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Divisional Clinical Examination

Divisional Clinical Examination

Provisional progression to Advanced Training

The 2020 Divisional Clinical Examination (DCE) has been postponed until 2021. If you were planning to sit the exam this year, you can apply for provisional Advanced Training (pAT) for either later in 2020 or in 2021 if you meet the requirements.

Find out more about pAT.

The exam assesses your clinical and interpersonal skills and clinical acumen to determine if you’ve reached the standards required to complete Basic Training.

Find out more about previous exam pass rates.

Overview
Apply
Prepare
Exam day
Results

Key dates

We'll advise new dates as soon as they've been confirmed.

Fees

Australia: AUD$2972.00
Aotearoa New Zealand: NZD$3417.80

See College Fees Terms and Conditions (PDF).

If you have outstanding fees, you’re ineligible to sit the exam unless you’ve applied to the Honorary Treasurer for special consideration.

Eligibility

To find out if you’re eligible to sit the exam:

refer to the Basic Training handbooks
view the status of your training requirements by logging into the Basic Training Portal

We’ll email you if you’re eligible to apply for the exam.

If you’re not currently in an accredited training position, register your interruption of training with the College to sit the exam.

Location

The exam is hosted across Australia and Aotearoa New Zealand and you're required to travel to a different city or state from where you reside to complete your exam.

You won’t be examined in hospitals where you’ve had training rotations.

Requirements

Australia

These requirements must be completed when you apply for the exam. You must have:

passed the Divisional Written Examination
renewed your registration as a trainee for 2020
completed all necessary training requirements
paid all College training fees

If you have outstanding fees, you won’t be eligible to sit the exam. Contact us to discuss.

Overseas Trained Physicians: Check eligibility requirements with your overseas trained physicians case officer before applying.

Aotearoa New Zealand

These requirements must be completed by 20 December 2019. You must:

have passed the Divisional Written Examination
be in an accredited training position or an approved interruption in training
complete all PREP requirements
comply with the requirements in the Progression Through Training Policy (PDF)
have paid all College training fees

If you have outstanding fees, you won’t be eligible to sit the exam. Contact us to discuss.

Overseas Trained Physicians: Check eligibility requirements with your overseas trained physicians case officer before applying.

Exam allocation

You’ll receive an exam allocation email confirming your successful registration, candidate number and venue.

This depends on your eligibility, fees and training requirements being up to date.

Withdrawal

Withdrawals are not counted as exam attempts. Contact us to withdraw up until the start of the exam. Refund rules apply.

To request a refund outside of these rules on medical or compassionate grounds, submit an application under the Special Consideration for Assessment Policy (PDF).

If you withdraw, you can re-apply to sit the exam the following year if you meet the eligibility criteria. Application fees will not be rolled over from one year to another.

Special consideration

Submit your special consideration request by the closing date. We’ll consider these circumstances before the exam:

permanent and longstanding impairment
temporary impairment with medical grounds
non-medical compassionate grounds or serious disruption
essential commitments (religious, cultural, societal or legal obligations)
probability that you may know patients at the exam location

You’ll receive an email with your exam date and venue. Contact us as soon as possible if you've worked or taken exam preparation at the venue.

Once you’ve started, only technical or other issues occurring during the exam are considered.

Your mark or result won’t be adjusted due to any special circumstances. For more information, including how to apply, see the Special Consideration for Assessment Policy (PDF).

Attempts

See the Progression Through Training Policy (PDF), effective from 1 January 2017, for limits on total training time and number of exam attempts. View your exam attempts to date on the Basic Training Portal.

Preparation tips

Regular clinical activities in your own hospital are the best preparation. In most hospitals, the Director of Physician or Paediatric Education (DPE) and other Fellows will assist you by discussing the exam and arranging Long Case and Short Case practice sessions.

We don’t endorse any commercial preparation courses.

Informal advice and general information that may also help you prepare:

Leading up to the exam

Your wellbeing

Look for ways you can better look after yourself in the lead up to your exam. Exercising, eating well and getting enough sleep are important. Some people find meditation or relaxation techniques helpful.

If you’re struggling with exam anxiety, you’re not alone. Contact the RACP Support Program for support, coaching and counselling.

Practice

One of the biggest pieces of advice we receive from trainees who have passed the exam, is the importance of practice.

For some, this means taking opportunities to receive feedback from multiple sources on short and long practice cases.

For others the quality of practice opportunities took precedence over quantity – finding the right patients and consultants, sticking to timings in presentations and asking for constructive feedback on clinical approaches and presentations.

Many trainees felt coaching on how to structure their presentations was critical to their success.

Join a study group

The shared experience of studying with others has helped many trainees feel more motivated, confident and on-track during the crucial preparation period. Many created or joined a group that was supportive, met regularly, shared resource ideas and provided an environment for constructive feedback.

Find a mentor

Trainees with mentors felt the feedback they received was effective and targeted development in key areas. Although these trainees practiced with a variety of consultants, the regular check-ins with a mentor helped to pinpoint improvements and areas for further development.

Some trainees benefit from having their mentor, a supervisor or a senior registrar sit in with them as they gather the history and examination in the long case.

If you’ve previously attempted the exam

Meet with your DPE/mentor

If you’re actively training, meet with your Director of Physician Education (DPE). If you’re on an interruption of training, meet with your mentor to talk through your previous attempts.

Your DPE/mentor is likely to have valuable insights to share about areas you need to focus on and areas to improve.

Use the Improving Performance Action Plan template and plan your study to maximise time spent on these focus areas. For example, once a week you could spend time on each area to make sure you have a thorough understanding of each topic. You could also ask your supervisor or mentor to share trial case studies and cross-reference them with the Basic Training Curriculum.

Get feedback

After an unsuccessful attempt, the Assessment and Selection team invites you to discuss your feedback sheets with a member of the NEP (Australia) or a member of the SEP or supervisor (Aotearoa New Zealand). This information is in your results letter.

Combine strategies

Combine successful strategies from past attempts with new strategies.

Tackle some tough cases in practice sessions – deliberately set up scenarios outside your comfort zone.
Videotape a few practice presentations and review with a mentor for a different approach to feedback (bearing in mind the importance of confidentiality and gaining appropriate patient consent).
Use your kit regularly to ensure you feel comfortable with these items.
If your DPE/mentor suggests a communication workshop, a presentation skills course or believes that some counselling might assist in managing exam anxiety, seriously consider these ideas.
Use technology to help organise your study. For example, there are several websites and apps available where you can create and share study flashcards.
Talk to your DPE/mentor and fellow trainees for recommendations on textbooks, other resources or general tips. You might like to include their suggestions in your own preparation plan.

Start early

Start preparing early. Consider starting before completing the Divisional Written Examination. Most successful candidates started preparing well before their examination.

Resources

The College Learning Series helps you prepare for Long Cases. It’s an interactive e-learning platform with videos and resources covering clinical topics linked to the curriculum. The Clinical Examination Series is an 8-week series of Long Case presentations.
Resources has useful learning tools and guides.
Check the Events page for lectures, videoconferences and events.
The RACP Support Program provides members with access to confidential counselling, coaching and support for workplace and personal issues. Anxiety about the exam is understandable and debriefing is helpful. All RACP members get 4 free sessions a year.

Exam format

The exam involves real patient situations in 2 x Long Cases and 4 x Short Cases. All cases are taken in one day across morning and afternoon cycles, each with 1 x Long Case and 2 x Short Cases.

See example timetables.

Long Case | 95 minutes

60 mins You’ll have 60 minutes to:

take a patient’s history
examine the patient
develop a management plan for the patient

You’ll receive medication lists and urinalysis/rectal examination results if relevant.
Check the items to include in your examination case.

10 mins You’ll have 10 minutes to
prepare your discussion points
and move to the examiners’ room.

25 mins You’ll spend 25 minutes
discussing the patient
with the team. Excessively long
case presentations are not
advisable and may be
interrupted by an examiner.

Short Case | 17 minutes

2 mins Before entering the Short Case room, you’ll have 2 minutes to read an introduction to the case (the ‘stem’), including the patient’s name, relevant body system and sometimes, the dominant clinical problem.

Each examination lasts
15 minutes. You may be asked to
comment on diagnostic tests,
for example x-rays, ECGs,
and/or nominate appropriate
investigations.

There’s a break
of up to 10 minutes
between Short Cases
in each cycle.

Case selection

While a broad range of cases are selected for the exam, it’s possible you may be asked to examine similar systems on multiple patients.

Examiners

You’ll be examined by a team of at least 2 examiners on each Long Case and Short Case. They’ll determine your score. Usually, one will lead the discussion. A third examiner may be present as an observer.

You’ll see at least 4 different teams of examiners.

Long Case patient review

Before each cycle, examiners will:

take the patient’s history
examine the patient
identify relevant issues for discussion.

This review is done without patient notes or prepared histories. This allows examiners to accurately appraise a patient’s ability to give a history and signs.

Short Case patient review

Each patient is assessed by the examiners without patient notes or prepared histories.

Conduct

Adolescent patients

It’s inappropriate for you to request patients’ parents or guardians leave the room to interview adolescent patients privately.

Neurological examinations

Clean disposable pins should be used for neurological examinations (for both Long and Short Cases). Dispose of pins appropriately.

Pre-exam contact at exam sites

In the past, some Trainees have approached hospitals to obtain exam information.

Some actions are seen as attempting to gain an advantage and may lead to disqualification from the exam and/or affect your progress through training.

These actions include attendance at practice cases or exams at your allocated hospital and attempts to:

gain information on possible cases from staff organising the exam at your allocated hospital
inspect rooms or departments possibly involved in the exam at your allocated hospital
find out who the examiners will be
contact potential examiners and seek guidance on improving performance
contact examiners after the exam except through the standard feedback procedures for failed candidates

Refer to the Academic Integrity in Training Policy (PDF).

Timetable

The exam takes an entire day. Times are confirmed in your candidate allocation email.

Example: Australian timetables

Adult Medicine | Arrive by 8:15am

	First cycle	Second cycle
Morning	1 x Long Case + 2 x Short Cases	2 x Short Cases + 1 x Long Case
Morning	8:55am to 11:20am	9:10am to 11:50am
Afternoon	2 x Short Cases + 1 x Long Case	1 x Long Case + 2 x Short Cases
Afternoon	1:50pm to 4:30pm	1:35pm to 4pm

Paediatrics & Child Health | Arrive by 8:45am

	First cycle	Second cycle
Morning	1 x Long Case + 2 x Short Cases	2 x Short Cases + 1 x Long Case
Morning	9:25am to 11:50am	9:40am to 12:20pm
Afternoon	2 x Short Cases + 1 x Long Case	1 x Long Case + 2 x Short Cases
Afternoon	2:20pm to 5pm	2:05pm to 4:30pm

You’ll get a 10-minute break between Short Cases.

While all hospitals try to adhere to the schedule, individual variations may occur.

Hospitals provide a vegetarian lunch. You can also bring your own or go out for lunch.

Example: Aotearoa New Zealand timetable

Adult Medicine + Paediatrics & Child Health | Arrive by 9am

	First cycle	Second cycle
Morning	1 x Long Case + 2 x Short Cases	2 x Short Cases + 1 x Long Case
Morning	9:20am to 11:50am	9:35am to 12:20pm
Afternoon	2 x Short Cases + 1 x Long Case	1 x Long Case + 2 x Short Cases
Afternoon	2:15pm to 5pm	2pm to 4:30pm

Most hospitals provide light refreshments. You're responsible for your own lunches unless the examining centre is remote, in which case lunch is provided.

Items on the day

Personal items

Tip: Dress in smart professional attire but don't invest in a new suit. Your clothes should be appropriate, comfortable and allow you to easily examine your patient.

printed or digital copy of your candidate allocation email
current photo ID with your full name and signature (for example, passport or driver licence) – digital IDs are not accepted
your own stationery (for example, blank manila folders, blank cards, paper, pens/pencils)
your own equipment

Equipment for your examination case

blank paper/cards and pencils/pen
BMI charts
stethoscope (must not be electronically augmented unless you’ve obtained permission for medical reasons)
standard handheld ophthalmoscope (not a Panoptic ophthalmoscope)
otoscope (standard and MacroView)
red-topped hat pin or equivalent, for visual field testing
standard auroscope
pocket torch
tape-measure and/or ruler
tendon hammer
single-use spatulas
tuning forks (128 and 256 Hz)
cotton wool
single-use neurological examination pins for testing sensation
printed picture for higher centres testing
props such as a jar, key and shirtsleeve with button for hand function testing
handheld visual acuity chart(s) (PCH only)
standard growth chart (PCH only)
toys for distraction and testing of development (PCH only)

The equipment allowed is standardised to ensure clinical signs you elicit match those obtained by the examiners.

Not permitted

Tip: Recording devices, including mobile phones, lead to automatic disqualification. Unauthorised materials may also lead to disqualification.

pre-printed/written templates or reminders, textbooks, notes, MIMS, drug compendia
references
pro-forma sheets
iPads/tablets
smartwatches
mobile phones
other written or electronic data-storing/sharing/recording devices

Your examination case may be checked. If you have an unacceptable item, declare it to the organisers. They’ll keep it until the exam is finished.

Hand hygiene

Hand hygiene is key for preventing healthcare-associated infection. It’s also essential under the Australian Health Service Safety and Quality Accreditation Scheme. See the World Health Organization’s Hand Hygiene: Why, How & When? (PDF).

To maintain health and safety standards, you must perform appropriate hand hygiene.

Hand sanitiser is provided outside or inside the patients’ rooms.

Handshaking with examiners is discouraged in the interests of time and infection control, as you would need to sanitise your hands again.

Duration of the hand hygiene process

Handrub: 20-30 seconds
Handwash (if visibly soiled): 30-40 seconds

Moments for performing hand hygiene

On entering the examination room
Before touching a patient
After touching a patient
After touching patient surroundings
After body fluid exposure risk (This risk occurs rarely in exams. If it does, you must use infection control appropriate for the exposure, including hand hygiene.)
After performing a procedure (Unlikely to apply in exams.)
On leaving the room

Note: Your examination hospital infection control policies may be different to your training site. If additional procedures beyond universal standards are required, you’ll be advised.

Examination assistants (Australia only)

They will

escort you between rooms during the exam
supply candidate identification stickers to each examination team
sit in during the presentations of both Long and Short Cases

Tip: If you need assistance, inform the examiners.

They should not

be asked to be involved in the exam in any way
communicate with you when you’re with the examiners
assist you with timekeeping during segments (e.g. giving a five-minute warning)

You must not ask them

to assist you with timekeeping
for feedback on your performance
for any details about the patients before or after the exam

Patient records

All patient records, including your own notes about patients, are confidential. You cannot reproduce or distribute them. After the exam, you must leave patient notes with the organisers for destruction. Refer to the Academic Integrity in Training Policy (PDF).

Results email

Contact us if you don’t receive the email. The Reconsideration Review and Appeals Process (PDF) doesn’t apply to the outcome or results. We’re unable to discuss results over the phone or by email.

Feedback

You’ll receive a formal results email within 4 weeks of the results email.

Examiners complete feedback sheets after each case to help candidates learn from the exam.

Feedback sheets are confidential exam material and/or patient information. All specific personal patient information is removed and case summaries are not provided. The sheets cannot be reproduced or distributed. Do not discuss this information outside of your feedback meeting. See the Academic Integrity in Training Policy (PDF).

Successful results

If you’re successful, you’ll receive copies of your feedback sheets by email.

Unsuccessful results

Australia

If you’re unsuccessful, you’ll be invited to review your feedback sheets and discuss your performance with a member of the National Examining Panel (NEP).

They’ll use the feedback sheets and their experience with the exam to help you recognise your strengths and weaknesses and advise you how to improve your performance in a future exam.

You should schedule your feedback session with your allocated NEP member shortly after you receive your results because candidate feedback is not retained indefinitely. You may want to invite your DPE and/or supervisor to join the meeting.

You’ll also get details for NEP members to contact for this feedback.

Aotearoa New Zealand

If you’re unsuccessful, you must schedule a feedback session with a supervisor or senior examiner. You can invite a support person to attend.

You’ll get your feedback sheets and discuss your experience to help you recognise your strengths and weaknesses and advise you how to improve your performance in a future exam.

Criteria for assessment of performance

Examiners assess if you display the required skills in the time allowed, based on criteria for assessment of performance. The exam is criteria referenced. You’re assessed based on the criteria rather than compared to other candidate scores.

The video below outlines the purpose and format of the exam, the purpose of Long and Short Cases and the criteria for assessment of performance.

Divisional Adult Medicine Criteria for assessment of performance
Divisional Paediatrics & Child Health Criteria for assessment of performance

Long Case

The Long Case tests clinical examination skills with an emphasis on these domains:

accuracy of history
accuracy of the clinical examinations
synthesis and prioritisation of clinical problems
understanding the impact of the illness on the patient and family
development and discussion of an appropriate management plan

Short case

The Short Case tests clinical examination skills with an emphasis on these domains:

interaction with the patient and/or family
technique and accuracy of physical examination
interpretation and synthesis of physical findings
investigations/management

Note: These criteria help you understand how examiners judge your performance. They don’t support a particular method of history-taking and examination.

Marking

Each case is marked out of 6 points.

All cases are different and some assessment domains will be more important than others for a given case. Examiners take this and your overall performance into account. They provide independent marks and discuss to reach a final consensus score for each case.

The video below outlines the process for combining case scores using the banded model approach.

Short and Long Case scores will be combined to determine your overall outcome using the Score Combination Grid (PDF).

The score combination approach ensures the outcomes are consistent with the overall purpose of the assessment, based on analysis of previous candidate performances.

It draws on expertise of experienced examiners. It’s been carefully analysed and shown to result in more valid outcomes while preserving standards consistent with the previous scoring system.

Advanced Training

If you pass the exam, you may be eligible for entry into Advanced Training.