The candidate card
Setting
Community diabetes clinic
Candidate
In this original independent practice scenario, you are a nurse seeing Mr Ephantus Jeptoo, aged 44, who has type 1 diabetes and wants to undertake a religious fast beginning tomorrow. He uses background and mealtime insulin, has no individual fasting plan and proposes omitting his background insulin because he will not be eating. You have already confirmed that he feels well, has taken his usual insulin and has not started fasting or changed treatment; a diabetes specialist nurse can see him today before he leaves. Your focus is to address his misunderstanding and agree that next step: the specialist will undertake the detailed risk assessment, treatment planning and safety education.
Task (interlocutor: patient)
- Find out what the fast involves and what matters most to him about observing it
- Explain briefly why background insulin is still needed without food and why fasting needs individual specialist advice
- Explore his concern about specialist involvement and reassure him that the discussion will take his beliefs and priorities seriously
- Agree that he will stay for today's specialist discussion and postpone fasting and self-directed insulin changes until an individual plan is agreed, then check his understanding
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.
In this original independent practice scenario, you are a nurse seeing Mr Ephantus Jeptoo, aged 44, who has type 1 diabetes and wants to undertake a religious fast beginning tomorrow. He uses background and mealtime insulin, has no individual fasting plan and proposes omitting his background insulin because he will not be eating. You have already confirmed that he feels well, has taken his usual insulin and has not started fasting or changed treatment; a diabetes specialist nurse can see him today before he leaves. Your focus is to address his misunderstanding and agree that next step: the specialist will undertake the detailed risk assessment, treatment planning and safety education.
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
- Use the established case facts: he feels well, has taken his usual insulin and has not started fasting. Begin by asking what the fast involves and why it matters to him.
- Address his specific misunderstanding briefly: background insulin remains necessary without food, and leaving it out can cause dangerous ketone build-up. Explain that fasting can disturb glucose levels and cause dehydration, making individual specialist advice necessary.
- Ask what worries him about specialist involvement. Acknowledge his concern and explain how today's discussion can consider his beliefs and priorities alongside his health.
- Seek agreement that he will stay for today's specialist discussion and postpone fasting and self-directed insulin changes until an individual plan is agreed. Allow him to respond to that recommendation.
- Check his understanding of the agreed next step and invite questions. Detailed assessment, written instructions and emergency teaching belong to the specialist discussion that follows.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- Thank you for raising this before the fast begins.
- What would you most like the specialist to understand?
- May I check that my explanation makes sense?
- What still feels unresolved for you?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| Background insulin | Insulin your body still needs when you are not eating. |
| Mealtime insulin | Insulin used with meals. |
| Ketoacidosis | A dangerous build-up of ketones that needs emergency treatment. |
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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Next step for Australian nursing: if your pathway requires OBA after OET and NCLEX-RN, explore OSCE practice for Australian nurses at OSCE Australia, run by the same company as OETAce.
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Questions about this role-play
What if he has already missed his background insulin?
In this scenario, he has already confirmed that he has taken his usual insulin. If a patient instead reports an omission, establish what was missed and when, then arrange prompt clinical assessment and specialist advice rather than continuing routine fasting counselling. Do not invent a replacement or catch-up dose. Source: https://www.nhs.uk/conditions/diabetic-ketoacidosis/ ; checked 3 November 2026.
What immediate advice should cover suspected low glucose?
This is background safety guidance, not an additional task in this role-play. Stop fasting, check glucose promptly and treat suspected low glucose with fast-acting sugar only if awake and able to swallow safely. Follow any existing personal hypoglycaemia plan. Call 999 in the UK or 000 in Australia if the person deteriorates, does not improve with treatment, cannot swallow safely, has a seizure or becomes unconscious; give nothing by mouth if swallowing is unsafe. If unconscious but breathing normally, use the recovery position; if not breathing normally, start CPR and follow the emergency operator's instructions. The specialist discussion should confirm complete personal treatment instructions. Source: https://www.anzcor.org/home/first-aid/guideline-9-2-9-first-aid-management-of-a-diabetic-emergency ; checked 3 November 2026.
What warning signs require emergency help for possible ketoacidosis?
Possible signs include thirst, frequent urination, tiredness, recent weight loss, dehydration, nausea, vomiting, abdominal pain, fast or deep breathing, fast heartbeat, flushed cheeks, acetone-smelling breath, drowsiness, confusion or reduced consciousness. Suspected ketoacidosis needs 999 in the UK or 000 in Australia; do not wait for every sign or drive yourself. These are background safety details, not an additional teaching task in this role-play. Sources: https://www.healthdirect.gov.au/conditions/metabolic-diseases/diabetic-ketoacidosis and https://www.nhs.uk/conditions/diabetic-ketoacidosis/ ; checked 3 November 2026.
Sources
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