The task
Assume that today's date is 3 November 2026. It is 14:15, and Mr Hamed Alshehri is awaiting ambulance transfer. Allow 45 minutes: 5 minutes for reading and 40 minutes for writing. This practice timing does not change the transport arrangements: the ambulance must depart as planned at 14:30 and must not be delayed while awaiting completion of this letter.
This is original independent practice. You are the doctor treating Mr Hamed Alshehri in a rural emergency department. Write a transfer letter to Dr Khadija Alsubaie, Surgical Registrar, Surgical Department, 18 Hospital Road, NSW 2000, Australia. Summarise the evolving clinical findings, treatment and agreed transport arrangements, requesting urgent surgical assessment for suspected appendicitis. 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: Transfer letter.
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Which case notes belong in this letter?
Suspected appendicitis: transfer
This is original independent practice. You are the doctor treating Mr Hamed Alshehri in a rural emergency department. Write a transfer letter to Dr Khadija Alsubaie, Surgical Registrar, Surgical Department, 18 Hospital Road, NSW 2000, Australia. Summarise the evolving clinical findings, treatment and agreed transport arrangements, requesting urgent surgical assessment for suspected appendicitis. 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: Mr Hamed Alshehri
- DOB: 14/05/1998 (28 yrs)
- Rural ED attendance: 03/11/26, 11:30; transfer arranged today
Social background
- Lives with partner; independent; works on a farm
- Partner can follow ambulance; contact details supplied
- Complained that receptionist seemed uninterested in his indigestion
Medical history
- Intermittent post-meal epigastric burning for 6/12; self-treated with OTC antacid
- Previous episodes brief; no vomiting or lower abdominal pain
- No prior abdominal surgery; no regular prescribed medicines
- Allergies: nil known
Assessment chronology
- 02/11, 20:00: central abdominal pain; assumed indigestion
- Antacid ineffective; pain persisted overnight
- 03/11, 08:00: pain → RIF; worse walking/coughing
- Anorexia; vomited twice; no diarrhoea or dysuria
- 11:30: diffuse tenderness; no guarding; pulse 96
- 13:45: focal RIF tenderness + guarding; no generalised rigidity
- 13:45: T 38.1°C; pulse 104; BP 118/74; alert
- FBC: neutrophilia; CRP ↑; renal function preserved
- Urinalysis: no blood, nitrites or leucocytes
- No CT/ultrasound available locally; diagnosis not confirmed
Treatment/Progress
- Patent IV cannula; IV crystalloid started
- 13:00: IV paracetamol; pain 8/10 → 5/10
- 13:45 reassessment: guarding noted despite pain reduction after analgesia
- No antibiotics administered; registrar informed
- Nil by mouth; last food 07:00; last water 10:30
Transfer plan
- 14:00: Dr Khadija Alsubaie accepts urgent transfer for suspected appendicitis
- Ambulance departure 14:30; estimated journey 90 min; receiving ED notified
- Registrar's transport plan: continue IV fluids; ambulance observations; immediate clinical escalation if deterioration
- Request surgical assessment on arrival; further investigation and management
- Blood results and medication administration record accompany patient
Who is reading, and what do they need?
Dr Alsubaie has accepted the transfer but needs a concise clinical handover showing why urgent surgical assessment remains necessary. Prioritise the latest examination, observations, treatment, fasting status and transport instructions. Mr Alshehri’s name and date of birth identify the patient; supporting history and investigations should occupy less space than the immediate handover.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| 14:00 urgent transfer accepted for suspected appendicitis; local CT/ultrasound unavailable; diagnosis unconfirmed. | Establishes the agreed purpose and explains why definitive assessment must occur at the receiving hospital. |
| Overnight central pain → RIF; 13:45 focal tenderness and guarding, without generalised rigidity. | Shows the clinical evolution supporting urgent review without implying confirmed appendicitis or generalised peritonitis. |
| 13:45: temperature 38.1°C, pulse 104, BP 118/74; alert. | Provides the receiving team with the latest documented physiological baseline for assessment and comparison. |
| Patent IV cannula; crystalloid started; continue fluids, ambulance observations, immediate clinical escalation if deterioration. | Communicates active treatment and every element of the registrar’s agreed transport plan. |
| 13:00 IV paracetamol: pain 8/10 → 5/10; 13:45 reassessment found guarding despite pain reduction; no antibiotics, registrar informed. | Distinguishes pain relief from the guarding found on later reassessment and clarifies treatment already given or outstanding. |
| Nil by mouth; last food 07:00; last water 10:30. | Preserves the fasting information needed when planning urgent surgical investigation and possible intervention. |
| 14:30 ambulance departure planned; 90-minute estimated journey; receiving ED notified. | Allows the receiving service to coordinate arrival without presenting planned transport as already completed. |
| Neutrophilia, raised CRP, preserved renal function; blood results and medication record accompany patient. | Offers concise supporting evidence and directs the receiving team to the accompanying clinical documentation. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Lives with partner; independent; works on a farm. | Routine social circumstances do not explain the acute findings or change the agreed transfer. |
| Receptionist seemed uninterested in his indigestion. | The complaint does not contribute to surgical assessment, treatment continuity or transport coordination. |
| Six months of post-meal epigastric burning, self-treated with OTC antacid. | A brief reference to previous indigestion can contrast with the current persistent, migrating pain; a lengthy account of the six-month history would distract from the urgent handover. |
| Previous episodes brief, without vomiting or lower abdominal pain. | Optional contrast with earlier symptoms can be compressed; the current chronology already explains the urgent referral. |
| Partner can follow ambulance; contact details supplied. | Useful logistical background if space permits, but it does not displace clinical status or the ambulance plan. |
A paragraph plan for this case
Open with the accepted urgent transfer and request for surgical assessment, then trace the acute pain and examination changes, optionally contrasting the initial diffuse tenderness without guarding and pulse 96 with the latest findings. Follow with current observations and treatment; anorexia, vomiting, relevant symptom negatives, antacid failure, urinalysis, surgical history, prescribed-medicine history and allergy status can be compressed or omitted according to space. Close with fasting times, departure and journey estimates, all agreed transport instructions and accompanying records.
Where candidates slip on this task
- At 14:15 the patient is still awaiting departure: 14:30 plus the estimated 90-minute journey gives approximately 16:00 arrival, rather than an already completed transfer. The 45-minute practice timing does not change these arrangements; the ambulance must depart as planned and must not be delayed while awaiting completion of the letter.
- Guarding was absent at 11:30 and found on reassessment at 13:45 despite pain improvement after IV paracetamol; preserve this sequence and avoid describing the suspected appendicitis as confirmed.
- No antibiotics have been administered and the registrar knows this; do not invent an antibiotic regimen, fluid rate, imaging result or instruction to delay transfer.
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 earlier indigestion history dominate the clinical account?
No. A brief reference to previous indigestion or brief episodes can help contrast them with the present persistent pain that moved to the right iliac fossa. Avoid a lengthy account of six months of burning and self-treatment; omit that detail when the acute chronology already makes the distinction clear.
Must every investigation and negative symptom appear?
No. Neutrophilia and raised CRP provide useful support, while the detailed urinalysis and symptom negatives are optional. Preserve the latest focal guarding, observations, IV treatment, fasting information and agreed transport arrangements before adding supporting results.
Sources
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