Official Guide to OET - ieltsgo.ir · The Occupational English Test (OET) was developed to test...

OfficialGuidetoOET®

TEST®isaregisteredtrademarkofthe...

TableofContentsOfficialGuidetoOET®

CoverTitlePageCopyrightHowtoUseThisBook

PartOne:TheBasicsChapter1:TakingOET

UnderstandingOETAnOverviewofOET

Chapter2:PreparingforTestDayStudyPlannerOETStudyPlannerOETStudyPlannerGeneralStrategiesforOETTipsfortheFinalWeek

PartTwo:TheListeningSectionListeningintro:SectionOverviewChapter3:ListeningPartA

ObjectivesStrategiesListeningPartA:PracticeSetAnswersListeningTranscripts

Chapter4:ListeningPartBIntroductiontotheVerbalSectionStrategiesListeningpartB:PracticeSetAnswersListeningTranscripts

Chapter5:ListeningPartCListeningPartCStrategiesListeningPartC:PracticeSetAnswers

ListeningTranscriptsPartThree:TheReadingSection

Readingintro:SectionOverviewChapter6:ReadingPartA

ObjectivesStrategiesReadingPartA:PracticeSetAnswers

Chapter7:ReadingPartBObjectivesStrategiesReadingPartB:PracticeSetAnswers

Chapter8:ReadingPartCObjectivesStrategiesReadingPartC:PracticeSetAnswers

PartFour:TheWritingSectionWritingIntro:SectionOverviewChapter9:TheWriting

ObjectivesStrategiesWritingPracticeSetAnswers

PartFive:TheSpeakingSectionSpeakingintro:SectionOverviewChapter10:TheSpeakingTask

ObjectivesStrategiesSpeakingPracticeSetAnswers

PartSix:ThePracticeTestListeningSectionReadingSectionWritingSectionSpeakingSectionAnswers

Specialthankstotheteamwhomadethisbookpossible:

CatAhlberg,EdwardAntram,KimBowers,LouiseCook,LindseyDew,ScarletEdmonds,JoannaGraham,BradHissey,BrianHolmes,SirkkaHowes,AmnaHussein,EleanorLindberg,NimeshShah,DavidWiltshire,KevinYang,AmyZarkos

TheOETlogoisaregisteredtrademarkofCambridgeBoxhillLanguageAssessmentPtyLtd,usedunderlicence.

Thispublicationisdesignedtoprovideaccurateinformationinregardtothesubjectmattercoveredasofitspublicationdate,withtheunderstandingthatknowledgeandbestpracticeconstantlyevolve.Thepublisherisnotengagedinrenderingmedical,legal,accounting,orotherprofessionalservice.Ifmedicalorlegaladviceorotherexpertassistanceisrequired,theservicesofacompetentprofessionalshouldbesought.Thispublicationisnotintendedforuseinclinicalpracticeorthedeliveryofmedicalcare.Tothefullestextentofthelaw,neitherthePublishernortheEditorsassumeanyliabilityforanyinjuryand/ordamagetopersonsorpropertyarisingoutoforrelatedtoanyuseofthematerialcontainedinthisbook.

PublishedbyKaplanPublishing,adivisionofKaplan,Inc.750ThirdAvenueNewYork,NY10017

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HowtoUseThisBook

ThisbookhasbeencreatedtohelpyouachievethehighestpossiblescoreinOET.Eachpartincludeseasy-to-learnstrategiesandrelevanttest-takingtips.There’salsoaweeklystudyplanner,accesstolisteningtracks,samplewritingtasks,andafulllengthPracticeTestwithWritingandSpeakingspecifictotheNursingandMedicinehealthcareprofessions.Followthestepsbelowtogetthebestusefromthisbook.

StepOne:ReadPartOne

Inthefirstpartofthisbook,youwillbegivenanoverviewofOET,learnwhattoexpectonTestDay,andlearnaboutthekeystrategiestohelpyouachieveahighOETscore.

StepTwo:FillOutYourStudyPlanner

OETisahighstakestest.Ifyouwanttoscorewell,youcannotsqueezeallofyourstudytimeintooneweek.Beforegettingstartedwiththeexercisesinthisbook,youshouldturntoPart2andfilloutyourstudyplannerwithrealisticstudygoals.YoushouldconsiderhowmanydaysyouhaveuntilyoutakeOET,andhowmuchtimeyouwillrealisticallybeabletodedicatetorevisingeveryday.Rememberthatifyouhaveworkedallday,youmaynothavetheenergytolearnnewstrategies.Instead,usethetimetorevisethepartsofthetestyouhavealreadymastered,andsavethemorechallengingpartsforwhenyouarefreshandrested.

StepThree:SharpenYourSkills

ThisbookcontainsexercisesandstrategiesforcorrectlyansweringeachsectionofOET.Themostimportantstrategiesforyoursuccessarehighlighted,soyoucaneasilyrefertothem.Attheendofeachsection,youwillfindpracticequestions.

Onceyouhavecompletedthequestions,turntotheanswersandmarkyourwork.Checkthroughanyincorrectanswers,usingthelisteningscriptsatthebackofthechapterifneeded.

StepFour:UsetheOnlineAudio

PartTwoandthefulllengthPracticeTestattheendofthisbookincludeaudio.Registeronlineatkaptest.com/booksonlinetoaccessyouraudioandonlineresources.Onceyou’veregistered,accessyouraudioandresourcesatkaptest.com/loginordownloadtheKaplanMobilePrepapponGooglePlayortheAppStoreforyourAndroidoriOSdevice.

StepFive:TakeKaplan’sOETPracticeTest

AfterpractisingthestrategiesforOET,youshouldusethePracticeTestasatestrunfortherealthing.Aftertakingthetest,usetheanswerkeytoscoretheListeningandReadingsectionsofyourPracticeTest,andusethemarkingcriteriafortheSpeakingandWritingsectionstogradeyourwork.

StepSix:Review

ReturntoPartsTwo,Three,FourandFiveofthisbook,andreviewthosesectionsofthetestwhereyourperformancewasweak.ReadtheTipsfortheFinalWeektomakesureyouarefullypreparedonTestDay.

Followthesesixsteps,andyoucanbeconfidentthatyouaretrulyreadyforOET.

THEBASICS

CHAPTER1

TakingOET

INTHISCHAPTER

UnderstandingOETHowandWhereOETisadministeredAnOverviewofOET

UnderstandingOET

BeforegettingstartedwiththecontentofOET,let’slookatsomebackgroundinformationaboutthetest.

WHATISOET?

TheOccupationalEnglishTest(OET)wasdevelopedtotesthealthcareprofessionals’Englishcommunicationabilities.OETtestsEnglishlanguageabilityinfourareas:Listening,Reading,WritingandSpeaking.Test-takerswillneedtodemonstratetheirabilitytounderstandandanswerquestionsaboutgeneralhealthcareconsultationsandpresentations,inadditiontotextsinageneralhealthcaresetting.Test-takersarerequiredtowriteaccurate,professionalletterswiththeaidofpromptsandusespeakingpromptstocarryoutappropriateandeffectiveconversationswithpatients,relatingtospecifichealthcareprofessions.

WHOPRODUCESOET?

OETwasdevelopedbyProfessorTimMcNamaraattheUniversityofMelbourne.IthasbeenownedandproducedbyCambridgeBoxHillLanguageAssessmentTrust–aventurebetweenCambridgeEnglishandBoxHillInstitute–since2013.

WHICHVERSIONOFOET?

OETcanbetakenbyhealthcareprofessionsinanyofthefollowing12professions:Dentistry,Dietetics,Medicine,Nursing,OccupationalTherapy,Optometry,Pharmacy,Physiotherapy,Podiatry,Radiography,SpeechPathology,andVeterinaryScience.TheReadingandListeningpartsofthisbookarerelevanttoall12healthcareprofessions.TheSpeakingandWritingpartsofthisbookcoverNursingandMedicinespecifictestcontent.Pleasenotethatifyouareahealthcareprofessionalfromadifferentprofession,theSpeakingandWritingsectionsofyourtestwillvaryfromthecontentprovidedinthisbook.

WHENWASOETUPDATED?

InSeptember2018,CambridgeBoxhillLanguageAssessmentlaunchedanupdatedformatofOETintheReadingandListeningsectionsofthetext,tomoreaccuratelyassesstheEnglishlanguageabilitiesoftest-takersinahealthcaresetting,andcreateadditionalassessmentcriteriafortheSpeakingTest.Thisbookdiscussesthe2018OETtestformat.

HOWTOAPPLYFOROET?

YoucanapplytotakeOETbyvisitingwww.occupationalenglishtest.org/apply-oet/.WhenyouregistertotakeOET,youmightonlybeabletoselectfromthenexttwoavailabletestdates,soyoushouldaimtobeginrevisingforthetestbeforeapplying.Toapplyonline,youwillneedtorefertoanidentificationdocumentanduploadacolourpassportphotographofyourself.

AnOverviewofOET

FormatandContent

OETisapproximately2hoursand45minuteslongandconsistsof42Listeningquestions,

42Readingquestions,2Speakingrole-playsand1Writingtask.ThefollowingchartgivesabreakdownoftimesforeachpartoftheOET

Section

Time Testscandidate’sabilityto

Listening 40minutes listenandunderstandarangeofrecordingsonhealthcaretopicsfrom

differenthealthcaresettings.

Reading 60minutes readandunderstandvarioustextsonhealthcaretopicsfromdifferent

healthcaresettings.

Writing 45minutes writealetter,usuallyareferralletterusinginformationprovidedinpatient

casenotes.

Speaking 20minutes communicatewithapatientinareal-lifecontextthroughtheuseofrole-

plays.

SCORING

InOET,candidatesreceiveanumericalscorerangingfrom0to500inten-pointincrements(e.g.350,360,370…).Thenumericalscoreswillbemappedtoaseparatelettergradeforeachsectionofthetest,rangingfromA(highest)toE(lowest).Thereisnooverallgrade

format

scores

September

OETbanddescriptors IELTS

equivalent

bandscore

Cancommunicateveryfluentlyandeffectivelywith

patientsandhealthprofessionalsusingappropriateregister,

toneandlexis.Showscompleteunderstandingofanykind

ofwrittenorspokenlanguage. 8.0–9.0

Cancommunicateeffectivelywithpatientsandhealth

professionalsusingappropriateregister,toneandlexis,

withonlyoccasionalinaccuraciesandhesitations.Shows

goodunderstandinginarangeofclinicalcontexts.

7.5–7.0

Canmaintaintheinteractioninarelevanthealthcare

environmentdespiteoccasionalerrorsandlapses,and

followstandardspokenlanguagenormallyencounteredin

his/herfieldofspecialisation.6.5

C 6.0–5.5

Canmaintainsomeinteractionandunderstand

straightforwardfactualinformationinhis/herfiledof

specialisation,butmayaskforclarification.Frequent

errors,inaccuraciesandmis-oroveruseoftechnical

languagecancausestrainincommunication.

Lessthan5.5Canmanagesimpleinteractiononfamiliartopicsand

understandthemainpointinshort,simplemessages,

providedhe/shecanaskforclarification.Highdensityof

errorandmis-oroveruseoftechnicallanguagecause

significantstrainandbreakdownsincommunication.

TIMING

OETisatimedtest.Thismeansthatyourscoregreatlydependsonbeingabletocompletethequestionswithinthetimeallowed.

Wewillindicatetheamountoftimeyouwillbegiventocompleteeachpartofthe

testatthebeginningofeachchapter.IntheListeningTest,youwillnotneedtotimeyourself,asyouwillbeadvisedwhentoanswerquestionswhileyoulistentotherecording,butyouwillstillneedtokeepupwiththepaceoftherecording.Atfirst,youmaynotfeelyouhaveenoughtimetoanswerthequestionsandcompletethetasks

effectively.However,bypractisingthestrategiesinthisbook,youshouldbeabletogetthroughallofthe

testquestionsinthetimeprovided.Rememberthatevenifyouarenotabletocompleteawholesectionwithinthetimelimit,youshouldstillincludeananswer–evenifitisaguess.Youmaychoosethecorrectanswerbychance,andgainanadditionalpoint;ifyouleavethosequestionsunanswered,youwillreceivenopoints.

Asyougothroughthebook,payattentiontotheamountoftimeyouspendansweringquestionsandcompletingtasks;notewhenyouaremovingtooslowly,andpractisespeaking,writingandansweringquestionsmorequickly.WhenyouarereadytotakethePracticeTest,besuretotimeyourselfverycarefully,togiveyourselfthemostrealistic

testexperiencepossible,andtoshowyouexactlywhereyouneedimprovement.

CHAPTER2

PreparingforTestDay

INTHISCHAPTER

StudyPlannerGeneralstrategiesforOETTipsforthefinalweekStressbusters

StudyPlanner

Lookatthetemplateforafive-weekcalendaronthefollowingpage.Youcanaccessaprintableversionofthiscalendartousetoplanyourstudyschedule.Youshouldusetwoofthesecalendartemplatestofillinaspecificstudyscheduleforatenweekperiod.BerealisticabouttheamountoftimeyouhavetostudyandpractiseyourEnglishlanguageskills.Updateyourscheduleasnecessary.

DonotforgettoscheduletimetotakethePracticeTest,markyourPracticeTest,andreviewanypartofthetestwhereyoustruggledalongwithyourscheduleforlookingthroughtherestofthebook.TakethePracticeTestafteryouhavelookedatalloftheotherchaptersofthebookandcompletedalloftheexercises.TakethePracticeTestasifitweretherealthing:findaquietplacewhereyouwillnotbeinterrupted,andtakeitinonesession.Timeyourselfaccurately.Thiswillhelptoprepareyoufortheactualtest.

GeneralStrategiesforOET

LookthroughthetipsinthissectiontomakesureyouareawareofthepracticalstepsyoushouldtakebeforeTestDay.Thissectionalsocontainstipsonhowandhowoftentorevise.AllOETtesttakersarealreadyfamiliarwithhighpressuretestsituations,buteachtestisdifferent,andrequiresdifferentpreparationandmaterials,somakesureyou'reawareofwhatyouneedtodobeforeyoutakethetest.

TipsfortheFinalWeek

Intheweekbeforeyourtest,youshoulddothefollowing:

Recheckyourregistrationforaccuracy;contacttheOEThelpdeskifthereareanyproblems.Visitthetestvenueifpossible.Itcanbehelpfultoknowhowlongittakesyoutogetthere,andtoseethetestvenuewhereyouwillactuallytakeyourtest.PractiseworkingontestmaterialasifitwereTestDay.LookatyourresultsfromthePracticeTestandcontentinthisbook,andidentifyyourstrengthsandweaknesses.UsethelastweekbeforeTestDaytofocusonyourweakerareas,andrereadthosechaptersofthisbook.

THEDAYBEFORETESTDAY

Trytoavoiddoingintensivestudyingthedaybeforethetest.Ashealthcareprofessionals,youarelikelyrevisingforthetestalongsideabusyworkschedule.Onthedaybeforethetest,youarelikelytoalreadyknowallyouneedtoabouttakingOET.Insteadoftryingtolearnnewinformation,youmightfindithelpfultoreviewkeystrategies,prepareeverythingyouwillneedforTestDay,andtrytofindsomefreetimetorelax.

TESTDAY

Plantoarriveearlyatyourtestvenue;theadministratorswillnotadmitlatecomers.Makesureyouhaveyourtestkitwithyou,especiallyyourID.

Duringthetest,trynottothinkabouthowyouareperforming.Instead,focusonthetaskofprovidingthecorrectanswer,readingandlisteningactively,andspeakingandwritingclearly.Thinkabouthowwellyouhaveprepared,andbeconfidentandpositiveaboutyourabilities.

AFTEROET

AfterallyourhardworkinpreparingforOET,besuretocelebrateonceitisover.Gettogetherwithyourfamilyandfriends,relax,andhavefun.Youhavealottocelebrate:Youpreparedforthetestaheadoftime.Youdidyourbest.You’vedoneallyoucantogetagoodscore.

BeforetheTest

Asaqualifiedhealthprofessional,youarealreadyusedtorevisingforandpassingdifficulttests,anddealingwithstress.However,OETisanEnglishlanguagetest,andwillrequireyoutoprepareinaslightlydifferentwaythantheprevioustestsyouhaveencountered.Herearesometipsforpreparingyourselfaheadofyourtest,soyoucanperformwellonTestDay.

MakeEnglishaPartofEveryDay

SurroundyourselfwiththeEnglishlanguageintheweeksandmonthsleadinguptoyourtest.GetinthehabitofreadingorlisteningtosomethinginEnglisheveryday,andwritingandspeakinginEnglishaboutwhatyouhavelearned.Theseactivitiesshouldbecompletedseparatlyfromyourstudytime.EvenjusthalfanhourofpractisingeachdaywillhelpyoutoimproveyougeneralEnglishskills.Evenmoreimportantly,youwillbecomemoreandmorefamiliar,andthereforemorecomfortable,withEnglish.ThelevelofcomfortyouhavewithEnglish,whetheryouarelistening,reading,writingorspeaking,willhelpreducestressandnervousnesswhenyoutakeOET.

TalktofriendsorcolleagueswhoaretakingOET,orhavealreadytakenit.Sharingyourstrategies,andhearingtheirexperienceswithrevisingforandtakingthetestwillhelpyoutogetreadyforTestDay.Rememberthereisn'tonestrategythatwillworkforeveryone.Trythestrategiessuggestedbyyourfriendsandcolleaguesbutalsofeelconfidenttodevelopyourownortousetheones

suggestedinthisbook.IfyoudodiscussOETwithcolleagueswhohavealreadytakentheOET,rememberthattheformatofthetesthaschangedovertheyears,somakesuretocheckwww.occupationalenglishtest.orgtoconfirmthatyouknowwhattoexpectforyourtest.

TakeaBreak

Rememberthatinordertolearnsomething,itisnecessarytogiveyourselfabreakeverysooften,toallowyourmindtoprocessnewinformation.Healthcareprofessionalsareusedtoworkinglongshifts,andabsorbinglargeamountsoffactualinformation,butimprovinglanguagerequiresadifferentapproach.Makesureyougiveyourselftimetohaveabreak,frombothOETrevisionandwork.Theeasiestwaytodothisistostartrevisingattheearliestopportunity,sothatyouhaveenoughtimetoreadthroughalloftheinformationinthisbook,andstillgiveyourselftimetorelax.

DURINGTHETEST

OETrequiresahighlevelofconcentrationandquickresponses.Yourstateofmindasyoutakethetestwillaffectyourscore.HerearesometipsforperformingyourbestasyoutakeOET.

KeepMoving

WhenyoufindyourselfstuckduringOET,whetheryou’restrugglingtounderstandwhataspeakerissayingintheListeningTest,tryingtofindmeaninginadifficultparagraphintheReadingTest,ortryingtorememberthecorrectwordorphrasetouseintheSpeakingandWritingTests,remindyourselfthatitisokaytomakesomemistakesonOET.Youdonothavetogeteverythingrighttoachieveagoodscore,sodonotspendanexcessiveamountoftimeonaquestionthatistoodifficultforyou,ortryingtorememberaphrasetouse.Makeaneducatedguess,orexplainwhatyoumeanasbestyoucan,andthenmoveon!

Concentrate

Othertesttakersmayseemtobeworkingmorebusilythanyouare,butdonotpayattentiontothem!Otherpeople’sactivitylevelsarenotnecessarilysignsofprogressorhigherscores.Continuetoworkcarefullyandthoroughly,andaimtoanswerthequestionswithinthetimelimit.

ThinkPositively!

WhiletakingOET,remindyourself:

Youdonothavetogeteverysinglequestionrighttoachieveahighscore.Byhavingstudiedthestrategiesinthisbook,youarebetterpreparedthanthemajorityofothertesttakers.Youareprobablydoingbetterthanyourealise.

THELISTENINGSECTION

ListeningIntroduction

SectionOverview

TheOETListeningTestconsistsofthreeseparatepartswithatotalof42questions,andlastsaround40minutes.Youonlyheareachrecordingonce,soyoushouldfamiliariseyourselfwiththeformatofeachofthethreeseparatepartsinthissectionbeforeTestDay.Allofthelisteningcontentisappropriateforhealthcareprofessionalsinanyofthe

12different

professions,anddoesnotrequirespecialistknowledgeinaparticularhealthcarefield,thoughthelisteningcontenttestsyourlevelofEnglishinahealthcare-specificenvironment.

ThethreedifferentpartsoftheListeningTest

aredescribedbelow.

InPartAyouheartwodifferentconsultationsineachofwhicha

healthcareprofessionalistalkingtoapatient.Thereisonenote-completiontaskwith12gapstofillforeachconsultation.PartAlastsaround10minutes

Beforeeachrecording,youhearinformationaboutthecontextandinstructionsaboutwhatyouhavetodo.Thisinformationwillalsobeprintedonyourtestpaper.Beforeeachrecording,youhavetimetoreadthroughthequestionsandthinkaboutwhatyou'regoingtohearbeforeyouanswerthequestions.

andtestsyourabilitytounderstandandrecordspecificinformationaboutpatients.

InPartByouhearsixdifferentextractsfromtheworkplace.Ineachextract,youhear

healthcareprofessionalseithertalkingtoeachother,ortoapatient.Thereisonemultiple-choicequestiontoanswerabouteachextract.ThisPartlastsaroundtenminutesandtestsyourabilitytounderstandeverydayworkplaceinteraction.

InPartCyouheartwolongerrecordings.Eachrecordingiseitheranintervieworaworkplacepresentationonatopicrelatedto

healthcare.Therearesixmultiple-choicequestionstoanswerabouteachrecording.Thispartlastsaround15minutesandtestsyourabilitytounderstandthespeaker’sideasandexperiencesrelatedtothetopic.

LISTENINGSTRATEGIES

TheOETListeningTestisafixedformattestwithstandardisedinstructions.TheinstructionsyouseeinthisbookaretheinstructionsyouwillreceiveonTestDay.Youshouldmakesureyouarefamiliarwiththeseinstructions,soyouknowwhattoexpectaheadofyour

ThetopicsintheListeningTestareofgenerichealthcareinterest,accessibletocandidatesacrossallprofessions.UsethetimeyouaregivenbeforeeachtaskintheListeningTesttolookatthequestionsandthinkaboutwhatyou‘regoingtohear.YoucanusethisinformationinPartAandCtohelpyouunderstandthestructureoftherecordingyouwillhear,andinPartB,youshouldreadthroughthequestionssothatyouknowwhatinformationandideasyou’relisteningforwhenyouheartherecording.Youmayfindithelpfultounderlineimportantwordsinthequestionfor

Multiple-Choicequestions,andunderlineimportantwordsthatappearbeforeandafterthegapsinNoteCompletionquestions.

YouonlyheartherecordingforthetasksintheListeningTestonce,soyouwillneedtorecordyouranswersasyoulisten.MakesureyoufillinallofthegapsinPartA,andselectananswerchoiceforallofthequestionsinPartsBandC.Youwillnotlosemarksforincorrectanswers.Don’tworryifyoumissananswerasyouworkthroughthetask–continueto

moveforwardwiththerecording,otherwiseyouwillmissthenextquestion,too.Onceyou’vefinishedthetask,youcanlookbackatthequestionyoumissed,selecttheanswerthatseemsmostlikely,andmoveon.ListentoEnglisheveryday.Youcanimproveyourlisteningabilitiesbylisteningtoarangeoflisteningmaterialsfromavarietyofsources,suchaspodcastsandvideos,ratherthanfocusingontest-relatedcontexts.Writeclearlyandlegibly–ifthe

assessorcan’treadwhatyouhavewritten,youranswerwon'tbemarkedascorrect.

CHAPTER3

ListeningPartA

LEARNINGOBJECTIVES

Bytheendofthischapter,youwillbeableto:

Listenfordetails,includingthepatient’ssymptoms,medicalhistoryandtreatment.Scanthenotestoidentifytheimportantwords.Identifythecorrectinformationinlongconsultations.PractisestrategiesforcompletingthenotesinListeningPartA.

INTRODUCTION

InPartAoftheListeningTestofOET,youlistento2separateconsultationsandcompletenotesthatfollowthedetailsoftheconsultation,byfillinginthegaps.Thereare12gapsforeachconsultation.

EachconsultationinPartAlastsfor4to5minutes.Youhave30secondstolookthroughthenotesbeforetherecordingbegins,andyoumustanswerthequestionsasyoulistentotheconsultation.

Strategies

KnowtheInstructions

Youshouldmakesureyouarefamiliarwithwhatyouhavetodobeforeyoutakethetest.Theinstructionslooklikethis:ListeningTest

TheListeningtesthasthreeparts.Ineachpartyou’llhearanumberofdifferentextracts.

You’llheareachextractONCEONLY.

Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,ahealthprofessionalistalkingtoapatient.

Forquestions1to24,completethenoteswithinformationyouhearintherecording.

Extract1:Questions1to12

YouhearaneurosurgeontalkingtoareferredpatientcalledHaleyWaterman.Forquestions1to12,completethenoteswithawordorshortphrase.

KnowtheFormat

TheconsultationsyouhearinPartAarebetweenahealthcareprofessionalandapatient.Occasionally,thehealthcareprofessionaltalkswitharelativeofthepatient,insteadofthepatientthemselves.Thepatientspeaksmorethanthehealthcareprofessionalandmostoftheinformationinthenotescomesfromwhatthepatientsays.

Theconsultationbetweenthetwospeakerscoversanumberofaspectsofthepatient'sconditionandtreatment.Youshouldusethe30secondsofsilencebeforethePartAconversationbeginstoreadthenotesandthinkabouttheinformationthatyou'relisteningfor.

READTHENOTESBEFORETHERECORDINGBEGINS

OnTestDay,youhave30secondstoreadthroughthenotesforeachPartAconsultation,beforetherecordingbegins.Usethistimewisely,tomakesurethatwhentherecordingbegins,youareanticipatingthetypeofinformationyouneedtolistenfortofillthegaps,suchasasymptom,aformofmedicationoratypeoftreatment.

Asyoulookthroughthenotes,makesuretoconsiderthefollowingpoints:1.Whatisthestructureoftheconsultation?

Lookattheheadingsandsub-headingsinthenotestounderstandtheorderoftheinformationyouaregoingtohear.Thiswillhelpyoutofollowtherecordingasyoulisten,andkeepyourplaceinthetask.

2.Whattypeofinformationisneededinthegap?

Lookatthenotesandthinkaboutthetypeofinformationthatismissing.Forexample,ifthenotesbeforethegapsaythatsymptomsare‘describedas’something,thistellsyouthatyou‘relisteningforthepatient’sactualwords,sothat'swhatyoushouldlistenfor.

IDENTIFYINGIMPORTANTINFORMATIONINTHENOTES

Someoftheinformationinthenoteswillassistyourunderstandingofwhattypeofinformationyouneedtocompletetheblanks.Forexample,ifthenotessay‘patientdiagnosedwith(1)afterreportingextremebackpain’,theimportantwordsare‘diagnosedwith’,whichsuggeststhatyouneedtolistenoutforaparticularcondition,and‘extremebackpainandnumbness’,whicharethesymptomsyouneedtolistenoutforinthepatient’sspeech.Fromtheinformationinthenotes,wecanpredictthatthepatientcouldsaysomethinglike:Iwenttothedoctor’sbecauseIwashavingthisreallyterriblepaininmyback,andalsothisnumbnessinmylegs.Afterdoingsometests,theysaidIhadsciatica.

Theunderlinedwordsshowhowthemeaninginthenotesispresentedinthepatient’sspeech:theybeginbydescribingtheirsymptoms,andthentheyrefertothediagnosis.Thewordinboldmustbethegapinthenotes,asthebackpainandnumbnesstheyexperiencedledtoadiagnosisofsciatica.

Exercise

Take20secondstolookatthenotesbelow,andunderlinethewordsthatwouldhelpyoutolistenforthe3gapsinthenotes.

Treatment Beganbytakingorlistatandfollowingthediet(limiting(1),lotsofvegetables)

After6months,beganexercisinggently,butfounditdifficultdueto(2).

After12months,nosignificantsustainedweightloss.

Underwent(3)in2014-nocomplications.

Now,giveyourself20secondstolookthroughthenotesbelow,thenanswerquestions4–7.

Patient FelixLeak

(A) diagnosedwithstage1testicularcancerin2015

underwentanorchidectomyinlate2015

alsogiven2cyclesofchemotherapyfollowingsurgery

(B) hasrecentlyexperiencedhaematuria

reportsfeelingtired,achingmuscles

describesthepainas‘alwayssore,butbearable’

(C) worksasanexecutivedirectoratalawfirm

reportsanincreaseinwork-relatedstressfollowingarecentpromotionmoderatedrinker

historyofsmoking

(D) bookultrasoundscan

givebloodteststocheckfortumourmarkers

EachconsultationinPartAlastsforaround5minutes,andusuallycoversthefollowingareasofinformation.

1.RecentMedicalHistory

4. Forsections(A)–(D)ofthetext,describethetypeofinformationbeingrecorded.

5. Howwasthepatient’scancertreated?

6. WhatisthemostlikelyreasonforFelix’srecentconsultation?

7. WheredoesFelixwork?

RecentmedicalhistoryisacommontopicinPartAconsultations,asthissectionofthetestisdesignedtotestyourabilitytounderstandrealisticpatientlanguageinEnglish,andrelatingmedicalhistoryisacommonfeatureinconsultations.

Exercise

ListentoTrack1,whichgivesanexampleofthissectionofaPartAconsultation,andanswerquestions8–11below.

2.OtherMedicalHistory

Youmayalsoneedtofillingapsinthenotesaboutthepatient’smoregeneralmedicalhistory.Thismightincludethepatient’scurrentmedication,lifestylechoices,andpastsurgeriesandillnesses.

8. Howlongagodidthepatient’ssymptomsbegin?

9. Whatwasthepatientdoingdifferently,asaresultofthesymptoms?

10. Inadditiontobeingtired,whatothersymptomsdidthepatienthave?

11. WhatdidDrLopez’sbloodtestsshow?

Exercise

Take10secondstoscanthenotesbelow,thenplayTrack2,andfillinblanks12–15asyoulisten.

MedicalHistory (12)throughout2016(noproblems)

diagnosedwithanaemiaafterfeeling(13)andtired

sufferedfromheavyperiods

regularly(14)

brokearmand(15)(2004)

3.CurrentSymptoms

Inthissectionoftheconsultation,thehealthprofessionalaskshowthepatientiscurrentlyfeeling.Patientsoftendescribetheirsymptomsineverydayterms,usingidiomsandphrasesthatmaybeunfamiliar.Itisyourtasktorecordwhatpatientssayabouttheseissues.Notallthemissinginformationwillbemedicalterms–sometimesyouwillneedtowritedowntheword(s)thepatientusestodescribethesymptoms.

Exercise

PresentCondition taking(16)medicationforthepast3months.

headachesinforehead,describedas(17)

somenauseaafterfood

hotflushesandsweating(clammyhands)

troublesleeping,feeling(18),andparanoid

formerbehavioursarereduced

butisnow(19)aboutdifferentthings

4.Treatment

Thissectionoftheconsultationdiscussesthepatient'scurrentandfuturetreatment.Thepatientmaydescribehowtheyhavebeenfindingtheirtreatment,ortheymaysimplydescribethetreatmenttheyhavebeenfollowingsofar.

Exercise

Treatment given(20)byparamedicsonwaytohospital

morphineadministeredaspainrelief

(21)usedundertonguetoimprovebloodflow

observed(22)usinganEKGmachine

(23)procedureperformed

InPartAoftheListeningTest,youneedtomakesureyoucankeepupwiththeconversationandunderstandthekeythingsthatthespeakersaresaying.FamiliariseyourselfwithcommonphrasesandidiomsinEnglish,andpractise-listeningtonativeEnglishspeakersuseeverydaylanguage,tohelpyouscorewellinthissectiononTestDay.

IMPROVEYOURSCORE

Findarecordingofaconsultationonlineandlistenandwritedownthe:

namesofsymptomsnamesofmedications

IMPROVEYOURSCORE

Usethe30secondpausebeforetherecordingplaystofocusyourlistening.Underlinewordsandphrasesbeforeandafterthegapsinthenotes,andlistenforthisinformationwhentherecordingstarts,sothatyouarepreparedtolistenfortheanswer.

IMPROVEYOURSCORE

IntheListeningTest,youhearspeakersfromavarietyofEnglish-speakingcountries.YouarelikelytoheararangeofaccentsonTestDay,including:American,Australian,Canadian,UK,IrishandNewZealand.Theseaccentswillbemildandeasilyunderstood.SearchforpodcastsandvideosonlinecreatedinthesevarietiesofEnglishtomakesureyou’refamiliarwiththerelevantaccents,andareabletounderstandwhatthesespeakersaresaying.Thelisteningcontentinthisbookusesarangeofspeakerswithvariousaccentstohelpyoutoprepare.

namesoftests/treatmentoptions,etc.

ListeningPartA:PracticeSet

Questions1to12

Take30secondstoscanthepatientnotesonthispage,thenlistentoTrack5andanswerquestions1–12.

YouhearanoptometristtalkingtoanewpatientcalledAidanFitzpatrick.Forquestions1to12,completethenoteswithawordorshortphrase.

Patient AidanFitzpatrick

Symptoms

BackgroundDetails

firstnoticeddifficultyreadingtwoweeksago

describeshisvisionas‘(1)’,

hasdifficultyreadingprintedletters

needsincreasingly(2)toreadinevenings

foundhewashavingtoholdobjectsclosertosee

purchasedglassesfrom(3)

oftenfindsthathe’s(4)hiseyes,evenwhenwearingglasses

whenstrugglingtosee,canalsoexperience(5)

Aidantreatspainwith(6)(fast-acting)

woreglassesasachild

brotheralsowearsglasses,possibly(7)

MedicalHistory

NextSteps

recentlysufferedfrom(8)

treatedwithantibiotics—

stillexperiencingsymptomsof(9)—

lostexcessweightfollowinga(10)(describesas‘wakeupcall’)

isn’twillingtowear(11)

mustbegiven(12)(neverhadone)

EXTRACT1:QUESTIONS13TO24

Take30secondstoreadthroughthepatientnotesonthispage,thenlistentoTrack6andanswerquestions13–24.

YouhearanobstetriciantalkingtoanewpatientcalledHilaryJohnson.Forquestions13to24,completethenoteswithawordorshortphrase.

Patient HilaryJohnson

Reasonforreferral

Familyhistoryof

diabetes

Pregnancysymptoms

Occupation

glucosein(13)indicatesriskofdiabetes

describesherselfas(14)sugaryfoods

noticedextra(15)whichmaybeunrelatedtopregnancy

her(16)suffersfromdiabetes(Type2,controlledthroughdiet)

morningsickness–paininher(17),butnovomiting

(18)controlledwithmedication

recentlysufferingfrombackache,describedas‘(19)’pain

hasbeenfeelingincreasingly(20)

problemssleeping

concernedaboutdiet(takinga(21))

Secondaryschoolteacher

feeling(22),increasedworkload

Nextappointment willtakean(23)glucosetest(she’sfamiliarwiththeprocedure,afriend’s

hadthetest).

hasbeengivena(24)toconsultaheadofherbloodtest

IMPROVEYOURSCORE

PartAisdesignedtotestyourabilitytolisteneffectivelytopatients.Assuch,thegapsyouneedtofillininPartAaregenerallyfoundinthepatient’sspeech.Makesuretopayattentiontowhatthepatientsaysabouttheirtreatmentsofar,theirmedicalhistory,andtheircurrentsymptoms.

Answers

1.diet,limiting(youwouldexpecttolistenforatypeoffoodthepatientnolongereatsregularly)

2.exercising,difficultdueto(youwouldexpecttolistenforsomethingthatmakesexercisinghard)

3.underwent,2014(youwouldexpecttolistenforaprocedurethepatienthadin2014)

4.medicalhistorycurrentsymptomslifestyleORpersonaldetailsnextstepsORtreatmentplan

5.orchidectomy

6.haematuria,tired,achingmuscles

alawfirm

8.2months

9.goingstraighttobed

10.gainingweight,troublefocusingandpayingattention

11.thyroxinewaslow

12.pregnant

13.dizzy

14.donatedblood

15.(acoupleof)ribs

16.fluoxetine

shootingpain

18.anxious

19.compulsiveOROCD

20.aspirin

21.nitro-glycerine

22.heartrhythms

23.angioplasty

PRACTICESETS

Questions1to12

1.fuzzy

2.morelight

3.(the)pharmacy

4.squinting

5.(aprettypersistent)headache

6.ibuprofen

7.short-sighted

8.sinusitis

Questions13to24

9.(a)cold

10.myocardialinfarction,orMI

11.contactlenses

12.(an)eyetest

1.urinesample

2.craving

3.weight

4.aunt

5.stomach

6.heartburn

7.throbbing

8.tired

9.prenatal

10.(alittlebit)stressed

11.oral

12.leaflet

ListeningTranscripts

Track1

F: Couldyoutellme,inyourownwords,what’sbroughtyouheretoday?M: Yes,ofcourse.Well,Iwenttoseemygeneraldoctor,DrLopez,

becauseI’dbeenfeelingreallytired.Ithadbeengoingonforabouttwomonths,thoughIhadn’tbeentohimsoonerbecauseIwasn’tsureitwasseriousenoughtowarrantavisittothedoctor’s–I’mgenerallythesortofpersonthatjustgetsonwiththings,youknow,Itendtoletmybodyhealitself–butitgottothepointwhereIwasgoingstraighttobedwhenIgothomefrommyjob,andnotwakingupuntilthemorning.AndI’dstillbetiredthenextday,despiteallthatsleep!IalsofoundthatIwasgainingweight,eatingthesameamountoffoodI’vealwayshad–maybeevenless.Ibecameabitofazombie,really.Ihadtroublefocusingatwork,andpayingattentiontowhatpeopleweresaying.Itwasmywifethateventuallygotmetogoandseethedoctoraboutit,shesaidIlookedlikeIwasonautopilot.Anyway,whenIsawDrLopezhegavemelotsofbloodteststoseeifIwaslackinginanything...mosteverythingturnedoutfine,butthebloodtestsshowedthatmy...Ithinkitwasmythyroxinelevels...wereonthelowside,soDrLopezreferredmetoyou.

TRACK2

F: Well,otherthanthis,I’mnotsureI’veeverhadanyserioushealthproblems.IsupposeIhadtovisitthedoctorafairamountin2016,becauseIwaspregnantwithmydaughter...eventhatwasfairlystraightforward,therewerenocomplicationsorconcerns...then,Isupposealittlewhilebeforethat,Isufferedfromanaemia...Ifeltreallytired,andIhaddizzyspells.Therewereabunchofdifferentthingsthatthedoctorsthoughtmightbecontributingtoit:Iwashavingheavyperiods,andIdonatedbloodasoftenasthey’dletme...Ithinktheyalsomentionedthatcaffeinecouldbeanissue.IrememberthinkingitwasweirdthatIhadit,becauseatthetimeIwaseatingquitealotofredmeat,andIthoughtthatwassupposedtogiveyouplentyofiron.Anyway,assoonasIvisitedthedoctorstheysortedmeout...Otherthanthat,IsupposetheonlyhealthissueIcanthinkofisfallingoffabikein2004andbreakingmyarm.Ibrokeacoupleofribs,aswell,buttheytendtosortthemselvesout.Ihadtowearaslingforalongtime,withthatarm.Sometimesitachesslightly;it’sbarelynoticeable,though,anditmightnotberelated.

TRACK3

M: Ijustdon’tthinkthatmedicationisdoingmeanygood.Forthreemonths,eversinceIstartedtakingfluoxetine,I’vebeenfeelingreallybizarre...Igettheseterribleheadachesthatcomeandgo-it’slikeashootingpaininmyforehead-andIsometimesfeelnauseousaftereating...AndIkeephavingthesehotflushes,myhandswillgetclammy,andIfeelanxiousandstartshaking!Ifinditdifficulttosleep...ummwhenI’minbed,Igetkindofagitated,andI’llstartthinkingaboutallofthethingsthatwentwrongatwork,orthingsthatcolleaguessaidtome...well,perhapsIfeelabitparanoid,Idon’tknow.Ijustthinkit’sreallynotworthallthesesideeffects.IsupposeIengageinmyformerOCDbehaviourless,asaresultofthemedication?ButIthinkthatmightjustbebecauseI’mspendingmytimeworryingabouteverythingelse!It’slikeI’vejustswappedmyformerhabitsfornewones...I’mcompulsiveaboutdifferentthingsnow,likestressingatnight.Atleastbefore,myOCDwasonlyimpactingpartsofmyday...thesedrugs,though!They’remakingmylifesomuchmoredifficult.

TRACK4

F: Okay,Mark,socanyoutellmeaboutwhathappenedwhenyouhadyourheartattack?

M: Yeahsure...Itallhappenedreallyquickly,butIrememberfeelingthisreallyweirdchestpain,likeatightnessinmychest,Itoldmywifemychestwashurting,andwhenImentionedIhadpainsinmyleftarmshecalledanambulanceimmediately...goodthingsheknew!SoIremembertheparamedicsputmeintotheambulanceandgavemesomeaspirin.TheytookmetotheERandtheretheygavemeamorphineshotforthepainIwasfeeling...umm...theyalsoputamaskonmeforoxygentohelpmebreath,andsomethingunderthetonguetohelp...Ithinkitwastohelpmyheartgetmoreblood.Itwascallednitroglycerin.Mywifewaswithme,Iremember,andshewasreallygreat,reallyhelpedmetokeepcalm,althoughshetoldmelaterthatshewasfreakingout!ThentheyhookedmeuptoanElectrocardiogram(ECG)machinetolookatmyheartrhythms.Evidentlyitmusthaveshowedsomekindofblockagebecausetheytookmetothecatheterlabstraightaway!Ihadtobeoperatedon,theycalleditanangioplasty,becauseIwashavingaheartattack.Thewaytheydescribedittome,itwasbasicallylikecleaningoutthepipesthatpumpedbloodtomyheartmuscle.TheysaidthatifI’dwaitedanylongertocallanambulance,theheartmusclewouldmostlikelyhavediedfromthelackofoxygen!

TRACK5

N: YouhearanoptometristtalkingtoapatientcalledAidanFitzpatrick,whohasbeenexperiencingblurredvision.

F: HiAidan.I’mDrSalkeld...couldyoustartbytellingmeaboutwhat’sbeengoingonwithyourvision?

M: Sure...Well,Iguessitmust’vestartedawhileago,butIdidn’treallynoticeitproperlyuntilabout2weeksago.IwasworkinginmygardenandInoticedthatIwashavingahardtimereadingtheinstructionsonthegardeningproductsthatI’djustbought.InormallysticktotheoneI’vebeenusingforyears,butIthoughtit’dbenicetotrysomethingdifferent.Anyways,itkindoffeltlikeeverythingwasfuzzyaroundtheedges,andIjustcouldn’tseethelettersclearly.Aftertalkingtomydaughter,shementionedthatI’dbeenusingincreasinglymorelighttoreadatnightandevenpullingthingsclosertometoread.Ihadn’tevennoticed!SoIwentoutandgotsomeofthoseglassestheysellatthepharmacyandtheyhelped,butmydoctorsaidthatit’dbebetterifIcametoseeaneyedoctor...Welltheymadethingslessblurred,anyway,Iguess.Myvision’sstillnotcrystalclearoranythingwhenIusetheglasses,butIwasn’treallyexpectingthat.IstillnoticethatI’msquintingtoseethings...it’smostlywhenI’mtryingtoreadsomethingclose-up,likesmallwriting.I’mbetterwhenthingsareatadistance...Idon’tknowifit’srelated–butI’vealsonoticedaprettypersistentheadache...IguessIt’skindofatthesidesofmyhead,Isuppose.Itcomesandgoes,butit’sdefinitelyworstwhenI’mhavingtroubleseeingsomething.Whenitgetsreallybad,Ijusttakeafast-actingibuprofen,andthattendstosortitout.

F: Everhadanyvisionproblemsbefore?

M: WhenIwaslittle,atsomepointinelementaryschool,IthinkIhadglasses,butI’msureIbrokethemandwejustnevergotroundtohavingthemreplaced.Mybrotherhasglassesthathe’sbeenwearingforyears,Idon’treallyknowawholelotaboutwhat’swrongwithhiseyes....maybehe’sshortsighted?Butthatremindsme,mybrotherthoughtIshouldmentionthatacoupleofmonthsorsoagoIwasreallyprettyill,Iwassufferingfromsinusitis.And,anyway,Ileftitprettylatetogoandseethedoctoraboutit.Kindofthoughtthatitwouldjustsortitselfout,anyway,itlingeredforawhile,sowhenItoldmydoctorhegavemesomeantibioticsanditclearedupprettyquicklyafterthat.Well,forthemostpart...althoughIstillfeellikeIhaveacold.OtherthanthatI’vebeeninreallygoodhealthforthelastfewyears.Itakemyhealthreallyseriously,I’mnotsureIfthedoctortoldyou,butIusedtobequiteoverweight,butIlostitallafterabitofawakeupcallsomeyearsback...Ihadwhatyouguyscallamyocardialinfraction...itwasprettyscary,andIwasquiteoverweightatthetime,andreallystressedoutaboutmyjob.SincethenI’vemadearealefforttolookaftermyselfproperly.

F: I’mgladtohearit.So,intermsofyourblurredvision,whatdoyouthinkmightworkforyou?

M: Well,Idon’tparticularlyliketheideaofwearingglassesallthetime,buttouchingmyeyesfreaksmeoutsocontactlensesaredefinitelynotanoption.IguessthebestthingmightbetojusthaveglassesthatIwearallthetimesoIdon’tkeepforgettingtoputthemonwhenIamoutsomewhereandnotathome.I’veactuallyneverhadaneyetest,soIshouldprobablyscheduleoneofthoseasanextstep.

F: Ithinkthatsoundsreasonable.Let’sdosometeststocheckoutyoureyesandgofromthere.

TRACK6

M: HilaryJohnson?Hi,docomeinandtakeaseat.I’mDrSmithandI’maseniorobstetricianhere...So,Hilary,you’vebeenreferredtousbyyourmidwife.Ihavehernoteswithmehere,butcouldyoutellmeinyourownwordswhyyou’vebeenreferred?

F: Yeah,noproblem...umm,IthinkI’vebeenreferredtoyoubecausethemidwifesaidshefoundsomeglucoseinmyurinesampleandwasworriedaboutdiabetes.IfIunderstandcorrectly,Icouldhavediabetesduringmypregnancy,butifIdo,it’snotlikelytocontinueaftergivingbirth?I’venoticedthatI’mcravingsweetsandcakesallthetimeatthemoment,andI’vejustbeenlettingmyselfeatwhatever,soI’veputonabitofweight,andIdon’tthinkit’salljustbabyweight,either...I’veneverhadaproblemwithdiabetesbefore,andI’mhopingitwillturnouttobesomethingelse.Myauntactuallyhastypetwodiabetes,butshe’salwayseatenalotofsugar,soIthinkthatmightbeafactor.Shejustcontrolsherswithdietnowanddoesn’thavetotakeanymedication.

M: Oh.okay.Thanksforlettingmeknow...Iseefromyournotesthatyou’re24weekspregnantnow,howhasyourpregnancybeenuptonow?

F: Oh,I’vebeensolucky!Igottheusualsicknessearlyon–well,youknow,stomachpain,butnotactuallybeingsick–Ithinkthat’sprettycommon,anditsettledafterthefirsttrimester.I’vebeentakingsomemedicationbecauseIalsohadprettyhorribleheartburn,anditseemstotakecareoftheproblem...andalsoI’vestartedtogetabitofbackpaininthelastweekorso...I’dsayit’slikeathrobbingfeelingbutotherthanthatI’vebeenprettyfortunate.IsupposeI’vebeengradually

gettingmoreandmoretiredsincethestartofmypregnancy.I’vejustputitdowntotheextraenergymybabyneeds,butitcouldalsobebecauseIhaven’tbeensleepingverywell.Also,sometimesthenauseastopsmefrommakingsomethinghealthyfordinner,whichisannoyingbecauseIknowIneedtoeathealthily.Itakeaprenatal,though,tomakesureI’mgettingtherightnutrition.

M: Well,itseemslikeyou’remanagingtodealwithmostofyoursymptomswell.

F: Yeah,thisismyfirstpregnancyandtobehonestIdidn’thaveacluewhattoexpectbutsofarsogood.It’sonlythisglucosethingthat’sgotmeworried,Iimagineit’sjustaoneoffbutIguessit’sbesttogetitseento.

M: Certainly,andI’mpleasedyou’reheresothatwecangetthingssorted.So,we’llneedtobookanotherappointmenttocarryoutsometests.

F: Okay,sowhenwillIhavetohavethisbecause,I’mabitbusyatworkattheminute?

M: Wellideallyassoonaspossible.CanIaskwhatyoudoforaliving?F: I’mahighschoolteacherandit’sjustgettingtothattimeofyearwhere

thekidsaregearingupfortheirexaminations.SoIcan’taffordtobetakingtoomuchtimeoffduringtheday.I’mactuallyalittlebitstressedatthemomentaswell,I’vehadtodoalotmoreworkoverthepastfewweeks...Ithinkit’sjustthattimeofyear.I’vebeenateacherfor4yearsnowsoI’mstartingtodevelopwaysofcopingwiththemadness.Withthatinmind,ifournextappointmentcouldbeatfive-ishorlater,thenthatwouldbeperfect.

M: Noproblem,justmakesuretoletthereceptionistknowyourpreferences.Whenwefindsugarinpreliminarytestsweofferanoralglucosetolerancetest,whichiswhatwe’lldowhenyoucomeinnext.Doyouknowwhatthatinvolves?

F: Well,IaskedafewofmyfriendsabouttheirpregnanciesandmyfriendBethsaidthatshehadthesamethingandtoldmeaboutthattest.Shesaidthatshehadtocomeintothehospitalanddrinkasugarydrinkandthenhaveabloodtesttotellifshehaddiabetes.Isthatright?

M: Yesthat’sprettymuchit.Hereisaleafletthatexplainsthetestsothatyoucanhaveareadaboutitwhenyougethome.Doyouhaveanyotherquestionsforme?

F: NoIdon’tthinkso,I’llgoawayandreadthis,andwaitandseewhatthetestsays.Thankyouforyourhelptoday.

M: You’rewelcome.I’llseeyouoncewehavetheresultsandwecantakeitfromthere.

CHAPTER4

ListeningPartB

LEARNINGOBJECTIVES

Identifythequestiontype.Choosetheanswerthatrelatestothespokeninformation.PractisestrategiesforansweringGist,Detail,SpeakerPurpose,Function,OpinionandCourseofActionquestions.

INTRODUCTION

InPartBoftheListeningTest,youlistento6differentshortrecordingsinahealthcaresettingandansweronequestionabouteachrecording.ListeningPartBtestsyourabilitytounderstandandidentify:

Eachofthe6shortlisteningtasksinPartBlastsforaround45seconds,andtherecordingisheardonlyonce.Therecordingwillcoveraworkplaceinteractioninvolvinghealthcareprofessionals,suchasabriefingorhandover.Youhave15secondstolookatthequestionbeforeeachindividualrecordingand5secondstomarktheanswerafterhearingtheworkplacecommunication.

IMPROVEYOURSCORE

ThereisonlyonequestionforeachrecordinginPartB.Usethe15secondpausebeforetheaudiobeginstofocusonthequestionbeingasked,andthinkabouthowthisquestioncouldbeanswered.

thegistoftherecordingspecificdetailswithininteractionsthespeaker’spurposetheopinionofthespeakertheactionsthatwillresultfromtheworkplacecommunication

Strategies

KnowtheInstructions

Youshouldmakesureyouarefamiliarwithwhatyouareaskedtodobeforeyoutakethetest.Theinstructionslooklikethis:InPartBoftheListeningTest,you’llhearsixdifferentextracts.Ineachextract,you’llhearpeopletalkinginadifferenthealthcaresetting.

Forquestions25to30,choosetheanswerA,BorCwhichfitsbestaccordingtowhatyouhear.

KnowtheContext

PartBoftheListeningTestcontains6differentrecordings,eachfromadifferenthealthcaresetting.Therecordingsinthispartofthetestshouldbefamiliartoahealthcareprofessionalfromanyofthe12sectorscoveredbyOET,becausePartBtaskshavegeneric,hospital-basedcontexts.

Therecordingsyouhearinthissectionwillcontainoneortwospeakers.Thereisalwaysatleastonehealthcareprofessionalineachrecording,andeachrecordingwillgiveanexampleofaneverydayworkplaceinteractioninarangeofcontexts.

PreparefortheDifferentQuestionTypes

Usethe15secondsbeforetherecordingbeginstoanalysethequestion.Don’tlookatanyofthefollowingquestionsduringthistimeperiod,justfocusonthe

questionfortherecordingyouareabouttohear.Whenyoulookatthequestion,underlinewordsthatwillhelpyoutolistenfortheanswer.

Thereare7differentquestiontypesinListeningPartB:Gist,Detail,SpeakerPurpose,Function,Opinion,AgreementandFutureActions.

1.Gist

Gistquestionsaskyoutochoosetheoptionthatcorrectlysummarisestheinformationheardintherecording.Toanswerthesequestions,youneedtoidentifytheidea,orgist,oftheinteraction.Thisquestionislookingforanoverviewoftheinformationgivenintheaudio,notaspecificdetail.Theanswerchoiceswillreporttheinformationintherecordingwithoutrepeatingtheexactwords.ThisisthemostcommonquestiontypeinthePartBsectionoftheListeningTest.ThefollowinglistgivesexamplesofGistquestions:

Whatarethenursestalkingabout?TheaimoftheresearchwasThevetisexplainingthat

Exercise

PlayTrack7andanswerquestions1and2.

1. Youhearadentistdiscussingbookingproblemswithherreceptionist.

Whathascausedtheproblem?

anerrorwiththebookingsystem(A)adoublebookedappointment(B)alackofcommunication(C)

2. YouhearadoctordiscussingchestX-rayinformationwithamedicalstudent.

Whatisthedoctorexplaining?

theorderfordiscussingresultstothepatient(A)theinformationtoincludeinpatientnotes(B)howtocorrectlyexaminethepatient’scondition(C)

2.Detail

Detailquestionsaskaboutaspecificpartoftherecording.Thedetailaskedforisoftenoneofthecentralideasintherecording,ratherthanamoretrivialpieceofinformation.Youheartheinformationthatallowsyoutoanswerthequestion–butthequestionmayormaynotusetheactualwordsheardintherecording.ThefollowinglistgivesexamplesofDetailquestions:

Whatwouldhaveimprovedthetrainee’sperformance?Thepatient’smedicationhaschangedbecauseWhatstrategydoesthesurgeonsuggest?

Exercise

3. YouhearanENTsurgeontalkingtoacolleagueaboutcochlearimplants.

Thesurgeonisexplainingthatcochlearimplants

transmitvoicesmoreclearlythanothernoises.(A)emitavarietyofsoundsintoamicrophone.(B)restorehearingindeafpeople.(C)

4. YouhearaGPtalkaboutdiagnosingType2diabetesmellitus.

3.SpeakerPurpose

Whyshouldafastingplasmaglucosetestbebookedinthemorning?

Thepatientwillneedtoattendan8hourappointment.(A)Thetestwillneedtobecarriedouttwice.(B)Toallowthepatienttoeatduringtheday.(C)

SpeakerPurposequestionsaskaboutwhatoneofthespeakersisdoing,ortryingtodo.Toanswerthesequestions,youneedtounderstandwhythespeakerissayingwhattheyaresaying,andwhatresultthespeakerisaimingfor.ThefollowinglistgivesexamplesofSpeakerPurposequestions:

Whatdoeshewanttoknowabouthistreatment?ThedoctorexplainsthatthepracticeshouldThetraineeistryingtounderstand

Exercise

5. Youhearadentisttalkingtoapatientwithachippedtooth.

Whatdoesthepatientwanttoknow?

howlongtheprocedurewilllast(A)whenhernextappointmentwillbe(B)whatherdifferenttreatmentoptionsare(C)

6. Youhearapodiatristtalkingtoapatientwithfallenarches

4.Function

Thepatientexplainsthathistreatment

willneedtocontinueforsometime.(A)hasbecometootime-consuming.(B)isnotimprovinghiscondition.(C)

Functionquestionsaskaboutwhatoneofthespeakersisdoing,orwhatthefunctionofwhattheyaresayingis.Toanswerthesequestionscorrectly,youneedtounderstandtheactionsthattheirlanguagedescribes.ThefollowinglistgivesexamplesofFunctionquestions:

Whatisthedentistdoing?Whyhasthepatientcalledthedoctor?

Exercise

7. Youhearadoctortalkingtoapatientinanemergencydepartment.

Whatisthedoctordoing?

explaininghowthepatientwillbetreated(A)reassuringthepatientthatsheisnotatrisk(B)goingoverthecauseofthepatient’sinfection(C)

8. Youhearamedicalstudenttalkingtoaseniorresidentaboutassessingapatient.

Whatistheseniorresidentdoing?

teachingthestudenthowtoexaminethepatient(A)explainingwhentoprescribeadditionalmedications(B)showingthestudentwheretoobservethejugularvein(C)

5.Opinion

Opinionquestionsaskyoutoidentifytheopinionofaspeakerontheissuediscussed.WhenansweringOpinionquestions,payattentiontohowthespeakerssaythings,andtheirattitudetowardsthetopicinthequestion.ThefollowinglistgivesexamplesofOpinionquestions:

TheradiographerthinksthatthepatientHowdoesshefeelaboutherrole?Thenursebelievesthatthedoctor

Exercise

PlayTrack11andanswerquestion9.

9. Youhearapsychiatristpresentingacasestudy.

6.Agreement

Agreementquestionsaskyoutoidentifywhatthespeakersareinagreementabout.Toanswerthesequestionscorrectly,listentotheconversationandpayattentiontothereactionsofeachspeakertotheother’ssuggestions.ThefollowinglistgivesexamplesofAgreementquestions:

Whatdidthepsychiatristfindunusualaboutthecase?

Thesymptomssuggestedadifferentcause.(A)Effectswereexperiencedlongafterthecause.(B)Thecauseoftheillnesscouldnotbedetermined.(C)

ThespeechpathologistagreesthatWhatdotheyagreeabout?Thephysiotherapistsagreethattheywill

Exercise

10. Youhearadietitiantalkingwithapatient.

7.CourseofAction

CourseofActionquestionsaskyoutodecidewhatthespeakerswilldoasaresultoftheconversationortalk.Payattentiontoanythingthatwillbedonelaterwhilelisteningtotherecording,andbeawareofwheninthefuturetheactionswillbedone.Forexample,aspeakermaytalkaboutwhatneedstobedonetonight,andwhatshouldbedonetomorrow.Thequestionspecifieswhichoftheseactionsiscorrect.ThefollowinglistgivesexamplesofCourseofActionquestions:

Whatdotheyagreeabout?

Thepatienthasforgottentheiroverallgoal.(A)Thepatienthasbeentooseverewiththeirdiet.(B)Thepatienthasbeentryingtolosetoomuchweight.(C)

Whatdoesthenursehavetodonext?

Whatwillthedoctordotonight?Nextweek,thepatientmust

Exercise

11. Youhearaveterinariantalkingwithanowner.

OnTestDay,youshouldaimtoidentifythefocusofthequestionduringyour15secondsofscanningtimebeforetheaudiobegins,sothatyouknowthetypeofinformationtolistenforintheaudio.Onceyouhaveidentifiedthequestiontype,youshouldlookforimportantwordsinthequestion,andthinkofparaphrasesfortheanswerchoices.Then,whentheaudiostarts,youwillbepreparedtolistenfortherightinformation.

IMPROVEYOURSCORE

Whatwilltheownerdolatertoday?

givehiscatplentyofattention(A)givehiscatdrugstoreduceovergrooming(B)givehiscatfoodatthesametimeaslastnight(C)

ManyPartBrecordingsarebetweentwohealthcareprofessionalsinaworkplacesetting,andtheycanalsoincludepatients.YoumightfindithelpfultowatchatelevisionprogrammesetinahospitalfromtheUK,Australia,theUS,oranotherEnglishspeakingcountry.Whiletheseprogrammeswillrarelydiscusshealthcareinatechnicalway,theywillhelpyoufamiliariseyourselfwithcommonvocabularyandinteractionsinanEnglishspeakinghealthcaresetting.

ListeningPartB:PracticeSet

PlayTrack14andanswerquestions1–6.

1. YouhearanEDnursetalkingtotherelativeofapatientwhohasbeenrecentlyadmitted.

Whatistherelativedoing?

describingherfather’smedicalhistory(A)suggestingwaystointeractwithherfather(B)explainingthatherfathercanbecomeviolent(C)

2. Youhearanobstetriciandescribingacaesareansectiontoapregnantpatient.

Hesaysthattheprocedurewill

beshorterandlesspainfulthanatraditionalbirth.(A)becarriedoutwhilethepatientisconscious.(B)notbenecessaryinthepatient’scase.(C)

3. YouhearaGPandhispracticenursediscussingtheiryearlyschedule.

Theyagreethatthepracticeshould

hireagencystafftohelpduringthebusierweeks.(A)avoidtakingholidayinthebeginningofSeptember.(B)lookaftertheirhealth,tolowerthelikelihoodofsickness.(C)

4. Youhearanursepreparingapatientforaflushot.

Whatisthenursedoing?

explainingwhytheflushotisnecessary(A)discussingwhytheflushotcausesreactions(B)describingcommonsideeffectsoftheflushot(C)

5. Youhearadoctortalkingtoapatientaboutherinjury.

Whatwillhappenwhenthepatientreturnstothesurgery?

Shewillhaveherstitchesremoved.(A)Thedoctorwillstitchupherwound.(B)Theywillseeifthewoundwillscar.(C)

6. Youhearatraineenurseaskingaseniorcolleagueaboutthetreatmentforapatientwithchronicobstructivepulmonarydisease,orCOPD.

Theseniorcolleagueisexplainingthatgivingsuchpatientsnormallevelsofoxygen

caninhibitbreathingrate.(A)willcauselight-headedness.(B)lowerscarbondioxidelevels.(C)

Answers

1. Calackofcommunication.

2. BTheinformationtoincludeinpatientnotes.

3. Atransmitvoicesmoreclearlythanothernoises.

4. CToallowthepatienttoeatduringtheday.

5. Cwhatherdifferenttreatmentoptionsare

6. Cisnotimprovinghiscondition.

7. Aexplaininghowthepatientwillbetreated

8. Ateachingthestudenthowtoexaminethepatient

Effectswereexperiencedlongafterthecause.

10. BThepatienthasbeentooseverewiththeirdiet.

11. Agivehiscatplentyofattention

PRACTICESET

1. Cexplainingthatherfathercanbecomeviolent

2. Bbecarriedoutwhilethepatientisconscious.

3. BavoidtakingholidayinthebeginningofSeptember.

4. Cdescribingcommonsideeffectsoftheflushot

5. AShewillhaveherstitchesremoved.

6. Acaninhibitbreathingrate.

Track7

N: Youhearadentistdiscussingbookingproblemswithherreceptionist.F: HeyKieran,MrLaojustmentionedthathe’dtriedtoreschedulehis

appointmentyesterday,firstonline,andthen,whenthatdidn’twork,hecalledup.Butapparentlyhecouldn’treschedule...anyideawhy?

M: Hmm...Iwasn’tworkingyesterday,butletmecheckthenotes...so,Lanaleftanoteaboutthecall.ShesaysthatMrLaowantedtoreschedule,butwedidn’thaveanyotherappointmentsthisweekafter3pm,whichistheonlytimehecouldmake.Heaskedifhecouldmakeanappointmentnextweek,buthisprocedurewasmarkedonoursystemas‘urgent’,soshehadtomakeitinthesameweek–thesystemwouldn’thaveletherrescheduleitanylater.Shewouldn’thavehadtheauthorisationtochangethat...still,sheshouldhavediscussedthiswithyouatlunchorattheendoftheday,becausethenyoucouldhavedecidedwhetheritcouldhavebeenpostponedforaweek.

F: Yeah...Inhiscircumstance,itwouldhavebeenfinetorescheduleataslightlylaterdate.Weshouldpreventsomethinglikethisfromhappeningagain.

M: Mmm,you’reright.I’lltalktoheraboutittomorrow,andI’llsendoutanemailtoeveryoneelse,sothatthey’reaware.

N: YouhearadoctordiscussingchestX-rayinformationwithamedicalstudent.

F: Hey,DrYan,we’vegottheX-raysbackforMrRegisinbedeight...fromthismorning.

M: Great,canyoudocumenttheminthenotes?F: Umm...Doyoumindshowingmehowtowritetheinterpretation

properly?M: Ofcourse.Makesureyouputthepatientdetails:fullname,dateofbirth,

patientnumberandhomeaddressfirst.Thenputthehospitalandward,dateandtime.Makesureyournameisonthedocument,too.IncludetheindicationfortheX-raylike“haemoptysis”or“dyspnea”beforedocumentingyourinterpretation.Now,IuseasimplemnemonictomakesureIdon’tmissanything,ABCDE:Airway–trachea,carina,bronchiandthehilarstructures;Breathing–lungfieldsandpleura;Cardiac-heartsizeandheartborders;Diaphragm–position,shapeandcostophrenicangles.Finally,Everythingelse:themediastinalcontours,bonesandtubesordevices.Makesureyoudocumenteverythingclearlyusingthissysteminthenotes.

TRACK8

N: YouhearanENTsurgeontalkingtoacolleagueaboutcochlearimplants.M: Weimplantanelectrodearray,whichlookslikeseveralsmallwiresmade

ofaplatinum-iridiumalloyintodifferentregionsofthecochlea.Thesemetalwiresconducttheelectricalimpulsesgeneratedfromthemicrophone,whichpicksupsoundfromtheenvironmentandsendsthesignalstotheelectrodearraythroughatransmitter.There’salsoaspeechprocessorbetweenthetwothatfiltersmoreimportantsoundssothatthepatientcanhearpeopletalkingratherthanothersounds.

F: Right,okay.Sodoesthisrestorehearingtonormallevels?M: No,withthecurrenttechnology,we’regivingdeafpeopleagood

representationofsoundsfromtheenvironmentandhelptounderstandspeech.Aftersurgery,patientsundergotherapytorelearntheirsenseofhearing.Noteveryonebenefitsfromthedevicetothesameextent.

N: YouhearaGPtalkaboutType2diabetesmellitus.F: Hello!I’llbecoveringthediagnosisofType2diabetesmellitus.So,there

arefourmethodsthatwecanuse.Thefirstisafastingplasmaglucosetest.Thisisourpreferreddiagnostictest,asit’seasiertocarry-out,oftenmoreconvenient,andcostsuslessthantheotherthreetests.Ithelpstotryandbooktheseappointmentsinthemorning,asthepatienthastorefrainfromeatingforatleasteighthoursbeforetheycantakethetest.Normalfastingbloodglucosewillbebetween70and100milligramsperdeciliter.Avalueofover126milligramsperdeciliterindicatesadiagnosisofdiabetes.Bearinmindthatthistestshouldbecarriedouttwicetoconfirmapositiveresult.Thesecondmethodwecanuseistomeasuretheaverageglycemicloadoverthepastthreemonths...

TRACK9

N: Youhearadentisttalkingtoapatientwithachippedtooth.M: Sowe’vetalkedaboutdifferentoptions,anditseemslikeaveneerwould

bethebesttreatment.Giventhecostoftheprocedure,areyouhappytogoahead?

F: It’squiteexpensive,butIdefinitelyneedtogetitfixed.Willitstayput?M: Veneerstendtoneedreplacingeverytentofifteenyears,sotheyarea

long-termsolution.Itwillcertainlybemoredurablethancompositebonding,anditwilllookmorerealistic,too.

F: Ah,okaythat’sgreat.AndisthereanythingIcandotoextendtheirlifespan?

M: Well,youneedtomaintaingoodoralhealth,youknow,brushing,flossing,regularcheck-ups.Youshouldavoidbrushingyourveneertoohard,asitcouldcausedamage.

N: Youhearapodiatristtalkingtoapatientwithfallenarches.F: Soyousayyou’reexperiencingfootpain,areyouwearingsupportive

shoes?M: Uh-hu,I’mwearingappropriateshoes,andI’malsowearingorthoticsthat

shouldbehelping,butI’mstillexperiencingpaininmyfeet.Sometimestheyfeelabitnumb,too.

F: Right,okay.Andyoumentionedthatyou’vebeengivensomefootexercisestodo?

M: Yeah,thephysiotherapistIwenttoshowedmethose.AtfirstIthoughttheywerehelping,butnowIthinkI’masbadasI’veeverbeen.Isthereanythingelsewecando?

TRACK10

N: Youhearadoctortalkingtoapatientinanemergencydepartment.M: Helloagain,I’mDrOliveira,Ithinkwemetearlieratthebeginningof

myshift.Howareyoudoingnow,MrsJames?F: Idon’treallyknowwhat’sgoingon,I’mjusthopingtofindoutwhat’s

wrongwithme.M: OkayMrsJames,Iunderstand,andthankyouforwaiting.They’verun

thetestsandtheythinkyou’vegotaconditioncalledpseudomembranouscolitis.It’salongwayofsayingyou’vegotaninflamedcolon.You’vebeenwaitingsolonghereinA&Ebecauseyou’regoingtoneedasideroom,becauseoftheinfectionrisk.

F: Ohdear,thankyoufortellingme.HowlongwillitbetillIgetaroom?Isitserious?

M: Well,atthemoment,MrsJames,we’reoperatingona‘onein,oneoutbasis’...butIdothinkthatasideroomwillfreeupinthenextfewhours.Theoutlookisverygoodinmostcases,we’regoingtogiveyouantibioticsandfluidsbutthereisasmallriskoftheinfectionreturninginthefuture.

N: Youhearamedicalstudenttalkingtoaseniorresidentaboutassessingapatient.

M: IunderstandthatMrFredrickhaschronicheartfailure,andthatweareconcernedwithvolumeoverloadifhedoesn’tadequatelyexcreteenoughfluid.Buthowdowedeterminehisvolumestatusandwhetherornotheneedsdiureticmedications?

F: Thatisagoodquestion!So,thereareseveralwayswecanassessvolumestatus.First,wecanperformaphysicalexaminationonthepatient.Whatwouldwebelookingfor?

M: Well,wecanassessforperipheraledema.Wewouldlookatthepatientshandsandfeettoassessswellinganddeterminewhetherornotthereispitting.

F: Yes!Verygood.Wecanalsoassessforjugularvenouspressure.Thisismosteasilydonebyhavingthepatientlayata45degreeinclineandthenobservinghisexternaljugularvein.Thefillinglevelofthejugularveinshouldbelessthan3centimetresabovethesternalangle.

TRACK11

N: Youhearapsychiatristpresentingacasestudy.

M: Goodmorningeveryone!IwouldliketospeakaboutacuriouscasethatIwasinvolvedinlastyear.Thepatientwasayoungmanwhoreportedcontinuedvisualdisturbances.

Whatmadethiscasesointerestingwerethechangeshedescribedtohisvisualfield.Objectsbegantogetlargerandsmallerashelookedatthem,hisfather’sfaceslowlymorphedintothatofastranger,andhewouldseetrailsoflightzigzaggingacrosshisfieldofview.Theseareuncommonforvisualhallucinations,theyareunlikelycharacteristicsofaprimarypsychoticdisorder,buttheyareakintoapsychoactivesubstance-inducedhallucination.However,hisurinedrugscreenwasnegativeforanysubstances,

andhereportedthathislastuseofanyhallucinogenwasthreemonthsago!WehavefoundseveralcasereportsofHallucinogenPersistingPerceptionDisorder(HPPD)andbelievethatthispatientmatchesthecriteriaforsuchadiagnosis.

TRACK12

N: Youhearadieticiantalkingwithapatient.F: Okay,MrWeiss,soitlookslikeyouhaven’tlostanyweightthismonth..

.Doyouhaveanyideawhythatmightbe?M: Ugh...really?IfeellikeI’vebeentryingreallyhardtoloseweight.In

fact,IthoughtIwouldtakeitastepfurtherinthepastcoupleofweeks,becauseIwasabitbadinthefirstweekorso.SorecentlyI’vebeentryingtocutoutallcarbs,andanyjunkfood.Tobecompletelyhonestthough...I’vewoundupcheatingonmydiet.

F: Youneedtostopbeingsostrictwithyourself.Wedesignedyourdietsothatitwouldbeachievable.Whenyoutryanddothingstooquickly,andmaketoomanychangestowhatyourbodyisusedto,it’sdifficulttomaintainlong-term,andyouendupovereatingasaresult.Also,Ican’timaginethatitmadeyoufeelgoodaboutyourprogress,whenyoukeptgoingofftrack?

M: No,itreallydidn’t.Iseewhatyou’resaying...IguessIneedtobekindertomyself,andbemorepatientwiththeslowandsteadyroute.

TRACK13

N: Youhearavetdiscussingtreatmentwithacat’sowner.F: Yeah...I’veseenthisbefore.Typically,whencatsbitetheirfuroff,or

overgroomthemselves,it’sasignofanxiety.CanyouthinkofanythingthatmightbecausingFelixtobecomestressed?

M: Urrr...gosh,thatmakesmefeelterrible!Well,Isupposewehavemovedhouserecently,andI’vetriedtogetFelixtoexploreourbackyard,buttheneighbourshaveadogthatbarks,andIguessthat’sbeenscaringhim.Also,I’vebeenworkinglatequiteoften,soIsupposehe’sgettingfedlaterthanusual,andseeingmeless.Butthere’sreallynothingIcandoatthemoment,IhaveadeadlinethatIhavetomeetthisweek,soI’llbeworkinglateuntilthen.

F: Right,okay...Inthatcase,I’dsuggesttryingtoimplementacoupleofchangesathome,startingnextweek.YoushouldsetaregulartimeforFelix’sdinner,andsticktoit.Ifyouhavetoworklate,canyouarrangeforFelixtobefedbysomeoneelse?Also,andyoushouldstartthisassoonasyougethome,youneedtomakesureyou’respendingenoughtimewithFelixeveryday.Ifheisn’tgoingout,thenyou’retheonlypersonhe’llseeeachday.I’llscheduleanotherappointmentinamonthtoreview,ifhe’sstillovergroominghisback,wecanputhimonacourseofmedication,tohelpwithanxiety.

TRACK14

N: YouhearanEDnursetalkingtotherelativeofapatientwhohasbeenrecentlyadmitted.

M: Didyouwanttotalktome,MissTanaka?F: Oh...yes,yousee,Ijustwantedtoletyouknowthatmyfather...well,

asyouknow,he’srecentlybeendiagnosedwithdementia...mostofthetimeit’snotanissue,andhisspatsneverlastlong.It’sjustthatIwantedtoprepareyou,sometimeshe’sreallynothimself.

M: Ah,okay,MissTanaka,IthinkIunderstand.Canyourfatherbecomeaggressive?

F: Yes...Imean,Ithinkit’sjustthathegetsfrustratedsometimes.Hecan’trememberthings,andIthinkit’sscaryforhim.Hewasnever,everlikethisbeforehisdementia,andthoseperiods,well,theyreallydon’treflecthistruecharacter.

M: Ofcourse,thanksforlettingmeknow.N: Youhearanobstetriciandescribeacaesareansectiontoapregnant

patient.M: Labourcanprogressdifferentlyfordifferentpeople.Insome

circumstances,iflabourislongerthanexpectedandifwedetectthatthebabyisdistressedthenwemayhavetoconsideranemergecycaesareansection.It’saprocedurethatweperformintheatreanditiscarriedoutunderspinalorepiduralanaesthetic,sothatyoudon’tfeelanything,butyouwillbeawake.Ascreenisplacedacrossyourbodysoyoudon’thavetoseewhat’sbeingdone.Wemakeanincisioninyourtummyandwomb,justunderyourbikiniline,toremoveyourbabyandthenstitchupthewound.Ittakesaround40minutesandyourbirthpartnercanbethereatalltimes.Doesthatmakesense?

N: YouhearaGPandhispracticenursediscussingtheiryearlyschedule.M: InSeptemberwe’llhavealotofnewpatients,asthefirstyearuniversity

studentswillallregisterduringfreshers.F: Yes,wewerereallyrunoffourfeetlastyear,weren’twe?M: Yep.Itwasamadhouse.F: Doyouthinkweshouldhireagencystafftohelpoutforthefirstcoupleof

weeksthistimearound?M: Well,Ithinkpartoftheproblemwasthatlastyear,DrIgweandNurse

Fletcherwerebothaway–DrIgwewenttoCostaRica,andNurseFletcherhadtheflu.

F: Right!Iremember.Well,wecan’tdomuchtopreventstaffillness.M: No,butwecanaskpeopletoavoidbookingtimeoffinthosefirstthree

weeks.F: Okay,I’llsendanemailouttoday.N: Youhearanurseprepareapatientforaflushot.F: GoodmorningMr.Henderson,Dr.Rayhasrecommendedthatyougeta

fluimmunisationshotbeforeyouaredischarged.I’vegottheinjectionreadytogivetoyou.Areyouallergictoanything?

M: I’monlyallergictolatexandpenicillin.Idon’tknowifIwanttheflushot.ThelasttimeIgottheshot,Igotsick.

F: I’msorrythathappenedtoyou.Whatkindofsymptomsdidyouhaveafterthatlastflushot?

M: Igotarunnynoseandaheadache.Myarmfeltlikesomeonepunchedme.F: Sometimestheflushotcancausereactionslikeasoreinjectionsiteand

headache.Othercommonsymptomsincludebeingtired,muscleandjointaches,shiveringandfever.Allofthesesymptomscanbeseenwiththeflu,buttheshotcan’tgiveyoutheflu.

N: Youhearadoctortalktoapatientaboutherinjury.M: Goodmorning,Mrs.Bowder.I’llbeyourdoctortakingcareofyourcut

there.Whatexactlyhappened?F: It’sembarrassingreally,yousee,Iwasjusttryingtochopsometomatoes

fordinnerandtheknifeaccidentallyslipped.Oh,I’msoclumsy,Ihopeitdoesn’thurttoomuchtostitchbackup!

M: Well,we’regoingtonumbtheareanowwithashotofLidocaine.You’llfeelapokeoftheneedleandaslightburn,butafterwardstheareashouldbenumbandyou’llfeelnothingduringtheprocedure.Weshouldbefinishedinabout10minutes.

F: Ohgood!HowmanystitcheswillIneed?Howlongwilltheyhavetostayin?I’mreallyconsciousaboutmyhandssoIhopeIdon’thaveascar.

M: IwillonlyknowforsureonceIfinishsuturing,butbymyestimation,youmightrequireatleastfourtofivesutures.They’llhavetostayinfor5to10daysandyouwillneedtocomebackintogetthemremoved.I’lldomybesttotryandlinetheedgesuptocreateaslittlescarringaspossible,butIcan’tguaranteetherewillbenothingthere!

N: Youhearatraineenurseaskingaseniorcolleagueaboutthetreatmentforapatientwithchronicobstructivepulmonarydisease,orCOPD.

M: Ihaven’ttreatedanyonewithCOPDbefore;whatwouldweneedtododifferently?

F: Oneofthemostimportantthingswouldbetomakesuretoprescribeoxygenatlevelsbetween88–92%.

M: Okay...sowhywouldthatbenecessary?Ifhe’shavingtroublebreathing,shouldn’tweprescribehigheroxygenlevels?Mostpatientsreceiveoxygenatlevelsbetween94–98%.

F: Well,inhealthyindividuals,ariseincarbondioxidewouldresultinanincreaseddrivetobreatheinordertoeliminatetheexcessgas.

M: Right.F: However,insomepatientswithCOPD,thisresponseisbluntedandtheir

mainmechanismforrespiratorydriveiscontrolledbythelevelofoxygeninthebodyinstead.IfthelevelofoxygengiventoaCOPDpatientis

increasedtoomuch,itcanactuallyreducethestimulustobreatheandcausehypoventilation,resultinginanincreaseinCO2.

CHAPTER5

ListeningPartC

LEARNINGOBJECTIVES

Followthelogicalflowofapresentationoraninterview.Listenforwordsindicatingexamplesandtheories.PractiseListeningPartCstrategies

INTRODUCTION

InListeningPartC,youneedtolistentotworecordings,whichcanbeeitherpresentationsorinterviewsinvolvingahealthcareprofessional,andanswer6multiple-choicequestionsforeachone.Eachrecordinglastsaround4–5minutes.

Therecordingsinthissectioncouldbeintheformofaworkplacepresentationorpodcast-styleinterview.Therewillbearangeoftopicsofbroadhealthcareinterest.

Strategies

KnowtheInstructions

Youshouldmakesureyouarefamiliarwithwhatyouhavetodobeforeyoutakethetest.Theinstructionslooklikethis:

Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,you’llhearhealthprofessionalstalkingaboutaspectsoftheirwork.

Forquestions31to42,choosetheanswer(A,BorC)whichfitsbestaccordingtowhatyouhear.

YouhearaSeniorNursecalledPierreDelacroixgivingapresentationaboutadrenalfatigue.

ThefirstpartoftheseinstructionsisthesameforthebeginningofeachPartCtest;youhearageneralintroductiontoPartC,thenthecontextsentenceandspecificinstructionsforeachtask.Intheexampleabove,forexample,youwouldexpecttohearaworkplacepresentation.

InListeningPartC,youheareitherapresentationoraninterviewineachrecording.ApresentationinPartChasonlyonespeaker,whowilltalkaboutanumberofdifferentpoints.AninterviewinPartCincludes2speakers;oneisahealthcareexpert,andtheotheristheinterviewer.Theinterviewerasksshort

questions,andthehealthcareexpertgiveslonganswerstothesequestions.Theinterviewer’squestionsalwaysrelatetothequestionyouneedtoanswerinthesectionyou’relisteningtoatthatpoint.

ScantheQuestions

Beforetherecordingbegins,youhave30secondstoreadthroughthequestions.Whenlookingatthequestions,payattentiontothewordsinthequestionandtheanswerchoices.Thewordsinthequestionwillhelpyoutoidentifytherelevantpartoftherecording,andthecorrectanswercanbeheardintherecordingshortlyafterthis.Toselectthecorrectanswer,youwillneedtochoosetheoptionthatbestreflectsthemeaningofwhatyouhearintherecording.ThequestionsinPartCtendtoaskforthegeneralmeaning,orgist,ofthesectionofspeech.Thesequestionsalsoaimtotestyourunderstandingoftheargumentsthespeakertalksabout,andtheattitudeoropinionofthespeaker.

ListenActively,andAnswertheQuestions

InPartCoftheListeningTest,youhavetokeeptrackofwhichquestiontherecordingisreferringto.Youneedtoanswer6questionswhiletherecordingcontinues,soit'simportantthatyouknowwhentomoveontothenextquestion.Therecordingincludescuesthatyoucanusetoidentifywhentomoveontothenextquestion–forexample,theinterviewer’squestionsinarecordingmatchthequestionsinthetask,andapresentationwillfollowasimilarstructure,usingwordsinthepresentationtohighlightwhichpartsoftherecordingrelatetowhichquestions.Besuretoreadthequestionscarefullybeforetherecordingbeginssoyouhaveaclearideaofwhattheaudioforeachquestioncovers–usethisknowledgetokeepyouontrackthroughoutthispartofthetest.

Lookatthequestionandanswerchoicesintheexercisebelow,andlookforwordsinthetexttolistenoutforbeforeyouplaytherecording.

Exercise

YouhearaGeneralPractitionercalledDrJeffordsgivingapresentationaboutpatientreferrals.

Take5secondstolookatthequestion,thenlistentoTrack15andanswerquestion1.

ListeningtoInterviews

Whenlisteningtoaninterview,usetheinterviewer’squestionsascuestomoveontothenextquestion.Payattentiontothekeywordsinthequestions,astheseareoftenreflectedinthequestionyouneedtoanswer.Practiseansweringthequestionsforeachsectionandmovingontothefollowingquestionintimebycompletingtheexercisebelow.

1. WhydoesDrJeffordsthinkit’simportanttoaskpatientswhythey’retakingcertainmedication?

tounderstandtheirmedicalhistory(A)tomeasurethepatient’sawareness(B)toquestionitseffectiveness(C)

Exercise

YouhearaninterviewwithavetcalledAmandaChenaboutfelineimmunodeficiencyvirus(FIV).

Take15secondstoscanthequestions,thenlistentoTrack16andanswerquestions2–4.

2. DrChenexplainsthatmanypeoplebelieveFIV

canbecontagioustohumans.(A)mightaffecttheirpet’sbehaviour.(B)hasminimalimpactonacat’slife.(C)

3. WhatdoesDrChensaypeoplefindconfusingaboutthevirus?

thelackofavailableinformation(A)themanydifferenttreatmentoptions(B)itsnameissimilartoamoreseriousillness(C)

4. DrChenadvisesthosewhoownFIVpositivecatsto

avoidunnecessarycontact.(A)

ListeningtoResultsofTrials

SpeakersinListeningPartCoftenmentionresearchtrialsthattheyhaveundertaken,orthattheyareawareof,orsurveysthathavebeencompleted,whicharerelevanttotheirresearchtopic.Youshouldbepreparedtoanswerquestionsabouttrialsandpatientsurveysduringthispartofthetest.

monitorthepet’shealthcarefully.(B)ensurethepetreceivesenoughexercise.(C)

Exercise

YouhearahospitaldoctorcalledDrAbuMohammedgivingapresentationontheresultsofarecentpatientsurvey.

CaseStudies

5. DrMohammedwassurprisedbytheyear-longsurveyonthesatisfactionofpatientsstayinginhospitalbecauseofthe

happinessofthepatients.(A)severityofmostpatients’conditions.(B)numberofpatientsthatgotinvolved.(C)

6. WhydoesDrMohammedsuggestpatientsintheir20sweremoresatisfiedthantherestofthepatientssurveyedinthestudy?

Theyweremoreoptimistic.(A)Theyspentlesstimeinhospital.(B)Theyshowedagreaterrateofrecovery.(C)

InPartC,healthprofessionalsoftendiscusscasestudies.Questionsinthissectionfocusontheindividualpatient’sexperiences,whatwasunusualabouttheirtreatment,andhoweffectivethetreatmentwas.Practiseansweringquestionsaboutspecificpatientsbycompletingtheexercisebelow.

Exercise

YouhearanursecalledJonathanMcKenziegivingapresentationontreatingpatientswhoaredealingwithstress.

InPartCoftheListeningTest,youmustshowthatyouareabletofollowahealthcareprofessionaltalkingindetailonahealthcaretopic.Practiselistening

7. NurseMcKenziesaysthattheCEOhadtroublemanagingstressbecause

itwasprolonged.(A)itwascausinghimtolosehoursofsleep.(B)hewasunfamiliarwithsuchsituations.(C)

8. Thepatientwasencouragedtoreadbecause

itwasahobbyofhis.(A)itcreatedarelaxingatmosphere.(B)heneededtolearnaboutthecauseofhisissues.(C)

topodcastsandpresentationsonlinecoveringhealthcaretopics,andmakenotesonthetopicasyoulisten.

IMPROVEYOURSCORE

Remembertoreadthequestionsfirstandunderlineanyimportantwords,sothatyoucanlistenactivelyfortheanswerswhenthespeakersbegintalking.

IMPROVEYOURSCORE

Don’tworryifthespeakersaretalkingaboutatopicyou’renotfamiliarwith.ThethelisteningsectionofOETisdesignedtobeunderstoodbyhealthcareprofessionalsfromavarietyofbackgrounds,soevenifthetopicisunfamiliartoyou,alltheinformationneededtoanswerthequestionsisgivenintherecording.

ListeningPartC:PracticeSet

YouhearaninterviewwithDrTaditaHussein,who’stalkingabouttreatingpatientswithcysticfibrosis.

Take30secondstoscanthequestions,thenplayTrack19andanswerquestions1–6.

1. DrHusseinsaysthatpatientswithcysticfibrosis

mayfindthesideeffectsalarming.(A)tendtorequiretreatmentfromayoungage.(B)canimprovetheirconditionwithfrequenthospitalvisits.(C)

2. WhatdoesDrHussainsayisdifficultwhentreatingpatientswhoarenotinhospital?

Theyoftenfindtheexercisestoocomplicated.(A)Theytendtohavedifficultysocialisingwithotherpeople.(B)Theydon’talwaysunderstandtheimportanceoftheir

treatment.(C)

3. WhatdoesDrHusseinsayabouttheroleof‘distractiontherapy’incysticfibrosistreatment?

Itcanberelatedtothetreatmentbeingprovided.(A)Itallowspatientstocompletetheiractivitiesmorequickly.(B)Itprovidesstaffwithmoreinformationaboutthepatient’s

condition.(C)

4. WhatchangesdidDrHusseinobserveinoneofherpatients?

Heshowedrespiratoryimprovement.(A)Hedeterioratedrapidlyfollowingachangeintreatment.(B)Hebegantoenjoyaspectsoftheirtreatment.(C)

5. DrHusseinplanstousetechnologytohelpcysticfibrosispatientstocommunicate

withotherpatientswhosufferfromthecondition.(A)withfamilymemberswhocannotvisittheminhospital.(B)

YouhearanpresentationgivenbyDrHubertJohnson,who’stalkingaboutwaystoimproveefficiency.

Take30secondstoscanthequestions,thenplayTrack20andanswerquestions7–12.

withpatientsofasimilaragesufferingfromdifferentconditions.

6. DrHusseinsuggeststhatfuturetreatmentsforcysticfibrosis

willalwaysincorporatelengthyprocedures.(A)couldpreventbreathingdifficultiesinsufferers.(B)mightbelesspainfulthanthecurrentoptionsavailable.(C)

7. DrJohnsonexplainsthatdelaysareincreasedwhenpatientsbelieve

theirappointmentwillnotbeginontime.(A)staffarenotconcernedaboutlate-arrivals.(B)beinglateforappointmentswillnotimpactothers.(C)

8. DrJohnsonusesanexampleofpoorefficiencytoillustratethepointthat

healthcareprofessionalsshouldassiststaffduringbusytimes.(A)practicesshouldavoidlimitingappointmentbookingoptions.(B)staffshouldbetrainedtohandledemandingsituations.(C)

9. DrJohnsonexplainsthat,inordertoimproveefficiency,healthcarepracticesmust

sanctionpatientsarrivinglaterthan10minutes.(A)avoidbookingappointmentsinthemorning.(B)showpatientsthattheycanrunontime.(C)

10. DrJohnsonsayshealthcareprofessionalsoftenforgetthatpatientswhobookappointmentsmustfirst

feelthattheyneedaconsultation.(A)findatimeanddatethatworksforthem.(B)considerwhatmightbecausingtheirissue.(C)

11. WhathappenedwhenDrJohnsonbegangivingweeklypresentationstopatients?

DrJohnsonwasabletoworkfewerhours.(A)Thegeneralhealthofpatientswasincreased.(B)Thenumberofappointmentsatthepracticedecreased.(C)

12. HowdoesDrJohnsonfeelabouttheuseoftechnologywhenbooking

appointments?

Practicesshouldbegintoencourageallpatientstomakebookingsonline.

Itcanincreaseefficiencyifotherbookingmethodsarecontinued.

Elderlypeoplearemostlikelytostruggletouseit.(C)

Answers

1. Btomeasurethepatient’sawareness

2. Acanbecontagioustohumans.

3. Citsnameissimilartoamoreseriousvirus

4. Bmonitortheirhealthcarefully.

5. Camountofpatientsthatgotinvolved.

6. BTheyspentlesstimeinhospital.

7. Athestressfulsituationwasprolonged.

8. Aitwasahobbyofhis.

PRACTICESETS

Questions1to6

Questions7to12

1. Btendtorequiretreatmentfromayoungage.

2. CTheydon’talwaysunderstandtheimportanceoftheirtreatment.

3. AItcanberelatedtothetreatmentbeingprovided.

4. CHebegantoenjoyaspectsoftheirtreatment.

5. CHebegantoenjoyaspectsoftheirtreatment.

6. Bcouldpreventbreathingdifficultiesinsufferers.

7. Atheirappointmentwillnotbeginontime

practicesshouldavoidlimitingappointmentbookingoptions.

9. Cshowpatientsthattheycanrunontime.

10. Afeelthattheyneedaconsultation.

11. CThenumberofappointmentsatthepracticedecreased.

12. BItcanincreaseefficiencyifotherbookingmethodsarecontinued.

Track15

M: Whendealingwithnewpatientsorpatientreferrals,youneedtoasknotonlywhatmedicationthey’recurrentlytaking,butwhythey’retakingit.Manydoctorsassumethatpatientsunderstandthereasonsfortheircourseoftreatment,butsomepatientsmayhavebeenprescribedthesedrugsalongtimeago,anddespitetheirpriordoctornodoubtoutliningthereasonswhysuchdrugsareneeded,patientscanforget,ormis-remembertheactualreasonwhytheseprescriptionsarenecessarytothem.Makesureyougothroughthisattheearliestconvenience-soagoodwaytostartthesediscussionsistoask‘Canyoutellmewhatyou’recurrentlytaking,andwhatit’sfor?’

TRACK16

M: TodayI’mtalkingtoDrChen,aveterinaryexpertinfelineimmunodeficiencyvirus,orFIV.Dr.Chen,whatcanyoutellusaboutthedisease?

F: Well,FIVisatopicthatItendtodiscussquitefrequentlywithmypatients.AlthoughlotsofpeoplehaveheardofFIV,andknowgenerallythatitisavirusthataffectscats,therearemanymisconceptionsaboutthecondition,whatitmeansforthecat,andwhatownerswithFIVpositivecatsmustdo.ManypeopleworryaboutcatchingFIVfrominfectedcats,whichisactuallynotpossible,asthediseasecannotbetransmittedtohumans.Unfortunately,thisbeliefoftenpreventspeoplefromadoptingcatswhosufferfromFIV,asthey’reconcernedaboutthemselvesortheirchildrencontractingthevirusfromthecat.

M: Isee...andarethereanyotherthingsthatmightconfusepeopleaboutFIV?

F: Therecertainlyare!Thereisanothervirusthatcanaffectcatsthatpeoplemaybeawareof,calledFelineLeukemia,orFeLV.FeLVsignificantlyreducesacat’slifeexpectancyandhealth.Duetothesimilarityofthetwovirus’snames,I’vefoundthatpeopletendtomixthetwovirusesup,sowhenthey’retoldthatacathasFIV,theybelievethatthecatisextremelyill,andwillrequirelengthyandexpensivetreatment,wheninfact,thecatshouldbeabletoleadafairlynormallife.

M: I’msuremanyownerswillberelievedtohearthat!So,whatadvicewouldyougivetoownersofFIVpositivecats?

F: Well,theviruscandepletecertainwhitebloodcells,whichmeansthatcatswithFIVareoftenmoresusceptibletocatchingotherinfections,andwilloftenfinditmoredifficulttorecoverfromtheseinfections.FIVis

oftencomparedtoAIDSinhumans,andthetwoimmunosuppressantvirusesareverysimilar.ThosewithFIVpositivecatsshouldbyandlargetreattheircatsthesameasanyothercats.However,thesecatsshouldbekeptindoors,tolowertheriskofinfection,andtopreventthemfromspreadingthevirus.Ownersshouldalsopaymoreattentiontothewell-beingoftheircat,andiftheirpetshowsanysignofillness,theyshouldbetakentothevetattheearliestopportunity.

TRACK17

M: Ashealthcareworkers,wealwaysputourpatientsfirst.We’verecentlyconcludedayear-longsurvey,lookingintothelevelofsatisfactionofadultin-patientsatthishospital,andIwantedtosharesomeofthoseresultswithyoualltoday.I’vebeendoingthesesurveysforawhilenow,andletmetellyou,firstoff,thatIwasabsolutelyflabbergastedbythepatientengagementlevelhere.Seriously,outofallofthepatientsaskedtocompletethissurvey,aremarkable86%responded.ThatmaybethehighestproportionI’veeverseen!Moreresponsesnotonlyprovideuswithmoredata,butitalsosuggeststhatyou’vecreatedagreatenvironmentinwhichyourpatientsfeelcomfortableexpressingtheirviews.

Let’stakealookatwhatsomeoftheserespondentsfeltaboutthecaretheyreceived.We’llstartwithin-patientsintheir20s.Thisgrouphadthehighestsatisfactionrateofallrespondents.Now,that’sgreat,butthereareacoupleofinfluencingfactorsweshouldbearin

mind,thatmightexplainwhythisgroupwasmoresatisfiedwiththeirtreatment.Thegroupofpatientsintheir20swasalsothegroupwiththeshortestaveragein-patientstay.Themajorityofthesepatientsweredischargedafterlessthanaweekinhospital.Assuch,thisgroupislesslikelytohaveexperiencedthefrustrationandworrythatcanbecomemoreofanissuewithpatientswhohaveextendedstaysatthehospital.

TRACK18

M: Hieveryone.I’dliketotalktoyouallaboutcaringforpatientsexperiencingstress.Unfortunately,it’saphenomenonmanyofushealthcareprofessionalshavefirst-handexperiencewith,butI’mgoingtotalkaboutoneofmypatients,anewlyappointedCEOofawell-knownmultinationalcompany.Now,thepatienthadbeenworkinginhigh-poweredrolesforalongtime,soitwasn’tthathewasunfamiliarwithstress.Theproblemwasthatinhiscurrentrole,hewasconstantlyputtingoutfires.Thebusinesswasverywell-known,anddominatedthemarketthatitwasin,butbehindthescenestherewerefinancialissues.Therewasalwaysanissuethatneededhisurgentattention.Stressisanunpleasantexperienceinandofitself,butitcanalsocauseproblematicsideeffects.Thepatientalsoexperiencedweightgain,andtroublesleepingasaresult.

Thepatientwaitedforawhilebeforeseekinghelp,andbythetimehedid,hewasabsolutelywornout.Weworkedwiththepatienttodevelopanumberofcoping

strategies,asitwasn’tpossibleforhimtoremovethemaincauseofstress–hisjob–fromhislife.Instead,ourtreatmentbeganwithreading.Thepatienttoldusthathehadlovedreadingfiction,buthadn’treadforpleasureindecades,andsooneofthefirstchangeshemadewastoreadforanhourbeforebed.Weneededtomakesurethepatientmadetimeforactivitiesthatheenjoyed.Thatonesmallchange,inturn,helpedhimtosleepbetter,whichgavehimmoreenergytodealwithstressfulsituationsduringtheday.

TRACK19

M: Cysticfibrosisisaconditionthatcausesmucustobethickerandstickierthanitshouldbe.DrTaditaHusseinspecialisesincysticfibrosistreatment,andisheretoshareherthoughtsoncaringforpeoplewiththecondition.Tadita,canyoutellusabitmoreaboutpatientswhosufferfromcysticfibrosis?

F: Absolutely.Suffererstendtocarrytwotofivetimesasmuchsaltintheirbodiesasthosewithoutthecondition,soyoucanseewhytheirmucusisthickerthanaverage.Treatmentforthesepatientsisusuallyquitetimeconsumingandrepetitive,patientsareoftenrequiredtostayinhospitalforlongstretches,and,asthesymptomsoftheconditionbegintopresentveryearlyoninthepatient’slife,manyofmypatientsareyoungpeople,andsowetendtoseelotsofpatientswithcysticfibrosisfindingthesehospitalvisitsfrustrating.Infact,throughouttheUK,about80%ofpatientswithcysticfibrosiswhoarehospitalised,reportfeelingatleastminimallevelsofdepression.

M: Howaboutyoungpatientswhoaren’tcurrentlyhospitalised?Whatcanbechallengingabouttheirtreatment?

F: Well,patientscanberequiredtotakearound30pillsadaytokeepcysticfibrosisundercontrol,soit’sunderstandablethatteenagersandyoungpeople,whojustwanttobefreeandindependent,mightresentthisordeal,iftheythinktheycangetawaywithit.Oneofthemostdifficultthingswehavetocontendwithisthefactthat,ifpatientsstoptakingtheirmedication,ordoingtheirdailybreathingtreatments,theirconditionwon’timmediatelyworsen.Instead,itwillgraduallybecomemoresevere,untiltheycontractaseriousinfectionwhichputstheirlivesatrisk.

M: So,whatapproachesdoyouusewhentreatingpatientswithcystic

fibrosis?F: Well,we’vefound‘distractiontherapy’tobeextremelyuseful.We’re

incrediblyluckytohavereceivedadonationofanumberofvirtualrealityheadsets,followingtheirsuccessinanumberoftreatmenttrials.Weusethevirtualrealityheadsetstotransportthepatienttooutdoorsettings,oftencorrespondingtotheactivitiesthey’rerequiredtodowithus.Whentheycompletebreathingexercisesonastationarybike,forexample,theVRheadsetsdisplayavirtualoutdoorbikeride.Ourpatientsfindithelpfultopretendtobesomewhereelseduringtreatment,andit’softeneasierforustoadministerbreathingtreatmentstopatientsusingtheseheadsets,asthey’remorerelaxedwhenthey’renotfocusedontheactualityofthetest.

M: Sowhatsortsofchangeshaveyouseeninyourpatientsasaresultofthesemethods?

F: Oneofmypatients,a24yearoldmanwithcysticfibrosiswhowasinhospitalwaitingforalungtransplant...well,hefoundtreatmentverydifficultatfirst.Hewaspreoccupiedbyhisneedforatransplant,andfrustratedbyfeelingsofpowerlessness.Hewouldoftenresisttreatment.Westartedusingthevirtualrealitysystemswithhimassoonaswegotthem,and,ittookawhileforhimtogetonboard,butwhenhedid,itwaslikesomeonehadbreathednewlifeintohim.Notonlydidhestophinderinghistreatment,heactuallybegantolookforwardtoit.He’sevenstartedhelpingustothinkaboutotherwayswecanimprovetheexperiencesofourpatients,likeimprovingsocialinteraction.

M: Yes.Iunderstandthattherearedifficultiesinvolvedinpatientcommunication.

F: Mmmm...We’relookingintothepossibilityofinstantmessagingfunctionsbetweenpatients,andevenvirtualgamesthattheycanplayagainsteachother.Unfortunately,patientswithcysticfibrosishavetobe

keptapart,toavoidcross-infection.It’sjustonemorecrosstobearforourpatients,thattheycan’ttalktothosegoingthroughthesamething.Ourpatientsgetplentyofinteractionwithmyselfandtherestofthestaff,butwe’dliketomakesuretheyhaveaccesstoanetworkoffellowsufferers,too,forsupportandadvice.

M: Isee.Thatallsoundsquitefuturistic!Arethereanyotheradvancesonthehorizon,forthetreatmentofcysticfibrosis?

F: Well,there’sanewdrugthat’sbeeninthenewsrecently,it’sacombinationoflumacaftorandivacaftor,youmightknowitbythebrandnameOrkambi.Thedrugworksbyimprovingthelevelofwaterandsaltinthebody,therebyreducingthethickmucusthatcausesillnessandrespiratoryissuesinthosewithcysticfibrosis.Evenmoreexcitingandfuturistic,though,isthepossibilityofgenetherapy–wherethegeneticmutationthatcausescysticfibrosisinindividualsisreplacedwithahealthygene.Thiswouldeffectivelycurethosewiththecondition,andsignificantlyextendthelivesofthousandsofpeople,andremovetheneedforlengthystaysinhospital.

TRACK20

Hieveryone!Myname’sDrHubertJohnson,andI’vebeenaskedtospeaktoyouaboutmyexperiencesinthehealthcareindustryconcerningsomethingthateffectsallhealthprofessionals-improvingefficiency.Itseemstobeagiventhesedaysthatpracticeswillstrugglewithalackofefficiency.We’veactuallyfoundthatthisexpectation,inandofitself,canreduceefficiencyandincreasedelaysevenfurther!Inarecentsurvey,whenpatientswereaskedwhytheyarrivedlatetotheirappointments,30%saidthattheyhadassumedthatthepreviousappointmentwouldrunlong.Patientsexpecttobekeptwaiting,and,tosomeextent,weexpectthatpatientswillbekeptwaiting,andsothefirstthingweneedtoaddressisourattitudes,andtheattitudesofourpatients.So,letmestartbytellingyouabouttheefficiencyIobservedinapracticeIvisitedacoupleofweeksago.Atthispractise,patientscouldnotmakeappointmentsonline,buttheycouldeitherphoneup,ormakeanappointmentinperson.Therewerenevermorethan2receptionistsworkinginthemorning,andthepracticegenerallyscheduled80appointmentseachday.Patientswhowerenotattendingafollow-upappointmentwererequiredtomaketheirappointmentonthedayof.Canyouimaginewhatthatpracticewaslikeinthefirstcoupleofhourstheywereopen?Thereceptionistswereinundatedbycallsandwalk-instryingtoscheduleappointments.Asyoucanimagine,patientswhohadseenwhatthepracticewaslikeinthemorningexpectedthatiftheydidn’thavethefirstslotoftheday,they’dbedelayedbyatleast10minutes.So,naturally,theyarrivedtotheirappointment10minuteslate.Oneofthemostimportantthingsyoureallymustaddressinyourpractice,inordertoimproveefficiency,isthewayyoupresentyourpracticetopatients.Iftheybelievethatyouarealwaysrunninglate,guesswhat?

They’llberunninglatetoo.Now,let’sthinkforamomentaboutwhatneedstobedoneonthepatient’sendbeforeanappointmentcantakeplace.Youmightbethinkingthatthereareonlytwostepstotheprocess:one,thepatientbooksanappointment,andtwo,thepatientarrivesatthepracticeintimefortheirappointment.Well,wehealthcareprofessionalsoftenforgetthatthere’sactuallyastepthatcomesbeforethis:firstly,thepatientmustdecidethattheirissueissignificantenoughtowarrantanappointment.So,aboutadecadeago,mypracticewasreallystrugglingfromalackofefficiency.Iwasworkingextremelylonghourstotrytoaccommodateeveryone,andIwasbecomingincreasinglyfrustratedwithconductingappointmentsthatdidn’tseemstrictlynecessary.IgottothinkingabouthowImightbeabletohelppatientstoreconsidertheirinitialassumptionwhenbookingappointments,andtotreatminorissuesathome.Atthesametime,Ididnotwantmypatientstofeelunsupported.IdecidedthatIwouldbegintogiveweeklypresentationsintheeveningsaboutself-care.AsItendedtoseeamultitudeofpatientscominginforsimilarissuesthattheycouldactuallytreatthemselves,eachweekIfocusedonadifferentcommontheme.Thepresentationslastedforjust1hour,butIfoundthattheyresultedin7fewerunnecessaryappointmentseachweek.Thesedays,ofcourse,Inolongerhavetogiveaphysicalpresentation.Thankstomoderntechnology,Isimplyuploadinstructionalvideostoourpractice’swebsite.Wealsoemailthesevideosouttopatientsperiodically.Wecanandshouldmakeuseoftechnologyasatoolinourpractices,tohelpustoimproveefficiency.However,it’simportanttonotethatwhilemany,perhapseventhemajority,ofyourpatientswillbecapableofusingtechnologytoarrangetheirappointments,therearemanypeopleuncomfortable,orunabletousetechnology,soyoumustalwaysmakesurethatthesepatientsareaccommodated,too.Providingyourpatientswithmoreoptions,ratherthanreplacingoldoptions,isoftenthebestpracticeforimprovingefficiency.

Now,let’smoveontolookatapracticethatusedtechnologyinasurprisingway...

THEREADINGSECTION

ReadingIntroduction

SectionOverview

TheOETReadingTestconsistsofthreeseparatepartswithatotalof42questions,andtakes1hourtocomplete.

ThethreedifferentpartsoftheReadingTestaredescribedbelow.

PartAoftheReadingTestcontains4textsonthesametopicthatahealthcareprofessionalmightuseinthecourseoftheirwork.Youwillhave15minutestoanswer20questionswhichcoveravarietyofquestiontypesabouttheinformationinthefourtexts.

PartBoftheReadingTestcontains6extractsfromworkplacecommunicationsinahealthcaresetting.Youshouldaimtospendroughly10minutesonthissection.

PartCoftheReadingTestcontains2longpassagesprovidinginformationondifferenthealthcaretopicswith8questionseach.Youshouldaimtospendroughly35minutesonthissection.

READINGSTRATEGIES

UnliketheOETListeningTest–whereyoumustkeeppacewiththerecordingtoavoidfallingbehind–youmustpaceyourselfintheReadingTest.Youshouldtimeyourselfwhileyouattemptthequestionswithinthischapter.MakesureyouarefamiliarwiththeReadingTestinstructionsinadvance,sothatonTestDay,youcanfocusonansweringthequestions.FamiliariseyourselfwiththedifferentpartsoftheReadingtest,andbepreparedforeachquestiontype.UsethischaptertobuildyourknowledgeofthedifferenttasksintheReadingtest,thenassessyourskillswiththepracticesetofquestionsattheendofeachpart.Revisitandreviseanyquestionsyoustruggledwith,identifywhatcausedyoutostrugglewiththequestion,andpractiseansweringsimilarquestions.Lookoutfortheimportantwordsinthequestionthatcanhelpyoutolocatetheinformationinthetext.

CHAPTER6

ReadingPartA

LEARNINGOBJECTIVES

Scanthe4textstolocatetheinformationneeded.Readsectionsofthe4textstofinddetailedmeaning.PractisestrategiesforansweringMatching,SentenceCompletion,andShortAnswerquestions.

INTRODUCTION

InPartAoftheOETReadingTest,youhavetoanswer20questionson4separatetexts.Youhave15minutestodothisonTestDay.ThetextsinthissectionwillbelabelledTextAtoTextD,andpresentinformationindifferentways,butallrelatetoonehealthconditionortypeoftreatment.

Strategies

KnowtheInstructions

Youshouldmakesureyouarefamiliarwithwhatyouhavetodobeforeyoutakethetest.TheinstructionsforReadingPartAlooklikethis:

TIME:15minutes

KnowtheFormat

InPartAoftheReadingTest,youneedtolookatthe4textsprovidedacrosstwopagesofyourtestbooklet.The4textsinthissectionareexamplesofavarietyoftexttypesyoumightfindintheworkplace-includingatleastonethatpresentsvisualortabularinformation,suchas:aflowchart,table,ordiagram.OthertextsinPartAwillincludeinformationinparagraphsandbullet-pointedlists.Someofthetextsinthissectionwillcontainnumbers,butyouarenotrequiredtomakeanycalculations.

Lookatthefourtexts,A–D,intheTextBooklet.Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.WriteyouranswersonthespacesprovidedinthisQuestionPaper.Answerallthequestionswithinthe15-minutetimelimit.

The4textsinReadingPartAtestyourabilitytoconsultandunderstandpracticalreferencedocumentsforspecificconditionsandtreatments,forexample,oneofthetextsmightoutlinethecorrectproceduretofollowwhenapatienthasabrokenarm.Don’tworryifatfirstthetopicofthetextsareunfamiliartoyou,youwillnotneedtohavepriorknowledgeofthespecificconditionortreatmentdiscussedinthetextsforReadingPartA.Simplyfocusonfindingthewordorphraseintherelevanttextthatallowsyoutoanswereachindividualquestion.

WhenyoubeginPartA,youshouldstartbylookingbrieflyateachofthefourtextsinthetestbooklettounderstandthetypeofinformationbeingprovidedineachtext.Youshouldspendonlyashorttimeatthe4textsbeforeansweringthequestions,asthefirsttaskwillhelpyoutounderstandtheinformationprovidedinthe4texts.

Exercise

Brieflylookatthefourtextsonthefollowing2pages,thenanswerquestions1–5asquicklyasyoucan.

Hypertension:Texts

Themedicationsusedtotreathighbloodpressurefallunderoneofthefollowingcategoriesdescribingtheirmechanismofaction:

Whichmedicationapatientreceivesdependsontheirageandethnicity.BlackpatientsofAfricanorCaribbeandescentareknowntohavehigherriskofhypertension.Wheneverapatient’streatmentregimefailstowork,itisstepped-upbyaddinganadditionalmedicationofadifferentcategory.

ACE-inhibitorAngiotensin-IIantagonistCalcium-channelblockerThiazide-typediuretic

ControllingHighBloodPressure

Advisepatientstostopsmoking;offeradviceforhelpandcounselling.Patientscanusenicotineaidsandjoinlocal‘stopsmoking’schemes.Ifunabletoquitsmoking,encouragethemtoreducedailycigaretteconsumption.Patientsmustnotdrinkalcoholtoexcessandsticktoweeklyalcohollimits,whichare14UnitsperweekMAXIMUMforbothmalesandfemales.Encourageregularexercise,atleast150minutesofmoderateaerobicactivity(suchaswalking,cycling,swimming)perweek,includingstrengthexercisesonatleasttwodaysperweek.Recommendabalancedandhealthydiet,lowinsaturatedfatsandsugars.Patientsshouldoptforleanproteins,browncarbs,andfruitandvegetables.Advisethosewithhighbloodpressuretopurchaseabloodpressuremonitortouseathomesothattheycanmeasurebloodpressureregularly.Patientsshouldkeepabloodpressurelogandtaketoeachcheck-upappointment.Providestrategiestohelpminimisestressandanxietyathomeandatwork.Offeradviceabouthelpandcounselling,recommendlocalservicesforstress,anxiety,ordepression.

Thefollowingareindicatorsofhighbloodpressure:

Highbloodpressureisoneofthebiggestriskfactorsforheartdiseaseandstroke.Itisaworldwideissueandisbecomingincreasinglycommon.TherewouldbeasignificantreductionintheincidenceofheartdiseaseandstrokeintheUKifallpatientswithhighbloodpressuremadelifestylechangesandtookstepstolowerandcontrolit.

Severe,suddenandrecurringheadachesFrequentnose-bleedsVisualchanges,suchasblurredvisionDizzinessShortnessofbreathChestpainNumbness

Thetablebelowshowsthesystolicanddiastolicvaluesfornormalandabnormalbloodpressure.

Category: SystolicPressure

(mmHg):

DiastolicPressure

(mmHg):

Hypotension 70–89 or 40–59

NormalBloodPressure 90–119 and 60–79

Prehypertension 120–139 or 80–89

Stage1(Mild)Hypertension 140–159 or 90–99

Stage2(Moderate)-

Hypertension

160–179 or 100–109

Stage3(Severe)Hypertension 180–209 or 110–119

1. Foreachofthefourtexts,A–D,brieflysummarisetheinformationgiven.

2. LookinTextAtofindwhohasanincreasedriskofhighbloodpressure.

3. LookinTextDtofindwhichcategoryofbloodpressureadiastolicmeasureof85mmHGwouldbelongto?

InPartAoftheReadingTest,youneedtoanswerquestionsusinginformationinthetextsasyouhavejustdoneinthisexercise.However,unlikethepreviousexercise,onTestDayyouwillnotbetoldwhichtexttofindtheinformationin,soyouneedtobepreparedtoscanallfourtextstofindtherelevantinformation,beforeyoucancompletethequestion.

Thequestionsinthispartofthetestdon’tfollowtheorderofthetexts.Eachtaskinthispartofthetestoperatesinadifferentway,andeachtaskwillrefertoall4texts.

Beforeyouscanthetextsforanswers,however,youshouldpayattentiontothewordsinthequestion,asthesecouldsuggestwhichtextyouwillfindthecorrectanswerin.Foreachquestion,underlinethemostimportantwordsorphrasestohelpyouscanthetextstofindtheanswers.

IdentifytheQuestionTypes

InPartAoftheReadingTestthereare4possibletasktypes:Matching,ShortAnswer,SentenceCompletionandNoteCompletion.ThefirsttaskwillalwaysbeMatching,andthistaskwillalwaysbefollowedby2oftheother3tasktypes.InPartA,the20questionswillbesplitacross3or4groupsofquestions.

4. LookinTextBtofindwhattypeofexercisepatientsshoulddotwotimeseachweek?

5. LookinTextCtofindwhatwouldhappenifpatientswithhighbloodpressuremadeanefforttolowerit.

Questions6–25onthefollowingpagescanbeansweredbyreferringtothe4textsaboutthethyroidonpages71and74.

MatchingQuestions

ThefirsttaskinReadingPartAalwaysasksyoutoidentifywhichtextcontainstheinformation.Youshouldalwaysanswerthesequestionsfirst,astheywillhelpyoutogainanunderstandingofthecontentwithineachtext.

Toanswerthesequestions,lookattheinformationgiveninthequestion.Thequestionswillavoidrepeatingwordsandphrasesexactlyastheyappearinthetexts,soyouwillneedtounderstandthemeaningofthequestion,andfindthematchinginformationinoneofthepassages.Thequestionsinthissectionaskyoutoidentifywhichtextcontainsaparticulartypeofinformationorinformationaboutaparticularaspectoftheconditionorissue.Forexample,aMatchingQuestionmightask‘Whichtextprovidesinformationaboutidentifyingdeliriuminpatients?’Toanswerthesequestions,youneedtounderstandthegeneralmeaningofthe4texts,ratherthanthespecificdetails.

Exercise

Answerquestions6–11usingthe4textsonpages71to74.Youshouldcompletethesequestionsin3minutes.

Inwhichtextcanyoufindinformationabout...

6. identifyingtheriskofmalignantcancerofthethyroid?

7. whichpatientsaresuitableforathyroidectomy?

8. thesymptomsofpatientsreceivinginsufficienttreatment?

9. changingthedosageofthyroidmedication?

10. assessingthethyroidfunctioninthosetakingL-thyroxine?

11. possiblecomplicationsinvolvedinthyroidremovalprocedure?

ShortAnswerQuestions

ToanswerShortAnswerquestions,youneedtolocatethecorrectwordorshortphrasefromthetexts.Youwillhavetowritetheanswertothesequestionsusingonlytheinformationgiveninthetexts.ShortAnswerquestionswillrequireyoutolookatthefourtextsinmoredetailthanyoudidforMatchingquestions,astheanswerstoShortAnswerquestionsmightbefoundinasinglesentenceinoneofthetexts.Thesequestionswilloftenincludespecificwords,suchastypesofmedication,treatmentorreactionsinpatients,thatyoucanlookforinthefourtextstofindwherethistypeofinformationinpresented.Onceyou’vefoundtheinformation,youneedtounderstandthetypeofwordorphraseyouneedtoanswerthequestion.Lookatthequestiontounderstandwhattypeofinformationisbeingaskedfor;forexample,aquestionthatasks‘Whatshouldpatientssufferingfromfeverbegiven?’couldbeansweredwithatypeofmedication,abeverage,oranitem.Thequestioncouldnot,ontheotherhand,beansweredwithanumberalone,oratypeofillness.Whenyou’restrugglingtofindtheanswertothequestion,itcanbehelpfultonarrowdownthetypeofansweryouneed,andlookforthepossibleanswersintherelevanttext.

Makesureyoucopythewordsexactly,anddonotincludewordsorphrasesthatarenotpresentinthetext.Theanswerwillgenerallyrequire1to3wordsfromthetext.Keepyouranswersshort,andavoidincludingunnecessaryinformation,asitmayleadtheassessortobelievethatyoudonotunderstandthetextfully,orarenotsureofthecorrectanswer.

IMPROVEYOURSCORE

Ifyou‘reconfidentyou’veidentifiedtheinformationinoneofthetexts,withoutcheckingtheothertexts,writeyouranswerdownandmoveon.

Exercise

Answerquestions12–16usingthe4textsonpages71to74.Foreachanswer,useawordorshortphrasefromthetext.Eachanswermayincludewords,numbersorboth.Youshouldcompletethesequestionsin5minutes.

12. WhatwillthelevelofFT4beinpatientsundergoingthyroxinereplacementtherapy?

13. WhatshouldpatientswhoaretakingL-thyroxinedoiftheynoticearrhythmiaandmoodswings?

14. Whichtypeofthyroidectomyhasanincreasedchanceofmorbidity?

SentenceCompletion

ToanswerSentenceCompletionquestions,youneedtofillthegapsineachsentencewithawordorshortphrasefromoneofthetexts.

TheprocessforansweringthesequestionsissimilartothatusedforShortAnswerquestions.Lookatthewordsinthesentencethatarelikelytoguideyoutotheinformationinthetext,scanthetextforthesewordsuntilyoufindtheinformation,andidentifythewordorshortphrasethatismostlikelytocompletethesentence.

Beforecompletingthesentence,readthesentencetoyourself(inyourhead,notoutloud)withyouranswer,toconfirmthatthesentencemakessenseusingthewordsyouhavechosen.Ifitdoes,completethesentence.Ifitdoesnotmakesense,readtherelevantpieceofinformationmoreclosely,andchooseanotherwordorshortphrase.

IMPROVEYOURSCORE

15. TestresultsforapatientwithsubclinicalhyperthyroidismwillshowwhatlevelofFT3?

16. Whatcanbetestedforusingacommerciallyavailablekit?

Thequestionsinthissectionarenotgivenintheorderthatthefourtextsappear,soifyou’vejustansweredaquestionwithinformationfromthethirdtext,thisdoesnotmeanthatthenextquestionwillbeinthefinaltext.Makesuretocheckallfourofthetextstofindtheanswer.

Exercise

Answerquestions17–21usingawordorshortphrasefromthe4textsonpages71to74.Eachanswermayincludewords,numbersorboth.Youshouldcompletethesequestionsin5minutes.

17. IfthyroidfunctiontestsindicatethatTSHhas(17),thiscouldsuggestheterophileantibodies.

18. Followingathyroidectomy,ifthepatientexperiencesaphonia,thissuggestsinjurytothe(18).

19. IftestsrevealthattheBRAFV600Emutationispresent,itisextremelylikelythatthepatienthas(19).

20. Duringathyroidectomy,theendoscopeisinsertedintoacutmadeinthe(20).

21. Tooptimisehypothyroidismtreatment,(21)canbeusedtodetecteuthyroidism,oncethecurrenttreatmentisstopped.

Thyroid:Texts

DiagnosisofHypothyroidisminPatientsTakingL-thyroxine

Patientsfrequentlytakethyroidhormonewithaninadequatediagnosisofhypothyroidism,thisisclinicallyrelevantandshouldbeaddressedtooptimisetreatment.Presentingcomplaintsincludefatigue,weightgain,andoligomenorrhea.Ifthepatientanddoctorestablishthatthediagnosiswasnotcomplete–thebestapproachistostoptreatmentfor5weeks.L-thyroxineanddesiccatedthyroidextractarethemostcommontreatmentoptions.Afterstoppingtreatment,serumT4andTSHconcentrationswillindicateeuthyroidismoraprimaryhypothyroidstate.

Carryouttests10-14daysafterstoppingdrugtherapyandanalysetheresultsforphysiologicalhypothyroidismfromsuppressionofthepituitary-thyroidaxisbytheexogenoushormone.

Alternativeapproach:halvetheL-thyroxinedoseandassessthyroidfunctionafter5weeks.

PatientstakinganexcessiveamountofL-thyroxinemayexperiencethefollowingsymptoms:

moodchanges/swingsarrhythmiatremorchestpain

Advisepatientstobeawareofthesesymptoms,andtoseekimmediatemedicalhelpifmorethanoneofthesesymptomsoccurs.

bonepaindiarrhoea

Minimallyinvasivevideo-assistedthyroidectomy

Procedure:

Safety:

Usuallyundertakenwiththepatientundergeneralanaesthesia.SmallincisionmadeabovethesternalnotchEndoscopeinsertedthroughincisionDissectionofthyroidlobeundertakenOperativespacemaintainedusingexternalretractionDonotusegasinsufflation

Caremustbetakentoidentifyandpreserverecurrentlaryngealnerve

Postoperativemorbidityrates,meta-analysisof9studies:10%(29outof289)forminimallyinvasivevideo-assistedthyroidectomy14%(42outof292)forconventional,openthyroidectomy

Superficiallaryngealnerveinjuryreportedin2%(5outof300)ofpatientsCanleadto:

Training:

Weakenedvoice(hoarseness)Lossofvoice(aphonia)Problemswiththerespiratorytract

Minimallyinvasivevideo-assistedthyroidectomyrequiresskillsadditionaltothoseofconventional,openthyroidsurgery.Adequatetrainingisimportantforsurgeonsusingtheminimally

invasiveprocedureTheprocedureisonlysuitableforaminorityofpatientswith

thyroiddiseaseThoserequiringsurgeryThosewiththyroidglandsofanappropriatesize

BRAFV600EMutationTestingforThyroidCancer

Mutationtestingshouldbeundertakentoavoidunnecessarysurgeryandreducethenumberofsurgicalproceduresforpatientswithsuspectedthyroidcancer.

FineneedleaspirationisthemostcommonmethodtoobtainthyroidtissuesamplesCytologicalexaminationcannotdistinguishbetweenbenignandmalignant

neoplasmsIfthebiopsyispositive–theaffectedlobeissurgicallyremovedThesampleundergoesapathologicalmicroscopicexaminationIfthetestingindicatescancer–theremainderofthethyroidglandisremoved

AtestforaBRAFV600EmutationcanbeperformedusingacommerciallyavailabletestingkitTheBRAFV600Emutationhasmorethan99%specificityforthyroid

cancerApositiveresultmeansthatthereismorethan99%chancethecancerismalignant

Thismakesitpossibletoremovethethyroidinoneoperationratherthantwo

ThyroidFunctionTestResultsandAnalysis

TSH FT4 FT3 Clinical

Decreased Normal Normal

Decreasedor

Normal

Decreasedor

Normal

Decreasedor

Normal

Increased Normal Normal

Normalor

Increased

Normalor

Increased

Normalor

Increased

thyroxinetreatment/ingestion—

subclinicalhyperthyroidism—

drugs:steroid,dopamine—

non-thyroidalillness—

earlyphasepost-treatmentfor-

hyperthyroidism

pituitarydisease—

congenitalTSHdeficiency—

subclinicalhypothyroidism—

heterophileantibody(interfereswithTSH

assay)

erraticcompliancewiththyroxinetherapy—

malabsorptionofthyroxineinpreviously

stablepatient

drugs:amiodarone,cholestyramine,iron—

recoveryphaseofnon-thyroidalillness—

TSHresistance—

drugs:heparin,amiodarone—

anti-iodothyronineantibodies,anti-TSH-

antibodies

familialdysalbuminaemic-—

hypothyroxinaemia(FDH)

thyroxinereplacementtherapy(including

non-compliance)

non-thyroidalillness,acutepsychological

disorders

TSH-secretingpituitarytumour—

resistancetothyroidhormone—

Remember,youonlyhave15minutestoanswerall20questionsinPartA,soyoumustuseyourtimewisely.Bythetimeyougettothedifferentsetsofquestions,suchasShortAnswer,NoteCompletionandIncompleteSentences,youshouldbefamiliarenoughwiththetextsthatyoucanidentifythetextthattheinformationislikelytoappearin,justbyreadingthequestion.Whenthisisthecase,checkthetexttoconfirm,findtheanswer,andmoveontothenextquestion.WorkingbrisklyandefficientlyarethekeystosucceedingonTestDay.

ReadingPartA:PracticeSet

TIME:15minutes

Anaemia:Questions

Questions1–6

Foreachquestionbelow,decidewhichtext(A,B,CorD)theinformationcomesfrom.

Youmayuseanylettermorethanonce.

Inwhichtextcanyoufindinformationabout...

Lookatthefourtexts,A–D,onpages78–81.Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.WriteyouranswersinthespacesprovidedinthisQuestionPaper.Answerallthequestionswithinthe15-minutetimelimit.

1. treatingpatientswithanaemia?

Questions7–14

Answerthequestionsbelow.Foreachanswer,useawordorshortphrasefromthetext.Eachanswermayincludewords,numbersorboth.

2. thesymptomsofhypoxia?

3. methodsusedtoidentifyanaemicpatients?

4. thedifferenttypesofanaemia?

5. thelevelsofhaemoglobininawomanwithanaemia?

6. howredbloodcellsizeaffectsanaemia?

7. Whatshouldveganpatientswithvitamindeficiencyanaemiabeencouragedtoaddtotheirdiets?

8. Ifthereisadecreasednumberofyoungredbloodcells,whattypeofanaemiaisbeingdealtwith?

9. Howwillapatient’sbreathingsoundwhenexperiencingasignificantreductionofoxygeninthebody’stissues?

10. Amalewithanaemiamusthavelessthanwhatpercentageofredbloodcells?

11. Whatisanincreaseinthenumberofreticulocytesanindicationof?

12. Whatreducestheamountofredbloodcellsinsomepatients?

13. Whatshouldbetreatedinanaemicpatients,afteridentifyingthecause?

Questions15–20

Completethesentencesbelowbyusingawordorshortphrasefromthetext.Eachanswermayincludewords,numbersorboth.

14. Howarethedifferenttypesofanaemiamostcommonlydistinguished?

15. Anaemiacausedby(15)shouldbetreatedwithabloodtransfusion.

16. Patientssufferingfromhypoxiaandchestpainarelikelytoalsohavea(16).

17. If(17)isfunctioningproperly,highreticulocyteanaemiaislikelytobepresent.

18. Anumberoftestsmaybenecessarytodiagnoseanaemia,duetothedifficultiesinvolvedinmeasuring(18).

19. Patientswithanaemiacausedby(19)shouldbeinstructedtoadjusttheirdiet.

20. Whenidentifyingthetypeofaetiology,(20)ofthepatientshouldbeconsidered,inadditiontolaboratorystudies.

Anaemia:Texts

Anaemiaisdefinedasanoveralldecreaseinredbloodcellmass.Therearemanyvaryingcausesofanaemia,whichallpresentwithsomegeneralsymptoms.Anaemiaresultsinalackofredbloodcellsintheblood.Becauseitisthehaemoglobininredbloodcellsthatcarriesoxygenfromthelungstotherestofthebody,adecreaseinredbloodcellsresultsinlessoxygengoingintothetissues.Thiscausesastateknownashypoxia,orreducedoxygeninbodytissues.

Thecommonsymptomsofallanaemiasarethoseofhypoxia:

Weakness,fatigue,difficultorlabouredbreathingPaleskinHeadacheandlight-headednessChestpain(ifthepatientalreadyhasadiseaseofthearteriessupplyingtheheart)

Therearemanyclassificationsystemstodifferentiateanaemias.Themostcommonlyusedisbasedonthesizeoftheredbloodcell.Anaemiaswithredbloodcellsthataresmallerthannormalareknownasmicrocyticanaemias.Iftheanaemiahasnormallysizedredbloodcells,itisreferredtoasanormocyticanaemia.Finally,iftheredbloodcellsaretoobig,itisknownasamacrocyticanaemia.Normocyticanaemiasarefurtherbrokenupintowhetherornotthereisanincreasednumberofyoungredbloodcells(a.k.a.reticulocytes),whichisanindicationifthebonemarrowisworkingproperly—forexample,iftheredbloodcellsarebeingdestroyed(haemolysis),thereshouldbehigherreticulocytesbecausethereisnoeffectonthebonemarrow’sabilitytoproducenewcells.

Whiletherearemanydifferentcausesofanaemia,laboratorystudiesanduniquefeaturesofthepatientcanbeusedtohelpdifferentiatebetweenvariousaetiologies.

Laboratorystudiesusedtodiagnoseanaemiainclude:

Ageneraldiagnosisofanaemiacanbedeterminedbythefollowingvalues:

Haemoglobin(Hb)—ameasureoftheproteinthattransportsoxygenintheredbloodcellHaematocrit(Hct)—ameasureofthepercentageofredbloodcellsinthebloodRedbloodcellamount(erythrocytecount)—ameasureofthenumberofredbloodcellsintheblood

HaemoglobinlevelMales:lessthan13.5g/dLFemales:lessthan12.5g/dL(womenhaveagenerallylowerhaemoglobinbecauseofbloodlossduringthemonthlymenstrualcycle)

HaematocritMales:lessthan45%redbloodcellsFemales:lessthan37%redbloodcells(womenhaveagenerallylowerhaematocritbecauseofbloodlossduringthemonthlymenstrualcycle)

Whiletheselaboratorytestsaregoodestimatesoftheredbloodcellmass,theyarenotperfect.Redbloodcellmassisverydifficulttomeasure,andthereforetheselaboratorytestsareusedtogethertoassesswhetherornotsomeonehasanaemia.

RedbloodcellamountMale:lessthan4.7millioncells/mLFemale:lessthan4.2millioncells/mL(womenhaveagenerallylowerredbloodcellamountbecauseofbloodlossduringthemonthlymenstrualcycle)

Thetreatmentofanaemiadependsheavilyonthetypeofanaemiathatthepatientisexperiencing.However,thereareseveraloverarchinggoalsoftreatment.

Ifpossible,treattheunderlyingcauseoftheredbloodcellloss.Forexample,ifthepatienthasanaemiabecauseofbloodloss,

giveabloodtransfusion.

Identifyandtreatanycomplicationsthathaveoccurredbecauseoftheanaemia.Educatethepatientonhowtomanagetheiranaemia.Forexample,apatientwithanaemiabecauseofirondeficiency

cansupplementtheirtreatmentwithironrichfoods,suchasleafygreenvegetables.Alternatively,apatientwithanaemiacausedbyvitamin

deficiencyshouldbeadvisedtoincreasetheirintakeoffolicacidandB-12.NotethatpatientswhofollowvegetarianorvegandietsmaystruggletomeetB-12requirements,soeatingfortifiedfoodsandusingsupplementsshouldbeadvised.

Answers

1.A–Medicationoptionsforpatientswithhighbloodpressure.B–AdvicetogivepatientswithhighbloodpressuretocontroltheirconditionC–symptomsofhighbloodpressureD–systolicanddiastoliclevelsfornormalandabnormalbloodpressure

2.BlackpatientsofAfricanorCaribbeandescent

3.Prehypertension

4.strengthexercises

5.Therewouldbeasignificantreductionintheincidenceofheartdiseaseandstroke

12.normalorincreased

13.seekimmediatemedicalhelp

14.(conventional)openthyroidectomy

15.normal

16.aBRAFV600Emutation

17.increased

18.superficiallaryngealnerve

19.malignantcancer

20.sternalnotch

21.serumT4andTSHconcentrations

PRACTICESET

7.fortifiedfoods(andsupplements)

8.lowreticulocytes

9.laboured

11.reticulocytes

12.menstrualcycle

13.complications

14.sizeoftheredbloodcell

15.bloodloss

16.diseaseofthearteries

17.bonemarrow

18.irondeficiency

19.chestpain

20.uniquefeatures

CHAPTER7

ReadingPartB

LEARNINGOBJECTIVES

Understandthedifferentreadingtexttypes.Readthetextcarefullytoidentifythecorrectanswer.PractisestrategiesforansweringReadingPartBquestions.

INTRODUCTION

PartBoftheReadingTestinOETisverysimilartoPartBoftheListeningTest.InReadingPartB,youwillread6differentextractsfromdocumentsgivingbackgroundinformationforhealthcareprofessionals,andansweronequestionabouteachextract.Youhave45minutestocompletePartsBandCoftheReadingTest.Youshouldallowroughly10minutestocompletethissectionsoyouleaveyourselfenoughtimetocompletePartC.Thismeansyoushouldaimtospendonaverage1minute30secondstocompleteeachPartBquestion,althoughyoumayfindsomequestionsquickertoanswerwhileothersmaytakemoretime.

Strategies

KnowtheInstructions

YoushouldmakesureyouarefamiliarwithwhatyouwillbeaskedtodoonTestDay.TheinstructionsforPartBoftheReadingTestwilllooklikethis:

Inthispartofthetest,therearesixshortextractsrelatingtotheworkofhealthprofessionals.Forquestions1to6,choosetheanswer(A,BorC)whichyouthinkfitsbestaccordingtothetext.

KnowtheSettings

ReadingPartBcontains6differenthealthcaretexts.Thetextsinthispartofthetestaregenerichospital-basedtextswhichcanbeusedandunderstoodbyanyofthe12healthcareprofessionscoveredbythetest.

Thetextsthatyouwillseeinthissectionofthetestrepresentthetypesoftextsanddocumentsthathealthcareprofessionalswilloftenrefertoforspecificreasons.Ratherthanfocusingontechnicalmedicalinformationthatyoumightfindinatextbook,forinstance,thesedocumentswillcoverguidelines,policiesandprocedures.Theymightremindhealthcareprofessionalsofthebestpracticetofollowinagivencircumstance,orupdatestoadatastoragesystem,oreveninstructemployeeshowtousemachinery.PartBtextswillgenerallybemadeupextractsfromthefollowingtesttypes:

Toanswerasmanyquestionsinthissectioncorrectlyaspossible,youneedtofocusyoureffortsonunderstandingthemainpointoftheinformationprovidedineachofthetexts.

ScantheQuestion

UnliketheListeningTest,theOETReadingTestdoesnotprovideadditionaltimetolookthroughthequestionsbeforeansweringthem,soyoushouldfactorthisintoyourtotaltime.Youshouldaimtoanswer6questionsinroughly10minutes,sodon’tspendtoolongonanyonequestion.Ifyoucan’tfindtheanswer,moveontothenextquestionandcomebacktothisoneattheend.

Inthissectionofthetest,therearethreedifferentquestiontypes.We’llgothrougheachquestiontypenow,andprovideexamplesforeachquestiontype.

MainIdea

Thesequestionsaskforthemainideaofthepieceofinformation.Toanswerthesequestions,youwillneedtoassesswhatthemainpointisofwhatisbeingcommunicated.

NoticesEmailsManualsMemosGuidelines

Exercise

Take4minutesand30secondstoanswerquestions1–3below.

1. Continuityandcoordinationofcare

Allhealthcareprofessionalsmustbeinvolvedinthesafetransferofpatientsbetweeneachotherandsocialcareproviders.Thisincludes:

Whencareistransferredordelegatedtoanotherhealthcareprofessional,itisyourresponsibilitytoensurethatthepersonprovidingcarehastheappropriateskills,qualificationsandexperiencetoprovideadequatelysafecareforthepatient.

Sharingallrelevantinformationwithcolleaguesthatareinvolvedwithyourpatient’scare,bothinsideandoutsidetheteam,includingwhenthecarehandoverisdoneattheendofduty,andwhencareisdelegatedorreferredtootherhealthorsocialcareproviders.Whenpossible,checkthatanamedteamorclinicianhasappropriatelytakenoverresponsibilitywhenyourrolehasendedinprovidingapatient’scare.Thisismostimportantinvulnerablepatientswhodonothavecapacity.

Thepolicydocumenttellsusthatahealthcareprofessional’s

dutytocareforapatientcontinuesafterareferral.(A)abilitytolookafterapatientshouldbedecidedbysuperiors.(B)obligationtocheckupontransfersdoesnotapplytoall

patients.(C)

2. AssessingPhysicalRestraints

Wefirstadviseproviderstoverballyde-escalateandoffermedicationsasamethodofcalminganagitatedpatientdown.However,ifthesedonotworkandthepatientbecomesviolent,astandardprotocolforphysicalrestraintsshouldbefollowed.Trainedpersonnelshouldcarryouttheactualactionofphysicallyrestrainingthepatientandabedwithrestraintsshouldbepreparedaheadoftime.MedicationsshouldbedrawnupinIMformandbereadytobegivenoncethepatienthasbeenphysicallyrestrained.Aphysicianshouldthenassessthepatient,firstdebriefingstaffonthesituationthatcausedthepatienttobeplacedinrestraintsandthenspeaktothepatientpersonallytodeterminetheirunderstandingofthesameevents.Cardiopulmonarystatusandrestrainttightnessmustbeassessedandthepatient’slevelofpainanddistressdocumented.

Theguidelinesinformusthatphysicalrestraints

canonlybeadministeredtopatientsbyqualifiedstaff.(A)mustbeappliedbeforepatientsbecomeaggressive.(B)shouldonlybeusedonpatientsasalastresort.(C)

3. CallingaConsult

Nophysiciancanhandleeverypatientbythemselves.Nomatterthespecialty,therewillcomeatimewhereyouneedtoreachoutforadditionalhelp.Ifyou’reworkingatanoutpatientoffice,you’lllooktoaspecialistinadifferentinstitution.Ifyou’reworkinginsidethehospital,you’llcallaparticularservicewithaconsult.Differentinstitutionshavedifferentprotocolsonhowtocalltheconsult,butattheverycore,youwillneedtopresentthepatienttothephysicianyou’veconsulted.Youshouldstartbyintroducingyourselfandyourroleonthetreatmentteam.Giveashortsummaryofthepatient,theirmedicalhistory,whythey’reinthehospitalandwhat’shappenedsofar.Youshouldthengointothereasonyou’reconsultingthespecialistandwhatyou’relookingfor–whetherit’streatmentrecommendations,aprocedure,ortoarrangeaservicetransfer.Concludebyaskingiftheyhaveanyotherquestionsthatyoucanhelpanswer.

Detail

Detailquestionswillaskyoutoansweraquestionaboutaspecificpartofthetext.Theywilloftenincludewordsinthequestionthatyoucanusetoskimthetextfortherelevantinformation.

Theguidelinesadvisephysicianson

seekingadvicefromothers.(A)receivingauthorisationforcare.(B)referringpatientstodifferentdepartments.(C)

Exercise

Take6minutestoanswerquestions4–7below.

4. EnsuringPatientPrivacy

PatientprivacyislegallygovernedbyHIPAA,whichestablishesstrictstandardsforhealthcareproviderswhensharingpatientinformation.EveryhospitalwillhaveguidelineshealthcareemployeesmustfollowtoavoidcommittinganHIPAAviolation,whichcanresultinterminationfromemploymentand/orseverefines.Employeesmustavoidtalkingaboutidentifiablepatientinformationwithotherpeoplethatarenotinvolvedintheircare.Thisalsoincludesdiscussingpatientdetailsinapublicsettinglikeahallwayorelevator.Whensendinginformationaboutpatientstootherproviders,itisimportanttousesecureformsoftransmissionsuchashospitalemailandfax.Avoideasybutunprotectedmethodsliketextingorpersonalemail.Disposeofanyidentifiableinformationinspeciallymarkedbinsforlaterincineration.

Whatpointdoesthetrainingmanualmakeaboutconfidentialdocuments?

Theymustnotbeconsultedinanopenarea.(A)Theymustonlybesharedviaworkemail.(B)Theymustbedestroyedafteruse.(C)

5. Extractfromguidelines:Post-ExposureProphylaxisforHIV

WhenworkingwithpatientswithsuspectedorconfirmedHIVinfectionorotherbloodborneviralillnesses,medicalstaffmustrememberthattheyareatriskofinoculationinjury,andtakenecessaryprecautionstopreventinfection.

Itisimportantthatstrictguidelinesareadheredtoandrapidactiontakenpost-exposure,inordertoreducepotentialriskofinfectionpost-incident,controlspread,andpreventfutureincidents.Exposuresaredefinedaspercutaneousinoculationviaaneedlestickinjury,orasplashofpotentiallyinfectedbodyfluids/bloodintomucousmembranes(suchaseyesormouth)oranopenwound.Immediateactionshouldbetakentowashtheinjuryorexposedregionwithcopiousamountsofwater;anywoundsshouldbeencouragedtobleed,andpreventedfrombeginningtoclotbeforetheareahasbeencleaned.Seniormembersofstaffshouldbeinformedimmediately,andtheOccupationalHealthdepartmentcontacted.Allcaseswillbedealtwithconfidentiallyandallbloodsamplestakenfromthe

affectedmemberofstaffwillbelabelledanonymously.AnIncidentFormshouldbecompletedurgently.OccupationalHealthwillrapidlyarrangecontactwith,andtestingof,thesourcepatient.

Whatshouldstaffwithopencutsexposedtoabloodborneviralillnessdo?

avoidcontactwithotherstaff.(A)preventascabfromforming.(B)disinfectandcoverthewound.(C)

6. CodeineandUltra-RapidMetabolisers

Codeineisawidelyusedopioidanalgesicusedtotreatmildtomoderatepain.Theabilitytometabolisecodeinetomorphinecanvaryconsiderablybetweenindividuals.Codeinehasaverylowaffinityforopioidreceptorsanditsanalgesiceffectisduetoitsconversiontomorphine.ThehepaticCYP2D6enzymethatmetabolisesaquarterofallprescribeddrugs,includingcodeine,regulatesthisprocess.

IndividualswhohavetwoormorefunctionalcopiesoftheCYP2D6geneareultra-rapidmetabolisers-abletometabolise

codeinetomorphinemorerapidlyandcompletely.Evenatnormaldoses,individualswhoareultra-rapidmetabolisersmayhavelife-threateningorfatalrespiratorydepression,orexperiencesignsofoverdose.IndividualswithnoactivecopiesofCYP2D6(“poormetabolisers”)showreducedmorphinelevels.Inthisscenario,alternativepainmanagementstrategiesmustbeestablished.

Healthcareprofessionalsandprescribersareencouragedtoeducatepatientsaboutpossiblesideeffectsassociatedwithcodeineuse.

Theguidelinesinformusthatcodeinecancausesideeffectsinpatients

whosufferfromopioidaddiction.(A)whotakeittogetherwithmorphine.(B)whohaveaparticulargeneticmakeup.(C)

7. Guidelines:IncisionalHernia

In12–15%ofabdominaloperations,incisionalherniasoccurpost-operatively.Anincisionalherniapassesthroughanincisionpreviouslymadeduringsurgery,whentheclosureofabdominal

tissuesfailstohealproperly.Besuretocoverduringcheck-ups:incisionalherniasarethesecondmostcommontypeofhernia.

Checkforhernia

Rememberthatthemajorriskwithincisionalherniasisstrangulation:theorganintheherniadevascularisesandthetissuedegenerates.Thismustbeidentifiedattheearliestopportunity–delaycanleadtosepticaemiaandshock.

Treatmentismostlysurgical:ameshcanbeusedtostrengthenthearea.Otherwise,openandkeyholerepairsremainanoption,however,betteroutcomeshavebeenreportedwiththeuseofmeshrepairs.

Lookforabnormalprotrusionoftissueororganthroughthecavityinwhichitissituated.

Rememberthatherniasaremostcommonintheabdomen,butcanalsoappearintheupperthighsandgroinregion.

Theguidelinesinformusthatincisionalhernias

arecausedbysurgery.(A)formwhenpatientscutthemselves.(B)occurmorefrequentlythanotherhernias.(C)

Purpose

Purposequestionsrequireyoutochoosetheanswerthatbestexplainsthepointofthetext.Thinkaboutwhythetextwaswritten,whatshouldhealthcareprofessionalsreadingthetextdoasaresultofreadingit?

Exercise

Take4minutesand30secondstoanswerquestions8–10below.

8. ProceduralGuidelinesforSet-upandAdministrationofIntravenousFluids

Intravenous(IV)fluidsareinfuseddirectlyintotheveinsofpatientsviaacannulaincasesofseveredehydration,electrolyteimbalance,bloodloss,andinsurgery.Intravenouslinescanalsobeusedforadministrationofdrugsdirectlyintothebloodofapatient,resultinginfasteraction.TheguidelinesbelowillustratethecorrectprocedureforsettingupandadministeringIVtherapy.

Firstly,alwayscheckthatthefluidbagisnotdamagedandthattheliquidinsideitisclear.Secondly,therehavebeenreportsofincompletepatientnotes,soitiscrucialthatyoucheckfordetailssuchasfluidtypeandexpirationdateandrecordtheseinthepatientnotesimmediately.Thirdly,itisvitalthatallclinicalstaffintroducethemselveswiththeirfullnameandroletoallpatientstheyengagewith;onlyafterconfirmingpatientdetailsandobtainingtheirconsentshouldonebegintheIVset-up.Finally,beextradiligentwhencalculatingthedriprateasto

avoidanyerrors.Feelcomfortabletoapproachafellowcolleagueforassistanceifuncertainatanystage.

Themainpurposeoftheguidelinesistoadvisestaffon

theproceduretofollowwhenfittinganIV.(A)howtocheckforissueswithIVinfusions.(B)whattodobeforeadministeringanIV.(C)

9. Fortheattentionofallpaediatricians:

Asapaediatrician,onemustalwaysrememberthatthepatientsarenotthedoctor’sonlyconcern;wemustalsofactorintheanxiousparentsworriedabouttheirchild.Thiscanbeanadditionalchallengeforstaffinadepartmentthatisalreadybusyandstressful,butadutywhichmustnotbeneglected.Parentswhoseekpaediatriccareforminorconditionsarenotintentionallyimpingingonmedicalcareforthosepatientswhomoreurgentlyneedit.Therefore,timeshouldbespentspeakingtotheseparentsandofferingreassuranceandsupportasappropriate,ratherthanignoringthemormakingthemalastpriority.Tentofifteenminutesspentinconversationwiththesefamilieswillsavemuchmoretimeinthelong-runandpreventcountlessbleepsandcallsfromthem,whichcouldotherwisehavebeenavoided.Inaddition,itisvitaltobeawareof

alternativepotentialcausesfortheparentalanxietythatcouldberootedinpasteventsandexperiences,orcausedbyproblemsintheirpersonallife.

Thepurposeoftheemailistoadvisepaediatricianstobe

mindfulthatparentsmaynotalwaysagreewiththeproposedtreatment.

awarethatevenminorillnessescanbedistressingforparents.(B)understandingandpatientwhenexplainingconditionsto

children.(C)

10. Toallfront-linemedicalstaff,

Recently,wehavebeennoticingasteadyincreaseinno-showappointmentsatthepractice.Previously,wedidnothaveaconcretepolicyoncancellationdeadlinesormissedappointmentfees.Giventhatno-showappointmentsnotonlytakeupvaluabletimefromourproviders,butalsopreventanotherpatientfromutilisingthesetimeslots,itisinourbestinteresttodiscouragepatientsfrommissingtheirappointment.Goingforward,officestaffwillcalleverypatientatleast48hoursbeforetheirappointmenttoremindthemofthedateandtimeoftheirappointment.Ifthepatientcancelswithin24hoursoftheirappointmenttime,officestaffwillmakeanoteinthepatient’s

chart.Ifthepatienthasmorethanthreesuchcancellations,heorshewillthenbeissuedwitha$25feetorescheduletheappointment.Patientswhoareusingmedicalinsuranceareexemptfromthisfeeandinsteadshouldhavetheirchartforwardedtoaproviderforfurtherevaluation.Weunderstandthatthisnewpolicymayresultinsomedifficultiesforstaff,sowewillallowfeestobewaivedinextremecircumstances.Wewillalsosetthestartdateofthispolicysixmonthsfromtoday’sdate,soallpatientswillhavesufficienttimetobeinformedofthenewrules.Pleasemakesurethatallpatientsareawareofthesechangesattheendofeachappointment.

Manythanks,

Theadminteam

Whatistheemailfromtheadminteamaskingfront-linestafftodooverthenext6months?

Chargeafeetopatientswhocanceltheirappointmentsthreetimes.

Callpatientswithareminder24hourspriortotheirappointment.

Informpatientsofthechangestobeimplemented.(C)

PartBoftheReadingTestisdesignedtoassessyourabilitytoscanandselectrelevantinformationfromhealthcaretextsthatyouarelikelytoencounterwhileworkinginyourprofession.Practiseforthissectionofthetestbyreadingthroughinstructivematerialsandmakingnotesonwhatisbeingexplained.TakenoteofthepurposeofanyemailsorcommunicationsyoureceiveinEnglish,andpayattentiontosignsandnoticesinEnglish,asthesewilloftenusesimilarlanguageandsettingstothoseusedinthispartofthetest.

IMPROVEYOURSCORE

Theanswerchoiceswillavoidrepeatingwordsorphrasesfromthetext.Assuch,itisimportanttothinkabouttheoverallmeaningoftheextract,andchoosetheanswerchoicethatbestcorrespondstothis.TheextractsinReadingPartBareshort,sogiveyourselftimetoreadthroughtheentiretext,usingthequestiontodirectyourunderstanding,beforeyouconsidertheanswerchoices.

IMPROVEYOURSCORE

Thequestioncanhelpyoutoidentifythetypeoftext.Generally,PartBmultiple-choicequestionswillhelptounderstandthetextbyexplainingthetypeoftext,orwhereyoumightfindit.Usethisinformationtohelpyoutounderstandthetext,forexample,ifthetextisanextractofapolicyupdateforhealthcarestaff,it’slikelytodiscussrecentchangestopracticesandprotocol.

ReadingPartBPracticeSet

1. PreparationofInjection

Lidocaineisalocalanestheticthatisofteninjectedsubcutaneouslybeforeminormedicalproceduressuchaslacerationrepair,excisionalbiopsy,andhormoneimplantation.Akeysteptoprepareforthisprocedureisclearingasuitableworkspaceandobtaininganynecessarysupplies.First,besuretocheckwithyourproviderabouttheconcentrationandmixtureofLidocainetobeused.Epinephrineisoftenincludedtoconstrictlocalbloodvesselsforlongerduration,butcanincreasetheriskofcausingischemiainareaswithpoorbloodsupply(fingers,ears,toes).SodiumbicarbonatecanalsobeaddedtoavoidpainduringinjectionduetoLidocaine’sacidicpH.Besuretoobtainthepropersizedneedleandsyringe,whichwillbedependenton

thelocationoftheinjectionandthesizeofthearearequiringanesthesia,respectively.

WhyisepinephrineaddedtoLidocaineinjections?

tonumbthearea(A)toprolongtheeffects(B)toreducepatientdiscomfort(C)

2. PolicyReminder:CollectingCollateralInformation

CollateralinformationisanimportantfactorindeterminingappropriatedispositionforpsychiatricpatientsintheEmergencyDepartment.Often,patientswithpsychiatriccomplaintsareunabletoaccuratelyorthoroughlydescribetheirmedicalhistory,baselinecondition,oreventsleadinguptotheirarrivalatthehospital.Thus,itbecomesimperativetocontactthosewhomightknowthepatientbestorwereinthepatient’scompanypriortotheirarrival.Contactinformationcanbeobtainedfromthepatientthemselves,personsaccompanyingthepatient,orthemedicalrecord.Wheninitiatingcontact,confirmtheotherperson’sidentitybeforerevealingthepatient’snameorthereasonyouarespeakingwiththem.Ifyoureachvoicemailandtheansweringmachinedoesnotclearlyidentifythepersonyou

arelookingfor,donotrevealanyinformationaboutthepatient–simplystateyourname,number,position,andwhomyouarerequestingacallbackfrom.

Thepolicydocumentoncollateralinformationoffersadvicetostaffabouthowto

gatherinformationfromcolleaguesaboutspecificpatients.(A)collectinformationaboutpatientsfromtheirfriendsand

relatives.(B)

informpatientsandtheircarersaboutrecentdiagnosesoverthephone.

3. AssessingandManagingPeripheralArterialDisease

Staffshouldassesspatientswhohavesymptomssuggestiveofperipheralarterialdiseaseordiabeteswithnon-healingwoundsforthepresenceofperipheralarterialdisease.

AskaboutthepresenceofintermittentclaudicationandcriticallimbischaemiaExaminethelowerlimbsforevidenceofcriticallimbischaemiaExaminepulsesinthelowerlimbs:femoral,poplitealandfeet

Imagingispossibleforpatientswithperipheralarterialdisease:duplexultrasoundisthefirst-lineimagingtechnique.Ifpatientsrequireadditionalimaging,contrast-enhancedmagneticresonanceangiographyisused.Ifthisiscontraindicatedornotpossible,usecomputedtomographyangiographyinstead.

Lifestylechangesarethefirst-linetreatmentforperipheralarterialdisease,thisincludes:smokingcessation,bettercontrolofdiabetes,bettermanagementofhypertension,managementofhighcholesterol,incombinationwithantiplateletdrugs.Finally,regularexercisehasshowntobeneficiallyrevascularisetissuesinthosewithclaudication.

Measuretheanklebrachialpressureindex

Whendealingwithpatientswithsymptomsofperipheralarterialdisease,staffshould

lookforsignsofswellingintheupperbody.(A)confirmthatthepatienthasahistoryofpoordiet.(B)identifythecausethroughphysicalexaminationandtests.(C)

4. Guidelines:AlcoholWithdrawalTreatment

Alcoholwithdrawalcanpresentasalife-threateningemergencyandrequirestreatmentatahospital.Providersusealgorithmstodeterminewhenandhowmuchmedicationtoadministerforasafeandoptimaloutcome.AkeycomponentofthisassessmentisdeterminingtheseverityofalcoholwithdrawalusingtheClinicalInstituteWithdrawalAssessmentforAlcohol(CIWA-Ar).Thescalecontains10subjectiveandobjectiveitemsthatcanbequeriedandscoredinminutes.Symptomsaskedaboutincludenausea,vomiting,tremors,sweating,anxiety,agitation,tactile/auditory/visualdisturbances,headache,andcognitivedysfunction.Everyhospitalhasdifferentcutoffsfortreatment,butasageneralrule,treatmentwithbenzodiazepinesbeginstartingatascore8–10,withhigherscoringindicatingincreasingamountandfrequencyofmedication.

Theguidelinesonalcoholwithdrawaltreatmentinformshealthcareprofessionalsabout

determiningthequantityofmedicationrequired.(A)reducingthedosageasthesymptomsimprove.(B)varioustypesofdrugstoprescribetopatients.(C)

5. Fortheattentionofallstaff:

RE:AGITATEDPATIENTS

AgitatedpatientsareacommonoccurrenceintheEmergencyDepartment.Therearemanyreasonsforagitation,rangingfrommedicalconditions,substanceintoxication,psychiatricillness,anddistressingcircumstances.Whilebothphysicalandchemicalrestraintsareavailabletoproviders,theseareitemsoflastresortastheirusecreatessignificantrisktothepatient,staff,andotherpersonsinthearea.Verbalde-escalationisaproven,effectivetechniquethatcanbeusedtocalmapatientdownandpromoteasafetreatmentenvironment.Whende-escalating,designateonepersontospeakforthegroup.Agitatedpatientscanbeeasilyconfusedbymultiplespeakersandaunifiedmessagemustbepresented.Respectpersonalspacetopreventthepatientfromfeeling‘trapped’andmaintainsufficientdistancetoavoidanyresultantphysicalaggression.Remembertointroduceyourselfandyourroleonthetreatmentteamtothepatient.Usetheirnameandorientthemtotheirsurroundingsandwhytheyarehereinthehospital.

Thememoisadvisingstaffdealingwithagitatedpatientsonhowto

identifythecauseoftheagitation.(A)avoidaddingtothefeelingsofagitation.(B)dealwithviolentbehaviourcausedbytheagitation.(C)

6. ExtractfromAppropriateTreatmentforPain

Painisoneofthemostcommoncomplaintsthatwillbebroughttoaphysician’sattention.Thissectionwillcovertreatmentofmildtomoderatepainwithouttheuseofopioids.Moreseverepainmayrequirejudicioususeofshort-actingopioidmedicationsoraconsulttopainmedicine.Formostpatients,thefirstlinemedicationsforpainareacetaminophenandibuprofen.Maximumdailydosageofacetaminophenissuggestedtobe4grams,reducedtounder2gramsforpatientswithliverissuessuchasacirrhosis.Ibuprofenisparticularlyeffectiveinpatientswhosepainiscausedbyinflammation,thoughcautionisurgedinelderlypatients,patientswithdiagnosedbleedingissues(especiallygastrointestinalbleeds),oranycardiacissues.Maximumdailydosagesuggestedis2.4grams.Acombinationofacetaminophenandibuprofencanbeusedifeitheroneusedaloneisnotsufficient.Formorelocalisedpainrelief,considerusinglidocainedermalpatchesovernon-brokenareasofskin.

Theguidelinesadvisethatpatientswithheartproblems

mayneedtoavoidibuprofen.(A)shouldbegivenlidocaineforpainrelief.(B)mustreceivealowerdoseofacetaminophen.(C)

Answers

1. Adutytocareforapatientcontinuesafterareferral.

2. Cshouldonlybeusedonpatientsasalastresort.

3. Aseekingadvicefromothers.

4. CTheymustbedestroyedafteruse.

5. Bpreventascabfromforming.

6. Cwhohaveaparticulargeneticmakeup.

7. Aarecausedbysurgery.

8. CwhattodobeforeadministeringanIV.

awarethatevenminorillnessescanbedistressingforparents.

10. CInformpatientsofthechangestobeimplemented.

PRACTICESET

1. Btoprolongtheeffects

2. Bcollectinformationaboutpatientsfromtheirfriendsandrelatives.

3. Cidentifythecausethroughphysicalexaminationandtests.

4. Adeterminingthequantityofmedicationrequired.

5. Cdealwithviolentbehaviourcausedbytheagitation.

6. Amayneedtoavoidibuprofen.

CHAPTER8

ReadingPartC

LEARNINGOBJECTIVES

Brieflylookthroughthetexttounderstandthegeneralmeaning.Lookforcuesandpromptsinthequestiontofindtherelevantinformationinthetext.Identifythemainideaofatextandofeachparagraph.PractisestrategiesforansweringDetail,AttitudeandOpinion,VocabularyandReferencequestions.

INTRODUCTION

InPartCoftheReadingTest,therearetwotexts,witheightquestionsoneachone.Thetypeoftextsyouwillencounterwillbeinthestyleofarticlespublishedforahealthcareaudienceinahealthcaresetting.Theywillnotbespecificallyaimedatanyonehealthcareprofession,andwilluseterminologythatcanbeunderstoodbyanyhealthcareprofessional.

Thereisacombinedtimeof45minutesforPartsBandC.Ifyouspentroughly10minutestocompletePartBoftheReadingTest,youwillhave35minutestocompletePartCofthetest.

Strategies

KnowtheInstructions

Youshouldmakesureyouarefamiliarwithwhatyouwillbeaskedtodobeforeyoutakethetest.TheinstructionsforPartCoftheReadingTestwilllooklikethis:

Inthispartofthetest,therearetwotextsaboutdifferentaspectsofhealthcare.Forquestions7to22,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext.

KnowtheFormat

Eachquestionreferstoadiscretepartofthetext,andthequestionsappearintheorderoftheinformationinthetext.Youneedtoanswer8questionsoneachofthe2textsinthissectionofthetest.Thequestionswilldirectyoutothepartofthetextwhichthequestionrefers,soyoudon’tneedtoskimtheentiretexttofindtheinformation.Inaddition,onceyouhaveansweredaquestionaboutonepartofthetext,youonlyneedtolookattheinformationthatfollowsfortheremainingquestions,youwillnotneedtolookatthepreviousinformation.

LookattheText

Thefirstthingyoushoulddo,whentacklingaPartCtext,istoquicklylookthroughthetext,tounderstandhowthetextisorganisedandwhatit'sabout.As

youskimthroughthetext,youmightfindithelpfultomakeafewbriefnotesaboutthemainideaortopicofeachparagraph,tohelpyoutorememberwhatthetextdiscusses.Don’tworryaboutunderstandingthetextindetailatthispoint,justgiveyourselfageneralsenseofthetext.Whenyoucometoanswerthequestions,thequestionswillguideyouthroughthetext.

Exercise

Take5minutestoskim-readthetextbelow.Asyoulookthrough,makebriefnotesaboutthecontent–aimforjust4or5wordsorphrasesperparagraph.Timeyourself.

TEXT1:SYNTHETICVOICES

Therearemanyreasonswhyapatientmaylosetheirvoice;indeed,manyofuswillalreadyhaveexperiencedpartiallossofvoice,whensufferingfromacoldorflu.Whilewetendtodismissahoarsevoiceasamildannoyance,whenpermanentvoicelossoccurs,itcanbetremendouslydifficultforthepatienttodealwith,bothpractically,andemotionally.Whenourvoiceworks,wedon’tspendtoomuchtimethinkingaboutwhatlikewouldbelikewithoutit,butthetruthisthatourvoiceisanintegralpartofwhoweare.Ourvoicesdefineus,theyallowourlovedonestoidentifyusoverthephone,orwhenvisibilityispoor.Theydistinguishusasindividualsfromcertainpartsoftheworld,andtheycanevenindicateoursocialstanding.Untilrecently,patientswhoexperiencedpermanentlossofvoicewouldhavehadrelativelyfewoptionsattheirdisposal.However,astechnologyadvances,therangeofspeechreplacementoptionsavailablebecomesincreasinglysophisticated.

Today,syntheticvoicesarethemostcommontypeofspeechreplacementdeviceusedbythosewhohavepermanentlylosttheirvoice.Thetechnologyusedtocreatethissoftwarecanalsobeseeninspeechcontrolledhomedevices,andmodernsmartphones.Aspermanentlossofvoiceisoftencausedbyrespiratoryissuesresultingfromotherillnesses,however,it’simportantthatspeechreplacementdevicesforthosewhohavelosttheirvoicetakethepatient’sotherdisabilitiesintoaccount.Speech-to-textsystemstypicallyinvolveasystemofleversorasimplifiedkeyboard;thelattertendstobeeasierforthosewithlimitedmobilitytooperate.Usersareabletomanipulatethesecontrolsinordertoselectwordsfromacomputerinterfaceandbuildthemintosentences.Somesystemscanalsooperateviaeyemovementalone,sothatwhenauserstaresataparticularwordonthescreenforacertainamountoftime,itisselected.

Thesesystemsshowaremarkableadvancementfromoneoftheearliestspeech-to-textmechanismsdesignedinthesixties:atypewriteroperatedthroughanairpipe,knownasasipandpufftypewriter.Thefirstelectricalcommunicationdevicefordisabledpeoplewhocouldnotspeak,asipandpufftypewritercalledthePOSM(PatientOrientedSelectorMechanism),wasdevelopedbyRegMaling,avolunteeratahospitalforparalysedpeople,afterhediscoveredthatpatientsatthehospitalwhohadlosttheuseoftheirvoicewereonlyabletocommunicateusingabell.Throughouttherestofthetwentiethcentury,thesetechnologiesweregraduallydeveloped,andinthe1970s,thefirstportable,commerciallyavailable,adaptivealternativecommunicationdevices(orAACs),wereproduced.Althoughtheywereadvertisedasportable,thesedevicesoftenweighedahefty15–20pounds,andtendedtorangefrom20to25inchesinsize.AsmanyoftheearlyportableAACusersalsousedawheelchair,inwhichitwasrelativelystraightforwardtodesignaholsteratthebackofthechairtostorethesedevices.

Thankfully,thetechnologycontinuedtodevelop,anddevicesbecamesmaller,easiertouseandmoresophisticated.IntheUnitedStatestherearenowovertwomillionpeoplewhorelyonsuchdevicesintheirday-to-daycommunications,yetmanyusersstillhavetomakedowithalimitednumberofvocalchoices—oftenlessthanadozen,withthemajorityofavailablevoicessoundingadultand/ormale.Thisisextremelyproblematic,asusersneedtochooseavoicethattheyfeelrepresentswhotheyare.Proponentsofnewdigitalvoicebanksareworkingtowardraisingthebarbysteadilywideningthescopeforself-expressionamongthemanymillionsofdiverseusersofAACs.

Ifpatientsaregraduallylosingtheirvoice,butstillabletospeak,theymaybeabletorecordtheirownvoicetousewiththeirAAC.Anotheralternativeopentopatientsistomakeuseoftheincreasingnumberofvoicesbeingdonated.Althoughvoicedonationdoesnotrequirethecontributortophysicallygivea

partofthemselvesaway,asisthecasewithclassicmedicaldonations,donatorscertainlymustgotheextramile.Theprocessofvoicedonationismuchmoreextensivethan,say,donatingakidney,orotherphysicalorgan.Whilethedonationofanorganrequiresarelativelyshortstayinhospital,todonateavoicerequiresmanyweeksofdonorcommitment.Donorsmustspeakmanythousandsofpreselectedwords,phrasesandsentencesintoarecordingmicrophone.Somecompaniesofferaservicetailoredtotheuser,whocanreadsciencefictionorfantasystoriesoutloud—ortextsaccordingtotheirinterests—inordertoremainmoreengagedintheprocess.

Onceavoicehasbeencomprehensivelyrecorded,itthenbecomespartofthesoftwareforAACs,andmadeavailabletoanypatientthatneedsit.ProfessorStephenHawking,thefamousCambridgephysicist,begantouseanearlytext-to-speechsystemin1986calledCallText.Interestingly,theprofessorneverchangedhissyntheticvoicetoamoresophisticateddesignthatbetterimitatednaturalspeech.Instead,HawkingretainedCallText,explainingthathefeltthelimitedmodulationsofthevoiceallowedhisspeechtobeeasiertohearandunderstandduringlectures.Clearly,Hawkingalsocametoseeitasapartofhisidentity.30yearsafterhebeganusingCallText,thesoftwarewasnearingbreakdown,butratherthansimplyreplaceit,hehadateamofresearchersreverseengineerthevoiceontoamoremodernplatform.

AnswertheDifferentQuestionTypes

Onceyou’vescannedthetext,youcanbegintoworkthroughthe8questions.Youshouldaimtospendonetooneandahalfminutesansweringeachquestioninthissection,somakesuretotimeyourselfaccuratelyasyoucompletetheexercisesinthischapter.

WhenyoucometoanswerthequestionsinPartC,firstlookatwhatthequestionisaskingyoutodo,thenscantherelevantparagraphofinformation,thenlookattheansweroptions.Markanyansweroptionsthatdefinitelydonotanswerthequestionwithacross,andifyou’restuckbetweentwoanswerchoices,readthroughtherelevantinformationagain,thenifyoustillcan’tfindtheanswer,selectoneoftheanswerchoicesasaguessandmoveon.

ThequestionsinPartCoftheReadingTestcanbebroadlydividedinto3differentquestiontypes.Wewillgothrougheachquestiontypebelow,andprovideexamplesforeachquestiontype.

Detail,AttitudeandOpinion

Detail,AttitudeandOpinionquestionswillaskyoutoidentifyinformationfromasectionofatext,andwillmostoftenfocusontheviewsandopinionsofthewriter.ThesequestionsarethemostcommonquestiontypeinPartC.ThefollowinglistgivesexamplesofthetypesofDetail,AttitudeandOpinionquestionsthatoccurinthissection:

Whatpointdoesthewritermakeinthethirdparagraph?ThewritersuggeststhatmaculardegenerationmayincreaseInthefourthparagraph,thewritersaysthatconventionaltreatmentscanbeproblematicbecause

Exercise

Take5minutestoanswerquestions1–4.Timeyourself.

1. Inthefirstparagraph,thewritersuggestslossofvoiceisdifficultforpatientsbecauseitis

partoftheiridentity.(A)necessaryforinteraction.(B)usedtoformrelationships.(C)anindicatorofsocialclass.(D)

2. Whydoesthewriterbelieveitisimportantthatspeechreplacementdevicesbeoperatedbyavarietyofmethods?

Thetechnologyshouldbekeptuptodate.(A)Patientsoftensufferfromvariousconditions.(B)Healthcareworkersmightalsoneedtousethem.(C)Thedevicesshouldbeusableacrossarangeofplatforms.(D)

3. Inthethirdparagraph,weleanthatRegMallingdevelopedthePOSMdueto

Vocabulary

Vocabularyquestionswillpresentyouwithasinglewordorphrasethatwillbeunderlinedandformattedinboldinthequestionandthetext.Toanswerthesequestionscorrectly,youwillneedtolookatthesurroundingwordsanddeducethemeaningaddedbythewordorphrase.Thesequestionsarenottestingyourknowledgeofthedefinitionofthewordorphraseitself.YoushouldexpecttoansweroneVocabularyquestionineachtextinPartC.ThefollowinglistgivesexamplesofVocabularyquestions:

thenumberofpeoplewhohadpermanentlylosttheirvoice.(A)thelackofaccessibilityinprevioussipandpuffdesigns.(B)thelimitedcommunicationoptionsfordisabledpeople.(C)therecentdevelopmentofsimilarsoundtechnology.(D)

4. Accordingtothewriter,whywereearlyportableAACsproblematicforthosenotinwheelchairs?

Theywereheavyandbulky.(A)Theywereremarkablyfragile.(B)Theycouldnotbeusedwhilewalking.(C)Theyneededaccesstoapowersource.(D)

Thewriterusesthephrase‘cutcorners’toreinforcetheideathatInthefinalparagraph,thewriterusesthephrase‘intheloop’tounderlineWhatissuggestedabouttheattitudetowardsthetrialbytheuseofthephrase‘onthefence’?

Exercise

Take2minutesand30secondstoanswerquestions5–6.Timeyourself.

Reference

Referencequestionswillaskyoutodecidewhatthewordorphraseunderlinedandinboldinthequestionandinthetextrelatesto.Toanswerthesequestions,youmightneedtobeabletokeeptrackofwhatisbeingdiscussedinlong

5. Thewriterusesthephrase‘raisingthebar’tounderlinethe

complexityofmoderndevices.(A)needforadiverserangeofvoices.(B)highqualityofthesoundrecordings.(C)numberofnewcommunicationsystems.(D)

6. Whatissuggestedaboutvoicedonationbythephrase‘gotheextramile’?

donationcentresareoftenfaraway(A)alargenumberofvoicesarerejected(B)donatorssacrificemorethanorgandonators(C)theprocessisextremelytime-consuming(D)

sectionsoftextwithcomplexsentences.YoushouldexpecttoansweroneReferencequestionineachpassageinPartC.ThefollowinglistgivesexamplesofReferencequestions:

Inthesecondparagraph,whatdoestheword‘it’referto?Whatdoestheword‘they’referto?Thephrase‘becauseofthis’refersto

Exercise

Take2minutesand30secondstoanswerquestions7–8.Timeyourself.

PartCoftheReadingTestisdesignedtoevaluateyourabilitytoquicklyreadandunderstandEnglishtextsinahealthcaresetting.MakereadinghealthcaretextsinEnglishahabittoprepareyourselfforthetest.OnTestDay,takeadeepbreath,readeachsectioncarefully,selectananswer,thenmoveontothenextquestion.

7. Inthefifthparagraph,theword‘user’refersto

healthcareworkerswhotreatlossofvoice.(A)patientswithpermanentlossofvoice.(B)AACtechnologydevelopers.(C)voicedonators.(D)

8. Whatdoestheword‘it’refertointhefinalparagraph?

Apresentationgivenbytheprofessor.(A)Theresearchcarriedoutfortheprofessor.(B)Thesyntheticvoiceusedbytheprofessor.(C)Thepermanentlossofvoiceoftheprofessor.(D)

IMPROVEYOURSCORE

QuestionsinPartCoftheReadingTestalwaysappearintextorderandwilloftendirectyoutotherelevantparagraph.Onceyou’veansweredaquestionaboutonepartofthetext,moveontothenextpart.

IMPROVEYOURSCORE

Wronganswerchoiceswilloftenfeatureotherdetailsfromthetextthatarenotaskedaboutinthequestion,orwillnotreflectthemeaningofthetext.Makesureyouarepickingthedetailthatanswersthequestionbeingasked.

IMPROVEYOURSCORE

PractiseforPartCoftheReadingTestbyreadingnewspaperarticles,papersandstudieswritteninEnglishonhealthcaretopics.Pickanarticlewitharound800wordsandgiveyourself5minutestoreadthetextandmakenotesonthecontent.

IMPROVEYOURSCORE

Wheneveryoureadarticles,papersorstudiesinEnglish,makealistofanywordsyoudonotrecognise.Besuretolookupthemeaningofeach

word,andnoteasynonymornon-technicaltermforthisword.Buildingyourvocabulary,andyourconfidencewithunfamiliarwordswillboostyourperformanceonTestDay.

ReadingPartC:PracticeSet

Forquestions1to16,choosetheanswer(A,B,CorD)whichyouthinkfitsbestaccordingtothetext.

TEXT1:DELIVERINGSERIOUSNEWS

Deliveringseriousnewstopatientsandrelatives:it’smanyhealthcareprofessionals’mostdreadedtask.Unfortunately,it’snotsomethingthatcanbeavoided,andit’ssomethingthatmustbedoneright.Patientsandrelativesneedourguidanceandsupport,particularlywhentheprognosisisserious.Inthisarticle,weusethephrase‘seriousnews’or‘life-alteringnews’ratherthanchoosingatermwithnegativeconnotations,suchas‘badnews’,forexample,asithelpstoreframethediscussion.Ifyoudiscuss‘seriousnews’withapatient,theycandecidehowtorespond,whereasgivingapatient‘badnews’,maypreventthemfrombeingabletoacceptthenewsinamoreconstructivelight.

Studiesshowthevastmajorityofpatientswouldprefertobeinformedofalife-alteringdiagnosis,ratherthanremaininignorance.However,theamountofinformationtheywishtoreceivecanvary,withmostwantingtoknowdetailsconcerningthedifferenttreatmentoptions,andtheeffectivenessofproposedtreatments,whiletheymaywanttohearlessaboutthespecificdetailsoftheirprognosis.Accordingtostatistics,inwesterncultures,themajorityofpatientsmaynotwishtoknowcertaindetails,suchaslifeexpectancy.Healthcareworkersmayalsofindfamiliesaskingthatdiagnosesbekeptfromthepatient,orthatpatientsprefertohavecarewhollymanagedbytheirfamily,ratherthanthemselves.

OnemodelfordeliveringseriousnewsiscalledSPIKES,developedbyWalterBaileandinitiallyusedfordiscussionswithcancerpatients.ThefirststepinSPIKESissettinguptheinterview.Aquietprivateareasuchasanexamroomorfamilymeetingroomisanidealsetting.Thepatientshouldbeabletochoosefamilymembersorfriendstobepresentforsupport.Forthosewhodon’tspeak

fluentEnglish,ahospital-contractedmedicalinterpretershouldbeused.Thehealthcareprofessionalshouldbepreparedtoanswerdifficultqueriesaboutprognosis,treatment,andoverallplangoingforward,butalsoknowwhentorefertoaspecialistformoreesotericinformation.Ifthereisamulti-disciplinaryapproach,everyteammembershouldbeonthesamepagewithregardstothecareplantoavoidconfusion.

TheseconditeminSPIKESisthepatient’sperception.Lastweek,Iaskedapatient,let’scallhimHarry,ifheunderstoodhiscurrentcondition.Ofcourse,hesaidhedid,butwhenhecametoexplainittome,Isawthatthereweremanygapsinhisknowledgethatneededtobeaddressed.Agoodwaytoassessthepatient’sunderstandingistoaskwhatthepatientalreadyknowsabouttheirconditionandwhattheyhavebeentoldsofar.Makesuretoassesstheleveloftheirunderstanding,aswellastheirawarenessofthebasicfacts.Thiswillallowyoutoassesstheirlevelofbackgroundknowledge,theircurrentknowledge,andwheretobeginyourowndiscussion.

ThethirditeminSPIKESisthepatient’sinvitationfordiscussion.Differentpatientsdesiredifferentlevelsofinformationabouttheircondition.Someofthemoretechnical-mindedoryoungerpatientsmaywanttoknowtheirdiagnosis,prognosis,treatments,courseofillness,etc.Others,includingolderpatients,maysimplywishtoknowthediagnosisandaccepttherecommendationsofthetreatmentteamasbeingintheirbestinterests.Beforebeginningtodiscusstheircondition,youmightfindithelpfultoask“Wouldyoulikemetodiscussalltheinformationweknowaboutyourconditionorjustcertainparts?Whatwouldyoulikeustotellyourfamily?”

ThefourthiteminSPIKESisgivingknowledgetothepatient.Youshouldbedirect,butavoidbeingunfeelingorbluntwhenyoudiscusstheircondition,andutilisenon-technicaltermsinsmallchunks.Prognosisandcourseofillness

shouldberealistic,butalsoconveyhopeandplanningforthefuture.Anappropriateopeningforourpatientwouldbe,“I’mafraid,wehavesomeseriousnewsabouttheCTscanthatwasperformed.Itshowedthatthecancerinyourliverhasspreadtoyourspine.”Takenoteofhowthewords‘hepatocellularcarcinoma’and‘metastasis’wererephrasedintolayman’sterms.

ThefifthiteminSPIKESisaddressingthepatient’semotions.Youshouldidentifytheemotionthepatientisexperiencing,thereasoning,andprovidesupportduringthisdifficulttime.Don’ttrytochangethepatient’semotions,justhelpthemtoexpresshowtheyfeel.Forexample,inapatientwhoisdysphoricandcrying,youcanofferatissueboxandphysicalsupportifappropriate.Youmightsaysomethinglike,“Iknowtheseresultsweren’twhatyouwantedtohear.Iwishwehadbetternewsforyou.”Otherresponsescanrangefromaskingthepatienttoelaborateontheirreaction,“Canyoutellmewhatyou’reworriedabout?”tovalidatingtheirconcerns,“Icanunderstandwhyyoufeltthatway.Manyotherpatientshavehadsimilarreactions.”

ThesixthiteminSPIKESisstrategyandsummary.Patientswhoreceiveseriousnewswilloftenfeelthattheyareinovertheirhead,soyoushouldmakesurethattheyleavewithaclearplanforthefuture.Thiswillhelpthemtofeellessanxiousandmorehopeful.Patientsshouldknowwhatoptionsareavailableforthemandwhatfollow-upisplanned.Youshouldalsorecheckthattheyunderstandwhathasjustbeendiscussedandhavehadalltheirquestionsanswered.Agoodopeningstatementcouldbe,“Iunderstandthisisalottotakein,butyouhaveseveraloptionsavailable.Adecisiondoesnotneedtobemadenow,butwewouldliketoreferyoutoanoncologistandfollow-upwithusinaweektodiscussyournextsteps.”

Givingseriousnewsisoneofthemostdifficultpartsofbeingahealthcareprofessional.However,withcarefulplanningandaneffectiveprotocol,patients

canleavefeelingwell-informedandincontroloftheirownoutcome.

Text1:Questions1to8

1. Whydoesthewriterprefertheterm‘seriousnews’?

Itenablesdoctorstoavoidunnecessaryconversations.(A)Itavoidsinfluencingthepatient’semotionalresponse.(B)Ithelpspatientstobetterunderstandtheircondition.(C)Itoffersamorespecificdefinitionoftheinformation.(D)

2. Thewriter’spurposeinthesecondparagraphistohighlight

thetreatmentoptionsavailabletomostpatients.(A)thedifficultyofknowingwhatapatientwantstobetold.(B)thetrendsconcerningwhatpatientsandrelativeswanttohear.(C)thedifferenttopicsthathealthcareworkersshouldcoverwith

patients.(D)

3. Whatdoestheword‘those’referto?

healthcarestaff(A)treatmentexperts(B)languagetranslators(C)patientsandrelatives(D)

4. Inthefourthparagraph,thewritermentionsthepatient,Harry,inordertoexplainthat

patientsareoftenreluctanttoaskforhelp.(A)patientsmaynotbeawareoftheirignorance.(B)healthcareprofessionalsoftenfindithardtorelatetopatients.(C)healthcareprofessionalsmaynotalwaysexplainthings

effectively.(D)

5. Thewritersuggeststhatolderpatientsmaybemorelikelyto

requiremoreinformation.(A)limittheirfamily’sinvolvement.(B)acceptthestaff’ssuggestedplan.(C)inquirefurtherabouttheirtreatmentplans.(D)

6. Inthesixthparagraph,thewriteroffersanexampletoemphasisethatwhenexplaininginformationprofessionalsshould

avoidusingcomplexmedicallanguage.(A)preventpatientsfrombecomingupset.(B)discusshowtheillnesswasidentified.(C)repeatinformationmultipletimes.(D)

7. Theseventhparagraphfocuseson

ensuringthepatientunderstandshowtoreact.(A)

helpingthepatienttofeelmorepositive.(B)comparingdifferentpatientresponses.(C)empathisingwiththepatient’sreaction.(D)

8. Theexpression‘inovertheirhead’isusedtostressthatpatientsmight

findtheinformationoverwhelming.(A)struggletorememberinformation.(B)makeachoiceabouttheirtreatmentquickly.(C)havedifficultyunderstandingtheirprognosis.(D)

TEXT2:TREATINGOPIUMADDICTION

IntheUnitedStatesalone,therearearound115deathscausedbyopioidaddictioneveryday.Theaddictionimpactsindividualsrapidlyanddrastically,damagesfamilies,andcoststheUShugeamountsofmoney:thetotaleconomicburdenofprescriptionopioidabuseisestimatedtobe$78.5billionayear,whiletheeconomicburdenofnon-prescriptionopioidabusesimplycannotbecalculated.Measuresareconstantlybeingimprovedtopreventpatientsfromdevelopingopioidaddictionstobeginwith,butitisalsoimperativethatwecontinuetoprovidetreatmentforthosealreadyinthethrallofopioidaddiction.

Jane’sstoryisoneheardoverandoveragaininopioidaddictionclinics.Whenshewas20,shehadabadautomobileaccidentthatrequiredtwosurgeries.Shewassoonhomefromthehospitalbutherresidualpainmeantshewasprescribedscheduledopiates.Jane’sbodysoonbecametolerantofthedosage;however,andsheneededhigherandhigherdosesinordertoachievethesamepainrelievingeffect.Sheeventuallyreachedalevelthatherphysicianfeltuncomfortableprescribing.Unabletofindanotherprescriberintime,Janeturnedtoalternativesourcesofnarcotics.Unfortunately,whenpurchasedonthestreet,thesepillsareexorbitantlyexpensiveandincreasinglyhardtocomebyinaneraofprescriptionmonitoringthroughouttheUnitedStates.Heroinismuchcheaperand,whendeliveredbyIV,producesamuchmorepotenthighandgreaterpainrelief.

Eventually,afterdestroyingrelationshipswithherlovedones,bankruptinghersavings,andhittingrock-bottom,Janeturnedtoalocalopioidaddictionclinicforhelp.Attheclinic,theyputheronMethadone,along-actingopioidagonistthatisstandardforaddictiontreatment.Itbindstothemu-opioidreceptors,preventswithdrawalsymptoms,reducescravings,andcanalsoprovidealevelof

painrelief.Ofcourse,asanopioidagonist,methadoneservesasasubstitutefortheprimaryaddiction,meaningmanyoftheissuesassociatedwithlong-termopioidusageremain.Patientsmustoftenbegintreatmentwithdailyvisits,whichcanbedisruptive.FortunatelyforJane,thesevisitsareherfirststepstowardsputtingherlifebacktogether.AsJane’sroadtorecoveryislikelytobelongandfraughtwithdifficulty,manydoctorsareledtowonder:doesshehaveanyotheroptions?

Oneoftheincreasinglypopularalternativestomethadoneisbuprenorphine,apartialmu-opioidagonist.Asidefromitsuniquemechanismofaction(MOA),therearetwomajordifferenceswhencomparedtoMethadone:first,itcanbeadministeredasoraltablets,sublingual/buccalfilms,andalong-actingimplant,second,Itcanbeprescribedmonth-to-monthfromaclinician’sofficedirectlytoalocalpharmacy.Thesefactorsmakeitmucheasiertouseinthecommunity,andareidealforpatientswhocannotvisitamethadonecliniceveryday.

Toinitiatebuprenorphine,apatientmustalreadybeinamildstateofwithdrawalduetothehighaffinityforthemu-opioidreceptordisplacingotheropioids.Thismeansthatpatientsgenerallytransitionbestfromashort-actingopioidlikeheroinoroxycodoneratherthanalong-actingopioidagonistlikeMethadone,giventhelengthoftimeneededuntilmildwithdrawaloccurs.AsJanehadbeenusingopioidsforalongtimepriortoheradmission,however,shewasbettersuitedtotreatmentwithMethadone,asthereisnoceilingeffecttothisdrug,andJanehaddevelopedahightolerancetoopioids.Buprenorphine,beingapartialagonist,hasamaximumlevelofeffectwhichitcannotbeincreasedbeyond.Forthisreason,buprenorphinecanbeusedasamaintenancetherapyinsomepatients,butitcanalsobetapereddownovertime.Thisallowspatientstoresumetheirnormalliveswithminimalinterruptionsandavoidrelapsethroughpharmacologicalblocking.

Alongsidetreatmentwithmedication,patientsrecoveringfromopioidaddictionmustalsodealwithrecoveryatamentallevel.Aswithmanyhealingprocesses,thefirststageisacceptance.Janewasnotabletoseekthetreatmentsheneededuntilshehadnowhereelsetohide.Onceeverythingwaslost,shecouldn’tdenythatshewasintroubleanymore,soshecametotheclinic.Manypatientssufferingfromopioidaddictionsarereluctanttoadmitthattheyareaddicted,andreluctanttoaskforhelp.Patientsareoftenworriedaboutbeingjudged,beingtreatedlikeacriminal,andmeetingwithdisapprovalfromthehealthcareprofessionalswhomusttreatthem.

Whenpatientsdoseekaid,healthcareprofessionalsneedtohelpthemtobuildasupportnetworkaroundthemselves,sothattheyareprotectedwhentheyfeeltheneedtorelapse.Opioidaddictsarelikelytohaveburnedbridgeswithfriendsandfamilywhohavenotenabledtheiraddiction,sopatientsbeginningrecoverymaynothavepositiverolemodelstosupportandinfluencetheirrecovery.Talkingtherapies,suchascognitivebehaviouraltherapy(CBT)canbeofferedtorecoveringpatientsexperiencinganxietyordepression,thoughpatientsmayfinditmoreusefultojoinlocalconfidentialsupportgroups,suchasNarcoticsAnonymous,astheycandiscussrecoverywiththosewhohavefirst-handexperience.ThoughJanewashesitanttodiscussherexperienceswithanyonewhenshewasfirstadmittedtotheclinicfortreatment,shehassincegoneontoattendweeklysessionsatNarcoticsAnonymous,whereshenotonlylistenstootherssharetheirstoriesofrecovery,butwhereshealsoisbeginningtotellherown.

Text1:Questions9to16

9. Inthefirstparagraph,thewriterhighlightsthatopioidaddictionintheUS

hasbeengraduallyincreasingforanumberofyears.(A)islargelyinfluencedbytheillegalsaleofdrugs.(B)causesmoredeathsthananyotheraddiction.(C)hasasignificantfinancialandsocialimpact.(D)

10. Inthesecondparagraph,thewriteroutlinesJane’scaseinordertoemphasisethat

opioidaddictionisincreasinglyrare.(A)itcanberemarkablyeasyforapatienttobecomeaddicted.(B)insomecases,heroinislessharmfultoaddictsthanopioids.(C)healthcareprofessionalsmusttakeresponsibilityforopioid

addiction.(D)

11. Thewriterusesthephrase‘hittingrockbottom’aboutthepatientJaneinordertodescribe

howheraddictionledtothemostdistressingpointinherlife.(A)hersuddenawarenessthatshehadtorecover.(B)thelargetoleranceshedevelopedforopioids.(C)thephysicalpainshefeltatthattime.(D)

12. Inthefourthparagraph,thewritersuggeststhatbuprenorphinemaybepreferablebecause

itislessaddictivethanalternatives.(A)

itcanbeeasierforpatientstoaccess.(B)itdoesnotinterferewithothertreatments.(C)itcanbepickedupmoreoftenthanothermedications.(D)

13. Whatdoes‘thismeansthat’referto?

Theeffectivenessofbuprenorphinewhencombatingopioiddisplacement.

Therequirementforthemedicationtobereservedforheroinaddicts.

Theneedforpatientstohavebeguntoexperiencewithdrawals.(C)Theimpactofmu-opioidsonrecoveredopioidaddicts.(D)

14. Inthefifthparagraph,thewritersuggeststhatJanewasprescribedmethadone,ratherthanbuprenorphinebecause

buprenorphineistoosimilartoheroin.(A)theeffectsofmethadonelastforlonger.(B)shewasdependentonhighdosesofopioids.(C)itismorereadilyavailableataddictionclinics.(D)

15. Accordingtotheseventhparagraph,whydopatientsoftendelayseekingtreatmentforopioidaddiction?

Theyareunwillingtofacethedamagetheyhavecaused.(A)Theydonotrealisetheyareaddicteduntilit’stoolate.(B)Theythinkthattheycanrecoverwithouthelp.(C)

Theydonotwanttobelabelledasanaddict.(D)

16. Inthefinalparagraph,thewritersuggeststhatrecoveringaddictsmayprefertodiscusstheirexperienceswith

thosewhohaveexperiencedaddiction.(A)peoplewhoarenotawareoftheirhistory.(B)healthcareprofessionals.(C)friendsandfamily.(D)

Answers

1. Apartoftheiridentity.

2. Bpatientsoftensufferfromvariousconditions.

3. CThelimitedcommunicationoptionsfordisabledpeople.

4. ATheywereheavyandbulky.

5. Bneedforadiverserangeofvoices.

6. Dtheprocessisextremelytime-consuming.

7. Dvoicedonators.

8. CThesyntheticvoiceusedbyStephenHawking.

PRACTICESETS

Questions1to8

1. BItavoidsinfluencingthepatient’semotionalresponse.

2. Cthetrendsconcerningwhatpatientsandrelativeswanttohear.

3. Dpatientsandrelatives

4. Bpatientsmaynotbeawareoftheirignorance.

5. Cacceptthestaff’ssuggestedplan.

6. Aavoidusingcomplexmedicallanguage.

7. Dempathisingwiththepatient’sreaction.

8. Afindtheinformationoverwhelming.

Questions9to16

9. Dhasasignificantfinancialandsocialimpact.

10. Bitcanberemarkablyeasyforapatienttobecomeaddicted.

11. Ahowheraddictionledtothemostdistressingpointinherlife.

12. Bitcanbeeasierforpatientstoaccess.

13. CTheneedforpatientstohavebeguntoexperiencewithdrawals.

14. Cshewasdependentonhighdosesofopioids.

15. DTheydonotwanttobelabelledasanaddict.

16. Athosewhohaveexperiencedaddiction.

THEWRITINGSECTION

WritingIntroduction

SectionOverview

TheWritingTestinOETconsistsofonetask,whichyoumustcompletein40minutesafterbeingallowed5minutesofreadingtime.Youmustreadthenotesprovidedaboutapatientandtheirtreatment,thenwritealetterofbetween180and200wordsapproximatelytoapersonnamedinthetask.Youwillbeprovidedwithaletterwritingtask,whichwilltellyouwhatsortoflettertowrite,whotowriteto,andseveralpagesofpatient'scasenotes,whichyouwillwriteaboutinyourletter.

Thewritingtaskwillbespecifictoyourhealthcareprofession.Inthisbook,wewillcoverwritingtasksforthoseworkinginMedicalandNursingprofessions.

Theletteryouwriteshoulduseinformationfromthepatientnotestocompletethetaskeffectively,andbewithinthewordlimit.

WRITINGSTRATEGIES

KnowtheinstructionsandformatbeforeTestDay,soyouknowwhattoexpectaheadofthetest:youwillalwaysbeaskedtowritealetterof180to200words,andyouwillalwaysbegivenpatientcasenotes.Startbyreadingthewritingtasksectionattheendofthetesttofindoutwhatsortofletteryouneedtowrite,andwhotowritetheletterto.Readthroughthecasenotes,startingwithwhoyouareinrelationtothepatient.Continuereadingthroughthecasenotes,thinkingaboutwhat'srelevanttoyourletterasyoudoso.Pleasenotethatyouareunabletounderlinekeywordsorphrasesduringthe5minutes’readingtime.Planyourletterbyoutliningwhatyouwillincludeinresponsetothewritingtask.Keepyourplanbriefandwriteinnoteform.Writeyourletter,usinginformationinthepatientcasenoteswherenecessary.Donotwriteadditionalpatientinformationintoyourletterwhichisnotcontainedinthecasenotes,youmustnotmakeuppatienthistory,orproposetreatmentoptionsiftheyarenotgiveninthenotes.Donotincludeanyinformationfromthepatientcasenotesthatisnotrelevanttotheletterrequirements.Makesurethetoneofyourwritingisappropriate.Ifyou’rewritingtoanotherhealthcareprofessional,youshouldusemedicalterminologywhererelevant.Ifyou’rewritingtoalayperson,suchterminologyshouldbeavoided.Thetoneofthelettershouldalwaysbeformal.Wherepossible,usearangeoftenses,grammarandvocabularytodemonstrateyourwritingskills.Aimtocompleteyourletteratleast3minutesbeforetheendofthetest,so

thatyouhavetimetoreadthroughyourletterandcorrectanymistakes.

CHAPTER9

TheWritingTask

LEARNINGOBJECTIVES

Analysethetask.Scanthepatientcasenotesforrelevantinformation.Planyourlettereffectively.Practisewritingaletterwithinthewordandtimelimits.

INTRODUCTION

IntheOETWritingTest,youwillbeaskedtowriteonelettertoaanotherpersoninvolvedinapatient’scare.Youwillhave40minutestoplan,writeandreviewyourletter,withanadditional5minutesatthestarttoreadtheletterwritingtaskandpatientcasenotes.

TheWritingTestwillbespecifictoyourhealthcareprofession.Inthischapter,wewilllookatexamplesforNursingandMedicine.

TheWritingTestisassessedusing5criteria.Togetagoodmarkinthissectionofthetest,youmustscorewellineachsection.BelowisanoverviewofthemarkingcriteriausedbyOETassessorstogradethewritingtasks,wewillgointomoredetailabouthowtoscorewellineachsectionlateroninthischapter.

Overalltaskfulfilment

Youmustcompletethetaskwithanappropriateresponsethataccuratelyaddressesthewritingtaskandisroughlywithinthewordcount.Forexample,thelettershouldbebetween180and200words,andifthetaskasksyoutowritealetterofdischarge,youmustmakesurethattheletteractuallystatesthatthepatientisbeingdischarged.

Appropriatenessoflanguage

Youmustmakesurethetoneofyourletterisappropriatetothetask,andtheregister(levelofformalityandtechnicality)issuitableforthesituation.Ifthewritingtaskasksyoutowritetoanotherhealthcareprofessional,itisappropriatetousemedicallanguage,whileifthetaskasksyoutowritetoalayperson,you

mightusemoreeverydaylanguage,andexplaintechnicalwords.Thiscriteriaalsotakesintoaccounttheorganisationoftheletter,withappropriatesequencingoftheinformationappropriatetothegenre.

Comprehensionofstimulus

Youmustwritealetterforthetaskthatusesthenecessaryinformationfromthecasenotes,anddoesnotuseunnecessarypoints.Thiscriteriontestsyourabilitytounderstandthewritingtaskandthepatient’snotes.Toachieveagoodscore,youshouldmakesureyouusealloftheinformationthatisrelevanttothetaskinthecasenotesforyourletter,andonlytherelevantinformation.Forexample,itisunlikelythatyouwouldneedtoincludeinformationaboutthepatient’shistoryofillnessifyouarewritingalettertotheirGPorfamilydoctor.

Controloflinguisticfeatures

Youmustusecorrectgrammarinyourletter,showarangeofgrammaticalstructuresandwritealetterthatiscohesiveandfollowsalogicalorder.Makesuretoreadthroughyourletterafteryouhavefinishedwritingit,tolookforanyerrorsinyourwriting,sothatyoucanfixthesebeforeyoufinishyourtest.

Controlofpresentationfeatures

Youmustavoidspellingerrors,usecorrectpunctuation,anduseclearletterlayout.

Strategies

Beginwiththeletterwritingtask

Beforeyoustarttolookattheinformationinthepatientcasenotes,youshouldfirstturntolookattheletterwritingtask.Thiswillinformyouofthetask,includingwhoyouneedtowriteto,andwhatyouneedtosay.Youshouldaimtospend30secondslookingatthewritingtasktodeterminewhatinformationisimportant,thereasonthatyouarewritingtheletter,andtothinkaboutwhatyourresponsewillinclude,beforemovingontothenextstage.

Exercise

Take30secondstolookatthewritingtaskbelow,thenanswerquestions1–5thatfollow.

WRITINGTASK

Usingtheinformationgiveninthecasenotes,writealetterofreferralforMrWalterPeterstoDrNShah,theAdmittingOfficeratNewCanterburyHospital,1ChurchStreet,Canterbury,forfurtherassessmentandtreatment.

Inyouranswer:

Thebodyofthelettershouldbeapproximately180–200words.

ExpandtherelevantnotesintocompletesentencesDonotusenoteformUseletterformat

1. Whoisthepatient?

2. Whowilltheletterbeaddressedto?

3. Whatishappening,thatmustbedescribedintheletter?

4. Wheremusttheletterbeaddressed?

Thesectionofthewritingtaskshowninboldwillbethesameforeverywritingtask,somakesureyouarefamiliarwiththeseinstructions.Theinstructionsemphasisetheimportanceoftakingthecasenotesandalteringthemwherepossible,tocreatealetterthatnotonlycommunicatesthetaskgivenintheletterwritingtask,butdoessoinawaythatdemonstratesyourwritingabilities.Togetahighscore,youmustexpandthecasenotes,andcreatealetterthatusescomplexsentences,arangeofappropriatevocabulary,andvariousgrammaticalstructures.Thecasenotesyouwillbeprovidedwithwillbewritteninbriefnoteform.Thecasenoteswilloftenincludeshortwordsandphraseswhicharenotcompletesentences,andtheymayincludecommonlyusedmedicalabbreviations.Thecasenoteshavebeenwrittenbyahealthcareprofessional,forotherhealthcareprofessionalswithintheirhospitalorclinic,soacertainamountofunderstandingisexpected.Assuch,aswellasexpandingthecasenotesintofullsentences,youshouldalsomakesurethatyouchangethewordingsothatitissuitablefortheintendedaudience,giveninthetask.Whileyoureadthetask,youshouldbegintoconsiderhowyoumightdemonstrateyourwritingskillsinthistaskandrespondappropriatelytothetask.

Thewritingtaskwillusuallyaskyoutowritealetterofreferral.Othertypesofletterwhichmightbeusedinthetestincludeadischargeletteroraletterofexplanation.

ScantheCaseNotesActively

Thenextstageinthewritingtaskistoscanthepatientcasenotes,whilekeepingtheletterwritingtaskinmind.Thepatientcasenotesprovidedwillcoverseveralpages,andprovidealotofinformation.Youarenotallowedtounderlinewordsorwriteonthecasenotesduringthistime,butyoushouldscanthecasenotesactively,andidentifykeywords,phrasesandinformationthatarerelevanttothe

letteryouwillneedtowrite,sothatyoucanincorporatethemintoyourletter.Youshouldspendthewhole5minutesreadingtimescanningthepatientcasenotescarefully,andidentifyingrelevantinformation.

Exercise

Scanthepatientcasenotesbelow,andmakeamentalnoteofanykeypiecesofinformationthatwouldberelevantforaletterwritingtaskthataskedyoutowritealetterofdischargetoarehabfacility.Timeyourselffor5minutesandafterthistimehaselapsed,gothroughthecasenotes,underlininganythingwhichyouthoughttoberelevant.

Notes:

MsLydiaFrankisa49-year-oldfemalewhowastransferredfromtheneurointensivecareunit(NICU)totheneurotelemetryunit.

Hospital: LexingtonHospital

Patientdetails:

Name: LydiaFrank

Maritalstatus: Divorcedfor8years

Nextofkin: Darlene(daughter–24-years-old,unemployed)

Admissiondate: 20January2018

Dischargedate: 13April2018

Diagnosis: Subarachnoidhemorrhage(SAH)

Pastmedicalhistory: Hypertension(2015)

Hyperlipidemia

Migraine

Anxietyanddepression

Smoker(approx.10cigsperweek)

Socialbackground: Worksfulltime–accountant,financiallyindependent.

Presenting

Complaint:

Foundunresponsiveatwork.Complainingof“worstheadacheever”.

Admission20/01/2018

Assessment: Vomituspresent.SAH.Pupilsequal,round+reactivetolight.

BP220/110mmHg.Endotrachealintubationperformed(weanedfrom

mechanicalventilationweek2).

Nosupplementaloxygenrequired

CraniotomyandendovascularcoilingperformedtotreatSAH

Developedcentralline-associatedbloodstreaminfectionandurinarytract

infection–multipleroundsofIVantibiotics.

21/01/2018: Orientedtoperson,place,time,andsituation-slowtorespond.

BPveryunstable.

Antihypertensivemedicationsadjusted5timessinceadmission(currently

takingclonidinePRN,scheduledlisinopril,scheduledlabetalol).

BPwithinnormallimits(145/90-150/80mmHg-oneweek)

Noreportsofheadache1/7.Left-sidedweaknessslowlyimproving.

Nursing

management:

NeurologicandBPchecksevery4hours.

Encouragepatienttobeseatedinbedsidechairformeals(→requires2

assiststopivotfrombedtochairsecondarytoleft-sidedweakness).Requires

assistancewithfeeding.

Nectarthickliquidsrequired.

Medicationscrushedwithapplesauce.

Assessment: Goodprogressoverall.

Dischargeplan: Dischargetorehabfacility,continuenursingmanagementasabove.

PlanYourResponse

Duringthereadingtime,readtheletterwritingtaskandidentifyrelevantpointstoincludeinyourletterfromthecasenotes.Youshouldnowhaveanideaofwhatyourletterwillinclude.Oncethewritingtimestarts,thenextstageistoplanyourletterbyoutliningthestructureofyourcorrespondence.Thekeywordsinthecasenotesarethewordsandphrasesthatrelatetothepurposeoftheletteryouneedtowrite,forexample,ifyouneedtowritealetterreferringthepatientforfurtherassessment,thenyoushouldlookforwordsinthecasenotesthatrelatetotreatment.Theinformationinthecasenotesthatrelatestopastmedicalhistoryislikelytoincludeinformationthatisnotrelevanttoyourletter.

Beginplanningyourletterbythinkingaboutthepersonyouarewritingto.Asmentionedearlier,thinkaboutthetoneyouwilluseforthepersonyouarewritingto,andalsothinkabouttheinformationtheywillneedtocompletenecessaryactionsafterreceivingyourletter.Askyourselfthefollowingquestionsasyouplan:

Whoareyouwritingto?Whyareyouwritingtothem?Whatdotheyneedtoknow?Whatdotheyknowalready?

Thelastquestionisimportantasinsomecases,thepersonyouarewritingtowillalreadybefamiliarwithsomeoftheinformation,soyoushouldavoidusinginformationfromthecasenotesthattheyarealreadylikelytoknow.

Asyoucontinuetoplanyourletter,thinkaboutwherethedifferentpartsofinformationmightappear.Thecasenotesyouareprovidedwithwillnotnecessarilypresenttheinformationinthebestorderforyourletter,soyoushouldplantousedifferentareasofthecasenotesforvariouspartsofyourletter.Itmightbebesttothinkaboutthreeorfourbroadpointsthatyouwanttocover.Forexample,whenwritingaletterofdischarge,youmightwanttodiscuss:

Onceyou’vedecidedonthepointsyouwillcover,youcanbegintoaddtoeachpointfromthecasenotes.Rememberthatthereareavarietyofdifferentapproachestotheletterwritingpartofthetest.Theoutlineprovidedbelowoffersanexampleofhowyoumightstructureyourresponsetothetask,butyoumayprefertouseadifferentoutlinetoplanyourletter.Asyoupractisethewritingtask,trytovaryyourresponsesforeachtask,ratherthanfollowingasetformat.Practisingdifferentwaystowritewillimproveyouroverallwritingabilities,prepareyouforanunexpectedwritingtaskonTestDay,andmakesureyouarepreparedtowritehealthcarelettersinEnglishintherealworld.

Asanexample,youmightcreatethefollowingplanforaletterofreferralusing

Whythepatientwasunderyourcare.Howthepatientwastreated.Whenthepatient’scurrentsituationwillchange(iftheyarebeing

dischargedorreferred).Whatthepatient’scurrentstateis,andwhatthepatient’scurrenttreatment

thecasenotesaboutLydiaFrankontheprevioustwopages.Pleasenotethatyoushouldavoidspendingmorethan5minutesplanningsoyoumaynotbeabletodevelopsuchadetailedplanonTestDay.

LydiaFrank(F)torehabfacility

Noticethattheplanbreakstheletteroutintofourseparatesections,andusesinformationfromthecasenotestosupporteachsection.

WhywasFadmitted?NICU20January2018–becausesubarachnoidhemorrhage(SAH)at

work.unresponsiveandreceivingmechanicalventilation

Whatwastreatment?2ndweektakenoffmechanicalventilation-madegoodprogressat1st-craniotomy+endovascularcoiling–SAHMs.treatment

complicated-centralline-associatedbloodstreaminfection+urinarytractinfection

CurrentconditionFwithoutinfectiongoodcougheffort,nosupplementaloxygenreq.,+

awareofperson,place,time,situation–BUTslowrespond.

Current/futuretreatment?F’sbloodpressurenowcontrolled-scheduledlisinopril,scheduled

labetalol,+PRNclonidine-crushedwithapplesaucenectarthickliquidsamustneedsassistance2people-pivotingbedtochair+ambulation–left-

sidedweakness.BP+neurologicalchecksevery4hours.

Now,completetheexercisebelowusingthecasenotesthatbeginbelowandfinishonthefollowingpage,andtherelevantTask1onpage130.

Exercise

Lookatthewritingtaskandpatientcasenotesonthefollowingpages.Take5minutestoreadthecasenotesandidentifythekeywords,thentakeafurther5minutestomakeabriefplanforyourletter.

Ms.BethanyTailorisa35-year-oldpatientinthepsychiatricwardwhereyouareworkingasadoctorornurse.

Hospital: St.Mary’sPublicHospital,32FredrickStreet,Proudhurst

PatientDetails: MsBethanyTailor

NextofKin:HenryTailor(father,65)andBarbaraTailor

(mother,58)

Admissiondate: 01March2018

Dischargedate: 18March2018

Diagnosis: Schizophrenia

Pastmedicalhistory: Hypertensionsecondarytofibromusculardysplasia

PrimaryhypothyroidismLevothyroxine88mcgdaily

Socialbackground: Unemployed,ondisabilityallowanceforschizophrenia.

Historyofpolysubstanceabuse,mainlycocaineandalcohol.

Lastusedcocaine28/02/18:

Admission01/03/2018: Patientself-admitted:decompensatedschizophrenia

Medicalbackground: Notcompliantwithmedications.

Admittedforauditorycommandhallucinationstellingpatientto

harmself.

Visualhallucinations–shadowfigureswithgrinningfaces.

Delusion–personalconnectionstovariouspoliticalleaders.

01/03/2018–agitatedandaggressive,respondingtointernal

stimuliwiththoughtblockingandlatency.

Commencedantipsychoticmeds(rispoderone).

10/03/2018:Patientceasedreportingauditoryorvisual-

hallucinations.

Lessdisorganisedthinking.Nosignsofthoughtblockingor

latency.

Abletominimisedelusionsandfocusonactivitiesofdaily

living.

Nursingmanagement: Assessforobjectivesignsofpsychosis.

Redirectpatientfromdelusions.

Ensuremedicalcompliance.

Helpmaintainbehaviouralcontrol,providetherapyifpossible.

Assessment: Goodprogress,chronicmentalillness,candecompensateifnot

onmedicationsorabusingsubstances.Insightgood,judgment

Dischargeplan: DischargeonRisperidone4gnightlybymouth.

Risperidone1milligramavailabletwicedailyp.r.nforagitation

orpsychosis.

Dischargebacktoapartmentwithfollow-upatProudhurst

MentalHealthClinic.

MedicalWritingTask1

Usingtheinformationgiveninthecasenotes,writeadischargelettertothepatient’sprimarycarephysician,Dr.GiovanniDiCoccio,ProudhurstFamilyPractice,231BrightfieldAvenue,Proudhurst.

Inyouranswer:

NursingWritingTask1

Usingtheinformationgiveninthecasenotes,writealettertothereceivingnurseatthelong-termcarehomewherethepatientwillgofollowingdischarge,MariaDiCoccio,ProudhurstMentalHealthHome,231BrightfieldAvenue,Proudhurst.

Inyouranswer:

Expandtherelevantnotesintocompletesentences

WriteYourLetter

Onceyou’veoutlinedthestructureofyourresponse,youcanmoveontowritingtheletteritself.Readthroughthefollowingstrategiestofamiliariseyourselfwiththetypeofletteryoumustwrite.Thestrategieswillcoverhowyoushouldwriteyourletter,andthecriteriayouwillbemarkedagainst.

HeadingsandEndings

Yourlettershouldalwaysbeginbygivingthedate,theaddressandnameoroccupationofthepersonyou’rewritingto,andagreetingtothepersonyou’rewritingto.Belowisanexampleofanappropriateintroductiontoaletter.

DonotusenoteformUseletterformat

DJHorus

PerthRehabilitationHospital

23-40MainStreet

20April2018

DearDrHorus,

Exercise

Practisefollowingasimilarformatwhenyouattemptyourwritingresponses,untilyouarefamiliarwiththeseheadings.

Overalltaskfulfilment

Toaddressthiscriteria,youshouldaimtowritebetween180-200wordsinthebodyofyourletter(after‘Dear___’andbefore‘Yourssincerely’).Thereisnoneedtocounttheexactnumberofwordsyouhavewrittenbutitisagoodideatoknowroughlyhowmanylinesofyourhandwritingare180-200words.Youcanworkthisoutbycountingthewordsofonefulllineofyourwritingandthendividing200bythisnumbertogiveyouthenumberoflines.Then,everytimeyoucompleteapractisetest,youcancheckyouhaveroughlythisnumberoflines.Ifyouhavewrittenmorethanthis,checkyouhaveincludedallrelevantinformationandleftoutallirrelevantinformationtheneditaccordingly.Keepinmindthatyourwordcountisjustoneindicationthatyou’veincludedrelevantinformation.It’spossiblethatyoumighthaveincludedtherightinformationbutstillmightfallslightlyoutsideofthe180to200wordrange.Fallingoutsideofthiswordrangedoesnotnecessarilymeanyou’llscorepoorlyinthiscriteria.

Youmustalsomakesurethatyouarewritingthetypeofletterspecifiedinthetask.Paycloseattentiontowhatthissectionsays,andbuildyourresponse

5. Usingtheletterwritingtaskprovidedonpage124,writeanappropriateheadingtoaletter.

aroundthetask.Don’ttrytopreparearesponsebeforelookingatthetask,ortryandmemorisealetterthatyoucanreproduceonTestDay,asthiswillnotshowthatyouareabletorespondappropriatelytothetaskthatisgiven.

Youshouldalsoavoidcopyingentirephrasesexactlyastheyappearinthecasenotes.Thisisnotagoodplanfortworeasons:

Demonstrateyourskillsbywritingaletterthatincorporatestherelevantfactsappropriatelyandinyourownwords.

Appropriatenessoflanguage

LettertasksintheWritingTestwillalwaysaskyoutowritelettersintheroleofahealthcareprofessional.Assuch,youshouldalwaysuseasuitablyformaltoneinthewritingsection.Youshouldavoidusingcasuallanguageoridioms(‘how’sitgoing?’),andwriteinfullwords,ratherthancontractions(‘can’t’‘isn’t’)orSMStextabbreviations(use‘before’,not‘b4’).

Ifyouarewritingtoahealthcareprofessional,youcanusetechnicalterminology,whereas,ifyouarewritingtoalayperson,youshouldmakesuretoexplainmedicalterminologythatmaybeunfamiliar.

Thephrasesusedinthecasenotesareinnoteform.Theyaregenerallynotappropriateintheircurrentstateforaletter,soyoumustexpandthesephrases,inordertowriteinanappropriatestyle.

Theassessorcanalsoseethecasenotes.Ifyoucopythelanguageinthecasenotesexactly,theassessorwillnotbeabletoassessyourunderstandingofthecasenotes,oryourwritingability.

Youshouldalwaysbeginyourletterbystatingwhatthepurposeofyourletteris.Ifyou’rewritingaletterofreferral,youmightbeginyourletterwithasentencelike

Notethatinthisexampleweincludedthedate,tomakesurethatthemostimportantinformationisprovidedtotherecipientoftheletterinthefirstsentence.Youshouldalsoincludedates,timesandtimeperiodsthroughoutyourletter,anduselanguagethatclearlysequencesthetime-periodoftheinformation,inordertoprovideaclearordertoyourletter.Forexample,insteadofwriting

Youcouldsaysomethinglikethis:

Lookatthevariouswaysthesecondexamplelinksthedifferentpiecesofinformation,andallowsreadertoseethesequenceoftheeventsmoreclearly.

Ifthetaskrequiresyoutowriteanurgentletter,youshouldmakethisclearin

JoannaHowardswillbedischargedtoyourNursingFacilityon12October2018.

Thepatientwasdiagnosedwithcanceroftheoesophagusandhadanoesophagectomyandchemotherapyandlostaconsiderableamountofweight.

Thepatientwasdiagnosedwithcanceroftheoesophaguson24thApril.Chemotherapywasscheduledtobegininthefollowingweekandlastforatotalofthreeweeks.Thepatientlostaconsiderableamountofweightasaresultofthistreatment.Anoesophagectomywasthensuccessfullycarriedouton3rdJune.

yourletter,too.Anurgentlettermayalsorequireyoutochangethestructureoftheletter,forinstance,youwouldneedtoputthepatient’scurrentconditionatthebeginningofanurgentletter,whileiftheletterwasnoturgent,itmightbemoreappropriatetobeginwiththepatient’shistory.Thetoneofyourlettershouldalwaystakeintoaccountyouraudienceandthepurposeofyourletter.Youcanonlyuse180–200wordsinyourletter,sothereisnotenoughroomforyoutoincludeanyunnecessarydetails.

Comprehensionofstimulus

Tomeetthiscriterion,youneedtoshowthatyouhaveunderstoodthecasenotes.Youcandothisbyusingthecasenotesappropriatelytocreatealetterthatfullyaddressesthetask.

Ratherthantryingtouseasmanycasenotesaspossible,thinkaboutwhattheindividualyouarewritingtoneedstoknow.Ifyouincludeinformationthatisnotrelevanttothetask,youwillreceivealowerscore,soonlyincludeitifyouthinkitisrelevanttoyourletter.Ifyouincludetoomuchsurroundingdetail,thenitwillalsomakeitdifficultfortheassessortoassessthatyouhaveunderstoodthetask.

Putthecasenotesintoyourownwordswhereverpossible,andconnectthecasenotestogetherappropriately.Remember,youshouldnotaddanyinformationtoyourletterthatisnotincludedinthecasenotes.

Exercise

Nowthatyou'vespentthe5minutesreadingtimereadingthroughthecasenotes,andanother5minutesplanningyourresponse,spendanother35minutestocompleteyourletterusingtheletterwritingtaskandpatientcasenotesonpages

128–130.Besuretoallow3-5minutesattheendtocheckyourwritingforerrors.

CheckYourLetterforErrors

Onceyouhavefinishedwritingyourletter,youshouldmakesuretocheckthroughwhatyouhavewrittenandcorrectanyerrors.Onceyouhavelookedthroughyourletterandidentifiedyourerrors,makealistofyourmostcommonerrors,andmakeanefforttotargettheseareasinparticular,beforecompletinganotherwritingtask.Forexample,ifyoucommonlymakearticleerrors,makesuretorevisethecorrectarticlestouse,forexample,youshoulduse‘inthebloodstream’ratherthan‘inbloodstream’,and‘aheartattack’shouldbeused,ratherthan‘anheartattack’.

GrammarandCohesion

Makesurethatyoushowthatyoucanvaryyourlanguagewhilewritingthetask.Onewaythatyoucanshowvariationinyourwriting,istotalkaboutpatientcareinthepast(forexample,whathasbeendonesofar),thepresent(forexample,thepatient’scurrentcareplan)andthefuture(forexample,howthepatient’streatmentshouldprogress).Youcanusesimplesentences,butyoushouldalsousecomplexsentencestoo.Whenyoureadthroughyourletter,lookatthelengthofthesentencesyouuse.Ifyouhavelotsofshortsentences,considerusingconnectivestojoinsomeofthesesentencesintolonger,complexsentences.Ontheotherhand,ifyouhavealotofverylongsentences,youmightwanttosplitthiscontentupintosmallersentences,orremoveinformationthatisnotnecessary,tomakesurethatyourwritingiscontrolled.

SpellingandPunctuation

Yourspellingandpunctuationwillalsobeassessedsowhenyoureviewyourworkyoushouldmakesurethatyourwordsarespelledcorrectly,andyourpunctuationisappropriate.InOET,youcanuseanyspellingconvention,suchasAmerican,AustralianorBritish.Whicheverspellingconventionyouchoosetouse,youmustkeeptothisconventionthroughoutyourwritingtask.Foryourinformation,thisbookiswritteninBritishEnglish.

Whencheckingyourwork,ifyouspotawordthatlookslikeitisspelledincorrectly,butyoucannotrememberhowthewordshouldbespelled,considerreplacingitwithasynonymthatiseasierforyoutospell.Itismoreimportantthatyoucommunicateeffectivelythanthatyouuselongwords.Rememberthatmostofthehealthcaretermsyouusewillbeinthecasenotes,sobesuretocheckyourspellingofthesewordsagainstthecasenotesasyoureviewyourletter.

Makesurethatyouareusingenoughfullstopstoseparatedistinctpiecesofinformation,andusingenoughcommastoseparateyourideaswithinsentences.Asyoureadthroughyourwork,readyourlettertoyourselfinyourhead,pausingforcommasandfullstops,andcheckthatit‘sounds’righttoyou.Ifitdoesn’t,lookatchangingyourpunctuation.Remembertoleavespace(oneblanklineisideal)betweeneachparagraph,sothattheassessorcanclearlyseethatyouhavesectionedyourwritingintoalogicalstructure.Eachparagraphshouldaddressonemainpointinyourletter.

Youneedtowriteclearlyandneatly,sothattheassessorcaneasilyreadyourhandwriting.Ifyourwritingisdifficulttoread,theassessormaynotbeabletoassessyourwritingability.Ifyoustrugglewithwritingneatlyandlegibly,practisewritinginEnglish,andaskotherpeopletoreadwhatyouhavewritten.

Exercise

Afterreadingthroughthelasttwocriteriainthesectionabove,take10minutestogooveryourletterandcorrectanymistakes.

TrytomakereadingandwritinginEnglishapartofyoureverydaylife.Themoreyouread,thebetteryourwritingwillbecome.WhenyoupractisewritinginEnglish,youcanfocusonwritingonmoregeneraltopics,aswellasfocusingonhealthcaretopics.Thiswillbroadenyourwritingskills,andhelpyoutoscorewellonTestDay.

IMPROVEYOURSCORE

Eachtimeyouwriteapracticeletter,youshouldassessitbasedontheofficialOETcriteria.Visitwww.occupationalenglishtest.orgtofindthelatestversion.Ifpossible,youcouldalsoaskafriend,familymemberorcolleaguewithgoodEnglishskillstoassessyourresponse.

IMPROVEYOURSCORE

Timeyourselfeverytimeyouwriteapracticeletter.Alwaysallowafewminutesbeforethetimeisuptocheckyourworkforspellingmistakes,inappropriatewordsandanyotherproblemswithyourgrammarorphrasing.

IMPROVEYOURSCORE

Makesureyouunderstandanycasenotesyouwillincludeinyourletter,andmakesuretoputthepatientcasenotesintoyourownwordswherepossible,toachieveahighscoreonTestDay.

IMPROVEYOURSCORE

Don’ttrytomemoriselongsectionsofletterstoreproduceonTestDay.Whileitcanbehelpfultoknowgeneralphrasesandterminologytouseinyourletter,preparinglargersectionsofwritingtouseinyourletterisunlikelytorelatetothewritingtask,ormakegooduseofthepatientcasenotes,andwillresultinalowerwritingscore.

IMPROVEYOURSCORE

Themoreyoupractisewritingwithinthewordcount,theeasieritwillbecometopredicthowmanywordsyouneedwithoutcounting.ThiswillsavevaluabletimeonTestDay.Toquicklyestimatehowmanywordsyouhaveused,youcancountthenumberofwordsinonelineofyourletter,andthenmultiplythisbythenumberoflines.However,aslongasyoumakesureyouarechoosingalloftherelevantcasenotesfromthecasestudy,andonlytherelevantcasenotes,yoursampleresponseshouldnaturallyfallwithinthewordcount.

WritingPracticeSet

ReadthecasenotesbelowandcompletetheWritingTasksthatfollows.ForeachWritingSet,therearetwoWritingTasks,oneforNursing,andoneforMedicine.Choosethetaskthatbestreflectsyourhealthcareprofession.Youshouldspend5minutesreadingthecasenotesand40minuteswritingyourletter.

Notes:

YouareanurseORafirstyearresidentinasurgicalward.SallyFletcherisa25-year-oldwomanwhohasrecentlyundergonesurgery.Youarenowdischargingherfromhospital.

Hospital: Fairbanks

Hospital,1001NobleSt,Fairbanks,AK99701

Name: MrsSallyFletcher

DateofBirth: 3/10/1993

Maritalstatus: Married,5years

Appointmentdate: 25/03/2018

Diagnosis: Endometriosis

Pastmedicalhistory: Painfulperiods

3years

Wantschildren,trying

1year++

Socialbackground: Accountant,regularwesterndiet.

Exercises3xweek

localgym

Medical

background:

Frequent

acutemenstrualpainlocalisedtothelowerleftquadrant.

PainpersistsdespitetakingOTC

naproxen.

Shydiscussingsexualhistory.

Occasionalconstipation,

associatedwithpaininlowerleftquadrant.

Trans-vaginalultrasoundshowing6cmcyst,likelyofendometrial

origin.

Patientrecoveringpostopfromlaparoscopicsurgery(25/03/2018)

–nocomplications.

Postopcare: Keepincisionscleananddry.

Showeringispermitted26/03/2018

Mobilitypostop: Patientcanambulateifconfident.

Drivingisprohibitedwhenonanalgesics.

Drivingcanberesumed24-48hrsafterfinaldose

analgesics.

Sexualactivitycanberesumed2weekspostop.

Nursing

management:

Encourageoralfluids.

Patientmayreturntoregulardiet.

Ambulationencouragedasperpatienttolerance.

Medicalprogress: Afebrile.Hct,Hgb,Plts,WBC,BUN,Cr,Na,K,Cl,HCO3,Glu

allwithinnormallimits.Patient

sittingcomfortably,

alert,

oriented×4(person,place,time,situation).

Assessment: Goodprogressoverall.

Dischargeplan: Patienttobedischargedwhencaneat,ambulate,urinate

independently.

Patientmustbedischargedtosomeonewhocandrivethemhome.

MedicalWritingTask2

Usingtheinformationgiventoyouinthecasenotes,writealetterofdischargetothepatient’sGP,DrStevens,MillStreetSurgery,Farnham,GU101HA.

Inyouranswer:

NursingWritingTask2

Usingtheinformationgiventoyouinthecasenotes,writealettersummarisingthepatient’sconditionandcommunicatingdischargeinstructionstothehomehealthnurse,JoanStevens,MillhouseVisitingNursesAssociation,Farnham,GU101HA.

Inyouranswer:

YouareaphysicianOR

anurseatafamilymedicalpractice.MsTabithaTaborlinisa45-year-oldpatientatyourpractice.

Office: FirstFamilyPrimaryCare,3959AbaloneLane,Omaha

PatientDetails

Name: TabithaTaborlin(Ms)

Maritalstatus: Single

Nextofkin: GregoryTaborlin(69,father)

Dateseen: 08April,2018

Diagnosis: Type1diabetesmellitus

Pastmedicalhistory: Essentialhypertension

Type1diabetesmellitus(non-compliantwithinsulinregimen)

Multipleepisodesofdiabeticketoacidosis(DKA)

Socialbackground: Schoolteacher,livesaloneinapartment

Doesnotexercise,BMI

18.2(underweight-48kg)

Smokesmoderately(2cigsdaily)

Medical

background:

LonghistoryofType1diabetes(since7y.o.)andnoncompliance

withinsulinregimen.

45units

LantusnightlyandpreprandialcorrectionalscaleHumalogwith

12unitnutritionalbaseline.

02/04/2018:admittedDKA(glucose530mmo/L)

IVfluidsandinsulinadministered.Dischargestable-HbA1c.

Appointmenttoday: Doingwellsincedischarge.

Stillnotusinginsulin.Hasinsulinavailable.

Notfollowingrecommendeddiet.

Discusseddiabeteseducation,

necessityofglucosetesting,insulinadministration,smoking

cessationeducation.

Discussedmicrovascular/macrovascularcomplicationsofdiabetes.

Plan: Dischargetoday–provideeducationalpamphletsandrefillsfor

LantusandHumalog.

Referraltoendocrinespecialistforstricterglycemiccontroland

possibleinsulinpump.

Follow-upin1month.

MedicalWritingTask3

Usingtheinformationgiveninthecasenotes,writeareferrallettertoDr.Sharon

Farquad,EndocrinologistatEndocrineSpecialistsandAssociates,115BurkeSt.Omaha.

Inyouranswer:

NursingWritingTask3

Usingtheinformationgiveninthecasenotes,writeareferrallettertothediabeticnurseeducator,Dr.Hank

Farquad,CertifiedDiabetesEducatoratEndocrineSpecialistsandAssociates,115

BurkeSt.Omaha.

Inyouranswer:

Expandtherelevantnotesintocompletesentences

DonotusenoteformUseletterformat

Answers

1.MrWalterPeters

2.DrNShah

3.thepatientisbeingreferred

4.NewCanterburyHospital,1ChurchStreet,Canterbury

5.DNShahAdmittingOfficerNewCanterburyHospital1ChurchStreetCanterbury15September2018DearDrShah

WritingTask1MedicalSampleResponse

19/03/2018

DearDr.DiCoccio,

Re:BethanyTailor(aged35),

Yourpatient,MsTailor,admittedherselfon1March2018withdecompensatedschizophrenia.Sheisnowreadyfordischargeandfollow-upatyourclinic.

Onadmission,shewasexperiencingsignificantthoughtdisorder,includingthoughtblockingandlatency.Shewasalsoexhibitingdelusionsandexperiencingauditorycommandandvisualhallucinations.

DuringherstayinhospitalMsTaylorwasplacedbackonhermedications,andhermentalconditionhasstabilisedandsheisabletofocusonheractivitiesofdailyliving.Herinsightisnowgoodandjudgmentfair.Hernursingmanagementinthehospitalfocusedoncompliancewithherantipsychoticmedications,behaviouralcontrol,andtherapy.Since10March,shehasnotreportedvisualorauditoryhallucinations.

MsTailorisonoralRisperidone4mgnightly.Additionaloralrisperidone1mgcanbeadministeredasneededtwicedailyforagitationorpsychosis.Shewillbedischargedfromthehospitaltoherapartmentwhereshelivesalone.Shewillfollow-upwithyouinordertocontinuehertreatmentofchronic

Dr.GiovanniDiCoccioProudhurstFamilyPractice231BrightfieldAvenueProudhurst

schizophreniaandtoavoidnon-complianceofhermedicationsorsubstanceabuse.

Ifyouhaveanyqueries,pleasecontactme.

Yourssincerely,

Doctor

[183words]

NursingSampleResponse

19/03/2018

DearMsDiCoccio,

Re:BethanyTailor(DOB:April20,2018),

MsBethanyTailorwillbedischargedtoyourfacilitytoday.Shewasadmittedtothehospitalon1March2018withdecompensatedschizophrenia,probablysecondarytomedicationnoncomplianceandsubstanceabuse.

Onadmission,shewasexperiencingsignificantthoughtdisorder,includingthoughtblockingandlatency.Shewasalsoexhibitingdelusionsand

MariaDiCoccioProudhurstMentalHealthHome231BrightfieldAvenueProudhurst

experiencingauditorycommandandvisualhallucinations.

Afterherstayinhospitalandbeingplacedbackonhermedications,hermentalconditionhasstabilisedandsheisabletofocusonheractivitiesofdailyliving.Sheisdemonstratingappropriateinsightandjudgement.Hernursingmanagementinthehospitalfocusedoncompliancewithherantipsychoticmedications,behaviouralcontrol,andtherapy.Since10March,shehasnotreportedvisualorauditoryhallucinations.

Ms.Tailorisonoralrisperidone4mgnightly.Additionaloralrisperidone1mgcanbeadministeredasneededtwicedailyforagitationorpsychosis.Sheisalsoprescribedlevothyroxine88mcgbymouthforhypertensionandhypothyroidism.Shewillrequiremedicationmonitoringtoavoidnon-complianceofhermedicationsorsubstanceabuse.

Yourssincerely,

[191words]

DrStevensMillStreetSurgeryFarnhamGU101HA

25March2018

DearDrStevens,

Re: MrsSallyFletcherD.O.B3/10/1993

Yourpatient,SallyFletcher,wasadmittedtothesurgicalwardofFairbanksMemorialHospitalon25March2018forthepurposeoflaparoscopicsurgerytotreatanendometrialcyst.Sheisnowreadyfordischargeintothecareofherhusband.

Whenadmitted,Sallyhadbeensufferingfrompainfulperiodsoverthepast3years,whichshehadbeenattemptingtotreatwithnaproxen,butthepainpersisted.Anultrasoundscanrevealedacysthadformedinherabdomen.Shearrivedatthewardthismorningandunderwentlaparoscopicsurgery,whichsuccessfullylocatedandremoveda6cmcystfromherabdomenwithoutcomplication.

Shehasbeenadvisedtokeeptheincisionsitescleananddry.Shehasreceivednarcoticpainmedicationandhasbeenadvisedthatsheisunabletodrivewhiletakingthismedication.Youshouldmonitorherprogress,andadvisewhentoceasetakingthismedication.Shemayresumedriving24-48hoursafterthelastdoseistaken.

Sallymayresumehernormaldiettoday,andisencouragedtodrinkplentyoffluids.Sheisalsoencouragedtowalkasmuchasshecantolerate.Sexualactivitycanresumeintwoweeks.

Ifyouhaveanyquestionspleasefeelfreetocontactme.

Yourssincerely,

Doctor

[194words]

25March2018

DearMsStevens,

Re: MrsSallyFletcherD.O.B3/10/1993

Yourpatient,SallyFletcher,wasadmittedtothesurgicalcentreofFairbanksMemorialHospitalon25March2018forlaparoscopicsurgerytotreatanendometrialcyst.Sheisnowreadyfordischarge.

Whenadmitted,Sallyhadbeensufferingfrompainfulperiodsoverthepast3years,causedbyendometrialtissuepresentoutsidetheuterus,whichformedacystinherabdomen.Shearrivedatthecentrethismorningandunderwent

JoanStevensMillhouseVisitingNursesAssociationFarnhamGU101HA

laparoscopicsurgerytoremovethecyst.Thesurgerysuccessfullylocatedandremoveda6cmcystfromherabdomenwithoutcomplication.

Shehasbeenadvisedtokeeptheincisionsitescleananddry.Shehasreceivednarcoticpainmedicationandhasbeenadvisedthatsheisunabletodrivewhiletakingthismedication.Shemayresumedriving24-48hoursafterthelastdoseistaken.Sheshouldbemonitoredforconstipation,urinaryretentionandpaincontrolwhiletakingthenarcotic.

Sallymayresumehernormaldiettoday,andisencouragedtodrinkplentyoffluids.Sheisalsoencouragedtowalkasmuchasshecantolerate.Sexualactivitycanresumeintwoweeks.

Ifyouhaveanyquestionspleasefeelfreetocontactme.

Yourssincerely,

[196words]

Dr.SharonFarquadEndocrinologistEndocrineSpecialistsandAssociates115BurkeSt.Omaha

08/04/2018

DearDr.Farquad

Re:TabithaTaborlin(aged45)

ThankyouforseeingMsTablorinasanewpatientatEndocrineSpecialistsandAssociates.Sheisa45yearoldfemalewithapastmedicalhistoryofessentialhypertensionanduncontrolledType1diabetesmellitus.

MsTablorinwasseenatmyclinictodayasafollow-upfromahospitaladmissionfordiabeticketoacidosiswithaglucosemeasureof530mmol/L.Shehashadmultiplepriorhospitalisationsforthesameissue.Shealsohasalonghistoryofbeingnoncompliantwithherinsulinmedications,whichare45unitsofLantusnightly,andpreprandialcorrectionscaleHumalogwith12unitsofnutritionalbaseline.HerHbA1cis11.0%.

Shehasbeeneducatedmultipletimesondiabetesrisksandcomplications,regardingherinsulinregimen,exercise,diet,andtobaccocessation.However,shehascontinuedtoignoretheserecommendationsandherconditionhasprogressivelyworsened.Itismyrecommendationthatsheseekahigherlevelofcare,thusIreferhertoyourpractice.MsTablorinwouldlikelybenefitfromastricterinsulinregimenandglycemicmonitoring,aswellasaninsulinpumpforreliabilityofmedicationadministration.

Yourssincerely,

Doctor

[183words]

DearDr.Farquad

Re:TabithaTaborlin(aged45),

ThankyouforseeingTabithaTaborlinasanewpatientatEndocrineSpecialistsandAssociates.Sheisa45yearoldfemalewithapastmedicalhistoryofessentialhypertensionanduncontrolledType1diabetesmellitus.

MsTablorinwasseenatmyclinictodayasafollow-upfromahospitaladmissionfordiabeticketoacidosiswithaglucosemeasureof530mmol/L.Shehashadmultiplepriorhospitalisationsforthesameissue.Shehasalonghistoryofbeingnoncompliantwithherinsulinmedications,whichare45unitsofLantusnightly,andpreprandialcorrectionscaleHumalogwith12unitsofnutritionalbaseline.HerHbA1cis11.0%.

Educationwasprovidedondiabetesrisksandcomplications,usingherinsulinregimen,exercise,diet,andtobaccocessation.Todate,shehasnotcompliedwiththeserecommendationsandherconditionhasprogressivelyworsened.It

Dr.HankFarquadCertifiedDiabetesEducatorEndocrineSpecialistsandAssociates115BurkeSt.Omaha08/04/2018

isrecommendedthatsheseekahigherlevelofcare,thusIreferhertoyourpractice.MsTaborlinwouldlikelybenefitfromastricterinsulinregimenandglycemicmonitoring,aswellasaninsulinpumpforreliabilityofmedicationadministration.Shewillrequiresupportwiththesechangestocare.

Yourssincerely,

[191words]

THESPEAKINGSECTION

SpeakingIntroduction

SectionOverview

TheOETSpeakingTestisaface-to-faceexamination,betweenaninterlocutorandyou.YourSpeakingTestwillbespecifictoyourhealthcareprofession;inthisbook,wewillcovermedicalandnursingtopics.IntheSpeakingTest,youwillcompletetworole-plays,whereyoutaketheroleofthehealthcareprofessional,andtheinterlocutortakestheroleofthepatient,thecarerorfamilymemberofthepatient.

SPEAKINGSTRATEGIES

Treattherole-playasifyouwerewitharealpatient.Allowtimetoestablisharelationshipwiththepatientandaskforrelevantinformation.RememberthattheassessoristestingyourabilitytocommunicateeffectivelywithpatientsinEnglish;theyarenottestingyourmedicalknowledge.Payattentiontothetypeofinformationyouneedtocommunicatetothepatient,andadjustthewayyoucommunicatethisinformationfordifferentsituations.Ifthepatientisbeinggivenbadnews,forexample,youshouldshowempathyandkindness.Don’tmemoriselonganswers.Anythingtheassessorthinkshasbeenmemorisedwillnotbeassessed.Usevariedvocabularywhichmatchestheneedsofthepatientandthecontextoftherole-play.Youneedtoshowyoucancommunicatewiththepatientinavarietyofways.Speakloudly,clearlyandconfidentlysotheinterlocutorcanhearyou.Pronouncewordsasclearlyandcorrectlyaspossible.Varyyourintonation-yourvoiceshouldriseandfallasanativespeaker’swould.Readtherole-playcardcarefully,soyoudonotmisunderstandormissoutonanyofthetopicorbulletpoints.Makebriefnotesforeachpointonthecard.Includeideasandexamples,butnotfullsentences.Trynottobenervous.Takeadeepbreath,smileandmakeeyecontactasyoubeginyourspeakingtask.Whileeyecontactisnotassessed,itcanhelpyoutofeelmoreconfident.Underlinekeywordsandphrasesonthecard,toassistyouwiththerole-play.Don’tbeafraidtoasktheinterlocutortoclarifyanythingontherole-playcard

whichisunclear.Thiscanincludethemeaningorpronunciationofvocabularyandthecontextoftherole-play.Ensurethatanyquestionsareaskedbeforetherole-playbegins.

CHAPTER10

TheSpeakingTask

LEARNINGOBJECTIVES

Analysetherole-playcard.PractisestrategiesfortheSpeakingTest.Assessyourownspeaking.

INTRODUCTION

TheSpeakingTestwilltakeapproximately20minutes.Youwillcomplete2role-plays,andwilltalktotheinterlocutorfor5minutesduringeachrole-play.Youwillhave2to3minutestoprepareforyourrole-play,usingyourrole-playcardbeforeeachrole-playbegins.

WewilloutlinecriteriathatwillbeusedtoassessyourSpeakingTestinthischapter.Whencompletingspeakingtasks,makesuretokeepthecriteriaprovidedinmind,andtrytodemonstrateyourabilitiesineachindividualsection.Wewillgiveexamplesforhowthesecriteriacouldbeaddressedinthespeakingexam,however,wedonotadvisestudentstotrytomemorisetheseexamples,orattempttoreproducethemwordforwordonTestDay.

Strategies

Gettingreadytospeak

ThefirststepintheSpeakingTestistofamiliariseyourselfwiththerole-playcard.Youwillonlybegivenonerole-playcardatatime,andyouwillnotbegiventheinterlocutor’srole-playcard.Beawarethatthenterlocutor'scardwillincludeinformationthatisnotincludedinyourrole-playcard,sothecardyouaregivenwillnotfullyprepareyouforeverythingthepatientwillsay,thoughitshouldgiveyouagoodideaoftheoutlinethattheconversationwilltake.

Belowaretworole-playcards.OneisaMedicalrole-play,andtheotherisaNursingrole-play.Selectthemostappropriaterole-playcard,anduseittoworkthroughthefollowingstrategies.

MEDICALTASK

CANDIDATE

CARDNO.1

MEDICINE

SETTING GeneralPractice

DOCTOR A44-year-oldhasbeenreferredtoyourclinicduetohighcholesteroland

hypertension.Theyarefrustratedaboutattendingtoday.

TASK Findoutwhatthepatientthinksthepurposeofthevisitistoday.

Explaintheimplicationsofhighbloodpressureandcholesteroloncurrentand

futurehealth(e.g.strokes,heartattacks,kidneydamage,etc).

Discusscholesterolloweringdrugsandanti-hypertensivesandexplaintheir

benefits.

Findoutaboutthepatient’slifestyle(e.g.smokinganddrinkinghabits)andadvise

thepatientonhowtoimprovehis/herhealth(e.g.reducingsmokingandalcohol

consumption,joiningasupportgrouporseeingacounsellor,increasingexercise,

etc.).

NURSINGTASK

CANDIDATE

CARDNO.2

NURSING

NURSE A67-year-oldpatientwhohashadhypertensionwithnoknowncauseformanyyears

hascomeinforafollow-upappointment.His/herbloodpressureismoderately

elevatedtodayandhe/sheappearsanxious.

Whoisthepatient?

Thefirstthingyoushouldidentifyisthetypeofpatientyouaregoingtotalkwith.Role-playcardswillinformyouofthekeydetailsaboutthepatientandthereasonfortheirappointment.Youmayalsobetoldaboutthepatient’semotions.Youshouldtakeallofthesepiecesofinformationintoconsideration,andplanyourapproachaccordingly.Forexample,ifapatientisnervousorworriedaboutaprocedure,youwillneedtoofferthemreassurance.

Findoutifthepatienthashadanyissuescomplyingwiththemedicationsor

exercising/eatinghealthily.

Explaintheimportanceofmedicationsforbloodpressurecontrol.

Discusslifestylechangesthatthepatientcanmaketoreducetheirbloodpressure

(e.g.takethemedicationsasprescribed,increaseexercise,andeatahealthierdiet,

etc.).

Exercise

Matchthefollowing3patientdescriptionswiththemostappropriateapproach.

1. An83yearoldneedsanMRIscan,andseemsconfused.

2. A56yearoldhasterminalcancer,andisextremelyupset.

3. A24yearoldhasaviralinfectionandisimpatientlyrequestingtreatment.

Listentowhattheyhavetosayandfindoutwhatthepatientwantstoknow.

Explaincarefully,perhapsmultipletimes,whilecheckingforunderstandingthroughouttheexplanation.

Brieflyoutlinetheoptionsavailableandrecommendtheoptimalcourseofaction.

Lookatthedescriptionofyourpatientintherole-playcardonthepreviouspage.Take30secondstoconsiderhowtobestcompletethetasksinbulletpoints

andmakebriefnotesbelow.Thinkaboutthelanguagerequiredtocheckforunderstanding.

Whatdoyouneedtofindout?

Next,lookatthebulletpointedtasks.Atleastoneofthesetaskswillaskyoutofindoutinformationfromthepatient.Identifywhatitisthatyouneedtofindoutfromthepatient,andthinkofwaystorephrasethetaskintoaquestionthatwouldbeappropriateforconversationalEnglish.Takeanother30secondstothinkaboutrephrasingtheinformationinthefirstbulletpointofyourrole-playcard,toturnthisintoappropriatequestions.Yourinitialquestionshouldbeanopenquestion(forexample,‘howareyoufeeling?’),whichshouldthenbefollowedupwithmoreclosedquestions(forexample,‘howlonghaveyoubeenexperiencingthesesymptoms?’).

Whatdoyouneedtotellthepatient?

Youwillberequiredtoprovideyourpatientwithnecessaryinformationabouttheircondition,testsandcourseoftreatment,andshouldensurethatthepatientunderstandstheinformation.Whatyouneedtocommunicatetothepatientwillbeoutlinedinthebulletpointsoftherole-playcard.Youmaysimplyneedtoexplainapointtothepatient,oryoumayneedtofindoutrelevantinformationfirst,beforetailoringyourresponsetothepatient’sindividualcase.Ifyouhavealotofinformationtocommunicatewiththepatient,youshouldbreaktheinformationdownintosections,sothatyoucancheckthepatient'sunderstandingforeachsectionofinformationbeforemovingontothenextsection.

SPEAKINGINENGLISH

Onceyourplanningtimeisup,youshouldhaveagoodideaofthestructureyourconversationwilltake.Whenspeaking,youneedtocoverthefollowingfourlinguistic,tomakesurethatyouareshowingtheassessoryourabilitytointeracteffectively.YouneedtoshowthatyoucanhavemeaningfulconversationswithothersinEnglish.Youshouldcommunicateconfidently,takecontroloftheinteraction,leadthetopicofconversation,andeffectivelycompletethespeakingtask,byaddressingallofthepointsinthetaskcard,andrespondingappropriatelytothepatient.Whileitisnotessentialthatyoucoveralloftheinformationinthe5minutesprovidedforeachconversation,youshouldnotwastetimeortalkaboutpointsnotmentionedintherole-playcard.

Intelligibility

Toscorewellinthiscriterion,youneedtocommunicateinawaythatcanbeeasilyheardandunderstood.Theassessorwillpayattentiontoyourpronunciation,therhythmyouusewhenyouspeak,thestressyouputonindividualwords,yourintonationandyourpitch.Avoidmemorisinglargechunksofspeechbeforethetest,asthiswillsoundunnatural.Instead,speakatanappropriatespeedandclearly,allowyourvoicetoriseandfall.PractisepronouncingwordsinEnglishsothattheysoundthesameaswhenanativeEnglishspeakersaysthem.Toaddressthefirstbulletpointedtaskinthenursingrole-playcard,youcouldsay:

“Tellmeifyouhavehadanyissuesfollowingthedietthatwediscussedatyourlastappointment.”

Thewordsshowninboldinthesentenceaboveshouldbestressedastheyarethewordswhichcarrythemeaninginthesentence.Stressisaslightincreaseinvolume,andaslightincreaseinthesoundlength.

Fluency

Thiscriterionaddressestherateandflowofyourspeech.Youneedtospeakatanappropriatespeedandcarefully,thinkaboutthesentenceyouaregoingtosaybeforesayingitratherthansayingsomethingthatyoulaterneedtocorrect.Youshouldavoidoverusingfillernoiseswherepossible,suchas

“Ah”“umm”“err”

andfocusonspeakingsmoothly,linkingyourspeechtogether,andpausingappropriately,forexample,youmightpausetoseparatedifferentpointsyouaremaking.Youcouldsay,forexample

“First,weneedtoaddressyourdiet(pause)then,wecanlookatmoreinvasivetreatments.”

Youcanalsopauseforemphasis,orbeforebeginninganewtaskontherole-playcard,givingyourselfamomenttothinkaboutwhatyouwillsaynext.

Appropriateness

Thiscriterionassessestheappropriatenessofyourlanguageandtone.Rememberthatyouarespeakingtoapatient,notamedicalprofessional,soyoushouldexplainanytermsthattheymightnotunderstand.Forexample,youwouldrephrase‘hypertension’intherole-playercardto‘highbloodpressure’.

Yourlanguageandtoneshouldalsoremainprofessionalandconfident,andyoushouldadjustyourtonetomatchtheemotionofthepatient,andthetopicbeingdiscussed.

Resourcesofgrammarandexpression

Youneedtoshowthatyoucanusegrammarcorrectlyandspeakinavarietyoftensesandsentencestructures.

Youshouldusegrammaticaldevicessuchaschunkingtomakeyourspeechclearer,andeasiertounderstand.Ifyouaregivingthepatientalargeamountofinformation,youmightsaysomethinglike

“I’mgoingtodiscussthevariousoptionsavailabletoyou.Thefirstis…”

Youshouldshowthatyoucancommunicateinformationinavarietyofways.Youmightrephrasesomethingyouhavealreadysaid,tomakesurethattheinformationcanbeunderstoodbythepatient.Makesurethatyouareusingthecorrectwordorderwhenspeaking,anddonotomitwordsfromyourspeech.

Youshouldusethecorrecttensewhenspeaking,tomakesurethatthepatientknowsifyouaretalkingaboutsomethingthathasalreadyhappened,orsomethingthattheywillneedtodo.

SPEAKINGWITHTHEPATIENT

AsOETisatestforhealthcareprofessionals,aswellashavingagoodcommandoftheEnglishlanguage,youalsoneedtobeabletocommunicateeffectivelyandresponsivelywithpatients.Therearefiveclinicalcommunicationcriteriawhichyouwillbeassessedon.Youdonothavetoaddressallpartsofeachofthe5criteriatoscorewellintheSpeakingTest.

Relationshipbuilding

Youshouldstartwithanappropriategreeting.Fromthebeginningofyourinterview,youshouldmakethepatientfeelwelcome,andatease.Beginbyintroducingyourself,thengiveyourrole,andexplainorremindthepatientwhytheappointmenthasbeenscheduled.Thefollowinggivesanappropriateexampleofagreeting:

“Hello,I’mDrAlbert,isitMargaretFrench?I’moneoftherheumatologistsattachedtothehospital.Yourfamilydoctorhasaskedmetoseeyouaboutthejointproblemsyou’vebeenhaving”

Astheinterviewprogresses,youshouldmakesuretoshowthatyouarepayingattentiontothepatient’sneedsandconcerns,andshowthatyouarelisteningtowhatthepatientistellingyou.Thiswillhelpyoutocreateacollaborativeenvironmentbetweenyouandthepatient,andallowthepatienttofeelatease

Initiatetheinteractionappropriately

Demonstrateanattentiveandrespectfulattitude

withyou.Tomeetthesecriteria,youcouldaskforthepatient’spermissiontodiscusstopicsthatcouldpotentiallycausethemtofeeluncomfortable,checkthatthepatientiscomfortablewithwhatisbeingdiscussedifthereareanysignsthattheymaynotbe,andshowsensitivitywhendiscussinganythingthatthepatientmayfindembarrassingorpersonal.Thefollowingisanexampleofhowyoumightdemonstraterespectforthepatient:

“WhatIwouldliketodoisspendafewminuteswithyounowdiscussingyoursymptoms?Isthatokay?Pleaseletmeknowifyouarefeelinguncomfortableatanytime”

Whenthepatientsharesinformation,youshouldacceptthisinformationwithoutreproachorjudgement.Donotdevalueorcriticisethepatientwhentheysharetheirthoughtsorbehaviours,asthiswilldiscouragethemfromcontinuingtoshareinformationwithyou.Youneedtomaintainrespectfulcommunication,soyoushouldacknowledgethepatient’semotionswhereverpossible.Thefollowinggivesanexampleofhowyoumightrespondtoapatientwhohasvoicedconcerns:

“Sowhatworriesyoumostisthattheabdominalpainmightbecausedbycancer.Icanunderstandthatyouwouldwanttogetthatcheckedout.”

Youshouldshowthepatientthatyouunderstandwhytheyfeelacertainway,iftheyareemotionalinyourinterview.Youshouldalsobepreparedtochangeyourapproachifthereisanemotionalelementtoyourinterview;forinstance,ifyouhavetobreakbadnews.Youcanshowthatyouaremeetingthesecriteria

Demonstrateanon-judgementalapproach

Showempathy

throughyourwords,butyoucanalsoshowempathythroughthetoneofyourvoice,andthroughnon-verbalsoundsofagreement,sympathyandencouragement.Youcoulddemonstrateyourempathyforthepatient,bysayingsomethinglike:

“Youmentionedearlierthatyouwereconcernedthatyouhadangina.Anginaisaveryparticularkindofpain,whichrelatestoseveralunderlyingconditions.IsitalrightifIaskyouafewmorequestionstoruleoutmuscularpain?”

“Icanseethatyourhusband’smemorylosshasbeenverydifficultforyoutocopewith;IimagineIwouldfeelsimilarlyifthesamethinghappenedtome.”

Understandingandincorporatingthepatient’sperspective

IntheSpeakingTest,youneedtoshowthatyou’reputtingthepatientatthecentreoftheconversation,planningyourspeecharoundhowyouexpectthepatienttoreactandmodifyingyourspeechiftheyreactinadifferentway.Followthenextthreestepstomakesureyouareusingtheinformationyourpatientprovidestoalteryourconversation.

Encouragethepatienttogivetheirthoughtsandopinionsabouttheircondition.Don’tsimplyaskthemtolisttheirsymptoms,butalsoexplorewhattheythinkmightbethecause.Forexample,youcouldsay:

Elicitandexplorethepatient’sconcerns

“Didyouhaveanythoughtsaboutwhatmightbecausingyoursymptoms?”

or,togetanideaofwhatthepatientmightbefeeling,youcouldsay:

“Wasthereanythingparticularyouwereconcernedabout?”

Ifthepatienthasnotexplainedsomethingfully,oryouwanttoexploresomethingfurther,youcandothisbysayingsomethinglike:

“Youmentionedthatyouwereconcernedabouttheeffecttheillnessmighthaveonyourwork,couldyoutellmemoreaboutthat?”

Alongsideencouragingthepatienttoprovideinformation,youwillalsoneedtoshowthatyou’retakingthisinformationintoconsideration,andshapingtheconversationaroundwhatthepatientistellingyou.Manytest-takersdonotscorewellintheSpeakingTestbecausetheytrytofollowaspecificstructurefortheconversation,whichtheydonotadaptandalteraccordingtonewinformationprovidedbythepatient.DonotmemoriselongdialoguetouseonTestDay.Instead,practisereactingtonewinformation,andincorporatingitintoyourspeech.Whenreactingtoemotionalpatients,youmightsaysomethinglike:

“Youusedthewordworried,couldyoutellmemoreaboutwhatyouareworriedabout?”

or,whenpatientsshowemotion,butdonottellyouthattheyfeelacertainway,youcouldsay,forexample:

“Isensethatyouarenothappywiththeexplanationsyou’vebeengivenin

Pickuponpatientcues,andreactaccordingly

thepast.”

Toshowthepatientthatyouareusingtheinformationthey’vegivenyoutostructureandguideyourspeech,youshouldletthepatientknowthattheirwordshavebeenheard.Ifapatientgivesnewinformationthatchangesthestructureofyourconversation,youcouldindicatethisbysayingsomethinglike:

“Asyousayyou’rehavingtroublesleepingatthemoment,let’stalkaboutthingsthatmighthelpyouaddressthisbeforewemoveon.”

If,ontheotherhand,thepatientprovidesinformationthatdoesnotaltertheconversation,youcanstillacknowledgetheirinputbysayingsomethinglike:

“Youmentionedearlierthatyouwereconcernedthatyouhadangina.Anginaisaveryparticularkindofpain,whichrelatestoseveralunderlyingconditions.IsitalrightifIaskyouafewmorequestionstoruleoutmuscularpain?”

ProvidingStructure

Youshouldstructuretheinterviewclearlyandefficiently.Beginbygreetingthepatient,discusswhythey’reseeingyoutoday,thentackleeachbulletpoint,onebyone.Afteryouhaveprovidedanexplanation,orcompletedaseriesofquestions,checkthatthepatienthasnofurtherquestionsandhasunderstoodyou

Relateyourexplanationstotheideas,concernsandexpectationsyouhaveelicitedfromthepatient

Sequencetheinterviewpurposefullyandlogically

beforemovingon.Whilemakingnotesonyourrole-playcardinthepreparationtime,lookthroughwhatyouhavetotalkabout,andthinkabouthowyoumightconnectthebulletpointstooneanotherinyourspeech,sothatyourspeakingflowslogically-thisrelatestosignposting.

Signpostsfunctionasapausebetweentopicsandallowyoutocheckforunderstandingandaskforpermissiontodiscusstopics.Theyalsoallowyoutosummariseinformationgivenbytheinterlocutor(thisrelatestolatercriteria).Whenmovingfromonetopictothenext,youneedtomakeitcleartothepatientwhatyouwilldiscuss.Aftergreetingthepatient,youshouldoutlinethetopicthatwillbediscussedbeforegettingintodetails.Wheneveryoumoveontoadifferenttopic,tellthepatientwhatyouaremovingontotalkaboutnext.Youmightstarttodiscussatopicbysayingsomethinglikethis:

“Sincewehaven’tmetbefore,itwillhelpmetolearnsomethingaboutyourpastmedicalhistory.Canwedothatnow?”

Afterapatienthasfinishedtellingyouaboutsomething,youmightoutlinewhatyouwanttodiscussnextbysayingsomethinglikethis:

“Youmentionedtwoareastherethatareobviouslyimportant,firstthejointproblemsandthetiredness,andsecond,howyouaregoingtocopewithyourkids.CouldIstartbyjustaskingafewmorequestionsaboutthejointpains,andthenwecancomebacktoyourdifficultieswiththechildren?”

Signpostinganychangesintopichelpsthepatienttokeeptrackofwhat’sbeingdiscussedandgivesaclearerstructuretoyourdiscussion.

Signpostchangesintopic

Thereareanumberofdifferentwaysthatyoumightorganiseyourexplanations.Again,yourprimaryconcernwhenorganisingyourexplanationsshouldbetomakeyourspeechasclearanddigestibletothepatientaspossible.Tohelpthepatientunderstand,andtomakeiteasierforthemtorememberinformationdiscussedatalaterdate,itcanbehelpfultodividewhatyouwilltalkaboutintocategories,andinformthepatientofthesecategoriesbeforeyougointomoredetailabouteachpoint.Forexample,youcouldsay:

“TherearethreeimportantthingsIwanttoexplain.FirstlyIwanttotellyouwhatIthinkiswrong,secondly,whattestsweshoulddo,andthirdly,whatthetreatmentmaybe.”

Theuseofcategorisationabovehelpstostructurethediscussionyouwillhave,sothatthepatientcanunderstandwhatwillhappennext.Whenyougointomoredetail,youshoulduseatechniquecalledchunking.Thisiswhenyoudeliverinformationinchunks,leavingcleargapsbetweeneachpieceofinformation,beforemovingontothenextone.Youmayalsofindithelpfultouseatechniquecalledlabelling.Labellingallowsyoutohighlightsignificantinformationtothepatient.Forexample,youcouldsay:

“Itisparticularlyimportantthatyourememberthis...”

Onceyouhaveexplainedallofthepointsyouwantedtocover,itcanalsobeusefultorepeatandsummarisethemostimportantpointstothepatient.Youcouldsay,forexample:

“Sojusttorecap:wehavedecidedtotreatthisasafungalinfectionwithacreamthatyouputontwiceadayfortwoweeksandifitisnotbetterby

Useorganisingtechniquesinyourexplanations

then,youaregoingtocomebacktoseeme.”

Repeatingandsummarisinginformationmakesiteasierforthepatienttostoretheinformationintheirmemory,andimprovestheirabilitytorecallthisinformationlater.Afteryouhavesummarisedtheinformation,youcancheckforthepatient'sunderstanding,whichmeetsothercriteriadiscussedlater.

Exercise

Spendoneminutethinkingaboutthestructureoftheconversationthatwilltakeplace,coveredintherole-playcardabove.Thinkabouthowyouwillguidetheconversation,andhowyoumightrephrasethetasksintoconversationalEnglish.

InformationGathering

It’simportanttogetasmuchrelevantinformationfromthepatientasyoucan.Ifyou’vefollowedthestepsoutlinedabove,youshouldhavecreatedanenvironmentwhereyourpatientfeelscomfortablesharinginformationwithyou.Now,youshouldreadthroughthenext5pointstomakesureyou’relisteningactivelytothepatient,andgatheringnecessaryandrelevantinformation.Thiscriterionassesyourabilitytoaddressthewaythepatientisthinkingandfeeling,ratherthanyourmedicalaccuracy.

Whenthepatientistalking,youneedtoshowthatyouarepayingattentiontothemandfollowingtheirspeech,withoutinterruptingthem,orhaltingtheflowoftheirnarrative.

Youcandemonstratethatyouarelisteningbyusinganumberoftechniques:

Facilitatethepatient’snarrative

“notcoping?”

Similarly,toshowagreaterunderstandingofwhatthepatientissaying,youcanrephrasewhatthepatientissayingintoyourownwords,orsuggestaninterpretationforwhatthepatientiscommunicating.Youcouldsay,forexample:

“AreyouthinkingthatwhenJohngetsevenmoreill,youwon’tbestrongenoughtonursehimathomebyyourself?”

Whenthepatientpausesduringtheirspeech,don’ttrytostarttalkingimmediately,anddon’tinterruptthepatientifthey’restilltalking.Instead,waituntilthepatienthasfinished,andpausetoconsiderwhattheyhavesaidbeforeresponding.Youcanuseshortverbalandnon-verbalsoundsofencouragementwhilethepatientisspeakingtoshowthatyouarepayingattention.Examplesinclude:

“Um”,“uh-huh”,“Isee”

Asthepatientrevealsinformation,youshouldshowthatyou’retakingthisonboardbyechoingthepatient,orrepeatingkeyphrasesandwordsfromtheirspeech,suchas

“chestpain?”

Useopenquestionsatthebeginningandclosedquestionsastheinterviewprogresses

Atthebeginningofyourinterview,youshouldaskthepatientopenquestions,tofindoutasmuchgeneralinformationaspossible.Thefollowingareexamplesofopenquestions:

“Startatthebeginningandtakemethroughwhathasbeenhappening...”

“Howhaveyoubeenfeelingsinceyouroperation...?”

“Tellmeaboutyourheadaches.”

Astheconversationdevelopsandyouhaveabetterideaoftheinformationyouneedfromthepatient,yourquestionscanbecomemoredirected,butshouldremainopen.Atthisstage,youcouldask:

“Whatmakesyourheadachesbetterorworse?”

Oncethepatienthasprovidedenoughgeneralinformationabouttheircondition,youcanmovetomorespecific,closedquestionstogetfurtherinformation.

“Doyoueverwakeupwiththisheadacheinthemorning?”

Toensurethatyouarereceivingreliableinformation,youshouldavoidinfluencingyourpatientwhenyouaskquestions,oraskingmultiplequestionsatonce.Anexampleofacompoundquestionis:

“Haveyoueverhadchestpainorfeltshortofbreath?”

Thepatientmaysimplyrespond‘yes’or‘no’,eveniftheanswerdoesnotrelate

Avoidcompoundquestionsandleadingquestions

toboththeirexperienceofchestpainandtheirexperienceofshortnessofbreath.Youshouldalwaysbreakcompoundquestionsupandaskonequestionatatime.

Leadingquestionsincludeassumptions.Thismakesitmoredifficultforthepatienttocontradicttheassumption.Avoidaskingleadingquestionsinyourinterview,suchas:

“You’velostweight,haven’tyou?or“youhaven’thadanyankleswelling?”

Thesequestionsareunlikelytoprovideyouwithreliableinformation.

Ifpatientsrespondtoyourquestionswithoutprovidingenoughinformation,orwitharesponsethatcouldbeinterpretedinanumberofdifferentways,itisimportanttoaskthepatienttoexplainwhattheymean.Youmightask,forexample:

“Couldyouexplainwhatyoumeanbylight-headed?”

Ifthepatientsayssomethingthatrequiresfurtheramplification,forinstance,iftheyappeartodescribeasymptom,butyou’dliketogetaclearerideaofwhattheyareactuallyexperiencing,youcanlookforamplificationbyaskingsomethinglike:

“Whenyousaydizzy,doyoumeanthattheroomseemstoactuallyspinround?”

Don’tmoveontodiscusssomethingelseuntilyou’recomfortablethatyou’veunderstoodwhatthepatienthassaid.Rememberthatpatientsmaybeless

Clarifystatementsthatarevagueorrequireamplification

precisewiththeirvocabulary,soitisimportanttoclarifytheirstatements.

Oncethepatienthasfinisheddiscussingatopic,andyouthinkthatyouhavealloftherelevantinformationyouneed,youshouldgiveabriefoverviewofwhatthepatienthastoldyou,andaskthepatienttoconfirmthis,andprovidemoreinformation.Youmightsay,forexample:

“CanIjustseeifI’vegotthisright–you’vehadindigestionbefore,butforthelastfewweeksyou’vehadincreasingproblemswithasharppainatthefrontofyourchest.Thishasbeenaccompaniedaccompaniedbywindandacidandit’sstoppingyoufromsleeping.It’smadeworsebydrinkandyouwerewonderingifthepainkillersweretoblame.Isthatright?”

Onceyou’vesummarisedtheinformation,andifthepatienthasagreed,pauseforamomentlonger,toallowthepatienttoprovideanyadditionalinformation,ortocorrectoralterpartoftheinformation.

InformationGiving

Afterthepatienthasfinishedprovidinginformation,andyouhavegatheredeverythingyouneed,andconfirmedthatitiscorrect,itisyourturntoprovideinformationtothepatient.Readthroughthenext5points,tomakesurethatyouexplaininformationaseffectivelyaspossible.Remember,itisnotaboutgivingthemostmedicallyaccurateexplanationspossible,butitisaboutcheckingthatthepatienthasunderstoodtheinformation.

Summariseinformationtoencouragethepatienttocorrectorgivemoreinformation

Thefirststepinexplaininginformation,istounderstandwhatthepatientisawareofalready,sothatyoucanfocusonexplainingthingstheydon’tknow,andavoidgoingoverthingsthey’realreadyfamiliarwith.Don’tassumethatthepatientisfamiliarwiththeirillnessortreatment,astheymaynotbe.Toestablishhowmuchthepatientknows,youmightasksomethinglike:

“ItwouldbehelpfulformetounderstandalittleofwhatyoualreadyknowaboutdiabetessothatIcantrytofillinanygapsforyou.”

“Basedonyourbloodtestresults,weneedtodiscusswaystoloweryourcholesterol.WhatdoyouknowaboutLipitor?”

Onceyouareawareofwhatthepatientneedstoknow,youcanbegintoexplaininformationtothem.Makesureyoutakebreaksthroughoutyourexplanation,allowingthepatienttimetoaskquestionsbeforemovingon.Forexample,youmightsaysomethinglike

“Soreally,giventhesymptomsyouhavedescribedandtheverytypicalwaythatyouwheezemoreafterexerciseandatnight,Ifeelreasonablyconfidentthatwhatyouaredescribingisasthmaandthatweshouldconsiderwayswemighttreatit.(Pause)Howdoesthatsoundsofar?”

Youshouldmakesurethatthepatientfeelscomfortablewithwhatyouare

Establishwhatthepatientalreadyknows

Pauseperiodicallywhengivinginformation,usingthepatient’sresponsetoguidenextsteps

Encouragepatientstocontributereactionsandfeelings

explainingsothatyoucanaddressthisbeforemovingon.Patientswhoarefeelinguncomfortable,confusedordistressedmayfinditmoredifficulttotakeininformation,soyoushouldchecktheirreactionstotheinformationfromtimetotime.Youcoulddothisbyaskingsomethinglike:

“Whatquestionsdoesthatleaveyouwith,haveyouanyconcernsaboutwhatIhavesaid?”

Aswellascheckingthepatient’semotionalreactionstotheinformation,youalsoneedtomakesurethatthepatientunderstandswhatyouareexplainingtothem.Youcanevaluatethepatient’sunderstandingbyaskingthemtorepeattheinformationthatyouhavejustgiventhem.Forexample:

“IknowI’vegivenyoualotofinformationtodayandI’mconcernedthatImightnothavemadeitveryclear–itwouldhelpmeifyourepeatedbacktomewhatwehavediscussedsofarsoIcanmakesureweareonthesametrack.”

Makesurethatthepatientcoverseverythingthatyouhaveexplained,andifanyinformationismissedinthepatient’srecap,remindthemoftheinformation,andcheckthattheyunderstandthisinformationbeforemovingon.

Afterconfirmingthatthepatienthasunderstoodeverythingthatyouhaveexplained,youshouldfindoutifthereisanythingelsethatthepatientwantstoknow.Youcouldask,forexample:

Checkthatthepatienthasunderstood

Discoverwhatfurtherinformationthepatientneeds

“Arethereanyotherquestionsyou’dlikemetoansweroranypointsIhaven’tcovered?”

Exercise

Askafriendorfamilymembertousetherole-playcardonthefollowingpages(theyshouldmakesuretheychoosetherole-playcardthatcorrespondswithyourrole-playcardearlierinthechapter,eithermedicalornursing)andplaytheroleofthepatient,whileyouplaytheroleofthehealthcareprofessional.Recordtheaudio(youcanuseyourmobilephoneorlaptoptodothis)sothatyoucanreviewitlater,andsetatimerfor5minutes.

NURSINGTASK

ROLEPLAYER

CARDNO.1

NURSING

PATIENT Youarea67-year-oldandhavehadhighbloodpressureformanyyears.Your

bloodpressurewaswellcontrolledwithmedicationanddiet/exercisewhenyou

wereworking,butsinceretiring2yearsagoyouhaveletyourroutinelapse.You

arenervousaboutseeingthenursebecauseyoudon’twanttobejudgedfornot

managingyourbloodpressurecorrectly.

TASK Whenasked,reluctantlyadmitthatyouhaven’tbeentakingyourmedication,

exercising,andeatinghealthilyallthetime.Explainthatyouhavebeenfeeling

fineanddon’tthinkthatyourbloodpressureisanissue.

Askthenursewhyyouhavetotakesomanymedications.

Beresistanttomakinganychangestoyourlifestyleinitially,buteventually

agreetothenurse’ssuggestions.

MEDICINETASK

ROLEPLAYER

CARDNO.2

MEDICINE

PATIENT Youarea44-year-oldwhohasrecentlybeentoldthatbothyourcholesteroland

bloodpressurearehigh.Youdon’treallywanttotakeanymedication.Youdon’t

reallywanttochangeyourlifestylebecauseyourhealthhasbeenfine.

Onceyou’vecompletedthespeakingexercise,lookthroughtheassessmentcriteriaagain,andevaluatewhetherornotyoumeteachcriteria.Thinkabouthowyoucouldhaveimprovedyourspeaking,andmakenotesonyourweakestareas.Practisetheskillsnecessarytomeetthecriteria,thentrycompletingthespeakingrole-playsattheendofthischapter.Youshouldalwaysrecordyourself,andlistenbackoveryourspeakingafteryou’vecompletedtherole-plays.

Witheachnewspeakingtask,youshouldimproveyourspeakingabilitiesfurther,untilyourspeakinglevelissufficientlyimprovedforyoutoapplytothetestsituationonTestDay.

Tellthedoctorthatthenursereferredyoubutyouthinkyou’rewasting

everybody’stimebecauseyourhealthisfine.

Bedismissiveofthedoctor’swarningaboutthefuture.Yourfriendhashigh

bloodpressureandcholesterolandtheyarefine.

Ifasked,tellthedoctorthatyouarereluctanttotakestatinsbecauseyouhave

heardthattheycancauseproblemswithyourjoints.

Ifthedoctorasks,divulgeyouralcoholandsmokinghistory(10cigarettesper

dayforthepast25years,2pintsofbeereachnight).Reluctantlyagreeto

reducehowmuchyoudrinkandsmoke.

SpeakingPracticeSet

Usethe4speakingrole-playsonthefollowingpagestopractiseyourspeakingskillswithafriend,relativeorcolleague.Giveyourself2to3minutestopreparefortherole-plays,usingonlyyourcandidaterole-playcard,thenrecordyourselfspeakingfor5minutes.Onceyouhavefinishedeachrole-play,assessyourabilitiesusingthespeakingcriteriainthischapter.Whenpractising,youshouldonlyreadthecandidatecard,asyouwillnotseetheroleplayercardinthetest.Youmightfindithelpfultophotocopyandprintthesetaskcardsontoonepage,andthenfolditinhalf,soyoucanfocusonthecandidatecardwhileyou'regettingreadytospeak.

MedicalTaskCards

CANDIDATE

CARDNO.3

MEDICINE

SETTING PainMedicineClinic

DOCTOR This32-year-oldpatienthasbeenattendingyourpainmedicineclinicfor

severalyearsandhasbeenprescribedopioids(painkillers)duetoa

workplaceinjury.He/sheisrequestinganearlyrefill,butyourclinichasa

noearlyrefillpolicy.

TASK Findoutwhythepatientisrequestinganearlyrefill.

PLAYER

MEDICINE

SETTING PainMedicineClinic

PATIENT Youare32andhavebeenattendingapainmedicineclinicforseveralyears

duetoaworkplaceinjury.Youareonshort-actingandlong-actingpainkillers,

whicharerefilledeverymonth.However,thisweekend,someonestoleyour

medications.Younowhavenoneandyourrefillistwoweeksaway.Youare

hopingtogetanearlyrefillbutarenervousthattheclinichasapolicyofnot

replacingstolenmedication.

Discusstheclinic’snoearly-refillpolicyandthereasonbehindit

(abuseofopioidmedication).

Tactfullyexplainthatyoucannotwritearefill,butthatyoucanhelpthe

patientmanagetheirpaininotherways(e.g.topicalcreams,over-the-

counterpainkillers,anti-depressantslikeCymbalta,etc.).

Tryandreassurethepatient.Explainthatifthepainbecomes

unbearable,theyshouldvisittheEmergencyDepartment.

Explainyoursituationtothedoctorandexpressyouranxietyabouthaving

tobeinpainagain.

Explainthatyouunderstandtheprovider’spolicyandtherationalebehind

it,butareaskingforleniencygiventhefirst-timenatureofthisincident.

Insistthatyoushouldbeabletoobtainarefill.

Becomeanxiousaboutmanagingyourpain.Bedifficulttoreassure.

CANDIDATE

CARDNO.4

MEDICINE

SETTING GeneralHospitalEmergencyDepartment

DOCTOR Youaretalkingtoa54-yearoldpatient,whohasbeenrecentlydiagnosed

withadenocarcinoma(lungcancer).AchestX-raywascompletedinthe

EmergencyDepartmentandrevealsbilateralopacifications(anunderlying

conditionsuchaspneumonia,oedema,haemorrhage,etc.isblockingair

gettingintothelungs).Youareconcernedthatthepatientmaybe

sufferingfromamalignantpleuraleffusion(fluidinthelungs)andrequire

athoracentesis(removalofthefluidviaaneedle).

ROLEPLAYER

CARDNO.4

MEDICINE

SETTING GeneralHospitalEmergencyDepartment

PATIENT Youarea54-year-oldpatientwhohasbeenrecentlydiagnosedwith

lungcancer.YouvisitedtheEmergencyDepartment(ED)andexplained

tothedoctorsthatyoucan’tcatchyourbreathandtakingdeepbreaths

causeschesttightness.Youarescaredandworriedbecauseyouwent

throughcancerrecoverybeforeandhadchemotherapyandradiationto

treatanaggressiveB-celllymphoma.Youareworriedthatyoumaynot

toleratemorechemotherapyandthisnewshortnessofbreathisrelated

toyourlungcancer.

Findoutaboutthepatient’sconcernsregardingtheirdiagnosis.

SharewiththepatienttheX-rayfindingsandthepossiblereasons

behindhis/hershortnessofbreath.

Reassurethepatientregardingthelikelycourseoftreatment:

ultrasoundtoseeifhe/shehasapleuraleffusionwithchemotherapyto

beorganisedwhentheothersymptomsresolve.

Findoutwhatfurtherinformationthepatientneeds.Referthepatientto

acounsellorandexplainthepossibletreatmentoptions(diuretics,

thoracentesis,notreatment,etc).

Expressconcernregardingchemotherapyandyournewsymptoms.

Askifyourshortnessofbreathmaybecausedbyyourlungcancer.

Askifchemotherapyisnecessaryandwhatyoucanexpectifyou

havechemotherapytreatment.

Whenasked,explainthatyoudon’treallywantmoreprocedures;

youjustwanttogohome.Youwouldliketospeaktoacounsellor.

Reluctantlylistentothedoctor’soptions.

NursingTaskCards

ROLEPLAYER

CARDNO.5

NURSING

SETTING OutpatientMentalHealthClinic

NURSE This24-year-oldpatientwasrecentlyprescribedlithiumforhis/her

bipolardisorderbutisnowworriedcontinuingwiththisdrug.He/sheis

wouldliketoknowmoreaboutthemedication,includingits

indications,sideeffects,andmonitoring.

ROLEPLAYER

CARDNO.5

NURSING

Findoutthewhythepatientisconcernedandiftheyare

experiencingsideeffects.

Explainhowlithiumworks(e.g.veryeffectivemoodstabiliser)and

thattheywillhavetotakeitforever,althoughthedosemaybe

adjusted.

Gooversomesideeffectswiththepatientwhileproviding

reassurance(e.g.acneandhairlossarecommonbutothersideeffects

likeseizuresarerare).

Checkthatthepatienthasunderstoodyourexplanationsandfindout

whatfurtheradvicetheyneed.Providefurtherreassurancethatthey

aredoingtherightthing.

SETTING OutpatientMentalHealthClinic

PATIENT Youare24yearsoldandhaveadiagnosisofbipolarmooddisorder.The

psychiatristhasprescribedyoulithiumasamoodstabiliser.Youhave

beentakingitforaweekanddonesomeresearchonline.Youare

worriednowbecauseeveryoneappearstoreporthavingnegativeside

effectsonthemedication.Youwouldliketoknowifyoushould

continuetotakethemedication,howitworksandwhatsideeffectsto

watchoutfor.

TASK Explainyourworryoverwhatyouhavereadonlineandyourconcern

aboutthesafetyofcontinuingthismedicine.

Askhowittreatsyourcondition.Willyouneedtotakeitforever?

Findoutwhatsortofsideeffectsaretypical.Howlikelyisitthey

willoccur?

Bereluctanttocontinuetakinglithium.Eventuallyagreetothe

nurse'sadvice.

CANDIDATE

CARDNO.6

NURSING

SETTING RehabFacility

PATIENT Youhavebeenaskedbyafamilymembertospeaktoapatientwhois

recoveringfromasubarachnoidhaemorrhage(SAH)(bleedingbetween

theskullandthecortex).Thepatientisconcernedthatafullrecoverywill

notoccurandthatanotherSAHisinevitable.

TASK Findoutthespecificsofthepatient’sconcerns.Reassurethepatient

thatfatiguewilllessenandphysicalenduranceandmemorywill

improveasthebraincontinuestoheal.

Explainthatsomepatientsareabletogobacktowork/live

independently.

Discusshowthepatientcouldliveindependently:e.g.,assistive

devices(walkerorcane,grabbarsinbathroom),visualcuestotrigger

PLAYER

NURSING

SETTING RehabFacility

PATIENT Youare49-years-oldandrecoveringfromasubarachnoidhaemorrhage

(SAH)(bleedingbetweentheskullandthecortex)thatoccurredthreemonths

ago.Youweredischargedfromanacutecarefacilitytoarehabfacility

yesterday.Youweretoldthatyouwillcontinuetoimproveoverthenext12

months,butyouareconcernedaboutthehighestleveloffunctioningthatyou

willachieve.YoualsowouldliketoknowhowtopreventanotherSAH.

memory(post-itnotes,pictures),settingalarmclockstoserveas

reminders(timeformedications,phonecalls,etc.).

StresstheimportanceoftakingBP(bloodpressure)medicationsas

prescribed.Suggestthatthepatientusea7-daypillorganiser.

Tellthenursethatyouareconcernedthatyouwillnotregainyourstamina,

financialcontrolorbeabletoliveindependently.

Askthenurseifpatientsareeverabletoliveindependentlyandgobackto

workafterrecoveringfromaSAH.

AskthenursehowyoucanmaintaingoodBP(bloodpressure)toprevent

anotherSAH.

Answers

THEPRACTICETEST

ListeningSection

PlayTrack21tocompletetheListeningTest.

ListeningTest

Thistesthasthreeparts.Ineachpartyou’llhearanumberofdifferentextracts.

You’llheareachextractONCEONLY.

Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,ahealthprofessionalistalkingtoapatient.

Forquestions1to24,completethenoteswithinformationyouhearintherecording.

YouhearafoundationdoctortalkingtoarecentlyadmittedpatientcalledRoyMiller.Forquestions1to12,completethenoteswithawordorshortphrase.

Name RoyMiller

Reasonsforadmission shortnessofbreath

difficultywalking(1),oftenbecomesshortofbreath—

breathlessnesshasincreased—

coughingandwheezing

soundslike‘(2)’andhasn’timproved—

worsewhen(3),preventingsleep—

coughingupphlegm,describedas(4)incolour—

Medicalhistory

Medication

phlegmhasgraduallydarkenedovertheweek—

sufferinghotandcoldspells,feels(5)

diagnosedwith(6)lastyear

wasa(7),stoppedsixyearsago

occasionallysuffersfromgout(treatedwith(8))

arthritislocatedin(9)

using(10)morefrequently

takesastatinfor(11)

occasionallyusesparacetamolforarthritis

(12)causesanallergicreaction

YouhearanoptometristtalkingtoapatientcalledMarshaSamarina.Forquestions13to24,completethenoteswithawordorshortphrase.

Patient MarshaSamarina

Descriptionofinitialsymptoms

InitialGPtreatment

painineye,feltlikesomethingwas(13)

noticedheadache

eyewas‘(14)’profusely(comparestochoppingonions)

roommatenoticedthateyewas(15),tooktoER

painwassevere,unableto(16)

unabletoidentifycause,performed(17)test

Optometristtreatment

Athometreatment

Currentcondition

GPsuggestedpossibilityof(18)

given(19)forpain-relief

eyeexamshowed(20)

advisedtoavoidwearingcontacts

prescribed:

(21)-usingtwicedaily—

and(22)lessoften,findsapplicationunpleasant—

alsotaking(23)forpainrelief

conditionhasimproved

paincausedby(24)

Inthispartofthetest,you’llhearsixdifferentextracts.Ineachextract,you’llhearpeopletalkinginadifferenthealthcaresetting.

25. Youheartwodoctorsdiscussthetransferofcareforapatient.

Thepatient’sCURB-65scoremeansthathewill

betransferredfromtheEmergencyDepartment.(A)receiveadditionalmedicationandtreatment.(B)betreatedasanout-patient.(C)

26. Youhearaspeechpathologisttalkingtothewifeofapatientwhohasrecentlysufferedastroke.

Whatdoesshewanttoknowaboutherhusband’scondition?

howlongitwilltakehimtomakeafullrecovery(A)

whetherhiscommunicationissueswillimprove(B)whatshecandotospeedthehealingprocess(C)

27. Youhearatraineedoctoraskingaseniorcolleagueaboutchesttubes.

Whatistheseniorcolleaguedoing?

explaininghowtousethemcorrectly(A)recommendinganalternativetothem(B)demonstratingwhatcangowrongwiththem(C)

28. Youhearapharmacisttalkingtoacustomeraboutpainrelief.

Whathasthecustomerbeenmisinformedabout?

thestockofmedicationinthepharmacy(A)theusefulnessofatypeofpainrelief(B)theavailabilityofamedicine(C)

29. Youhearatraineenursereceivingfeedbackfromhistutor

Whatdoessheexplain?

listeningtoapatient’sconcernsisessential(A)

howtobecomemoreself-assuredwheninteractingwithpatients

theimportanceofprovidingadequateemotionalsupporttopatients

30. Youheartwodoctorsplanningtheirpatient-careschedule

Whatistheirpriority?

identifyingthepatientsatgreatestrisk(A)dealingwithpatientswhoneedtestsarranging(B)ensuringthatallpatientshavekeydocumentation(C)

YouhearaninterviewwithDrMatthewLeach,who’stalkingaboutmeningitiscausedbyNeisseriameningitides.

31. DrLeachsaysthatduringtheonsetofmeningitis,manypatients

donotrealisetheyareunwell.(A)mistaketheillnessforsomethingelse.(B)experiencelife-threateningsymptoms.(C)

32. DrLeachsaysthatmeningitisiscommonincollegestudentsbecauseoftheir

poorhygienehabits.(A)proximitytonewpeople.(B)weakenedimmunesystems.(C)

33. WhydoesDrLeachsaythepatientdidn’tseektreatmentsooner?

Hewasunsureofwhattodo.(A)Hedidn’tthinkheneededtreatment.(B)Hewastryingtofinishhisassignments.(C)

34. DrLeachbegantreatingformeningitisbeforereceivingthespinalfluidresultsbecause

theillnessprogressesrapidly.(A)thetreatmentisthesameforallcauses.(B)thetestresultsdidnotaffectthediagnosis.(C)

35. DrLeachexplainsthatmeningitisismorelikelytocauselongtermafter-effectsif

itisnotaccuratelydiagnosed.(A)patientsdonotseektreatmentquickly.(B)reactionstothevirusareextremelysevere.(C)

36. DrLeachadvisesthosewhothinktheymaybeinfectedwithmeningitisto

YouhearapresentationgivenbyaclinicalpsychiatristcalledDrEvalinaHoughtonaboutagitatedpatientsinanemergencysetting.

getvaccinatedattheearliestopportunity.(A)avoidpeoplewhomaybesufferingfromthevirus.(B)takeprecautionstopreventothersfrombecomingill.(C)

37. DrHoughtonsaysthatpatientsintheEDaremorelikelytobeagitatedastheyarelikelyto

sufferfromuntreatedhealthproblems.(A)havebeengivenbadnewsrecently.(B)requiremedicalhelpfrequently.(C)

38. DrHoughtonexplainsthatcreatingspacebetweenthepatientandtheprovider

enablesbothpartiestoremaincalm.(A)encouragesthepatienttoexittheroom.(B)reducesthelikelihoodoftheproviderbeinginjured.(C)

ENDOFLISTENING

39. WhydoesDrHoughtonencourageproviderstospeakslowly?

toensurethepatientunderstandswhatisbeingsaid(A)togiveothermembersofstafftimetoprepare(B)togivethepatientanopportunitytospeak(C)

40. WhatapproachdoesDrHoughtonsuggestforpatientssufferingfromdelusions?

agreewiththepatientcompletely(A)acknowledgethepatient’semotions(B)explainwhytheirdelusionsarefalse(C)

41. DrHoughtonsuggeststhatchoicesgiventothepatientshould

avoidupsettingthepatientbyremainingpositive.(A)maintainthepatient’strustbybeingrealisable.(B)belimitedinordertopreventconfusion.(C)

42. DrHoughtonrecommendsthatwhenthepatientiscalmtheyshould

beremovedfromtheEDward.(A)understandwhytheirbehaviourwasinappropriate.(B)beencouragedtoexplainwhatcausedtheirreaction.(C)

THEPRACTICETEST

ReadingSection

TIME:15minutes

Asthma:Questions

Questions1–6

Foreachquestionbelow,1–6,decidewhichtext(A,B,CorD)theinformationcomesfrom.

Youmayuseanylettermorethanonce.

Inwhichtextcanyoufindinformationabout

Lookatthefourtexts,A–D,intheTextBooklet.Foreachquestion,1–20,lookthroughthetexts,A–D,tofindtherelevantinformation.WriteyouranswersinthespacesprovidedinthisQuestionPaper.Answerallthequestionswithinthe15-minutetimelimit.

1. relaxationtechniquesforthosesufferingfromanasthmaattack?

Questions7–12

Completeeachofthesentences,7–12,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

2. measuringtherespirationabilitiesinpatientswithasthma?

3. identifyingtheintensityofasthmaattacksinpatients?

4. theproceduretofollowwhentreatinganasthmaattack?

5. symptomsofasthmainpatients?

6. howtodiagnoseasthmainpatients?

7. Tounderstandhowsevereanasthmaattackis,(7)mustbemeasured,inadditiontoPEF.

8. Forpatientswhodonotrespondtotherapy,anIVof(8)canbeusedtotreatsevereasthmaattacks.

Questions13–20

Answereachofthequestions,13–20,withawordorshortphrasefromoneofthetexts.Eachanswermayincludewords,numbersorboth.Youranswersshouldbecorrectlyspelled.

9. Nitricoxidetestingcanbeusedtodetermine(9)inpatients.

10. Apatientsufferingfromarrhythmiaandapeakexpiratoryflowofgreaterthan33%wouldbediagnosedwith(10)asthmaattacks.

11. Spirometryteststhatcontain(11)typicallylastforhalfanhour.

12. (12)cancauseneutrophilicinflammationinpatientswithasthma.

13. Howoftenshouldpatientsbeadvisedtopracticebreathingexercises?

14. Howoftenshouldpatientswithapeakexpiratoryflowoflessthan75%begiven10mgofsalbutamol?

15. Whenshouldpatientsbegiven2mgofmagnesiumsulfate?

16. Whichpatientswilltypicallyneedtorunwhencompletingspirometrytests?

17. Whatshouldstaffdowhenassessingapatientsufferingfromalife-threateningpanicattack?

18. Whichlungfunctiontestishelpfulforunderstandinghowthepatientrespondstotreatment?

19. Whatsortofnoisemightpatientswithasthmamakewhenbreathing?

20. Whatisusedtomeasurepeakexpiratoryflowrate?

ASTHMA:TEXTS

Establishingtheseverityofanacuteasthmaattack

Moderateasthma Severeasthma Life-threatening

asthma

Adults MeasurePEFandarterialsaturation

PEF>50-75%predicted PEF33-50%predicted PEF<33%predicted

Asthmasufferersofanyseveritymayalsoexperiencethefollowing:

SpO2≥92%

PEF>50-75%predicted

Nofeaturesofacutesevere

asthma

SpO2≥92%

PEF<50%

predicted

RR≥25/min

HR≥110/min

difficultytalking

SpO2≥92%

silentchest

cyanosis

poorrespiratoryeffort

arrhythmia

hypotension

exhaustion

alteredconsciousness

shortnessofbreathcoughingtightnessorpaininthechestawhistlingsoundwhenexhaling

LungFunctionTestsinAsthma

Asthmatestsshouldbeundertakentodiagnoseandaidmanagementofthecondition.Thisisparticularlyimportantinasthma,becauseitpresentsslightlydifferentlywitheachpatient.Spirometryisthemostimportanttest,howeverseveraldifferenttypesoftestareavailable:

Peakexpiratoryflowrate(PEFR):thisisthemaximumflowrateduringexhalation,afterfulllunginflation.DiurnalvariationinPEFRisagoodmeasureofasthmaandusefultothelong-termmanagementofpatientsandtheresponsetotreatment.MonitorPEFRover2-4weeksinadultsifthereisuncertaintyaboutdiagnosis.Itismeasuredwithapeakflowmeter-asmall,handhelddevice-intowhichthepatientblows,givingareadinginl/min.Spirometry:measuresvolumeandflowofairthatcanbeexhaledorinhaledduringnormalbreathing.Asthmacanbediagnosedwitha>15%improvementinFEV1orPEFTfollowingbronchodilatorinhalation.Alternatively,considerFEV1/FVC<70%asapositiveresultforobstructiveairwaydisease.Aspirometrytestusuallytakeslessthan10minutes,butwilllastabout30minutesifitincludesreversibilitytesting.

Directbronchialchallengetestwithhistamineormethacholine:inthistest,patientsbreatheinabronchoconstrictor.Thedegreeofnarrowingcanbequantifiedbyspirometry.Asthmaticswillreacttolowerdoses,duetoexistingairwayhyperactivity.Exercisetests:theseareoftenusedforthediagnosisofasthmain

children.Thechildshouldrun6minutes(onatreadmillorother)ata

workloadsufficienttoincreasetheirheartrate>160/min.Spirometryisusedbeforeandaftertheexercise-anFEV1decrease>10%indicatesexercise-inducedasthma.

Allergytesting:canbeusefulifyear-roundallergiestriggerapatient’sasthma.Thiswillberecommendedifinhaledcorticosteroidsarenotcontrollingsymptoms.Threedifferenttestsareusedtomeasurethepatient’sreactiontoallergens:nitricoxidetesting,sputumeosinophilsandbloodeosinophils.

Patientswithasthmaofanyseveritymayfindtheirattackspanic-inducing.Rememberthatthepatient’sstruggletobreathecancausestress,panicandafeelingofhelplessness.Thereisastronglinkbetweenpeoplewhosufferfromasthmaandthosewhoexperiencepanicattacks.Staffmustkeepthisinmindwhentreatingpatientswithasthma,assomesuffererswillrequireadditionalemotionalsupport.

Patientsmayfindbreathingexercisesbeneficial.Advisepatientstopracticedaily,toallowtheseexercisestobecomehabitual.Whenexperiencinganattack,patientsshouldmakeaconsciousefforttorelaxtheirmusclesandmaintainsteadybreathing.Advisepatientstobreathedeeplyinthroughthenoseandoutthroughthemouth.

Smokersareatahigherriskofdevelopingbothpanicattacksandasthma.Inaddition,smokingcanirritatetheairwaysinpatientswithasthma,causingneutrophilicinflammation,andexacerbatingbreathingproblemsinthosewithasthma.Ensurethatpatientswhosmokearefullyawareoftherisksofsmokingwithasthma.

ManagementofAcuteAsthma

Rapidtreatmentandreassessmentisofparamountimportance.Itissometimesdifficulttoassessseverity.Maintainingacalmatmosphereishelpfultoresolvinganacuteasthmaticattack.

1. Thenoticeremindsstaffthatpatientswhoaredying

willneedtobeprescribedanti-emetics.(A)mightnotneedtocontinuewithcertainmedication.(B)shouldbeencouragedtodiscusstheirconditionwithloved

ones.(C)

End-of-LifeDecisionMaking

Rememberthefiveprioritieswhencaringforadyingpatient:

Recognisethattheendoflifemaybeapproaching.1.Communicatewithpatients,families,carersandstaff.2.Involvepatientsandthoseclosetothemindecision-

making.3.

Supporttheneedsoffamiliesandcarers.4.Developanindividualisedplanofcareforthepatient.5.

Anend-of-lifecareplanmustensurethephysical,psychological,socialandspiritualcomfortofthepatient,andshouldstriveforthebestpossiblequalityoflifeforthepatient’sremainingtime.Thisincludesprescribinganticipatorymedicationswhichcanbegivenasrequired,fallingunderthefollowingcategorieswhichstaffareencouragedtorememberasthe‘FourAs’:Analgesia(painrelief),Anxiolytics(anti-anxiety),Anti-emetics(fornauseaandvomiting),andAnti-secretory(forrespiratoryandairwaysecretions).Anyunnecessarymedications,suchaslong-termdiabetescontrolandbloodpressuremedicationscanbestopped.ADo-Not-Resuscitate(DNACPR)decisionalsoneedstobemade.

2. Theguidelinesinformusthatmultipleanaestheticscanbeused

toincreasethenumbingeffects.(A)topreventbleedingthroughouttheprocedure.(B)tomoreaccuratelycontrolhowlongitwilllast.(C)

AnaesthesiauseatHarlowDentalCentre

Atthispractice,preferenceisgiventotheuseoflocalanaestheticsincombinationwithconscioussedation.

Manylocalanaestheticsmaybeusedinordertoreversiblyblockspecificpainpathwaysand/orcauseparalysisofmuscles.Themostcommonlyusedlocalanaestheticatthecentreislidocaine-rememberthatthehalf-lifeoflidocaineinthebodyisabout1.5to2hours.Otherlocalanaestheticagentsincludearticaine,bupivacaine,prilocaineandmepivacaine.Often,acombinationoflocalanaestheticsmaybeused,sometimeswithadrenalineoranothervasoconstrictortomodulatethemetabolismofthelocalanaestheticandcontrollocalbleeding.

Sedationduringproceduresshouldmostlybelimitedtoconscioussedation.Benzodiazepinesenhancetheeffectofneurotransmittergamma-aminobutyricacid(GABA)attheGABAAreceptor.Thisresultsinasedative,hypnotic,anxiolytic,anticonvulsantandmusclerelaxantproperties.

3. Thepurposeofthismemoistoexplain

howtotreatmulti-resistantpathogens.(A)thecausesofbacterialinfections.(B)whentoprescribeantibiotics.(C)

Fortheattentionofallmedicalstaff:

Microbialresistancetoantibioticsisontheriseandinfectionwithmulti-resistantpathogens,suchasClostridiumdifficileandMRSAamongstothers,isbecomingmorecommon.

Patientsreceivingantibioticsareatincreasedriskofsuchinfections.Assuch,pleasebeawareofourantimicrobialprescribingguidelines,whichensurethatantibioticsareonlyprescribedwithclear,clinicaljustification;evidenceofinfection;and/orguaranteedmedicalbenefit.

Itisrecommendedthatspecimensshouldbeculturedandresultsobtainedbeforecommencingtreatmentwithantibiotics,thusonlyprescribingthetherapytowhichthemicrobeissensitive.Prescriptionofbroad-spectrumantibioticsshouldbeavoidedwherepossible,asthesenotonlydamagethenormalbacteriaofthehumanbody,butalsoincreasemicrobialexposuretoanti-microbialmedications,increasingtheirpotentialfordevelopingresistance.Reviewnarrow-spectrumantibioticprescriptionswithin5days,andbroad-spectrumprescriptionswithin48hours.

4. Thisguidelinesonautisminyoungpeopleinformusthat

thedisorderismoredifficulttoidentifyinpatientswithADHD.

mostchildrenwithautismarediagnosedbeforetheageof(B)

three.youngpeoplewithautismaremorelikelytosufferfromother

conditions.(C)

AutisminYoungPeople

Morethan1%oftheUKpopulationhasanautismspectrumdisorder.Signscanvarywidelybetweenindividualsandatdifferentstagesofanindividual’sdevelopment.WhenchildrenpresentwithotherconditionssuchasADHD(attentiondeficithyperactivitydisorder)orotherlearningdifficulties,autismspectrumdisordersoftengoundiagnosed.

Inchildrenwithautismspectrumdisorders,symptomsarepresentbeforethreeyearsofagebutdiagnosiscanbemadeafterthisagetoo.Individualswithautismspectrumdisordertendtohaveissueswithsocialinteractionandcommunication,includingdifficultywitheyecontact,facialexpressions,bodylanguageandgestures.Often,childrenwithautismspectrumdisordersmaylackawarenessorinterestinotherchildrenandtendtoplayalone.

Thecausesofautismspectrumdisorderareunknownbutarelinkedtoseveralcomplexgeneticandenvironmentalinteractions.

5. Thememoremindsallstafftoavoid

challengingapatient’scriticisms.(A)handlinggrievancesofasensitivenature.(B)recordingcomplaintsthatarenotlegitimate.(C)

Subject:FieldingPatientComplaints

Fortheattentionofallhospitalstaff:

AtCountyGreenHospital,weendeavourtoprovideourpatientsandfamilieswiththehighestqualityofservices.Unfortunately,theremaybetimeswhereperformancedoesnotmeetexpectation.Weroutinelysurveyourpatientsonhowwecandobetter,butmembersofthetreatmentteammayalsobeapproachedwithpatientfeedback,soallemployeesmustbeawareofthecorrectprocedureforhandlingpatientcomplaints.Thefirststepistolistentowhatpatientshavetosayanddocumentdetailsappropriately.Whetherornotyoufeelthereisalegitimategrievance,itisimportanttokeeparecordforlaterexamination.Whilelisteningtothecomplaint,theemployeeshouldvalidatethepatientorfamilymember’sexperience.Thisdoesnotmeanthereneedsbeagreementaboutthenatureofthecomplaint,butthattheemployeedemonstratesaclearunderstandingofwhythepatientorfamilymembermightbefeelingthisway.

6. Patientswithdeliriumaremorelikelytorecoverquicklyif

keptinadarkenedenvironment.(A)staffchangesarekepttoaminimum.(B)treatmentensurestheyreceiveadequaterest.(C)

DiagnosticCriteriaforDelirium

Deliriumaffectsupto87%ofpatientsinintensivecareandisparticularlycommonamongtheelderly.Deliriumcanhaveseriousadverseeffectsandevenleadtomortalityandmustthereforebetreatedasamedicalemergency.

Allhospitalstaffmustknowhowtoprevent,detect,andrapidlyassessandtreatdeliriumonthehospitalwards.Riskfactorsfordevelopingdeliriuminclude:changeofenvironment,lossofvision/hearingaids,inappropriatenoiseorlighting,sleepdeprivation,severepain,dehydration,drugwithdrawal,infectionsofanykind,recentsurgery,andoldage.Forpatientsatriskofdelirium,thinkofthemnemonicDELIRIUMwhichindicatesthecommoncauses:DrugsorDehydration,ElectrolyteImbalance,Levelofpain,InfectionorInflammation(suchaspost-surgery),Respiratoryfailure,Impactionoffaeces(severeconstipation),Urinaryretention,Metabolicdisorder(suchasliverorrenalfailure).

Managementrequiresre-orientationofthepatienttowheretheyareandwhoeverybodyaroundthemis,aswellasre-assuranceandanon-confrontational,empatheticapproachtowardsagitatedanddistressedpatients.Pleaserefrainfromchangingthestaffofthemedicalteamresponsibleforadeliriouspatient’scare,inordertoensureconsistencyforthepatient.Avoidunfamiliarnoises,equipmentandstaffintheimmediatevicinityofthepatient,andfacilitatevisitsfromfamilyandfriendsasmuchaspossible.

Text1:Work-RelatedStress&MedicalErrors

Stressisatermthatcropsupalltooofteninmodernconversation,usedtodescribeeveryunfortunatecircumstance,everyout-of-sequenceevent,andeveryfootoutofline.Whatisstress?Mostdefinitionsofstresscoveranyinternalorexternalstimuluswhichresultsinanegativeresponseordisturbanceinone’sphysical,socialormentalwellbeing.Unfortunately,stressiscommon,anditcanbedevastatingtopeople’slivesandhealthwhenitismaintainedoverlongperiodsoftime,andwhenitgainsthecapacitytooverwhelmone’scopingabilitiesandmechanisms.

Inthemedicalprofession,dailystressisalmostguaranteed.Recently,changestomanyhealthcareworkers’contractsintheUKhaveresultedinlongerandmoreantisocialworkinghours,aswellasanincreasedworkload,greaterbedcrisesinhospitalsandlargerbudgetcuts,sostresslevelsamongstUKhealthcareprofessionalsareontherise.A1996questionnairestudyintheLancetreportedthat27%ofdoctorsintheUKbelievedthatthestresstheyexperiencedwastriggeredbypoormanagement,lowjobsatisfaction,financialconcerns,andpatients’suffering,amongstotherfactors.

Overtwodecadeslater,theseproblemsstillexist;somehealthcareworker’sarguethatconditionshaveactuallydeteriorated.A2013reportbytheBritishMedicalAssociationstatedthatover50%ofUKdoctorshadexperiencedanincreaseinwork-relatedstressovertheprecedingyear,inadditiontoanincreaseinthecomplexityoftheirwork.25%ofjuniordoctorsinhospitalsalsoreportedareducedqualityofcareforpatientsduetohighlevelsofstressandthepressuresputonindividualmembersofstaff,withlevelsofstressexacerbatedbylongerworkinghours.Inmanyhealthcarejobs,stressistheelephantintheroom,particularlywithjuniorstaff,whomayfeelunabletovoiceconcernsabouttheirworkload.Unfortunately,however,thesefactorshavethepotentialtoleadtomedicalmistakes,whichcouldbedetrimentaltopatientlives.Insuchacircumstance,whoisreallytoblame?Theoverworkedmedicalstaff,orthepoormanagementofmodernhospitals?

Wedonotneedtolookfartoexaminetheeffectthatstresscanhaveondoctorstoday.In2015,DrHadizaBawa-Garbawasfoundguiltyofmanslaughterafterfailingtoprovidelife-savingtreatmenttoapatientwhenneeded,resultingintheunfortunatedeathofasix-year-oldchild,JackAdcock.In2018,thisexperiencedseniorpaediatricianwithapreviouslyunblemishedrecordwasstruckoffthemedicalregister,unabletoeverpracticeagainasadoctor.ThecaseofDrBawa-Garbainfuriatedmanyinthemedicalprofession,asfingerswerepointedatanoverworkeddoctorworkingunderimmensepressurewhowasblamedforgrossnegligence.Butwhoisthetrulynegligentoneinourcurrenthealthcaresystem?WhilethedeathofyoungJackisextremelysaddening,itisimportanttoexplorethecircumstancesaroundhisdeathinordertopreventsuchtragediesfromreoccurring.Onthedayoftheincident,DrBawa-Garbawascoveringherownworkloadaswellasthatoftwoseniorcolleagueswhowereaway,acrosssixwards,spanningfourfloors,withmalfunctioningITsoftwareandout-of-orderresultssystems.DidDrBawa-Garbamakedetrimentalmistakes?Yes.Butonemustask,arewecreatingarecipefordisasterwhenwerequireourmedicalstaff

toworkundersuchimmensepressures?Couldthisbeonetragiceventofmanywaitingtohappen?Suchmistakesruinlives.

Studieshaveshownthatthemostcommoncauseofmedicalerrorsistheuseofheuristicsinmedicaldecision-making,leadingtobias.Heuristicsareshortcutstakentoreachdecisionsquickly,basedonpreviouspatternsofdiseaseandsimilarcasesseenbythedoctor.Mistakesaremorelikelywhensuchshortcutsareusedbyjuniordoctorswholacktheexperiencenecessarytomakesuchfastdecisionsaccurately.TverskyandKahnemanoutlinedseventypesofheuristicsintheir1974article:Availabilityheuristicsarebasedonhoweasyspecificdiagnosesaretorecall,resultinginover-diagnosisofrarebutmemorableconditions;Representativenessheuristicsarebasedonsimilarityofpatientpresentationstoprevioustypicalcases,leadingtodelayedormisseddiagnosesinatypicalornon-characteristicpatients;Anchoringheuristicsoccurwhenadiagnosisisbasedononepieceofinformationonly,leadingtorapidconclusionswhichlackevidenceandearlydiagnosiswithoutconsiderationofallavailableinformation;Confirmationbiasoccurswhenadiagnosisisbasedonapre-conceivedidea,wherethedoctorpaysattentiontotheinformationthatsupportstheirtheory,andevidencewhichchallengesthediagnosisisconsciouslyorsubconsciouslyignored;Commissioningbiaswhereadoctoractstoosoonratherthanwaitingtogatherandreviewalltheinformationfirst;Gambler’sFallacywhichiswhereconsecutivepatientshavethesamediagnosisandsothedoctorassumesasimilarpatientwhofollowsmustalsohavethesamediagnosis;FundamentalAttributionErrorwhichisthetendencytoblamepatientsratherthantheircircumstancesfortheirpoorhealth.

Researchshowsthatthebestwaytoavoidmedicalerrorsindiagnosisistoconsiderseveralhypotheses,knownas“differentialdiagnoses”,andinvestigatethemallequallyuntiltheonewiththemostsupportingevidenceisfoundandagreedupon.Useofheuristicsandtheresultantflaweddecision-makingcould

bepreventedbyreducingworkstressesandpressuresonmedicalprofessionals.Onewaytoachievethiswouldbetoreduceworkinghoursandshiftdurationsinordertopreventsleepdeprivationinmedicalstaff,whichisknowntohinderfocus,thuscreatingasafermedicalenvironmentforbothstaffandpatients.

7. Thefirstparagraphexplainsthatstress

isusuallycausedbyafactorthancannotbecontrolled.(A)isinterpretedinvariouswaysbydifferentpeople.(B)isunusualwhenitlastsforanextendedtime.(C)generallyimpactspeople’sbehaviour.(D)

8. Inthesecondparagraph,doctorsaresaidtoclaimthatstress

isoftenimproperlymanagedbychronicsufferers.(A)couldbeimprovedbyincreasingthewelfarebudget.(B)generallyresultedintheirhavingtoworklongerhours.(C)wascausedbyanumberofissuesincludingmoneyworries.(D)

9. Thewriterusesthephrase‘theelephantintheroom’toemphasisethefactthat

levelsofstressexperiencedbystaffhasdeclined.(A)seniorstaffgenerallyexperiencelessstressthantheirjuniors.(B)manyhealthcareprofessionalsdonotdiscussthestressthey(C)

experience.juniordoctorshavereportedalowerqualitypersonallifeasa

resultofstress.(D)

10. WhydoesthewritercommentonDrHadizaBawa-GarbaandherpatientJack?

tosuggestthatdoctorsaremorelikelytomakesignificanterrorswhenstressed

tooutlineascenariowhereadoctor’sconcernsaboutstresswereignored

todemonstratethatstressinhealthcareprofessionalsisunacceptable

toemphasisetheimpactthedeathofapatientcanhaveonstress

11. ThewritersuggeststhatJackAdcock’sdeathwaspartlycausedby

technologythatwasoutofdateandfaulty.(A)ahospitalwardovercrowdedwithpatients.(B)aninsufficientnumberofnursingteamstaff.(C)alackofexperienceamongtheclinicalteam.(D)

12. Whymightdoctorswhouseheuristicsbeatagreaterriskofmakingclinicalerrors?

heuristicsaremorelikelytobeusedbyjuniordoctors(A)

doctorsmighttaketoolongtocompletetheirtasks(B)doctorsmightskipovertherelevantinformation(C)thedifferenttypesofheuristicsareconfused(D)

13. Thewriterclaimsthatconfirmationbiasmightcausedoctorstoignorerelevantinformationif

theyhaverecentlytreatedapatientwiththesamecondition.(A)theyareveryfamiliarwiththeevidencebeingpresented.(B)thepatientdisplaysextremesymptoms.(C)itdoesnotsupporttheirexistingtheory.(D)

14. Whatdoestheword‘them’refertointhefinalparagraph?

theteamofhealthcarestaff(A)avarietyofpossiblecauses(B)themistakesinpatientcare(C)anumberofdifferenttexts(D)

Text2:Electroconvulsivetherapy(ECT)

Electrodes.Wires.BiteBlocks.Formanythesetermsbringtomindasinistermentalasylumandtheforebodingimageofapatientabouttosufferatortuouselectricshock.Literaturewritteninthe20thcenturydidmuchtocriticisethispractice,withwritersfrequentlydescribingelectroconvulsivetherapy(ECT)asaformoftorture,reservedforthemostvulnerablemembersofsociety.Interestinglyenough,ECThasactuallybeenusedinthehealthcarefieldfor

hundredsofyears.Beforetheadventofeffectiveantipsychoticmedications,awidevarietyoftherapiesweretrialledforseriousmentalillnesses.Oneoftheseinvolvedthetherapeuticuseofinducingseizuresinpatients.AsearlyasBenjaminFranklin’s(1705–1790)time,anelectrostaticmachinecouldbeusedtocuresomeoneof‘hystericalfits’.

Throughthe19thcentury,Britishasylumsbegantoemployelectroconvulsivetherapyinawidespreadefforttocurediseasesofthemind.Intheearly20thcentury,aneuropsychiatristbythenameofLadislasJ.Medunapromotedtheideathatschizophreniaandepilepsywereantagonisticdisorders,andthatprecipitatingseizurescouldserveasapotentialtreatmentofschizophrenia.Therewereseveralmethodsusedtoinduceseizures,includinginsulincoma,seizure-inducingmedications(metrazol),andmostfamously,ECT.

Whilemanyofthesepracticesarenowseenasbarbaric,therewereveryfewoptionsforpsychiatrictreatmentbeforethedevelopmentofantipsychotics,moodstabilisers,andanti-depressants.Withtheriseofthesenewtreatmentoptionscameanincreaseinthepublicawarenessoftheofteninhumanconditionsofelectroshock.Therevelationsresultedinwidespreadbacklash,andtheuseofECTtherapybegantoswiftlydecline.However,inthelaterpartofthe20thcentury,aftermuchdebateandresearch,theNationalInstituteofMentalHealthintheUScametoaconsensusthatECTwasbothsafeandeffectivewhenproperguidelineswereimplemented.IntheUStoday,ECTtreatmentisroutinelycoveredbyinsuranceforsevereandtreatment-resistantformsofmentalillness.

TheexactmechanismofactionforECTisunknown,butthereareseveralhypotheses:Firstly,increasedreleaseofmonoamineneurotransmitterssuchasdopamine,serotonin,andnorepinephrine;secondly,enhancedtransmissionofmonoamineneurotransmittersbetweensynapses;thirdly,releaseof

hypothalamusorpituitaryglandhormonesandfourthly,anticonvulsanteffect.ECThasseveralindications,themostnotablebeingrefractorymajordepression,catatonia,persistentsuicidality,andbipolardisorder.Itisalsousedinpregnancyasitiseffectiveanddoesnothavetheteratogeniceffectsofsomeotherpsychiatricmedications.Whiletherearenoabsolutecontraindications,itgoeswithoutsayingthatwhenusingECT,therisksinvolvedwillcarrymoreweightwithcertainpatients.Thosewithunstablecardiovascularconditions,thosewhohaverecentlysufferedastroke,andthosewithincreasedintracranialpressure,severepulmonaryconditions,orahighriskinanaesthesiamaynotbesuitablecandidatesforECT.TofurtherexploretheappropriatenessofusingofECTonspecificpatients,considerthefollowingcasestudy.

Thepatient,let’scallherDana,isa35yearoldfemalewhohasahistoryofschizophrenia.Shewastakentothehospitalbyambulancebecauseherparentsfoundhermotionlessinherbed,staringblankly,notrespondingtoexternalstimuli,andnoteatingordrinkingfortwodays.Thepsychiatristcaringforherisunderstandablyconcerned,becausethisrepresentssymptomsofcatatonia.IfDanadoesnoteatordrink,shemaydeveloplife-threateningnutritionaldeficienciesandelectrolyteimbalances.Ifshedoesnotmove,Danamayendupdevelopingabloodclotthatcouldresultinafatalpulmonaryembolism.Thefirst-linetreatmentisbenzodiazepines,butinthisparticularcase,thereisnoimprovementinhercondition.ThepsychiatristdecidesthatthatECTisthenextbestoption.Thereistheissueofinformedconsent.Legaljurisdictionhandlesthisdifferentlythroughouttheworld,butifapatientlackscapacityoristooilltoprovideconsent,acourtmustprovidesubstituteconsenttoensureadequatelegaloversight.Oncethishappens,Danaismedicallyscreenedandpreppedfortreatment.

AcourseofECTtreatmentsdoesnothaveastandardregimen.Generally,mostpatientsrequirebetweensixtotwelvetreatments,buttheactualendpointis

determinedbythelevelofimprovement.ECTisoftengiventwotothreetimesaweek,usuallyonaMonday/Wednesday/Fridayschedulewithpsychiatricsymptomsandtestingcarriedoutonaregularbasistomonitorprogress.DanastartsMondaybybeingNPO(nothingbymouth)exceptforanynecessarymedications.Thisreducesthechanceforaspirationunderanaesthesiaduringtheseizure.ShewillbetakendowntotheECTsuitewhereananaesthesiologist,psychiatrist,andnursewillgreether.ShewillbeplacedinasupinepositionwithEEGmonitoringtodeterminethequalityoftheseizuregiven.Shewillhaveelectrodesplacedonherheadbitemporally,bifrontally,orunilaterallyontheright.Inthiscase,givenherlife-threateningcatatonia,wewillusethebitemporalposition.Theanesthesiologistwilltheninduceanaesthesia,firstpreoxygenatingthepatient,thenadministeringanticholinergicagenttoreduceoralsecretions,anaesthesicmedication,musclerelaxationmedication,andanycardiovascularprophylaxisasneeded.

Oncethepatientissufficientlysedated,abrief(0.5to2.0milliseconds)electricalpulsewillbeintroducedataleveldeterminedtoreliablycauseaseizure.AtherapeuticECTseizureshouldlastatleast15secondsbutnomorethan180seconds.Danawillbemonitoredforthirtytosixtyminutesoncethishasfinished,toensureherrecovery.Thegoalisforfurthertreatmentstoreducehersymptomsandenablehertoeat,drink,communicate,andmoveagain.Ofcourse,thereareadverseeffectsthatmustbeconsidered.Anaesthesiacancausenausea,aspirationpneumonia,dentalandtongueinjuries.Theseizureitselfcancausecardiovascularissues,andfracturesinpatientswithosteoporosis,andcantemporarilyimpaircognitionandmemory.ItisadvisedthatpatientsdonotmakeanymajororfinancialdecisionsduringorafterECTtreatment,andpatientsmustrefrainfromdrivinguntilafewweeksafterthelastsession.

Formostpatients,onetreatmentmaybeallthatisneeded.Forsome,continuationofECTasasinglesessioneverycoupleofweeksmayhelpto

preventrelapse.Maintenancetreatmentforpatientswithchronicallyrecurringpsychiatricillnessmayalsobeappropriate.Theschedulingofthesesessionsgenerallydependsonthepatient’sneedsandepisodes,sometimesevengoingonindefinitely.InDana’scase,afewtreatmentsareallthatisneededtoresolvehercatatoniaandsoonshewillbehealthyenoughtobedischargedhomewithoutpatientfollow-upforhermentalhealthmanagement.

15. Inthefirstparagraph,thewritermentionstheroleof20thcenturyliteraturein

informingpatientsofthesideeffectsofantipsychoticmedication.

preventingthemistreatmentofdefencelesspeople.(B)increasingthenumberofpatientsreceivingECT.(C)promotinganegativeimageofECT.(D)

16. Whatdowelearnaboutschizophreniainthesecondparagraph?

Itwaslessprevalentinpatientswhoexperiencedseizures.(A)Ithadasignificantimpactonthetreatmentofepilepsy.(B)ManyasylumsintheUKwerenotpreparedtotreatit.(C)Themedicationmetrazolcouldbeusedtoinduceit.(D)

17. WhatdidtheUSNationalInstituteofMentalHealthdecideinthe20thcentury?

PractitionersmustfollowidenticaltreatmentplanswhenusingECT.

PatientsshouldbegiventherighttorefuseECTtreatment.(B)ECTshouldonlybeusedasatreatmentinseverecases.(C)ECTwasacceptedasasafetreatmentforpatients.(D)

18. Inthefourthparagraph,whatideadoesthewriteremphasisewiththephrase‘itgoeswithoutsaying’?

SomewomenfindECTtreatmentssuccessfulwhilecarryingachild.

ItiswellknownthatsomepatientswillnotrespondwelltoECT.

FewpatientsrealisethattheycouldbenefitfromECTtherapy.(C)TherisksassociatedwithECTarerarelydiscussed.(D)

19. Inthecasestudy,thepsychiatristdecidestouseECTonDana

despiteDana’sparents’concernsaboutthistypeofprocedure.(A)becausethepatientexpressesapreferenceforthistreatment.(B)aftertreatmentwithbenzodiazepinesprovesineffective.(C)asshehasdevelopedanelectrolyteimbalance.(D)

20. Inthesixthparagraph,whyisn’tDanagivenfoodbeforeherECTtreatment?

ENDOFREADINGTEST

tolowerthelikelihoodofanaesthesia-relatedaspiration(A)toreducethelikelihoodofvomitingduringtreatment(B)asmedicationcaninterferewiththetreatment(C)asthecatatonicstatemakeseatingdifficult(D)

21. Intheseventhparagraph,whatdoestheword‘this’referto?

atreatmentplan(A)aseizurecausedbyECT(B)anabnormalreactiontomedication(C)animprovementtothepatient’scondition(D)

22. Inthefinalparagraph,thewritersuggeststhatDana’streatment

wascompleteafteronlyoneECTsession.(A)willultimatelycurehercatatoniausingonlyECTsessions.(B)willcontinueforanumberofweeksbeforeimprovementcan

beseen.(C)

willconsistoftwoECTsessionseachweekfortheforeseeablefuture.

THEPRACTICETEST

WritingSection

Readthecasenotesbelowandcompletethewritingtaskwhichfollows.

Mr.JacobMcCarthy,an82-year-old,isapatientinthemedical-surgicalunitofwhichyouareaphysician.

Hospital: JeffersonCountyHospital,35FranklinStreet,Knox

PatientDetails

Name: MrJacobMcCarthy

Nextofkin: BarbaraMcCarthy(76,spouse)

Admissiondate: 06April2018

Dischargedate: 26April2018

Diagnosis: Rightbelowkneeamputation(BKA)statuspostrightfoot

diabeticulcer

Pastmedicalhistory: Benignprostatichyperplasia,diabetesmellitusType2(non--

compliantwithmedication),age-relateddementia,essential-

hypertension,peripheralvasculardisease,osteoarthritis

Socialbackground: Retiredconstructionworker

Wifeprimarycarer

Moderatecognitiveimpairment

Needsassistancewithmedicationandactivitiesofdailyliving

(ADL’s)

Onadmission: Longhistoryofnoncompliancewithdiabeticmedication.

Admittedforinfectedrightdiabeticfootwoundofatleasttwo

weeks,didnotnoticeinjury→diabeticneuropathy.

Obvioussigns–gangrene,pus,abscess.

Fever,chills,Rfootnon-weightbearing.

Bloodculturespositiveforgram-positivecocci.

Medicalprogress: GivenIVantibiotics,vascularsurgeonconsultedtoassess

wound.

RecommendedBKA.

Surgeryperformedwithoutcomplication.

Transitionedtooralantibioticsandopiates.

Currentlyafebrile–woundisclean,dry,intact.

RequiresassistanceforADLs+wheelchairformobility.

Nursingmanagement: Monitorsurgicalsiteforinfection/drainage.

Checkforfever/chills+othersignsofinfection.

Encourageoralfluids,nutrition.

AssistwithADLsandmobility.

Changedressingsdaily.

Ensuregoodurinationandbowelmovements.

Frequentturning–avoiddecubitusulcers.

Assessment: Goodprogressmade,painundercontrol,nofurtherinfection

noted.

Bloodculturesnownegative.

Mobilityseverelyreducedafteramputation–requiresassistance

forADLsandroutinecare.

Dischargeplan: DischargetoSkilledNursingFacilityforacutecareand-

physiotherapy.

Canreassesslaterforstabilitywithhomenursingvs.long-term

carefacility.

Continueantibioticsandpainmedication.

Willneedtofollow-upwithvascularsurgeonin2weeks.

Ofnote,wifewanteddischargetohomeinhercare–

physiotherapyandoccupationaltherapyassessmentindicatethis

wouldnotbeasafedischarge.

MedicalWritingTask

Usingtheinformationgiveninthecasenotes,writeadischargelettertoDr.ShannonMeccam,MedicalDirectorofKnoxSkilledNursingFacility,25HarrowfieldAvenue,Knox.

Inyouranswer:

NursingWritingTask

Usingtheinformationgiveninthecasenotes,writeatransferlettertothereceivingnurseattheskilledcarefacility,ShannonMeccam,KnoxSkilledNursingFacility,25HarrowfieldAvenue,Knox.

Inyouranswer:

THEPRACTICETEST

SpeakingPracticeSet

Youhave5minutestocompletethetasksinthecandidatecard,whiletalkingwithapatient.

Readthecandidatecardnow,andtake2-3minutestoprepareforyourconversation.

MedicalTaskCardSet1

CANDIDATECARDNO.1 MEDICINE

SETTING SuburbanClinic

DOCTOR Youarespeakingtoa50-year-oldpatientwhohascometo

findouttheresultsofacoreneedlebiopsy(removalof

cellsandtissue)fromthelymphnodeofaswellingintheir

rightarmpit.He/shehasahistoryofcancer(previous

thyroid),buthasbeeninremissionfortwoyears.Thetest

resultsindicateHodgkinlymphomaandfurthertestsare

neededtodeterminethestaging(thespreadofthecancer).

TASK Findoutwhatresultthepatientisexpectingfromthe

Findouthowmuchinformationthepatientwantstoday.

Sensitivelyexplainthetestresults(e.g.thebiopsy

indicatesHodgkinlymphoma(cancerofthelymph

nodes)andfurthertestingisneeded,likeCTscans,to

ROLEPLAYERCARDNO.1 MEDICINE

PATIENT Youarea50-year-oldwhohasrecentlyfoundalumpin

yourrightarmpit.Asamplewastakenandyouhave

cometofindouttheresults.Youhavehadthyroidcancer

beforeandhavebeeninremissionfortwoyears.Youare

worriedthatitiscanceragain.

assessstaging–thespreadofthecancer,etc.).Checkfor

understandingandreassureifneeded.

Explainthatthestageisunclear,sofurtheradvicewill

begivenlater.

Summarisetheinformationgivenandfindoutwhat

furtherinformationisneeded.

Explainthatyouarenotsurewhattheresultsare,but

youareworriedthatthelumpiscancer.

Explainthatyouhavehadcancerbefore,soifitis

cancer,youwantalltheinformationpossible.

Bealittleshockedandworried.Findoutwhatthe

prognosisisandifyouhavetostopworking.

Beunclearwhythishashappenedtoyou.Explainthat

youwouldliketoreadmoreinformationonthe

disease.

MedicalTaskCardSet2

CANDIDATECARDNO.2 MEDICINE

SETTING SuburbanGeneralSurgeryPractice

DOCTOR A42-year-oldpatienthascometoseeyouforapost-

operativeappointmentafterhavinganopen

cholecystectomy(removalofthegallbladderwithone

incision)performedfivedaysagoforacutecholecystitis

(inflammationofthegallbladder).Recoverywas

uncomplicated,However,he/sheisworriedabouttheir

futureandkeenonunderstandingwhythisoccurredand

whatchangesmustbemadetoavoidthishappeningagain.

TASK Findouthowthepatienthasbeenrecovering.Goovera

recoverytimelineandexplainthelevelofphysical

activityhe/sheshouldbeabletoperform(4-6weeksto

fullyrecover;lightexerciseonly).

Discussthepatient’scurrentdietandbestpracticesnow

thathehashadacholecystectomy(avoidhigh-fat/spicy

foods,eatsmallmealstostartwith,trackdiet,etc.).

Explainpossiblefuturecomplications(e.g.post-

cholecystectomysyndrome)andthesignsofsymptoms

tolookoutforandwhentogototheEmergency

Department(ED)(e.g.ifacutepaininthe

abdomen/diarrhoea).

Givethepatientanestimationofhowlongtheywill

needtohavefollowupappointmentsfor(onceevery

twoweeksforsixweeks).

ROLEPLAYERCARDNO.2 MEDICINE

SETTING SuburbanGeneralSurgeryPractice

PATIENT Youare42andrecoveringfromacutecholecystitis

(inflammationofthegallbladder,oftencausedby

gallstones)thatbeganoneweekago.Youwere

dischargedfromthehospitalafteranopen

cholecystectomy(removalofthegallbladderwithone

incision)fivedaysago.Youareunsurehowmuch

physicalactivityisappropriateanddonotwanttorisk

tearingoutanystitches.Youalsowanttoknowwhatthis

meansforyourdiet,andifthereisanythingyouneedto

watchoutfor.

TASK Explainyourconcernsaboutphysicalactivityandfind

outhowlongyouneedtowaitbeforeyoucanreturn

towork.

Explainthatyoulivealoneanddon’tliketocook,so

yourdietisprimarilypre-packedfrozenmealsorfast

food.Askthedoctorwhatcouldhappenifyoudonot

followtherecommendeddiet?

Askwhataresomefuturecomplicationstobeaware

Askhowoftenshouldyouschedulefollow-up

appointmentswiththeclinic?

NursingTaskCardSet1

CANDIDATECARDNO.3 NURSING

NURSE Youarespeakingtoaparentofa4-year-oldboy,Max,who

hasAutismSpectrumDisorder(ASD)andhascometosee

youfordietaryadvice.Heisgloballydelayed(mentally,

physicallyandemotionally)anddisplaysdifficult

behavioursatthechildcarecentreheattends(e.g.becomes

upsetifaskedtositwithotherchildrenatmealtimes,etc.).

ROLEPLAYERCARDNO.3 NURSING

CARER Youaretheparentofa4-year-oldboy,Max,whohas

Exploretheparent’sperceptionoftheproblem.

Findouthowtheparentisstructuringmealtimesat

Createsomerealisticgoalswiththeparent(e.g.provide

regularmealsandsnacks–every2-3hours,changethe

mealtimeenvironment–graduallymovefromtheTVto

thetable,etc.).

Findoutwhatotherservicestheparentneeds(e.g.

speechtherapy–oralmotordevelopment,integration

aideforthechildcarecentre,supportgroup,etc.).

AutismSpectrumDisorder(ASD)andisaveryfussy

eaterandwillonlyeatbabyfood,smoothyoghurtand

mashedpotatowithyouatmealtimes.Youareworried

thatheisnotgettingenoughnutrients,andthatheisnot

progressingsociallywithhispeers.Hebecomesangryat

thechildcarecentrewhenaskedtoeatwiththeother

children.

TASK Explainthattheproblemstartedasaresponsetoa

viralinfectionat2yearsold,buthasnowbecomea

habit.Maxonlyeatsmushyfoodwithyouinfrontof

theTV.

AskthenurseifMaxwilldevelopavitamin

deficiency.

Describemealtimes:youhavetopromptMaxtoeat

whileyouholdthespoon,andMaxisangryifyou

changethebrandoffood.Heofteneatslateintheday,

andself-feedssweetbiscuits.

Beresistanttoanybigchangesinroutine.Youcould

probablyonlychangeonething.

Ifasked,youwouldliketoseeaspeechpathologist

andattendasupportgroup,butthechildcarecentre

doesn’thavefundingforintegrationaides.

NursingTaskCardSet2

CANDIDATECARDNO.4 NURSING

SETTING Hospital

NURSE Youarespeakingtoa90-year-oldpatientwhowasrecently

admittedtohospitalduetovomiting,nauseaandabdominal

pain,whichwaslaterdiagnosedasacutepancreatitis.The

doctorhasorderednofoodbymouth(NPO),soa

nasogastric(NG)tubehasbeeninserted.Intravenous(IV)

fluidwithpotassiumchloride(KCI)andhis/herpain

medication,meperidine(Demerol),havebeenordered.

ROLEPLAYERCARDNO.4 NURSING

SETTING Hospital

PATIENT Youarea90-year-oldwhowasrecentlyadmittedto

hospitalduetovomiting,nauseaandabdominalpain,

ExplainthereasonsfortheNGtube(toalleviatepain

fromeating,andtoallowfeedinguntilnauseaand

vomitingsubside).Likelytostopaftertwodays.Check

thatthepatientunderstandsyourexplanation.

TactfullyexplainwhytheNGtubeisinsertedwithmore

detail(e.g.largemealsrequireadditionalworkbythe

pancreasfordigestion,theinflammationstopsthis,and

causespain,etc.).

Reassurethepatientaboutthefurthertesting(CTscans

–non-invasive,relativelysafe,involvesx-rays,ableto

detectcomplicationse.g.necrosis–tissuedeath).

Validatethepatient’sconcernsbutexplainthelowlevels

ofradiation(e.g.lessthanfromaflight).Reassurethe

patientthatthetestsareneeded.

whichwaslaterdiagnosedasacutepancreatitis.You

haveatubeinyournoseandhaven’tbeengivenany

food.Youareanxiousanddon’tunderstandwhatis

happeningtoyouandwantanswersfromthenurse.

TASK Askthenursewhyyouhaveatubeinyournoseand

haven’tbeenallowedtoeatsolidfood.

Explainthatyoustilldon’tunderstandwhyyoucan’t

eat.Thetubeisuncomfortable,andyoumissyour

favouritefoods.

Whenasked,explainthatyouwanttoknowwhat

happensnext.Youdon’tknowwhattestsyouwill

havetodo,andyouareworried.

Continuetobeworriedaboutthetests;youdon’twant

radiationandyoujustwanttogohome.Eventuallybe

reassured.

THEPRACTICETEST

Answers

Listening

PartA:Questions1to12

1.upthestairs

2.barking

3.lyingdown

4.(dirty)green

5.feverish

6.COPD

7.smoker

Questions13to24

8.allopurinol

9.knees

10.(blue)inhaler

11.cholesterol

12.penicillin

13.stuck(init)

14.watering

15.swollen

16.concentrate

PartB:Questions25to30

17.fluoresceineyestain

18.infection

19.(numbing)eyedrops

20.cornealabrasion

21.antibioticeyedrops

22.healingointment

23.ibuprofen

24.brightlight

25. AbetransferredfromtheEmergencyDepartment

PartC:Questions31to36

26. Bwhetherhiscommunicationissueswillimprove

27. Aexplaininghowtousethemcorrectly

28. Ctheavailabilityofamedicine.

29. Ctheimportanceofprovidingadequateemotionalsupporttopatients

30. Aidentifyingthepatientsatgreatestrisk

31. Bmistaketheillnessforsomethingelse.

32. Bproximitytonewpeople.

33. CHewastryingtofinishhisassignments.

34. Atheillnessprogressesrapidly.

Questions37to42

35. Bpatientsdonotseektreatmentquickly.

36. Ctakeprecautionstopreventothersfrombecomingill.

37. Asufferfromuntreatedhealthproblems.

38. Creducesthelikelihoodoftheproviderbeinginjured.

39. Atoensurethepatientunderstandswhatisbeingsaid.

40. Backnowledgethepatient’semotions

41. Bmaintainthepatient’strustbybeingrealisable.

42. Cbeencouragedtoexplainwhatcausedtheirreaction.

READINGSECTION

PartA:Questions1to20

7.arterialsaturation

8.magnesiumsulfate

9.allergies

10.life-threatening

11.reversibilitytesting

12.smoking

13.daily

14.everyhour

15.inseverecases

16.children

17.warnICU

18.peakexpiratoryflowrateORPEFR

19.awhistlingsound

20.apeakflowmeter

PartB:Questions1to6

PartC:Questions7to14

1. Bmightnotneedtocontinuewithcertainmedication.

2. Ctomoreaccuratelycontrolhowlongitwilllast.

3. Cwhentoprescribeantibiotics.

4. AthedisorderismoredifficulttoidentifyinpatientswithADHD.

5. Achallengingapatient’scriticisms.

6. Bstaffchangesarekepttoaminimum.

7. Bisinterpretedinvariouswaysbydifferentpeople.

8. Dwascausedbyanumberofissuesincludingmoneyworries.

manyhealthcareprofessionalsdonotdiscussthestresstheyexperience.

10. Atosuggestthatdoctorsaremorelikelytomakesignificanterrorswhenstressed

11. Atechnologythatwasoutofdateandfaulty.

12. Cdoctorsmightskipovertherelevantinformation

13. Ditdoesnotsupporttheirexistingtheory.

14. Bavarietyofpossiblecauses

Questions15to22

15. DpromotinganegativeimageofECT.

16. AItwaslessprevalentinpatientswhoexperiencedseizures.

ECTwasacceptedasasafetreatmentforpatients.

18. BItiswellknownthatsomepatientswillnotrespondwelltoECT.

19. Caftertreatmentwithbenzodiazepinesprovesineffective.

20. Atolowerthelikelihoodofanaesthesia-relatedaspiration

21. BaseizurecausedbyECT

22. Cwillcontinueforanumberofweeksbeforeimprovementcanbeseen.

WRITINGSECTION

MedicalSampleResponse

26/04/2018

Dear.Dr.Meccam,

Re:JacobMcCarthy(aged82)

MrMcCarthywasadmittedon6April2018witharightdiabeticfootulcer.Avascularsurgeonwasconsulted,whorecommendedthatheundergorightbelowthekneeamputation,whichwasperformedwithoutcomplication.

Followingsurgery,MrMcCarthywasplacedonIVantibioticsandpainmedications,thesehavebeensuccessfullytransitionedtooralantibiotics.Hiswoundhasbeenhealingwellandhisrepeatbloodcultureshavebeennegative.

MrMcCarthyisnowstable,andcanbedischargedtoyourfacilityforfurthercare.HewillcontinuetoneedassistanceforADLsaswellasawheelchairformobility.Hissurgicalsiteshouldbeassessedforinfectionandhisdressings

Dr.ShannonMeccamMedicalDirectorKnoxSkilledNursingFacility25HarrowfieldAvenueKnox

mustbechangeddaily.Heshouldalsoreceivefrequentturningtopreventpressureulcers.

Ofnote,hiswifewantedhimtobedischargedbacktohishomeunderhercare;however,wefeelthatgivenhisdementiaanddecreasedmobilityfollowingtheamputation,thiswouldnotbeconsideredasafedischarge.Ourphysiotherapyandoccupationaltherapystaffagreedwithourassessment.Wefeelthataftersometimeatyourfacilityhemayshowsufficientimprovementtoreturnhome.

Yourssincerely,

[185words]

26/04/2018

DearNurseMeccam,

Re:JacobMcCarthy(aged82)

ShannonMeccamNurseKnoxSkilledNursingFacility25HarrowfieldAvenueKnox

Mr.McCarthywasadmittedon6April2018withaninfectedrightdiabeticfootulcerandpositivebloodcultures.Pastmedicalhistoryincludesbenignprostatichyperplasia,diabetesmellitusType2,dementia,hypertension,andperipheralvasculardisease.

Avascularsurgeonwasconsulted,whorecommendedarightbelowthekneeamputation,whichwasperformedwithoutcomplication.Followingsurgery,MrMcCarthywasplacedonIVantibioticsandpainmedicationswhichhavebeensuccessfullytransitionedtooraladministration.Hiswoundishealingwellandrepeatbloodculturesarenegative.

Mr.McCarthyisnowstablefordischargetoyourfacility.HewillcontinuetoneedassistanceforADLsandawheelchairformobility.Hissurgicalsiteshouldbeassessedforinfection,withdailydressingchanges.Heshouldalsoreceivefrequentturning,topreventpressureulcers.

Ofnote,hiswifewantedhimtotheirbedischargedbacktohomeunderhercare;givenhisdementiaanddecreasedmobilityfollowingtheamputation,physiotherapyandoccupationaltherapystaffdidnotbelievethiswasasafedischargeplan.Aftersometimeatyourfacility,hemayshowsufficientimprovementtoreturnhomeoradecisionmadeforlong-termcareplacement.

Yourssincerely,

[199words]

LISTENINGSCRIPT

N: I’mgoingtogiveyoutheinstructionsforthistest.I’llintroduceeachpartofthetestandgiveyoutimetoreadthequestions.

Thistesthasthreeparts.Ineachpartyou’llhearanumberofdifferentextracts.Atthestartofeachextract,you’llhearthissound:---***---.You’llheareachextractONCEonly.Remember,whileyou’relistening,writeyouranswersonthequestionpaper.Attheendofthetest,you’llhavefiveminutestotransferyouranswersontotheseparateanswersheet.

PartA.Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,ahealthprofessionalistalkingtoapatient.Forquestions1to24,completethenoteswithinformationyouhear.Nowturnoverandlookatthenotesforextractone.

Pause:5Seconds

N: Extractone.Questions1to12.

YouhearafoundationdoctortalkingtoarecentlyadmittedpatientcalledRoyMiller.Forquestions13to24,completethenoteswithawordorshortphrase.

Pause:30Seconds

---***---

F: So,Roy,Iseefromyournotesyou’vebeenadmittedbecauseofshortnessofbreath.Canyoutellmemoreaboutthatplease?

M: Yeah...wellitstartedlastweek.InoticedthatgettingupthestairswasmoreofaneffortandIfoundthatIhadtopauseontheway,tocatchmybreath.Ididusedtogetalittleoutofbreath,butit’sdefinitelygottenworse.Inormallymanagetogoshoppingwithmywifeandwewalktotheshopsandback.I’dgenerallyhavetohavealittlerest,butnow,everythingisjusttakingmelonger.Ifeelweary,youknow?AndI’vegotthiscough,it’slikeabarkingthingthatIjustcan’tshift.It’sworseatnightwhenI’mlyingdownandIgetabitwheezy.I’mjustreallytiredbecauseitkeepsmeawakeformostofthenight.Mywifehasbeensleepinginthespareroombecauseit’skeepingherawake...I’vealsosortofbeenbringingupthingswhencoughing...Withoutbeingtoographic,it’squitethick,itsasortofdirtygreencolour,Isuppose.Itwasn’tlikethatatthebeginningoflastweek,itwasjustclearbutoverthelastcoupleofdaysI’venoticedit’schangedcolourandI’mcoughingupalotmore.Mywifewasstartingtogetworriedsoshemademeanappointmentwithourdoctorandthenhesentmehere.

F: OKRoy.Doyouhaveanyothersymptoms?M: Yeah,IwasreallyhotyesterdayandIthoughtitwasbecausethe

heatingwason,butmywifehadn’tturnediton.ThenthenextminuteIwasshivering.IguessI’mfeverish?

F: Itsoundslikeyou’vebeenreallysuffering.Haveyougotanyothermedicalconditions?

M: WellIwasdiagnosedwiththislungconditionlastyear,I’veforgotten

thenameofit,holdon.....CO,CO,hangonI’llgetit,COPD,isthatit?Wellanywaytheytoldmethatmylungsweren’tworkingaswellastheycouldbebecauseIusedtobeasmoker,butIquitabout6yearsago.TobehonestIthinkitwasbecauseIworkedintheminesanditwasreallydusty.EitherwayI’vegotitanditmakesmeabitbreathlessbutnothinglikethis.OhandIalsogetgoutfromtimetotimeandItakesomethingcalledallopurinolorsomething.I’vealsogotarthritisinmykneesbutthat’sjustbecauseofmyagesoIjustputupwiththat.

F: Youmentionedtakingallopurinol.Areyouonanyothermedication?M: Well,thedoctorgavemeinhalers,andI’musingthose.I’mgetting

betterattakingthembecauseIfounditabitconfusingatfirst.I’vestartedtotakemyblueinhaleralotmoreoverthislastweekbecauseI’vebeensobreathless.ItakethestuffImentionedbefore,astatinformycholesterolandthentheoddparacetamolwhenmyarthritisstartstoplayup.Idon’treallyliketakingpillsbutifitkeepsmegoingthenit’sworthit...Also,I’mallergictopenicillin.Igetanawfulrashallovermybodyandit’ssoitchywhenevertheygiveittome.Don’tgivemeanyofthat!

F: Wewon’tRoy.Youmentionedyoulivewithyourwife,areyoubothmanagingathome?

M: Ohyes,westillgetaroundthetowntogetourshoppingandseethefamily.Thestairsarestartingtogetabitmuchnowsowe’rethinkingaboutmovingintoabungalow,butwehaven’tstartedlookingyet.

F: OKthat’sgood.Haveyougotanyideasastowhatmightbegoingon?M: WellIthinkitmightbeachestinfectionbecauseit’sjustgettingworse.

Ijustwanttostartfeelingbetter.F: OfcourseRoy,itdoessoundlikethatmightbethecase,butwe’llstart

doingsometeststomakesureandbegintreatment.

Pause:10Seconds

N: Nowlookatthenotesforextracttwo.

Extracttwo.Questions13to24.

YouhearanoptometristtalkingtoapatientcalledMarshaSamarina.Forquestions13to24,completethenoteswithawordorshortphrase.

Pause:30Seconds

---***---

M: Hi,MarshaSamarina?I’mDrKulshaw.Iunderstandthatyou’vebeenexperiencingsomeissueswithyourlefteye?

F: Yeahthat’sright.M: Okay,areyouabletotellmeabitaboutwhat’sbeenhappening?F: Yeahsure.So,lastFridaywasourofficeparty,andsoIwasoutquite

late,andI’dhadacoupleofglassesofwine.Anyway,whenIcamehomeImusthavebeenabitrecklesstakingoutmycontactlenses.Ididn’tnoticeanythingthen,butwhenIwokeupinthemorningIhadthispaininmylefteye...itfeltliketherewassomethingstuckinit.Also,Ihadaheadache,I’mnotsureifthat’sbecauseIwasstrainingmyeyes.Myeyewasalsowateringloads,itwaskindoflikewhathappenswhenyouchopuponions.Anyway,IthoughtI’djustsortofkeepblinking,andwhateverwasinmyeyewouldworkitswayout...so,wellIdidthatforabit,butIwasgettingmoreandmoreworried.Iwenttoaskmyroommateifshecouldseeanythinginmyeye,andshe

saidmyeyewasswollenandshethoughtweshouldgotothehospitalandgetitcheckedout.SowewenttotheED...Thankfullymyroommatewasabletogetthedayoffwork,soshedrovemethere.ThepainwasalsosoterriblethatIcouldn’tconcentrate.Idon’tknowwhatI’dhavedonewithoutherhelp.

M: Ah,okay...sowhathappenedwhenyouwenttothehospital?F: SowewaitedaroundattheEDforabit,andthenIwasseenbyaGP..

.umm...Itoldhimaboutthepain,andhowIthoughtIhadsomethingstuckinmyeyesoheopenedmyeyeandtriedtoseeiftherewasanythingintherethatshouldn’tbe.Itmusthavebeenquitedifficultforhimtoseeanything,sohedidafluoresceineyestaintest...thenhetookmetoadarklaboratoryroomtolookintoeyeswithoneofthose,um,microscopethings.Whenhestillcouldn’tfindanythingheseemedtothinkthatitcouldbeaninfection.That’swhenIstartedpanicking!

M: Andafterthat,youwerereferredtoanoptometrist?F: Yes,that’sright.Theysentmetothisdepartmentafterthat,andthe

optometristusedsomenumbingeyedropsonme–Iwasincrediblythankfultoherforthat!Myeyesfeltbetterverysoonafterwards.Thenshelookedatmyeye,andbecauseIwasn’tsquintingfromthepainanymore,shecouldseethattherewasacornealabrasion,shesaidthatImusthavescratcheditwhenItookmycontactsoutthenightbefore.

M: Isee,socanyoutellmehowyou’vebeentreatingyoureyeathome?F: Yes,shetoldmenottowearmycontactlensesuntilthisfollowup,and

sheprescribedmeacoupleofthings...I’musingtheantibioticeyedropsshegaveme–Iputthoseininthemorningsandevenings...andtheotherthingshegavemeisreallyhorribletouse,it’sahealingointment,butitfeelsgrossinmyeyesoIjustuseitonceaday.Unfortunately,theycouldn’tgivemeanyoftheirpainrelieftotake

home,soI’vejustbeentakingibuprofenwhenithurts.M: Andhow’syoureyefeelingnow?F: Muchbetter,thanks.Itstillhurtswhenthere’sbrightlightthough,andI

wasn’tsureifthatwasnormal?Theoptometristsaiditwouldtakequiteawhiletoheal,soIguessIneedtohangonabitlonger?

M: Yes,atthispointitwillmostlikelystillberecovering.DoyoumindifItakeacloselookatyoureyenow?Ifyoucanjusttakeyourglassesoff...

Pause:10Seconds

N: ThatistheendofPartA.Now,turnoverandlookatPartB.

Pause:5Seconds

N: PartB,questions25to30.Inthispartofthetest,you’llhearsixdifferentextracts.Ineachextract,you’llhearpeopletalkinginadifferenthealthcaresetting.

NowlookatQuestion25.Youheartwodoctorsdiscussthetransferofcareforapatient.Nowreadthequestion.

Pause:15Seconds

---***---

M: Hello,DrSalvos?ThisisDrBroderickfromtheEmergencyDepartment.I’mcallingyouwithregardstoanadmissiontothehospitalmedicineservice.

F: Right,yes.HelloDrBroderick...I’mtheadmittingphysicianforhospitalmedicine...Umm,Canyoutellmemoreaboutthepatient,andwhyheneedstobeadmittedfromtheemergencydepartment?

M: Sure...Sothepatientisa68-yearoldmanwithapasthistoryofCHF,DM2andachiefcomplaintofshortnessofbreathforthreedays.ChestX-Rayshowsarightlowerlobarpneumonia.HisvitalsignsarenormalbuthisBUNis36.

F: Isee...ItsoundslikehemeetsCURB-65criteriaforaninpatientadmission.Haveyoustartedhimonanymedicationsintheemergencydepartment?

M: Yes,wehavegivenhimsupplementaloxygenandstartedhimonbreathingtreatments.Hewillalsobegettingempiricalantibioticcoverage.Ifthereareanyotherordersyouwouldlikemetoplace,letmeknowandI’lldoso.

Pause:5Seconds

N: Question26.Youheartospeechpathologisttalkingtothewifeofapatientwhohasrecentlysufferedastroke.Nowreadthequestion.

Pause:15Seconds

F: Ijustdon’treallyunderstandwhymyhusbandcan’tspeakproperlyanymore.Isitaresultofbraindamage?

M: Problemsofthistypearearesultofdamagetothebrain,yes,butit’simportanttonotethattheseissueshaven’taffectedyourhusband’s

intelligence.F: No,ofcourse.Iknowit’sstillhim.It’sjustfrustratingwhenwecan’t

talklikeweusedto.Willhegetbettereventually?M: Yourhusbandhasshownimprovementalready,andwe’reconfident

thatthiswillcontinuewithregularsessionsandpractice.Patientstendtoshowthegreatestchangewithinthefirstsixmonths,whichiswhywe’veplannedsuchanintensivescheduleforhimduringthistime.We’reconfidentthatwe’llseegreatstridesinyourhusband’sconditionoverthecomingmonths.

Pause:5Seconds

N: Question27.Youhearatraineedoctoraskingaseniorcolleagueaboutchesttubes.Nowreadthequestion.

Pause:15Seconds

F: I’mstilljustabitunsureaboutchesttubes...Iwashopingyoumightbeabletogivemeabitmoreinformation?

M: Okay,sure.Soyouknowaboutthethreechambersonthechesttube,right?

F: Yep.There’sthecollectionchamber,thewatersealchamber,andthewetordrysuctionregulator.

M: Right.Soastheairfromthepleuralspacepassesthoughthewater-sealchamber,youshouldseegentlefluctuationinthewatereverytimethepatientbreathes.Thisiscalledtidaling.Ifyounoticethattidalingisnolongerpresent,thetubingmaybekinkedorobstructed,orthepatient’slungmayhavere-expanded.

F: Ahh,okay

M: Youshouldalsomakesurethechestdrainageunitremainsbelowthelevelofthepatient’schestatalltimes.

Pause:5Seconds

N: Question28.Youhearapharmacisttalkingtoacustomeraboutpainrelief.Nowreadthequestion.

Pause:15Seconds

F: Hello,canIhelpyou?M: Yes.Igetterriblebackache,andmyfriendsaidyoucouldgiveme

somecodeineforit?F: Doyouhaveaprescriptionfromyourdoctor?M: No.ButIdon’twantthefullstrengthstuff.Ionlyneedtheweakerone.

Y’know,theymixitwithibuprofenorparacetamol,soit’snotasstrong.

F: Ahokay.Well,firstofall,there’sbeensomeresearchdonerecentlythatsuggeststhatlowdosecodeinedoesn’toffermuchmorepainreliefthanparacetamoloribuprofenalone.We’renotactuallyauthorisedtoprovidecodeinewithoutaprescriptionanymore,soI’drecommendpickingupsomealternativepainrelieffromthefirstaislebythefrontdoor.

Pause:5Seconds

N: Question29.Youhearatraineenursereceivingfeedbackfromhistutor.Nowreadthequestion.

Pause:15Seconds

F: Howdoyoufeelyouhandledthepatient’sconcerns?M: Well,IthinkIwasokay.MaybeIwasn’tasconfidentasIcould’ve

been?I’mstillquitenervousaboutadvisingpatients.IguessIjustneedmoreexperiencetogainconfidence.

F: Maybe,butIactuallydon’tfeelthatwasanissueforyou.Doyouthinkthere’sanythingelseyoucould’vedoneforthepatientduringyourexamination?Youcould,perhaps,havetriedtobemorereassuring,ratherthanjuststatingthefacts?Sometimespatientsneedtofeelliketheiranxietiesarebeingheard.

M: Yeah...IactuallythinkIdidcoverthiswiththepatient,though.HetalkedthroughhisconcernswhileIwasexamininghim.

F: It’snotenoughforthepatienttosaythey’refeelingworried,youhavetoshowthatyou’relistening,andreassurethemthatyou’reworkingwiththeirbestinterestsinmind.

PAUSE:5SECONDS

N: Question30.Youheartwodoctorsplanningtheirpatient-carescheduleNowreadthequestion.

PAUSE:15SECONDS

M: Wehavetwentyfourpatientsintotaltoseetoday,acrosstwobays...andunfortunately,weonlyhavefourstaffmembers...Ithinkweshoulddivideourselvesintotwoteams.Wouldyouagree?

F: Absolutely!Also,IthinkweshouldseepatientsaccordingtotheirNationalEarlyWarningScore,thatway,we’llgetthroughallthosewhohaveurgentrequirementsbeforelunch...thenwecanbesurethatthemostpressinginvestigationsareperformedearliest,andthesoonerwegetthoseorganisedthebetter.Phlebotomistswillbecomingtothewardataroundhalfone,soanybloodformsshouldbegiventothemthen.

PAUSE:10SECONDS

N: ThatistheendofPartB.Now,turnoverandlookatPartC.

PAUSE:5SECONDS

N: PartC,questions31to42.Inthispartofthetest,you’llheartwodifferentextracts.Ineachextract,you’llhearhealthprofessionalstalkingaboutaspectsoftheirwork.

Nowlookatextractone.Questions31to36.

YouhearaninterviewwithaphysiciancalledDrMatthewLeach,who’stalkingaboutmeningitis.

Younowhave90secondstoreadquestions31to36.

PAUSE:90SECONDS

---***---

F: Helloeveryone,I’mherewithDr.MatthewLeach,anexpertoninfectiousdisease,who’sgoingtotellusaboutmeningitis.Thankyouforbeingwithustoday,Dr.Leach.Canyoutellmemoreaboutthedisease?

M: Sure.Wellfirstoff,noteveryonewhoisexposedactuallydevelopsmeningitis,buttherearesomecommonsymptomstolookoutforinthosethatareatrisk.Itcanbequitedifficultforpatientstorealisetheyhavemeningitisintheearlystages,asthesymptomscanleadthemtobelievethattheyaredevelopingtheflu,they’llsimplyfeeltiredandacheyforafewdays...Asthisinfectiondevelops,patientsmaythennoticeasuddenonsetoffever,headache,andinparticular,neckstiffness.Otherpossiblesymptomsincludenauseaorvomiting,confusion,sensitivitytolight,noappetiteorthirst,orevenaskinrash.Ifleftuntreated,bacterialmeningitisisverydangerous,quicklyprogressingtoseizures,shock,andevendeath.

F: Thatsoundsprettyserious.Youmentionedthatcertainpeoplemaybeatrisk.Whichpeoplearethemorelikelytodevelopmeningitis?

M: Well,therearemanycausesofmeningitis,butoneofthemostsevereiscausedbythebacteriaNeisseriameningitides.Thebacteriaarespreadbyrespiratorydroplets,andareoftenseenincollegestudents.Thisislargelybecauseofthesuddenchangeintheirlifestyle.Collegestudents,particularlythosewholiveoncampus,areexposedtoahotbedofdifferentinfectionsthattheyhaven’tpreviouslyencountered–allthesekidsfromdifferentpartsoftheUSandtherestoftheworld

gettogether,liveinsmalldormswitheachother,gotoparties...allthatclosecontactreallyisabreedinggroundforinfection.

F: Okay,thatmakessense.Now,canyoutellusaboutaspecificpatientwhohadthistypeofmeningitis?

M: Ofcourse.Itreatedan18yearoldmaninhisfirstyearofcollegewhowaslivinginthedormitories.Therewasaflugoingaround,andhestartedtofeelthesamesymptoms.Hewasworkinghardtotrytocompleteacoupleofimportantessaysbeforethedeadline,andheplannedtodelaygoingtothedoctorsuntilhehadsubmittedthem.Soonaftertheinitialsymptoms,however,hisroommatefoundhiminseverepainandfeverish,andbroughthimtotheemergencydepartmentwherewediagnosedmeningitis.Wetookasampleofspinalfluid,butstartedhimonantibioticsbeforewegottheresultsback.

F: So,youmentionedthatyoustartedantibioticsbeforeyougotthespinalfluidtestresultsback.Canyoutellmewhy?

M: Right.AsImentioned,therearemanycausesofmeningitis,likeviruses,funguses,parasites,andbacteria.However,itcantakesometimetodeterminetheexactcause,andwaitingfortheanswerwithouttreatmentwillmakethepatientworse.Instead,weusethepatient’spresentation,age,andourdeterminationofthemostlikelycausetostartantibioticsthatwouldkillmanyofthecauses.Oncewegettheresultsbackonthecause,wecanchangetheantibioticstobemorespecific.Bydoingthiswedon’tdelaytreatment,andareabletoreducethechanceofcomplications.

F: AhrightIsee...sohowisyourpatientdoingnowafterbeingtreated?Willheexperienceanylongtermafter-effects?

M: Well,heiscurrentlydoingmuchbetter.Herespondedwelltoantibiotictreatmentandregainedhismentalstatewithinafewdays.Unlessthe

patienthasadiseaseofhisimmunesystem,meningitisisunlikelytorecur.Becausethispatienthadsomedelaybeforeseekingtreatment,hemaystillhavesomesideeffects,butitwilltakesometimetoseewhatlongtermeffectitwillhaveonhim.Bacterialmeningitisrequiresurgentmedicaltreatment,andcancauseseriouscomplicationssuchashearingloss,memorydifficulty,braindamage,gaitproblems,orkidneyfailure.

F: Well,let’shopehemakesafullrecovery.Asidefromseekingimmediatemedicaltreatment,whatadvicecanyougivetoourlistenerstodayaboutbacterialmeningitis?

M: So,firstoff,thereisavaccinethatiseffectiveatpreventingthisdisease,soanyoneinclosecontactwithalargegroupofpeople,suchasthoselivinginamilitarybaseoronacollegecampus,shouldasktheirdoctoraboutit.Finally,ifyouhavenothadtheshotandhavespentalotoftimewithsomeonewhoislaterdiagnosedwithmeningitis,wearamasktopreventspreadingthebacteria,andgoandseeadoctorimmediately.Therearemedicationsthatcanreduceyourriskofdevelopingmeningitis,andgettingtreatedimmediatelywillreduceyourrisksignificantly.

Pause:10Seconds

N: Nowturnoverandlookatextracttwo.Questions37to42.

YouhearaclinicalpsychiatristcalledDrEvalinaHoughtondiscusstreatmentforagitatedpatientsinanemergencysetting.

Younowhave90secondstoreadquestions37to42.

Pause:90Seconds

F: Helloeveryone!MynameisDrEvalinaHoughtonandinmypresentationtodayI’dliketodiscussanissuethatIdealwithdaily,de-escalatingagitatedpatientsinanemergencysetting.Toprovidesomeperspectiveontheissue,mostpatientswhoenterthehospitaldosoviatheemergencydepartment(ED).Manywon’thavereceivedmedicaltreatmentyet,andthatcanmakeitmorelikelyforthesepatientstobecomeagitated.Thiscanbeexacerbatedbytheirmedicalcondition,apsychiatricillness,orotherstressfactors.GiventhechaoticandcrowdednatureoftheED,it’simperativethatweidentifyagitatedpatientsearlyandapplynon-physicalde-escalationtechniquesassoonaspossible.

Theproviderwhoisgoingtoinitiatethede-escalationprocessshouldmakesurethattheycreateaconsiderableamountofspacebetweenthemselvesandthepatient,andmakesurethatnooneelseisclosertothepatientthantheyare.Thisnotonlygivesthepatientspace,butalsokeepstheprovidersafeintheeventofattemptedphysicalviolence.Ideally,boththepatientandprovidershouldalsobeabletoleavetheareawithouttheotherblockingtheirexit.Bodylanguageandtoneofvoiceconveyoverallemotionalstatetoapatient,soprovidersshouldremainoutwardlycalmthroughouttheencounter.

Whenspeakingtothepatient,youshouldstartbyintroducingyournameandroleintheteam.Youshoulddeterminehowthepatientpreferstobeaddressedanderronthesideofbeingrespectful.Useshortsentencesandsimplevocabularytoenhanceunderstanding.Leaveasuitableamountoftimebetweenstatementstoallowpatientstoprocesswhatisbeingsaid–sometimesrepetitionandenunciationmaybe

necessary.Eyecontactshouldbeintermittent,sothepatientdoesnotthinkyou’restaring,andverbalresponsesshouldbecalmwithoutanyhintofinsultsorchallenges.Onlyoneprovidershouldinteractwiththepatient,asmultiplespeakerscanconfuseanagitatedpatient.

Whenthepatientspeaks,it’simportanttoidentifywhattheirwantsandfeelingsare,eveniftheymaybeimpossibletoaddressatthistime.Trytoconsiderthingsfromthepatient’sperspective.Althoughtheymaybesufferingunderaparticulardelusion,suchasparanoia,trytounderstandhowthepatientmightfeelorreactifthatdelusionhappenedtobetrue.Whilewedonotwanttoendorsethesedelusions,it’simportanttofindcommonground.Forinstance,ifthepatientisagitatedbecausetheythinktheyarebeingfollowed,theprovidercanagreewiththegeneralprinciple,sayingsomethinglike“Iunderstandthatyoursuspicionofotherpeoplecanmakeithardtogetthetreatmentyouneedhere.”Itisalsookayforaprovidertoagreethatwhiletheymaynotbehavingthesameexperienceasapatientwithanobviousdelusion,theycanbelievethepatientishavingthatexperienceandreactingtoit.

Inaddition,patientsshouldbeencouragedtomakechoices,inordertogivethemasenseofcontroloverthecurrentsituationanddefusetheiroverallaggressiveness.Thesechoicesshouldberealistic,however,anddeliverable,asunfulfilledpromisesmaybackfireandirreparablydamagethetherapeuticalliance.Someofthesechoicescanincludemedicationstohelpcalmthepatient.Agoodwaytostatethisis“It’simportantforyoutostaycalmsowecantalk.Canweprovideyousomemedicationtohelpyoufeellessanxious?”Offeringpatientsachoicebetweendifferentmedicationsorroutesofdeliverymayalsoprovideafeelingofcontroltothepatient.

Lastly,whenthecrisisisover,akeytechniqueisdebriefingboththepatientsandstaffonhowthesituationwent.Thepatient,nowcalm,maybeabletoprovidemoreinsightsonwhattheywerethinkingandhowtheywerefeelingatthetime.Theprovidercandiscusscopingskillsoralternativeoptionsinordertopreventanotheraggressiveincidentinthefuture.Itisalsoimportanttotalktostaffaswell,togainanythird-partyfeedbackontheprovider-patientinteraction,whatwasappropriate,whathelpedde-escalatethepatient,andanyotherchangesthatcouldbemadetoensurepatient,staff,andbystandersafety.

Thesetechniquescanbeapplicabletoawidevarietyofpatientsinnumeroussettings,they'renotjustrestrictedtotheemergencydepartment.Ourhopeisthatproviderswillbeabletodeescalatepatientssafelyandeffectivelywithouthavingtoresorttotheuseofphysicalorchemicalrestraints,whichshouldbeconsideredonlywhenallotherapproacheshavefailed.

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