The candidate card
Setting
Hospital follow-up clinic, UK
Candidate
You are a doctor in this original independent practice scenario. Mrs Leonie Riney, aged 53, is speaking with you alone after her husband's assessment; he is aged 68 and has agreed that you may discuss his recovery with her. He developed delirium during admission for pneumonia and was discharged ten days ago; today's assessment finds no new acute illness, but his attention still fluctuates despite some improvement. Mrs Riney wants a definite dementia diagnosis today; your proposed plan is to establish his previous functioning, reassess his recovery and investigate persistent difficulties, with appointment details confirmed before she leaves and a later joint discussion involving her husband to agree the plan.
Task (interlocutor: relative)
- Find out about her husband's memory and everyday functioning before the illness, changes since discharge and her main concern
- Explain the difference between delirium and dementia, including why his current symptoms do not establish whether he has dementia
- Respond to her request for certainty, acknowledging the improvement without promising complete recovery
- Agree a proposed recovery review and assessment plan for later joint discussion with her husband, including practical support and written appointment details
- Explain that new sudden confusion or sudden worsening requires immediate medical help rather than waiting for follow-up
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.
Prepare this card, then say it out loud.
Plan your opening and the tasks below. Keep these notes when you move to the AI role-play.
You are a doctor in this original independent practice scenario. Mrs Leonie Riney, aged 53, is speaking with you alone after her husband's assessment; he is aged 68 and has agreed that you may discuss his recovery with her. He developed delirium during admission for pneumonia and was discharged ten days ago; today's assessment finds no new acute illness, but his attention still fluctuates despite some improvement. Mrs Riney wants a definite dementia diagnosis today; your proposed plan is to establish his previous functioning, reassess his recovery and investigate persistent difficulties, with appointment details confirmed before she leaves and a later joint discussion involving her husband to agree the plan.
Getting your plan ready…
Preparation is free without an account. AI conversation and marking need sign-in; your first role-play is free. Notes are saved on this device when available. This checklist is your plan, not a score.
How to approach this card
- Begin by exploring what a definite diagnosis would help her understand or arrange. She may be worried about his future or managing at home; ask rather than treating either concern as established.
- Build a clear before-and-after account before discussing diagnostic labels. Ask her to separate his usual abilities before pneumonia from changes since discharge, because otherwise longstanding difficulties and recovery symptoms may become mixed together.
- Explain the distinction through timing and attention: delirium develops suddenly and can fluctuate; dementia involves longer-term decline. His present symptoms establish neither the presence nor absence of dementia. Delirium guidance.
- Acknowledge the improvement before explaining what remains uncertain. Avoid allowing reassurance to become a promise of complete recovery, or presenting further assessment as merely postponing an inevitable diagnosis; neither conclusion is supported here.
- Close with an agreed proposed review and support plan for later joint discussion with her husband, named responsibility for investigating persistent difficulties, and support matched to the needs she identifies. If time is short, protect this agreement and confirm written appointment details before she leaves.
Model route: what a strong candidate might say
Example lines in a workable order for about 5 minutes: opening, key questions, the patient's concern, explaining, then the close. Use them to plan, not to memorise: the patient's replies are not scripted here, and your next line should follow what they actually say.
1. Opening
- “Hello, Mrs Riney. I'm one of the doctors in the follow-up clinic. Your husband has agreed that I can talk with you about his recovery.”
- “How have things been at home since he came out of hospital?”
2. Key questions
- “How was his memory, and how did he manage everyday tasks, before he became unwell with pneumonia?”
- “What changes have you noticed since he was discharged ten days ago?”
- “What is your biggest worry at the moment?”
- “How are you managing at home, and what help would be useful?”
3. Handling the patient's concern
Likely concern: She is likely to press for a definite dementia diagnosis today and be frustrated by the uncertainty.
- “I can see how much you want a clear answer. I wish I could give one today, but it wouldn't be honest to name dementia when we can't tell yet.”
- “He has improved in some ways, which is encouraging, but I can't promise a complete recovery. We will keep checking how he is getting on.”
4. Explaining
- “Delirium is a sudden, fluctuating confusion that can happen during a serious illness like pneumonia. Dementia is a longer-term condition affecting memory and daily life. That's why knowing how he was beforehand matters.”
- “His attention still fluctuates, although it has improved a little, so today's symptoms alone can't tell us whether he has dementia. We will review his recovery and investigate any lasting difficulties. Does that fit what you've seen?”
5. Closing
- “So we'll learn how he was before, review his recovery and look into lasting difficulties, then agree the plan together with your husband. You'll have written appointment details before you leave.”
- “If he suddenly becomes confused or suddenly worse, call 999 straight away rather than waiting for the appointment. Is there any other support you need at home?”
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- What would having a definite answer today help you with most?
- I can hear how difficult this uncertainty feels.
- We will hear your husband's views when we discuss the plan together.
- Does that explanation fit what you have noticed?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| delirium | A sudden change in thinking and attention that can vary during the day. |
| dementia | A condition involving lasting decline in memory and thinking that affects everyday life. |
| fluctuating attention | Being able to concentrate better at some times than others. |
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). 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
How can I hear his account when his attention fluctuates?
This discussion is with his wife alone, with his agreement to discuss his recovery with his wife. Arrange to hear his account at the later joint discussion, using short questions and allowing time to answer; then invite her additional observations. His agreement to share information does not replace his own participation in decisions.
How can I make practical support specific without assuming dependence?
Ask her to identify an everyday activity he currently finds difficult and describe what happens. Establish what he can manage himself, what help is already available and what remains unmet. Offer to explore suitable assistance rather than assuming his wife can provide everything, and include him in the later joint discussion.
What urgent-change advice should I give?
In this UK scenario, new sudden confusion or sudden worsening requires calling 999 or going immediately to A&E. Call 999 for blue lips or skin or an immediate threat to health or safety. Stay with him, reassure him and keep him safe; he must not drive himself. Avoid repeated questioning or restricting his movement unless he is in danger, and do not wait for follow-up. NHS emergency guidance and supportive actions.
How do I respond if she presses again for a dementia answer?
Acknowledge the feeling, then restate in plain words what is known, what isn't, and what will give more information. Avoid vague hope or a premature label. Ask what she fears most, then move to the concrete next steps.
How should I treat her husband's wishes in this conversation?
He agreed you may discuss his recovery, so keep to that and avoid making decisions for him. Say clearly that his own views will shape the plan at the joint discussion, and that you are not settling anything without him.
Sources
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