Tips for Writing Sub-Test in OET Exam (Medicine). This guide has been prepared by Dr. Mohammed Mansor 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)
