Speaking Sub-Test Overview

The speaking sub-test consists of two roleplay scenarios. The interviewer will take the part of the patient
and the candidate takes his/her professional role as a nurse. The interview is usually about 20 minutes
long and structured as follows:

1. Identification check (not assessed)

2. Brief chat regarding the candidate’s medical career (not assessed)
3. The first roleplay including 2/3 minute preparation time and 5-6 minute roleplay (assessed)
4. The second roleplay including 2/3 minute preparation time and 5-6 minute roleplay (assessed)

During the preparation time you must read the roleplay card handed to you and you can make notes on
the card or underline key words. You may ask questions to interviewer if there is anything you are unsure
about, especially vocabulary. This is important because if you misunderstand the situation it could affect
how you approach the task.

You can refer to the card during your role-play and you should use the 2/3 minutes preparation time to
identify:

1. The setting
2. Background information about the patient and their condition or situation
3. Task requirements you need to complete in your role as a nurse including questioning,
explaining, giving advice, reassuring & persuading

Generally, if the interviewer is a male then the patient will be a male and if the interviewer is a female
then the patient will be a female. You can use the interviewer's name to address them with if you like, or
simply refer to them as Sir/Madam. Whatever you feel more comfortable with.

The interviewer may also take the role of a parent or carer of the patient i.e if the patient is a child, or has
a serious illness.

Roleplay Structure
The roleplay scenarios are based on real situations you are likely to encounter in you work as a nurse in
Australia. There are a variety of possible settings for the roleplay including:

 Suburban Health Clinic

 Community Health Centre
 Nursing Home
 Hospital Ward
 Hospital Emergency Department
 School
A typical roleplay structure is as follows:

 Brief introduction dependent on the task.

 Ask questions to help you assess the situation.
 Respond carefully to what concerns the patient has.
 Provide an explanation of the condition & respond to further questions and concerns of the
patient.
 Provide advice and reassurance as required.
 Short simple concluding sentence.

You only have 5-6 minutes to complete the roleplay so it is important to follow the task closely and not
spend too long on any one section. If the roleplay lasts more than 6 minutes the interviewer may signal
you to end the roleplay. This could be a problem if you have not finished key aspects of the task

Stage 1: Introductions and Opening Questions

Introductions are a very important part of the role-play as they allow you to start the conversation in a
positive way and in line with requirements of the roleplay card. Therefore the first thing to do is read the
card very carefully looking for information which will help you, as a health professional, determine how
to approach the patient or carer.

Important factors to consider

 Identify the setting such as Hospital Ward, Community Clinic, School or Large Company. This
will signify the relationship you have with the patient or carer.
 Identify the patient, male, female, parent of child etc. Note, in the exam, most cards are not
gender specific, so that if the interviewer is a male the patient will be a male and if the
interviewer is a female, then the patient will be a female.
 Is it the first time to meet the patient or are they a regular patient of yours
 For example if you know the patient is a good idea to begin with a familiar tone such as
o Hi Jane, how can I help you today? Rather than.
o Hello I am Naomi, Kate your Nurse. How may I address you?

It is very important to start the roleplay in a confident manner. Here are some standard ways to begin the
conversation.

At a clinic or health centre

 Good morning Madam, I’m Kate your Nurse . What brings you here today?
 Good morning Sir. I’m Kate your Nurse today. Tell me why you have come here.
 Good morning John, please sit down. I’m Kate your nurse. What seem to be the problem?
 Hello Steven, you’re here to have your stiches removed, aren’t you.
  Good morning Patricia, you’ve brought your daughter along I see. What seems to be the
problem?

At a nursing home or hospital ward

 Hello Maria, how are you feeling today?

 Hello John, you are looking better today. How do you feel?
 Good morning, Madam. I’m Jane, the nurse who will take care of your daughter during her
hospitalization.

Taking the patient history

Once you have made the initial introduction, you will need to ask some questions to determine the exact
nature of the patient’s problem or concern. Some of this information will be given to you on your card,
but it is a good idea to ask the basic questions anyway as forms the basis of your consultation. Just
remember, however, to keep your line of questions quite narrow and specific to the patient’s condition as
you have only 5~6 minutes to complete your task so there is no time for a general history.

Asking questions about the patient’s medical problem

 Have you ever had a serious illness in the past?

 Are you allergic to anything?
 How long have you been feeling this way?
 Have you ever been in hospital before?

Asking questions about the patient’s social history

 Will anybody be at home to look after you when you are discharged?
 Do your family live close by?
 Do you have any friends or neighbours who can help you?
 Is there anything you need help with at home, such as cooking meals, or cleaning the house ?

Stage 2: The Main Body

Once you have taken the history to a satisfactory level it is time to move to the second stage of the
roleplay which is often an explanation about a certain condition or method of treatment. This may take up
to a third of the roleplay (1-2 minutes) so it essential that you do it in a clear and well organised manner as
outlined below:

Informing the patient

  Based on my examination you are suffering from…….
 The blood test results indicate that your child has………
 The tests show that it is probably a condition known as……

Describing the condition

Make sure your explanation is clear and well organised. Patient with burns example:

Let me explain the three kinds of burns:

Third degree, which is very serious…..
Second degree, which is less serious but can be painful and result in scarring
And first degree, which your son has, is only superficial and does not leave scarring………..
Is that clear?....Good. Now, the dressing only needs to be on for a few days and the cut will heal.

Do you know anything about this condition? No? Okay I will explain it to you.
It is a condition caused by….
The symptoms include…….
The best treatment is to…….
It is highly contagious so you need to…

Try not to talk continuously. Stop from time to time to check if the patient understands your explanation.

 Is that clear?
 Do you understand so far?
 Do you have any questions?

Reassuring the patient

 It’s nothing to get alarmed about. It’s just a routine check.

 There really is nothing to worry about. The burns are only minor and your son will completely
recover.
 Let me reassure you, the home care services are excellent and will help you manage your
condition, provide meals if needed and even make you a cup of tea.

Persuading the patient

 If you return to work you run the risk of doing further damage to you health.
 As I said, if you follow my advice and keep the wound clean, it will completely heal, free of
infection. However if you do not follow my advice, and allow the wound to get dirty again, then
infection may occur.
 The doctor has said that it is very important to take all your medications.
 According to the doctor you are ready to leave hospital today.
Stage 3: Concluding the Roleplay

This can be a difficult part for some people. The important thing to remember is to make the closing
sentence short and concise. Here are some examples of how to do this:

At a clinic or health centre

 Is there anything else you would like to ask me?.......Okay take care now Mr Jones.
 Thanks for coming to see me today. Goodbye.
 Please come and see me again in a week.
 Here are some brochures to help you understand the treatment procedure. Please come again if
you have any problems with the medication.
 I would like to see your child again in two months time. Take care now.

At a nursing home or hospital ward

 I’ll come back in an hour to check on you.

 I’ll come back and check on your condition later today.
 If your condition/situation gets worse, please let me know.
 If you need me again, just press the buzzer.

Useful Website

 English Med is a useful website which contains some sample conversations & transcripts
between a health professional (usually a doctor) and a patient.

Techniques for Asking Questions

Correct questioning is a key aspect of the medical interview. It has many functions and is used in all
stages of the role-play. We ask questions in order to

 identify the patient's main problem or concern

 gather information
 to confirm what we have heard
 to encourage the patient to express themselves
 to check that the patient understands

Therefore, a good questioning technique can help the role-play run smoothly and allow for effective
communication between the health professional and the patient.

Open Questions
Open questions are often used at the start of the interview as they allow the patient to tell their story.
Open questions often begin with wh & how question words. Always listen attentively to what the patient
says in response to these questions as this will guide you on what to ask next.
What Where/When/Why How long How often How many/How
much

What kind of Where does it hurt? How long have you How often do you How many
exercise do you do? had the pain? brush your teeth? cigarettes do you
smoke per day?

What does your When did the pain How long has your How often do the How many hours
daughter usually start? daughter had this fits occur? sleep do you get
have for breakfast? rash? each night?

What time does she When was the last How long have you How often do you How many children
go to bed? time you visited a been on this get headaches? do you have?
dentist? medication?

What time did the Why have you How long have you How often do you How much do you
accident happen? come here today? had this cough? take this medicine? drink?

Closed Questions
Closed questions are useful to get specific details that you may not have got from the open questions.
They are also effective in the OET exam as they encourage natural interaction between the health
professional and the patient.
Do/Does Is/Are Have/Has Can/Could
Do you drink alcohol Is your daughter toilet Have you had any nausea Can you cook for
every day? trained? and vomiting? yourself?

Do you know what Is there asthma in the Have you been taking Can you put pressure on
eczema is? family? your medication? your foot?

Does anyone in your Are you eating Has your condition Could you tell when you
family have high blood normally? improved since you first noticed the rash?
pressure? started taking drug x?

Does the pain wake you Are you in any pain at Has there been any Could you open your
up at night? the moment? change in your bowels this morning?
symptoms?

Introducing the Question Topic

One common questioning technique which is very effective is to introduce the subject first with the
phrase what about or how about then follow with a yes/no question as in the sample dialogue below.

Nurse: What brings you here today?

Patient: Well nurse, I haven’t been feeling well recently.
Nurse: I‘m sorry to hear that, please tell me more.
Patient: I have been getting tired a lot.
Nurse: I see, what about your appetite. Are you eating well?
Patient: Not really, I haven’t felt hungry.
Nurse: What about your sleeping habits. Are you getting enough sleep?
Patient: Well about 4 or 5 hours a night
Nurse: Oh, it’s really not enough, is it?
Patient: I guess not.
Nurse: How about your work. Are you under any stress at the moment?
Patient: Yes, a little as it’s the end of the financial year so I am busy.

Embedded Questions
You can soften your questioning technique and sound more polite by using embedded questions. Practice
this forms as it easy to get the word order wrong. Note, however, that embedded questions follow the
word order of statements not questions.
Direct Question Embedded Question

Why have you come here today? Could you tell me why you have come here today?

How did you injure your leg? Could you tell me how you injured your leg?

What time did the accident happen? Do you remember what time the accident
happened?

When did the pain start? Can you tell me when the pain started?

How long have you had the pain? Could you tell me how long you’ve had the pain?

Is it a sharp or dull pain? Could you tell me if it is a sharp or dull pain?

Does the pain bother you at night? Can you tell me if the pain bothers you at night?

Why do want a prescription for sleeping tablets? Can you explain why you want a prescription for
sleeping tablets?

Encouraging Reluctant Patients

Sometimes the patient may need encouragement to provide the information that you need to make a
proper assessment of the patient's condition or situation. In these cases, try not to move onto the next
stage too quickly. It is better to persist until you get the information that you need. A good technique in
this situation is

 Tell me more about that please, John.

 Could you tell me more about that, Mary?
 Please tell me more.
 Is there anything you'd like to tell me?
Probing Questions
Probing questions are sometimes necessary to get more detailed or precise information from the patient.

 What do you mean by that?

 Where exactly is the pain?
 You look a bit anxious. Is there anything else that is troubling you?
 Can you explain exactly why you are worried?

Checking Understanding
It is very important to periodically check that the patient can follow your explanations and advice.

 Is that clear?
 How does that sound?
 Do you think you can do that?

Providing Information

It is very important that, as a health professional, you are able to express information in
a clear and organised manner. This worksheet provides a framework for doing this as
outlined below.

1. Begin with a topic sentence outlining what you are going to explain.
2. Use signposting language to facilitate patient understanding.
3. Check that the patient has understood your explanation before moving on.

Topic sentence Signposting Checking

Understanding
Let me explain why I Firstly.....Secondly.....Thirdly......Finally Is that clear?
have arranged this First of all....... Is that Okay?
appointment.
What I am going to do It is also important to...... It is also How does that sound?
now is discuss the necessary to.....
importance of proper
diet including a
nourishing breakfast
and having meals on
time. .
I’ll explain to you the This means..... That's the reason Do you think you can
importance of healthy why....... do that? Are you
lifestyle. prepared to do that?
How much do you Therefore.... So...... However,....... Do you have any
know about Jaundice? Now, .......In addition...... questions so far?
Okay, let me explain.

Here are some role-play scenarios which demonstrate successful communication

between a nurse and a patient.

Jaundice

Nurse: Good morning Jane! How are you today?

Patient: I am fine , but I really want to go home. I could not sleep here in the hospital.
Actually, I don’t like staying in the hospital. Is it possible to go home today, Nurse?
Nurse:I understand how you feel Jane. I know you really want to go home, but let me
discuss your situation and your baby’s condition. I recommend that you and your baby
stay here in the hospital for observation.
Patient: But why Nurse? I would really prefer to be at home instead of hospital.
Nurse: Because we noticed that your baby is very sleepy, not feeding well and
becoming jaundiced. That’s the reason why your baby needs to stay here for treatment.
Patient: What do you mean by jaundice Nurse, what causes it? Can you please explain
it to me
Nurse: Yes, I’ll explain it to you now. Jaundice is a yellowish discolouration of the skin.
One of the most common reasons why newborn babies have jaundice is because of an
infection in the blood. Usually, the doctor will order a blood test to diagnose your
baby’s condition. If the blood test results are higher than normal, the doctor will order
some antibiotics for your baby. Also, your baby will undergo a phototherapy. This
means your baby will stay under lights, which will help to lower the bilirubin level in
your baby’s blood.
Patient:But I am worried Nurse about the side effects of the treatment for jaundice.
Nurse:You don’t have to worry Jane. But let reassure you, about 99.9% of the babies
who have jaundice and receive early treatment, recover from the condition.
Patient: Okay Nurse. I’ll stay here. Please do the best for my baby.
Nurse: Of course, we’ll do our best. Thanks a lot Jane.

Poor Nutrition
Nurse:Good morning Mrs. Wilson. I am Mary, the Charge Nurse in this school. How
are you today?
Patient: Good morning Mary. I arranged to have time off from work this morning to
come here because I am worried about my son’s condition.
Nurse: I'm glad you came. Let me explain why I arranged this appointment. I am
worried about your son’s condition. After school commences, he frequently complains
of tiredness and he is also getting headaches.
Patient: Yes Nurse, I am worried too. I am a sole parent and I have three kids. It is hard
to look after them.
Nurse: Ah I see. I understand your situation Mrs. Wilson. Do you mind if I ask you a
few questions regarding your son’s general health?
Patient: No, go ahead.
Nurse: Do your children have a regular breakfast? Are they eating well?
Patient: Honestly Nurse, I don’t know. Because in the morning I have to leave early, my
eldest daughter Marie is the one who’s looking after her siblings.
Nurse: What about in the evening, Mrs. Wilson? What is your family routine in relation
to meals and bed times?
Patient: At night time I have to go to bed early as I am very tired. I am working in a
factory and I have to go there at 5:30 in the morning. My kids usually watch a bit of TV
at night, I can’t monitor them because, as I have said, I go to bed early. With Ronnie, he
seems to be okay after having a bowl of coco pops and some soft drink when he gets
home in the afternoon.
Nurse: Okay Mrs. Wilson, What I am going to do now is discuss the importance of
proper diet including a nourishing breakfast and having meals on time. Your child
needs to have a nourishing breakfast so that he will have energy for the whole day. Also
it will help for your child's brain function and concentration in class. How does that
sound?
Patient: Uhhmmm, I see.
Nurse: Good, Now, another thing that I would like to mention is having soft drink
with meals is not good for your son, especially if your son is not having regular meals.
This is because soft drinks are acidic and high in sugar. Secondly, I suggest that you
organise a weekly plan for your family’s meal. For example, you can cook some food
on the weekend then store it in the fridge so your eldest daughter Marie can heat it up at
meal time. After cooking the food, put it in the container and make a label, please
include the time and date so that you cook the food and have a routine check at night
before you go to bed if your kids eat their food. Also, you can stock some groceries. For
example, you can buy some cereals, Weetbix, milk, bread and jam. So it will be easy for
your children to prepare their breakfast. Lastly, please explain to your kids, especially
to Ronnie, that having enough rest and sleep will keep him going in the morning and he
won’t feel tired in the afternoon. So is that clear for you Mrs. Wilson?
Patient: Yes Nurse. Thank you very much. That is a really good advice.
Nurse: Your welcome Mrs. Wilson. I will set another appointment for a follow-up visit.
Is that okay with you?
Patient:Yes Nurse.
Nurse: That’s good. Thank you very much Mrs. Wilson. See you soon.

Myocardial Infarction

Nurse: Good morning David, how are you today?

Patient:Nurse, I am worried about my condition. I think it will affect my future health.
Nurse: I understand your concern David. Let me explain your condition and how you
can cope with this. Firstly, it is important for you to know that returning to normal life
is a gradual process, but I can assure you that if you follow your doctor’s advice you’ll
make a full recovery. Secondly, you really need to take your medications regularly.
Patient: Is it necessary to take all the medication, Nurse? Because, you know, my
doctor gave me too many tablets.
Nurse: Yes David, it is very important to take all your medications... because it will
help you to recover quickly and will prevent heart attacks.
Patient:Okay Nurse I’ll take all the medications, can you give me advice about a
suitable diet and exercise routine.
Nurse: Sure David, I’ll explain to you the importance of healthy lifestyle. In your case
David, the most important thing is to give up smoking. Have you heard that there is a
helpline that you can call if you want assistance in quitting smoking?
Patient: No I haven't. But I think it must be hard to quit smoking.
Nurse: Many people think that it is hard at first, but once you start, you will find out
that it’s not that hard. Also, I’ll give you a pamphlet that you can read and it contains
some websites that have all the information and testimonials from previous smokers
that have already quit smoking. Aside from that, it is also important to watch your diet
and do regular exercise. You must avoid fatty foods, decrease your caloric intake and
have a balance diet. You can eat fish instead from pork. Fish contains Omega-3 that is
good for your heart. While, exercising regularly will improve your circulation. Before
we proceed do you have any questions, David?
Patient:What about my work Nurse? Am I able to go back to work soon?
Nurse:Yes David, as long as you follow all of our advice. Just make sure that you’re
getting regular rest in-between activities. Also, if you feel pressure at work, you can do
deep breathing exercises. It will help you to relax and relieve the pressure at your work.
Do you have any other questions, David?
Patient: None, I think I’ll be fine. Thank you very much Nurse.
Nurse:Your welcome.Take care now.

Study Strategy
While it is impossible to control what a patient will say in the interview. You can at
least be half prepared by having a clear approach as described above. To develop
confidence and skill in this area, practise writing out dialogues based on common
situations which require explanations including:
• the cause of a condition or illness
• a particular medical condition
• a treatment procedure
• the pros and cons of a particular medication
• lifestyle advice
• a prognosis

Handy Hint
Study the transcripts from the Dr. Norman Swan series: Health Minutes to build up
your vocabulary and range of expression in a medical context. This really works and I
know of many students who have improved their spoken expression considerably and
passed OET due to dedicated study of Dr. Norman Swan!
 Language Functions
Effective communication is very important in the medical interview. As a health
professional, it is necessary to use language to achieve a particular purpose within a
particular context. These purposes can be categorised further into language functions
and language learners can improve their communicative ability by being familiar with
and using the language patterns associated with the various functions.

Note: The role-play scenarios used by OET have been designed to test the candidates
ability within the categories below so skill in these areas will help you achieve your
required score.

Expressing Concern and Understanding

This is obviously a very important part of the medical interview. It requires you to listen carefully to the
patient then respond appropriately.
I know how....  I know how you must be feeling.

I understand.....  I understand your concern

I understand how.....  I understand how you are feeling.

 I understand how you feel.

I understand why.....  I understand why you have this concern.

 I understand why you are worried about
fluoride in the water supply. However,.....

I'm sorry to hear that.  Oh, I 'm very sorry to hear that, but there is
a solution to every problem.

Yes, I can see that.....  Yes, I can see that it must be difficult for
you to manage.

Reassuring
This is also a very important part of the medical interview. Therefore you need to be comfortable using a
variety of expressions to do this.
Let me assure you....  Let me assure you, all the nurses here are
experienced and highly trained.

Let me reassure you that.....  Let me reassure you that if we can strictly
control his sugar levels within the normal
range with proper medications, Tom will
 live a normal life without any troubles.

As long as you.....  As long as you follow all the advice we

have given you, you will make a full
recovery.

Try not to worry too much.  Alright, Mrs. Small. Try not to worry too
much. If you can follow my suggestions,
John will get much better soon.

It is nothing to get alarmed about.  But it is nothing to get alarmed about, the
risk of complication is very low indeed.

Making Suggestions
Here are a few expressions you can use when giving suggestions.
It is important that......  It is important that you take your
medications regularly.

I suggest that.....  I suggest that you take a shower and go for

a short walk. It will make you feel much
better.

If you like, I could....  If you like, I could ask a nutritionist to give

you some dietary guidelines. How does
that sound?

The most important thing is......  The most important thing (for epilepsy
sufferers) is to avoid sports such as
swimming, diving and rock climbing.

Offering Advice
There are many way to offer advice and you can demonstrate your language skill by using some of the
more complex structures
I advise that ....  I advise that you continue taking this
medication.

My advice is that .....  My advice is that you continue taking this

medication.
What I would like you to do is.....  What I would like you to do is reduce your
alcohol consumption to no more than 2
standard drinks per day.

You should.....  You should follow a healthy diet and

avoid foods that contain a lot of fat and eat
more vegetables and fruits

Why not.......  Why not try these healthier alternatives

first?

Persuading
Many OET tasks require the health professional to convince the patient to do something they do not want
to do. A very useful technique in these situations is to explain the consequences if the patient does not
follow your advice.
I strongly recommend that....  I strongly recommend that you return to
the clinic immediately for further
treatment. Is that clear?

 I strongly recommend that you have a

porcelain crown because it can endure the
chewing forces and it also looks quite real.

You really need to.....  Patient: How much is it for the specialist
treatment?
 Dentist: I think it will cost around 800 to
1200 dollars.
 Patient: I don't want to see the specialist. It
scares me and I can not afford it. Can I just
get antibiotics or mouthwash
 Dentist: I'm sorry, but you really need to
see the specialist and it's the only way you
can save your teeth. Without the treatment
you will lose your teeth.

if.....  If you do not modify your lifestyle, the

disease may progress.
 If there are serious complications, you will
need surgery to remove the affected
bowel.
Seeking Approval
Checking with a patient first before asking a question helps in developing a good rapport between you
and the patient.
Is it okay if.....  Is it okay if I ask you a few questions
regarding your son's health?

Would you mind if I.......  Would you mind if I contacted Meals on

Wheels on your behalf?

Is that okay?  First of all, I would like to ask you more

questions to clarify what the problem is
and how severe it is. Is that okay?

Justifying
These expressions allow you to emphasise your opinion are can help in persuading a patient to follow
your advice.
That is the reason why.....  We noticed that your baby is very sleepy,
not feeding well and becoming jaundiced.
That’s the reason why your baby needs to
stay here for treatment.

For this reason......  Dentist: Based on my examination you

have a fissure in that tooth. I see the
previous filling is loose.So I think you
need to have your tooth restored with a
crown.
 Patient: Hum, I'd like to have another
filling or it that doesn't work I feel I can
live without that tooth.
 Dentist: Well, if you don't do a crown then
you have to get your tooth extracted. Then
there will be space and it's not easy to
chew, and also, it doesn’t look as good.
For this reason I advise a crown.

Moving Forward /Changing the Subject

The now is quite useful as it signifies that you are moving to a new topic. In terms of the medical
interview, it is a way of controlling the direction of the interview. This is very important, as a health
professional you are in charge of the interview, not the patient.
Now,......  Now, I'd like to talk about your discharge.
 Now, let's talk about your medications.
Are taking them regularly?
 Now, lets talk about your current health.
How are you feeling today?

Summarising
This is a useful technique, especially if you feel the interview has not gone the full 5 minutes, or if the
patient is not very communicative.
Let me go over again what we have talked about  Let me go over again what we have talked
today. about today. Your colonoscopy found that
you have diverticular disease. You need to
improve your diet which includes taking
high fibre foods, vegetables and fruit. Also
make sure your bowel movements are
regular and do regular exercise. I will see
you in two weeks’ time. Take care.

To summarise.....  To summarize, you came to see me

because you have fever and persistent
cough. I have ordered a chest x-ray and a
phlegm test. The results will be back in
next week. I will see you in one week’s
time.
Good bye.

Handy Tip
The list above is just a starting point. To improve your range of vocabulary and
expression as well as grammatical accuracy, practice writing out dialogues for
each of the functions described above based on the role-play tasks in your course.

Dos and Don'ts

There are many ways to successfully approach the speaking task. Below are a list of
simple points to remember to help you succeed on the day.

Dos Don'ts
Do read the roleplay card carefully and ask Don't plan what you are going to say in
the interviewer if you are unsure of any of advance. React to the scenario on your
the words or expressions in the task. roleplay card and plan your role
accordingly.
Do react to what the interviewer (as Don't plan what you are going to say in
patient) asks or says and respond advance. React to the scenario on your
accordingly. This is much more important roleplay card and plan your role
than simply following the tasks on the accordingly.
card.
Do focus on the patient and respond to Don't be card focussed at the expense of
their questions and concerns. the patient. It is much more important to
respond to the patient in a natural and
caring manner (where required).
Do take charge of the roleplay. You are a Don't wait for the interviewer to lead the
medical professional and should act roleplay. They may not!!
accordingly by leading the roleplay. This This is your job.
means you must start and conclude the
roleplay, and if the patient is quite or silent,
then it is your responsibility to keep the
conversation moving.
Do utilise the allowed 2~3 minutes to Don't rush through your card in 30 seconds
identify the key points on your card and say you are ready to start! You may
including: miss some important details.

 the setting
 whether you know the patient, or if
it's the first time to meet
 the main topic of conversation &
relevant background information
 task requirements

Do refer to your card occasionally during Don't try to memorise the whole card. You
the exam, especially if you are unsure of can refer to it as required during the
what to say. roleplay.
Do be prepared to discuss matters which Don't feel you must complete every aspect
are not on your card. The patient's card of your task. Remember it is a guide only
usually contains information which is not and you will not be penalised if you do not
on your card. complete every detail of your card.
Do look at the patient during the roleplay. Don't look at you card only and read it
Although only your speech is recorded, while the patient is talking as you must
your communication will be more effective listen carefully to what they the patient
if you have eye contact with the says so that you can respond appropriately.
interviewer.
Do stay focussed on the task at hand. You Don't spend too much time on unrelated
only have 5-6 minutes to complete the matters such as a detailed medical history
task! as you do not have time for this.
Do practise as many tasks as possible with Don't ignore the task requirements and say
a partner to ensure you are familiar with what you think based on your medical
the speaking test. Remember it is very knowledge. Remember it is a test of
different to IELTS and requires different English language ability and not a place to
language skills, such as the ability to demonstrate your medical knowledge.
persuade, convince and reassure.
Do act confidently and speak with a Don't show how nervous you are as this
positive voice. If you are unsure of the can negatively affect your result. Lots of
details of the condition, it is okay to make practice is the best way to overcome
it up! Remember it is a test of English not nerves.
your medical knowledge.
Do slow down your speech when using Don't use a lot of medical jargon and
unfamiliar words such as names of technical words. You need to use layman’s
medications or treatment procedures. language to describe the condition.
Always be prepared to explain the meaning
of any medical terminology you use.
Do regularly check that the patient Don't speak continuously in a
understands your explanations. Ask monologue.You are taking part in a 2 way
questions such as: conversation.

 Is that clear?
 Can you do that?

Do stop speaking if the patient wants to Definitely do not talk over the patient. You
interrupt you. You must respond to the will be penalised for this!
patient.
Correct a grammatical or vocabulary Don't rush your sentences as you are more
mistake immediately if you are aware that likely to make an error. Try to remain clam
you have made one. (Native speakers and in control.
certainly do this!)
Do be aware of the gender of your patient Don't be too stressed if you make a gender
and if you say he instead of she, try to error, 1 or 2 slips is acceptable but more
correct it. than this may be penalised.

Possible Roleplay Topics

There is a wide range of possible roleplay tasks. You can prepare by being familiar with common
scenarios. It is common for there to be some conflict between what the patient wants to hear and what the
doctor has to say. Therefore your role, as a medical professional will be to clearly explain the condition,
reassure the patient where required and at times persuade the patient to follow a certain course of action
which they may not want to do. You will be assessed on how well you are able to meet these
requirements. Below is a list of topics which commonly appear in the exam.
  Alzheimer's disease
 Asthma
 Broken Bone
 Burns
 Chicken Pox
 Cholesterol
 Complaint against hospital staff/procedure
 Diabetes
 Discharge of an aged patient
 Eczema
 Epilepsy
 Fear of surgery
 Head Lice
 Infection
 Immunisation
 Jaundice
 Medication change
 Myocardial Infarction
 Palliative care
 Poor nutrition
 Post surgery activity
 Pneumonia
 Urinary track infection

Ask yourself the question, do you feel confident dealing with these situations? If not you can prepare for
the speaking test by researching common medical conditions such as those above and writing out
possible dialogues between you and the patient. A useful website which explains common conditions in
layman's language is The Better Health Channel.

John Murtagh's Patient Communication: This website provides excellent worksheets

summarising common conditions in simple language

On any reprints please include references as shown on the last page of the guide
CALGARY - CAMBRIDGE GUIDE TO THE MEDICAL INTERVIEW – COMMUNICATION
PROCESS
INITIATING THE SESSION
Establishing initial rapport
1. Greets patient and obtains patient’s name
2. Introduces self, role and nature of interview; obtains consent if necessary
3. Demonstrates respect and interest, attends to patient’s physical comfort
Identifying the reason(s) for the consultation
4. Identifies the patient’s problems or the issues that the patient wishes to address
with appropriate opening question (e.g. “What problems brought you to the
hospital?” or “What would you like to discuss today?” or “What questions did you
hope to get answered today?”)
5. Listens attentively to the patient’s opening statement, without interrupting or
directing patient’s response
6. Confirms list and screens for further problems (e.g. “so that’s headaches and
tiredness; anything else……?”)
7. Negotiates agenda taking both patient’s and physician’s needs into account
GATHERING INFORMATION
Exploration of patient’s problems
8. Encourages patient to tell the story of the problem(s) from when first started
to the present in own words (clarifying reason for presenting now)
9. Uses open and closed questioning technique, appropriately moving from open
to closed
10. Listens attentively, allowing patient to complete statements without
interruption and leaving space for patient to think before answering or go on after
pausing
11. Facilitates patient's responses verbally and non–verbally e.g. use of
encouragement, silence, repetition, paraphrasing, interpretation
12. Picks up verbal and non–verbal cues (body language, speech, facial
expression, affect); checks out and acknowledges as appropriate
13.Clarifies patient’s statements that are unclear or need amplification (e.g.
“Could you explain what you mean by light headed")
14. Periodically summarises to verify own understanding of what the patient has
said; invites patient to correct interpretation or provide further information.
15. Uses concise, easily understood questions and comments, avoids or
adequately explains jargon
16. Establishes dates and sequence of events
Additional skills for understanding the patient’s perspective
17. Actively determines and appropriately explores:
• patient’s ideas (i.e. beliefs re cause)
• patient’s concerns (i.e. worries) regarding each problem
• patient’s expectations (i.e., goals, what help the patient had
expected for each problem)
• effects: how each problem affects the patient’s life
18. Encourages patient to express feelings
PROVIDING STRUCTURE
Making organisation overt
19. Summarises at the end of a specific line of inquiry to confirm understanding
before moving on to the next section
20. Progresses from one section to another using signposting, transitional
statements; includes rationale for next section
Attending to flow
21. Structures interview in logical sequence
22. Attends to timing and keeping interview on task
BUILDING RELATIONSHIP
Using appropriate non-verbal behaviour
23. Demonstrates appropriate non–verbal behaviour
• eye contact, facial expression
• posture, position & movement
• vocal cues e.g. rate, volume, tone
24. If reads, writes notes or uses computer, does in a manner that does not
interfere with dialogue or rapport
25. Demonstrates appropriate confidence
Developing rapport
26. Accepts legitimacy of patient’s views and feelings; is not judgmental
27. Uses empathy to communicate understanding and appreciation of the patient’s
feelings or predicament; overtly acknowledges patient's views and feelings
28. Provides support: expresses concern, understanding, willingness to help;
acknowledges coping efforts and appropriate self care; offers partnership
29. Deals sensitively with embarrassing and disturbing topics and physical pain,
including when associated with physical examination
Involving the patient
30. Shares thinking with patient to encourage patient’s involvement (e.g. “What
I’m thinking now is....”)
31. Explains rationale for questions or parts of physical examination that could
appear to be non-sequiturs
32. During physical examination, explains process, asks permission
EXPLANATION AND PLANNING
Providing the correct amount and type of information
33. Chunks and checks: gives information in manageable chunks, checks for
understanding, uses patient’s response as a guide to how to proceed
34. Assesses patient’s starting point: asks for patient’s prior knowledge early on
when giving information, discovers extent of patient’s wish for information
35. Asks patients what other information would be helpful e.g. aetiology,
prognosis
36. Gives explanation at appropriate times: avoids giving advice, information or
reassurance prematurely
Aiding accurate recall and understanding
37. Organises explanation: divides into discrete sections, develops a logical
sequence
38. Uses explicit categorisation or signposting (e.g. “There are three important
things that I would like to discuss. 1st...” “Now, shall we move on to.”)
39. Uses repetition and summarising to reinforce information
40. Uses concise, easily understood language, avoids or explains jargon
41. Uses visual methods of conveying information: diagrams, models, written
information and instructions
42. Checks patient’s understanding of information given (or plans made): e.g. by
asking patient to restate in own words; clarifies as necessary
Achieving a shared understanding: incorporating the patient’s perspective
43. Relates explanations to patient’s illness framework: to previously elicited
ideas, concerns and expectations
44. Provides opportunities and encourages patient to contribute: to ask
questions, seek clarification or express doubts; responds appropriately
45. Picks up verbal and non-verbal cues e.g. patient’s need to contribute
information or ask questions, information overload, distress
46. Elicits patient's beliefs, reactions and feelings re information given, terms
used; acknowledges and addresses where necessary
Planning: shared decision making
47. Shares own thinking as appropriate: ideas, thought processes, dilemmas
48. Involves patient by making suggestions rather than directives
49. Encourages patient to contribute their thoughts: ideas, suggestions and
preferences
50. Negotiates a mutually acceptable plan
51. Offers choices: encourages patient to make choices and decisions to the level
that they wish
52. Checks with patient if accepts plans, if concerns have been addressed
CLOSING THE SESSION
Forward planning
53. Contracts with patient re next steps for patient and physician
54. Safety nets, explaining possible unexpected outcomes, what to do if plan is
not working, when and how to seek help
Ensuring appropriate point of closure
55. Summarises session briefly and clarifies plan of care
56. Final check that patient agrees and is comfortable with plan and asks if any
corrections, questions or other items to discuss
OPTIONS IN EXPLANATION AND PLANNING (includes content)
IF discussing investigations and procedures
57. Provides clear information on procedures, eg, what patient might experience,
how patient will be informed of results
58. Relates procedures to treatment plan: value, purpose
59. Encourages questions about and discussion of potential anxieties or negative
outcomes
IF discussing opinion and significance of problem
60. Offers opinion of what is going on and names if possible
61. Reveals rationale for opinion
62. Explains causation, seriousness, expected outcome, short and long term
consequences
63. Elicits patient’s beliefs, reactions, concerns re opinion
IF negotiating mutual plan of action
64. Discusses options eg, no action, investigation, medication or surgery, non-drug
treatments (physiotherapy, walking aides, fluids, counselling, preventive
measures)
65. Provides information on action or treatment offered
name
steps involved, how it works
benefits and advantages
possible side effects
66. Obtains patient’s view of need for action, perceived benefits, barriers,
motivation
67. Accepts patient’s views, advocates alternative viewpoint as necessary
68. Elicits patient’s reactions and concerns about plans and treatments including
acceptability
69. Takes patient’s lifestyle, beliefs, cultural background and abilities into
consideration
70. Encourages patient to be involved in implementing plans, to take responsibility
and be self-reliant
71. Asks about patient support systems, discusses other support available