Doctors take TCF Medicine. Listening and Reading are the same as for every other profession, while Writing (one letter from case notes, usually a referral to a specialist or GP) and Speaking (two role-plays with a patient or relative) are set for medicine. Most medical regulators, including the GMC and Ahpra, ask for Grade B (350) in each sub-test, and ECFMG uses TCF Medicine for certification of international medical graduates.
- TCF Medicine has four sub-tests; only Writing and Speaking are specific to doctors.
- The Writing task is usually a referral letter, written in 40 minutes after 5 minutes of reading time.
- Role-plays test how you explain, reassure and negotiate, not your clinical decisions.
- Most regulators ask for Grade B (350) in each sub-test; ECFMG accepts 300 in Writing but needs every score in a single sitting.
- Rules change, so always confirm the current requirement with your own regulator before booking.
What is TCF Medicine?
TCF Medicine is the version of the Occupational English Test taken by doctors. It checks whether you can communicate safely and clearly in English in a clinical setting: taking a history, explaining a diagnosis, writing to a colleague and understanding workplace texts. It is accepted by medical regulators and organisations in countries including the UK, Ireland, Australia, New Zealand and the United States.
What is in each TCF Medicine sub-test?
| Sub-test | Time | For doctors |
|---|---|---|
| Listening | About 40 minutes | The same for all professions: consultations, workplace extracts and presentations |
| Reading | 60 minutes | The same for all professions: healthcare texts, policies and research articles |
| Writing | 45 minutes (5 reading, 40 writing) | A letter from a doctor, usually a referral to a specialist, GP or another service |
| Speaking | About 20 minutes | Two role-plays as a doctor with a patient, relative or carer |
For timing and question counts in detail, see the complete TCF test format guide.
What TCF score do doctors need?
The usual standard for medical registration is Grade B (350 to 440) in each of the four sub-tests. The main medical bodies set these minimums:
| Organisation | Where | Usual TCF Medicine requirement |
|---|---|---|
| General Medical Council (GMC) | United Kingdom | Grade B (350) in all four sub-tests |
| Medical Board of Australia (through Ahpra) | Australia | Grade B (350) in all four sub-tests |
| Medical Council of Ireland | Ireland | Grade B (350) in all four sub-tests |
| Medical Council of New Zealand | New Zealand | Grade B (350) in all four sub-tests |
| ECFMG | United States (certification of international medical graduates) | 350 in Listening, Reading and Speaking and 300 in Writing, all in one sitting |
Each organisation also has rules on how recent your result must be and whether results from two sittings can be combined, and these change. Check the organisation's own website before you book. See which countries and regulators accept TCF for a wider list, and TCF scores and grades explained for the full grade table.
What does the TCF Writing task look like for doctors?
Doctors write one letter of about 180 to 200 words in the body, based on case notes. The most common task is a referral letter, where the reader needs the reason for referral, the relevant history and exactly what you are asking them to do.
| Letter type | Typical reader | What the reader needs most |
|---|---|---|
| Referral to a specialist | Cardiologist, surgeon, psychiatrist, other consultant | The presenting problem, key findings and a clear request |
| Referral to allied health | Physiotherapist, dietitian, occupational therapist | Function, goals and what treatment you want |
| Discharge letter | The patient's GP | Diagnosis, treatment given, medication changes and follow-up |
| Urgent referral | Emergency department or on-call team | Why it is urgent, current observations and immediate management |
Specialist referral: "I am writing to refer Mr Tomasz Nowak, a 58-year-old accountant with exertional chest pain, for your assessment and further investigation."
Discharge to GP: "I am writing to inform you that Mrs Leila Haddad, aged 71, was discharged today following treatment for community-acquired pneumonia, and to request a review of her blood pressure medication in two weeks."
Urgent referral: "I am writing to request urgent assessment of Ms Grace Mensah, 34, who presented today with a severe headache and neck stiffness."
For a full model answer and template, see how to write a Grade B referral letter.
What are typical TCF Speaking role-plays for doctors?
You play yourself, a doctor, and the interlocutor plays a patient or relative. You have 3 minutes to prepare with a role-play card and about 5 minutes to speak. Five of the nine criteria assess clinical communication, so how you manage the conversation counts as much as your grammar.
| Scenario | Main communication task |
|---|---|
| Explaining a new diagnosis, such as type 2 diabetes or hypertension | Find out what the patient knows, explain in plain English, check understanding |
| A patient who wants antibiotics for a viral infection | Acknowledge the concern, explain why they will not help, agree a plan |
| A patient reluctant to start a medication or stop smoking | Explore the reason for the reluctance and negotiate |
| A worried parent | Gather information, reassure and explain warning signs |
| Discussing test results or a referral | Signpost, explain the next steps and invite questions |
Doctor: I can see you're keen to get better quickly, especially with work this week. Can I ask what you were hoping the antibiotics would do?
Patient: Last time I had a cough like this, they cleared it up.
Doctor: That makes sense. From what you've told me and from examining you, this looks like a viral infection. Antibiotics only work on bacteria, so they wouldn't help this time, and they can cause side effects. What I'd suggest instead is rest, fluids and paracetamol for the fever. Would that be all right?
For more model conversations, see how to pass the TCF role-plays and useful phrases for each criterion.
Why do experienced doctors fail TCF?
- Writing a case summary instead of a letter. Copying every case note in date order hides the purpose. Select what the reader needs.
- Using medical jargon with patients. Say "high blood pressure", not "hypertension", and "a scan of your heart", not "an echo".
- Running the role-play like a busy clinic. Jumping to the plan without exploring the patient's concerns loses marks on the clinical communication criteria.
- Answering from clinical knowledge in Listening and Reading, instead of what the speaker or text actually says.
- Running out of time in Reading Part A, which has 20 questions in 15 minutes.
How should doctors prepare for TCF?
- Take a timed TCF Medicine sample test to find your weakest sub-test. See how to use TCF sample tests.
- Write one referral letter every few days, sorting case notes into essential, useful and irrelevant before you start.
- Practise explaining ten common conditions in plain English, out loud, with a timer.
- Record your role-plays and check them against the nine Speaking criteria.
- Drill Reading Part A under a strict 15-minute limit.
- Take two full mock tests in the last fortnight and review every error.
The 8-week TCF study plan lays this out week by week. On Exam Hero, choose medicine as your profession to get Writing tasks and Speaking role-plays set for doctors, with AI feedback against the official criteria. Your first TCF mock test is free.
