How the RACGP CCE Is Marked: Domains, Criteria and Performance Tips

The RACGP CCE marking criteria are built around clarity, consistency, and competency. These criteria map to 12 clinical competencies that the CCE assesses within the broader curriculum framework of 5 curriculum domains and 13 high level core skills [1] [2] [3] Every one of the 9 cases you will face is carefully designed to test selected combinations of these competencies[4] .

In the first few moments of any station, examiners are already assessing how you engage, how you think, and how you communicate. The exam is not simply a test of memory. It is a structured assessment of the way you practise general medicine in real time.

Here are the core domains:

Examiners observe how you communicate as a professional, including your ability to respond to emotion, build rapport, explain ideas clearly, and explore ICE. The question is not whether you sound polished. The real measure is whether you sound safe, empathetic, and patient centred.

Strong communication in the CCE includes:

• Using clear language without jargon
• Demonstrating empathy early
• Validating patient feelings
• Exploring cultural or contextual needs
• Responding to emotional cues immediately

This must be paired with cultural sensitivity, particularly when consulting with Aboriginal and Torres Strait Islander patients. The competency list for the CCE includes items such as Communication and consultation skills, Managing uncertainty, Aboriginal and Torres Strait Islander health, and Rural health, which are explicitly enumerated in RACGP’s CCE competency pages[2]..

This domain evaluates how you gather information, interpret findings, and make diagnostic and management decisions. Examiners expect structured thought and clear logic. You will be assessed on your ability to:

• Prioritise the most relevant differentials
• Justify investigations and management steps
• Apply guidelines appropriately
• Explain your reasoning clearly

Every case is rated with a 4 point Likert scale ranging from “competency not demonstrated” to “competency fully demonstrated,” and examiners also provide a global rating on a 5 point scale that contributes to the borderline regression score used for awarding pass or fail[5] [6] . These criteria ensure the exam reflects real general practice and identifies whether you are ready for independent Fellowship level care.

Safe practice is the backbone of the RACGP CCE. Examiners frequently state that clarity, structure, and safety matter more than perfection. You have 10 to 15 minutes for each case, with 5 minutes of pre case reading, to demonstrate that your practice is dependable, reproducible, and centred on patient wellbeing[4]. The CCE is currently delivered online via Zoom, with remote delivery processes and technical requirements detailed in the RACGP technical guide and CCE webpage[1] [4] .

Here is what examiners specifically look for:

You must demonstrate that you recognise urgent concerns quickly. This includes identifying red flags immediately and structuring your consultation around them.

Safety netting is not optional. It is one of the most consistent marking expectations across all cases.

Examiners expect clear statements such as:

• “If your symptoms worsen overnight, please go to the emergency department.”
• “If this medication does not improve your symptoms in 48 hours, I would like to review you.”

Follow up plans show examiners that you understand continuity of care. Examples include:

• Scheduling a review within a specific timeframe
• Arranging repeat blood tests
• Advising the patient when and how results will be communicated

Confirming patient understanding is a simple but highly effective way to demonstrate safe practice. Good communication prevents errors.

Safe practice is not about cramming everything into the station. It is about demonstrating that you make safe, patient centred decisions consistently under time pressure. For additional practical techniques, see our CCE communication checklist for phrasing and sequencing tips.

Diagnostic reasoning must be spoken clearly. Examiners assess your internal logic by listening to what you say, not by guessing what you might be thinking. This is one of the most important skills in the CCE, and it is directly assessed within the Diagnosis, decision making and reasoning competency [2][6].

Examiners do not want a theatrical monologue. They want structured clinical reasoning articulated in simple language. When you verbalise your thought process, you allow examiners to score the clinical reasoning domain accurately.

Effective ways to demonstrate reasoning

• Clearly state the differential diagnoses
• Explain why each diagnosis is likely or unlikely
• Justify investigations with clear, guideline based reasoning
• Explain medication choices with brief rationale

For example:

“Given your age and chest pain, cardiac causes must be prioritised. I would order an electrocardiogram because it helps identify ischaemic changes.”

Avoid scattergun reasoning. The scattergun approach often looks like a panicked list of tests and diagnoses. Examiners see this frequently and score it poorly. They prefer:

• Clear structure
• Logical sequencing
• Relevance to the presenting complaint
• When you show your reasoning deliberately, carefully, and consistently, examiners recognise your competence immediately[5][6].

Uncertainty is part of general practice. The RACGP CCE examines how you respond when a diagnosis is not clear. Your ability to manage uncertainty using structured communication and safety netting is essential, and Managing uncertainty is an explicit CCE competency area [2][5].

Phrases like:

• “The diagnosis is uncertain at this stage.”
• “This could be caused by several conditions.”
• “I need more information before confirming the diagnosis.”
• all demonstrate clinical maturity.

Clear safety netting shows that you understand risk and are committed to patient safety. It must be explicit. Examples include:

• Clinical red flags to monitor
• Timeframes for escalation
• Emergency instructions

For examiners, follow up planning is one of the clearest markers of competence. Follow up can include:

• Booking a review appointment
• Ordering investigations and reviewing results
• Coordinating referrals
• Managing uncertainty is not a weakness. It is evidence of how safe and thoughtful your practice is, which is consistent with the RACGP’s summative expectations for practice at the point of Fellowship[5] [6].

Understanding common mistakes is one of the most powerful ways to improve your score. These errors appear consistently in RACGP CCE guidance and public exam reporting about candidate performance at the standard expected for Fellowship[5] [6]..

Common pitfalls to avoid

• Not following case instructions accurately
• Disorganised consultations without structure
• Failing to respond to emotional cues or demonstrate empathy
• Inadequate safety netting
• Missing clear opportunities for follow up
• Failing to verbalise reasoning clearly

When these errors occur, examiners cannot score the relevant domains. For example:

• No safety netting means the safety domain is not demonstrated
• No explanation of reasoning means clinical reasoning cannot be scored
• Missed instructions mean specific marking criteria are unmet

How to avoid them

• Practise structured consultations consistently
• Slow down and listen for emotional cues
• Use a verbal checklist before finishing each case
• Include safety netting and follow up in every scenario
• Review examiner guidance and public reports to learn from past sittings[5]
• Mistake prevention is one of the highest yield skills in exam preparation.