The candidate card
Setting
General practice
Candidate
You are a GP. Mr Paul Hartley, a 52-year-old warehouse supervisor, has come back to discuss his recent blood tests. His HbA1c is 64 mmol/mol (8.0%) and his fasting glucose is 9.1 mmol/L, confirming type 2 diabetes. His kidney function is normal. You plan to start metformin first (other medicines may be added later if needed), but he has told the receptionist he 'doesn't want to be put on tablets'.
Task (interlocutor: patient)
- Find out what Mr Hartley already understands about his results and how he feels about the diagnosis
- Explain what type 2 diabetes is and why treatment is important now (blood sugar too high, long-term damage to eyes, kidneys, nerves, heart)
- Find out the reasons for his reluctance to take medication
- Explain metformin (how it works, starting dose 500 mg with the evening meal and increasing slowly, possible stomach upset, usually settles)
- Discuss lifestyle changes and agree a follow-up plan (diet, activity, diabetes educator, review of how he is tolerating the tablets in 1–2 weeks, repeat blood test in 3 months)
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
- Open by asking what he took from his results and what the word diabetes means to him. His refusal of tablets came before the consultation, so listen first. Explaining too early risks him feeling lectured before he has been heard.
- Explain the diagnosis in plain words and link his blood sugar to why treatment matters now. Name all four organs at risk (eyes, kidneys, nerves, heart) without alarming him. He is likely to hear the threat before the benefit.
- Ask an open question about his reluctance, then explore what lies behind it. Listen for specific pictures of tablets (for example lifelong dependence or side effects) without assuming which applies. Answer only after you know his actual objection.
- Present metformin after you know his objection, so you can answer it directly. Give the start (500 mg with the evening meal, building up slowly) and be honest that stomach upset can occur and usually settles. Say other medicines may be added later if needed.
- If time runs short, protect the shared decision and follow-up: agree what he will try, then confirm the 1–2 week tolerance review and 3-month blood test. Typical error: closing with a prescription he has not actually agreed to.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- Many people feel worried when they first hear this word. What went through your mind?
- Tell me what being put on tablets would mean for you.
- This is your decision, and I would like us to make it together.
- Let me check I explained that well. How would you take the tablet?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| HbA1c | A blood test showing your average blood sugar over recent months. |
| fasting glucose | Your blood sugar level after a period without food. |
| metformin | A tablet that helps lower your blood sugar. |
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
What if he says he wants to try diet alone first?
Take it seriously rather than arguing. Lifestyle change is already part of your plan, so present medicine and lifestyle as working together, not as alternatives. Restate why treatment now matters, then show that the 1–2 week and 3-month reviews mean decisions are revisited. Avoid ultimatums.
How much should I say about complications?
Name all four areas (eyes, kidneys, nerves, heart) in a sentence or two and tie them to prevention, not to worst cases. Check how he reacted before adding more. Over-detailing can increase his resistance, while leaving one out leaves the explanation incomplete.
How do I explain the slow dose increase without confusing him?
Say you will start with a small amount at the evening meal and go up gradually so his body can adjust, then tie it to the check-in in 1–2 weeks. Keep to one step at a time and ask him to repeat the first step back.
Sources
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