What these items look like
Each Part C text has eight items. At most a couple of them test meaning in context: what a word or phrase means here, or what a reference word points back to. There are only a few, but they are often quick marks if you use the right method.
- The word X in paragraph 3 is closest in meaning to…
- What does the writer mean by X?
- In paragraph 2, this refers to…
- Such an approach in paragraph 5 refers to…
The key idea: the answer is the meaning in this sentence. Many words have several meanings, and the item often tests one that is not the first meaning you learned.
The replace-the-word test
- Find the word. Read the whole sentence and the sentence before it.
- Cover the word and think of a simple word that would fit the space.
- Put each option into the sentence in place of the word.
- Choose the option that keeps the meaning of the sentence. Reject options that are a real meaning of the word but make this sentence strange.
Text: 'The authors describe their figure of 300 avoidable admissions as conservative, since it excludes patients treated in private hospitals.' Item: The word conservative is closest in meaning to…
traditional (the meaning you know best)
deliberately low (the figure leaves some patients out, so the real number is probably higher)
Why: The rest of the sentence, since it excludes…, explains the word. Here conservative means cautious, probably lower than the true number.
Text: 'Several wards were slow to adopt the new checklist. Staff on Ward 2, by contrast, embraced it within a week.' Item: The word embraced suggests that Ward 2 staff…
held the checklist
accepted it willingly and quickly
Why: By contrast tells you Ward 2 was the opposite of slow. The literal meaning (to hold someone in your arms) does not fit.
When the item tests a phrase
Some items test a phrase, often informal or figurative: a double-edged sword, the tip of the iceberg, raised eyebrows, on the back foot. You may already know the phrase, but still check it against the context.
Text: 'The 40 reported incidents are likely to be the tip of the iceberg, as staff surveys suggest that most near misses are never written down.'
The 40 incidents were the most serious ones.
The 40 reported incidents are a small part of a much larger number.
Why: The second half of the sentence (most near misses are never recorded) confirms the meaning.
Reference words: this, these, the latter, such
Reference items ask what a word points back to. Writers use these words to avoid repeating themselves. The answer is almost always earlier in the text, usually in the same sentence or the one before.
| Word | Usually refers to | Watch out for |
|---|---|---|
| this / that | An idea, often a whole clause or sentence, not just the nearest noun | Choosing a single noun when the reference is to an action or a finding |
| these / those | A plural group just mentioned | An option that is singular |
| the former / the latter | The first / the second of two things just named | Mixing them up; mentally number the two things 1 and 2 |
| such an approach / this strategy | A method described in the previous sentence or two | An option naming a different method from earlier in the text |
| it / they | A recent noun that makes sense in the sentence | A nearer noun that does not make sense |
Text: 'Some units send patients home with printed instructions; others phone them two days after discharge. The latter appears to reduce readmissions, although it takes more staff time.' Item: The latter refers to…
printed instructions
phoning patients two days after discharge
Why: The latter is the second of the two things. The rest of the sentence agrees: a phone call takes staff time.
Text: 'Pharmacists reviewed every discharge prescription before the patient left. This added about 20 minutes to each discharge, but it prevented several errors.' Item: This refers to…
the patient
the pharmacist review of every discharge prescription
Why: This stands for the whole action in the previous sentence. Only an action can add 20 minutes to a discharge.
Text: 'One hospital stopped routine overnight observations for stable patients so that they could sleep. Such an approach would not suit every ward, the authors note.' Item: Such an approach refers to…
routine observations
not waking stable patients for routine observations at night
Why: The approach is the change the hospital made, not the observations themselves.
Mistakes to avoid
- Choosing the dictionary meaning. If an option is a real meaning of the word but makes no sense in this sentence, it is wrong.
- Choosing the nearest noun. For this and that, check whether the word refers to a whole idea or action.
- Reading only the sentence with the word. The explanation is often in the sentence before or after.
- Spending too long. These items are usually short. If the replace-the-word test has not decided it in about 2 minutes, choose the best fit and move on.
Check yourself
4 quick questions. Tap an answer to see why.
1 Text: 'The clinic's approach to pain was aggressive: patients were reviewed every hour and doses were adjusted quickly.' Here aggressive means…
2 Text: 'Two options were considered: a new ward and extra community nurses. The former was rejected because of cost.' What was rejected?
3 What is the best first step for a reference item about this?
4 How many items per Part C text usually test meaning in context or reference?