The Ultimate

Guide to the OET

Speaking Sub-test
Clinical Communication Criteria

www.oet.com
2 | The Ultimate Guide to the OET Speaking Sub-test
Contents

About the Clinical Communication Criteria 4

1. Indicators of Relationship Building 6

2. Indicators of Understanding and

Incorporating the Patient’s Perspective 14

3. Indicators of Providing Structure 18

4. Indicators for Information Gathering 26

5. Indicators for Information Giving 36

OET | 3
 About the Clinical
Communication
Criteria
Good communication is about more than just
your delivery of the English language. It’s also
about how you start a conversation, interact
with patients (or their relatives), and check if
someone needs additional help.
This is what OET’s assessors will look for when scoring your language test.
Our Clinical Communication Criteria are what sets OET apart as the best
English test for healthcare professionals. These five criteria will test you on not
just your knowledge of English, but the communications skills which are valued
by patients, healthcare regulators, and employers.

Introducing the five Clinical

Communication Criteria

1. Relationship 2. Understanding and 3. Providing

Building Incorporating the Structure
Patient’s Perspective

4. Information 5. Information
Gathering Giving

4 | The Ultimate Guide to the OET Speaking Sub-test

What will the outcome be
of an OET Speaking Test?

This is your opportunity to build familiarity and

proficiency in the skills you’ll need when working
in an English-speaking workplace.
After passing the OET Speaking Test, you will feel
confident that you have the knowledge to speak
to patients and their relatives comfortably, about
a range of healthcare topics.

Note:
To be clear, the Clinical Communication Criteria
are language-based - they will not evaluate your
medical knowledge.

OET | 5
1. Indicators of
Relationship Building
In the first of the Clinical Communication Criteria,
OET assessors will focus on how well you develop
rapport - that is, a close and comfortable relationship
- with your patient or their relative.

There are a number of ways to develop rapport which are covered by this criterion:

1 Initiating the interaction

appropriately 3 Adopting a
non-judgemental attitude

2 Demonstrating an attentive
and respectful attitude 4 Showing
empathy

Initiating the interaction appropriately

Initiating an interaction appropriately means getting
the role play off to a good start. First impressions
matter. The first words of any conversation with a patient
could reduce their anxiety, or raise it. This is why it’s
so important to begin all interactions in an appropriate
manner for the context.

But how do you decide what is appropriate? You’re

obviously not going to start a difficult conversation with a
cheerful greeting. Equally, if you know a patient has been
waiting a long time for you, you wouldn’t start talking
without apologising for the delay.

6 | The Ultimate Guide to OET

the OET
Speaking
Speaking Sub-test
To understand what is or is not appropriate,
you will need to consider:

Where is the conversation taking place?

-Are you visiting the patient at home, or have they been hospitalised?
The setting to
your conversation -Is it an emergency?

[Each of these situations would require a different way of starting the

conversation, to demonstrate that you are aware of the setting.]

Do you know the patient, and have you met before?

-Is this the first time you are greeting them?

-Have you just examined the patient as per the role card?
The background
to the situation
[If meeting for the first time, introductions will be appropriate. But, if
you’ve met before then greetings instead of introductions are fine.
Finally, if you’ve examined the patient as per the role card, no greetings
or introductions are required - simply start with task one and the findings
of your examination.]

What do you know about how the patient is feeling?

-Does their background information give you any clues as to their

emotional state? Perhaps they are frustrated from waiting, or anxious
Any emotional about possible bad news.
factors
[If you believe you know how someone is feeling, try to acknowledge
this when starting the role play by offering the appropriate response - an
apology for being late, some reassurance about your news, etc.]

Why are you having this conversation?

-Are you providing advice, test results, or a diagnosis?

The nature of the -Are you offering an explanation, treatment options, or reassurance?
conversation
[Clarifying what you plan to discuss at the beginning of a conversation
can help ease someone’s anxiety. It will also allow them to process their
thoughts and positively contribute to the discussion.]

OET | 7
How did our three example candidates
manage the beginning of their role plays?

Listen to real candidates completing a role play to understand the examples throughout the rest of
this guide. Keep the audios open so you can access them in the following chapters.

Steps for listening to the audio with the examples:

Doctor Audio Listen here 1 | Match the profession audio above with the
profession in the examples to hear the relevant audio.
Nurse Audio Listen here
2 | Use the time stamps in each example to find the
right part in the audio for each example. For example,
Speech Pathologist Audio Listen here open the Doctor audio and find 0:32 (from the Doctor
example) in the audio.

Example 1
The Doctor is seeing a patient recovering from a mild anterior acute myocardial infarct.
Setting: General Practice. The patient may or may not have met the doctor before, so the candidate
may either introduce themselves or simply greet the patient as if they know each other already
Background: The patient is ‘very concerned about the long-term process of recovery’, suggesting
that reassurance will be an important part of the conversation.

[00:00:32.57]
Doctor: Good afternoon. My name is Rico, I’m a doctor on duty today. May I confirm
your name?

[00:00:39.56]
Interlocutor:
Certainly. My name is Sally.

[00:00:41.66]
Doctor:
Sally, nice to meet you. How can I help you today?

Assuming this was their first meeting, the introduction and inclusion of “nice to meet you” are
appropriate and pleasant. The final question, “How can I help you today?”, invites the patient to
offer their reason for the visit, which is also appropriate.
If the Doctor knew him/her already, they could have acknowledged the patient’s concerns in
place of this question.

8 | The Ultimate Guide to the OET Speaking Sub-test

Example 2
The Nurse is visiting a patient at home for the first time. This visit was arranged by a doctor.
Setting: The patient’s home
Background: The purpose of the visit is to discuss the patient’s diabetes, and specifically their
insulin injections. There is no mention of how the patient might be feeling about this topic.

[00:00:33.07]
Good morning. My name is Amrit. I’m a nurse and I have been sent to
Nurse: you by your general practitioner - your doctor. Um, he reported that your
blood sugars have been high recently. Would you like to tell me about
your diabetes level?

Given the Nurse is visiting the patient at home, it’s likely they would know the patient’s name
(it could have been checked during the preparation time). This could have been added to the
initial greeting, after “Good morning”. The Nurse’s introduction and explanation for the reason for
her visit are both appropriate. Additionally, the final question allows the patient to explain their
situation in their own words.

Example 3
The Speech Pathologist is speaking to the spouse of one of her patients about a recent
assessment that she conducted at a private clinic.
Setting: The two speakers know each other
Background: There is no mention about how the spouse is feeling, but the background information
tells us that the patient is feeling anxious.

[00:01:23.38]
Hi, I’m Calina. I’m the speech pathologist that’s been working with your
Speech Pathologist: spouse and we’re here to discuss the results of an assessment. How
much information, um, do you want today? What kind of information are
you looking for?

Here, the Speech Pathologist could have added “as you know” before giving her name. This would
have made both the introduction and stating of her role more appropriate, and also excused her
from not asking the spouse for their own name. Otherwise, the Speech Pathologist briefly states
the purpose for the conversation and offers the spouse an opportunity to explain her objectives
through the use of an open question.

OET | 9
 they want to say next, or to check how many
Demonstrating an tasks they still need to speak about. This can be
attentive and respectful very obvious to assessors, as when the patient
stops speaking, the candidate says something
attitude inappropriate in response or abruptly changes the
direction of conversation.
In some respects, the Speaking Test makes
it easier to show attentiveness than in real Remember - focus on your patient while they
life, where you would likely have a computer are speaking. You must HEAR what they are
screen or chart in front of you while listening to saying. This shows respect, and allows you
the patient. Without these distractions, you’re to understand your patient’s feelings and
opinions, even if you don’t agree with them.
free to give the patient your whole attention.
In patient-centred care, their feelings and
Some candidates do not do this. They will use opinions should be invited, accepted and, if
the time a patient is speaking to consider what necessary, explored and modified.

Example 1
Here, the Speech Pathologist demonstrates both an attentive and respectful attitude by picking up
in her response the example that the spouse has just mentioned (socialising), while demonstrating
empathy for the impact this has on the spouse themselves.

[00:02:43.66]
Well, it’s been really difficult to be honest. It’s been hard when we’ve been
Interlocutor:
out socialising because, you know, you want to have a conversation, but
you can’t quite understand what he’s saying.

[00:02:55.27]
Speech Pathologist: Especially out with multiple people, the volume level’s up for everybody
and he doesn’t get to express himself. That must be hard for you, too.

[00:03:04.81]
Interlocutor:
It has been.

Example 2
Reminder:
The Doctor also demonstrates attentiveness by responding Listen to the matching
to the patient appropriately after each comment they
make. In this exchange about diet, the Doctor makes it audio found on page 8.
clear the patient’s preferred foods are not very healthy, Click here
without it sounding critical.

[00:04:06.44]
Doctor:
OK, diet is very important. What do you eat regularly?

[00:04:14.60]
Well, I have to admit, I really like drinking lots of beer and, you know, eating
Interlocutor:
lots of, you know, steaks and pies and chips - and things like that. They’re
my favourite foods.

[00:04:27.86]
Doctor: Mmm. OK, I see. Yeah, but fatty and oily food, well, it’s not good for your
health.

10 | The Ultimate Guide to the OET Speaking Sub-test

Example 3
The Nurse also talks to her patient about diet and discovers that the patient doesn’t eat foods which
are suitable for someone with diabetes. She uses softening language to sound less critical before
providing her advice.

[00:01:24.35]
Sure. Um, so I guess I think I have a pretty normal diet. I like to have, you
know, baked beans and toast in the morning and, you know, for lunch I’ll
Interlocutor: have, you know, a sandwich. And, you know sometimes I like to have, like,
fruit afterwards. And then, you know, in the afternoon, I like to have a sweet
biscuit and tea and then, you know, just normal sort of, you know, meat and
three veg for dinner.

[00:01:53.39]
I see. What I’m suspecting is that you have been taking sugar, as you
mentioned, you are taking sweet biscuits and you are taking breakfast in the
Nurse
morning, which was sandwiches and beans. I believe they are high in sugar
and it is very important for you to just take diet - which is low fat and sugar
free. So this will really, really help you to maintain your diabetes levels.

As a result, they will often want their wishes

Adopting a non- to be taken into consideration and may be
judgemental approach resistant to hearing something different.
Of course, you are not expected to always
This aspect is directly linked to the previous
agree with your patient’s self-assessment. You
one on demonstrating attentiveness and
are still the expert, and must guide them on
respect. As part of patient-centred care, what is safe and appropriate for their needs.
healthcare professionals are expected to listen How you achieve this is the main focus of this
to their patient’s opinions. But, these days aspect of Relationship Building. You must find
many patients turn up to appointments already a balance between guiding your patient, while
‘informed’ - having Googled their symptoms. respecting their existing opinion.

Things you will need to be non-judgemental about:

1 Preference for a particular treatment path, i.e.

antibiotics, non-surgical/medicinal options 3 Poor
diet/exercise

2 Reluctance to change lifestyle

factors/current routines 4 Use of
alcohol/tobacco.

Earlier, we saw both the Nurse and Doctor hear that their patients had diets which were less than
ideal for their respective health conditions. Both of them managed to respond to their patients’
descriptions of their diet without judgement, while also making it clear that some changes would
be beneficial. The Speech Pathologist’s conversation partner (the spouse of the patient) did not say
anything which she needed to be non-judgemental about.
Your role card may not expect you to demonstrate every aspect of every criterion. This is why you will
complete two role plays in the Speaking Test, so that you can provide the range of language naturally.

OET | 11
 best tool you have to reassure your patient, and
Showing empathy to help them feel less nervous - like you really
Empathy is the ability to understand and care for their situation.
share the feelings of another person. Where In real life, empathy can be as simple as a kind
appropriate, showing empathy to your patient smile or, where appropriate, a light physical
is another way of demonstrating respect and touch (such as a squeezing of their hand). In your
avoiding a judgemental approach. But it can Speaking Test, which is recorded as an audio file
also be so much more. for the assessor, you must ensure your empathy
When patients seek healthcare advice or is verbal. Using words like “understand”,
treatment, they often do so because something “appreciate”, “reassure” or even “we” instead of
is or feels wrong. They may feel anxious, “you” or “I” will show that you are working with
vulnerable and afraid. Empathy could be the your patient as a team, rather than an individual.

Example 1
The Speech Pathologist heard the patient’s spouse say that socialising is difficult at the moment
because the patient finds it embarrassing that people can’t understand him. She shows empathy
by agreeing with what the spouse has said and provides reassurance that the technology she had
previously mentioned will assist with this situation.

[00:05:08.28]
Very understandable. Yeah, it will definitely. Especially with the speech
Speech Pathologist:
pathologist that you choose to work with, these, um, technologies that will
help, um, find the right one that he can feel the most comfortable with.

Example 2 Reminder:
During her role play, the Doctor’s patient expresses concern Listen to the matching
that she is going to be an invalid for the rest of her life, audio found on page 8.
following her recent heart attack. The Doctor shows empathy Click here
by acknowledging the concern and providing reassurance.

[00:06:03.02]
Yeah, it must be difficult for you about the situation, but let me reassure
Doctor:
you. I’d like to say your condition is manageable and also curable as
long as you follow my advice.

Example 3
The Nurse misses some opportunities to show empathy to her patient when they are discussing
the process of self-injecting insulin. Firstly, the patient admits she is afraid of injecting insulin, then,
once the Nurse has started her explanation, she also says, “Oh”, in a way which clearly sounds
worried and unhappy. Both were chances for the Nurse to show empathy.
[00:02:53.78]
Interlocutor:
No, no. I’m very afraid of, um, injecting insulin.
[00:02:57.54]
Nurse:
OK. Let me explain that to you.
[00:03:31.43]
Interlocutor:
Oh!
[00:03:31.85]
Nurse:
So do not worry.

In the above example, the Nurse seems to register the concern - but telling the patient “do not
worry” is inadequate. It does not show any understanding of the patient’s concern nor does it
sound reassuring. If anything, it dismisses the patient’s concern and causes their anxiety to grow.

12 | The Ultimate Guide to the OET Speaking Sub-test

 [00:04:03.38]
Interlocutor: Oh that sounds very scary. I mean, I don't know what that layer of skin is.
And the pinching - all of that sounds really, really scary.

[00:04:12.44]
Nurse: I can understand your concern because you have never used the insulin
syringe. It is totally fair.

Here, finally the Nurse responds to the patient’s distress but, as we saw in Appropriateness
of Language, the tone does not match the words - so she still sounds quite dismissive of her
patient’s feelings.

OET | 13
2. Indicators of Understanding
and Incorporating the
Patient’s Perspective
In this second criterion, assessors will focus on how
well you involve the patient or their relative in the
conversation.

In particular, they will assess how you:

1 Elicit (ask) and explore

the patient’s views 2 Pick up on the
patient’s cues 3 Relate your explanations
to the patient’s views.

Note: Points 1 and 3 of what assessors are looking for are linked, so they will be covered together.

Elicit and explore The OET Speaking Test aims to simulate actual
workplace communications. As such, during the role
the patient’s views play you will be expected to involve the patient in the
conversation, as you would in real life.
- and relate your This means you must actively elicit (ask) what the
explanations to the patient thinks about their situation. You can do this with
questions, and then explore further using follow-up
patient’s views questions or by summarising your understanding of what
the patient has said.

Verbs at the start of the cards give you clues as to when this is expected. For example:

1. Find out 3. Confirm

2. Explore 4. Establish

Once you have discovered the patient’s views, it is then important to include these in any subsequent
explanation you give. This will demonstrate you have been listening, and will help you personalise the
information for your patient.

Ask Listen Respond/Explore further Listen Explain/Reassure Include the patient’s views

14 | The Ultimate Guide to the OET Speaking Sub-test

How did our three professionals
do at these elements? Reminder:
Listen to the matching
Example 1 audio found on page 8.
The Nurse demonstrates good eliciting of the patient’s views regarding her diet, Click here
and then relates the explanation she gives the patient to these views.

[00:01:16.36]
Nurse Okay, I understand that. Could you tell me a bit more about your diet? Er, what kind of diet you
have been taking?
[00:01:24.35]
Sure. Um, so I guess I think I have a pretty normal diet. I like to have, you know, baked
beans and toast in the morning and, you know, for lunch I'll have, you know, a sandwich.
Interlocutor:
And, you know sometimes I like to have, like, fruit afterwards. And then, you know, in the
afternoon, I like to have a sweet biscuit and tea and then, you know, just normal sort of, you
know, meat and three veg for dinner.
[00:01:53.39]
I see. What I'm suspecting is that you have been taking sugar, as you mentioned, you are taking
Nurse: sweet biscuits and you are taking breakfast in the morning, which was sandwiches and beans. I
believe they are high in sugar and it is very important for you to just take diet - which is low fat and
sugar free. So this will really, really help you to maintain your diabetes levels. Is that clear for you?

Example 2
The Doctor is able to elicit from the patient what they are seeking help for at the start of the conversation, and then relates
their response to the information the patient gives.

[00:00:41.66]
Doctor:
Sally, nice to meet you. How can I help you today?
[00:00:46.07]
Interlocutor: Well, um, I had a mild heart attack two weeks ago and I've just been feeling really tired, I
guess. And I'm a bit worried about what that means for me in the future.
[00:01:02.51]
Doctor: I see. It's perfectly normal to feel worried at this stage. So let me reassure you. So I'd like to
suggest joining a cardiac rehabilitation program which my hospital provides for outpatients.

Example 3
The Speech Pathologist also provides a good example of eliciting the spouse’s views and including these views in the
response she gives her.

[00:03:27]
Speech Pathologist:
Um, and what are your thoughts about, um, assistive technology?
[00:03:33.16]
Well, it's something I'm very unfamiliar with. I guess the problem with his speech is kind of a new
Interlocutor:
thing. So, you know it's all very new to me. I don't really know much about what the treatment
options are or kind of what we can do. But, um, yeah, I'm really open to sort of anything that can help.
[00:03:51.76]
Speech Pathologist: Yeah. So a full assessment of his needs right now, um, and his capabilities right now will go into fitting
him for technology that will work. And then you guys can pick what works best for the two of you.

To make this an even stronger response, the Speech Pathologist could have directly acknowledged what the spouse said.
For example, “That’s great that you’re open to technology”, or, “It’s understandable that you’re unsure, there are so many
options available.”

OET | 15
 (shock, disagreement, fear, happiness),
Picking up the and accompany those feelings with a word,
patient’s cues phrase or statement. Noticing cues is very
important - missing them could increase
Cues from a patient can either be visual a patient’s discomfort or confusion, which
or audible, but will often be both. They may then cause you difficulties as you try to
may show their feelings on their face repair the situation.

• I see what you’re saying • But…

Examples
Examples of
• Right of Negative • Mmm
Positive Cues
Cues
• That’s clear • Oh!

[These show the information you have given a [These show the patient has doubts or concerns
patient has been understood.] about the information.]

Example 1
Missed cues are clearly seen in the Nurse’s role play. She is starting to explain how the patient
will self-inject insulin, but misses a number of verbal cues from the patient who has become
increasingly anxious.

[00:02:49.76]
Nurse:
Ok. And have you ever used insulin injections?

[00:02:53.78]
Interlocutor:
No, no. I'm very afraid of, um, injecting insulin.

[00:02:57.54]
OK. Let me explain that to you. Er, as I mentioned your blood sugar
levels are high. We need you to use insulin injections at home. Um, I'll
Nurse explain to you how to use insulin injections. So, for the insulin injection,
you will be given the insulin needles. They are disposable. They are only
for one use for the procedure. Er, it is going to be a subcutaneous layer,
which is the superficial layer.

[00:03:31.43]
Interlocutor:
Oh!

[00:03:31.85]
So do not worry, I will explain to you how to correctly use the needle to
your skin. So, you have to just prick your subcutaneous layer at the forty-
Nurse five angle; you need to insert the needle very nice and slow and the
medication will go inside, and after that you will have no side effects. But
if you do have a headache or dizziness, I suggest you immediately seek
a doctor's advice.

[00:04:03.38]
Interlocutor: Oh that sounds very scary. I mean, I don't know what that layer of skin is
and the pinching. All of that sounds really, really scary.

16 | The Ultimate Guide to the OET Speaking Sub-test

Example 2
On the other hand, the Speech Pathologist does a good job picking up on the spouse’s implied cue
about what life has been like for her.

[00:02:34]
Interlocutor: He's been slurring his speech a little bit and it's been sometimes hard to
understand what he's saying.

[00:02:40.63]
Speech Pathologist:
Yeah. And so how are you doing with that?

The Speech Pathologist demonstrates she has truly listened to what the spouse has said, and that
she recognised that what she’s describing must be difficult. She follows up with a question to find out
how it is making the spouse feel.

Example 3
The Doctor’s patient is quite direct about the information she requests and provides, which makes
it easier for the Doctor to respond to these cues.

[00:04:49.55]
Doctor: So I'd like to suggest to keep a healthy diet and if you want, I can
arrange an appointment to see a dietitian.

[00:05:00.71]
Interlocutor: Yeah, I think that's really important. I don't want to admit it, but I think I
probably should. Yes.

[00:05:10.49]
Doctor:
And also how about do you have any hobbies to reduce your stress?

To make this conversation stronger, the Doctor could have responded to the patient’s agreement
before moving on to ask about hobbies. For example, “That’s good. And also how about…”.

OET | 17
3. Indicators of Providing
Structure
The third criterion that OET assessors will use to score
you is Indicators of Providing Structure.
There are three indicators that you will need to show:

1 2 3
Sequencing (arranging) Signposting Using organising
the interview purposefully changes in topic techniques
and logically within explanations.

Sequencing the interview - unlimited time is, unfortunately, not available in

most healthcare settings.
purposefully and logically
This indicator has two parts that you will Of course, you can’t rush, either. You must
need to consider, both contained in the title: learn to balance ensuring a patient feels heard
‘purposefully’ and ‘logically’. and informed with the time you have available
for the conversation. As such, preparing for
This is a real-life skill that you will need in any the OET Speaking Test is a great way to train
healthcare workplace. During conversations for this element of your work. To support you,
with a patient or their relative, it is up to you the series of tasks on your card outline what
- the healthcare professional - to start and
you should discuss with each patient. It is
manage the discussion. You will typically decide
when to move onto the next topic once the first your responsibility, though, to manage the five
has been sufficiently covered. Employers in the minutes available to you by allocating the time
healthcare sector will expect you to be efficient you spend on each task.

18 | The Ultimate Guide to the OET Speaking Sub-test

Exercise: Learning to To make this decision, you’ll need to consider
the complexity of the task in terms of the
manage your time in a information you will need to provide, and
conversation whether you expect the patient to have many
questions or difficulties understanding.
To manage your time effectively, it can be
useful during preparation to quickly analyse
each task and allot an amount of time to
spend on it.

Here are some examples:

Task Time Requirements

Find out what further As little as less than a minute, requiring just a simple question and
information you need. answer.

Advice on other
appropriate activities
(e.g. walking, Up to a minute. It’s simple information to provide, although the
swimming) and then patient will likely have questions. It should not lead to a lengthy
check to see how the debate.
patient feels about the
suggestions.

Describe specific leg

strengthening exercises One to one and a half minutes. There is quite a bit of information to
suitable for your provide and you will need to pause, check for clarification, etc.
patient.

Convince the patient One and a half minutes or more. Convincing a patient of something
that the nasal spray is means they may not agree immediately, you will need to provide
the best option. further explanation as to why this treatment is right for them.

1 To be ‘purposeful’
You need to have a plan for how to
2 To be ‘logical’
You must follow the order of the tasks
complete the content within the time as they are given on your card. The
allowed. If the patient asks questions tasks have been written to create a
which take more time to respond to, natural flow for your conversation, and
that’s fine - it’s a natural part of your are mirrored on the card the interlocutor
role. But if the patient moves the uses. Try to cover off each task before
conversation forward rather than you, moving on to the next one - so there
or you spend too long on a topic which is no need to return back to old topics
could be completed more speedily, you afterwards (unless required because of
may be penalised. a patient question).

OET | 19
All three of our example health professionals have been successful at managing
the time in their role play and moving through the tasks logically.
The Nurse and Speech Pathologist have shown more purpose by clearly moving the conversation
forwards onto the next task. The Doctor, however, often moves forwards based on a question asked
by the patient - rather than because they themselves have indicated that it is time to move on.

Example
In this example, the Doctor checks if the information she
Reminder:
has just given the patient about exercise is clear. But
instead of following this up by asking the patient if she Listen to the matching
has questions, it would have been more purposeful to audio found on page 8.
move onto the next task: ‘provide recommendations for Click here
prevention of future attack’.

[00:02:54.35] OK. Because exercise will help decrease the lower

Doctor: cholesterol level and also lose your weight and strengthen your heart.
So it's very positive for your condition. Is that clear for you?

Interlocutor: [00:03:12.32] Yeah, that's very clear. Thank you.

Doctor [00:03:14.78] Do you have any questions?

[00:03:16.79] I do actually. I'm really hoping that I can return to work.

Interlocutor: And I was wondering, um you know, whether I can do that or you know if
I have to be off work for a long time.

20 | The Ultimate Guide to the OET Speaking Sub-test

Signposting changes in topic
Signposts can be simple:
To move a conversation forwards effectively, you
will need to make it clear to the patient that you
are doing so - especially when changing topics to • Ok…
discuss the next task. The normal way to do this is to • So...
use a word or phrase to act as a ‘signpost’ to direct the • Now...
patient to the new topic.

Or slightly longer:

“Is it OK if we come back to that?”

“Thanks for that.”
[Indicating that you have heard the patient’s
[Indicating the end of one topic and the start of
question but it’s not a priority at this point in the
another.]
conversation.]
“Is it OK if we move on?”
“Can we talk about…”
[Indicating you feel the topic is complete and
[Indicating the start of a new topic.]
are seeking confirmation that the patient feels
the same.]
Signposts enable the conversation to move forwards smoothly while ensuring you don’t miss
important details that the patient wants to share. Without them, the patient can end up feeling
confused because it may take them a few seconds to realise the topic has changed.

Example 1
The Speech Pathologist doesn’t make use of signposting words or phrases, instead starting most
of her statements or questions with “um”, including in the example below. “Um” can act the same
as a signpost but it doesn’t make the speaker sound confident, or professional. One of the above-
mentioned examples would have been better.

[00:03:06.70] Um, there are many treatment strategies that we can look
Speech Pathologist:
into. Um, there's devices that we can use to assist in his speaking.

Example 2
Equally, the Nurse uses less confident/professional-sounding signposts to indicate a change in
topic. She also sounds a little flustered because she has realised she needs to change topic.

[00:05:14] It is err, it is, um, alright. Um and also, I need you to, um,
dispose of the needle in a safe way, so we will provide you the container,
Nurse:
which is a yellow container, and you need to dispose the needle in there
in the yellow box.

Example 3
As mentioned previously, the Doctor wasn’t particularly purposeful in her role play, meaning that the
patient was often moving the conversation forwards to the next topic. At these times, the Doctor
didn’t need to use signposting language because she was responding to the change of topic
introduced by the patient.

OET | 21
Using organising techniques in explanations
We have already seen how organisation can help a conversation with a patient progress smoothly.
Organising your ideas within an explanation will make the information you need to provide to the
patient easier for them to understand and process.

Giving explanations is an important part of a healthcare professional’s work.

You might need to explain…

1 Why a particular treatment

is necessary. 3 How to use a piece of
healthcare equipment.

2 Why the treatment pathway the patient is

requesting is not suitable for their healthcare needs. 4 How to follow a healthier
lifestyle, etc.

But, explanations can be long and contain a lot of new information for the patient or their relative.
This could make them confusing, or make the patient feel anxious about whether they will
remember all of the details.

There are some simple techniques you can use to make

explanations more successful. These include:
1. Chunking (splitting) information into smaller chunks that are easy to remember, e.g. the
steps of a process
2. Pausing between pieces of information to allow the patient time to understand each before
moving on to the next
3. Checking with the patient as you provide the explanation, to ensure they understand what you’re
telling them
4. Using organisational language, e.g. “firstly”, “then”, “the final thing…”, etc.

5. Using highlighting language, e.g. “critical”, “essential”, “must”, “mustn’t”, etc.

6. Providing a summary, or asking the patient to provide a summary, at the end of an explanation
(we will cover this more in the criterion Indicators for Information Gathering).

Remember:
Although you may have given this explanation many times before, it
is likely the first time your patient has heard it. Think about how you
feel when you are given a lot of important verbal information and try
to incorporate some organising techniques within your explanations.
This can reduce the mental strain on the patient, and lead to better
healthcare outcomes.

22 | The Ultimate Guide to the OET Speaking Sub-test

OET | 23
Example 1
The Nurse needs to explain to her patient how to Reminder:
self-inject insulin. She covers a number of steps fairly Listen to the matching
quickly, without taking into account the patient’s
fears. Using the organisational techniques mentioned
audio found on page 8.
above (as well as lay language) would have made this Click here
explanation more successful.

[00:02:49.76]
Nurse:
Ok. And have you ever used insulin injections?

[00:02:53.78]
Interlocutor:
No, no. I'm very afraid of, um, injecting insulin.

[00:02:57.54]
OK. Let me explain that to you. Er, as I mentioned your blood sugar levels are
high. We need you to use insulin injections at home. Um, I'll explain to you how
Nurse:
to use insulin injections. So, for the insulin injection, you will be given the insulin
needles. They are disposable. They are only for one use for the procedure. Er, it
is going to be a subcutaneous layer, which is the superficial layer.

[00:03:31.43]
Interlocutor:
Oh!

[00:03:31.85]
So do not worry, I will explain to you how to correctly use the needle to your skin.
So, you have to just prick your subcutaneous layer at the forty-five angle; you
Nurse:
need to insert the needle very nice and slow and the medication will go inside,
and after that you will have no side effects. But if you do have a headache or
dizziness, I suggest you immediately seek a doctor's advice.

[00:04:03.38]
Interlocutor: Oh that sounds very scary. I mean, I don't know what that layer of skin is and the
pinching. All of that sounds really, really scary.

Example 2
The Doctor needs to explain the importance of exercise to the patient for their post-heart-attack
recovery. Her speech is quite slow and carefully delivered, meaning that different parts of the
information are clear to the patient. She also allows space for the patient to request clarification.

[00:04:49.55]
Interlocutor: I'm not sure how much physical activity I'm meant to do, you know. I'm a bit
worried about that.

[00:01:46.49]
Yeah, OK, right. So it's better to avoid strong exercise, for example, jogging or
Doctor: swimming, within six weeks. But after six week, you can try a strength exercise,
but usually it's better to start from light exercise - for example, walking or
stretching.

[00:02:13.04]
Interlocutor: OK, and I guess I want to know how much is advisable because I'm worried about
there being a relapse. So if I walk every day, is that too much?

24 | The Ultimate Guide to the OET Speaking Sub-test

 [00:02:30.17]
Doctor: Yes, I understand your concerns. Yes. So it's better to start from about 30 minutes
only on the weekends. Is it possible for you?

[00:02:43.10]
Interlocutor: I mean, it's a bit unusual. I'm not really a fan of exercise, but I think it's something I
have to do. So, I guess I can.

[00:02:54.35]
OK, because exercise will help decrease the lower cholesterol level, and
Doctor:
also lose your weight and strengthen your heart. So it's very positive for your
condition. Is that clear for you?

[00:03:12.32]
Interlocutor:
Yeah, that's very clear. Thank you

Example 3
The Speech Pathologist needs to explain the condition of dysarthria to the patient’s spouse, and that
dysarthria is a common symptom of Parkinson’s disease (which the patient already has). She provides
the information at a steady speed to make it easier for the spouse to understand. In addition, she
uses lay language (simpler language) and checks with the spouse as she goes along to find out if she
requires additional information or explanation.

[00:01:47.50]
Speech
OK, um, so we found that he has dysarthria, which is difficulty speaking clearly.
Pathologist:
Um, it's a common symptom of Parkinson's and it looks like it's been progressing.

[00:02:04.25]
Interlocutor:
Mmm, mmm.

[00:02:04.25]
Speech
Um, the causes of dysarthria are the weakening of articulatory muscles. Do you
Pathologist:
know what that means?

[00:02:15.01]
Interlocutor:
Er, no.

[00:02:15.01]
Speech
So it means that the muscles that it takes to speak are getting weaker and it's
Pathologist:
harder for him to put them into action, and to form the sounds.

[00:02:25.96]
Interlocutor:
Ah, OK, right.

Speech [00:02:27.46]
Pathologist: So maybe a little slower, it may be a little off sounding as well.

[00:02:31.27]
Interlocutor:
Oh, OK. Yes, that's definitely been the case.

OET | 25
4. Indicators for
Information Gathering
The fourth Clinical Communication Criterion covers
the way that you collect information from the patient,
or their relative.
There are five aspects within this criterion that assessors will focus on when scoring your speaking:

Note:
There is a lot of detail provided within each of the
below five aspects. Blue text has been used to
make the most important words stand out.

1 Facilitating the patient’s narrative with

active listening techniques, minimising interruption 4 NOT using compound
questions/leading questions

2 5
Clarifying statements
Using initially open questions, appropriately which are vague or need
moving to closed questions amplification

3 Summarising information to
encourage correction/invite further information.

Active listening There are a number of ways you can do this.

They will not only show your patient that you’re
techniques listening to them, but can encourage them to
How do you show someone that you're keep talking to you so you hear, in their own
listening to them? In particular, how do words, the situation that they are describing. This
you show that you are listening on an audio is highly important - interrupting your patient may
recording, which is what the OET assessors mean you miss important details, which could
use to score your Speaking Test? impact the rest of the conversation and any
decisions you make about their treatment.

26 | The Ultimate Guide to the OET Speaking Sub-test

Active listening techniques are easy, and could be something you do already
when speaking with patients. Here are some examples:
1. Mmhmm 4. Go on...

2. OK 5. Oh dear (when the patient expresses

something sad or difficult).
3. I see

As you can see, an active listening technique is a small expression which you can include when the
patient pauses in their description or explanation. It shows you are paying attention, but doesn’t
interrupt them from continuing.

What about body language?

In real life, body language is a great means of showing active listening: Look at your patient, tilt
your head slightly to one side, nod or shake your head, or use facial movements.
Of course, these will not show up in the audio recording of your Speaking Test. But, you can still
use them to help you feel that this is a real conversation. It will also better prepare you for an
English-speaking healthcare workplace.

Active listening through responding and rephrasing

During a conversation, consider also responding to what the patient has just said by repeating
or rephrasing their words. This is a third way to show active listening, as it proves that you
heard what they said - and understood.
Some candidates find this more difficult. They move on to their next topic without making an
appropriate response. However, this could feel uncomfortable to the patient.

Here are some examples of what to do and what not to do to show this type of
active listening:

What the Patient Says Appropriate Response Inappropriate Response

“I’ve been busier at work “Yes, those two things are often “What is your diet like?”
and am finding it harder linked: being busier and having
to sleep at night.” poor sleep.” [This is a totally different topic.]

“Steroids are the best treatment

“I don’t really like the “You’re not alone in thinking
for this condition.”
sound of taking steroids. that. The steroids I am
I’ve heard there are lots of thinking of for you will be safe
[Doesn’t respond to the
side effects.” because…”
patient’s concern.]

OET | 27
What evidence of active listening can we find from our
three professionals?
Example 1
Reminder:
The Doctor makes a good effort to actively listen,
responding each time the patient says something to her. Listen to the matching
To make these responses even more successful, she could audio found on page 8.
repeat the patient’s concern/topic rather than using more Click here
vague words.

[00:03:22] And I was wondering, um, you know, whether I can do that or,
Interlocutor:
you know, if I have to be off work for a long time.

[00:03:12.32] I see. OK, let me explain about it. [“...about getting back to
Doctor:
work” would have been better.]

Example 2
Similarly, the Speech Pathologist could have been more specific in her responses to what the spouse
of her patient has just said. She has used very simple responses in this example:

Interlocutor: [00:03:49] I'm really open to sort of anything that can help.

Speech Pathologist: [00:03:51.76] Yeah. So a full assessment of his needs…

Example 3
The Nurse overuses the phrase “I understand your concerns” in her role play, but does attempt to
show empathy and actively listen in this response:

Interlocutor: [00:04:54] I'm really, really still a bit worried.

[00:04:56.42] I understand your concern. Lot of patients feel the same

Nurse:
way as you are feeling. But let me assure you, you will be fine.

28 | The Ultimate Guide to the OET Speaking Sub-test

Using initially open Many candidates find they have some bad
habits in their English when asking questions.
questions, appropriately This comes from not realising they are making
moving to closed questions a mistake. To check if you have any such bad
habits, record yourself asking some of the
Asking questions is one of the most important
questions you most frequently use with patients
tools for a healthcare professional. Each day
and then ask a teacher or colleague with fluent
at work you must ask literally hundreds of
English to check them for you. It may be hard
questions to find out what’s going on and help
to change old habits, so you must be vigilant to
your patients develop a treatment plan. For this
use the correct form until it becomes your
reason, it’s crucial that you can ask questions
new habit.
using accurate English.

‘Open’ and ‘closed’ questions

The main focus of this aspect of Information Gathering is your use of ‘open’ and ‘closed’ questions
specifically. So what’s the difference?

In general:

1 Open questions invite the patient to provide as much

information as they can to you, in their own words.

2 Closed questions typically require just a very short answer: Yes,

no, here, yesterday, etc.

Have a look at these examples:

• “Can you tell me about your • “Where is the pain?”

symptoms?”
• “Have you ever been given
Open Closed
• “How can I help you today?” a general anaesthetic?”
Questions Questions
• “How are you feeling about • “Do you have any
my suggestions?” questions?”

It is appropriate at the start of a conversation with a patient to hear their own words by asking open
questions. What has brought them in to see you today? How are they feeling? What is worrying
them? And so on.
Once you have heard their answers, closed questions will be a useful way of collecting more
specific detail, such as checking if they understood the information they have been given.

OET | 29
Let’s look at some examples from our three professionals
of their use of open and closed questions

Example 1
The Nurse starts with two open questions and then, later, moves on to use closed questions.

[00:00:49]
Nurse:
And, err, would you like to tell me about your diabetes level?

[00:01:16.36]
Nurse:
Okay, I understand that. Could you tell me a bit more about your diet?

[00:02:30.02]
Nurse:
Do you have any question you would like to ask me?

Example 2
The Doctor starts with introductions, which are appropriate, then asks an open question. She moves
onto a closed question at the end of her first explanation.

[00:00:41.66]
Doctor:
Sally, nice to meet you. How can I help you today?
[00:01:23]
Doctor: There is a physiotherapist and they will give you good advice for
exercise and also about your daily activities. How does it sound?

Example 3
The Speech Pathologist, as a part of her opening to the conversation, asks a closed question
followed by an open question. This could be because she realised the first question wasn’t open
enough and so corrects her error. It may also be an example of ‘compound questions’, which we’ll
look at next…

Reminder:
Listen to the matching
audio found on page 8.
Click here

30 | The Ultimate Guide to the OET Speaking Sub-test

NOT using compound questions/leading questions
Compared to open and closed questions, which are both useful tools to use with patients,
compound questions and leading questions should be avoided.
So what are they?

1 Compound question:
Asking more than one question before giving the patient a chance to answer. The problem
with these is that the patient won’t know which question to start with, or may not give full
answers to each question - meaning you miss important details.

2 Leading question: Suggesting the answer to the patient in the question you ask.
The problem here is that you are not hearing the patient’s own opinion - they are simply
agreeing or disagreeing with yours. Leading questions should be rephrased to avoid
including your suggestions.

Here are some examples:

• “You’ve had this pain

• “Have you had this pain
before, haven’t you?”
before?”
Leading Rephrased
• “Is the heel really sore?”
Question Question • “How does the heel feel?”
• “Did the fever start with the
• “When did the fever start?”
headache?”

Example 1
As mentioned earlier, the Speech Pathologist starts with compound questions - she should have
avoided this and asked just one question at a time.

[00:01:30]
Speech Pathologist: How much information, um, do you want today? What kind of information
are you looking for?

Example 2
The Nurse does something similar at the start of her own conversation.

[00:01:16.36]
Nurse: Okay, I understand that. Could you tell me a bit more about your diet? Err,
what kind of diet have you been taking?

Example 3
The Doctor does not use compound questions or leading questions.

OET | 31
Clarifying statements Sometimes, what they tell you may be
insufficient to fully understand the situation. This
which are vague or need could be because it wasn’t specific enough, or
amplification didn’t give you as much detail as you needed.
As we have mentioned, this criterion is all To manage this, you will need to ask the patient
about showing you are listening to the patient to clarify what they have said by asking them for
or their relative. more details.

Common topics patients may be vague about include:

1. Symptoms (severity, location, etc.)

2. Lifestyle factors (quantity, frequency, etc.)

3. Compliance to diet/medication

4. Medical history (events, treatment, etc.).

There are a number of reasons a patient may be vague when they talk to you.
They include:
1. Poor memory

2. Embarrassment

3. Fear of criticism

4. Pain preventing the retrieval of information.

32 | The Ultimate Guide to the OET Speaking Sub-test

If you haven’t got the information you need from a patient, don’t worry about asking further
questions to gain it. The more you know, the better help you can offer. But, consider also why the
patient might possibly be concealing information and show empathy for this, if needed.

Example 1
The Nurse’s patient tells her at the start of their conversation that they have been modifying their diet,
but they use quite vague language. The Nurse asks for clarification.

[00:01:02]
Interlocutor: And, um, I've been trying a few new things with my diet, and I've been
trying to cut out sugar. And, you know, that's been really my main focus.

[00:01:16.36]
Nurse:
Okay, I understand that. Could you tell me a bit more about your diet?

Example 2 Reminder:
The Speech Pathologist does not ask the spouse of her Listen to the matching
patient for any clarification. It is possible that this won’t be audio found on page 8.
necessary in every role play; however, you’re likely to use
all of the indicators in at least one of your two role plays Click here
making up your test.
One instance where the Speech Pathologist could have asked for clarification was when the spouse
mentioned her lack of knowledge of treatment options using quite vague language. Clarification
may have helped the Speech Pathologist find out exactly what the spouse was aware of in terms of
treatment options.

[00:03:43]
I don't really know much about what the treatment options are or
Interlocutor:
kind of what we can do. But, um, yeah, I'm really open to sort of
anything that can help.

Example 3
Similarly, the Doctor doesn’t ask her patient to clarify anything. There are a couple of instances
where she could have enquired further to gain a more detailed understanding of her patient’s current
exercise habits/preferences, or the frequency that she consumes her favourite foods:

[00:01:35.81]
Well, I mean, it sounds good, but the issue for me is that I'm not sure how
Interlocutor:
much physical activity I'm meant to do, you know. I'm a bit worried about
that.

[Here the Doctor could have asked: “How much exercise do you usually like to do?”, or, “What
exercise do you like doing?”]

[00:04:14.60]
Well, I have to admit, I really like drinking lots of beer and, you know, eating
Interlocutor:
lots of, you know, steaks and pies and chips - and things like that. They're
my favourite foods.

[Here the Doctor could have asked: “How many times per week are you eating your favourite
foods?”, or, “How many beers do you drink in a week?”]

OET | 33
Summarising information to Contrary to what you may be thinking, this isn’t
about providing a whole outline of what you have
encourage correction/invite discussed during the course of your conversation
further information (although this is something you can do). Instead,
it’s a way of checking what you heard.
Finally, one more means of clarifying
information is to summarise what you have
heard to allow your patient to correct your
understanding, or provide further details.

Here are some examples of language to summarise and then invite correction or further information:

1. “From my understanding … Is that correct?”

2. “From what you have told me … Would you say there was anything else to add?”

3. “To summarise what you said … Would you agree?”

The important point from these last two aspects (asking clarifying questions and summarising
information) is that you never just passively receive information. You are expected to confirm your
understanding and request further detail to ensure you have an accurate picture of your patient’s
healthcare needs.

Example 1
While the Doctor doesn’t use summarising techniques in the conversation, there is a good example
provided by their patient - who seeks confirmation of her understanding.

[00:06:53.83]
Interlocutor: OK, so, just so I get this right, so I'm going to go see a dietitian and then I'll
see you in a week and I've got to change my diet.

[00:07:03.40]
Doctor:
Yes.

Example 2
The Nurse repeats back to the patient what they told her about their diet, which could be seen as an
attempt at a summary - but there is no invitation at the end of this for the patient to correct or provide
extra detail, e.g. “Is that right?”

[00:01:53.39]
I see. What I'm suspecting is that you have been taking sugar, as you
Nurse:
mentioned, you are taking sweet biscuits and you are taking breakfast in the
morning, which was sandwiches and beans.

Example 3
The Speech Pathologist’s second task was to “outline the assessment results” given in quite a lot of
detail in her background information. This gave her the opportunity to summarise the assessment
details, but she skips providing detail about the assessment and moves straight to the second part
of the task - to explain dysarthria. This was a missed opportunity and is not recommended. You are
expected to complete all parts of the task on the role card.

[00:01:36.22]
Interlocutor: Well, um, I really want to know what the assessment showed. So, um, anything
that you can tell me about the assessment and what the findings mean.
[00:01:47.50]
Speech Pathologist:
Ok, um, so we found that he has dysarthria.

34 | The Ultimate Guide to the OET Speaking Sub-test

OET | 35
5. Indicators for
Information Giving
The final Clinical Communication Criterion that
you will need to learn is Indicators for Information
Giving - or in other words, your ability to take the
patient or their relative into account when providing
information that is likely to be new to them.

There are five parts to this criterion:

Note:
There is a lot of detail provided within each of the
below five aspects. Green text has been used to
make the most important words stand out.

1 Establishing initially what the

patient already knows 4 Checking whether the patient
has understood information

2 Pausing periodically when giving information,

using the response to guide next steps 5 Discovering what further
information the patient needs.

3 Encouraging the patient to

contribute reactions/feelings

36 | The Ultimate Guide to the OET Speaking Sub-test

Establishing what the came from another healthcare professional, a
friend, or the internet).
patient already knows
It’s therefore important when providing the
Healthcare professionals speak to patients at
patient with information that you check what
different stages of their healthcare treatment.
they already know. This could be at the
As such, they may have already heard some beginning of the conversation, or even during -
information about their condition or treatment whenever a new topic comes up that the patient
pathways before speaking to you (whether it may already be aware of.

There are a few reasons for doing this:

1. To avoid repeating information that the patient already has

2. To avoid contradicting any information the patient has previously been given by another
healthcare professional
3. As an important means of demonstrating patient-centred care.

Once you have established what the patient already knows, you can begin to answer their queries
or, when necessary, correct any misunderstanding or misinformation that they have reported to
you.

OET | 37
Is there evidence of our three healthcare professionals
establishing what their patients already know?

Example 1 Reminder:
The Speech Pathologist gives a good example of this at the Listen to the matching
start of her conversation. She asks the patient’s spouse what audio found on page 8.
information she wants from the patient’s assessment - which Click here
will assist her to answer more effectively and efficiently.

[00:01:23.38]
Speech Hi, I'm Calina. I'm the speech pathologist that's been working with your
Pathologist: spouse and we're here to discuss the results of an assessment. How much
information do you want today? What kind of information are you looking for?

Example 2
The Nurse checks what the patient already knows when she introduces the concept of self-injecting
insulin. From the patient’s response, she discovers that they have very limited information. This assists
her to know that she needs to provide a detailed explanation.

[00:02:41.57]
Nurse:
Right. That sounds good. Er, do you know about the insulin?
[00:02:46.58]
Interlocutor:
I've heard about it. The doctor did mention it.

Example 3
The Doctor does not show this criterion well. Near the start of the conversation, when the patient
mentions her worries about the future following a heart attack, the Doctor could have added a
question about what the patient already knows.

[00:00:46.07]
Interlocutor: Well, um, I had a mild heart attack two weeks ago and I've just been feeling really
tired, I guess. And I'm a bit worried about what that means for me in the future.
[00:01:02.51]
I see. It's perfectly normal to feel worried at this stage. So let me reassure you.
Doctor:
So I'd like to suggest joining a cardiac rehabilitation program which my hospital
provides for outpatients.
[Instead of suggesting her patient join a cardiac rehabilitation program, the Doctor could have asked:
“Can I ask what you were told about your recovery when you were discharged from the hospital?”]

Pausing periodically when Think back to when you were a student first
learning about a particular healthcare diagnosis,
giving information, using or the treatment required for a particular
the response to guide the condition. It would have felt like a lot of new
information to take in, right? You would have
next steps probably wanted the teacher to deliver the
As we’ve mentioned, it’s important to information relatively slowly, using Indicators of
understand that the information you may Providing Structure.
be giving a patient or their relative could be
This is the same for your patient.
new to them.

38 | The Ultimate Guide to the OET Speaking Sub-test

Adding pauses to your conversation
Including pauses both when you are giving information and when you have reached the end of a
piece of information gives the patient a chance to respond or ask a question.
A pause is the equivalent of taking a breath. It can also be helpful, while you pause, to look at
your patient. This signifies, in conversational terms, that you are offering them the chance to say
something. As we saw in the previous aspect of this criterion (establishing what the patient already
knows), giving them a chance to respond can assist you to provide the information they most want.

Pausing in your OET Speaking Test

It will be obvious to your assessor when pauses are not used well. In these instances, the
conversation will feel out of control as more details are added without any check with the patient to
ensure they understand what you’re saying.
The patient is also likely to indicate that there’s a problem by using their body language, i.e. their
eyes might widen, or their face looks anxious. They may make an attempt to interrupt you. Try to take
notice of such cues so you remember to pause and let the patient process the new information.
In test terms, it would be better to not complete all of the tasks on the role card than to complete
everything in a big rush, in a way the patient struggles to understand.

Example 1
It is clear that the Nurse is thinking about time, and has prioritised completing all of the set tasks over
considering how well her patient is taking it all in. When trying to provide reassurance and mention
the final point on her task (the safe disposal of needles), the information all comes out in a rush. The
patient only receives a break because the Nurse stops to say “um” a couple of times.

[00:05:10]
And, err, I will be assisting you when you are using the needle. It is err, it is, um,
Nurse: alright. Um and also, I need you to, um, dispose of the needle in a safe way, so
we will provide you the container, which is a yellow container, and you need to
dispose the needle in there, in the yellow box.

Example 2
The Speech Pathologist, while never overloading the patient’s spouse with details, could also add
some pauses to separate what she is saying. See in this example, where pauses may have been
helpful - indicated by [p].

[00:04:33.82]
Um, Parkinson's is typically not going to change. [p] There's no cure for
Speech
Parkinson's. [p] So it will progress, [p] but there are lots of ways to help him keep
Pathologist:
communicating. [p] So the muscles will probably continue to deteriorate but there
are lots of ways to help.

Example 3
As has been mentioned before, the Doctor’s speech is already quite slow, and her responses are
never lengthy. She pauses at the end of what she has said, allowing the patient to add something
they would like more detail about.

[00:05:31.09]
OK, I see. Because stress can cause a heart attack. So, controlling your mental health
Doctor:
is also important. So if you have, for example, something you like - listening to music
and hanging out with your friends - it's important to your daily activities.
[00:05:53.17]
Interlocutor:
Ok, and do you think that the condition will make me an invalid for the rest of my life?

OET | 39
Encouraging the patient agreement. If they are, compliance is much
more likely, making it also more likely that they
to contribute reactions/ will achieve the healthcare outcomes you have
feelings planned for them.
Patient-centred care should be a two-way So, you must find out what the patient thinks
conversation. It’s not about you telling the and feels about the information you have given
patient what to do and expecting them to them. If they are not OK with your suggestions,
simply agree with you. It is important to know you will need to explore the reasons for this and
whether the patient is comfortable in the reach a negotiated agreement.

Think about tone of voice

A patient’s tone of voice may not always match their words. For example, if they say “OK” quickly
and with confidence, you can accept that they are happy with what you have said.
However, if they say “OK” in a more drawn out way with a doubtful tone, you know they are saying
“yes” but really meaning “I’m not sure about this”. Try to listen to both your patient’s words and tone
to check that they match, or, if not, to explore what may be concerning them.

Example 1
The Doctor shows a good example of this aspect. After she has recommended a physiotherapist to
her patient, it gives them a chance to express their reaction and raise concerns.

[00:01:23]
Doctor: There is a physiotherapist and they will give you good advice for exercise and also
about your daily activities. How does it sound?
[00:01:35.81]
Interlocutor: Well, I mean, it sounds good, but the issue for me is that I'm not sure how much
physical activity I'm meant to do, you know. I'm a bit worried about that.

Example 2
The Speech Pathologist also encourages the spouse of her patient to contribute their feelings about
using assistive technology.

[00:03:27]
Speech Pathologist:
Um, and what are your thoughts about, um, assistive technology?
[00:03:33.16]
Well, it's something I'm very unfamiliar with. I guess the problem with his
Interlocutor: speech is kind of a new thing. So, you know it's all very new to me. I don't
really know much about what the treatment options are or kind of what we
can do. But, um, yeah, I'm really open to sort of anything that can help.

40 | The Ultimate Guide to the OET Speaking Sub-test

Example 3
Finally, the Nurse also encourages her patient to share their feelings about her explanation of self-
injecting insulin. In this conversation, though, it is an example of ‘too little, too late’ because the Nurse
has missed a number of cues about the patient’s fears (including a direct cue before she started
explaining the process, when the patient said she was very afraid of injecting insulin). When she
finally does ask the patient to share their reaction, the patient does so with strong language.

[00:04:25]
And first injection, I will give it to you so you can watch how I have used the
Nurse:
insulin injection. And I'm sure after that you will feel a bit confident with that.
Is it sound good so far?
[00:04:37.94]
I'm still nervous to be honest. Um, I know you're taking me through it, but
Interlocutor:
I still just think I'm going to freak out, you know, when it happens - that I'm
going to get overwhelmed. I'm really, really still a bit worried.

Reminder:
Listen to the matching
audio found on page 8.
Click here

OET | 41
Checking whether the health or treatment options, but the only way
to be confident is to check.
patient has understood
Even if you have used lay language and followed
information the other recommendations in this guide, it isn’t
You may believe that you have been very clear guaranteed that your patient followed the new
when giving a patient information about their information and understood.

Here are some suggestions about questions to ask:

1. “Does that make sense?” 3. “Is that clear?”

2. “Do you feel comfortable with what 4. “Do you understand?”

I have told you?”

There’s also another approach you can try. Once you have delivered your information, ask the
patient to explain back to you what they have understood. For example, “Can I check your
understanding by asking you to summarise what we have discussed?”

Example 1
The Doctor gives one example of checking her patient has understood. It comes after she has
explained the importance of exercise.

[00:02:54.35]
OK. Because exercise will help decrease the lower cholesterol level and also lose
Doctor:
your weight and strengthen your heart. So it's very positive for your condition. Is
that clear for you?

[00:03:12.32]
Interlocutor:
Yeah, that's very clear. Thank you.

That said, there are a couple of other explanations the Doctor gives (about diet and regular
monitoring) which would have benefitted from similar checks before continuing.

Example 2
The Speech Pathologist makes use of a question to check the spouse’s understanding after using the
technical term ‘dysarthria’.

[00:02:04.25]
Speech
Um, the causes of dysarthria are the weakening of articulatory muscles. Do you
Pathologist:
know what that means?
[00:02:15.01]
Interlocutor:
Er, no.
[00:02:15.01]
Speech
So it means that the muscles that it takes to speak are getting weaker and it's
Pathologist:
harder for him to put them into action, and to form the sounds.
[00:02:25.96]
Interlocutor:
Ah, OK, right.

Example 3
As previously discussed, the Nurse misses opportunities during her explanation of self-injecting
insulin to provide this information in a patient-centred way. Her use of “Is it sound good so far?”
could be seen as an example to check the patient’s understanding, but the patient has already been
expressing her concern well before this question was asked. Therefore, it’s not successful evidence
of this indicator.

42 | The Ultimate Guide to the OET Speaking Sub-test

Discovering what further information the patient needs
This last aspect is one that most OET candidates feel very comfortable with. Simply, it involves
finding out if the patient has any questions or wants to know any additional information.

“Do you have any questions?” is a perfectly Here are some examples to try:
good way to do this. But, don’t overuse the
question in one conversation. Doing so can
have a couple of unintended negative results: “Can I help you with anything else?”

1. It may sound to the assessor that you have “Is there anything more you would like to know
run out of things to say, or to the patient about…?”
like you are trying to finish the conversation
and move on to the next patient “Does that answer all of your questions?”

2. Additionally, it doesn’t demonstrate that

you have a range of options to use for “Would you be interested in a leaflet about…?”
this aspect. Like with anything, there is
more than one way to discover if the “Can you think of anything you’d like to ask me
patient requires further information. about…?”

What examples can we see from our 3 healthcare professions?

Example 1
The Speech Pathologist doesn’t make any direct attempts to cover this aspect in her conversation
with the patient’s spouse, so this would be something for her to work on.

Example 2
The Doctor asks the patient a couple of times if she has any questions, and follows up the second
response by offering an information leaflet for the patient to read.

[00:07:04]
Doctor:
Do you have any questions?
[00:07:06.70]
Interlocutor:
Um, no. I think those are all the questions that I have.

[00:07:11.32]
Doctor: Ok, so I will give you the leaflet about the patients after a heart attack so you can
read at home, and if you have any questions, feel free to ask me.

Example 3
Likewise, the Nurse asks the patient a couple of times if she has any questions. She also slightly
changes the question each time for variety.

[00:02:30.02]
Nurse:
Do you have any question you’d like to ask me?
[00:05:36.99]
Nurse:
Do you have any questions so far?

OET | 43
Notes

44 | The Ultimate Guide to the OET Speaking Sub-test

OET
OET| |4545
 The world's leading English
test specifically for healthcare
professionals

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46 | The Ultimate Guide to the OET Speaking Sub-test