The Real Reason Your OET Writing Score Won’t Move Past 300 (And How to Fix It)

When AHPRA raised its writing requirement from C+ (300) to B (350), something interesting happened. A sub-test that most candidates used to clear without much thought suddenly became the wall.

I hear the same sentence over and over now:

“I can score 300 without a problem. But 350? I can’t get it to stay there.”

If that’s you, this article is for you. I’m not going to hand you another generic template or a list of “impressive” phrases. Instead, I want to show you how the letter is actually judged — because once you see the logic behind the rubric, the path to a stable 350+ becomes surprisingly clear.

Everything comes down to one question: does your letter make the reader work?

Open up the official OET writing criteria and read them carefully. Purpose. Content. Conciseness & Clarity. Genre & Style. Organisation & Layout. Language.

Six criteria, but underneath all of them sits a single axis: does this letter place unnecessary load on the reader, or not?

Spelling. Grammar. Paragraph structure. How information is sequenced. Every one of these is really asking the same thing — can the clinician receiving this letter grasp the information instantly, or do they have to stop, re-read, and reconstruct it themselves?

Here’s the mindset shift I want you to make: instead of only asking “How do I gain points?”, start asking “What drags candidates into the lower bands?” — and then systematically eliminate those things. Subtraction before addition. That’s the strategy behind everything below.

First, the unglamorous part: spelling and grammar

Before any technique, a habit: when you finish writing, go back and check the small stuff. Patient names. Dates. Symptoms. Medication names.

Why start here? Because if these errors sit uncorrected in your letter, no amount of clever structure will save you — the deductions eat your score before your organisation ever gets credit. And there’s a deeper problem: in a real clinical handover, a misspelled drug name or wrong date doesn’t just look sloppy. It undermines the credibility of the document itself.

Test-day keyboards are unfamiliar, and typos happen more than you’d expect. So build the ritual: two or three minutes at the end, every single time, scanning for exactly these details. It’s the cheapest score insurance you’ll ever buy.

Structure your letter by category, not by timeline

There are two broad ways to write the letter:

1. The summary approach — reorganise the case notes into categories (purpose, findings, risk factors, request)
2. The chronological approach — follow the case notes in the order they’re written

The official OET guidance says to choose depending on the case notes. But if you want my honest, results-based answer: the summary approach is dramatically more stable.

Here’s why. The chronological approach walks you straight into one of the most damaging phrases in the entire rubric — the Band 1 descriptor about heavy reliance on case note structure.

Think about what the case notes actually are. They’re raw material handed to you. Copying them out in their original order means abandoning the one skill this task is fundamentally testing: reshaping information into the form the reader needs.

The receiving clinician doesn’t care about the order events were documented. They care about what they need to know, in the order they need to know it. Reorganise for them, and two things happen at once: your letter becomes easier to read, and you naturally create opportunities to use the connective, summarising language the rubric rewards.

The paragraph skeleton that works

The basic flow:

Purpose → Findings → Risk factors (medical history, family history, allergies) → Closing request

State why the letter exists. Then what today’s consultation revealed. Then the background that matters for diagnosis and ongoing management. Then, clearly, what you’re asking the recipient to do.

Within this, the piece candidates most often get wrong is prioritising the risk factors.

Not all background information carries equal weight. Family history and allergies that bear directly on the working diagnosis tend to matter most — so when in doubt, surface those first. Don’t lay every risk factor out flat like items on a shelf. Ask yourself: if I were the clinician receiving this patient, what would I need to know first? That editorial judgment — deciding what leads and what follows — is precisely what the summary approach lets examiners see.

Technical language: less is more (yes, really)

This one surprises people. Surely a letter written doctor-to-doctor should be packed with precise terminology?

Not according to the rubric. Band 1 explicitly flags the misuse or overuse of technical language and abbreviations as something that strains the reader. In other words: specialised vocabulary earns you nothing by itself. Past a certain density, it actively works against you.

Even when the reader knows a term, a page thick with abbreviations forces constant micro-pauses — “wait, what was that again?” Each pause is load. (If you’ve ever returned to a dense, plot-heavy series after a year away and found yourself flipping back pages just to keep the character names straight, you know exactly what this feels like. Now imagine that experience in a referral letter.)

A useful rule of thumb: if a term or abbreviation already appears in the case notes, it’s usually safe to use. If you’re about to introduce an abbreviation the notes don’t contain, stop and ask: will this read effortlessly, or am I making the reader decode?

Learn to write complex sentences — deliberately

English sentences come in two basic flavours. A simple sentence has one subject and one verb. A complex sentence joins two or more clauses with a connector.

Simple sentences are clear, and that’s their trap. String them together one after another and your information arrives fragmented — a pile of disconnected facts the reader must assemble themselves. This is the signature of letters that are technically accurate but somehow exhausting to read. If your feedback keeps saying “correct but choppy,” this is why.

You may have heard the classic exam advice: “write simply, minimise deductions.” For OET — and IELTS and TOEFL, for that matter — the calculus is reversed. The rubric rewards demonstrated range, and that means consciously building complex sentences.

The key when combining clauses: bundle information from the same category. Tie the related findings together in one sentence, the related history together in another. Do that, and the case notes reach the reader pre-digested.

Ultimately it’s a choice: do you hand the reader loose facts and make them draw the connections — or do you hand over facts already connected? That difference is the readability difference.

Highlight what actually matters

This last technique is subtle, and it’s the one that separates strong candidates from the rest.

Band 7 — the top band — describes letters where key information is highlighted and subsections are well organised. Read that again: the highest band explicitly rewards deliberate emphasis.

When every finding is presented with identical weight, the reader has no signal about what’s critical. They’re forced to read everything at maximum attention — which, again, is load.

So when you’re conveying the result that will drive the diagnosis — the value that changes management — don’t let it sit flat alongside routine observations. Shape the sentence so your intent is unmistakable: this is the part I need you to see. You’re using language to direct the reader’s eyes.

A clinical letter isn’t made persuasive by writing everything emphatically. It’s the contrast — emphasis where emphasis belongs — that lets the truly important information land.

About the word count (relax, mostly)

“The task says approximately 180–200 words. I wrote 250. Am I in trouble?”

I get this question constantly. This isn’t official data — it’s pattern recognition from real candidates’ results — but going somewhat over the guideline generally doesn’t sink a letter. I’ve seen multiple passes above 300 words. Coming in noticeably under, on the other hand, correlates with weaker outcomes far more often.

Two caveats. More words mean more surface area for grammar and spelling errors. And padding your letter with low-priority information raises reader load — the very thing we’ve spent this whole article eliminating. But if information genuinely needs to be communicated? Include it. Don’t sacrifice content to hit an arbitrary number.

A working phrase bank

One quiet advantage of OET over IELTS or TOEFL: the range of expressions you actually need is narrow. Learn phrases by their function in the letter, and you’ll always have the right tool at hand.

① Stating the purpose

• I am writing to refer [patient] to you for [assessment/investigation/management] of [condition/symptoms].
• Thank you for seeing [patient], a [age]-year-old [occupation/status], who [main issue].

② Reporting findings

• [Test] showed/revealed [finding].
• Investigations confirmed [diagnosis/condition].
• I am concerned about the possibility of [serious condition]. (reserve this for genuinely serious findings)

③ Describing symptoms and course

• Over the last [period], [patient] has experienced [symptom/change].
• [Patient] presented with a [duration] history of [symptoms].
• The symptoms have become more frequent/severe despite [treatment].

④ Medical history and allergies

• [Patient] has a history of [condition].
• Her/His past medical history includes [condition/procedure].
• She/He is allergic to [drug/substance]. / She/He has no known drug allergies.

⑤ Current treatment and medications

• She/He is currently taking [medication + dose + frequency].
• She/He has been prescribed [medication + dose + frequency].
• She/He has been advised to [lifestyle/management advice].

⑥ Closing

• I would be grateful if you could assess [patient] and advise on [specific issue].
• Please do not hesitate to contact me if you require any further information.

⑦ Emphasis (use sparingly — once or twice per letter, maximum)

• Of note, …
• Importantly, …
• Given …, please …

The thread that runs through all of this

Look back over every point in this article and you’ll notice they’re all the same point, wearing different clothes:

Lower the load on your reader.

Don’t copy the case note structure. Don’t overload the terminology. Bundle related information. Emphasise what’s critical. Every technique here exists to let the assessor read easily and accurately.

Before you add “better expressions,” subtract whatever tires the reader. That inversion — subtraction before addition — is what turns an unstable 300 into a dependable 350.

Your letter isn’t a display of your English. It’s a handover. Write it like one.