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Dr Shaun Tan, FRACGP, MD, BMSC
Medical Examiner | Associate Lecturer
Scored 90% on the AKT & Top 15th percentile in the KFP
Understanding clearly how the RACGP CCE is marked is the foundation of confident exam performance. When you know exactly what examiners are looking for, you walk into each station with structure, clarity, and purpose. This guide explains how the RACGP Clinical Competency Exam is marked, what each domain means in practice, and how to demonstrate competency consistently.
If you want an even deeper dive into exam structure, see our comprehensive AKT timing guide for strategy alignment.
Understanding the CCE Clinical and Communication Domains
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:
Communication and consultation skills
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].
Clinical decision making and reasoning
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.
Demonstrating Safe General Practice in 10 to 15 Minutes
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:
Clear prioritisation
You must demonstrate that you recognise urgent concerns quickly. This includes identifying red flags immediately and structuring your consultation around them.
Explicit safety netting
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.”
Defined follow up plans
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
Confirmation of understanding
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.
Managing Uncertainty and Follow Up Plans
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].
Acknowledge uncertainty openly
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.
Provide structured safety netting
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
Plan follow up deliberately
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].
Frequently Asked Questions (FAQ)
1. How is the RACGP CCE marked overall? Do I need to pass every case?
Your result is determined by your combined performance across all 9 cases. Each case is scored using a 4 point Likert scale, and your final result is determined using a borderline regression method that incorporates an examiner 5 point global rating [5] [6]. You do not need to pass every case individually. Your total aggregated score determines your outcome [1].
2. How many cases are in the CCE and how long is each?
The RACGP CCE includes 9 cases. Each case consists of 5 minutes reading time and 15 minutes of clinical interaction, delivered remotely via Zoom with RACGP technical and procedural controls [1] [4].
3. What competencies or domains are assessed in the CCE?
The CCE assesses 12 clinical competencies that sit within a curriculum framework of 5 domains and 13 high level core skills. These competency areas include Communication and consultation skills, Clinical information gathering and interpretation, Diagnosis, decision making and reasoning, Clinical management and therapeutic reasoning, Professionalism, Managing uncertainty, and population and context specific competencies such as Aboriginal and Torres Strait Islander health and Rural health [2] [3].
4. How can I best prepare to demonstrate safe practice?
Practise structured consultations, include explicit safety netting consistently, and familiarise yourself thoroughly with RACGP competency wording and case expectations. Using defined follow up plans in all practice scenarios builds confidence for exam day, and it aligns with how cases are assessed at the point of Fellowship [5] [6].
5. What are the best ways to avoid common mistakes?
Follow instructions carefully, use structured approaches, demonstrate empathy, articulate reasoning clearly, and practise safety netting and follow up consistently. Mock exam practice with feedback mapped to the 12 competencies can highlight blind spots before the real exam [2] [5].
Common Marking Mistakes Candidates Make
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
Why these mistakes cost marks
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.
Showing Diagnostic Reasoning Out Loud
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].
The exam expects you to verbalise
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].
If you feel unsure about your preparation, Fellow Academy provides high quality AKT and KFP question banks, concise exam notes, evidence based flashcards, free KFP case packs, webinars, and practical study resources to support your learning journey every step of the way.
Disclaimer: This content is not affiliated with, endorsed by, or representative of the Royal Australian College of General Practitioners, RACGP. The strategies and approaches shared are based on personal experience and the experiences of other GP candidates who successfully passed their exams. They are intended as general study guidance only and should not be taken as official RACGP advice.
Disclaimer: This content is not affiliated with, endorsed by, or representative of the Royal Australian College of General Practitioners, RACGP. The strategies and approaches shared are based on personal experience and the experiences of other GP candidates who successfully passed their exams. They are intended as general study guidance only and should not be taken as official RACGP advice.
References
[1] Royal Australian College of General Practitioners. Clinical Competency Exam. Page last updated 3 July 2025. East Melbourne, VIC: RACGP. https://www.racgp.org.au/education/fracgp-exams/racgp-exams/clinical-competency-exam
[2] Royal Australian College of General Practitioners. The Clinical Competencies for the CCE, including Competencies list and performance criteria. Last revised 19 March 2024. East Melbourne, VIC: RACGP. https://www.racgp.org.au/education/fracgp-exams/racgp-exams/clinical-competency-exam/the-clinical-competencies-for-the-cce/the-clinical-competencies-for-the-cce
[3] Royal Australian College of General Practitioners. The Clinical Competencies for the CCE, PDF overview of domains and core skills. 2024. East Melbourne, VIC: RACGP. https://www.racgp.org.au/getattachment/5195905d-d222-460b-91cf-ec7d87aafa2c/The-Clinical-Competencies-for-the-CCE.aspx
[4] Royal Australian College of General Practitioners. CCE Candidate Technical Guidelines. 2025. East Melbourne, VIC: RACGP. https://www.racgp.org.au/getattachment/cb2a167e-a466-4f73-8f3b-f98d35f2e8e6/CCE-candidate-technical-guidelines.aspx
[5] Royal Australian College of General Practitioners. Public Exam Report 2025.1, Clinical Competency Exam. 2025. East Melbourne, VIC: RACGP. https://www.racgp.org.au/getmedia/f4fc7ea1-ba17-4eae-86ea-d4369d22e5aa/2025-1-CCE-Public-Exam-Report.pdf.aspx
[6] Royal Australian College of General Practitioners. How are CCE cases marked. Last revised 10 August 2023. East Melbourne, VIC: RACGP. https://www.racgp.org.au/education/fracgp-exams/racgp-exams/clinical-competency-exam/candidate-guidelines-for-the-clinical-competency-e/clinical-competency-exam-cce/how-are-cce-cases-marked
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Dr Shaun Tan, FRACGP, MD, BMSC
Medical Examiner | Associate Lecturer
Scored 90% on the AKT & Top 15th percentile in the KFP
Summary
Understanding clearly how the RACGP CCE is marked is the foundation of confident exam performance. When you know exactly what examiners are looking for, you walk into each station with structure, clarity, and purpose. This guide explains how the RACGP Clinical Competency Exam is marked, what each domain means in practice, and how to demonstrate competency consistently.
If you want an even deeper dive into exam structure, see our comprehensive AKT timing guide for strategy alignment.
Understanding the CCE Clinical and Communication Domains
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:
Communication and consultation skills
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].
Clinical decision making and reasoning
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.
Demonstrating Safe General Practice in 10 to 15 Minutes
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:
Clear prioritisation
You must demonstrate that you recognise urgent concerns quickly. This includes identifying red flags immediately and structuring your consultation around them.
Explicit safety netting
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.”
Defined follow up plans
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
Confirmation of understanding
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.
Managing Uncertainty and Follow Up Plans
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].
Acknowledge uncertainty openly
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.
Provide structured safety netting
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
Plan follow up deliberately
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].
Tools That Make Active Recall Easy
Digital tools simplify the process of integrating active recall and spaced repetition into your RACGP exam preparation.
-
Brainscape: Uses adaptive algorithms to determine when you should review each flashcard based on your confidence level.
-
Anki: Allows custom deck creation for topics like PBS rules or emergency management.
-
Quizlet: Offers collaborative decks for study groups.
Using these tools allows you to:
-
Review flashcards during commutes or between patients.
-
Automatically revisit topics you’re struggling with.
-
Track progress and identify weak areas.
These platforms bring structure to your study plan, ensuring regular reinforcement and better recall.
(For time management strategies, see our AKT Study Planner.)
How to Combine These Methods for Peak Performance
When you combine active recall with spaced repetition, the results are exponential. This combination, known as “spaced retrieval practice”, creates a continuous cycle of learning, forgetting, and relearning that strengthens memory.
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Start early (at least 6–12 months before your exam).
-
Create flashcards for each guideline or high-yield topic.
-
Use Brainscape or Anki daily to review material in spaced cycles.
-
Schedule mock exams every 3–4 weeks to test your applied knowledge.
Research indicates spaced repetition can significantly increase long-term retention, with spaced learners achieving approximately 58% accuracy compared to 43% among traditional learners (p<0.001) [4].
By six months into this method, most candidates report not only improved recall but also better confidence under pressure. You’re no longer scrambling to remember—you’re retrieving information automatically.
Frequently Asked Questions (FAQ)
1. How is the RACGP CCE marked overall? Do I need to pass every case?
Your result is determined by your combined performance across all 9 cases. Each case is scored using a 4 point Likert scale, and your final result is determined using a borderline regression method that incorporates an examiner 5 point global rating [5] [6]. You do not need to pass every case individually. Your total aggregated score determines your outcome [1].
2. How many cases are in the CCE and how long is each?
The RACGP CCE includes 9 cases. Each case consists of 5 minutes reading time and 15 minutes of clinical interaction, delivered remotely via Zoom with RACGP technical and procedural controls [1] [4].
3. What competencies or domains are assessed in the CCE?
The CCE assesses 12 clinical competencies that sit within a curriculum framework of 5 domains and 13 high level core skills. These competency areas include Communication and consultation skills, Clinical information gathering and interpretation, Diagnosis, decision making and reasoning, Clinical management and therapeutic reasoning, Professionalism, Managing uncertainty, and population and context specific competencies such as Aboriginal and Torres Strait Islander health and Rural health [2] [3].
4. How can I best prepare to demonstrate safe practice?
Practise structured consultations, include explicit safety netting consistently, and familiarise yourself thoroughly with RACGP competency wording and case expectations. Using defined follow up plans in all practice scenarios builds confidence for exam day, and it aligns with how cases are assessed at the point of Fellowship [5] [6].
5. What are the best ways to avoid common mistakes?
Follow instructions carefully, use structured approaches, demonstrate empathy, articulate reasoning clearly, and practise safety netting and follow up consistently. Mock exam practice with feedback mapped to the 12 competencies can highlight blind spots before the real exam [2] [5].
If you’re feeling overwhelmed by RACGP exam preparation, Fellow Academy offers high quality AKT and KFP questions, exam notes in concise and comprehensive format, and high yield, evidence based flashcards designed to help you study smarter and perform with confidence. You’ll also find free KFP case packs, webinars, and practical study resources to guide you every step of the way.
Disclaimer: This content is not affiliated with, endorsed by, or representative of the Royal Australian College of General Practitioners (RACGP). The strategies and approaches shared are based on personal experience and the experiences of other GP candidates who successfully passed their exams. They are intended as general study guidance only and should not be taken as official RACGP advice.
References
-
GP Supervisors Australia. (2025). Study Skills Guide for GP Registrars: Studying Smarter, Not Harder. GPSA.
-
Carpenter, S. K., Pan, S. C., & Butler, A. C. (2022). The science of effective learning with spacing and retrieval practice. Nature Reviews Psychology, 1(10), 496–511.
-
Durrani, S. F., Yousuf, N., Ali, R., et al. (2024). Effectiveness of spaced repetition for clinical problem solving amongst undergraduate medical students studying paediatrics in Pakistan. BMC Medical Education, 24(1), 676.
-
Price, D. W., Wang, T., O’Neill, T. R., et al. (2025). The effect of spaced repetition on learning and knowledge transfer in a large cohort of practising physicians. Academic Medicine, 100(1), 94–102.
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