Writing on the OET rewards selection, brevity, and structured handover — not the comprehensive free-writing doctors do every day. Since 2014 we have corrected thousands of doctor letters against the six OET criteria. Profession-specific case notes, 24-hour turnaround, built for the 2026 ECFMG single-sitting rule.
Quick answer
Internationally trained doctors need Grade B (350) in each of the four OET sub-tests for GMC (UK), AHPRA (Australia), and ECFMG (USA) registration. From 2026, ECFMG requires all four Grade B passes in a single sitting; sequential pass-and-retake is no longer accepted. There is no Grade C+ Writing concession for doctors. Writing is the most retaken sub-test — typically due to Conciseness & Clarity losses from clinical narrative habits.
If you are an internationally trained doctor pursuing US residency through ECFMG, the OET requirements changed in 2026. All four sub-tests — Listening, Reading, Writing, Speaking — must now be achieved at Grade B (350) in a single sitting. Combining results from multiple sittings is no longer accepted.
This raises the bar significantly on Writing, where IMG candidates historically have the lowest first-attempt pass rate. Sequential pass-and-retake is no longer a viable strategy. Targeted Writing preparation is now essential — not optional.
Inpatient summary to the patient's GP. Tests your ability to condense an admission into actionable next steps — diagnosis, treatment given, medications on discharge, follow-up plan.
Marking watch-out: Conciseness — discharge tempts narrative recap. Resist.
Patient handover to a specialist team or another facility. Often emergency or peri-operative context. Addressee usually expects to act on the letter immediately.
Marking watch-out: Purpose — open with the reason for transfer in the first sentence, not the patient's history.
Urgent referral to a specialist or on-call team. Tests your ability to convey clinical urgency without melodrama.
Marking watch-out: Genre & Style — match the register to clinical urgency. "Please see urgently" is acceptable; over-hedging weakens Purpose.
Daily clinical writing builds habits that work in the hospital and against you in the OET. These four patterns show up across thousands of doctor letters we have corrected — each fixable in 2-3 targeted submissions.
Costs marks in: Conciseness & Clarity
Including the full admission history when the addressee already needs only the discharge summary. Fix: select only what the addressee must know to act.
Costs marks in: Genre & Style
Using full medical jargon when the addressee is a community service or patient family member. Fix: adjust register to the recipient — clinical for clinical, accessible for non-clinical.
Costs marks in: Purpose
Spending two sentences on patient demographics before stating why you're writing. Fix: reason for writing in the first sentence.
Costs marks in: Language
Long clinical-style sentences that obscure the main message. Fix: one clinical fact per sentence in the opening paragraph; longer constructions only where needed.
Correctors familiar with clinical handover conventions, GMC vocabulary, and IMG-specific writing patterns.
Practice case notes spanning emergency, peri-operative, specialty, and primary-care contexts.
Per-criterion scoring (Purpose, Content, Conciseness & Clarity, Genre & Style, Organisation & Layout, Language) — no single black-box grade.
For 2026 ECFMG candidates: corrections explicitly geared toward Grade B in a single attempt — no "just pass Writing later" strategy.
The GMC requires Grade B (350) in each of the four OET sub-tests — Listening, Reading, Writing, and Speaking. There is no equivalent of the NMC Grade C+ Writing concession for doctors; all four sub-tests must reach B.
From 2026, ECFMG requires that all four OET sub-tests are passed at Grade B in a single sitting. The previous strategy of passing sub-tests sequentially across multiple sittings is no longer accepted. For internationally trained doctors targeting US residency, this raises the bar significantly on writing preparation, where the failure rate is highest.
Doctors most often write discharge letters or transfer letters, frequently in emergency or specialist contexts. The addressee is usually another doctor (GP, specialist, on-call team). Less commonly, a counselling letter to the patient or family member is tested.
Daily clinical free-writing rewards comprehensiveness and detail. The OET Writing sub-test rewards the opposite — selection, brevity, and structured handover. Across our thousands of doctor letters, the most common criterion lost is Conciseness & Clarity, followed by Genre & Style (register mismatch when writing to a non-clinical addressee).
For first-time candidates, 4-6 weeks with 4-8 corrections is sufficient if you start with the criteria in mind. For re-takers, 6-8 weeks with 8-12 corrections is more typical. Doctors targeting ECFMG single-sitting must prepare all four sub-tests in parallel; do not under-invest Writing because it is the historic failure point.
What examiners look for, criterion by criterion.
Reference structures for discharge, transfer, referral.
Cross-profession patterns that cost marks.
Profession-specific guidance for nursing, pharmacy, physio and more.
Marked against the six OET criteria by a medically-aware corrector. 24-hour turnaround on every letter. thousands of doctor letters corrected since 2014.
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