The candidate card
Setting
Hospital follow-up clinic (UK)
Candidate
You are a doctor in this original independent practice scenario, seeing Mr Burley Kuphal, aged 44, two weeks after a confirmed pulmonary embolism; he reports improving breathlessness and new bruising and wants to stop apixaban. Fictional documented discharge plan: continue apixaban exactly as prescribed until the treating team's review three months after diagnosis, when duration will be reconsidered, with no automatic stop at that review; today you can assess the bruising and arrange a medication review with the anticoagulation service before he leaves. General clinical information: anticoagulation prevents clot extension and new clots, improvement in symptoms does not establish that treatment can safely stop, bruising and bleeding need assessment, and non-prescribed ibuprofen can increase bleeding risk and should be avoided pending professional advice. Check current symptoms, bleeding severity, adherence and other medicines; severe or uncontrolled bleeding, black stools, vomiting blood or a significant head injury need immediate emergency assessment, while sudden breathlessness, chest pain or collapse require an emergency ambulance call, and a full ongoing clinical assessment may continue after this focused conversation.
Task (interlocutor: patient)
- Find out why Mr Kuphal wants to stop treatment and briefly assess his current breathing, bruising or bleeding and use of prescribed and non-prescribed medicines
- Explain why feeling better does not replace the documented anticoagulation plan
- Respond to his bleeding concerns and explain the prompt medication review, including the precaution about ibuprofen if relevant
- Agree the immediate plan and follow-up, checking that he knows when to seek emergency help
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, seeing Mr Burley Kuphal, aged 44, two weeks after a confirmed pulmonary embolism; he reports improving breathlessness and new bruising and wants to stop apixaban. Fictional documented discharge plan: continue apixaban exactly as prescribed until the treating team's review three months after diagnosis, when duration will be reconsidered, with no automatic stop at that review; today you can assess the bruising and arrange a medication review with the anticoagulation service before he leaves. General clinical information: anticoagulation prevents clot extension and new clots, improvement in symptoms does not establish that treatment can safely stop, bruising and bleeding need assessment, and non-prescribed ibuprofen can increase bleeding risk and should be avoided pending professional advice. Check current symptoms, bleeding severity, adherence and other medicines; severe or uncontrolled bleeding, black stools, vomiting blood or a significant head injury need immediate emergency assessment, while sudden breathlessness, chest pain or collapse require an emergency ambulance call, and a full ongoing clinical assessment may continue after this focused conversation.
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 has led him to consider stopping and what concerns him most about the bruising. Fear of bleeding is a likely concern, but explore his reasoning rather than assuming he is careless or has already stopped treatment.
- Assess current breathing and the extent of bruising or bleeding before reassuring him. Ask neutrally about missed or changed doses and prescribed and non-prescribed medicines, so the immediate plan reflects what he is actually taking.
- Explain that apixaban prevents the clot extending and new clots forming; improving breathlessness does not establish that stopping is safe. Anchor the discussion in his documented discharge plan rather than offering a generic treatment duration.
- Take the bruising seriously without labelling it harmless or automatically dangerous. Explain that assessment and an anticoagulation-service medication review can address his concerns; ask specifically about non-prescribed ibuprofen and advise avoiding it pending professional advice because it increases bleeding risk.
- Arrange the medication review before he leaves and confirm continuation exactly as prescribed until the treating team's review three months after diagnosis. Clarify that this is a reassessment, not an automatic stopping date, and check understanding of emergency advice.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- The new bruising deserves careful attention.
- Thank you for raising your concerns.
- Please tell me if my explanation leaves anything unclear.
- How confident do you feel about what happens next?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| pulmonary embolism | A blood clot in the lungs. |
| anticoagulation | Treatment that reduces blood clotting to help prevent clots extending or new ones forming. |
| adherence | How closely the medicine you take matches the prescription. |
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
What if he says he has already missed apixaban doses?
Ask what he missed and when, record his actual use and include it in today's medication review. Do not invent catch-up instructions, recommend doubling a dose or treat disclosure as misconduct. The supplied card supports professional review, not an improvised dosing adjustment.
Should I recommend another painkiller if he has been taking ibuprofen?
Do not turn the precaution into an unsupported substitute prescription. Establish why he is taking ibuprofen and what else he uses, then seek advice through the medication review. The card does not provide enough information to select another medicine or specify a dose.
Which symptoms need emergency help rather than waiting for medication review?
For sudden breathlessness, chest pain or collapse, call 999 for an ambulance and do not drive yourself. Severe or uncontrolled bleeding, black stools, vomiting blood or a significant head injury need immediate emergency assessment; do not wait for the planned review. NHS 111 can provide immediate medical advice about bleeding when there is no ambulance emergency. First establish the extent of the bruising, how it is changing and whether there is any associated bleeding. If assessment identifies no emergency warning signs, arrange today's medication review as described on the candidate card. Persistent troublesome side effects without emergency warning signs should be discussed with the GP or anticoagulation clinic. [NHS pulmonary embolism](https://www.nhs.uk/conditions/pulmonary-embolism/), [NHS anticoagulant side effects](https://www.nhs.uk/medicines/anticoagulants/side-effects/). Sources checked 3 November 2026.
Sources
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