Clinical Communication Skill Criteria Providing Structure

This is yet another criterion of OET speaking which is exclusive to OET. Other English tests do not have such criterion mainly as those are the tests where a conversation is led by an examiner. OET prepares you for your workplace. At the workplace, medical professionals are the one to direct the whole conversation, not the patient. Similarly, in OET Speaking exam you are expected to demonstrate the ability to lead a well-structured consultation.

So, what does the ‘well-structured’ conversation mean?

A consultation which is moving forward in the right direction from taking history to giving the explanation and advice.

As an OET candidate, you should divide your role-play into the 3 main stages.

1. History taking.
2. Explaining the condition.
3. Providing treatment plan & advice.

1. History Taking: –

• Always use a forwarding statement to hint the patients you move forward from one stage to another.

For Example:

‘ Since this is your first visit, I would like to ask a few questions to get the detail picture, is that ok ?’

• Such statements give the message to the patient that you are going to ask questions which may sound personal and intrusive, but you need the information for a therapeutic purpose. Also, through this, you can exhibit your professional approach and the fact that you respect their right to privacy.
• It should be always kept in mind that in OET speaking test, the examination findings and the final diagnosis are given beforehand which means you don’t need to ask too many questions like a routine actual consultation, to rule out other conditions. So, keep your questions ‘subject-specific’ and pre-plan the sequence of questioning as per the clinical communication skill framework. Complaint →Duration→ Severity→ Aggravating & relieving factors → associated symptoms and the history of previous treatment if any.

Following this sequence will help you to be calm and composed throughout the role-play. On the other hand, not doing so will confuse both you as well as your patients.

2. Explaining the condition :

• This is a very difficult aspect as the clients usually do not have background knowledge of Anatomy & Physiology. Whereas you as a healthcare professional possess in-depth knowledge.
• Remember that you are not supposed to explain the whole pathophysiology. So, the best way is to start with Anatomy. Explain to them which body organ does it affect and what is the function of that organ.
• Next, explain the condition in 1 to 2 sentences without using medical jargons.
• I have seen, many students completing this explanation in one line.

For example:

    “ Asthma is constriction of bronchi/airway.”

Such an explanation does not explain things clearly.

The correct explanation would be.

“Asthma is an allergic condition.”

          ↓

Due to allergy, the air-pipe, which takes oxygen to the lungs, becomes narrow

          ↓

“As a result, the air cannot freely enter into lungs.”

          ↓

“This leads to breathing difficulty and decreased level of oxygen.”

• The third step would be to explain who is affected usually, what are the signs and symptoms ( also, compare them with the patient’s own symptoms) usual recovery time and prognosis.
• Throughout this stage, it is paramount to use signal markers/discourse markers such as
  

• Regarding the prognosis/recovery………….
• The common symptoms are ………….
• It mainly spreads through ……………….
• Therefore / As a result / Hence / Thus
• Because of/due to
• The main goal while performing this stage of the roleplay is ‘clarity’. Your ability to explain is judged based on how clear it was for the patient to understand. So do not use ‘ complex sentences or string of sentences’, but divide the information in ‘chunks’ as explained in the example above instead.
• The phrases you can use to ask if they have understood clearly are
  

• I know this is a lot to take in, so I would try to make it simple for you.
• Do you understand so far?
• Is this clear
• Was this explanation helpful?
• Can you tell me what have you understood so far about asthma?

3. Providing treatment plan & advice:

• Do not make it a speech. Suggest the treatment plan one after another in organised sequence and after each plan ask if the patient agrees to what you have suggested.
• Use signal markers such as

  • Firstly what you need to do is to keep an eye on a thing which causes your symptoms. Those are the trigger factors. Now, once we have figured out the allergies the second advice is to keep away from them as long as possible.

  • In addition, I strongly recommend that you keep this inhaler always with you and use it whenever you feel breathing difficulty or choking sensation.

  • It is also important to inform your university, neighbours and friends about your condition so that they know what to do in case you get such attack and need help.

• The phrases you can use to ask their agreement are.
  

• Are you with me?
• How does that sound?
• I may sound a bit strict, but can you do that?
• Is it possible for you too…?

In conclusion, at every stage throughout the role-play, you should demonstrate the ability to use ‘cohesive devices’ naturally and spontaneously to convey a ‘CLEAR’ message to the client. This is a must to get a B level in ‘OET speaking Exam’

Written by,

Priya Shah

OET Expert

Acumen, English for Healthcare Professionals

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