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.
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 the RACGP KFP there are 26 questions in a 4-hour timeframe. It has a slightly awkward optimal cadence of around 8.5 minutes per question (7 questions per hour). Consider:
- 2 questions per 15 minutes
- 8 questions at the end of the 1st hour
- 16 questions at the end of the 2nd hour
- 24 questions at the end of the 3rd hour
- 26 questions done with 45 minutes to spare
Compare this to:
- 2 questions per 20 minutes
- 6 questions at the end of the 1st hour
- 12 questions at the end of the 2nd hour
- 18 questions at the end of the 3rd hour
- 24 questions done but 2 questions left unanswered at the end
So, the optimal cadence is something like one question per 8.5 minutes resulting in:
- 7 questions at the end of the 1st hour
- 14 questions at the end of the 2nd hour
- 21 questions at the end of the 3rd hour
- 26 questions done with 17 minutes left to spare at the end
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 KFP has Special Needs
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 overcoding. 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
The following quote is from an RACGP KFP practice exam marking key:
In the marking grids, you will find some answers are “grouped”. Grouping is a tool used in the marking process to ‘group together’ similar responses and awards higher marks to the most specific response. It prevents repeated responses within the same ‘group’ from accumulating marks.
In the example below, answers B, C, and D have been placed in Group 1. Candidates will only be awarded marks for one answer given within this set. For each group set, only the most valuable answer provided contributes towards the point-score of the
question. If a candidate answers B and C, they will only receive 3 marks. If a candidate answers C and D, they will only receive 2 marks.A. Brief duration of pain, lasting a few seconds to minutes (Score: 1)
B. Trigger point in the distribution of the nerve (Score: 3; Group: 1; Group Score: 3)
C. Trigger point in the distribution of pain (Score: 2; Group: 1; Group Score: 3)
D. Trigger point (area not specified) (Score: 1; Group: 1; Group Score: 3)
E. Pain triggered by chewing, cold, brushing teeth, shaving etc. (Score: 2)
F. No sensory and/or motor loss in area of pain (Score: 1)Note that any additional responses provided by the candidates for the question that fall outside of this group set may score additional marks. [Comment: so B and E will score 5]
RACGP
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.
Public Exam Report Comments
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.