The task
Original independent practice. Assume it is 14:40 on 5 November 2026. All patient findings, telephone conversations and individual transfer arrangements are fictional case facts.
You are the doctor in an acute hospital assessment area. Using the case notes, write a transfer letter to Dr Rabi Buhari, Emergency Receiving Doctor, Emergency Department, 24 Station Road, SW1A 2AA. Communicate the reason for emergency transfer, the latest accepting doctor and confirmed destination, and the clinical deterioration reported after the initial handover. 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 cauda equina syndrome: transfer
You are the doctor in an acute hospital assessment area. Using the case notes, write a transfer letter to Dr Rabi Buhari, Emergency Receiving Doctor, Emergency Department, 24 Station Road, SW1A 2AA. Communicate the reason for emergency transfer, the latest accepting doctor and confirmed destination, and the clinical deterioration reported after the initial handover. 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
- Mr Roshan Kodituwakku
- DOB: 18/03/1980 (46 yrs)
- 05/11/26, 14:40: acute hospital assessment area; awaiting ambulance
Social background
- Warehouse worker; frequent lifting
- Lives with wife; independent before this episode
- Enjoys watching cricket
- Complained receptionist was unfriendly
Medical history
- Regular medicines: nil; no anticoagulants
- Appendicectomy aged 19; uncomplicated
- No known drug allergies
- No previous bladder dysfunction
Assessment today
- Lower back pain for 3 days; began after lifting a box
- Today: pain now radiating down both legs
- No fever or recent trauma
- New perineal numbness today; examination confirms reduced perineal sensation
- Difficulty initiating urination since this morning
- Impression: suspected cauda equina syndrome → emergency assessment
- Ankle dorsiflexion power 4/5 bilaterally
- Haemodynamically stable; alert
- No analgesia administered; patient declined
Telephone handovers and progress
- 14:10: Dr Amal Atapattu, orthopaedic registrar, initially accepted direct orthopaedic ward transfer
- 14:20: Dr Rabi Buhari, emergency receiving doctor, accepted instead; confirmed destination: Emergency Department
- No orthopaedic ward bed available; earlier direct ward arrangement superseded
- 14:25: passed small amount of urine
- 14:30: new urinary leakage without awareness; not present during earlier handovers
- 14:35: Dr Buhari notified by telephone of leakage; reconfirmed immediate ED transfer
- No spinal imaging performed
Current plan
- Agreed with Dr Buhari: immediate ambulance transfer; urgent investigation and spinal specialist assessment on arrival
- Continuous nursing observation pending ambulance departure
- Ambulance crew given updated destination and symptoms
Who is reading, and what do they need?
Dr Rabi Buhari is the emergency receiving doctor who accepted this transfer and received the subsequent telephone update. He needs a concise record of the emergency findings, deterioration and agreed arrangements for continuing care. Identify Mr Roshan Kodituwakku, DOB 18/03/1980, briefly, then prioritise information supporting immediate investigation and spinal specialist assessment.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Suspected cauda equina syndrome requiring emergency assessment | Establishes the emergency purpose and working diagnosis guiding the receiving doctor's next actions. |
| New perineal numbness today; examination confirms reduced perineal sensation | Provides both the reported sensory change and its examination finding supporting urgent spinal assessment. |
| Difficulty initiating urination since this morning | Establishes the earlier urinary symptom needed to understand the subsequent deterioration. |
| 14:20: Dr Rabi Buhari accepted instead; confirmed destination Emergency Department | Identifies the current accepting doctor and destination, preventing reliance on the superseded ward arrangement. |
| 14:30: new urinary leakage without awareness, absent during earlier handovers | Communicates the deterioration occurring after acceptance and distinguishes it from the previously reported urinary difficulty. |
| 14:35: Dr Buhari notified of leakage; immediate ED transfer reconfirmed | Records that the receiving doctor knows about the deterioration and has reconfirmed the immediate transfer. |
| Agreed immediate ambulance transfer; urgent investigation and spinal specialist assessment on arrival | Specifies the agreed transport and receiving-care actions required to continue emergency management. |
| Pain radiating down both legs; ankle dorsiflexion power 4/5 bilaterally | Adds useful neurological context when space permits, without displacing the essential urinary changes and transfer arrangements. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Enjoys watching cricket | The leisure interest has no bearing on emergency investigation, transfer arrangements or immediate spinal assessment. |
| Complained receptionist was unfriendly | The reception complaint does not help Dr Buhari assess the deterioration or continue emergency care. |
| Uncomplicated appendicectomy aged 19 | The remote uncomplicated operation does not explain the current emergency or affect the documented transfer plan. |
| Lives with wife; independent before this episode | Household and baseline independence details can be omitted because the immediate request concerns emergency investigation rather than discharge support. |
| Warehouse worker; frequent lifting | Occupational detail can be compressed; the immediate lifting event provides sufficient context for this emergency transfer. |
| 14:25: passed small amount of urine | Optional chronology; this isolated void must not suggest resolution of the urinary difficulty or reduce the significance of subsequent leakage. |
A paragraph plan for this case
Open with the emergency purpose, current ED destination and Dr Buhari’s acceptance, keeping the patient identifiers brief. Next, organise the perineal, urinary and bilateral leg findings chronologically; back pain for three days after lifting a box and absence of fever or recent trauma can be compressed if useful. Close with the new leakage, the 14:35 update and reconfirmation, and the agreed ambulance transfer and arrival assessments; optionally add continuous nursing observation, the crew’s updated information and the 14:40 awaiting-ambulance status.
Where candidates slip on this task
- Do not preserve the 14:10 direct orthopaedic ward plan as current: Dr Buhari accepted ED transfer at 14:20, and the absent ward bed explains why the earlier arrangement was superseded.
- Keep suspected cauda equina syndrome provisional; haemodynamic stability and alertness do not cancel the documented neurological and urinary findings. No spinal imaging has been performed, so avoid suggesting confirmation.
- Treat nil regular medicines/no anticoagulants, no known drug allergies, no previous bladder dysfunction and declined analgesia as optional context; if mentioning analgesia, retain that none was administered.
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 changing transfer arrangement needs explanation?
Prioritise Dr Buhari’s 14:20 acceptance, the confirmed Emergency Department destination and his 14:35 reconfirmation after notification of leakage. The earlier orthopaedic acceptance and unavailable ward bed can be compressed into brief context if needed to clarify why the destination changed.
Does passing some urine at 14:25 make the later leakage less important?
The notes do not support that interpretation. The essential sequence is difficulty initiating urination, followed by new leakage without awareness after the earlier handovers. The small void is optional detail; if retained, avoid interpreting it as recovery or using it to minimise the subsequent change.
Sources
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