The candidate card
Setting
Community clinic (general practice)
Candidate
You are a practice nurse. Mr Javier Castillo, aged 19, is a university student with asthma who has come in for a repeat prescription of his salbutamol reliever (a pressurised metered-dose inhaler). His records show that last year he was prescribed a budesonide preventer dry-powder inhaler to take every morning and every night, but he has not requested a repeat for several months. The GP, who is in clinic today, has asked you to review his asthma before the prescription is written.
Task (interlocutor: patient)
- Find out how Mr Castillo is using his inhalers, how his asthma has been recently and how he is today (reliever use, night symptoms, exercise, breathlessness now)
- Explain in simple terms the difference between his reliever and his preventer and why relying on the reliever alone is a concern
- Persuade him to use a preventer every day as the GP advises and respond to his doubts about it
- Check and correct his reliever inhaler technique (spacer, one puff at a time, slow breath in, breath-hold)
- Agree a plan, including seeing the GP today before he leaves for a treatment review and written asthma action plan, and when to call an ambulance
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 uses each inhaler day to day, without blame. Missing repeats only suggest he is not using the preventer, so ask rather than assume, and check how he is breathing right now before anything else.
- Order matters: today's symptoms first, then explanation, then persuasion, then technique. Use one image, such as the preventer working in the background on airway inflammation while the reliever only opens the airways briefly. Avoid a long pharmacology lesson.
- Ask what makes him hesitant about a preventer every morning and night, and what he thinks it does, before you counter. His doubts may be about routine, side effects or whether he needs it. Answer each doubt specifically.
- The trap is a device mix-up: the reliever is a pressurised inhaler used with a spacer, the preventer a dry-powder inhaler. Watch him use the reliever, correct kindly, and have him repeat it. Ask to see the preventer too if time allows.
- Confirm GP review today for treatment and a written plan. For an attack, sit upright and take four separate salbutamol puffs through a spacer, one at a time with four breaths after each. Wait four minutes; repeat if not better, then call 000 if still not better. Call immediately for severe or rapidly worsening breathlessness or difficulty speaking. Continue four puffs every four minutes while waiting.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- Can you walk me through what a usual day with your inhalers looks like?
- Some people find a twice-a-day inhaler hard to fit in. What has it been like for you?
- Would you show me how you take your reliever, so I can see what works?
- Let me check I explained that well. How would you describe the two inhalers?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| preventer | A daily inhaler that works in the background to keep your airways calmer, even when you feel well. |
| reliever | A quick-acting inhaler that opens your airways for a short time when you are wheezy or breathless. |
| spacer | A plastic tube that attaches to your puffer so more of the medicine reaches your lungs. |
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.
More Nursing role-play cards
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All sets: nurses, doctors, other professions. Your profession's guide: OET Nursing.
Questions about this role-play
He just wants the reliever script and nothing else. What do I say?
Explain that the GP wants to review his asthma first, so he will see the GP today and the GP will decide about the prescription. Do not promise or refuse it yourself. Keep the focus on the review rather than on withholding anything.
How do I respond if he says he feels fine without the preventer?
Accept that he may feel well, then ask about reliever use, night symptoms and exercise to see the day-to-day picture. Link the preventer to the pattern he describes rather than lecturing, and explain it is advised as a daily treatment, as the GP recommends.
How much technique teaching is realistic in a short role-play?
Watch him use the reliever first, then correct one or two errors at a time and have him repeat the corrected version. Praise what he does correctly. A quick demonstration with a spacer is more effective than describing the steps.
Sources
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