RACGP CCE: What It Is, Who Sits It, and How It’s Assessed

The CCE is required for every doctor seeking Fellowship of the RACGP, regardless of training pathway. This ensures that all doctors entering the Australian GP workforce meet the same safety and competency standards. According to RACGP Fellowship eligibility criteria, candidates must be in an eligible pathway and meet exam requirements before attempting the clinical exam [2].

• AGPT registrars must complete the CCE as part of their formal GP training [2]].
• Doctors in the Practice Experience Program Standard Stream must pass all Fellowship exams including the CCE [2].
• Doctors in the Fellowship Support Program require the CCE to obtain Fellowship recognition [2].
• IMGs working through any recognised RACGP pathway also complete the CCE as the final step in demonstrating competency for independent practice [2].

In addition, candidates must have already passed the Applied Knowledge Test and the Key Feature Problem exam before sitting the CCE. This structure ensures that the CCE focuses on applied performance and communication rather than knowledge recall alone [2].

The performance statistics published by the RACGP reflect the importance of first time preparation: Overall pass rate: 85 percent [4]. First attempt pass rate: 90.09 percent [4]. Second attempt pass rate: 64.37 percent [4]. Third attempt pass rate: 57.89 percent [4]. Fourth or subsequent attempts: 27.78 percent [4].

These numbers highlight that initial preparation is critical. The consistent decline in pass rates across repeated attempts underscores the advantage of approaching the first sitting with structured, deliberate practice and strong supervisor guidance.

Doctors preparing for the CCE can deepen their preparation by reading our exam timing frameworks and clinical reasoning modules for exam day performance calibration, including safe pacing and verbalisation strategies.

The RACGP CCE consists of 9 clinical scenarios delivered over 2 separate days through Zoom. These scenarios represent common general practice presentations, ensuring candidates demonstrate multiple competencies reflective of daily practice. Each case includes 15 minutes for the consultation and 5 minutes of reading time prior to the encounter. These delivery details and timings are defined in current RACGP guidance [1],[3].

Core structure

• 9 cases total [1].
• 4 examiner led case discussions [1].
• 5 clinical encounters with a role player [1].
• 15 minutes for each consultation [1]..
• 5 minutes of reading time prior to each case [1].
• 2 separate exam days, usually 1 week apart, delivered online via Zoom [1]..

Each scenario is designed to assess nuanced competencies across the RACGP teaching domains, which include communication, applied knowledge, public health awareness, professionalism, and organisational or legal understanding. These domains and related competencies are set out in the CCE candidate materials and curriculum mapping documents [3].

General practice is known for time pressure, patient variation, and unpredictable complexity. The CCE replicates that through scenarios such as:

• A patient presenting with abdominal pain where red flags must be excluded within tight time limits.
• Management of chronic disease complications during a consultation that begins with a completely different agenda.
• Addressing medication safety when a patient has confusion about dosage or experiences new side effects.
• Providing shared decision making discussions for antidepressant initiation where patient hesitancy requires careful reassurance.

The CCE assesses competence across:

• Communication and rapport building.
• Clinical data gathering and reasoning.
• Management planning and shared decision making.
• Professionalism and ethical conduct.
• Organisational responsibilities including documentation and follow up.

These domains are mapped closely to the RACGP Curriculum and Syllabus for Australian General Practice and are explicitly referenced in the CCE candidate guidance and examiner marking information [3.

The CCE uses a criterion referenced marking system, meaning you are assessed against defined standards rather than competing with other candidates. Examiners score cases according to how effectively you demonstrate core competencies expected of a new Fellow. Each case uses a structured rubric with a 4 point scale that ranges from competency not demonstrated to competency fully demonstrated [3].

Examiners consider:

• The clarity of your differential diagnosis and the reasoning behind it.
• Whether your management plan is aligned with current Australian guidelines, with safe follow up and safety netting.
• Your ability to communicate sensitively, particularly with anxious or vulnerable patients.
• Safe prescribing practices including explanation of medication effects and monitoring plans.
• Professional behaviour such as maintaining boundaries, noting red flags, and closing consultations with clear next steps.

These statistics are essential for understanding exam readiness and underscore the value of deliberate practice, supervisor feedback, and structured exam training. Candidates preparing for the CCE can explore our internal guide on performance based marking, with annotated station transcripts and timing drills to build consistency across all cases.

The shift from OSCE to CCE marked a significant evolution in RACGP assessment. The CCE was designed to capture deeper clinical reasoning, patient centred communication, and professional decision making not easily assessed in short OSCE stations. This change is documented in RACGP and newsGP communications that outlined the rationale and intended benefits of the new format [3],[5].

Key differences reported in official RACGP updates

• OSCE required attendance at exam centres, whereas the CCE is delivered online, supporting consistent access across Australia[1],[5]
• OSCE used 14 short cases, while the CCE uses 9 extended cases, allowing more depth of reasoning and patient centred management [5],
• OSCE relied heavily on checklists, while the CCE focuses on competency based rubric scoring that captures clinical reasoning quality [3]..
• The CCE includes examiner led discussions that test clinical thinking explicitly, without the need for a role player, which broadens the sampling of competencies [1],[3].
• The CCE emphasises holistic, contextual, and culturally safe care in alignment with modern general practice and current curriculum expectations [3].

This update was particularly important given the expansion of telehealth, changes in Australian general practice, and the increased emphasis on reasoning, documentation, and safety netting. The CCE format ensures that candidates are assessed on competencies that directly align with contemporary GP expectations.

For further comparison between structures and to plan your practice schedule, read our OSCE to CCE transition resource with a week by week rehearsal plan and simulated circuit checklists.