Three practical shifts have emerged across 2024–2026. ECFMG now requires single-sitting passes. OET Writing marking has become more variable, with stricter application of Conciseness & Clarity and Genre & Style criteria. Clinical relevance is weighted more heavily in case-note selection. Here is what each change means — and how to prepare.
Quick answer
Three things changed for the OET across 2024–2026: (1) ECFMG requires international medical graduates to pass all four sub-tests at Grade B in a single sitting; (2) OET Writing marking is more variable, with stricter application of Conciseness & Clarity and Genre & Style; (3) clinical relevance carries more weight in case-note selection. The Grade B (350) pass threshold itself has not changed. The OET is owned by Cambridge Boxhill Language Assessment Trust (CBLA).
International medical graduates targeting US residency must now achieve Grade B in Listening, Reading, Writing, and Speaking within a single OET attempt. Sequential pass-and-retake strategy is no longer accepted by ECFMG.
Full ECFMG guideSince 2024, OET Writing markers apply Conciseness & Clarity and Genre & Style more strictly. The same letter that would have scored Grade B in 2022 may score Grade C+ in 2026 if it carries extra case-note detail or register slips.
Selecting the clinically significant case-note items now matters more for the Content criterion. Letters that include everything in the case notes — or that omit clinically critical details — lose marks more reliably than before.
Writing has the highest first-attempt failure rate. Stricter marking widens the gap. If you have limited preparation time, prioritise Writing — Listening and Reading practice compounds faster on its own.
Most candidates can write a 250-word letter. Fewer can choose which 250 words to include. Mark the clinically significant items first; structure your letter around those.
Generic correction can catch grammar. Only profession-aware correction catches the clinical-relevance judgement calls that the 2026 marking environment rewards.
For doctors targeting US residency: prepare all four sub-tests in parallel from day one. Do not assume you can retake Writing later.
AI is useful for daily practice between corrections — flagging common errors, reinforcing structure. It does not replace human correction in the 2026 marking environment.
Three practical shifts have emerged across 2024–2026. First, ECFMG (USA) now requires international medical graduates to achieve Grade B in all four sub-tests within a single sitting. Second, OET marking — particularly in Writing — has become more variable, with markers applying criteria more strictly on Conciseness & Clarity and Genre & Style. Third, clinical relevance is weighted more heavily: case-note selection that misses clinically significant details now costs marks more reliably than it did pre-2024.
The OET is owned by Cambridge Boxhill Language Assessment Trust (CBLA), a joint venture between Cambridge University Press & Assessment and Box Hill Institute. CBLA is the authoritative source for changes, scoring criteria, and regulator-acceptance notices.
No. Grade B (a score of 350) remains the standard pass threshold required by most regulators (GMC, AHPRA, GPhC, GDC, HCPC, NMBI, ECFMG). The NMC continues to accept Grade C+ (300) in Writing if combined with Grade B in the other three sub-tests within a 6-month window.
Three adjustments. One: invest more in Writing-specific practice — historic pass rates suggest Writing is the most-retaken sub-test, and stricter marking widens that gap. Two: ECFMG-bound doctors must prepare all four sub-tests in parallel for a single sitting, not sequentially. Three: profession-aware case-note practice matters more, because clinical-relevance weighting penalises generic 'include everything' approaches.
AI tools are useful for daily practice — flagging common errors and reinforcing the six criteria. They do not replace human correction. The 2026 marking environment rewards judgement calls on case-note selection and addressee register that generic AI cannot reliably reproduce. Use AI tools between human corrections, not instead of them.
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