The task in one paragraph
The OET Writing sub-test gives you a set of case notes about one patient and asks for one formal letter, usually a referral, discharge, transfer or advice letter to another professional, written as your profession. You have 45 minutes: five minutes of reading time, then 40 minutes of writing time, for a letter in the 180 to 200 word range (OET Test Handbook 2026 and the OET Ready writing page). Two OET assessors mark it on six criteria: Purpose (0 to 3), Content, Conciseness and Clarity, Genre and Style, Organisation and Layout and Language (each 0 to 7), and OET says a Grade B letter scores 2 on Purpose and 5 on each of the others. The skill being tested is selection, not vocabulary: the case notes always contain more than the reader needs, and the mark follows how well you choose, order and rewrite what matters for that reader. The 2025 data says this sub-test deserves attention: OET's demographic PDF shows 63.2 per cent of Nursing candidates at Grade B in Writing against 82.2 per cent at B or above in Speaking, and for Tagalog first-language candidates 57.9 per cent in Writing against 85.4 per cent in Speaking.
- 45 minutes: 5 minutes of reading time + 40 minutes of writing time (Test Handbook 2026).
- 180 to 200 words as the range; no automatic penalty for over or under, but the criteria scores show it (Ready writing page).
- Six criteria, two assessors; Grade B = 2 of 3 on Purpose, 5 of 7 on the rest.
- No fixed layout; use the title and address in the task. No note form; complete sentences only.
- On computer and at home the letter is typed; on paper it is handwritten.
The 45 minutes: a plan that leaves time to check
| Minutes | Do this | Not this |
|---|---|---|
| 0 to 5 (reading time) | Read the task line first: who is the reader, what letter type, what are they being asked to do. Then read the notes once, top to bottom, asking of each line "does this reader need this to care for the patient?" | Memorising numbers; reading the notes three times; planning sentences. |
| 5 to 10 | Write the opening sentence with the purpose and the patient's full name. Decide the order: chronological for a routine history, most important first for an acute situation (the two orders OET's Writing Guide describes). Mark the notes to include. | Starting with "I am writing to refer" before you know the letter is a referral. |
| 10 to 35 | Write the body in three to five paragraphs, one theme or one time period each. Expand notes into complete sentences; keep each fact's tense and meaning. | Copying note form; adding every visit; explaining the reader's own job to them. |
| 35 to 40 | Write the request paragraph: exactly what you want the reader to do, with any follow-up detail. Close formally. | Vague endings ("please do the needful"). |
| 40 to 45 | Read it as the reader. Any question left unanswered? Any fact changed? Any contraction, abbreviation or judgement word? Any tense slip? | Counting words. |
OET's own Writing Guide suggests finishing with a few minutes to spare and reading the letter as the reader, asking: how would the reader feel at the end, will they know what they need to do to continue care, do they have the right information to action it, are the facts correct, and is the grammar and vocabulary accurate. If you finish with no time to read it back, you wrote too much.
The six criteria and what Grade B needs on each
The middle column paraphrases OET's Writing assessment criteria PDF and its Writing Guide, both linked from the OET Ready writing page. The "Grade B looks like" column is ours.
| Criterion (scale) | What it measures (OET, paraphrased) | Grade B looks like (TalkDrill) |
|---|---|---|
| Purpose (0 to 3) | Whether the reason for writing is apparent from the start and developed through the letter. | First sentence names the patient and the reason; the final paragraph expands it into a specific request (how often, what for). |
| Content (0 to 7) | Whether the required information is included and is accurate for the reader. | Everything the reader needs to continue care, nothing invented, every fact kept in its original tense and meaning. |
| Conciseness and Clarity (0 to 7) | Whether the letter omits irrelevant information and is an effective summary. | No social detail the reader cannot act on, no superseded history, similar facts grouped into one sentence. |
| Genre and Style (0 to 7) | Whether register, tone and use of abbreviations suit the reader. | Formal, factual, non-judgemental ("smokes 20 cigarettes a day", not "heavy smoker"); no contractions; abbreviations only the reader will know. |
| Organisation and Layout (0 to 7) | Whether the letter is organised and laid out for the reader. | Paragraphs by time or theme, most important first within each; the request easy to find. |
| Language (0 to 7) | Whether grammar, vocabulary, spelling and punctuation communicate the information accurately. | Accurate tenses, articles and prepositions; a range of structures; spelling of common clinical words correct. |
Notice that four of the six criteria are about the reader, not about English. This is why candidates who write beautiful but complete medical histories score 5 on Language and 3 on Conciseness, and come out with a C+.
From case notes to letter: what goes in, what stays out
Two questions decide every line
The Content section of OET's Writing Guide gives two questions to ask of each note: is there an existing professional relationship between the patient and the reader? and what aspect of the patient's care will the reader be involved with? A letter to the patient's own GP updates; a letter to a stranger introduces. A letter to a physiotherapist needs mobility detail and not the diet history; a letter to a dietitian is the reverse.
The three selection mistakes OET names
- Information the reader already knows or cannot act on. OET's example: a patient's feeling that the health centre did not take her seriously is outside the endocrinologist's role, so it goes.
- Too much history. If the notes record six visits, summarise the trajectory in one or two sentences and give detail only where it changes care.
- Not grouping similar facts. Three separate mentions of non-compliance across the notes become one sentence, in OET's own example: "He has not been compliant with his diet or medication regimen, reporting poor memory as the primary cause."
Accuracy when you paraphrase
Two faults change the facts without the writer noticing, and OET's Writing Guide shows both: swapping a word for a near-synonym ("live with his daughter" becoming "near his daughter"), and changing the tense (a medicine that was "added" written as "will be added"). Keep the timeline. Prefer the plain verb in the notes over a more elegant one that means something slightly different.
A six-point final check
The Writing Guide's advice condenses to six checks, which we remember as READER: Reason stated first; Explain the situation in order with time expressions; Accuracy of facts and grammar; Divide into paragraphs, most important sentence first in each; End with the exact action you need; Relevance, only what bears on the current situation. It is a good order for the final five minutes.
Sample letter 1: nursing discharge to a community nurse
Written by TalkDrill as a teaching example. The case notes and patient are fictional and shortened; a real OET task gives fuller notes. By OET's counting rule (the closing sentence, close and job title are not counted) the body is 189 words; with the closing sentence it is 198.
Case notes (abridged, TalkDrill)
Patient: Mrs Leela Varghese, 72. Admitted: 11 Oct 2026, City General Hospital, left total knee replacement 12 Oct. History: type 2 diabetes (metformin 500 mg twice daily), hypertension (amlodipine 5 mg daily). Lives alone, ground-floor flat, daughter visits daily. Progress: wound clean and dry, 14 clips in place, to be removed day 12 to 14 post-op. Mobilising with a walking frame; physiotherapy exercises taught, patient compliant. Pain controlled with paracetamol 1 g four times daily; one episode of mild hypoglycaemia 14 Oct after missed lunch, resolved with oral glucose; patient advised re regular meals. Blood pressure stable. Discharge: 17 Oct 2026. Enoxaparin 40 mg subcutaneous daily for 14 days post-op; patient unable to self-inject, daughter unwilling. Writing task: write a letter to the Community Nurse, Eastside Community Health Centre, requesting daily injections, wound review and clip removal.
Community Nurse
Eastside Community Health Centre
17 October 2026
Dear Nurse,
Re: Mrs Leela Varghese, aged 72
Mrs Varghese is being discharged today following a left total knee replacement on 12 October 2026. I am writing to request daily enoxaparin injections, wound monitoring and clip removal.
Mrs Varghese has been prescribed enoxaparin 40 mg subcutaneously once daily until 26 October, completing 14 days of treatment. She cannot self-inject and her daughter, who visits daily, has declined to do so. The surgical wound is clean and dry with 14 clips in place, due for removal between 24 and 26 October.
Her medical history includes type 2 diabetes, managed with metformin 500 mg twice daily, and hypertension, controlled with amlodipine 5 mg daily. On 14 October she had mild hypoglycaemia after missing a meal, which resolved with oral glucose. She has been advised to eat regularly.
Mrs Varghese is mobilising with a walking frame and managing her physiotherapy exercises well. Her pain is controlled with paracetamol 1 g four times daily. She lives alone in a ground-floor flat.
I would be grateful if you could administer the daily injections, check the wound, remove the clips as scheduled and monitor her blood glucose in view of the recent hypoglycaemia.
Please contact me if you require any further information.
Yours faithfully,
Ward Nurse
Why it scores
- Purpose: the first paragraph names the patient, the operation and the three requests; the last paragraph expands them, including a monitoring request the notes imply.
- Content and conciseness: the community nurse gets the injection dose, end date and why the family cannot do it, the clip dates, the hypoglycaemia and the home situation. The blood pressure reading, the admission date and the detail of the physiotherapy exercises are left out because the reader cannot act on them.
- Genre and style: formal, no contractions, no judgement about the daughter ("has declined", not "refuses to help").
- Organisation: the request-related facts come first, then the relevant history, then mobility and social context, then the request.
Sample letter 2: medicine referral to a specialist
Written by TalkDrill as a teaching example. Fictional patient, abridged notes. By OET's counting rule the body is 187 words; with the closing sentence it is 196.
Case notes (abridged, TalkDrill)
Patient: Mr Daniel Okafor, 54, accountant. Seen: general practice. 12 Aug 2026: three-month history of intermittent epigastric pain after meals, some bloating; no weight loss. Smokes 15 cigarettes a day for 30 years; alcohol 10 units a week. BMI 29. Started omeprazole 20 mg daily; advised to stop smoking. 9 Sep 2026: partial improvement; H. pylori stool antigen positive; triple therapy prescribed for 7 days. 7 Oct 2026: pain persists, now most nights; reports two episodes of dark stools in past week; appetite reduced; weight 84 kg (87 kg in August). Haemoglobin 10.9 g/dL (13.8 in August), ferritin low. Father died of stomach cancer aged 61. Patient anxious. Plan: urgent referral to gastroenterology for upper GI endoscopy. Writing task: write a letter to Dr Meera Nair, Consultant Gastroenterologist, St Mary's Hospital, requesting urgent assessment.
Dr Meera Nair
Consultant Gastroenterologist
St Mary's Hospital
7 October 2026
Dear Dr Nair,
Re: Mr Daniel Okafor, aged 54
Thank you for seeing Mr Okafor urgently for assessment and upper gastrointestinal endoscopy. He has a three-month history of epigastric pain that has not responded to treatment and now presents with features that raise concern about a possible malignancy.
Mr Okafor first attended on 12 August 2026 with intermittent post-prandial epigastric pain and bloating. He was commenced on omeprazole 20 mg daily. At review on 9 September, a stool antigen test for Helicobacter pylori was positive and he completed seven days of triple therapy, with only partial relief.
Today he reports nightly pain, reduced appetite and two episodes of dark stools in the past week. His weight has fallen from 87 kg to 84 kg since August. Haemoglobin has dropped from 13.8 g/dL to 10.9 g/dL, and his ferritin is low. His father died of gastric cancer at the age of 61.
He smokes 15 cigarettes a day and drinks approximately 10 units of alcohol a week. He has been advised to stop smoking. He is understandably anxious about his symptoms.
I would be grateful if you could arrange an urgent endoscopy and advise on further management. I have not started iron replacement pending your assessment.
Yours sincerely,
Dr [Name], General Practitioner
Why it scores
- Purpose: "urgently", "endoscopy" and "possible malignancy" in the first paragraph; the request is unmissable.
- Content: every red flag the specialist needs (weight loss, melaena, anaemia, failed eradication, family history) with dates and values; occupation and BMI are omitted because they do not change the next step.
- Genre and style: abbreviations the gastroenterologist will know are acceptable, but "H. pylori" is still written in full on first use; smoking and alcohol stated as facts, not as "heavy smoker".
- Organisation: chronological, because the trajectory is the point, with the current red flags grouped in one paragraph.
- Language: past tenses for the history, present for the current picture, present perfect for changes over time.
Rewrite either letter from the notes yourself before reading ours; then compare paragraph by paragraph. For the full plan that puts two letters a week into the timetable from week two onwards, see the six-week study plan.
The common faults, and the fix for each
| Fault | Criterion it hits | Fix |
|---|---|---|
| Opening with "I am writing to refer" when the task is a discharge or transfer | Purpose | Match the verb to the letter. The Purpose section of OET's Writing Guide lists transfer, discharge, update, recommend, see, accept, request and provide as alternatives to refer. |
| Copying the notes in note form ("Pt c/o pain, BP 150/90") | Genre and Style, Language | Complete sentences, every time. OET's Writing Guide says it plainly: do not use note form. |
| Including the whole history because it is "safer" | Conciseness and Clarity | Apply the two reader questions to each line; superseded history goes. |
| Changing tense while paraphrasing | Content | Keep the timeline: "was commenced", "has been", "will be" each mean something different. |
| Judgement words: "obese", "alcoholic", "non-cooperative" | Genre and Style | Facts with numbers: "BMI 32", "drinks 30 units a week", "has not attended two appointments". |
| Contractions and informal phrasing ("he's keen", "thanks for seeing") | Genre and Style | "He is keen", "Thank you for seeing". |
| Abbreviations the reader may not share (AF, SOB, T2DM to a community nurse) | Genre and Style | Write in full unless the reader is a specialist in that condition. |
| The request buried in the middle or missing | Purpose, Organisation | A final paragraph that says exactly what you want, and by when if the notes say. |
| Paragraphs by note order rather than by theme or time | Organisation and Layout | Decide chronological or thematic before writing; most important sentence first in each paragraph. |
| "Kindly do the needful", "the same", "revert back" | Genre and Style, Language | Indian-office English is not clinical English: "I would be grateful if you could", "this", "reply". |
| Spending the last five minutes counting words | Everything | Learn your words-per-line before the test and spend the last minutes reading as the reader, which is what OET's Writing Guide advises. |
| Illegible handwriting on paper | Language (assessors can only mark what they can read) | Cross out and continue rather than erase; or choose the computer mode, where the letter is typed. |
Two of these faults are first-language habits more than writing habits. Malayalam and Hindi speakers bring office English ("kindly", "the same", "revert") into clinical letters; Tagalog speakers soften requests until the reader is not sure anything is being asked. Both are covered, with drills, on the Malayalam, Tagalog and Hindi and Arabic pages. The official criteria PDF, the full Writing Guide and free sample tasks with case notes are on the OET Ready writing page; a vocabulary refresher for the clinical terms you will need to spell correctly is in our medical English vocabulary guide. If the letter is the sub-test standing between you and registration, check the regulator table: the NMC accepts C+ (300) in Writing, which changes how much risk you are carrying.