If you are preparing for the Occupational English Test (OET), you already know that the Writing sub-test is often considered the most challenging section. Achieving a Grade B (350+) or a Grade C+ (300+) requires much more than just perfect English grammar. It requires clinical communication skills, audience awareness, and the ability to filter crucial medical data under strict time constraints.
To help you succeed, we have built this guide around the same principles as our free AI-scored platform: give you the criteria, show you what good looks like through real worked examples, and give you a system to evaluate your own letters before test day.
This guide covers how the OET Writing test works, decodes all six official grading criteria with worked examples, walks through three full practice scenarios at different difficulty levels, and gives you a self-marking checklist to use on every letter you write.
Why Most OET Practice Fails Candidates
Many candidates make the mistake of using generic grammar checkers to evaluate their OET letters. However, generic tools do not understand the complexities of healthcare communication.
In the real exam, your letter is assessed against six specific criteria by highly trained assessors. A standard grammar checker might give you a perfect score for a beautifully written letter, completely missing the fact that you forgot to include a critical patient allergy or used an inappropriate medical abbreviation for a social worker.
The same problem applies to practicing with static PDFs and no feedback. You can write fifty letters and reinforce the same mistakes every single time. The only practice that improves your score is practice with feedback calibrated to the actual OET criteria.
The Core Skill OET Actually Tests:
You are not being tested on whether you can write a grammatically perfect sentence. You are being tested on whether you can select, transform, and prioritise clinical data for a specific reader under time pressure. This is a distinct skill from general English proficiency, and it must be practised deliberately.
How the OET Writing Sub-Test is Structured
Regardless of your specific healthcare profession (Nursing, Medicine, Dentistry, Pharmacy, etc.), the format of the Writing sub-test is identical.
- Total Time: 45 minutes.
- Reading Time: The first 5 minutes are strictly for reading the case notes. You cannot write, highlight, or make any marks during this time.
- Writing Time: 40 minutes to plan, write, and proofread your response.
- The Task: You will be provided with a set of profession-specific case notes and a specific writing task at the very end. The task tells you who you are writing to (e.g., a specialist, a GP, a community nurse) and the purpose of the letter (referral, discharge, or transfer).
- The Goal: Expand the relevant case notes into complete sentences, avoid note form, and structure your response as a formal letter.
The Single Most Important Strategy for Reading Time: Do not start reading the case notes from the top. Scroll straight to the bottom and read the Writing Task first. Knowing who your reader is and why you are writing dictates which case notes are relevant and which are irrelevant distractors. Everything else follows from this.
The 6 Official OET Assessment Criteria — Decoded with Examples
When you submit a letter to our OET writing practice test free tool, you receive a detailed score out of 500, broken down into the six official criteria used by human examiners. Here is what each criterion actually means in practice.
1. Purpose (Scored out of 3)
Your reason for writing must be immediately apparent to the reader and sufficiently expanded upon throughout the letter. Busy healthcare professionals scan for urgency and need to know exactly what you want them to do within the first few seconds.
Strategy: Use a “Circular Structure.” State the main medical issue and the action required in your opening sentence, and then explicitly repeat the specific request in your final concluding paragraph.
- Weak opening: “I am writing regarding Mr. Thompson who has been under our care.”
- High-scoring opening: “I am writing to urgently refer Mr. Thompson, a 67-year-old with suspected myocardial infarction, for immediate assessment and management.”
2. Content (Scored out of 7)
This criterion checks whether you have included all the necessary information for the reader to safely continue the patient’s care, and whether that information accurately reflects the case notes. It is the highest-weighted criterion alongside the others scored out of 7, and it covers two equal risks: omission (leaving out safety-critical data) and hallucination (including information not present in the notes).
Strategy: Audience awareness is critical. If you are writing an update to a patient’s regular GP, they already know the patient’s past medical history. Including history the GP already has is a Content error. Focus only on new, actionable information.
- Critical content that can never be omitted: drug allergies, abnormal vital signs when referring to ED, confirmed diagnoses, current medications relevant to the referral.
3. Conciseness & Clarity (Scored out of 7)
You must act as an effective filter. This criterion rewards you for omitting irrelevant details and summarising information efficiently. The most common failure here is “data dumping” — copying every vital sign from a five-day admission instead of summarising the trend.
Strategy: Synthesise data into trends rather than listing. “Blood pressure has remained consistently elevated throughout admission (range 160–175/95–105 mmHg)” scores far higher than six lines of individual readings.
4. Genre & Style (Scored out of 7)
This assesses whether your tone is clinical, factual, and appropriate for the specific reader. It covers professional register, abbreviation use, and the absence of judgmental or emotive language.
Strategy: Avoid language that passes moral judgement on the patient. Instead of “the patient refused treatment,” write “the patient declined treatment.” Instead of “stubbornly non-compliant,” write “has been resistant to the prescribed regimen despite education.”
Also tailor abbreviations to the reader: expand them for social workers and community nurses; keep standard ones for specialists.
5. Organisation & Layout (Scored out of 7)
Examiners look for logical paragraphing, standard letter formatting, and effective prioritisation of information. The most penalised error under this criterion is chronological narration in an emergency scenario — burying acute vital signs after two paragraphs of medical history.
Strategy: Group information by clinical theme, not chronological order. Standard high-scoring structure: Introduction/Purpose → Current Presentation → Relevant History → Management/Request.
6. Language (Scored out of 7)
This covers grammatical accuracy, vocabulary, sentence structure, spelling, and punctuation. Crucially, OET assessors apply what is sometimes called “human grace” — minor slips that do not interfere with clinical meaning (a dropped article, a slight preposition error) do not destroy your Language score. A candidate can score 7/7 with one or two minor slips.
Strategy: Demonstrate a mix of simple, compound, and complex sentences. Avoid monotonous short sentences and avoid overly convoluted ones. One well-constructed complex sentence (e.g., using a relative clause or a participial phrase) within each paragraph signals natural English proficiency.
Advanced Strategies That Separate Grade B from Grade C+
The Urgency Switch
The order of your paragraphs must change based on how urgent the referral is.
- Routine referrals: A chronological approach is acceptable — background, then current issue, then request.
- Urgent referrals (ED transfer, suspected acute event): Trigger the “Urgency Switch.” The paragraph immediately after your Purpose statement must contain today’s acute presentation and vital signs. Placing past medical history before the current emergency is a critical Organisation error.
Eliminating Polite Clutter
Phrases like “I would be most grateful if you could provide ongoing care” and “In light of the above-mentioned signs and symptoms” are heavily penalised in modern OET grading. Official OET assessors categorise these as “polite clutter” that wastes a busy clinician’s time.
Replace wordy templates with direct, transactional language: “Please assess and manage,” “Your review would be appreciated,” “Urgent assessment is requested.”
The Word Count Myth
The instructions state the body of the letter should be approximately 180–200 words. OET assessors do not rigidly count your words. Writing 215 words will not automatically penalise you. Length is only penalised when it is caused by including irrelevant information (too long) or omitting critical data (too short). If you have correctly selected and filtered, your letter will naturally land in the right range.
Practice Scenario 1: The Discharge Letter — Mr. John White
Discharge letters are the most commonly mishandled letter type. Candidates either data-dump the entire admission or write so briefly that the receiving team inherits a patient without enough information to continue care safely. This scenario tests both risks.
Letter Type: Discharge to Aged Care Facility Head Nurse Core Skill Tested: Content selection, medication changes, and actionable instructions for the receiving team
⏱ Set your timer: 5 minutes reading, 40 minutes writing. Write your letter before reading the model answer below.
CASE NOTES — Mr. John White
Role: Charge Nurse, Coronary Care Unit, St. Margaret’s Hospital. Today: 17 September 2023.
Patient: Mr. John White | DOB: 25 June 1961 | Maple Grove Aged Care, 14 Orchard Lane, Westwick, WE4 5GH
Admission (14 Sept 2023): Acute exacerbation of chronic heart failure (CHF). Presented with worsening shortness of breath (SOB), bilateral pitting oedema (+++) to mid-shin, 3kg weight gain over 4 days. Admission vitals: T 36.8, P 98, RR 26, BP 160/95, SpO₂ 91% RA. Admission U&Es: Na 134, K 3.8, Urea 8.9, Creat 110 — all within normal range.
Medical & Social Background: Chronic Heart Failure (CHF), Hypertension (HTN), Osteoarthritis. Regular pre-admission meds: Ramipril 5mg mane, Frusemide 20mg mane, Paracetamol 1g PRN. Widower. Son David lives locally, visits weekly, aware of admission.
Hospital Progress (14–16 Sept): Commenced on IV Frusemide. Responded well with significant diuresis. Oedema resolved. SOB only on moderate exertion; none at rest.
17 Sept 2023 (Today): Clinically stable for discharge. Vitals: T 36.6, P 78, RR 18, BP 130/80, SpO₂ 96% RA. Mobilising independently with wheeled walker at pre-admission baseline.
Discharge Plan (for 18 Sept 2023): Frusemide INCREASED to 40mg orally OD (morning). NEW: commence daily morning weight monitoring. Notify GP if weight gain >1.5kg over 2 days or SOB/oedema returns. Patient educated on daily weights and symptom reporting. Continue low-salt diet. GP review arranged for 1 week post-discharge.
Writing Task: Write a discharge letter to Ms Brenda Reid, Head Nurse, Maple Grove Aged Care, 14 Orchard Lane, Westwick, WE4 5GH. The letter will accompany Mr. White back to the facility upon discharge tomorrow. Expand the relevant notes into complete sentences. Do not use note form. Use letter format. The body should be approximately 180–200 words.
The key decisions for this scenario:
Must Include
Reason for admission (acute exacerbation CHF). Hospital course summary (responded to IV Frusemide, clinically improved). Changed medication: Frusemide increased from 20mg to 40mg OD — this is the highest-stakes content item. New nursing instruction: daily morning weights. The specific threshold for alerting the GP (>1.5kg over 2 days or return of SOB/oedema). Discharge vitals confirming stability. GP review in one week.
Omit or Summarise
Individual admission U&E values (all normal — summarise as “within normal limits”). Admission vitals (replaced by discharge vitals, which are what matters now). The social background (son David is already known to the facility). Osteoarthritis — not relevant to this cardiac admission.
The Frusemide Change is a Patient Safety Item:
The pre-admission dose was 20mg. The discharge dose is 40mg — a doubling. If the aged care nurse resumes the old dose from the medication chart without reading this letter, it is a medication error. This must be stated explicitly and clearly, not buried in a list.
Model Answer — Mr. John White Discharge Letter:
Annotations:
Opening: Purpose stated immediately — discharge notification and reason for admission in one sentence. No preamble.
Paragraph 2: Summarises the clinical story efficiently (admission reason → treatment → response → current status). Discharge vitals confirm he is safe to transfer. Individual admission U&E results are omitted — “responded well” and the discharge obs convey clinical stability without listing data the receiving nurse cannot act on.
Paragraph 3: The medication change is given its own bolded sentence. This is a deliberate Genre & Style choice: bolding a critical safety item is appropriate in a discharge letter to a non-physician. It cannot be missed.
Paragraph 4: The nursing instructions are specific and actionable (the 1.5kg threshold, the two-day window, the return of specific symptoms). “Please monitor” alone would score poorly on Content — the receiving nurse needs the exact threshold to act on.
Practice Scenario 2: The Routine Referral — Ms. Helen Carter
This scenario tests the Genre & Style and Content criteria most heavily. The clinical picture strongly suggests a thyroid nodule, but the diagnosis has not been confirmed. The writer must convey urgency and concern while staying within nursing scope of practice. There is also a psychosocial dimension — patient anxiety — that is clinically relevant and must be handled with care.
Letter Type: Routine referral to GP (same-day, not emergency) Core Skill Tested: Hedging, psychosocial content selection, clinical concern without overreach
⏱ Set your timer: 5 minutes reading, 40 minutes writing. Write your letter before reading the model answer below.
CASE NOTES — Ms. Helen Carter
Role: Practice Nurse, Community Health Centre, Anytown. Today: 11 October 2023.
Patient: Ms. Helen Carter | DOB: 25 March 1958 | Next of kin: Sarah Peterson (Daughter)
Presenting Complaint: Presented for routine BP check; reluctantly raised concern re: lump in neck. Noticed ~4 weeks ago. Patient attributes lump to “swollen glands” following URTI ~6 weeks ago.
Medical & Social History: Hypertension (HTN), controlled — Ramipril 5mg daily. Osteoarthritis (knees) — Paracetamol PRN. Family Hx: Sister had breast cancer (dx 2018, now in remission). Mother d. MI @ 80. Non-smoker. Minimal alcohol (2–3 units/week). Retired librarian, lives alone. Daughter Sarah (a nurse) lives 2hrs away; urged patient to seek advice.
Consultation — 11 October 2023: O/E: Palpable nodule, right anterior neck. ~2cm, firm, non-tender, smooth surface, mobile. Moves superiorly on swallowing. No overlying skin changes. No palpable cervical lymphadenopathy. Patient reports ↑fatigue, feeling cold, weight gain ~5kg over 3 months. Denies dysphagia, hoarseness, or dyspnoea. BP: 132/84 mmHg. Patient expressed significant anxiety about “lumps” due to sister’s cancer history. States: “I’ll see the doctor, but I’m not promising any scans or tests.” After discussion, reluctantly agreed to GP consultation.
Referral Plan: Refer to GP for assessment of thyroid nodule and further management. Encouraged patient to discuss fears and concerns openly with GP.
Writing Task: Write a referral letter to Dr Anil Sharma, Anytown Medical Centre, 123 High Street, Anytown, AT3 4RT for assessment and management of the neck nodule, briefly outlining your consultation with Ms. Carter today and your concerns. Expand the relevant notes into complete sentences. Do not use note form. Use letter format. The body should be approximately 180–200 words.
The key content decisions:
Must Include
Description of the nodule with all clinical characteristics (size ~2cm, firm, non-tender, smooth, mobile, moves on swallowing — this is the classic thyroid nodule presentation). Associated systemic symptoms: fatigue, feeling cold, 5kg weight gain over 3 months (suggestive of hypothyroidism). Patient’s significant anxiety about cancer due to sister’s history. Patient’s stated reluctance regarding tests (“not promising any scans”). Normal BP result (routine check — brief mention only).
Omit or Handle Carefully
Mother’s death from MI — not relevant to a neck nodule. Daughter’s profession (nurse) — not clinically relevant. Specific URTI six weeks ago — background only, patient’s own attribution to it is mentioned briefly to contextualise the timeline.
Why the Psychosocial Content Matters Here:
Ms. Carter’s anxiety and her stated reluctance about tests are not “soft” details — they are clinically actionable information. If the GP does not know this going into the consultation, they may order investigations without adequate preparation, potentially causing the patient to disengage from care entirely. Including it scores on Content and demonstrates advanced clinical communication.
Hedging note: The clinical picture (solitary thyroid nodule, moves on swallowing, no lymphadenopathy, systemic hypothyroid symptoms) is highly suggestive of a thyroid nodule requiring investigation. As a Practice Nurse, you cannot write “Ms. Carter has a thyroid nodule requiring a biopsy.” You can write “her presentation is consistent with a thyroid nodule” and flag that investigation is warranted — leaving the management plan to the GP.
Model Answer — Ms. Helen Carter Referral Letter:
Annotations:
Opening: Clean, direct. The nodule is identified as the purpose immediately.
Paragraph 2: All clinical characteristics of the nodule are captured — size, consistency, surface, mobility, and crucially, that it moves on swallowing (the classic feature that localises it to the thyroid). No lymphadenopathy is included — this is a negative finding with diagnostic relevance. BP is mentioned briefly but not dwelt on — it is the routine check, not the reason for the referral.
Paragraph 3: The systemic symptoms (fatigue, cold intolerance, weight gain) are grouped together and explicitly linked to the nodule presentation with the hedged conclusion: “consistent with a thyroid nodule warranting further investigation.” This is not a diagnosis — it is an informed clinical observation that frames the urgency for the GP.
Paragraph 4: The psychosocial content gets its own paragraph because it requires a specific action from the GP (a sensitive, carefully managed consultation). Burying it as a parenthetical at the end of paragraph two would be an Organisation error.
Practice Scenario 3: The Urgent Transfer — Mr. Petros Colombo
This is the highest-stakes scenario type in the OET. A post-operative patient with sudden-onset pleuritic chest pain, tachycardia, and desaturation requires an Urgency Switch letter. Every structural decision must serve one goal: getting the ED physician the information they need to act within seconds of opening this letter.
Letter Type: Urgent intra-hospital transfer to Emergency Department Core Skill Tested: Urgency Switch, critical data prioritisation, active voice for professional responsibility
⏱ Set your timer: 5 minutes reading, 40 minutes writing. Write your letter before reading the model answer below.
CASE NOTES — Mr. Petros Colombo
Role: Registered Nurse, Orthopaedic Ward, St. Mary’s Hospital. Today: 28 October 2023.
Patient: Mr. Petros Colombo | DOB: 15 May 1957 | Admitted: 23 October 2023 | Next of kin: Jane Colombo (Daughter)
Reason for Admission: Elective Left Total Knee Replacement (TKR)
Medical Background: Hypertension (HTN). Hypercholesterolaemia. Hospital admission for community-acquired pneumonia 2021 — full recovery. Allergies: NKDA. Regular medications: Ramipril 5mg daily, Atorvastatin 40mg nocte. Retired accountant, lives with wife. Non-smoker, 2–3 units alcohol/week.
Post-operative Course: 24 Oct — Left TKR performed. Procedure uneventful. Commenced prophylactic Enoxaparin 40mg SC daily post-op. 25–27 Oct — Recovery unremarkable. Mobilising with frame per physio plan. Pain well-controlled on oral analgesia.
28 October 2023 (Today):
- 14:30 — Sudden onset sharp, right-sided pleuritic chest pain. Pain 7/10 on inspiration. Pt states “It’s probably just a stitch from coughing, I’m sure it will pass.” Appears anxious.
- 14:35 — Obs: RR 28/min, HR 115 bpm, SpO₂ 91% RA, BP 135/85 mmHg, Temp 37.8°C.
- 14:40 — O₂ commenced @ 2L/min via NP → SpO₂ improved to 94%. IV access gained. 2.5mg Morphine IV given for pain (now 4/10). ECG: Sinus Tachycardia, no acute ischaemic changes.
- Daughter Jane contacted, en route to hospital.
Referral Plan: Urgent referral to Emergency Department for assessment and management of suspected pulmonary embolism, as per discussion with Surgical Registrar Dr. Evans.
Writing Task: Write a letter of referral to the Emergency Department Consultant on Duty, St. Mary’s Hospital, 123 Health Road, Cityville, outlining the case and requesting urgent assessment and management for suspected pulmonary embolism. Expand the relevant notes into complete sentences. Do not use note form. Use letter format. The body should be approximately 180–200 words.
The urgency switch applied:
This patient is deteriorating in real time. The letter structure must reflect that.
❌ Fatal Structural Error
Opening with: “Mr. Colombo is a 66-year-old retired accountant admitted on 23 October for an elective left total knee replacement with a background of hypertension and hypercholesterolaemia…”
By the time you reach today’s acute observations, the ED physician has already lost confidence in the letter’s clinical prioritisation — and lost seconds.
✅ Correct Urgency Switch Structure
Open with: today’s acute presentation and the suspected diagnosis. Then: current observations and interventions already performed. Then: surgical and medical background. Never the reverse.
Two Content Items That Cannot Be Omitted:
1. Enoxaparin 40mg SC daily post-op — the ED physician must know this patient is already on anticoagulation. It directly affects their management decisions.
2. Interventions already performed (O₂, IV access, Morphine 2.5mg IV, ECG result) — the ED team must know what has already been given to avoid duplication and to understand the patient’s current clinical state on arrival.
Note on the patient’s own minimisation: Mr. Colombo stated “It’s probably just a stitch from coughing.” Do not include this quote in the letter — it is not clinically actionable and may inadvertently reduce the perceived urgency. Your clinical assessment (RR 28, HR 115, SpO₂ 91%) overrides the patient’s self-assessment. The letter reflects your professional judgement, not the patient’s.
Model Answer — Mr. Petros Colombo Urgent Referral:
Annotations:
Re: line: “URGENT TRANSFER: Suspected Pulmonary Embolism” is included in the Re: line itself. In a genuine emergency, the recipient must be able to triage this letter before reading it. This is excellent Genre & Style practice.
Paragraph 1: Purpose, suspected diagnosis, and the fact that this has been discussed with the Surgical Registrar — all in one sentence. The registrar detail establishes that this is a medically sanctioned transfer, not a unilateral nursing decision.
Paragraph 2: Today’s acute events in chronological order of occurrence (onset → observations → interventions → ECG). Note that all three interventions — O₂, IV access, and Morphine — are documented with doses and effects. This is not padding; this is handover-critical information.
Paragraph 3: Background comes after the acute presentation. The Enoxaparin is explicitly named with dose, route, and frequency — the ED team’s anticoagulation decisions depend on knowing this. NKDA is included because drug allergies are always relevant when handing over to a team who will be administering medications.
Closing request: “Urgent assessment and management are respectfully requested” uses the passive voice appropriately — it is formal, direct, and professional without being brusque.
The Self-Marking Checklist — Use This on Every Practice Letter
After writing any practice letter, run it through this checklist before submitting it for AI feedback. This trains the evaluative instinct that separates consistent Grade B candidates from those who score variably.
Purpose
☐ Is the reason for writing in my opening sentence? ☐ Have I stated the specific action I want in my closing paragraph? ☐ Would a reader scanning the first and last lines understand exactly why this letter was written?
Content
☐ Have I mentioned all drug allergies? ☐ Have I included current medications relevant to the referral? ☐ Have I included all information I found in the case notes that the recipient needs? ☐ Have I invented any facts not present in the case notes? (If yes — delete immediately.)
Conciseness
☐ Is every sentence earning its place? (Does it add clinical value for the reader?) ☐ Have I summarised trends rather than listing individual data points? ☐ Have I removed all “polite clutter” phrases?
Genre & Style
☐ Have I used hedging where I cannot confirm a diagnosis? ☐ Have I removed any judgmental language about the patient? ☐ Are abbreviations appropriate for my specific reader?
Organisation
☐ If this is an urgent referral, are the acute vital signs in paragraph two (immediately after Purpose)? ☐ Are my paragraphs grouped by theme, not by timeline? ☐ Is the standard letter layout in place (date, recipient, Re: line, salutation, sign-off)?
Language
☐ Have I used a mix of sentence structures (not all short, not all complex)? ☐ Have I used the passive voice for clinical observations and active voice when taking professional responsibility? ☐ Have I avoided contractions (didn’t, can’t, won’t)?
Common Pitfalls Our Analysis Identifies Most Often
Based on thousands of practice letters submitted through our platform, these are the most consistent reasons scores fall below 350:
- Interpretive errors: Misreading abbreviations (e.g., reading “PID” without checking context — it can mean Pelvic Inflammatory Disease or Prolapsed Intervertebral Disc depending on the scenario). Always read the full case notes before committing to an interpretation.
- Tone inconsistency: Transferring the blunt language of case notes directly into the letter. Case notes say “refuses to lose weight.” Your letter says “has been resistant to lifestyle modifications.”
- Burying the emergency: In urgent scenarios, three or more sentences of history before the acute presentation is an automatic Organisation penalty.
- Scope of practice overreach: Especially for nurses — stating diagnoses that only appear as symptoms in the notes.
- Polite clutter in the closing: “I would be most grateful if you could find time to see this patient at your earliest possible convenience” costs you on Conciseness every time.
How to Take Your Free OET Writing Practice Test
Ready to see where you actually stand? Taking our OET writing practice test free is straightforward.
Step 1: Sign up at FluencyX — no credit card required. You receive your first clinical prompt immediately on login.
Step 2: Simulate real exam conditions. Set a timer: 5 minutes reading only, then 40 minutes writing. Use the checklist above before you submit.
Step 3: Submit for instant evaluation. Our AI Mentor analyses your letter across all six criteria simultaneously.
Step 4: Review your feedback report. You receive an overall score (0–500) and grade band, a per-criterion breakdown, margin notes on specific omissions or tone errors, and a single highest-priority fix to make before your next attempt.
Related reading: Best OET Writing Apps Compared & Reviewed 2026
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