The candidate card
Setting
Endocrine outpatient clinic, UK
Candidate
You are a doctor in this original independent practice scenario. Ms Esperanza Pineda, aged 55, was recently diagnosed with hypothyroidism and started prescribed levothyroxine ten days ago. She reports no weight reduction and is considering extra tablets; no dose change has been authorised, and this discussion does not require selecting a dose. Your proposed plan is to check her actual use, continue the prescribed regimen unless clinical review indicates otherwise, and confirm individual blood-test and results-review arrangements before she leaves.
Task (interlocutor: patient)
- Find out what she expects treatment to achieve, how she has taken it and whether she has already taken extra tablets or developed new symptoms
- Explain that levothyroxine replaces missing thyroid hormone and that treatment cannot guarantee immediate weight loss
- Respond sensitively to her frustration and explain why taking extra tablets without review can be harmful
- Agree to use only the prescribed regimen and confirm individual blood-test and results-review arrangements, including whom to contact about problems
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. Ms Esperanza Pineda, aged 55, was recently diagnosed with hypothyroidism and started prescribed levothyroxine ten days ago. She reports no weight reduction and is considering extra tablets; no dose change has been authorised, and this discussion does not require selecting a dose. Your proposed plan is to check her actual use, continue the prescribed regimen unless clinical review indicates otherwise, and confirm individual blood-test and results-review arrangements before she leaves.
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
- Ask what she hoped would change after starting treatment and what the absence of weight reduction means to her. Disappointment is evident, but do not assume concerns about appearance, previous advice or a particular weight target.
- Establish actual tablet use before offering reassurance. Invite a straightforward account of what she has taken and any new symptoms; neutral wording makes disclosure easier than asking whether she has followed instructions properly.
- Acknowledge her frustration before explaining hormone replacement in everyday language. Separate the purpose of treatment from a promise about weight, and avoid replacing her expectation with another unsupported prediction about when or whether weight will change.
- Discuss extra tablets without moral judgement: more treatment is not automatically better treatment, and taking extra without review can be harmful. Avoid selecting a dose or improvising changes to compensate for what she reports.
- Make monitoring a shared practical agreement, with individual blood-test arrangements, responsibility for reviewing results and a contact route for problems. If time is short, protect the medication agreement and confirm how she will receive and discuss results.
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 Ms Pineda, I'm one of the doctors in the clinic. Thanks for coming. I'd like to see how the levothyroxine has been going since you started it.”
- “You started ten days ago. What were you hoping the treatment would do for you, and how have things been so far?”
2. Key questions
- “Could you tell me exactly how you've been taking the tablets, including the time of day and whether you've ever missed a dose?”
- “Have you taken any extra tablets, or are you thinking about it? Please be open with me, as I won't judge.”
- “Have you noticed any new symptoms since starting, or anything that has changed how you feel?”
- “What would you most like to see change, and what do you already understand about what levothyroxine does?”
3. Handling the patient's concern
Likely concern: She may be frustrated that she has seen no weight loss and think more tablets would speed it up.
- “I can hear how frustrating this is. You started treatment hoping for a change and haven't seen the one you wanted. Anyone would feel that way.”
- “Thank you for being honest about wanting to take more. Let me explain why that's risky, and then we can work out how to support you.”
4. Explaining
- “Levothyroxine replaces the thyroid hormone your body is missing. It isn't a weight-loss treatment, so I can't promise it will bring weight loss quickly. Does that fit with what you expected?”
- “Taking extra tablets without a review can give you too much thyroid hormone, which can cause a racing or pounding heartbeat, shakiness and trouble sleeping. That's why any change should only come after we've reviewed you.”
5. Closing
- “So you'll take only the prescribed tablets. Before you leave we'll confirm your blood test and who will go through the results with you. Can you tell me how you'll take them?”
- “If you've taken extra tablets or feel unwell, please get advice the same day from us or NHS 111. If you feel seriously unwell, call 999. Is there anything else you're unsure about?”
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- You were hoping to notice a change by now.
- Thank you for telling me exactly what you have taken.
- What still feels unclear about the treatment?
- Who will you contact if a problem comes up?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| hypothyroidism | An underactive thyroid that does not make enough thyroid hormone. |
| levothyroxine | Medicine that replaces the thyroid hormone your body is missing. |
| prescribed regimen | The instructions agreed for taking your medicine. |
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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Questions about this role-play
What should happen if she has already taken extra tablets?
Assess what she took, when and any symptoms. In this UK scenario, she should speak to a pharmacist as soon as possible after taking more than prescribed. If a pharmacist is unavailable or she took too much deliberately, contact NHS 111. Call 999 for life-threatening symptoms. Keep the medicine packet available. NHS levothyroxine guidance. In Australia, call the Poisons Information Centre on 13 11 26 without waiting for symptoms; call 000 for a life-threatening emergency. Do not induce vomiting or give food or drink before obtaining poisons advice. Keep the packaging and follow emergency instructions; start CPR if she is unresponsive and not breathing normally. NSW Poisons first aid. Advice checked 4 November 2026.
What if she cannot remember what she was prescribed?
Check the prescribing record or clarify with the prescriber before confirming instructions. Do not guess from a usual dose or ask her to reconstruct an uncertain prescription from memory. Distinguish uncertainty about the prescription from uncertainty about what she actually swallowed.
Should I introduce a weight-loss programme during this consultation?
Do not assume she wants a separate programme or introduce dietary prescriptions unsupported by the card. Ask whether she would like weight concerns discussed further once the immediate medication issue has been addressed. Keep that conversation separate from any suggestion that extra thyroid tablets are a weight-management option.
What if she admits she has already taken extra tablets?
Thank her for telling you and stay non-judgemental. Ask how many she took, when, and whether she feels unwell. Tell her she needs prompt medical review today, not a wait-and-see approach, and advise 999 if she feels seriously unwell.
How do I stay sensitive without sounding dismissive about her weight?
Name her frustration first and use her own words about what she hoped for. Then explain clearly what the tablets are for, without minimising her concern, and ask what else she would like help with so her goal is not ignored.
Sources
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