The candidate card
Setting
Residential aged care facility
Candidate
You are a GP who visits the facility weekly. Mrs Iris Foster, aged 86, has moderate Alzheimer's disease. Over the past two weeks she has become restless and agitated in the late afternoon and has had two falls without serious injury. You have examined her today: she is tender in the lower abdomen, has not opened her bowels for five days, and staff report she is passing urine more often. You suspect delirium caused by a physical problem. You have ordered a urine test and bloods, started treatment for constipation, asked staff to monitor her observations, fluid intake and behaviour, and plan to reassess her within 48 hours. Her daughter, Ms Diane Foster, has asked to speak to you and wants her mother 'given something to settle her'.
Task (interlocutor: relative)
- Acknowledge Ms Foster's concerns and find out what changes she has noticed in her mother
- Explain that her mother probably has delirium (a sudden worsening of confusion) and its likely causes (constipation, infection, pain), and the tests and treatment you have started
- Explain why sedating or antipsychotic medication is not recommended at this stage (increased risk of falls, stroke and death; limited benefit)
- Discuss non-drug approaches and how the team will manage her mother's care (treating causes, routine, familiar objects, music, falls prevention)
- Respond to her concerns about the care her mother is receiving and agree a plan for review
In the test you get 3 minutes to read the card and plan, then about 5 minutes to talk. This card is original, written for this site; the interlocutor's card is not shown.
How to approach this card
- Begin by listening. Her request for something to settle her mother may reflect distress at seeing her upset, so find out what she has noticed and what is behind it. Acknowledge before disagreeing, and do not open with the word no.
- Describe delirium as a sudden worsening of confusion, then link it to what you found: a tender abdomen, five days without opening her bowels, and passing urine more often. Say probably, not definitely, because the urine test and bloods are pending.
- Frame the reasons against sedation as protecting her mother, not rationing: risks of falls, stroke and death, and limited benefit. She has already had two falls, which makes this concrete. Say clearly you are acting, because treating the cause is the action.
- Explain the non-drug measures in concrete terms she can help with, such as familiar objects, music and routine, and invite her to contribute because she knows her mother's usual self. Include falls prevention as part of the team's plan.
- If she questions the care so far, respond without defensiveness: acknowledge, explain what has been ordered and the reassessment within 48 hours, and agree how staff will contact her. Typical error: defending the facility instead of answering her fear.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- It is very hard to watch your mother so unsettled, and I want to help.
- Tell me how she has been different from her usual self.
- We are acting. We are treating what we think is behind it.
- I will see her again within 48 hours and we will update you then.
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| delirium | A sudden worsening of confusion, often triggered by a physical problem. |
| antipsychotic medication | A strong medicine sometimes used to calm severe agitation, with serious risks in older people. |
| observations | Regular checks of her general health, such as how she is eating, drinking and behaving. |
How this card is marked
Two assessors mark the recording on nine criteria: intelligibility, fluency, appropriateness of language and resources of grammar and expression (each 0–6), then relationship building, understanding and incorporating the patient's perspective, providing structure, information gathering and information giving (each 0–3). Grade B usually means 5 on each language criterion and 2 on each clinical one. See the AI Speaking practice guide for what each criterion looks for.
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All sets: nurses, doctors, other professions. Your profession's guide: OET Medicine.
Questions about this role-play
She says dementia just gets worse, so isn't this normal?
Acknowledge that dementia changes over time, then explain that a sudden change over two weeks is what makes you look for another cause, which may be treatable. Avoid telling her it is not dementia. Say you are checking and treating likely causes.
What if she keeps insisting on sedation?
Explore what she fears will happen if nothing is given. Restate the risks as concerns for her mother's safety, then show the plan and review time. Do not promise to prescribe, and do not turn it into a standoff.
How do I mention falls, stroke and death without terrifying her?
Say these are risks with these medicines, not certainties, and tie them to what she has already seen with the falls. Pair each risk with the alternative you are offering. Keep your tone steady and pause so she can respond.
Sources
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