The writing sub-test is where many nurses lose marks in the OET — and where the biggest gains are possible with the right preparation. Unlike IELTS, which requires formal essays on abstract topics, OET writing asks you to do something practical: write a clinical letter based on patient case notes. For nurses, this is almost always a referral letter.
This guide breaks down exactly how to structure your letter, what examiners are looking for, and the mistakes that cost nurses their Grade B.
What the OET Writing Task Looks Like
You receive a set of patient case notes — typically one to two pages covering the patient's personal details, medical history, presenting complaint, examination findings, diagnosis, treatment, and plan. A prompt tells you who to write to (usually a GP, specialist, or community health team) and why.
You have 40 minutes to read the case notes and write a letter of approximately 180 to 200 words. The letter must be written in full sentences and paragraphs — bullet points are not acceptable.
Letter Structure: The Format That Works
Every OET referral letter should follow this structure:
1. Recipient and Date
Address the letter to the person named in the prompt. Include their title and position. Add the date.
2. Reference Line
Write 'Re:' followed by the patient's name, age (or date of birth), and a brief identifier such as the diagnosis or reason for referral. This gives the reader immediate context.
3. Opening Paragraph
State the purpose of the letter clearly in the first sentence. For example: 'I am writing to refer Mrs. Sharma for further assessment and management of her newly diagnosed Type 2 diabetes.' Do not bury the purpose in the second or third paragraph — examiners check for this immediately.
4. Body Paragraphs
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Organise the clinical information into two or three logical paragraphs. A common approach is to cover the patient's background and relevant medical history in one paragraph, current presentation and findings in the next, and treatment to date and current status in the third. Select only the information that is relevant to the reader and the purpose of the referral — do not copy everything from the case notes.
5. Closing Paragraph
End with a specific request or action. For example: 'I would appreciate your assessment and ongoing management of Mrs. Sharma's condition.' Add a line offering to provide further information if needed. Sign off with 'Yours sincerely' followed by your name and title.
What Examiners Are Looking For
OET writing is graded on six criteria, each of which directly affects your score:
- Purpose: Does the letter clearly state why it is being written in the opening paragraph?
- Content: Have you selected the right information from the case notes and excluded irrelevant details?
- Conciseness and Clarity: Is the letter focused and free of unnecessary repetition or wordiness?
- Genre and Style: Does it read like a professional clinical letter, not a patient chart or an essay?
- Organisation and Layout: Is the information logically grouped and easy for the reader to follow?
- Language: Is grammar, spelling, vocabulary, and sentence structure accurate and appropriate?
You need strong performance across all six criteria to achieve Grade B. Nurses most commonly lose marks on content selection (including too much or too little) and conciseness (being wordy or repetitive).
Common Mistakes That Cost Grade B
- Copying case notes verbatim. Examiners expect you to paraphrase and transform note-style abbreviations into professional prose. 'Pt c/o SOB on exertion x 3/7' should become 'The patient has reported experiencing shortness of breath on exertion over the past three days.'
- Burying the purpose. If your first paragraph discusses medical history before stating why you are writing, you will lose marks on purpose and organisation.
- Including everything. The case notes contain more information than you need. If you are referring a patient for diabetic management, their childhood tonsillectomy is not relevant. Be selective.
- Using bullet points or note format. The letter must be in full prose. Lists, dot points, and telegram-style sentences will lower your score.
- Forgetting the closing request. A referral letter without a clear ask ('I would be grateful for your assessment') feels incomplete and loses marks on genre and purpose.
Practical Tips for Test Day
- Spend the first 5 minutes reading the case notes and the prompt carefully. Underline the information you plan to include and cross out what you will leave out.
- Write a brief outline before you start: purpose, paragraph topics, closing action. This takes 2 minutes and prevents rambling.
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- Aim for 180 to 200 words. Going significantly over means you are probably including unnecessary detail.
- Leave 3 to 5 minutes at the end to proofread for grammar errors, missing articles, and spelling mistakes. These small errors accumulate and drag down your language score.
- Practice with a timer. Write at least 10 referral letters under timed conditions before test day.
Sample Opening Lines That Score Well
Strong openings set the tone for the entire letter. Here are examples of clear, purpose-driven opening sentences:
- 'I am writing to refer Mr. Ahmed for specialist assessment of his chronic lower back pain, which has not responded to conservative management.'
- 'I am writing to request a home visit assessment for Mrs. Chen, an 82-year-old patient who was recently discharged following a left hip replacement and requires ongoing community nursing support.'
- 'I am writing to transfer the care of Baby Singh to your neonatal unit for further monitoring of his neonatal jaundice.'
Notice the pattern: each sentence names the patient, states the action requested, and gives the clinical reason — all in one sentence.
Next Steps
The OET writing sub-test rewards preparation and structure over creativity. Learn the format, practise selecting relevant information from case notes, and time yourself consistently. If you can write a clear, well-organised referral letter in 35 minutes and leave 5 minutes for proofreading, Grade B is well within reach.