The task
Original independent practice. All patient details, observations and individual care arrangements are fictional. Assume that today's date is 3 November 2026. Ms Randall has attended your general practice today. Allow 45 minutes: 5 minutes reading and 40 minutes writing.
You are Ms Joline Randall's general practitioner. Using the case notes, write a referral letter to Dr Kaylie Dennis, Gynaecologist, Gynaecology Outpatient Clinic, 26 Park Road, SW1V 3JD, United Kingdom. Request urgent assessment of her unexplained postmenopausal bleeding, explaining the findings and investigation status without presenting a confirmed diagnosis. 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: Referral letter.
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Which case notes belong in this letter?
Postmenopausal bleeding: referral
You are Ms Joline Randall's general practitioner. Using the case notes, write a referral letter to Dr Kaylie Dennis, Gynaecologist, Gynaecology Outpatient Clinic, 26 Park Road, SW1V 3JD, United Kingdom. Request urgent assessment of her unexplained postmenopausal bleeding, explaining the findings and investigation status without presenting a confirmed diagnosis. 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
- Name: Ms Joline Randall
- DOB: 14/04/1967 (59 yrs)
- Address: 8 Orchard Road, SW1V 3JD
Social background
- Lives with partner; works part-time as bookkeeper; independent; partner can provide transport
- Can attend clinic at short notice; prefers afternoons
- Complained that reception staff were unfriendly
Medical history
- Remote appendicectomy; no ongoing complications
- Hypertension; stable on unchanged treatment, details held by GP
- Menopause aged 51; no bleeding until current episodes
- Never used HRT; no anticoagulants or tamoxifen
- No known drug allergies
Previous assessment and progress
- 19/08/26: vaginal dryness; no bleeding or discharge; symptoms for 3/12; examination then deferred
- Non-hormonal moisturiser advised → dryness improved; used intermittently; no vaginal oestrogen prescribed
- 2023 cervical screening: negative; no previous abnormal results
Current assessment — 03/11/26
- 03/11/26: light vaginal spotting 31/10 and 02/11; first postmenopausal episodes
- Neither episode postcoital; no pelvic pain or offensive discharge
- No haematuria, rectal bleeding or change in bowel habit; appetite unchanged
- No weight loss; BMI 33
- Speculum: pale mucosa; no visible bleeding source or cervical lesion
- Bimanual examination: no palpable mass or tenderness
- Currently well; no active bleeding at examination
- TVUS requested today; appointment unallocated; no endometrial sampling performed
- Pt initially assumed spotting was from dryness
Plan
- Explained: cause uncertain; atrophy possible, not confirmed; investigation necessary
- No treatment commenced for bleeding
- Urgent gynaecology referral today; do not await ultrasound appointment
- Request assessment and appropriate endometrial investigation
- Pt understands referral does not establish cancer; agrees to attend
Who is reading, and what do they need?
Dr Dennis needs sufficient information to prioritise a new gynaecology referral and arrange appropriate investigation. Emphasise the first postmenopausal bleeding episodes, examination findings and outstanding investigations. Patient identifiers support correct triage; appointment availability may assist booking. Historical dryness, routine background and reassuring findings deserve space only when they clarify the current problem.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Light spotting on 31/10 and 02/11; first postmenopausal episodes | Establishes the presenting problem and its precise chronology for urgent triage. |
| Menopause aged 51; no bleeding until these episodes | Establishes the preceding absence of bleeding and the postmenopausal context. |
| Pale mucosa; no visible bleeding source or cervical lesion on speculum examination | Reports the relevant examination without claiming that the bleeding source has been established. |
| TVUS requested today; appointment unallocated; no endometrial sampling performed | Defines the investigation status so the specialist can plan the next assessment. |
| Cause uncertain; atrophy possible but unconfirmed; investigation necessary | Preserves diagnostic uncertainty and explains why an apparently plausible explanation cannot conclude the assessment. |
| Urgent gynaecology assessment and appropriate endometrial investigation; do not await ultrasound | States the requested action and prevents the pending scan from delaying referral. |
| Never used HRT; no anticoagulants or tamoxifen | Provides useful exposure history when assessing possible explanations for the bleeding; omission remains defensible. |
| BMI 33; no weight loss | Adds relevant assessment context if space permits, without making the absence of weight loss reassuring enough to delay investigation. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Complaint about unfriendly reception staff | Does not help the gynaecologist prioritise or investigate the bleeding. |
| Remote appendicectomy without ongoing complications | Has no stated connection to the current presentation or requested assessment. |
| Part-time bookkeeping and independence | Occupational and functional detail does not affect the stated referral arrangements. |
| Detailed August dryness history and intermittent moisturiser use | May be compressed to brief context; the earlier symptom history must not overshadow the new bleeding. |
| Negative cervical screening in 2023; no previous abnormal results | Optional background that can distract from the unresolved bleeding; it does not establish its cause. |
| Stable hypertension with unchanged treatment | Can be compressed if useful, but the notes provide no treatment details requiring a specific handover. |
A paragraph plan for this case
Open with the urgent assessment request and patient identifiers, followed by the menopause history and dated bleeding episodes. Present the speculum findings, then add selected supporting details such as BMI, exposure history, associated symptom negatives, bimanual findings, current condition and allergies; keep earlier dryness and other historical background brief. Finish with diagnostic uncertainty, the exact investigation status and the instruction not to await ultrasound, adding treatment status, referral understanding or booking arrangements only if useful.
Where candidates slip on this task
- Keep both spotting dates, 31 October and 2 November, distinct from the consultation on 3 November; do not describe continuous bleeding or additional episodes.
- Pale mucosa and previous dryness support consideration of atrophy only; neither establishes the bleeding source, and negative cervical screening does not settle the current problem.
- Separate a requested ultrasound with no allocated appointment from completed investigation; no endometrial sampling has occurred, and urgent referral must proceed without waiting for imaging.
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
How much of the earlier dryness history belongs in this referral?
A brief reference is optional if it helps explain why atrophy was considered. The August symptom duration, deferred examination and intermittent moisturiser use need little space. Keep the new bleeding, current examination and investigation status prominent, and do not turn the patient's initial assumption into a diagnosis.
Should every reassuring symptom and examination finding be included?
No. Select supporting negatives that help Dr Dennis understand the presentation within the word limit. The speculum findings and unresolved investigation status remain central. If using a grouped note, preserve its relevant distinctions and avoid suggesting that absent symptoms or a normal bimanual examination establish the cause.
Sources
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