RACGP CCE Exam – 104 Reading Time

The RACGP CCE consists of 9 cases where the key points are:

  • 4 case-based discussions where you interact directly with an examiner.
    • Most of the information is given to you during the 5 minutes of reading time
    • The examiner then asks you questions and manages the time
    • The questions are delivered verbally by the examiner with ~ 5 questions of ~ 3 minutes duration
    • The conversational level is doctor -> doctor medical words require no explanations
  • 5 clinical encounters where you interact with a patient (role player) while the examiner watches.
    • Some of the information is given to you during the 5 minutes reading time
    • You are presented with 2-5 specific tasks to cover during the case
    • During the case, further information will be given by the role player if you ask for it correctly
      • The role player is highly scripted, which means they can only offer certain information and/or prompts
      • The role player has information to be given freely and
      • Information that will only be given in response to specific questioning
      • You must be able to perform a thorough history and review of systems to extract the information
    • You must manage your own time, interact with the role player, and cover the tasks
    • The conversational level is doctor <-> patient, so medical jargon must be explained or avoided
      • How much medical jargon or simplification is required depends on the patient
  • All cases are the same 20-minute length, with
    • 5 minutes of reading time.
    • 15 minutes of case time.
  • When the timer stops, examiners will allow you to finish your sentence, but nothing said after the timer has stopped will be rated.
    • The examiner is highly scripted, which means they can only offer certain information and/or prompts.
  • Everything the patient/examiner states is important.
  • You have to cover all aspects of care
  • Each case is assessed by a different examiner.

You should use the 5 minutes of reading time to prepare, and the following template will assist you. This can be filled in on an A4 sheet of paper. With DDx, you should not simply rely on Occam’s Razor but also consider Hickam’s Dictum. This is because all CCE questions have multiple problems to find and manage.

Task List (Unknown for Case-Based Discussion)Patient Problem List
The task list will typically include some of:
1) Outline your problem representation
2) Take further history
3) Explain the examination required
4) List your differential diagnosis
5) Explain the investigations required
6) Explain your management
7) Address Ideas, Concerns, and Expectations
8) Follow-up & Safety Netting
1) Patient name, age, sex, ATSI status? Rural context?
2) Problem statement and specific problems for this case ie H/T, Chol, eGFR, ACR, HbA1c
3) ATSI or Refugee -> Country, Interpreter
4) Children – Confidentiality and HEADS
5) Mandatory reporting
6) SNAP-O
7) Are immunisations up to date?
8) Other preventative ie CST, Mammogram, DEXA?
History (PRoMPF STOPI)DDx (PROMPT Model)
1) Presenting Complaint (PC)
2) Review of Systems (RoS) including Red Flags
3) Medication History (MHx) + Allergies
4) Past Medical History (PHx)
5) Family History (FHx)
6) Social History (SHx) inc SNAP-O
7)Travel and Exposure History (THx)
8) O&G and Sexual History (OHx)
9) Psychiatric History (PsychHx)
10) Immunisations & Preventive Care History (IHx)		1) Start with the 1-3 most probable diagnoses
2) Next, list red flag diagnoses that present high risk to the patient ie impending AMI, cancer, suicide
3) Next, use VINDICATED MEN to make a broad list
4) Women (10-60) are pregnant until proven otherwise
5) Pregnant women have an ectopic until proven otherwise
6) Consider psychiatric (suicide), domestic violence and OSA
7) In the CCE, patients often have multiple problems to find and manage.
Examination Investigations
1) General appearance and basic observations – T, P, BP, RR, SaO2, Height, Weight, BMI
2) Primary and Secondary Survey in trauma
3) Focussed examination rather than full…
4) Talley and O’Connor approach
5) Inspection, Palpation, Percusion, Auscultation
6) Look, Feel, Move (active and passive)
7) Psycological ABASMATT PCIR		1) Office-based tests: BSL, Urine, βhCG, ECG, Spirometry, Hearing
2) Point-of-care tests with iStat (rural locations)
3) Pathology
4) Imaging – Xray, U/S, CT, MRI, PET
5) Radiation Risk
6) Special ie Sleep Studies, FENO, DEXA
ManagementFollow Up & Safety Netting
1) Emergency – DRS ABCDEFG
2) Bad News – SPIKES
3) Non-Pharmacological – SNAP-O, 5As, FLAGS
4) Pharmacological – Prescribe, De-prescribe STOPP/START
5) C/I to certain medications i.e. COCP and MEC4
6) Gillick and Frazer
7) Procedural – Consent, Setup, Perform, Aftercare
8) Referrals
9) Medical Certificate
10) Documentation		1) ICE – Patients Ideas, Concerns and Expectations
2) Support – Psychological / Family
3) Concussion
4) Driving
5) Handouts
6) Preventative Healthcare – Immunisations, Screening, SNAP-O
7) Patient safety – suicide risk and domestic violence risk
8) Next steps
9) Safety Netting – diagnostic uncertainty
10) Documentation