RACGP CCE Exam – Exam Reports

The following is a summary of the RACGP CCE Public Exam Reports (and RCE). I strongly encourage you to read all the RACGP CCE Public Exam Reports, as they give specific guidance as to what is required and what the common pitfalls are.

The CCE assesses how candidates apply their knowledge and clinical reasoning skills when presented with a range of common clinical scenarios. It allows candidates to demonstrate their competence in a range of clinical situations and contexts.

Each case assesses multiple competencies, each of which comprises multiple criteria describing the performance expected at the point of Fellowship.

Examiners rate each candidate’s performance in relation to the competencies being assessed in the context of each case. Ratings are recorded on a four-point Likert scale, ranging from ‘competency not demonstrated’ to ‘competency fully demonstrated’.

The CCE is designed as a summative measure of competency. It is not designed to give candidates feedback, and as such, examiners do not comment on individual candidate performance; examiners rate performance based on the demonstration of competencies.

Each case assessed an average of 12 criteria. Competencies are assessed multiple times over the exam, and some are assessed more frequently. Examiners are surveyed on exam day to identify candidate performance characteristics demonstrating competency and the common pitfalls observed.

Candidate Clinical Performance: General Comments

Successful candidates demonstrate an empathic and non-biased approach to patient management, taking into consideration the patient’s context.

General stereotyping and making assumptions are inappropriate and demonstrate a lack of understanding of the patient context. Competent candidates should demonstrate a nonjudgemental approach to all patients.

Other common pitfalls included formulaic responses that used a scattergun approach in answering the question. This does not demonstrate clinical reasoning ability or understanding of individual patient context and needs. Assumptions and formulaic responses to specific cultural groups, for example, without considering individual circumstances, might lead to incorrect conclusions.

Reflecting on areas of practice with which a candidate might be less familiar and addressing these gaps is helpful in exam preparation. In some stations, examiners could clearly see that candidates had not previously managed a certain type of presentation in practice. This leads to a formulaic rather than patient-centred approach.

A structured and systematic approach will assist candidates in encompassing important potential diagnoses that guide their history, examination, investigations, and management.

Process: General Comments

Most candidates engaged well with the process and had a smooth examination experience. However, a small number of candidates had not tested their technology and arrived at the exam without adequate audio and camera functionality. The RACGP information technology team, administrators, and examiners supported those candidates in progressing through the examination, but pre-exam preparation would have ensured a better experience for them.

This is a reminder that, if needed, candidates should use the ‘ask for help’ (NOT the raise hand function) button in Zoom to alert the administrator to a problem and not leave the exam until speaking with an administrator if they have encountered a technology-related problem.

A small number of candidates appeared to be unfamiliar with the functionality of the Zoom platform and were, therefore, less prepared to manage on-screen documents. Candidates should practise resizing documents and obtaining a gallery view in Zoom, which allows for resizing the shared document and face tiles. Additionally, some candidates experienced slow internet connections that affected their connectivity to the exam. The likelihood of this occurring can be reduced by testing internet speed prior to the exam. Refer to the CCE candidate technical guidelines for more information.

Preparation is key to a smooth experience. We encourage all candidates to optimise their examination environment and tools when preparing to sit the CCE.

How Candidates Demonstrate Competency

  1. Communication and Consultation Skills: Candidates showcased exceptional ability in not just listening but actively engaging with patients, demonstrating empathy, and providing clear, empathetic explanations of medical conditions and treatments. This included adapting their communication styles to suit different patient needs, effectively managing difficult conversations, and facilitating shared decision-making.
  2. Clinical Information Gathering and Interpretation: Proficiency was noted in conducting thorough and systematic history-taking and physical examinations. Candidates were able to elicit key information, understand its relevance, and use it to guide their clinical thinking, differentiating between significant and incidental findings to focus their diagnostic reasoning.
  3. Making a Diagnosis, Decision Making, and Reasoning: Successful candidates demonstrated strong analytical skills, employing a logical approach to narrow down differential diagnoses. They used evidence-based investigations strategically, interpreting results accurately to confirm or refute their clinical suspicions, and made informed decisions on patient management.
  4. Clinical Management and Therapeutic Reasoning: Highlighted was their ability to develop comprehensive, holistic management plans that integrated current best practices and guidelines. They considered the patient’s context, preferences, and overall health in their therapeutic choices, ensuring plans were realistic and sustainable.
  5. Preventive and Population Health: Candidates excelled in integrating preventive health measures into their clinical practice, offering tailored advice on lifestyle modifications, and appropriately utilizing screening tests based on patient risk factors. This demonstrated an understanding of the role of primary prevention and early detection in improving long-term health outcomes.
  6. Professionalism: Demonstrated professionalism encompassed ethical practice, including maintaining patient confidentiality, obtaining informed consent, and treating patients with respect and dignity. Candidates showed a commitment to ethical principles and the welfare of their patients, navigating complex ethical dilemmas with sensitivity.
  7. General Practice Systems and Regulatory Requirements: Candidates displayed a comprehensive understanding of the healthcare system, including referral pathways, the appropriate use of healthcare resources, and adherence to clinical guidelines and regulatory requirements. They effectively navigated system complexities to optimize patient care.
  8. Procedural Skills: Exhibited competency in performing or explaining common procedures relevant to general practice. They demonstrated technical proficiency, safety awareness, and the ability to communicate procedural aspects, including risks and benefits, ensuring patient understanding and consent.
  9. Managing Uncertainty: Effective management of clinical uncertainty was a key competency, with candidates demonstrating the ability to articulate uncertainty to patients, use a cautious approach in investigations, and make provisional plans while awaiting further information, maintaining patient safety and trust.
  10. Identifying and Managing the Seriously Ill Patient: Rapid identification and appropriate response to signs of serious illness were critical competencies. This included prioritizing urgent care, initiating stabilizing treatments, and facilitating timely referrals or emergency care when necessary.
  11. Aboriginal and Torres Strait Islander Health: Candidates showed sensitivity to cultural differences, employing culturally appropriate communication strategies and understanding the importance of holistic approaches to health that incorporate physical, emotional, and spiritual well-being. They also reflected respect for Indigenous health perspectives.
  12. Rural Health: An appreciation for the unique challenges of rural health care was evident, including logistical issues of distance and resource availability. Candidates demonstrated adaptability in their management plans and utilized telehealth effectively, understanding the importance of accessibility in rural settings.

Common Pitfalls

  1. Communication and Consultation Skills: Some candidates failed to establish a rapport with patients, used complex medical jargon without ensuring patient understanding, or did not adequately address patient concerns and preferences, impacting the effectiveness of consultations.
  2. Clinical Information Gathering and Interpretation: Inadequate history-taking or physical examination techniques led to missed or incorrect diagnoses. Some candidates failed to appreciate the significance of specific findings, which impacted their clinical decision-making.
  3. Making a Diagnosis, Decision Making, and Reasoning: A notable pitfall was the reliance on unnecessary or inappropriate investigations, which reflected a lack of critical thinking or overreliance on diagnostic tests rather than clinical judgment.
  4. Clinical Management and Therapeutic Reasoning: Management plans sometimes lacked consideration of the patient’s lifestyle, preferences, or ability to adhere to treatment recommendations, leading to suboptimal care outcomes.
  5. Preventive and Population Health: Opportunities for preventive care or health promotion were often missed, including failing to recommend appropriate screening tests or lifestyle interventions relevant to the patient’s health risks.
  6. Professionalism: Challenges included handling ethical dilemmas inadequately, breaches in patient confidentiality, or instances of cultural insensitivity, undermining patient trust and professional integrity.
  7. General Practice Systems and Regulatory Requirements: Some candidates showed limited knowledge of healthcare systems, which led to inefficient resource use or failure to follow up on patient care effectively.
  8. Procedural Skills: Lack of confidence or skill in explaining or performing basic procedures or failing to obtain proper consent was a common shortfall, affecting patient safety and care quality.
  9. Managing Uncertainty: Difficulty in articulating or managing clinical uncertainty led to overtesting or overtreatment, reflecting a discomfort with not having immediate answers.
  10. Identifying and Managing the Seriously Ill Patient: Delays in recognizing signs of critical illness or initiating appropriate emergency responses were critical pitfalls, potentially compromising patient outcomes.
  11. Aboriginal and Torres Strait Islander Health: Insufficient cultural competence and stereotyping affected the quality of care and patient relationships, indicating a need for greater cultural awareness and sensitivity.
  12. Rural Health: Underestimating the impact of geographical and resource limitations on patient care in rural settings led to unrealistic management plans, underscoring the need for greater awareness of rural health challenges.

Please see the RACGP CCE Exam Technique page for some analysis of where the marks are to be lost/found.