The task
Original independent practice. All patient details, appointments and individual care arrangements are fictional. Assume that today's date is 3 November 2026. Jacob's diagnosis has been confirmed and his mother requests written advice.
You are Jacob Hallanan's general practitioner. Write to his mother, Ms Tammy Moher, 16 Station Road, AB10 1AA, explaining ongoing gluten avoidance, dietitian support and the agreed school arrangements. Use plain language and distinguish coeliac care from treatment for a food allergy. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Advice letter.
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Which case notes belong in this letter?
New coeliac disease: advice
You are Jacob Hallanan's general practitioner. Write to his mother, Ms Tammy Moher, 16 Station Road, AB10 1AA, explaining ongoing gluten avoidance, dietitian support and the agreed school arrangements. Use plain language and distinguish coeliac care from treatment for a food allergy. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Child: Jacob Hallanan
- DOB: 15/03/2017 (9 yrs)
- Mother: Ms Tammy Moher; primary carer
- Home: 16 Station Road, AB10 1AA
Social and medical background
- Lives with mother and younger sibling; primary-school pupil
- Mother prepares meals; child usually eats school lunches
- Enjoys swimming; school swimming certificate received recently
- Previous childhood ear infections; no ongoing hearing concerns
Investigations and diagnosis
- 08/09/26: intermittent loose stools, bloating and tiredness for 3/12
- No blood in stools; appetite maintained
- Initial blood tests suggested coeliac disease
- Gluten continued during diagnostic investigations
- Mother initially blamed school lunches; no supporting evidence
- 29/10: paediatric gastroenterology review; biopsy-confirmed coeliac disease
- Confirmed diagnosis explained; gluten-free diet started that day
- No diagnosed food allergy or previous immediate food reactions
Current review and dietary plan
- 03/11: stools improving; mother requests practical written advice
- Mother worries healthy foods will become too expensive
- Plan: lifelong gluten avoidance, including wheat, barley and rye
- Check labels; balanced alternatives include rice, potatoes, gluten-free bread
- Prevent gluten mixing: clean utensils and preparation surfaces
- No dairy exclusion advised; discuss oats with dietitian
- Dietitian appointment 09/11: labels, meal planning and balanced nutrition
School arrangements and follow-up
- Mother to meet teacher/catering staff: gluten-free lunches, preparation and celebration snacks
- GP explained: coeliac disease alone requires no adrenaline autoinjector
- School informed with mother's agreement; catering arrangements not yet confirmed
- Mother agreed to supply packed lunches until arrangements confirmed
- Mother complained about clinic parking charges
- Review 10/12: symptoms and growth; earlier contact if persistent diarrhoea/weight loss
- No current regular medicines; mother wants simple written instructions
Who is reading, and what do they need?
Tammy Moher is Jacob's mother, primary carer and meal preparer, and already knows the confirmed diagnosis. She needs simple, affordable dietary guidance and clear arrangements for a primary-school pupil who usually eats school lunches. Prioritise practical actions and support over diagnostic history. Identifiers belong in the heading; her cost concern should guide discussion without assuming particular financial circumstances.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Biopsy-confirmed coeliac disease, 29 October; gluten-free diet started that day. | The confirmed diagnosis establishes why ongoing dietary management, rather than further diagnostic gluten exposure, is now being explained. |
| Lifelong gluten avoidance, including wheat, barley and rye. | The duration and all three named grains are central to the requested dietary explanation. |
| Check labels; rice, potatoes, gluten-free bread; clean utensils and preparation surfaces. | These concrete measures turn avoidance into practical food selection and prevention of gluten mixing. |
| No dairy exclusion advised; discuss oats with dietitian. | This prevents unnecessary restriction and preserves the specific unresolved dietary question for professional advice. |
| Dietitian appointment 9 November: labels, meal planning and balanced nutrition. | The appointment date and purpose identify the arranged support; help with a balanced gluten-free diet is an accurate summary without listing every agenda item. |
| Agree lunches, preparation and celebration snacks with school; packed lunches until catering confirmed. | All school topics and the interim arrangement are needed because suitable catering has not yet been confirmed. |
| No diagnosed food allergy or immediate reactions; coeliac disease alone requires no adrenaline autoinjector. | This addresses the requested distinction between coeliac management and treatment for a food allergy. |
| 10 December symptom/growth review; earlier contact for persistent diarrhoea or weight loss. | This useful follow-up detail explains planned monitoring and both documented reasons for earlier contact. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys swimming; recently received a school swimming certificate. | The achievement does not help Tammy implement the diet or school meal arrangements. |
| Previous childhood ear infections; no ongoing hearing concerns. | The resolved ear history has no documented connection with coeliac care. |
| Mother initially blamed school lunches; no supporting evidence. | Repeating an unsupported attribution could confuse the school discussion and imply a cause the notes do not establish. |
| Complaint about clinic parking charges. | The parking complaint does not inform dietary advice, nutrition support or school planning. |
| Gluten continued during diagnostic investigations. | This completed diagnostic instruction is a tempting distraction that could conflict with the current lifelong avoidance message. |
A paragraph plan for this case
Open with the purpose of the practical advice and the confirmed diagnosis, keeping presenting symptoms and preliminary blood tests brief or omitting them. Follow with lifelong avoidance, all named grains, label checking, the listed food alternatives, clean preparation, the dairy and oats qualifications, and dietitian support for balanced meals and cost concerns. Close with the distinction from food-allergy treatment and the school meeting topics, clearly separating agreed interim packed lunches from unconfirmed catering; optional follow-up detail should retain the 10 December review and both persistent diarrhoea and weight loss as reasons for earlier contact.
Where candidates slip on this task
- The instruction to continue gluten belonged to diagnostic investigations before confirmation on 29 October; do not carry it into advice about the lifelong gluten-free diet now underway.
- Keep wheat, barley and rye together when explaining avoidance; do not invent dairy restriction or describe oats as already approved before the planned dietitian discussion.
- School notification does not mean gluten-free catering is confirmed; preserve the interim packed lunches and avoid presenting coeliac disease alone as an indication for an adrenaline autoinjector.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
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Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should the letter explain why school lunches caused the illness?
No causal explanation is supported. The notes explicitly describe Tammy's initial suspicion as unsupported. Omit that attribution and focus school content on gluten-free lunches, food preparation and celebration snacks, with packed lunches continuing until catering arrangements are confirmed.
Must the advice remove dairy and approve oats?
Neither change is authorised. The notes state that dairy exclusion was not advised and that oats should be discussed with the dietitian. Use these qualifications to avoid unnecessary restriction, alongside the documented label checking, food alternatives and appointment for balanced nutrition.
Sources
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