If you are studying for the RACGP AKT KFP CCE exams or the ACRRM MCQ MiniCEX or StAMPS exams and would prefer to work smarter rather than harder, you are almost certainly at the right place. Ace your GP exams with our comprehensive AKT, KFP, CCE, MiniCEX, and StAMPS preparation guide. Boost your chances of success now!
Fundamentally, exams are not about assessing whether you are a good doctor. They are simply about assessing your ability to pass exams. Understanding exactly what is required allows you to score higher marks from exactly the same clinical knowledge and practical skills base.
The philosophical question about how best to train doctors and how then to check their initial and ongoing competency is a great after-dinner topic but will not be discussed further. What will be discussed focuses on a simple fact: you must jump through a series of hoops to become a GP. Those hoops currently look like this:
| Assessment Style | RACGP | ACRRM |
| MCQ | AKT | MCQ |
| Short Answer Questions | KFP | – |
| Clinical Exam | CCE | MiniCEX and StAMPS |
| OSCE | CE (Clinical Encounter) | Mini CEX (Workplace) |
| Q&A with Examiner Leading | CBD (Case Based Discussion) | StAMPS |
Logbooks, Multi-Source Feedback and Projects may also be required depending on your personal pathway/steam.
Time Management
You do not run out of time on an exam. You mismanage exactly the same time everyone else had. So don’t do that. You can not score marks for questions you have not answered, and yet, on every exam cycle, the examiners note some candidates did not finish the paper.
Before you sit an exam, you should know how many questions are on it, how long it is, and, therefore, where you should be at any given time. For example, the RACGP AKT MCQ is 150 questions in a 4-hour timeframe.
- 10 questions per 15 minutes
- 40 questions at the end of the 1st hour
- 80 questions at the end of the 2nd hour
- 120 questions at the end of the 3rd hour
- 150 questions done with 15 minutes to spare
Before any exam, take a couple of minutes to learn the cadence required to finish on time. That way, if you are running behind schedule, you know you need to speed up, and conversely, if you are ahead of schedule, you can afford the time to get up, stretch your legs, walk to the toilet, and empty your bladder. 4 hours is a long time to hold your water, and it’s hard to fully concentrate on the next question if you are physically uncomfortable. Know the cadence. Don’t ever run out of time and leave (almost) free marks on the table.
You can not score marks for questions you have not answered.
The MCQs
MCQ exams provide the colleges with an opportunity to test the breadth of your knowledge. The carpentry adage to measure twice, cut once speaks to the exam mantra – read the question (twice), then answer the exact question asked once.
There are a range of common errors to avoid:
- Running out of time and, therefore, not providing an answer.
- Knowing the correct answer but physically shading the wrong box/circle.
- Knowing the right answer but failing to read the question carefully enough, ie not answering the question asked.
- Not considering the fact that while the first answer you see may be correct(ish), one of the following answers may be more correct (i.e. jumping to conclusions).
- Following advice to leave problem questions until later!
- Quite frankly, this is a terrible idea for a whole range of reasons, including:
- If you don’t know now, you are unlikely to know < 4 hours later.
- If you leave an exam full of unanswered questions, you increase the possibility of not answering questions because you have run out of time and never got back to them
- It takes just as long to read the question the first time as it does the second, so you have just added an extra question to the exam and thrown your time management plan out the window.
- Do that 10 times on the AKT, and the schedule above says you will run out of time.
- You apply unnecessary stress to yourself and may not be putting 100% focus on the current question because you continue to think about the unanswered question(s).
- Quite frankly, this is a terrible idea for a whole range of reasons, including:
- Not using exclusion to make a high-probability guess from the remaining possibilities.
- You will always be able to exclude some answer options, so do that, guess from the remaining possibilities (usually only 2 or 3) and accept that the law of statistics says you will gain 1/2 or 1/3 of a mark from all the questions you reduce down to an educated guess.
- There is no negative marking, so not shading a circle is a waste of fractional marks.
- If you do not do this, it is entirely possible you not only fail to grab the 1/3-1/2 mark on offer for this question but also fail to grab whole marks from questions you do know the answer to but don’t have time to focus on properly.
- Exclude, guess, answer, move on.
- The other 149 questions need your full and undivided attention.
- You will always be able to exclude some answer options, so do that, guess from the remaining possibilities (usually only 2 or 3) and accept that the law of statistics says you will gain 1/2 or 1/3 of a mark from all the questions you reduce down to an educated guess.
The exam section covers a range of other tips and tricks, including examiner comments on what candidates did wrong, which ultimately inform the top ten tips for improving your AKT exam performance.
The KFP
The KFP has a well-earned reputation for being a hard exam. It has the lowest pass rate of any of the RACGP exams. It is a 26-case exam with several questions per case, where, for each question, the requested number of answers are each written on a single line. Questions also include an MCQ style shade the circle(s) component, usually related to selecting the best X answers from a long list of possible investigations. It is a unique exam with some interesting quirks, such as candidates being marked down for both too much detail and not enough detail.
Undercoding
Providing insufficient detail is called undercoding and is penalised. For example, if asked for a diagnosis, an answer of “diabetes” might score 0, “type 2 diabetes” score 1, and only “type 2 diabetes secondary to metabolic syndrome” yield the full 2 marks on offer.
Overcoding
Providing too much detail is called overcoding, and each time you do it, 0.25% is subtracted from your final mark. If your answer includes commas, the words “and”, “or”, and the symbol “/”, you may be overcoming.
For example, while RICE (Rest, Ice, Compression, Elevation) is a perfectly reasonable answer for acute management of a sprained ankle, you should know that RICE never scores marks, and, if written on one line is overcoding x 3. On that, writing SNAP-O (Smoking, Nutrition, Alcohol, Physical Exercise, Obesity) never scores marks either, and if, for example, “Physical Exercise” is a correct answer, that would be a 1 mark answer compared to an answer of “30 minutes of moderate-intensity exercise 5 days a week” which would yield the full 2 marks on offer.
Note that in the clinical exams, RICE and SNAP-O may represent entirely appropriate management, but you will expand each item as part of your holistic patient-centred management plan.
Grouping
Providing multiple valid options from the same pathophysiological or pharmaceutical class is called grouping and will reduce your marks. For example, if asked to provide 4 first-line drugs for the treatment of hypertension, list one each of an ACEI, ARB, CCB and Thiazide because if you list:
- 4 ACEIs, you will get 1 mark,
- 2 ACEIs and 2 ARBs will get you 2 marks,
- 2 ACEIs, 1 ARB and a Thiazide will get you 3 marks and only
- One drug from each of the 4 groups will yield the full 4 marks
Zeroing
Candidates who offer a dangerous answer may attract a zero score. A dangerous answer would include responses that place the patient at risk of imminent harm. In recognition of the risk posed to the patient, the entire question (but not the case) would score zero marks.
In the public exam reports, the examiners offer the same generic advice every cycle:
- Candidates must answer the question in the context of the clinical scenario, using all the information provided. The information will be relevant to consider in response to each question and will impact answers because it may provide information that could significantly impact investigations or management.
- It is important to ensure that the answers provided are relevant to the key features of the case presentation, including the age, gender, comorbidities and other information provided.
- Provide only the number of answers requested; providing additional answers increases the risk of overcoding.
- Do not provide examples unless requested.
- Be specific in answers. Non-specific answers may not score or could attract fewer marks.
- Ensure that the answers provided are appropriate to, and address the severity and acuity of, illness within the case presentation, as well as the location of the patient encounter.
- Because the cases are all developed in line with current guidelines, it is important that candidates are aware of current clinical guidelines relevant to the provision of primary care at the Fellowship level.
- Candidates should access the practice exams provided and use the RACGP assessment resources, such as the exam support online modules accessed via gplearning.
- From 2023.2 onwards there will be no drug doses required within the KFP, although candidates may still be required to provide route of administration or frequency of administration.
The exam section covers a range of other tips and tricks, including examiner comments on what candidates did wrong, which ultimately inform the top ten tips for improving your KFP exam performance.
The Clinical Exams
For about a decade, I had the dubious honour of being invited to be an OSCE examiner for the local Medical School. When I went through medical school, OSCE exams were not used, so it was interesting to see both the fake patient format and the marking key in action. While the marking keys varied with the case, they fundamentally consisted of tick boxes. When clearly competent students failed to demonstrate the skill required for me, as the examiner, to tick the box, I could not tick the box.
Here is an example I found published online where the first station task is to examine the cranial nerves.
As you can see, the marks live in 2 areas – a general process/structure section with six marks and then 1 mark for examining each of the 12 cranial nerves. There is also a section called “Approach to patient”, where the U S E letters are shorthand for Unsatisfactory, Satisfactory and Exceeds. Finally, there is a global score about the examiner’s impression of whether the student performed above or below the expected standard, and if below a 14/20 grade, there is room for comments about that. The cut mark largely relates to the marks of candidates who are consistently judged borderline.
More is missed by not looking than not knowing
Professor Thomas McCrae (1870-1935) was a student and later colleague of Sir William Osler.
The RACGP has a somewhat formulaic approach to clinical encounters:
We discuss practical consultation tips including adequate preparation and ‘housekeeping’, use of silence, appropriate use of expressive touch, strategic use of the computer, appropriate examination, strategies to manage uncertainty, adequate explanation of the problem, shared decision-making, comprehensive follow-up and safety netting, time management, and asking about ideas, concerns and expectations.
Starting off in general practice – consultation skill tips for new GP registrars – RACGP Australian Family Physician
Practice Exams
In medical school, you may have been one of those people who, for example, did a lot of practice exams. That strategy is less likely to be helpful with GP Fellowship exams because, with a topic so broad, the questions are more or less endless. In addition, changing guidelines and a lack of high-quality, up-to-date questions that have answers related to the Australian GP context make this a relatively low-yield endeavour.
That said, practice exams do have a role. It’s simply that their role is not a big one, with the exception of the Clinical Exams where there is a need to practice you delivery so as to cover off on all the necessary details in the 15 minute time allocation.
In 1999, psychology researchers David Dunning and Justin Kruger published a study titled “Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments”, in which they described our tendency to hold overly favourable views of our abilities. One benefit of practice exams might be impartially identifying your personal knowledge gaps in the unlikely event you can’t. It is a distinct possibility you don’t know what you don’t know unless you perform a ruthless analysis.
Another benefit of doing a practice exam is to familiarise yourself with the format, the question style, and the time frame so that you understand the cadence required to stay on pace and get the job finished on time.
RACGP data notes candidates who do the practice AKT/KFP exams have 20-37% higher pass rates. To be precise, for the RACGP 2021.1 AKT, the pass rates looked like this:
| Exam Cycle | Pass Rate – Did Practice Exam | Pass- Rate – No Practice Exam | Percentage Gain |
| 2020.1 | 81% | 61% | +20% |
| 2019.2 | 83% | 56% | +27% |
| 2019.1 | 70% | 36% | +34% |
| 2018.2 | 70% | 40% | +30% |
| 2018.1 | 80% | 50% | +30% |
| 2017.2 | 73% | 36% | +37% |
| 2017.1 | 71% | 39% | +32% |
| 2016.2 | 71% | 42% | +29% |
| 2016.1 | 67% | 33% | +34% |
For some reason, the RACGP stopped publishing this data after the 2020.1 cycle. While we can speculate as to why this trend exists, exist it does, so let’s simply jump to the take-home point.
Do the practice exams!
Success rates for candidates who do this are 20-37% higher.
RACGP Public Exam Reports
For candidates undergoing the RACGP exams, the data suggests you should solidly focus on doing what is required to pass the KFP because only 1% of candidates who pass the KFP fail the AKT. In the 2023.1 cycle, we can see the pass/fail correlations.
| AKT Result | KFP Result | Number | Percentage |
| Pass | Pass | 501 | 68.4% |
| Pass | Fail | 135 | 18.4% |
| Fail | Pass | 7 | 1.0% |
| Fail | Fail | 89 | 12.1% |
| Total | 732 | 100% |
If you pass the KFP, there is a 99% chance you will pass the AKT. Look after the KFP, and the AKT will look after itself.
Closing Thoughts
As shown below, there is a general trend suggesting that candidate success diminishes with each subsequent exam attempt. While the data below was extracted from the RACGP 2023.1 KFP Public Exam Report, this trend applies to all the other GP exams, so it makes sense to give it your best shot the first time around.
| Attempts | Pass Rate (%) |
| First attempt | 78.0% |
| Second attempt | 34.8% |
| Third attempt | 21.4% |
| Fourth and subsequent attempts | 16.7% |