🎯 The 20 skills OET rewards most

Criteria: Content · Conciseness & Clarity. The notes always contain more than the reader needs. Ask of every line: will this change what the reader does for this patient?

• Keep: the diagnosis, abnormal findings, treatment started, risks, social factors that affect care, the request.
• Cut: old resolved problems, hobbies, normal results one by one, routine vaccines – unless they matter to this reader.

“He enjoys lawn bowls and fishing and had his appendix removed in 1978.”

“Routine bloods, including thyroid function, were unremarkable.”

Practise it (23): Referral to a cardiologist – paroxysmal atrial fibrillation · Referral to a respiratory and sleep physician – suspected obstructive sleep apnoea · Referral to an endocrinologist – newly diagnosed hyperthyroidism · Referral to a gastroenterologist – positive coeliac serology with iron-deficiency anaemia · Referral to a neurologist – suspected Parkinson's disease · Referral to an ENT surgeon – nasal polyps with loss of smell …

Criteria: Purpose · Content. Say exactly what you want the reader to do, and repeat it in the closing paragraph.

“I would be grateful for your review.”

“I would be grateful if you could arrange an echocardiogram and advise on rhythm or rate control, including whether ablation is suitable.”

Practise it (15): Referral to a respiratory and sleep physician – suspected obstructive sleep apnoea · Referral to an endocrinologist – newly diagnosed hyperthyroidism · Referral to a gastroenterologist – positive coeliac serology with iron-deficiency anaemia · Urgent referral to rheumatology – suspected giant cell arteritis · Referral to a physiotherapist – subacute low back pain · Referral to a dietitian – newly diagnosed coeliac disease …

Criteria: Organisation & Layout. Each paragraph has one job – presenting problem, relevant history, medicines, social situation, plan. Do not simply follow the dates in the notes.

“His cardiovascular risk factors include hypertension, a BMI of 31 and, until recently, three to four standard drinks a day.”

Practise it (12): Referral to a respiratory and sleep physician – suspected obstructive sleep apnoea · Referral to an endocrinologist – newly diagnosed hyperthyroidism · Referral to a neurologist – suspected Parkinson's disease · Referral to a rheumatologist – early inflammatory arthritis · Referral to an ENT surgeon – nasal polyps with loss of smell · Referral to a dermatologist – chronic plaque psoriasis not controlled with topical treatment …

Criteria: Conciseness & Clarity. Combine related notes into one sentence; summarise normal findings in a clause.

“FBC was normal. U&E were normal. eGFR was normal. LFTs were normal.”

“Full blood count, renal and liver function were normal.”

Practise it (10): Referral to a gastroenterologist – positive coeliac serology with iron-deficiency anaemia · Referral to a rheumatologist – early inflammatory arthritis · Referral to a dermatologist – chronic plaque psoriasis not controlled with topical treatment · Referral to a gynaecologist – heavy menstrual bleeding with uterine fibroids · Urgent referral to cardiology – suspected unstable angina · Referral to a dietitian – newly diagnosed coeliac disease …

Criteria: Purpose (0–3). The first sentence after the salutation should say who the patient is, the key problem and what you are asking for.

“I am writing to refer Mrs Lee, a 58-year-old teacher with newly diagnosed rheumatoid arthritis, for your assessment and advice on disease-modifying treatment.”

Practise it (8): Referral to a cardiologist – paroxysmal atrial fibrillation · Referral to an ENT surgeon – nasal polyps with loss of smell · Referral to a psychiatrist – depression not responding to treatment, possible bipolar disorder · Letter to an occupational physician – sleep apnoea and return to driving · Discharge letter to a GP – new type 1 diabetes presenting with DKA · Transfer letter to a rehabilitation unit – hip fracture after hemiarthroplasty …

Criteria: Content · Organisation. Name, dose and frequency, and say what is new, changed or stopped. A short sentence often works better than a long list.

“I have started apixaban 5 mg twice daily and metoprolol 25 mg twice daily, and increased his perindopril to 10 mg in the morning.”

Practise it (5): Referral to a cardiologist – paroxysmal atrial fibrillation · Referral to a rheumatologist – early inflammatory arthritis · Discharge letter to a GP – NSTEMI treated with coronary stenting · Discharge letter to a GP – bleeding duodenal ulcer · Discharge letter to a GP – decompensated heart failure

Criteria: Language · Organisation. Use the past simple for events (“presented on 3 May”), the present perfect for situations up to now (“has been taking”), and time markers (“since”, “two weeks later”, “currently”).

“Since his discharge two weeks ago, he has been walking independently with a frame.”

Practise it (5): Referral to a neurologist – suspected Parkinson's disease · Referral to a gynaecologist – heavy menstrual bleeding with uterine fibroids · Referral to a psychiatrist – depression not responding to treatment, possible bipolar disorder · Urgent referral to cardiology – suspected unstable angina · Transfer letter to a rehabilitation unit – hip fracture after hemiarthroplasty

Criteria: Genre & Style. Formal and polite to colleagues, never chatty, never commanding. No contractions, no note form.

“You need to see him ASAP.”

“I would be grateful if you could see him as a matter of urgency.”

Practise it (5): Referral to a psychiatrist – depression not responding to treatment, possible bipolar disorder · Referral to a physiotherapist – subacute low back pain · Letter to a school principal – child with newly diagnosed epilepsy · Transfer letter to a hospice – metastatic pancreatic cancer · Transfer letter to an aged care facility – dementia after delirium

Criteria: Purpose · Content. In an urgent letter, state the urgency in the first sentence and give the reason, then the key findings – nothing else comes first.

“I am writing to refer Mr Haddad urgently for assessment of a suspected pulmonary embolism.”

Practise it (4): Urgent referral to the emergency department – suspected pulmonary embolism · Urgent referral to cardiology – suspected unstable angina · Urgent referral to general surgery – suspected bowel obstruction · Urgent referral to rheumatology – suspected giant cell arteritis

Criteria: Genre & Style · Content. A teacher, employer or carer needs plain words and practical advice, not diagnoses in Latin. Explain what to watch for and what to do.

“If Ella becomes very pale, sweaty or confused, please give her the glucose tablets in her bag and call her mother.”

Practise it (3): Letter to a school principal – child with newly diagnosed epilepsy · Letter to a university disability adviser – student with Crohn's disease · Transfer letter to an aged care facility – dementia after delirium

Criteria: Information giving · Appropriateness of language. Find out what the patient knows, give one idea at a time, then check.

“Can I start by asking what you already know about diabetes? … So, in simple terms, your body isn't using sugar properly. Does that make sense so far?”

Practise it (23): Newly diagnosed type 2 diabetes · High blood pressure confirmed on home monitoring · New diagnosis of asthma in a young adult · Underactive thyroid found on blood tests · First attack of gout · Heartburn diagnosed as acid reflux …

Criteria: Understanding the patient's perspective · Relationship building. Don't argue. Acknowledge, explore the reason, then offer information and a choice.

“You really must take it.”

“I can hear you're worried about side effects. Can you tell me more about what concerns you?”

Practise it (21): High blood pressure confirmed on home monitoring · First attack of gout · Irritable bowel syndrome after normal tests · Migraine with frequent painkiller use · Osteoarthritis of the knee · Stopping smoking after a chest infection …

Criteria: Relationship building · Information giving. Reassure with facts, not empty promises.

“Don't worry, everything will be fine.”

“The scan shows no bleeding, which is very reassuring. I'll tell you exactly what to watch for over the next 24 hours.”

Practise it (14): Newly diagnosed type 2 diabetes · New diagnosis of asthma in a young adult · Underactive thyroid found on blood tests · Heartburn diagnosed as acid reflux · Irritable bowel syndrome after normal tests · Returning to exercise after a heart attack …

Criteria: Information giving · Providing structure. Tell the patient what warning signs mean they should come back or call 000, and when to follow up.

“If the headache becomes severe, or you notice vomiting or drowsiness, please call 000 straight away.”

Practise it (14): New diagnosis of asthma in a young adult · Heartburn diagnosed as acid reflux · Migraine with frequent painkiller use · Returning to exercise after a heart attack · Request for antibiotics for a sore throat · Patient requesting a scan for back pain …

Criteria: Relationship building. Name the emotion, normalise it, and pause.

“It sounds as if this has been really frightening for you. Many people feel the same way.”

Practise it (14): Iron deficiency anaemia with heavy periods · Reducing alcohol after abnormal liver tests · Concerns about childhood vaccination · Explaining a colonoscopy · Starting insulin for type 2 diabetes · Wrist fracture and plaster cast care …

Criteria: Patient's perspective · Information giving. Link the benefit to what matters to the patient, and leave the decision with them.

“You mentioned wanting to keep up with your grandchildren – stopping smoking is one of the best things you can do for that. Would you like to talk about some options?”

Practise it (12): High blood pressure confirmed on home monitoring · First attack of gout · Osteoarthritis of the knee · Stopping smoking after a chest infection · Weight loss and type 2 diabetes risk · Returning to exercise after a heart attack …

Criteria: Appropriateness of language. Replace or explain every medical term.

“Your HbA1c suggests suboptimal glycaemic control.”

“Your three-month sugar test is higher than we'd like.”

Practise it (7): Newly diagnosed type 2 diabetes · Osteoarthritis of the knee · Stopping smoking after a chest infection · Consent for laparoscopic gallbladder removal · Explaining a colonoscopy · Using a spacer and preventer inhaler for a child …

Criteria: Information gathering. Start open, then focus, then summarise. Avoid leading questions.

“You haven't had any chest pain, have you?”

“Tell me about the pain… Has it ever come on when you're resting? … So, to summarise, …”

Practise it (6): Underactive thyroid found on blood tests · Iron deficiency anaemia with heavy periods · Reducing alcohol after abnormal liver tests · Long-term insomnia and sleeping tablets · Deciding about a prostate blood test · Low mood after losing a job

Criteria: Relationship building · Providing structure. Let them speak, acknowledge, apologise for the experience, explain and agree what happens next.

“I'm sorry you've had such a long wait – I can see how upsetting that is. Let me explain what is happening and what we'll do now.”

Practise it (4): Request for antibiotics for a sore throat · Angry relative about emergency department waiting time · Disclosing a medication error · Supporting a carer of a parent with dementia

Criteria: Patient's perspective · Information giving. Warning shot, simple words, silence, then support and a plan.

“I'm afraid the scan has shown something we need to talk about… [pause] … I'll make sure you have support, and we'll go through the next steps together.”

Practise it (2): Disclosing a medication error · Abnormal finding on the pregnancy scan