The candidate card
Setting
Respiratory outpatient clinic
Candidate
You are a respiratory nurse in this original independent practice role-play. Mr Shep Frami, aged 42, has diagnosed COPD and attends a routine review after receiving a prescribed maintenance pressurised metered-dose inhaler three weeks ago; he says everything is fine. He appears comfortable at rest and has brought his inhaler, but you have not yet assessed his current symptoms or observed him using the device. For this fictional case, the treating team's plan is for you to assess practical difficulties, offer observed teaching using the matching non-medicinal demonstration device and its instructions, and arrange review by the respiratory prescriber available today if he cannot use his inhaler reliably; you must not independently change his medicine or device.
Task (interlocutor: patient)
- Find out how Mr Frami has been managing his inhaler, including any missed doses, practical difficulties and changes in his breathing.
- Explore his reluctance to mention difficulties without blame, acknowledging any concerns about being judged.
- Explain why being able to operate the device matters and ask permission to observe him handling the matching demonstration device without forcing painful movements.
- Offer supported teaching and explain why persistent difficulty needs a prescriber-led device review rather than simply more practice.
- Agree an immediate plan for today's review and check his understanding of the next steps without recommending an independent treatment change.
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 respiratory nurse in this original independent practice role-play. Mr Shep Frami, aged 42, has diagnosed COPD and attends a routine review after receiving a prescribed maintenance pressurised metered-dose inhaler three weeks ago; he says everything is fine. He appears comfortable at rest and has brought his inhaler, but you have not yet assessed his current symptoms or observed him using the device. For this fictional case, the treating team's plan is for you to assess practical difficulties, offer observed teaching using the matching non-medicinal demonstration device and its instructions, and arrange review by the respiratory prescriber available today if he cannot use his inhaler reliably; you must not independently change his medicine or device.
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
- Start by asking what managing the inhaler has actually been like, then clarify missed doses and changes in breathing. Accept his initial reassurance respectfully, while leaving room for difficulties he has not yet mentioned.
- A likely concern is being judged for struggling, but explore rather than assume this. Ask what makes difficulties hard to discuss, acknowledge any concern he expresses, and use practical language such as handling difficulties instead of failure.
- Explain briefly that operating the inhaler matters for using his prescribed treatment as intended. Ask permission before observing the matching non-medicinal demonstration device, follow its instructions, and make clear that he need not force painful movements.
- Base supported teaching on what you observe, rather than delivering a generic technique lecture. The usual trap is prescribing more practice despite persistent difficulty; inability to use the inhaler reliably requires review by the respiratory prescriber available today.
- Close with an explicit agreement about what happens during today’s visit and ask him to explain the next steps in his own words. If time runs short, prioritise current breathing, reliable device handling and arranging any needed prescriber review.
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 Mr Frami, I'm the respiratory nurse. Thanks for bringing your inhaler with you today. This is a friendly review, not a test.”
- “What has it been like using the inhaler day to day since you started it three weeks ago?”
2. Key questions
- “Have you missed any doses of the inhaler, and if so, what got in the way?”
- “Is there anything about handling or using the inhaler that has felt awkward or uncomfortable?”
- “How has your breathing been lately, compared with before you started it?”
- “Is there anything that makes it hard to tell us when things aren't going smoothly?”
3. Handling the patient's concern
Likely concern: He may worry about being judged or seen as not coping.
- “Inhalers can be tricky to use, and it's the device we're looking at, not you. Nobody here is judging you.”
- “Telling me about any difficulty helps me get you the right help. I won't change your medicine or device myself.”
4. Explaining
- “The inhaler only helps if the medicine reaches your lungs, so being able to work the device matters. May I watch you handle the matching demonstration device? We'll stop if any movement is painful.”
- “I can teach you step by step. If you still can't use it reliably, the respiratory prescriber available today needs to review the device with you, as more practice alone wouldn't be the answer. Does that make sense?”
5. Closing
- “So today I'll watch and teach you with the demonstration device, and if you can't use your inhaler reliably I'll arrange for you to see the prescriber today. Until then, keep using it as prescribed.”
- “Could you tell me in your own words what happens next, and what questions you have for me?”
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- Thank you for telling me what has been difficult.
- What would make this conversation easier for you?
- We can pause whenever you need.
- Which part would you like me to explain differently?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| COPD | The lung condition you have been diagnosed with. |
| maintenance inhaler | The inhaler prescribed for your regular treatment. |
| non-medicinal demonstration device | A matching practice inhaler that contains no 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 if he asks whether to take extra medicine after a missed dose?
The card gives no missed-dose instructions, so do not invent a catch-up schedule or recommend an extra dose. Acknowledge the question and obtain advice from the respiratory prescriber available today before giving specific instructions about what he should take.
Does his comfortable appearance at rest show that his treatment is working?
It establishes only that he appears comfortable at rest during this visit. It does not establish how he has been breathing at other times, whether he has missed doses, or whether he can operate the inhaler. Avoid presenting this observation as proof of treatment effectiveness.
How much background information about COPD should I give?
Ask whether he has a particular question about his diagnosis before adding background information. This encounter does not provide findings for a broader discussion of severity or prognosis. Keep explanations relevant to his question and avoid predicting improvement or promising an outcome from teaching.
What if he refuses to demonstrate with the device?
Respect it and don't push. Ask what makes him uncomfortable, offer to show him first, or return to talking about difficulties. Explain that you can't judge how reliably he uses it without seeing it, and that today's prescriber review is still available.
What if his hands hurt while he is handling the device?
Stop immediately and never force the movement. Treat it as a practical difficulty and explain that this is exactly what the prescriber should know about. Do not suggest a new device or medicine yourself; the prescriber review decides that.
Sources
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