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Eligibility

To be eligible to sit the exam, you must:

• have passed the Divisional Written Examination
• be registered with the College (for training or interruption) by Tuesday 28 February 2023
• have 24 months FTE of certified Basic Training (PREP Basic Training program) OR completed the Consolidation phase of training (new Basic Training program) before the beginning of the clinical year in which the exam is held
• have completed all necessary training requirements as specified in the handbook
• have not exceeded the exam attempt limits and comply with all other requirements in the Progression Through Training Policy
• comply with the relevant Divisional Clinical Examination application closing date
• be fully current with all College training fees

If you have outstanding training fees, you’re ineligible to sit the exam. See College Fees Terms and Conditions.

Overseas Trained Physicians: Check eligibility requirements with your Overseas Trained Physicians Case Officer before applying.

Exam allocation

Allocation confirmation is dependent on your eligibility, fees and training requirements being up to date.

You'll receive your exam allocation email confirming the date, time and location a minimum of 6 weeks before your exam day. We aim to get this to you sooner where possible.

Contact us as soon as possible if you've worked or taken exam preparation at the venue you’ve been allocated or if there's a probability that you may know patients at the exam location.

Attempts

The 2023 exam counts toward your allowable exam attempts.

The Adult Medicine Divisional Clinical Examination Committee continues to monitor impacts on exam preparation and delivery across Australia and Aotearoa New Zealand.

Transitional arrangements

The transitional arrangements provide additional time to complete exam attempts and don't extend the time limit to complete other Basic Training requirements as set out in the Progression Through Training Policy (see Item 3). They are in place to ensure current Basic Trainees aren't disadvantaged. 

According to the Progression Through Training Policy (PDF), all training programs must be completed within the time limit for the length of the program. In March 2020, the College Education Committee approved a 12-month extension to the time limit to complete training for all trainees who started training in 2020 or earlier, in recognition of the exceptional circumstances due to COVID-19. This extension applies to the training program(s) that the trainee was registered in for the 2020 training year.

Note: Training program requirements include but are not limited to, satisfactory completion of clinical experience requirements, examinations, work-based assessments, projects, and modules.

Withdrawal

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

If you withdraw, you may be eligible for a refund. Refund amounts depend on when you withdraw.

To request a refund outside of these rules on medical and non-medical compassionate grounds, submit an application form under the Special Consideration for Assessment Policy.

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.

Contact examinations@racp.edu.au to withdraw from the 2023 exam.

Special consideration

We’ll consider circumstances before the exam, including:

• temporary or permanent/longstanding impairment (medical grounds)
• essential commitments (religious, cultural, societal or legal obligations)
• non-medical compassionate grounds or serious disruption 

Once you’ve started, only technical or other issues occurring during the exam are considered. Impaired preparation is not considered grounds for a post-examination special consideration request - candidates who believe their preparation has been impaired for any reason are advised to withdraw from the examination. Special consideration requests for a supplementary exam cannot be accepted once results have been released.

Your mark or result won’t be adjusted due to any special circumstances. For more information on application requirements and the possible outcomes, see the Special Consideration for Assessment Policy.

Submit your special consideration request by the closing date using the Special Consideration for Assessment application form and guide (PDF).

COVID considerations

• Contact us as soon as possible if you need to quarantine for COVID-19 reasons
• The Special Consideration for Assessment application form and guide (PDF) applies.

Prepare

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.

Exam format

The exam involves real patient situations in 2 x Long Cases and 4 x Short Cases.

See the exam timetables.

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

Long Case patient review

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

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

Neurological examinations

Clean disposable pins should be used for neurological examinations (for both face-to-face 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.

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

Specific instances 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.

You may sit your exam at your training hospital due to COVID-19 restrictions. Seeing familiar patients may be unavoidable. Your DPE, local exam organiser and examiners take this into consideration. You’re still assessed against the CLEAR rubric.

Exam day

Arriving at the hospital

When you arrive at the hospital:

• provide ID for the local exam assistant or invigilator to verify
• sign the Candidate Etiquette and Consent Form (PDF)

Exam timetables | Traditional format

You'll start the exam with either a Long or Short Case. This difference results in a slight variation in start and finish times.

In the traditional face-to-face format, you'll see 1 Long Case patient and 2 Short Case patients in the morning, followed by a second Long Case and another 2 Short Cases in the afternoon. The order of these cases will differ based on candidate scheduling.

Items on the day

Dress code

• wear appropriate and comfortable clothing that allows you to move freely
• you should be bare below the elbow
• scrubs are acceptable
• no suits, ties or jackets
• watches may be worn - this will be at the discretion of each individual hospital in line with local health guidelines

Personal items

• 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

Mobile phones

• mobile phones will be collected at the start of each exam cycle
• mobile phones will be returned for the lunch break and then returned at the end of the day

Equipment for your examination case

• blank paper/cards and pencils/pen (optional)
• BMI charts (optional)
• handheld visual acuity chart(s)
• stethoscope (must not be electronically augmented unless you’ve obtained permission for medical reasons)
• otoscope, standard and MacroView (optional)
• standard handheld ophthalmoscope, not a Panoptic ophthalmoscope (optional)
• red-topped hat pin or equivalent, for visual field testing
• standard auroscope (optional)
• 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 (optional)
• props such as a jar, key and shirtsleeve with button for hand function testing (optional)
• wipes to clean your equipment
• If hospitals have cases which require the candidate to complete an eye exam using an ophthalmoscope, this will be provided by the individual hospital sites.

The equipment allowed is standardised to ensure clinical signs you elicit match those obtained by the examiners. Ensure all items are single-use or wipeable.

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
• other written or electronic data-storing/sharing/recording devices

Your examination equipment 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. To maintain health and safety standards, you must perform it correctly. 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.

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).

Duration of the hand hygiene process

• handrub: 20 to 30 seconds
• handwash (if visibly soiled): 30 to 40 seconds

Moments for performing hand hygiene

1. on entering the examination room
2. before touching a patient
3. after touching a patient
4. after touching patient surroundings
5. after body fluid exposure risk – this risk rarely occurs in exams but if it does, you must use infection control appropriate for the exposure, including hand hygiene
6. after performing a procedure (unlikely to apply in exams)
7. 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

They will

• escort you to the relevant rooms during the exam
• sit in during the presentations of Short Cases
• assist with issues before or during the exam
• knock on and open the door at the end of the patient interview

They should not

• be involved in the exam in any way
• communicate with you when you’re with the examiners

You must not ask them

• to assist you with timekeeping in any interactions except patient interviews
• 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).

2023 results release schedule

The Reconsideration, review and appeals process doesn’t apply to the outcome or results. We’re unable to discuss results over the phone or by email.

Feedback

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 aren't provided to candidates. The sheets cannot be reproduced or distributed. Don't discuss this information outside of your feedback meeting. See the Academic Integrity in Training Policy.

Successful results

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

Unsuccessful results

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 (PDF)

Long Case

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

• accuracy of history
• accuracy of the clinical examinations (traditional format)
• discussion of the clinical examination (modular format)
• 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 discussion to reach a final consensus score for each case.

This video 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.