The task
Assume that today's date is 21 October 2026 and the time is 13:00. The patient will be transferred by ambulance at 14:00.
You are the doctor on duty at Millbrook District Hospital. Using the information in the case notes, write a letter to Dr Sophie Grant, the orthopaedic registrar at Kingsford Regional Hospital, who has accepted Mrs Kowalski for transfer and surgical management. Address the letter to Dr Sophie Grant, Orthopaedic Registrar, Kingsford Regional Hospital, 1 Hospital Drive, Kingsford. 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.
Case notes
Patient details
- Name: Mrs Edna Kowalski
- DOB: 30/09/1945 (81 yrs)
- Retired dairy farmer
Social background
- Lives with husband (82, Parkinson's disease) — she is his main carer
- Pre-morbid: independent with ADLs; walking stick outdoors
- Daughter lives interstate; grandchildren visit at Christmas
- Husband unable to stay home alone — pt very worried; local respite placement being arranged by social worker here
- Neighbour feeding the dog
Medical history
- Atrial fibrillation — warfarin (target INR 2–3), dose 4 mg daily
- Hypertension — ramipril 5 mg daily
- Type 2 diabetes — metformin 500 mg BD; HbA1c 6.9% (Jul 2026)
- CKD stage 3a (baseline eGFR 52 mL/min/1.73 m²)
- Mild cognitive impairment (MoCA 23/30, 2025)
- Cholecystectomy 1990
- Codeine intolerance (vomiting)
Presentation 21/10/26
- 07:00 tripped on rug at home; no head strike, no LOC
- On floor approx. 2 hrs — husband unable to lift her; ambulance called
- Unable to weight-bear; L leg shortened and externally rotated
- Pain 8/10 on arrival
Examination & investigations
- HR 96 irregular; BP 142/80; T 36.4°C; GCS 15; alert, oriented
- Small skin tear L forearm — dressed
- Hip X-ray: displaced intracapsular fracture L neck of femur
- INR 2.8 (09:30)
- Hb 118 g/L; eGFR 50 mL/min/1.73 m²; CK 610 U/L; BSL 9.2 mmol/L; weight 58 kg
- ECG: AF, rate 96; CXR: clear
Management
- Warfarin withheld (last dose 20/10, 18:00)
- Vitamin K 5 mg IV at 10:30
- Repeat INR due approx. 16:30 (6 hrs post vitamin K)
- Ultrasound-guided fascia iliaca block by ED consultant (ropivacaine 0.2%, 30 mL) at 10:15 — pain now 3/10
- Paracetamol 1 g IV at 10:15 (QID); oxycodone 2.5 mg oral at 12:00
- Fasting since 09:00
- IV 0.9% sodium chloride 80 mL/hr; metformin withheld
- Pressure area care — heels offloaded
- Pt upset about 2-hr wait for ambulance; asked how to make a complaint
Who is reading, and what do they need?
Dr Grant is an orthopaedic registrar who has already accepted the patient and will plan surgery. She needs the clinical picture, anticoagulation status and timings, analgesia, fasting and comorbidities that affect anaesthesia and surgery. She does not need a full life history, so social detail should be brief and limited to what affects care and discharge planning.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Tripped on rug 07:00; on floor about 2 hrs; leg shortened, externally rotated | Establishes mechanism, the long lie and the clinical findings supporting the fracture diagnosis. No head strike or LOC is a relevant negative. |
| X-ray: displaced intracapsular fracture L neck of femur | This is the surgical diagnosis and the reason for transfer, so it should anchor the letter. |
| AF on warfarin; last dose 20/10 18:00; INR 2.8 at 09:30 | Anticoagulant status and the last dose time directly affect surgical timing and bleeding risk. The ECG showing AF at rate 96 can be linked here. |
| Vitamin K 5 mg IV 10:30; repeat INR due about 16:30 | The repeat INR falls after the 14:00 transfer, so the receiving team must know it is outstanding and act on it. |
| Fascia iliaca block 10:15, pain 3/10; paracetamol IV; oxycodone 12:00; codeine intolerance | The registrar needs analgesia given and timing to plan further pain relief, and the codeine vomiting avoids a repeat problem. |
| Fasting since 09:00; IV saline 80 mL/hr; metformin withheld | Fasting time and fluid and diabetic medicine status are needed for theatre and anaesthetic planning. |
| CKD 3a, eGFR 50; Hb 118; CK 610; type 2 diabetes | Renal function, baseline Hb, CK after the long lie and diabetes bear on perioperative care. Weight 58 kg can accompany these. |
| Mild cognitive impairment; carer for husband with Parkinson's; respite being arranged | Cognition matters for consent and perioperative care, and early discharge planning is relevant. Keep the social element short. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Pt upset about 2-hr wait for ambulance; asked how to make complaint | A complaint is not clinical handover information for the surgeon and should go through the hospital's own process, not this letter. |
| Daughter interstate; grandchildren at Christmas; neighbour feeding the dog | Family and pet arrangements do not affect surgical or medical management and add words the reader does not need. |
| Retired dairy farmer; cholecystectomy 1990 | Occupation and an old unrelated operation add little to this admission, so omit or give minimal mention. |
| HbA1c 6.9% (Jul 2026) | An older result is less useful for immediate surgery than the current blood sugar and withheld metformin. |
| Small skin tear L forearm — dressed | Minor and already treated; at most a brief mention, as it does not change the surgical plan. |
| CXR: clear | A trap in the investigations: the ECG showed AF so it is not a normal result, and the clear chest film needs only a passing mention if space allows. |
A paragraph plan for this case
Open with the reason for transfer, the diagnosis and the mechanism. Then cover anticoagulation and reversal with times and the outstanding repeat INR, followed by analgesia, fasting and relevant comorbidities. Close with brief cognitive and social points relevant to discharge planning.
Where candidates slip on this task
- The repeat INR is due about 16:30, after the 14:00 transfer, so state clearly that it is outstanding for the receiving team. Do not imply the result is known or that reversal is confirmed.
- Give exact times for the last warfarin dose, INR, vitamin K, block, paracetamol, oxycodone and fasting. Vague wording like earlier today weakens a handover that depends on timing.
- Do not drop the AF finding or call the ECG normal. Do not include the ambulance-wait complaint; keep social detail to what affects care, such as the husband needing respite.
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
More Medicine letter tasks
- Transfer to a residential aged care facility after delirium transfer letter
- Urgent referral to a gastroenterologist: iron-deficiency anaemia and rectal bleeding referral letter
- Discharge to GP after pneumonia with new atrial fibrillation discharge letter
Your profession's guide: OET Medicine. Layout and structure: OET letter format.
Questions about this task
Should the letter mention the patient's complaint about the ambulance wait?
No. It is not clinical information the orthopaedic registrar needs to act on. The long lie on the floor is relevant clinically, but the question about making a complaint belongs in a separate process.
How much social detail should be included?
Only what affects care: she is the main carer for her husband, who has Parkinson's, and respite is being arranged. Her cognitive impairment is also relevant. Family elsewhere and the dog are not.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.