.png)
.png)
.png)
Dr Shaun Tan, FRACGP, MD, BMSC
Medical Examiner | Associate Lecturer
Scored 90% on the AKT & Top 15th percentile in the KFP
The Clinical Competency Exam is the final gateway to Fellowship, and the RACGP CCE: What It Is, Who Sits It, and How It’s Assessed has become the defining milestone for every aspiring GP in Australia. Whether you are an AGPT registrar, an IMG navigating a new health system, or a doctor completing the Practice Experience Program, the CCE is the moment where your training, reasoning, empathy, and professionalism are evaluated in one carefully structured assessment.
For many doctors, the CCE feels significant because it tests not only competence but readiness. It assesses whether you can listen with intention, communicate with clarity, and take confident action while juggling time, uncertainty, and patient emotion. This guide offers a warm, practical walkthrough of the exam, explaining exactly what it involves, who sits it, how it is marked, and what has changed since the OSCE era.
What Is the RACGP Clinical Competency Exam, and how does the RACGP CCE: What It Is, Who Sits It, and How It’s Assessed shape readiness
The RACGP Clinical Competency Exam is the final clinical examination that determines whether a doctor can safely practise unsupervised in general practice. It evaluates applied knowledge, clinical reasoning, professional judgement, and patient centred communication. It was introduced in 2021 as a replacement for the OSCE and the interim Remote Clinical Exam and was designed to more accurately replicate the complexity of real clinical encounters in Australian general practice [1,3].
The CCE is delivered via Zoom and presents candidates with realistic general practice scenarios. These cases reflect the diversity of Australian communities and require candidates to apply guidelines, demonstrate clear reasoning, and communicate safely and respectfully. The shift to Zoom also allows the exam to be delivered consistently across all training pathways, particularly supporting IMGs who may not live near major exam centres [1].
To help you picture the scenarios the CCE aims to simulate, consider these examples:
A young adult presenting with vague chest discomfort where anxiety and cardiac red flags overlap.
A new parent bringing in a baby with fever, expressing fear influenced by online misinformation.
An older patient reporting functional decline and shortness of breath, with complex multimorbidity requiring stepwise reasoning.
A patient with depression who is reluctant to begin pharmacological treatment and needs skilled motivational interviewing techniques.
A patient from an Aboriginal or Torres Strait Islander background requiring culturally safe care and respectful rapport building.
The goal is not only to judge your answers, but to observe how you think, speak, and make decisions in the moment. The RACGP explicitly states that CCE scenarios are designed to reflect real GP consultations, capturing the complexities that define general practice in Australia [1,3].
For CCE study techniques and guidance, see our curated CCE resources for structure, marking criteria, and timing strategies.
Who Needs to Sit the RACGP CCE, IMGs, PEP, FSP, AGPT
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.
How the RACGP CCE Is Marked
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].
What examiners look for
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.
Frequently Asked Questions (FAQ)
1. What exactly does the RACGP CCE test?
The CCE tests clinical reasoning, communication, professional judgement, and safe clinical management. It evaluates real world GP capability and readiness for independent practice in Australia, aligning with the RACGP curriculum and examiner rubrics that sample these competencies across multiple cases [3].
2. Who must sit the RACGP CCE?
All doctors pursuing RACGP Fellowship, including AGPT registrars, PEP Standard Stream participants, FSP candidates, and IMGs, must complete the CCE as part of their Fellowship pathway. Eligibility rules specify pathway enrolment and prerequisite exam requirements before clinical exam enrolment [2].
3. How is the RACGP CCE structured?
The RACGP CCE consists of 9 cases, 4 examiner led discussions and 5 patient role player consultations across 2 exam days. Each case lasts 15 minutes plus 5 minutes of preparation time. The whole exam is delivered online via Zoom with allocated sessions communicated in advance [1].
4. What is the pass rate for the RACGP CCE?
The RACGP reports an overall pass rate of 85 percent [4]. First attempt pass rate of 90.09 percent [4]. Second attempt pass rate of 64.37 percent [4]. Third attempt pass rate of 57.89 percent [4]. Fourth or later attempts at 27.78 percent [4]. These figures demonstrate the importance of a strong first sitting.
5. What major changes occurred from OSCE to CCE?
The CCE replaced the OSCE by shifting to online delivery, reducing station number from 14 to 9, adding examiner led discussions, and adopting competency based marking to reflect deeper assessment of reasoning and communication. These updates were introduced to align the assessment with current practice and to ensure robust sampling of clinical competence [5,3].
What Has Changed from OSCE to CCE
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 [5,1].
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.
CCE Structure, Stations, Timing, Domains
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].
Realistic pressures represented in the exam
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.
Domains assessed in every case
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].
If preparation feels stressful or unclear, Fellow Academy can support you with high quality AKT and KFP questions, comprehensive and concise exam notes, evidence based flashcards, and free KFP case packs and webinars to help you study with clarity and confidence.
Disclaimer: This content is not affiliated with, endorsed by, or representative of the Royal Australian College of General Practitioners. It is intended as general study guidance based on experience 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. It is intended as general study guidance based on experience and should not be taken as official RACGP advice.
References
[1] Royal Australian College of General Practitioners. (2025, July 3). Clinical Competency Exam, CCE, format and delivery. East Melbourne, VIC, RACGP. https://www.racgp.org.au/getattachment/cb2a167e-a466-4f73-8f3b-f98d35f2e8e6/CCE-candidate-technical-guidelines.aspx
[2] Royal Australian College of General Practitioners. (2025, May 27). Fellowship exam eligibility requirements, AKT, KFP, CCE. East Melbourne, VIC, RACGP. https://www.racgp.org.au/education/fracgp-exams/racgp-exams/exam-enrolment-instructions/exam-eligibility
[3] Royal Australian College of General Practitioners. (2023, August 10). CCE candidate guidelines, format, marking, competencies. 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
[4] Liotta, M. (2022, August 5). RACGP clinical exam report released. newsGP, Royal Australian College of General Practitioners. https://www1.racgp.org.au/newsgp/racgp/racgp-clinical-exam-report-released
[5] Woodley, M. (2020, May 6). RACGP to replace OSCE with new clinical exam from 2021. newsGP, Royal Australian College of General Practitioners. https://www1.racgp.org.au/newsgp/racgp/racgp-to-replace-osce-with-new-clinical-exam-from
AKT Exam Preparation: Study Strategies That Work
AKT vs KFP: Which RACGP Exam Is Harder (and How to Prepare for Both)
Trial Fellow Academy for Free
Complete the Form to Access 30 FREE KFP MSQs & AKTs + Invite to Our Free 2026.1 RACGP Exam Prep Webinar
Dr Shaun Tan, FRACGP, MD, BMSC
Medical Examiner | Associate Lecturer
Scored 90% on the AKT & Top 15th percentile in the KFP
Summary
The Clinical Competency Exam is the final gateway to Fellowship, and the RACGP CCE: What It Is, Who Sits It, and How It’s Assessed has become the defining milestone for every aspiring GP in Australia. Whether you are an AGPT registrar, an IMG navigating a new health system, or a doctor completing the Practice Experience Program, the CCE is the moment where your training, reasoning, empathy, and professionalism are evaluated in one carefully structured assessment.
For many doctors, the CCE feels significant because it tests not only competence but readiness. It assesses whether you can listen with intention, communicate with clarity, and take confident action while juggling time, uncertainty, and patient emotion. This guide offers a warm, practical walkthrough of the exam, explaining exactly what it involves, who sits it, how it is marked, and what has changed since the OSCE era.
What Is the RACGP Clinical Competency Exam, and how does the RACGP CCE: What It Is, Who Sits It, and How It’s Assessed shape readiness
The RACGP Clinical Competency Exam is the final clinical examination that determines whether a doctor can safely practise unsupervised in general practice. It evaluates applied knowledge, clinical reasoning, professional judgement, and patient centred communication. It was introduced in 2021 as a replacement for the OSCE and the interim Remote Clinical Exam and was designed to more accurately replicate the complexity of real clinical encounters in Australian general practice [1,3].
The CCE is delivered via Zoom and presents candidates with realistic general practice scenarios. These cases reflect the diversity of Australian communities and require candidates to apply guidelines, demonstrate clear reasoning, and communicate safely and respectfully. The shift to Zoom also allows the exam to be delivered consistently across all training pathways, particularly supporting IMGs who may not live near major exam centres [1].
To help you picture the scenarios the CCE aims to simulate, consider these examples:
A young adult presenting with vague chest discomfort where anxiety and cardiac red flags overlap.
A new parent bringing in a baby with fever, expressing fear influenced by online misinformation.
An older patient reporting functional decline and shortness of breath, with complex multimorbidity requiring stepwise reasoning.
A patient with depression who is reluctant to begin pharmacological treatment and needs skilled motivational interviewing techniques.
A patient from an Aboriginal or Torres Strait Islander background requiring culturally safe care and respectful rapport building.
The goal is not only to judge your answers, but to observe how you think, speak, and make decisions in the moment. The RACGP explicitly states that CCE scenarios are designed to reflect real GP consultations, capturing the complexities that define general practice in Australia [1,3].
For CCE study techniques and guidance, see our curated CCE resources for structure, marking criteria, and timing strategies.
Who Needs to Sit the RACGP CCE, IMGs, PEP, FSP, AGPT
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.
How the RACGP CCE Is Marked
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].
What examiners look for
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.
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.
-
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. What exactly does the RACGP CCE test?
The CCE tests clinical reasoning, communication, professional judgement, and safe clinical management. It evaluates real world GP capability and readiness for independent practice in Australia, aligning with the RACGP curriculum and examiner rubrics that sample these competencies across multiple cases [3].
2. Who must sit the RACGP CCE?
All doctors pursuing RACGP Fellowship, including AGPT registrars, PEP Standard Stream participants, FSP candidates, and IMGs, must complete the CCE as part of their Fellowship pathway. Eligibility rules specify pathway enrolment and prerequisite exam requirements before clinical exam enrolment [2].
3. How is the RACGP CCE structured?
The RACGP CCE consists of 9 cases, 4 examiner led discussions and 5 patient role player consultations across 2 exam days. Each case lasts 15 minutes plus 5 minutes of preparation time. The whole exam is delivered online via Zoom with allocated sessions communicated in advance [1].
4. What is the pass rate for the RACGP CCE?
The RACGP reports an overall pass rate of 85 percent [4]. First attempt pass rate of 90.09 percent [4]. Second attempt pass rate of 64.37 percent [4]. Third attempt pass rate of 57.89 percent [4]. Fourth or later attempts at 27.78 percent [4]. These figures demonstrate the importance of a strong first sitting.
5. What major changes occurred from OSCE to CCE?
The CCE replaced the OSCE by shifting to online delivery, reducing station number from 14 to 9, adding examiner led discussions, and adopting competency based marking to reflect deeper assessment of reasoning and communication. These updates were introduced to align the assessment with current practice and to ensure robust sampling of clinical competence [5,3].
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.
RACGP Exam Mistakes: Common Pitfalls That Stop Candidates Passing the RACGP Exams
AKT Exam Preparation: Study Strategies That Work
AKT vs KFP: Which RACGP Exam Is Harder (and How to Prepare for Both)