Key Takeaways
- Your OET Speaking score depends on both linguistic ability and clinical communication.
- Treating the role-play as a checklist can make the conversation sound mechanical.
- Strong candidates listen, respond to patient cues and adapt their language appropriately.
- Memorised empathy phrases are not enough if they do not address the patient’s actual concern.
- Clear structure, patient-friendly explanations and checks of understanding are essential.
- A high level of general English does not automatically produce a high OET Speaking score.
Introduction
Many International Medical Graduates (IMGs) prepare thoroughly for OET (Occupational English Test) Speaking but still miss their target score. This can be particularly frustrating when they have strong medical knowledge and already communicate in English at work.
The problem is often not one major error. Several smaller communication problems may occur throughout the role-play.
OET Speaking recordings are assessed using four linguistic criteria—intelligibility, fluency, appropriateness of language, and resources of grammar and expression—alongside five clinical communication criteria. These examine relationship-building, understanding the patient’s perspective, providing structure, gathering information and giving information (OET, n.d.).
Candidates therefore need to demonstrate more than accurate vocabulary and grammar. They must use English to conduct a patient-centred clinical conversation.
Why Your OET Speaking Score Matters
Different regulators set their own requirements, so candidates should always check the rules applying to their intended registration pathway.
For example:
- The UK General Medical Council currently requires at least Grade B in each OET Medicine component, achieved in the same test (GMC, n.d.).
- For its 2027 Pathways, ECFMG in the United States requires a minimum Speaking score of 350, alongside its specified scores for the other sub-tests (ECFMG, 2026).
- Australia’s current English-language registration standard lists an OET Speaking score of 350 (Ahpra, n.d.).
- The Medical Council of New Zealand requires 350 in OET Medicine Speaking under its test pathway (MCNZ, 2025).
- In Canada, requirements are determined by individual medical regulators. For example, Manitoba accepts OET Medicine with at least Grade B in all four sub-tests under its current policy (CPSM, 2026).
These authorities establish registration requirements; they do not publish personalised feedback about individual candidates’ Speaking performances. The seven problems below are practical patterns aligned with the official OET assessment criteria.
1. Treating the Role-Play Card as a Checklist
Candidates sometimes believe that success means covering every bullet point on the role-play card as quickly as possible.
This can produce a conversation like this:
“How long have you had the pain? Is it severe? Do you smoke? Are you taking medication?”
Although the questions may be relevant, the interaction can sound like an interrogation.
The role-play card gives you tasks to address, but it is not a script. Listen to the patient’s answers and allow the conversation to develop naturally.
For example:
“You mentioned that the pain has been affecting your sleep. Could you tell me a little more about that?”
This still gathers clinical information but also demonstrates listening and responsiveness.
2. Talking Too Much and Listening Too Little
Some candidates try to demonstrate their English by speaking for most of the role-play. They may give long explanations, interrupt the patient or move quickly to the next task.
However, effective clinical communication is a two-way process.
Allow the patient to finish and use their response to guide your next question:
Patient:
“I’m worried that this pain could be cancer.”
Less effective response:
“Do you have any allergies?”
Better response:
“I can understand why that would worry you. What has made you particularly concerned about cancer?”
The better response acknowledges the concern before returning to further information gathering.
Silence is not always a problem. A brief pause can give the patient time to think and can make you sound more natural rather than rushed.
3. Missing the Patient’s Perspective
OET Speaking is not simply a test of whether you can identify the correct medical problem.
Candidates should explore the patient’s:
- Ideas about the condition
- Concerns or fears
- Expectations
- Experience of the symptoms
- Practical circumstances
Useful questions include:
- “Is there anything in particular that you’re worried about?”
- “What do you think may be causing this?”
- “How has this been affecting your daily life?”
- “What were you hoping we could do today?”
Suppose a patient is reluctant to start medication. Giving more information immediately may not solve the problem.
First explore the reason:
“Could you tell me what concerns you about taking the medication?”
The patient may be worried about side effects, dependency, cost or a previous negative experience. You can only respond effectively once you understand the concern.
4. Using Empathy as a Memorised Phrase
Many candidates learn expressions such as:
- “I understand your concern.”
- “I’m sorry to hear that.”
- “That must be difficult.”
These phrases can be useful, but repeating them automatically does not necessarily demonstrate empathy.
The response should connect to what the patient has said.
Patient:
“I’m frightened that I won’t be able to look after my children.”
Generic response:
“I understand your concern.”
More specific response:
“Your children are clearly very important to you. Let’s discuss how the treatment may affect you and what support might be available.”
The second response identifies the patient’s particular worry and moves the conversation forward.
Effective empathy involves listening, acknowledging the emotion and responding appropriately—not simply inserting a prepared sentence.
5. Using Medical Jargon or Overly Formal English
Some candidates use complicated language because they believe it will demonstrate a higher level of English.
In reality, language should be appropriate for the patient.
Instead of:
“Your symptoms are consistent with gastro-oesophageal reflux.”
Try:
“Your symptoms may be caused by stomach acid coming back up into your food pipe.”
Instead of:
“You should maintain adequate hydration.”
Try:
“Try to drink plenty of water.”
Instead of:
“I recommend commencing analgesia.”
Try:
“I recommend starting some pain relief.”
Using plain English does not reduce the quality of your answer. It shows that you can adapt medical information for a patient.
Avoid sounding too casual as well. The aim is friendly, respectful and professional communication.
6. Giving Information Without a Clear Structure
A medically accurate explanation can still be difficult to follow if the information is presented in the wrong order.
Try to:
- Begin with the main message
- Divide information into smaller sections
- Signpost changes of topic
- Pause between important points
- Invite questions
- Check understanding before continuing
Useful phrases include:
- “First, I’d like to explain what may be causing the symptoms.”
- “There are two treatment options.”
- “Let’s look at each option separately.”
- “Before we continue, what questions do you have?”
- “Does that make sense so far?”
Avoid giving the diagnosis, treatment, side effects and safety-netting advice in one uninterrupted speech.
A clear structure helps the patient follow the conversation and also helps you remain focused during the role-play.
7. Focusing Only on Grammar and Vocabulary
Grammar and vocabulary matter, but they are only part of the assessment.
Candidates may lose fluency because they try to construct overly complicated sentences or mentally correct every small error while speaking.
Compare:
“It would perhaps be advisable, considering the circumstances you have described, that you might consider reducing your consumption of tobacco products.”
With:
“I recommend cutting down on smoking. Would you be willing to discuss some support options?”
The second version is clearer, more direct and easier to say naturally.
Pay attention to:
- Speaking at a comfortable pace
- Pronouncing important words clearly
- Using natural stress and intonation
- Avoiding unnecessarily long sentences
- Recovering calmly if you make a mistake
- Using professional but conversational language
Do not try to eliminate your accent. Focus on intelligibility and making your message easy to understand.
How to Improve Before Your Next Test
Watching model role-plays and memorising phrases may help, but they are not enough on their own.
Effective preparation should include:
- Practising unfamiliar clinical scenarios
- Responding to unexpected patient answers
- Reviewing both sets of assessment criteria
- Receiving specific feedback on linguistic and clinical communication
- Identifying repeated habits rather than correcting isolated sentences
- Practising explanations in patient-friendly language
- Learning how to manage the role-play within the available time
After each practice, ask:
- Did I respond to the patient or simply follow the card?
- Did I explore the patient’s main concern?
- Was my explanation easy to follow?
- Did my empathy sound specific and sincere?
- Did I check the patient’s understanding?
- Did I speak clearly and naturally?
Professional feedback can help identify problems that are difficult to notice while you are concentrating on completing the role-play.
Final Thoughts
Missing your target OET Speaking score does not necessarily mean that your English is poor or that you lack clinical knowledge.
The Speaking sub-test assesses how effectively you use English in a patient-centred clinical interaction. Candidates need to listen, respond to concerns, organise information and explain it in language the patient can understand.
Avoid treating the role-play as a performance in which you must say everything perfectly. Treat it as a clinical conversation with a patient whose ideas, concerns and circumstances matter.
With focused practice and specific feedback, your communication can become clearer, more natural and better aligned with the official assessment criteria.
Book a consultation to discuss your goals and see how I can help.
References
Australian Health Practitioner Regulation Agency (Ahpra) (n.d.) ‘English language skills registration standard’. Available at: https://www.ahpra.gov.au/Registration/Registration-Standards/English-language-skills/English-language-skills-registration-standard.aspx (Accessed: 2 August 2026).
College of Physicians and Surgeons of Manitoba (CPSM) (2026) English Language Proficiency. Available at: https://cpsm.mb.ca/assets/Policies/English%20Language%20Proficiency.pdf (Accessed: 2 August 2026).
Educational Commission for Foreign Medical Graduates (ECFMG) (2026) ‘2027 Pathways: Assessment of communication skills, including English language proficiency’. Available at: https://www.ecfmg.org/certification-pathways/oet.html (Accessed: 2 August 2026).
General Medical Council (GMC) (n.d.) ‘Using your Occupational English Test (OET) certificate’. Available at: https://www.gmc-uk.org/registration-and-licensing/join-our-registers/before-you-apply-guide-for-doctors/evidence-of-your-knowledge-of-english/using-your-oet-certificate (Accessed: 2 August 2026).
Medical Council of New Zealand (MCNZ) (2025) Policy on English language requirements. Available at: https://www.mcnz.org.nz/assets/Policies/English-language-policy.pdf (Accessed: 2 August 2026).
Occupational English Test (OET) (n.d.) ‘OET Speaking: overview of criteria for the test’. Available at: https://oet.com/post/speaking-criteria-overview (Accessed: 2 August 2026).