What the assessor can actually hear
Your Speaking test is marked from the recording only. The interlocutor in the room does not give you a score. At least two assessors listen later. They cannot see your face, your nod or your warm smile. If your kindness is not in your words and your voice, it does not exist for them.
Relationship building is one of five clinical communication criteria, each scored 0 to 3. A B grade usually means around 2 out of 3 on each of these (this is approximate, not a fixed rule). In our words, this criterion covers four observable behaviours:
| Indicator | What the listener hears |
|---|---|
| A1 Opening the conversation | A greeting, your name, your role, why you are talking today, and often a check of how the person wants to be addressed. |
| A2 Attentive and respectful attitude | You let the person finish, you use their name, you ask permission, you respond to what they just said instead of reading the next item from your card. |
| A3 Non-judgemental approach | No blame, no lecturing, no sighing. Choices like smoking, missed medicines or late visits are discussed calmly and with curiosity. |
| A4 Showing empathy | You name the feeling or situation aloud: worry, frustration, tiredness, fear. You do this at the moment it appears, not only once at the start. |
A1: the first 20 seconds
Many candidates are nervous and jump straight into the first task on the card. That costs you an easy behaviour. A good opening has four parts and takes about 15 to 20 seconds.
- Greet: "Good morning."
- Name and role: "My name is Arjun, and I'm the nurse looking after you this afternoon."
- Check how to address them: "Is it Mrs Okafor? Are you happy for me to call you that?"
- Purpose and permission: "I'd like to talk about how you'll manage your dressing at home. Is now a good time?"
Doctor in a GP clinic. The card says the patient has come back for blood test results.
Hello. Your HbA1c is 8.4, so we need to talk about medication.
Hello, I'm Dr Lin, one of the GPs here. Is it Mr Haddad? Thanks for coming back in. I'd like to go through your blood test results with you today and talk about what they mean. How have you been since we last met?
Why: The better version greets, introduces, confirms the name, states the purpose and invites the patient in. The weak version starts with a number the patient may not understand.
A2 and A3: respect you can hear
Respect on a recording sounds like small things: asking before you start, saying "please" and "thank you", letting the person finish, and reacting to their words. Being non-judgemental means you describe behaviour without attaching blame.
- Ask permission before sensitive topics: "Would it be all right if I asked about alcohol?"
- Thank them for honesty: "Thank you for telling me that. It really helps."
- Use neutral words: "How often do you manage to take the tablets?" instead of "Why don't you take your tablets?"
- Use "we" for shared plans: "Let's see what we can do together."
Nurse. The patient admits he has been taking off his compression bandages at night.
You shouldn't do that. The doctor told you to keep them on.
Thank you for being honest about that. A lot of people find them uncomfortable at night. Can you tell me what bothers you most about them?
Why: The better response thanks him, normalises the difficulty and asks an open question. The weak response sounds like a telling-off and closes the conversation.
A4: empathy must be said aloud
Empathy is not a single magic sentence. It means noticing the feeling and responding to it in words. Good empathy is specific. "I understand" on its own is weak, because it does not show what you understood.
Phrase bank: relationship building
Hello, I'm Sam, one of the nurses here today. Is it all right if we talk for a few minutes?
Opening: name, role, permission.How would you like me to address you?
Early in the opening, when you are unsure about the name or title.I'd like to talk about the plan for your discharge, if that's okay with you.
Stating the purpose of the conversation.That sounds really exhausting, looking after him every night.
Naming a carer's situation, not just the feeling.It's completely understandable that you're worried about this.
When the patient expresses worry; it normalises the feeling.I can hear how frustrating this has been for you.
When the person is annoyed. It shows you listened.Thank you for telling me. I know that isn't easy to talk about.
After a sensitive disclosure (alcohol, mood, missed doses).There's no right or wrong answer here. I just want to understand.
Before asking about habits, to sound non-judgemental.Let's work out together what would suit you best.
Using "we" to share the plan.Take your time. There's no rush.
When the person hesitates or becomes upset.You've clearly been doing your best to manage this.
Acknowledging effort before suggesting a change.I'm glad you came in today.
Validating the decision to seek help, especially if they feel silly for coming.
Weak vs better: a short dialogue
Hi. I need to explain your new diet.
My dad hates this pureed food. He's barely eating anything.
It's the speech pathologist's decision. He has to eat it.
No introduction, no purpose, no empathy, and the reply sounds like the nurse is blaming a colleague and closing the topic.
Good afternoon, I'm Mei, the nurse looking after your father today. You must be Daniel? I'd like to talk with you about his new diet, if that's okay.
My dad hates this pureed food. He's barely eating anything.
That must be really worrying to see, especially when food matters so much to him. Can you tell me a bit more about what he's been saying?
Opening, a named concern, empathy linked to the specific situation, then an open question. All of this is audible.
How it plays out across 5 minutes
- Minute 0 to 0.5: full opening (A1). Do not skip it even if the card's first task feels urgent.
- Throughout: each time the interlocutor shows emotion, respond to it before moving on (A4). Interlocutors are often briefed to show worry or annoyance; that is your signal.
- When a sensitive topic comes up: ask permission and use neutral words (A2, A3).
- Near the end: thank the person and keep the door open: "If anything else comes up, please ask any of the nurses."
Check yourself
4 quick questions. Tap an answer to see why.
1 Which opening best shows the A1 behaviour?
2 A patient says, "I know I should have come in sooner, I feel stupid." Which reply is most non-judgemental?
3 Why does a smile not help your Relationship building score?
4 Which empathy line is strongest?