Quick answer: the hardest moment in OET Writing is the start of every sentence. The fix is a small library of starter frames for each situation, a chain of professional connectors, and two rules: every fact carries its reason, and every sentence must be logical and complete. Master these, and the case notes turn into a letter almost by themselves.
Here is the problem I see in every batch, and it is not what you think. Students read the case notes. They understand everything. They know exactly which information to pick. And then they sit in front of the page, thinking, thinking, thinking, unable to write the first word. The knowledge is there. The sentence is not. That stuck moment is where OET Writing is lost, because every frozen minute is stolen from a 40 minute clock. This guide is my sentence system from three years of classes: the starter frames that kill the blank page, the connector chain that gives your letter its flow, the compression rule that turns five case note lines into one sentence, and the 25 minute benchmark I use myself.
This page is the sentence level. If the shape of the letter around those sentences is not yet fixed in your mind, read the OET referral letter guide first, then come back here to build the lines that fill it.
The rule above all rules
Before the frames, understand my first principle. There are millions of correct sentences. The same information can be written in ten different formats, and I am not giving you scripts to memorize. I am giving you frames to start from. The only two tests any sentence must pass: is it logical, and is it complete? If yes, it is a valid sentence, whether you are a doctor or a nurse, because the English is the same for everyone. Fragmented, incomplete sentences are the loudest red flag a letter can raise. Complete and logical, always.
The Starter Frames. The cure for the blank page.
Match your situation to its frame, and the sentence starts itself.
| Situation in the case notes | Your starter frame |
|---|---|
| Patient arrived with symptoms | Mrs. Jagosh presented to the emergency department with complaints of… |
| Symptoms with a duration | Mr. Johnson presented with a 6 hour history of pain and weakness in his left leg. |
| The first of several visits | Initially, … — this one word tells the reader it was the first presentation |
| A dated visit | On 6th January 2020, Mr. Johnson presented to me with… |
| Describing the admission moment | On admission, … or At the time of admission, … |
| No symptoms mentioned, events in hospital | During hospitalization, … or During his hospital stay, … |
| After a surgery | Postoperatively, … |
| Later visits, condition unchanged | During his subsequent visit, his condition did not improve despite changing medications. |
| A turn for the worse | The next day, Mrs. Jagosh's condition worsened. |
Two warnings inside this table. First, the article trap: at the time of admission is correct, at time of admission is a mistake, the article is missing. If you want fewer words, write on admission instead. Second, the complaints rule: it is always with complaints of, plural, with the s. These tiny slips are exactly the mistakes examiners collect.
The Compression Rule. Five lines become one sentence.
Case notes love to give you long chains of events: three visits, three medications that did not work, then one that did. Do not walk the reader through every failure. Skip the middle. One sentence covers the whole failed journey: during his subsequent visits, his condition did not improve despite changing medications. That phrase, despite changing medications, contains all three failed drugs without naming one.
The Compression Rule
Skip the middle. Spend your words where the story turns.
Case notes hand you long chains: three visits, three medications that failed, then one that worked. Do not walk the reader through every failure.
What the notes give you
- Visit 2 · no improvement
- Drug A stopped, drug B started
- Visit 3 · still no improvement
- Drug B stopped, drug C started
- Visit 4 · no improvement
- 16 Jan · spironolactone started, improving
What you write
During his subsequent visits, his condition did not improve despite changing medications.
On 16th January 2020, he was started on spironolactone, and his condition began to improve.
Those three words, despite changing medications, carry all three failed drugs without naming one. Nothing is missing. The reader gets the whole journey and you keep the words for the moment it turned.
Then you spend your words where the story turns: on 16th January 2020, he was started on spironolactone, and his condition began to improve. Two sentences, the whole journey, nothing missing. This is the summarizing skill that scored me 400 with a 215 word letter, and it lives right here, at the sentence level.
The Curiosity Rule. Every fact carries its reason.
Read this sentence: three units of red blood cells were transfused. Now feel what the reader feels. Why? Why were they transfused? What was the reason? A fact without its reason leaves the reader curious, and in the exam's language, that is ineffective presentation of information. You provided the information, but the information is not clear.
So the rule is simple: every significant fact travels with its cause or its consequence. Her ECG revealed prominent Q waves, and as a result, she was shifted to the cardiac care unit. The fact, then the because, or the therefore. A medical letter is not a list of events. It is a chain of reasons.
The Connector Chain. The words that create flow.
Here is a real paragraph flow from my own letter, and watch the connectors carry it. On examination, she was febrile. An initial diagnosis of myocardial infarction was made. Please note her ECG revealed prominent Q waves and T wave inversion, and as a result, she was shifted to the CCU immediately. The next day, her condition worsened. Consequently, a diagnosis of anterior wall myocardial infarction was made, for which she was commenced on clopidogrel. Subsequently, her condition improved. Today, Mrs. Jagosh is stable and is due to be discharged into your care.
That is the chain:
- on examination
- please note
- as a result
- consequently
- for which
- subsequently
- the next day
- today
Each connector tells the reader what kind of sentence is coming: a finding, a consequence, a time jump, a current status. Learn the chain, and your letter reads like one continuous story instead of stacked facts.
Want a trained eye on your sentence flow before the exam judges it? See the writing correction programme.
The Professional Passive. The voice of a medical letter.
Listen to the register of these sentences. An initial diagnosis was made. She was commenced on clopidogrel. An echo was requested. A follow up is requested in one week. This is the professional passive, the natural voice of clinical handover, and it should carry most of your clinical events. Not I diagnosed her, but a diagnosis was made. Not I started clopidogrel, but she was commenced on clopidogrel. It sounds like medicine, because it is how medicine writes.
The small rules that save real marks
- The and connector. Listing symptoms? The and comes before the last item only: chest heaviness, pain radiating to the left arm, jaw, and epigastric region. Two symptoms? The and sits between them. Forgetting it is a tiny mistake the examiner counts.
- The paragraph name rule. Every new paragraph opens with the patient's name, then pronouns may follow inside the paragraph. Mrs. Jagosh first, she afterwards.
- The closing. Yours sincerely, with a small s and no apostrophe, then your name and title on the next line.
- Start logically, always. How the patient came, what was found, what was done, in that order. Never jump into the middle of the story.
The 25 Minute Benchmark and the proofread
25 min
The 15 that remain buy you the skill most students never use: one continuous read of the finished letter, top to bottom, exactly the way the examiner will read it.
My personal standard, and the one I set for my students: the letter itself takes 25 minutes. That leaves real time inside the 40 for the final skill most students skip, the one flow proofread. Read your finished letter top to bottom in one continuous read, like the examiner will. You are checking four things. Verb mistakes. Preposition mistakes. The flow, does it read like one story. And completeness, is anything from the case notes missing. When I finish that read and find no verb mistake, no preposition mistake, and I am liking my flow, the letter is done. Not before.
Frames learned. Now train them on real letters. My writing correction program takes your actual letters and returns them marked against the exam's standards, sentence by sentence, so every letter you write teaches you the next one.
About the author. Dr. Nasir Bukhari, MBBS, is an OET Certified teacher. He completed OET's official Teacher Training in all four skills, Reading, Listening, Writing and Speaking, certified by OET's Head of Education. He has taught OET to healthcare professionals in more than 40 countries. He is the founder of CliniVerba, the house behind OET HQ.