The candidate card
Setting
Hospital pre-admission clinic
Candidate
You are a doctor in the pre-admission clinic. Mr Ronald Pike, aged 74, is booked for an elective right total knee replacement next Thursday, first on the morning list (admission 06:30, surgery 08:00). He has atrial fibrillation and takes apixaban 5 mg twice daily; his kidney function is normal. The surgical and anaesthetic teams' plan is: last dose of apixaban on Monday morning (at least 72 hours before surgery, so that a spinal anaesthetic is possible), no further doses until after the operation, no bridging injections, restart as directed by the ward team. Hospital fasting times for his operation: no food or milk after 02:00 on Thursday; clear fluids (water, black tea) until 06:00.
Task (interlocutor: patient)
- Find out how Mr Pike takes his medication and what he knows about the operation day
- Explain why apixaban must be stopped before surgery and exactly when to take the last dose
- Explain the fasting instructions for the morning of the operation (food, milk and clear fluids, with clock times)
- Find out about any concerns he has about the anaesthetic or the operation
- Check his understanding of the instructions and give him the written plan
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
- Start by asking how he actually takes his tablets and what he already believes about the day of surgery. This shows where confusion may lie. Use it only to tailor your explanation. The stop date itself never changes.
- Give the stop instruction as fixed: last dose Monday morning, nothing after that until the ward team says to restart. Explain the reason in plain terms first, that the gap is needed so a spinal anaesthetic can be considered. Then state the day clearly.
- Do not let him blur the two instructions. Keep the tablet plan (stop after Monday morning, no injections to replace it, restart as directed) separate from the fasting plan. Mixing them is the commonest cause of mistakes on the day.
- Give fasting times as clock times and name each item: no food or milk after 02:00 on Thursday, clear fluids such as water or black tea until 06:00. Link them to his 06:30 admission. If time is short, prioritise this and the last dose.
- Ask what worries him about the anaesthetic or the operation, and listen before reassuring. Then ask him to repeat back the last-dose day and the two fasting times, correct any gaps, and hand over the written plan.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- Many people find tablet instructions confusing before an operation, so I will go through it slowly.
- Is there anything about the anaesthetic that you have been wondering about?
- So that I have explained it clearly, could you tell me in your own words when your last tablet is?
- First we will cover your tablets, and then the eating and drinking rules for the morning.
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| Apixaban | Your blood-thinning tablet that helps protect you from clots caused by your irregular heartbeat. |
| Spinal anaesthetic | An injection in your back that numbs you from the waist down for the operation. |
| Fasting | Not eating or drinking certain things for a set time before the operation. |
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 Mr Pike asks to keep taking apixaban for safety because of his heart rhythm?
Acknowledge the worry, then explain that the surgical and anaesthetic teams have set this plan and the gap is needed so a spinal anaesthetic is possible. Do not change the date. Say the ward team will direct when to restart, and that no injections will be used in the meantime.
How do I explain the fasting rules without confusing him?
Separate the two clearly. Say food and milk stop after 02:00 on Thursday, and clear fluids, meaning water or black tea, are allowed until 06:00. Name examples, use clock times, and ask him to repeat both times back. Link them to his 06:30 admission.
What should I do if I do not know something he asks, for example what happens if he forgets the last dose?
Do not guess or invent advice. Say honestly that the card gives you the plan but not that detail, stress that the last dose is Monday morning, and tell him to contact the hospital team promptly if he is unsure or thinks he has made a mistake.
Sources
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