Problem: correct paragraphs can still read like stacked boxes — each true, none connected. Answer in brief: cohesion is a small toolkit (reference chains, logical linkers, parallel structure) applied inside the standard referral skeleton. This guide teaches the toolkit on a COPD-exacerbation referral, and OET Writing for Doctors — Course 4 trains organisation and cohesion across 15 topic sections with mock tests.
The standard skeleton, briefly
Purpose, background, today, request — the shape from the earlier courses, assumed here. Organisation marks how paragraphs connect, not just how they stack. A skeleton gives positions; cohesion gives movement. The course this article supports makes that distinction its subject, with 15 topic sections on paragraphs, cohesion and full practice letters.
The cohesion toolkit: reference, linkers, parallels
Reference chains: name the patient once, then “he/his”; name a condition once, then “this exacerbation”, “the infection”. Chains tell the reader what each sentence is about without repetition. Logical linkers: one per boundary, meaning what it says — “however” for contrast, “as a result” for consequence, “in addition” only for genuine addition. Parallel structure: list findings the same way (“afebrile, saturating 94% on air, chest clear”) so the eye groups them. Three devices, used sparingly, beat twelve connectors sprayed per sentence.
See the toolkit drilled on full letters? The complete OET Writing for Doctors — Course 4 teaches organisation paragraph by paragraph, with the COPD-exacerbation practice letter, the standard skeleton and 5 mock tests. Explore the course →
Worked letter: COPD exacerbation referral
Fictional case, newly written: Mrs Okafor, 68, known COPD (FEV1 42% predicted), three-day worsening breathlessness with purulent sputum; saturating 91% on air, afebrile; started on prednisolone and doxycycline; frequent exacerbator — three courses of steroids this year.
Cohesion in action: “Mrs Okafor” becomes “she” after paragraph 1; “this exacerbation” links back to the three-day history; “as a result” connects hypoxia to the referral (not decoration — consequence); parallel findings group (“saturating 91% on air, respiratory rate 24, chest with widespread wheeze”). Request: “I would appreciate respiratory review with a view to a self-management and pulmonary-rehabilitation plan; she has been safety-netted for emergency care if breathlessness worsens.” Roughly 180 words; every paragraph hands the next one its subject.
Four cohesion mistakes
- Full-name repetition. “Mr X… Mr X… Mr X” in every paragraph. Fix: pronoun chains after first mention.
- Linker stacking. “However, moreover, furthermore” in sequence. Fix: one linker per boundary, correctly meant.
- New-subject openings. Each paragraph starts on a fresh topic. Fix: open paragraphs 2–4 by echoing paragraph 1’s subjects.
- Request disconnected. The ask introduces new facts. Fix: the request paragraph contains zero new information — only decisions.
FAQs
How many linkers should a letter contain?
Five to seven, each earning its place. More than that usually signals stacking; fewer with strong reference chains can still cohere well.
Are pronouns safe in a formal letter?
Yes — “he/she” after a named first mention is standard professional style and demonstrates control. Ambiguity is the only danger: with two patients or mixed genders, re-name.
What does the course include?
Fifteen topic sections on organisation, paragraphs and cohesion, the standard referral skeleton, the COPD-exacerbation practice letter and 5 complete mock tests.
The matching course
OET Writing for Doctors — Course 4 is the organisation course: paragraphs with jobs, cohesion devices that connect them, the standard referral skeleton and full practice including the COPD-exacerbation letter — 15 topic sections with 5 mock tests. If your letters list facts but do not flow, train here.
Sources and note
- OET Writing format per the official OET site: oet.com — Writing. Check current format guidance before the exam.
- Course details verified from its public staging page (read-only): 15 topic sections, cohesion and skeleton training, 5 mock tests.
- Case and letter lines are newly written and fictional; other valid structures exist.
Put this into practice
Compare these course outlines and choose the practice that matches your next goal.
