomach, 30 minutes before breakfast.

Patient: Priya Sharma D.O.B: 17/12/1986

Actor Instructions

This may reveal scenario objectives!

You are Priya Sharma (Pree-yah Shar-mah).

Opening statement: "Hello, I've come to pick up my prescription."

Patient information:

To be given if the student asks.

Name: Priya Sharma
Date of birth: 17/12/1986
Medical conditions:

“I just got diagnosed with hypothyroidism. I was feeling really tired and my blood tests showed low thyroid levels. I think that’s what this medication is for”
No other medical conditions

Medications:

“Just this new medication.”

Allergies:

“No allergies.”

Background:

Had this medication before? "No, this is the first time."
Knowledge about the medication: "My doctor said it's for my thyroid, but I don't really know much about it."

Questions to ask the pharmacist:

"Why do I need to take it 30 minutes before breakfast?"

General acting notes:

Only give information when directly asked — do not volunteer details unprompted.
Be friendly and cooperative throughout.
If asked anything not covered in this brief, say: "I'm not sure about that."

Mark Scheme

Introduction

0 / 4

Introduce yourself with an appropriate greeting

Confirms patient details: name and date of birth

Explains the purpose of the consultation

Offers a private space / ensures a suitable environment for the consultation

History Taking

0 / 5

Asks if the patient has had this medicine previously

Asks what the patient already knows about the medicine

Asks if the patient is taking any other medicines (prescribed or OTC)

Asks about any other medical conditions

Asks about allergies

Medication Counselling

0 / 6

Informs the patient that they have been prescribed levothyroxine

Informs the patient that levothyroxine is used to treat an underactive thyroid (hypothyroidism)

“This medication replaces a hormone your body is lacking and helps your metabolism work normally again.”

States to take one tablet orally

States to take once daily at the same time in the morning

States that it is for regular use (not to stop without speaking to their doctor)

Explains the cautionary label: take on an empty stomach, 30 minutes before breakfast

Excellent students may mention that Iron and calcium supplements significantly reduce the absorption of levothyroxine, therefore it is important to separate administration by at least 4 hours. However, most importantly, the student must convey that this should be taken on an empty stomach

Patient Question

0 / 1

"Why do I need to take it 30 minutes before breakfast?"

Accept any explanation conveying that ood/caffeinated drinks/other medication can affect how well the tablet is absorbed.

Closing the Consultation

0 / 3

Asks if the patient has any further questions

As this is a very basic counselling scenario, we have limited the number of available marks. However, excellent students will also discuss side effects, including symptoms due to overreplacement such as palpitations, sweating, weight loss and anxiety, and to seek help if these occur.. They would also mention monitoring requirements e.g. TSH, potential interactions especially with OTC products such as iron and calcium supplements and missed dose advice.

Checks patient understanding

Concludes the consultation appropriately

Patient Safety

0 / 1

The student did not say anything that could harm the patient

This includes but is not limited to: providing incorrect information, advising the patient to stop taking the medication without speaking to their doctor, or failing to act on a reported allergy.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

References

Joint Formulary Committee. British National Formulary. [online] London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk [Accessed May 2026].
NICE, 2019. Thyroid disease: assessment and management. NG145. [online] Available at: https://www.nice.org.uk/guidance/ng145 [Accessed May 2026].
NHS, 2021. Levothyroxine. [online] Available at: https://www.nhs.uk/medicines/levothyroxine [Accessed May 2026].

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