OET_SUPPORT

Writing SUB-TEST(MEDICINE)
Prepared by Dr. Mohamed Mansour

Format of the OET Writing sub-test

In the Writing sub-test, you are required to write a letter

based on patient case notes.

First 5 minutes
The first five minutes of the test is when you read the task
and the case notes.

Writing the letter (40 minutes)

You are required to write a letter of 180-200 words.
(You will not lose marks for writing more than 200 words. However, if
you have written more than this, your letter may include irrelevant
information or be badly organised, and this would have a negative
impact on your score.)
The first 5 minutes:

During the first five minutes, you can study the task and the
case notes. You cannot write, underline or make any notes of
your own.

Writing the letter:

The letter is different for each medical profession, so a nurse

writes a task for nursing and a dentist writes a task for dentistry
and so on.
The letters are based on a typical workplace situation and the
demands of your profession. The letter may be a referral letter,
a letter of transfer or discharge, or a letter to advise or inform a
patient or caregiver.
You are given a patient’s case notes and from them you extract
the relevant information for your letter.
You write in the printed answer booklet provided, which also has
space for rough work. You can write in pen or pencil.
Tips for success on Test day

Before the Test

Practice writing letters using the language you are likely to need
in the test.

Do a practice test beforehand so you know what it feels like.

Learn about the 5 assessment criteria you will be marked on.

On the day

Bring your ID and a pen.

Use the first 5 minutes effectively. Make sure you understand

the particular task you are being asked to do.

Make sure you understand the case notes.

Think about the best way to organise your letter.

Only include relevant case notes. Leave out unnecessary
information.

Write in paragraphs. Leave a blank line before starting a new

paragraph.

Write clearly so that the assessor can grade your letter fairly.
Letter Structure: Date and address

Correct address layout is important, but these are easy marks

to gain. All the information is on the page in front of you – just
be sure to write it in the correct way.

1. Always date the letter with ‘today’s date’ (the date you
are completing the OET writing test task). The accepted
format in Australia and NZ is 14 August 2014 but any clear
format is acceptable.
2. Leave an empty line after the date and then write the
address.
3. Address layout does not require commas (,) or full stops
(.). So where you see a comma (,) just start a new line.
4. You can write Street as St (Avenue as Ave; Road as Rd
etc.).
5. Check:
o copy proper nouns (names) correctly – use capital
letters as shown
o all parts of the address should be left-aligned
o no punctuation (, / .)
o no ‘at’ before Central Hospital
o no spelling mistakes
o clear handwriting
Letter structure: Presentation features

1-Date: Remember the date should be written in a format

which is clear and straightforward for the intended reader, e.g.
day / month / year (14 August 2014). Leave an empty line after
the date.

2-Address: Use the full name in the address (e.g. Dr Robert

Blake). Leave an empty line after the address.
3-Salutation: a standard formula for greeting someone.
Write the salutation (Dear …) Use (Dr/Mr/Ms/Mrs/Miss etc.)
then the family name e.g. Dr Blake. Do not use the person’s first
name.
In modern letters, you do not need a comma (,) after the
salutation. (If you do use a comma, then you must remember
to use a comma after ‘Yours sincerely’ too.)
Leave an empty line after the salutation.

4-Reference: a short heading stating the name of the

patient you are writing about.
Write the reference Re: …
State the name and age (or D.O.B.) of the patient.
Leave an empty line after the reference.

5-Body: The main part of the letter where you give

information about the patient and his/her condition. (180-200
words in total).
Write 3-4 short paragraphs.
Leave an empty line after each paragraph.

6-Closing: Yours sincerely is the simplest and most acceptable

choice of closing. Note that only the first word has a capital
letter (Yours sincerely).
You do not need a comma (,) after the closing.
7-Name (and title): Sometimes you will need to write your
own name. At other times, you may also need to write a title
given to you in the task (e.g. Doctor)

Letter structure: The body

The first paragraph of the body of your letter should clearly

explain the purpose of writing. It tells us who the patient is,
what happened, where it happened, and when and how it
happened.
Write it using as few words as possible – don’t waste words
here.
Here is the type of information you might include:
 I am writing with regard to Mr Gilbert.
 Mr Gilbert works as a head chef in a busy restaurant.
 He is experiencing severe knee pain.
 The pain began after he experienced a meniscal cartilage
injury last year.
 Pain medication and physiotherapy have had little effect
on his discomfort.
Practice writing all this information into one or two sentences.
Example 1: (1 sentence)
I am writing with regard to Mr Sam Gilbert, a head chef, who
has been experiencing severe knee pain following a meniscal
cartilage injury last year.

Example 2: (2 sentences)
I am writing with regard to Mr Sam Gilbert, a head chef. Mr
Gilbert suffered from a meniscal cartilage injury last year and
has since been experiencing severe knee pain.

Note that both these examples succeed in communicating the

key information and would contribute to a good score in the
OET.

The Sample Answers avoid short simple sentences by using a

variety of grammatical structures, e.g.:
 an appositive phrase: , a head chef,
 a participle clause: …following a meniscal cartilage
injury…
 an adverbial phrase (time): …has since been
experiencing…
These are some of the structures you can use to include more
detail, while keeping your message clear.
The middle paragraphs of the letter will contain details of
relevant medical and social history from the case notes.

The final paragraph should summarise your request (why you

are referring this patient, or what care the reader can provide).

Writing up relevant detail

Look at this selection from the case notes and try to combine
the relevant information into one short paragraph (2-3
sentences).
21 July 2014
Pain in Left knee worse despite regular NSAIDs, oxycodone
prn and physio.
Knee brace minimal effect.
Knee popping especially walking down stairs (nec for job).
Knee gives way occasionally (without warning).
Objective
Left knee swollen, click heard on flexion of the knee

Possible Answer:
As of late July 2014 the knee brace has had little effect and
there has been no improvement in Mr Gilbert’s condition. He
reports increased levels of pain, in addition to his knee
occasionally ‘popping’ and giving way. I can also confirm visible
swelling and an audible click during left knee flexion.
You need to make grammatically correct, easy-to-read
sentences, and aim to stay within the 200 word limit in the
letter.
To do this, you may need to:
 summarise
 change the order of information
 paraphrase information
 change the word forms (e.g. change a noun to a verb).

Understanding short forms

Case notes may include:

 abbreviations - shortened forms of a word/phrase e.g. 10
mg
 acronyms – the initial letters or syllables of a
name/phrase used to make a new word e.g. AIDS
 initialisms – a series of letters read separately e.g. MRI
Generally, you can write the short form of the word in your
letter if it is well known and likely to be understood by the
intended reader, but sometimes it may be more appropriate to
write the full-length word.
Avoiding informal language

Referral letters are written in a formal style, so avoid using:

 contractions (e.g. can’t, won’t, you’ll)
 informal or colloquial language (e.g. tummy bug, meds,
woozy).
 Personal pronouns (I think, I want her to...)

Rewrite each sentence below. Use a formal style that is

appropriate for a referral letter.
1. I think she got a concussion when she banged her head.
2. Maggie was feeling really queasy and threw up when she
came in so at first we thought she might have a tummy
bug of some sort.
3. The child is too thin for someone his age.
4. He looked tired and in need of more food.
5. I’m sending this patient to you so you can check what’s
wrong with her.

Possible Answer:
1. It is suspected that she may be suffering concussion as a
result of the blow to her head.
2. Maggie was experiencing extreme nausea and vomited
upon admission; staff initially suspected gastroenteritis.
 3. The child is underweight for his age.
4. The elderly gentleman appeared thin and fatigued.
5. I am referring this woman to you for diagnosis.

Grammatical accuracy

Tenses

When writing the letter, take care to use correct verb tenses.
Correct use of tenses is part of organising the information
clearly and logically for the reader, so this contributes to your
scores for Appropriateness of Language as well as Linguistic
Features.
It could be that you mostly use:
 Present simple (for the current situation)
 Present perfect (for recent events)
 Past simple (for an action/situation/event in the past)
You may occasionally have to use past perfect to refer to an
event that had happened prior to another event.
Voice

In the active voice, the subject is the ‘doer’ of the action

e.g. The doctor took the patient’s temperature at 10 pm.
In the passive voice, the ‘doer’ is not important but attention
is drawn to the person or thing acted upon
e.g. The patient’s temperature was taken at 10 pm.
The passive voice is commonly used in technical and formal
writing.
Correct use of passive forms is part of organising the
information in a way which meets the intended reader’s
expectations, so this contributes to your scores for
Appropriateness of Language as well as Linguistic Features.

Adjective + preposition

Take care to learn and use the correct prepositions that follow
certain adjectives e.g. This child is afraid of the dark. Be careful
with that specimen!

Certain verbs collocate with certain prepositions. When you

learn a verb, take note of any prepositions that follow and learn
them together e.g. The patient insisted on getting out of bed.
consent to, recover from, substitute a different antibiotic for
the penicillin, prevent … from, provide … with, believe in, rely
on, suitable for, capable of, pleased with, accustomed to,
serious about

Relative pronouns

(who, whom, whose, which, that, what) can be used to

combine two short sentences like conjunctions.

For example:
I have a case. It might interest you. > I have a case which
might interest you.
She didn’t understand what I said.

When and where can be used in a similar way.

For example:
He told her the day when the procedure would be carried out.
There’s a special room where visitors can wait.

Modals

Modal verbs (could, may, might, will, would etc.) are used to
talk about things which we expect, which are possible, which
we think are necessary or which we are not sure about e.g. It
is suspected that she may be suffering concussion.
It is important that your letter follows a simple and clear
format, so that its contents can be quickly and easily
understood by the recipient. You have already learnt how to
extract only the relevant information from the case notes. Now
you need to consider how this information can be most
effectively organised into paragraphs.

e.g. Order of information

A general overview of the patient’s situation and reason for

writing
Information about the patient’s initial health problems
Information about the patient’s recent treatment and progress
Advice on how the patient can be assisted in the future
An offer to answer questions and provide further clarifications
Planning your response

Now read the case notes and prepare a brief plan for a letter.

You are Mrs Sylvia Peterson's GP. Write a referral letter to Dr

Sandra Fielding, Ophthalmologist, for confirmation of
diagnosis and ongoing management. Address your letter to Dr
Sandra Fielding, Ophthalmologist, Crown Heights Medical
Clinic, Winslow.
Today’s Date
21 July 2014
Patient details
Female
Sylvia Peterson
The Banksia Retirement Home
55-57 Breewarana Rd
Banksia 4711
DOB 6/10/1942 (Aged 72)
Social background
widow
lives in supported living unit at a retirement
home - nurse on site
Medical history
1982: Joint pain after severe bout of flu - Rheumatoid Arthritis
ruled out (bld test). Joint pain resolved after 2 wks NSAIDs
1996: Vaginal Hysterectomy
2010: Pneumonia - treated in hospital bec. of social issues
(recent death of husband, pt malnourished). Moved into
supported living retirement home.
Oct 2013: Polymyalgia rheumatica diagnosed - pain in
shoulder, morning stiffness. treated Prednisolone 15mg
(reducing dose). Also advised analgesics and NSAIDs.
21 July 2014
Referred by nurse at retirement home. Pt c/o sudden, severe
headaches.
Blurred vision
Pain in jaw when chewing
Objective
Temp 37.0, BP 95/66, Pulse 64, RR 14, Oxygen sats 100%
Weight: 62kg
Impression
Temporal arteritis in patient with polymyalgia rheumatica
Current Medications
Prednisolone 2mg on Mon, Wed, Fri, Sun
Prednisolone 1mg on Tues, Thurs, Sat
Multivitamin daily
Paracetamol 1g prn for pain
Voltarol pain-relieving gel prn for shoulder pain
Possible Answer (plan)

1. S.P., 72, referred 21/07/14, suspect temporal arteritis w/

rheumatica
2. Jaw pain, vision problems, sudden h/aches noted on
admission
3. Current treatment – Prednisolone, analgesics, NSAIDs.
4. Ophthalmologist to confirm impression/suspected
temporal arteritis
5. Offer to answer questions and provide further
clarification

Important tips on writing

It is important to provide a general context in the opening

paragraph so that the reader immediately knows who you are
writing about and why you are writing. In 1-2 brief sentences
provide the patient’s name, their hospital admission date, what
health problem he or she was admitted for, and what action is
being taken now.
A chronological sequence for the next 3-4 paragraphs helps
the reader follow the patient’s situation – outline the patient’s
condition upon admission, tests and treatment protocols they
have undergone while in your care, including information on
their progress, and finally advise the reader on how he or she
can assist the patient in treating or managing the condition
post-discharge.
Note how this structure allows you to finish your letter with
the most important information: what action the recipient of
the letter needs to take. This information is more likely to be
remembered if it is placed at the end of the letter.
Finish your letter by briefly offering to answer any questions
the recipient may have. This is common courtesy in medical
letter writing in Australia and New Zealand.
Writing your letter

Possible Answer

21 July 2014

Dr Sandra Fielding
Ophthalmologist
Crown Heights Medical Clinic
Winslow

Dear Dr Fielding

Re: Mrs Sylvia Peterson, aged 72 years

Thank you for seeing Mrs Peterson who is presenting with

symptoms of cranial discomfort following a previous diagnosis
of polymyalgia rheumatica.

Mrs Peterson was initially diagnosed with polymyalgia

rheumatica in October last year after experiencing shoulder
pain and joint stiffness in the morning. She was prescribed
Prednisolone and advised to use analgesics and NSAIDs to
further reduce discomfort.
In July 2014 Mrs Peterson was again referred to my care, this
time presenting with blurred vision, occasional jaw pain and
the onset of sudden, severe headaches. I instituted 1 and 2 mg
of Prednisolone on alternating days in addition to 1 g
paracetamol and Voltarol pain-relieving gel as required. Her
vital signs show her to be within a healthy range for her age
group.

At this stage my provisional diagnosis is polymyalgia

rheumatica compounded by temporal arteritis. However,
further testing will need to be conducted in order to confirm
this.

Thank you for your ongoing care and assessment of this

patient, and please contact me if you require any further
information. Please note that Mrs Peterson also has a resident
nurse at the Banksia Retirement Home who can also be
contacted should you have any concerns about her future care.

Yours sincerely
Dr. (your name)

Best wishes
Dr. Mohamed Mansour