OET Speaking

Format for Speaking Sub-Test

The Speaking sub-test takes about 20 minutes. It is a profession-specific test in which you are required to complete two role-plays based on typical workplace situations. 

In each role-play, you are expected to demonstrate proficient communication skills in situations that are relevant for your specific profession (medicine, nursing, etc.).

 To complete the role plays, you interact with an interlocutor who takes on the role of a patient or, in some cases, a patient’s career or relative. You always take on the role of your profession, for example, a nurse.

The role plays relate to real-life scenarios that you may face in your specific healthcare field and you are expected to demonstrate a range of communication skills like: 

• Eliciting information from a patient using open and closed questions 
• Seeking clarification when the patient’s statement is unclear 
• Explaining the investigations, diagnosis or treatment using language that the patient can understand 
• Offering reassurance, warmth, or comfort to anxious or agitated patients or their family members 
• Providing advice — on lifestyle, health promotion or managing risk factors – that is relevant to the patient’s circumstances                                                   
• Adapting speech when interacting with patients of different age groups, or different patient types (uncommunicative or irritated)

Assessment criteria – an overview

The assessment criteria have been divided into four main linguistic and five clinical communication criteria. These are further divided into multiple sub-criteria. 

Linguistic criteria (6 marks each) 

• Intelligibility 
• Fluency 
• Appropriateness of language 
• Resources of grammar and expression 

Clinical communication criteria (3 marks each) 

• Relationship building 
• Understanding and incorporating the patient’s perspective 
• Providing structure 
• Information gathering 
• Information giving 

Your performance is marked by two different Assessors. Each Assessor independently scores your performance according to the nine criteria. 

Linguistic criteria

Intelligibility

Intelligibility refers to how well and clearly a candidate’s speech can be understood. It is affected by aspects of speech like pronunciation, intonation, stress, rhythm, pitch, and accent. 

Fluency

Fluency refers to the rate of your speech. In other words, it means the ability to speak easily, reasonably quickly, and without having to pause frequently to recall a word to express what you want to say.

Appropriateness of language

This criterion assesses to what degree you can tailor your language to make it appropriate for the context and the patient. In other words, it assesses your ability to explain things in a clear language understood by the patient and to adapt tone and register to deal with different patients and situations.

When communicating with patients on sensitive matters or topics that they may find uncomfortable, choose a language that puts them at ease. The more comfortable a patient feels, the more forthcoming he or she will be when answering questions. Employ indirect language to facilitate the conversation. 

What is the difference between direct and indirect language? 

Rather than asking questions about sensitive or embarrassing matters directly, soften the questions by prefixing appropriate expressions/phrases. This makes your questions sound less intrusive and more polite which, consequently, helps put your patients at ease while answering questions. 

How do we form indirect questions? 

Indirect questions can be formed by starting your question with a phrase like, ‘Can you tell me …’ or ‘Can I ask …’. Some other examples of phrases that can be used to turn questions from direct to indirect are: 

• Would you mind telling me about … 
• Would you please tell me … 
• May I ask … 
• Please tell me … 
• I am wondering if you can tell me something about … 

Resources of grammar and expression 

This criterion assesses your ability to use a range of grammatical structures accurately in speaking. 

Clinical communication criteria

1. Relationship building 

Relationship building is divided into four sub-criteria:

1. initiating the interaction appropriately (greeting, introductions, nature of interview)

1. demonstrating an attentive and respectful attitude

For example: 

May I sit here? What I would like to do is spend 20 minutes with you now discussing your problems and examining you. Is that okay? Please let me know if you experience discomfort at any time. 

Before proceeding further, I’d like to ask you some questions about your smoking habits. It’ll help me get a better understanding of your condition. Is that alright? 

The doctor is worried your weight might put you at risk of complications post-surgery. Is it okay if we discuss your eating habits and lifestyle? 

I’m concerned about your recent sugar levels. Would it be alright if I asked you some questions about how you have been managing your sugar intake? 

Using language that reflects common courtesy keeps your interactions with the patient respectful and consequently improves rapport. Let’s look at some communicative functions and their examples that you can use while speaking with patients. 

3.dopting a non-judgemental approach 

A non-judgemental response would include accepting the patient’s perspective and acknowledging the legitimacy of their views and feelings. 

An effective example would be:                 

So what worries you most is that the abdominal pain might be caused by cancer. I can understand that you would want to get that checked out. 

4.showing empathy for feelings/predicament/emotional state

Empathy is one of the key skills in relationship building. Empathy involves the understanding and sensitive appreciation of another person’s predicament or feelings and the communication of that understanding back to the patient in a supportive way. It’s a vital component of any health professional-patient relationship and helps in building rapport. This can be achieved through both non- verbal and verbal behaviors.

1. Understanding and incorporating the patient’s perspective

This criterion is divided into three sub-criteria: 

B1. eliciting and exploring patients’ ideas/concerns/expectations

Understanding the patient’s perspective is a key component of patient-centered healthcare. Each patient has a unique experience of sickness that includes feelings, thoughts, concerns, and effects on life that any episode of sickness induces. Patients may either volunteer these spontaneously (as direct statements or cues) or in response to questions. 

A health professional might need to ask directly, as in ‘Did you have any thoughts yourself about what might be causing your symptoms?’ or ‘Was there anything particular you were concerned about?’. 

 B2. picking up patients’ cues

Patients are generally eager to tell us about their own thoughts and feelings but often do so indirectly through verbal hints or changes in non-verbal behavior (such as vocal cues including hesitation or change in volume). Picking up these cues is essential for exploring both the medical and the patient’s perspectives.

Mirroring: This means repeating keywords or the last few spoken words with rising intonation, which acts as a prompt for him/her to continue. For example, ‘Something could be done … ?’. 

Echoing or reflecting: This means using your own words to reflect the content and emotion of what the patient has said. For example, ‘I sense that you are not happy with the explanations you’ve been given in the past’. % 

Questioning and clarifying: This means asking questions about the statements or hints to understand the patient. For example, ‘You used the word worried; could you tell me more about what you were worried about?’. 

All of the above examples act as verbal encouragement for a patient to talk further if they would like to. 

B3. relating explanations to elicited ideas/concerns/expectations.

One of the key reasons for discovering the patient’s perspective is to incorporate it into explanations in the later parts of the interview. If the explanation does not address the patient’s individual ideas, concerns and expectations, understanding and satisfaction suffer as the patient is worried about their still unaddressed concerns. 

An effective example might be: ‘You mentioned earlier that you were concerned that you might have angina. I can see why you might have thought that, but in fact, l think it’s more likely to be a muscular pain because .’ 

Providing structure

There are three sub-criteria under the providing structure criterion: 

C1. sequencing the interview purposefully and logically

During the three-minute preparation time, mentally plan how you can sequence your interview logically and purposefully during the five-minute timeframe. 

For example: 

Before I review your medications, I’d first like to ask some questions about your past health problems. Would that be alright? 

So, here’s what l am going to do. First, I’ll ask you some questions to get a detailed picture of your situation. Then, I’ll take you through some treatment options. Finally, I’d be happy to answer any questions that you might have. May I proceed? 

C2. signposting changes in the topic

Signposting is a key skill in enabling patients to understand the structure of the interview by making its organization overt: both the health professional and the patient need to understand where the interview is going and why. A signposting statement introduces and draws attention to what we are about to say. 

For instance, it is helpful to use a signposting statement to introduce a summary: ‘Can I just check that I 

have understood you, let me know if I’ve missed something .’ 

Signposting can be used to make the progression from one section to another and explain the rationale behind the next section. 

C3. using organizing techniques in explanations

In OET Speaking, your explanations should be well-organized to make it easier for the patient to follow and stay focused. Some techniques that can be used during the role plays to present and arrange information in a logical order are mentioned below. 

The categorization is a technique in which the health professional forewarns the patient about which categories of information are to be provided. For example, ‘There are three important things I want to explain. First, I want to tell you what I think is wrong; second, what tests we should do; and third, what the treatment might be.’ 

Labeling means explicitly highlighting certain components of your explanation to emphasize their importance. For example, ‘It is particularly important that you remember this … ‘ 

Chunking is a technique in which information is divided into smaller amounts (‘chunks’) and delivered one bit at a time, with a clear gap between each section. After relaying a chunk of information, you should check that the patient has understood and retained what you have told them by asking a follow up question like ‘What is your current understanding of…?’ Proceed to the next chunk only when you are confident that the patient has fully understood the information you have previously given them. 

Repetition refers to the action of repeating what the patient has said. This enables you to clarify the patient’s meaning rather than just focusing on the words they use. For example, ‘If I understood you correctly…. you’re saying that you’ve had chest pain for the last three days, which is about a six on a scale of 0to 10, and it’s a burning feeling that causes tightness in the chest. Is there anything else that you would like to add?’ 

Summary of important points – for example, ‘So just to recap: we have decided to treat the fungal infection with a cream that you use twice a day for two weeks. If the infection is not better by then, you are going to come back and see me.’ 

When using repetition and summarizing skills, always check whether what you have paraphrased is accurate by asking clarifying questions like: 

• Is that right? 
• Is that correct? 
• Would you like to add anything to that? 
• Is that an accurate summary? 

Remember, the summary statement should not be a word-to-word repetition. You should summaries only the main points.

D Information gathering 

 Information gathering is divided into five sub-criteria: 

D1. Facilitating patients’ narrative with active listening techniques, minimizing interruption 

D2. Using initially open questions, appropriately moving to closed questions

Closed questions are questions for which a specific and often one-word answer, such as yes or no, is expected. They limit the response to a narrow field set by the questioner. 

Open questioning techniques, in contrast, are designed to introduce an area of inquiry without unduly shaping or focusing the content of the response. They still direct the patient to a specific area but allow the patient more discretion in their answer, suggesting to the patient that elaboration is both appropriate and welcome. 

Simple examples of these questioning styles are Open: ‘Tell me about your headaches.’ 

More directive but still open: What makes your headaches better or worse?’ Closed: ‘Do you ever wake up with a headache in the morning?’ 

Open questioning techniques: 

‘Start at the beginning and take me through what has been happening 

‘How have you been feeling since your operation … ?’ 

D3. NOT using compound questions/leading questions 

D4. Clarifying statements which are vague or need amplification

D5. Summarising information to encourage correction/to invite further information

Summarising is the deliberate step of making an explicit verbal summary to the patient of the information gathered that far. This is one’ of the most important of all information-gathering skills. Used periodically throughout the interview, it helps with two significant tasks – ensuring accuracy and facilitating the patient’s further responses. 

For example: 

Can I just see if I’ve got this right – you’ve had indigestion before, but for the last few weeks you’ve had increasing problems with a sharp pain at the front of your chest, accompanied by wind and acid? It’s stopping you from sleeping. It’s made worse by drink and you were wondering if the painkillers were to blame. Is there anything that I have missed? 

From what I have understood so far, you have been experiencing indigestion for the past few weeks, and at times, it is accompanied by headaches which last for a few hours and are only relieved with medication. You feel the indigestion is caused when you eat rice for dinner. Is there anything else that you’d like to add? 

Just to recap what you just told me, for the last month you have occasionally experienced an urgent need to urinate. The symptoms have gradually worsened, and you urinate every 2–3 hours and experience an urgent need 2-3 times a day. At times, the urge to urinate is so strong that urine leaks on the way to the bathroom. It’s impacting your life negatively by preventing you from exercising and socializing. Is that right? 

Information giving

Information giving is further divided up into five sub-criteria: 

E1. Establishing initially what the patient already knows

For example: 

It would be helpful for me to understand a little of what you already know about diabetes so that I can try to fill in any gaps for you. 

Could you tell me what you know about this condition so far?_ What’s your current understanding of hypertension? 

You said that you’ve had diabetes before. How was the condition explained to you then? 

What do you remember about the treatment of the condition from the last time that you experienced a flare-up? 

E2. Pausing periodically when giving information, using the response to guide next steps

 E3. Encouraging the patient to contribute reactions/feelings

For example: 

What questions does that leave you with — have you any concerns about what I’ve said? I’d really like to hear your reaction to this diagnosis.

l can appreciate that this is a lot to take in. Would you like to ask any questions about what I’ve just explained?

E4. Checking whether the patient has understood information 

For example: 

I know I’ve given you a lot of information today and I’m concerned that I might not have made it very clear – it’d help me if you repeated what we’ve discussed so far so I can make sure we’re on the same track. 

To ensure that you’ve understood everything correctly, would you mind reiterating what we’ve discussed? 

Just to be sure I’ve explained everything clearly, it’d be helpful for me to hear your understanding of what you need to do. Can you summarise the treatment plan that you’ll be following? 

E5. Discovering what further information patient needs

Are there any other questions you’d like me to answer or any points I haven’t covered? 

Before we wrap up the consultation, is there anything else you’d like to ask?