The task
Assume that today's date is 3 November 2026. You have just seen Mr Waititi in your surgery and have spoken by telephone with the on-call cardiologist.
You are a general practitioner at a suburban medical practice. You have spoken by telephone with Dr Seren Vaughan, the on-call Consultant Cardiologist, who has agreed to assess Mr Waititi today. Using the information in the case notes, write a letter to Dr Vaughan to accompany Mr Waititi for same-day acute cardiology assessment. Address the letter to Dr Seren Vaughan, On-call Consultant Cardiologist, Cardiology Department, Regional Hospital. 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.
Case notes
Patient details
- Name: Mr Malakai Waititi
- DOB: 14/05/2002 (24 yrs)
- Seen 03/11/26 — first visit to practice since 2024
Social background
- Final-year engineering student; lives in shared house with 3 friends
- Competitive club rower (heavyweight crew); trains 6 days/wk, often 2 sessions/day
- National selection trials in 4/52 — very keen to compete
- Non-smoker; alcohol ~6 standard drinks/wk (weekends); denies illicit drugs
- Takes caffeine-based pre-workout supplement most mornings
- Plays guitar in a band at weekends
- Pt annoyed — says coach 'overreacting' and has told team-mates about collapse
Family history
- Paternal cousin died suddenly aged 19 while playing football (2019); family told 'heart problem' — post-mortem details unknown
- Father (52) well; has never had cardiac screening
- Mother says father's family 'never talk about their health problems'
Medical history
- Childhood asthma — no inhaler use since age 12
- # R clavicle 2020 (cycling accident), conservative mx
- No regular medications; allergies: nil known
Presenting complaint
- 31/10/26: collapsed near end of maximal-effort 2 km ergometer test
- Few secs of lightheadedness & 'heart racing' immediately before collapse
- LOC ~20–30 sec (witnessed by coach); no jerking, incontinence or tongue biting; fully alert within 1–2 min
- Declined ambulance; rested, then drove himself home same evening
- Lightheadedness ×2 during hard sessions in last 3/12, no LOC — not previously reported
- No chest pain; no SOB beyond usual exertion
Examination
- BP 124/76 lying, 120/74 standing; HR 56 regular
- Soft ejection systolic murmur LSE — ↑ on standing & Valsalva, ↓ on squatting
- Heart sounds otherwise normal; chest clear; no neurological deficit
- Small bruise L forearm from fall
Investigations
- 12-lead ECG: sinus bradycardia 56/min; LVH voltage criteria; deep TWI V4–V6, I & aVL
- Bloods (FBC, U&E, glucose, TFTs): all normal
Assessment and plan
- Imp: exertional syncope with palpitations + abnormal ECG + dynamic murmur + FHx sudden death — ? HCM; high risk → needs same-day acute specialist assessment
- Advised: stop all training, competition & strenuous exercise until cardiology review
- Advised not to drive; father to take him directly to hospital today
- Safety-netting: call emergency services if further collapse, chest pain or sustained palpitations, incl. on way to hospital
- Pt initially reluctant (trials) — accepted advice after discussion of risk
- Tel. d/w on-call cardiologist (Dr Vaughan) today → agreed same-day acute assessment, Cardiology Dept, Regional Hospital; if cannot be seen directly → attend ED. Request: echo, monitoring/risk assessment as appropriate; advice re family screening; ECG copy enclosed
Who is reading, and what do they need?
Dr Vaughan is the on-call cardiologist who has already agreed by phone to see Mr Waititi today, and the letter accompanies him. They need the red-flag features, ECG and family history at a glance, the advice already given and exactly what is requested; routine background can be minimal.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Collapsed near end of maximal 2 km ergometer test 31/10; LOC ~20–30 sec, witnessed | Exertional syncope is the reason for urgency; the date matters because he was seen three days later. |
| Lightheaded and 'heart racing' just before; no jerking, incontinence, tongue biting; alert in 1–2 min | Palpitations before collapse and the absence of seizure features support the cardiac concern; recovery time is useful. |
| Two earlier lightheaded episodes in 3/12, no LOC, not previously reported | Earlier symptoms add to the history; state that he had not reported them before. |
| Cousin died suddenly at 19 playing football; post-mortem unknown; father (52) never screened | Family sudden death is a key feature; the unknown post-mortem and unscreened father explain the request for screening advice. |
| HR 56 regular; soft ejection systolic murmur, louder standing and Valsalva, softer squatting | The murmur's response to manoeuvres is part of the stated impression; other findings can be summarised as otherwise normal. |
| ECG: sinus bradycardia 56, LVH voltage criteria, deep TWI V4–V6, I and aVL | An abnormal ECG is a key reason for same-day review; state the leads accurately and note the copy is enclosed. |
| Competitive heavyweight rower, 6 days/wk; caffeine pre-workout most mornings; trials in 4/52 | Gives training and stimulant exposure context, and explains why exercise restriction was discussed. |
| Advised stop exercise, no driving; father taking him; requests echo, monitoring, family screening advice | The cardiologist should know current advice and the asks; emergency advice covers all three triggers: further collapse, chest pain, sustained palpitations, including on the way. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Pt annoyed; coach 'overreacting'; told team-mates about collapse | Trap: his attitude and gossip are not clinical, and his initial reluctance was resolved after discussion. |
| Engineering student, shared house, plays guitar in a band | Social detail with no bearing on cardiac assessment. |
| Childhood asthma, no inhaler since 12; R clavicle fracture 2020 | Old, unrelated history; 'no regular medications, no known allergies' is enough. |
| Small bruise L forearm from fall | A minor injury that does not alter the cardiac assessment. |
| Mother says father's family 'never talk about their health problems' | Second-hand comment; the essential points are the unknown post-mortem and the unscreened father. |
| FBC, U&E, glucose, TFTs normal; alcohol ~6 drinks/wk; denies drugs | Compress to a single clause; the ECG and examination carry the urgency. |
A paragraph plan for this case
Open by stating the same-day request and that the telephone call has taken place, with a one-line statement of the concern. Use the next paragraph for the collapse, warning symptoms and family history, then examination and ECG. Close with advice given, safety measures and the specific requests.
Where candidates slip on this task
- Get the timeline right: the collapse was on 31/10, he was reviewed on 3/11, and he declined an ambulance then drove himself home that evening. Do not describe the collapse as happening today.
- Present hypertrophic cardiomyopathy as a query, not a diagnosis, and show it rests on the combination: exertional syncope with palpitations, abnormal ECG, dynamic murmur and family history of sudden death. Do not list only some.
- State the plan completely: no driving, father taking him directly to hospital, emergency services for further collapse, chest pain or sustained palpitations including on the way, and ED attendance if he cannot be seen directly.
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 should be said about the phone conversation?
A brief reference is enough: Dr Vaughan agreed to same-day assessment in the cardiology department, with ED attendance if he cannot be seen directly. The remaining space belongs to clinical findings and the requests.
Should the normal bloods be listed?
Compress them into a single statement that FBC, U&E, glucose and TFTs were normal. The abnormal ECG and examination findings carry the urgency, and the word limit leaves little room for detail that changes nothing.
Sources
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