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Understanding the Importance of Linking and Time Referencing


In this quick guide, we will explore the essential elements of linking and time referencing in OET writing.

Linking and time referencing are highly significant in OET writing. They help the reader  understand when events occurred and how they are connected. as well as guiding the reader through the patient’s story.

Let’s look at some examples.

Adding information: In addition, Additionally, In addition to

  • In addition and Additionally are followed by a comma and go at the start of a sentence. For example:

In addition, the patient is able to mobilise unaided.

  • in addition to often goes in the middle of a sentence and doesn’t have commas, it’s followed by a noun or a verb with -ing. For example:

He was administered antibiotics in addition to IV fluids
He was administered antibiotics in addition to having IV fluids

Comparing and contrasting: However

  • However is a common contrasting linker used at the beginning of a sentence followed by a comma, or within a sentence. For example:

He has had several chemotherapy sessions which have reduced tumour size. However, he is not yet in remission.
The chemotherapy has reduced tumour size, however, the patient is not yet in remission.

Remember to only use it when there is a genuine contrast expressed in the case notes.

Expressing results or cause and effect: as a result of, due to

  • Expressions like as a result of and due to indicate the outcome of an action or the cause-and-effect relationship, they’re usually followed by a noun or the -ing form of a verb. For example:
    Her recovery has been slow due to
    He has made good progress as a result of working hard in physio sessions.

Timing sequencing: Currently, Prior to/After the operation, On admission

  • Currently (meaning now) can go before or after the verb. For example:

    Currently, he is able to mobilise with a walking frame.
    He is currently able to mobilise with a walking frame.

Expressions like on admission, prior to the operation and after the operation are typically placed at the beginning of sentences followed by a comma. For example:

On admission, she was experiencing shortness of breath.
Prior to the operation, he was in significant pain.

Note that you can put these at the end of a sentence (without a comma) but it is signposts the time more clearly when you use it at the beginning of a sentence.

She was experiencing shortness of breath on admission.
He was in significant pain prior to the operation.

More advanced linking expressions

There are other linking expressions that you can use, however, make sure that you know how to use them correctly.

Despite the fact that (contrast)
This expression is followed by a clause (a complete sentence with a subject and a verb). For example,

He denies he is underweight despite the fact that he only weighs 51 kilograms.

Despite (contrast)
You can use despite followed by the -ing or noun form. For example,

He denies he is underweight despite weighing only 51 kilograms.
Her condition has not improved despite intensive treatment.

For which (cause/effect)
You  can use for which to show cause or effect, for example when connecting a medication to a specific medical condition.

She presented with a  UTI for which antibiotics were prescribed.

What to avoid

Remember to use the linking expressions that you’re confident with. For example, if you’re not confident in using despite, use but.

He denies that he is underweight but he only weighs 51 kilograms.

Avoid overly academic connectors like moreover and overly informal expressions like besides or so. These aren’t appropriate for OET letters.

Putting it into practice

Now let’s apply what we’ve learned. Read an extract from a sample letter and decide which linkers you would use to complete it.  You’ll find the answers at the end of this article.

I’m writing regarding Mrs. Smith who was admitted to a hospital on 04/02/2023 with a fractured femur (1) _________  a fall. She underwent an open reduction internal fixation (ORIF) and is now ready to be discharged back into your care. (2) __________  the operation, Mrs. Smith was administered antibiotics and analgesics. Alternate staples have been removed and the wound is clean and dry. (3) __________ , the wound will need to be monitored to ensure it continues to heal. The remaining staples need to be removed on 12/02/2023 (4) __________ the wound can stay exposed. Paracetamol can be given for the pain as needed. (5) __________ , Mrs. Smith needs help mobilising. (6) __________ , she requires full assistance for her ADLs.

Top tips

  • Study sample letters and notice how ideas are linked together.
  • Practise writing example sentences using various linking expressions so you get used to using them.

Using linking expressions correctly will improve the accuracy of your communication skills and help you excel in the OET writing test.

Have a look at our video where  SLC’s  OET Jo explains linking expressions:

For more comprehensive guidance on OET writing, including advanced strategies and in-depth techniques, why not enrol on an SLC preparation course?


  1. as a result of / due to
  2. After
  3. However
  4. After which
  5. Currently
  6. In addition
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