What structure means on a recording
An assessor listening to your recording should always know where the conversation is going. Structure is about you leading the conversation in a logical order, telling the listener when you change topic, and packaging information so it is easy to follow. A B grade usually needs around 2 out of 3 on this criterion (approximate). In our words, three behaviours count:
| Indicator | What the listener hears |
|---|---|
| C1 Sequencing the conversation purposefully and logically | Topics come in a sensible order. You lead; the patient does not drag you from point to point. You do not spend two minutes on a simple question. |
| C2 Signposting changes in topic | Short phrases that announce a move: "Now I'd like to...", "Before we finish...". |
| C3 Organising explanations | You tell the patient how many things are coming, you group them and you summarise: "There are two things you can do at home..." |
C1: follow the card, plan the clock
The interlocutor's card lists their prompts in the same order as the tasks on your card. If you follow your card order, the conversation flows naturally and the interlocutor's responses arrive when you expect them. If you jump around, you may trigger responses out of sequence and lose your thread.
Use your 3 minutes of preparation to give each task a rough time. A quick factual question needs less than a minute. A task where you have to persuade or reassure someone may need a minute and a half or more.
0:00 open - name, role, purpose 0:30 how is she feeling - sleep, feeding, support (open Q) 1:30 explore worry - 'bad mother'? EMPATHY 2:30 explain: common, not her fault - 3 points 3:45 options: partner, GP, helpline 4:30 check + close
C2: signposting
A signpost is a short phrase that tells the listener the topic is changing. It helps the patient, and it is very easy for an assessor to hear. Use one each time you move to a new task on your card.
Doctor. Moving from history to explaining a plan for stopping a blood thinner before knee surgery.
Okay. So you need to stop the warfarin before the surgery.
Thanks, that gives me a clear picture. Now I'd like to explain what we'll do with your blood thinner before the operation, because the timing really matters.
Why: The better version closes the previous topic, names the next one, and says why it matters.
Phrase bank: structure
I'd like to start by asking a few questions about the pain, then we can talk about options.
Agenda at the start. Tells the patient the plan.Thank you, that's really helpful. Now I'd like to move on to your medicines.
Closing one topic and opening the next.Can we come back to that in a moment? I just want to check one thing first.
When the patient jumps ahead and you need to keep order.There are three things I'd like to go through.
Before an explanation, so the listener knows how much is coming.The first thing is... The second is... And finally...
Numbering the chunks within an explanation.So, to sum up what we've agreed so far...
Mini-summary before changing topic.The main thing to remember is this.
Highlighting the single most important point.Before we finish, is there anything else you'd like to ask?
Signalling the close.So the plan is that you'll call us if the redness spreads, and we'll see you on Thursday.
Closing with a clear next step.Let me just go back to something you said earlier.
Returning to an earlier topic in a controlled way.
C3: organising explanations
When you give information, a long unbroken paragraph is hard to follow, even if every word is correct. Use the pattern: announce, chunk, check, summarise.
- Announce: "There are two main things I'd like you to do at home."
- Chunk: give the first thing in one or two sentences. Pause.
- Check: "Does that make sense so far?" or invite a reaction.
- Give the second chunk. Pause.
- Summarise: "So, keep the leg raised, and call us if it gets more swollen."
Nurse. Explaining how to use an inhaler spacer to a parent.
You put the inhaler in the spacer and shake it and then he breathes in and out a few times and you press it and make sure the mask is on properly and wash it once a week.
I'll go through this in three steps. First, shake the inhaler and fit it into the spacer. Second, put the mask gently over his nose and mouth. Third, press once and let him breathe normally for a few breaths. Shall I go through that once more?
Why: Announcing three steps and numbering them makes the instructions easy to follow and easy for the assessor to hear.
Weak vs better: a transition
So your pain is about seven out of ten. You can have paracetamol and you should walk around and also the drain comes out tomorrow and you can't shower yet.
Sorry, what was that about the drain?
Four topics in one breath, no signpost, no chunking. The patient gets lost.
Thank you for describing that, it really helps. Now I'd like to talk about what we can do for the pain, and then I'll explain what happens tomorrow. Is that okay?
Yes, that's fine.
So first, the pain. I'll check your chart and see what the doctor has prescribed for you, and we can review it in half an hour.
Close, signpost, agenda, then one topic at a time.
Closing and time management
The role-play usually comes to a natural end after about five minutes, and the interlocutor will indicate clearly if time is up. You do not lose marks simply for not covering every point. But a planned close shows structure and leaves a good final impression.
- Around minute 4, glance at your card. If you are behind, give the remaining tasks briefly rather than skipping them.
- Close with a summary, a next step, and an invitation for questions.
- Do not start a brand new topic in the last 15 seconds.
Check yourself
4 quick questions. Tap an answer to see why.
1 Which sentence is the clearest signpost?
2 The patient keeps jumping ahead to ask about going home while you are still gathering history. What is the best response?
3 Why does following the card order help?
4 Which explanation best shows C3?