Original letter:

Mr. John Prowle

Diabetic Specialist Nurse
John Milton Clinic,
Crow Lane,
Bristol.

18 August 2018

Re: Mr. George Livingstone, 70 years old

Mr. Livingstone was admitted to our Hospital Bristol Royal Infirmary on 15 August 2018
with Diabetic Ketoacidosis. After appropriate treatment, he is making good progress,
however Mr. Livingstone will need your supervision to ensure that he continues to manage
his diabetes appropriately at home.

When admitted Mr. Livingstone presented blood sugar superior to 25 mmol/L, his blood
work came back positive for ketones. During this time, he was disorientated, thirsty and
exhaled a fruity-scented breath. Consequently he, also had an episode of vomiting. He was
treated according to the hospital protocol for Diabetic Ketoacidosis, which includes the
insertion of fluids, electrolytes and insulin. Over the 48 hours his blood sugar was monitored
hourly until presented stabilized values, and he showed no ketones in his blood. He then
became conscious of his environment.

We have given Mr. Livingstone guidelines to follow up post-discharge, which include daily
blood sugar and ketones observation. It would be appreciated if you could do frequent
monitor his diabetes management and ensure that he adheres to a healthy diet and practices
physical activity. If necessary, insulin adjustments can be made by your team.
I would also request educating him on how to procced when his blood sugar and ketones
present high values.

If any further information is needed, regarding Ms Hill, please do not hesitate to contact me.
Yours sincerely,

Charge Nurse

Correction:

Mr. John Prowle

Diabetic Specialist Nurse
John Milton Clinic,
Crow Lane,
Bristol.

18 August 2018

Re: Mr. George Livingstone, 70 years old

I am writing to refer Mr. Livingstone, who was admitted to our hospital Hospital Bristol
Royal Infirmary on 15 August 2018 with Ddiabetic Kketoacidosis. After appropriate
treatment, he is making good progress, however Mr. Livingstone will need your supervision
to ensure that he continues to manage his diabetes appropriately at home.

When admitted Mr. Livingstone presented blood sugar above superior to 25 mmol/L, his
blood work came back positive for ketones. During this time, he was disorientated, thirsty,
vomiting and had exhaled a fruity-scented breath. Consequently he, also had an episode of
vomiting. He was treated according to the hospital protocol for Ddiabetic Kketoacidosis,
which includes the insertion of fluids, electrolytes and insulin. Over the 48 hours, his blood
sugar was monitored hourly and has now stabilized until presented stabilized values, and he
showed no ketones in his blood. His condition improved, he became increasingly orientated
and aware. He then became conscious of his environment.

We have given Mr. Livingstone guidelines to follow up post-discharge, which include daily
blood sugar and ketone monitoring s observation. It would be appreciated if you could
support him with do frequent monitor his diabetes management, including insulin
adjustments and ensure that he adheres to a healthy diet and engages in practices physical
activity. If necessary, insulin adjustments can be made by your team.
I would also request educating him on how to procced when his blood sugar and ketones
are present high values.
If any further information is needed, regarding Ms Hill, please do not hesitate to contact me.

Yours sincerely,
Charge Nurse

Word count: 205

The word count should be 180-200 words.

KEY

Red: correction of grammar / vocabulary mistakes

______(?) : meaning unclear, needs to be rephrased

Purple: spelling mistake

Green: suggested improvements

Make sure to check the added comments for extra feedback

Feedback:

 Purpose:
1. The purpose of your letter is not immediately apparent or sufficiently expanded. Make sure
your opening paragraph includes the reason for writing and the main issue. You are referring
the patient to a diabetes specialist nurse for support with diabetes management after he
was admitted to your ward with diabetic ketoacidosis.

 Content:
1. You have generally selected the relevant case notes and information is presented clearly.

 Conciseness and Clarity:

1. Your writing is concise, the word limit has been respected and the relevant information is
summarized effectively.

 Genre and style:

1. The writing is clinical, factual and appropriate to the genre and the intended reader.
  Organisation and Layout:
1. Paragraphing and layout are generally logical and clear.

 Language:
1. Better word choice and sentence structure needed. Make sure to use a wide range of
vocabulary to score high on Language. Revise commonly used medical collocations to make
your writing sound more naturak.
2. Review the rules of capitalization. Names of medical conditions are capitalized if they are
named after someone. Names of medical procedures are not capitalized.
E.g. - diabetes (not capitalized), Alzheimer’s disease (the name is capitalized).

Estimated grade: C+

Scores based on OET Writing Assessment Criteria and Level Descriptors https://prod-wp-
content.occupationalenglishtest.org/resources/uploads/2019/04/23132911/Writing-Criteria-Final.pdf

Purpose Band Your score

Purpose of document is 3
immediately apparent and
sufficiently expanded as
required

Purpose of document is 2 2
apparent but not sufficiently
highlighted or expanded

Purpose of document is not 1

immediately apparent and
may show very limited
expansion

Purpose of document is 0
partially obscured/unclear
and/or misunderstood
 3.
Content Band Your score
Content is appropriate to 7
intended reader and addresses
what is needed to continue
care (key information is
included; no important details
missing); content from case
notes is accurately
represented
Performance shares features 6
of bands 5 and 7

Content is appropriate to 5 5
intended reader and mostly
addresses what is needed to
continue care; content from
case notes is generally
accurately represented

Performance shares features 4

of bands 3 and 5

Content is mostly appropriate 3

to intended reader; some key
information (about case or to
continue care) may be missing;
there may be some
inaccuracies in content

Performance shares features 2

of bands 1 and 3
Content does not provide 1
intended reader sufficient
information about the case
and what is needed to
continue care; key information
is missing or inaccurate

Performance below Band 1 0

4.

Conciseness and Clarity Band Your score

Length of document is 7
appropriate to case and reader
(no irrelevant information
included); information is
summarised effectively and
presented clearly

Performance shares features 6

of bands 5 and 7

Length of document is mostly 5

appropriate to case and 5
reader; information is mostly
summarised effectively and
presented clearly

Performance shares features 4

of bands 3 and 5

Inclusion of some irrelevant 3

information distracts from
overall clarity of document;
attempt to summarise only
partially successful

Performance shares features 2

of bands 1 and 3

Clarity of document is 1
obscured by the inclusion of
many unnecessary details;
attempt to summarise not
successful

Performance below Band 1 0

5.
Genre and Style Band Your score
Writing is clinical/factual and 7
appropriate to genre and
reader (discipline and
knowledge); technical
language, abbreviations and
polite language are used
appropriately for document
and recipient
Performance shares features 6
of bands 5 and 7

Writing is clinical/factual and 5 5

appropriate to genre and
reader with occasional, minor
inappropriacies; technical
language, abbreviations and
polite language are used
appropriately with minor
inconsistencies
Performance shares features 4
of bands 3 and 5

Writing is at times 3
inappropriate to the document
or target reader; over-reliance
on technical language and
abbreviations may distract
reader

Performance shares features 2

of bands 1 and 3
The writing shows inadequate 1
understanding of the genre
and target reader; mis- or
over-use of technical language
and abbreviations cause strain
for the reader

Performance below Band 1 0

6.

Organisation and Layout Band Your score

Organisation and paragraphing 7
are appropriate, logical and
clear; key information is
highlighted and sub-sections
are well organised; document
is well laid out

Performance shares features 6

of bands 5 and 7

Organisation and paragraphing 5 5

are generally appropriate,
logical and clear; occasional
lapses of organisation in sub-
sections and/or highlighting of
key information; layout is
generally good
Performance shares features 4
of bands 3 and 5

Organisation and paragraphing 3

are not always logical, creating
strain for the reader; key
information may not be
highlighted; layout is mostly
appropriate with some lapses

Performance shares features 2

of bands 1 and 3

Organisation not logical, 1

putting strain on the reader; or
heavy reliance on case note
structure; key information is
not well highlighted and the
layout may not be appropriate

Performance below Band 1 0

7.
Language Band Your score
Language features 7
(spelling/punctuation/vocabul
ary/ grammar/sentence
structure) are accurate and do
not interfere with meaning

Performance shares features 6

of bands 5 and 7

Minor slips in language 5

generally do not interfere with
meaning

Performance shares features 4 4

of bands 3 and 5

Inaccuracies in language, in 3
particular in complex
structures, cause minor strain
for the reader but do not
interfere with meaning

Performance shares features 2

 of bands 1 and 3

Inaccuracies in language cause 1

considerable strain for the
reader and may interfere with
meaning

Performance below Band 1 0

Sample Letter – Writing Test 6

Mr. John Prowle

Diabetic Specialist Nurse

John Milton Clinic

Crow Lane

Bristol

18 August 2018

Dear Mr. Prowle,

Re: Mr. George Livingstone, 70-year-old

I am writing to refer Mr. Livingstone, who was admitted on 15 th August and diagnosed with diabetic
ketoacidosis.

On admission, Mr. Livingstone was hyperglycaemic and confused, having been found at home in the
same state. He presented with thirst and a fruity-scented breath in addition to vomiting. Follow up
tests came back positive for ketones.

Mr. Livingstone’s treatment followed the hospital protocol for DKA in order to prevent a rapid
decrease in blood sugar and cerebral oedema. He was given fluids, electrolytes, and insulin, which
he responded well to. In the following days, his condition improved, he became increasingly
orientated and aware, and his blood sugar stabilized. His vital signs and arterial blood gases are
normal, however frequent blood sugar and ketones monitoring is highly recommended at home.

I would greatly appreciate it if you could arrange regular follow ups for diabetes management. This
should include support for healthy eating habits, physical activity, and insulin adjustments. In
addition, in order to prevent future admissions, information should be given about the approach in
dealing with situations of high blood sugar and high ketones.

Please do not hesitate to contact me for any questions you have regarding Mr. Livingstone.

Yours sincerely,

Charge Nurse