TCF Speaking lasts about 20 minutes: a short warm-up that is not assessed, then two role-plays. For each role-play you get 3 minutes to prepare and about 5 minutes to talk with an interlocutor playing a patient, relative or carer. Your recording is assessed on nine criteria, and five of them are about clinical communication. That means how you build rapport, structure the conversation and check understanding counts as much as your grammar. Below you will find a role-play template and a worked example with a model conversation.
TCF Speaking at a glance
| Stage | Time | Assessed? |
|---|---|---|
| Warm-up about your professional background | A few minutes | No |
| Role-play 1 preparation | 3 minutes | No |
| Role-play 1 | About 5 minutes | Yes |
| Role-play 2 preparation | 3 minutes | No |
| Role-play 2 | About 5 minutes | Yes |
The nine assessment criteria
Linguistic criteria
- Intelligibility: pronunciation, stress and intonation that are easy to understand.
- Fluency: an even pace, without long hesitation or false starts.
- Appropriateness of Language: the right words and register for a patient, including explaining technical terms in plain English.
- Resources of Grammar and Expression: accurate, varied grammar and vocabulary.
Clinical communication criteria
- Relationship-building: a respectful start, showing empathy, and a non-judgemental attitude.
- Understanding and Incorporating the Patient's Perspective: asking about and responding to the patient's ideas, concerns and expectations.
- Providing Structure: a logical order, with signposting so the patient knows what comes next.
- Information-gathering: open questions first, then focused ones, active listening and summarising.
- Information-giving: checking what the patient already knows, giving information in small chunks, and checking understanding.
A 3-minute preparation plan
- Minute 1: read the card. Who is the patient, where are you, and what is the main task, such as reassuring, persuading or explaining?
- Minute 2: note a word or two for each card point, and plan how you will explain any technical term in plain English.
- Minute 3: plan your opening line and one question to explore the patient's concerns.
TCF Speaking role-play template
Most Grade B role-plays move through the same five stages. Use them as a structure and adapt the wording to the card. Do not recite them as a script.
1. Open and build rapport. "Hello, [Mr/Ms surname]. I'm [name], the [profession] looking after you today. I understand you'd like to talk about [reason from card]. Is that right?"
2. Explore their perspective. "Before I explain anything, could you tell me how you're feeling about [topic]?" / "What worries you most about it?"
3. Signpost, then give information in small chunks. "I'd like to explain [topic], and then we can talk about [next step]. Is that okay?" [One idea in plain English]. "Does that make sense so far?"
4. Respond to concerns and agree a plan. "I can understand why you'd feel [emotion]." [Address the concern]. "How would you feel about [suggested plan]?"
5. Check understanding and close. "Just so I know I've explained it clearly, could you tell me [key point]?" "Is there anything else you'd like to ask?"
Worked example: role-play card and model conversation
Setting: general practice clinic
Patient: a 34-year-old recently diagnosed with asthma and prescribed a daily steroid preventer inhaler. They have not started using it.
Task:
- Find out why the patient has not started the inhaler.
- Explain the difference between the preventer and the reliever inhaler in simple terms.
- Reassure the patient about steroid side effects at this dose, and advise rinsing their mouth after use.
- Encourage daily use, even when they feel well.
- Arrange a review to check their inhaler technique.
Candidate: Hello, Ms Silva. I'm Dr Hughes. Thanks for coming in. I understand we're here to talk about your new asthma inhalers. How have you been getting on with them?
Patient: Well, I've used the blue one, but I haven't started the brown one.
Candidate: Okay, thank you for telling me. Could you tell me a bit about what's stopped you starting the brown one?
Patient: It says it's a steroid. I've heard steroids make you put on weight.
Candidate: That's a really common worry, and I'm glad you mentioned it. Is there anything else that concerns you about it?
Patient: No, mainly that.
Candidate: Right. First I'll explain what each inhaler does, and then we can come back to the steroid question. Is that okay? The blue inhaler is a reliever. It opens your airways quickly when you're wheezy. The brown one is a preventer. It calms the swelling in your airways over time, so attacks are less likely. Does that make sense so far?
Patient: Yes, I think so.
Candidate: Good. About weight gain: that's linked to steroid tablets taken over a long time. Your inhaler uses a very small dose that goes straight to your lungs, so side effects like that are very unlikely. The main thing is to rinse your mouth with water after each use, which helps prevent a mouth infection called thrush.
Candidate: Just so I know I've explained it clearly, could you tell me when you'll use each inhaler?
| What the candidate did | Criterion it supports |
|---|---|
| Greeted the patient, gave their name and role, and confirmed the reason for the visit | Relationship-building |
| Asked what stopped the patient, and whether there was anything else | Patient's Perspective, Information-gathering |
| "First I'll explain..., and then..." | Providing Structure |
| "Reliever" and "preventer" explained without jargon, one idea at a time | Information-giving, Appropriateness of Language |
| Named the worry as common before answering it | Relationship-building, Patient's Perspective |
| Asked the patient to explain back, instead of "Do you understand?" | Information-giving |
Common mistakes in TCF Speaking
- Racing through the card. Listing every point without responding to the patient scores poorly on the clinical communication criteria.
- Talking too much. Long monologues leave no room to gather information or check understanding.
- Jargon. Words such as "hypertension" or "contraindicated" need a plain-English explanation.
- Ignoring emotion. If the patient sounds angry or anxious, acknowledge it before you move on.
- Not handling resistance. When the patient refuses, ask why before trying to persuade them.
How to practise TCF Speaking
- Practise with a timer: 3 minutes to prepare, 5 minutes to speak, and no pausing.
- Record yourself and count your open questions, your checks of understanding and how often you mention the patient's concerns.
- Practise difficult conversations too. See the role-play examples guide.
Exam Hero's AI patient runs full TCF role-plays for your profession and scores your recording on all nine criteria. Your first role-play is free in the TCF question bank.
