What examiners listen for - not what they read

Many candidates assume that examiners will infer their reasoning from context. They believe that if they take the correct actions, their thinking will be obvious. In high-stakes clinical exams, this assumption is unsafe.

Examiners are trained to assess observable performance. They do not infer intention, insight or reasoning unless it is spoken clearly and explicitly.

“Examiners can only mark what they hear. Unspoken reasoning does not score.” - A/Prof George Eskander

Why silence loses marks

Silence is not interpreted as efficiency. It is interpreted as omission. When candidates fail to verbalise their reasoning, examiners cannot award marks for:

• risk assessment
• clinical prioritisation
• justification of decisions
• safety-netting
• escalation planning

Even when the final management decision is correct, marks are lost if the reasoning pathway is not spoken aloud.

What examiners are actively listening for

During clinical assessments, examiners listen for:

• recognition of red flags
• clear sequencing of management
• explicit discussion of risk
• justification for investigations or referrals
• clear safety-netting instructions

These elements reassure examiners that the candidate’s practice is safe, reproducible and defensible.

Why clarity matters more than fluency

Fluent communication without structure often scores poorly. Examiners prioritise clarity, safety and organisation over conversational polish. Short, structured statements score more reliably than long explanations that wander.

Candidates who verbalise their reasoning deliberately give examiners confidence in their clinical judgment.

Conclusion

Exams reward what is spoken, not what is assumed. Candidates who consistently verbalise their reasoning transform internal knowledge into examinable performance and score more reliably.

Reference
Norman G. Research in clinical reasoning: history and current trends. Medical Education. 2005.