General practice guides · Examiner reports

Why candidates lose marks in the RACGP exams

RACGP examiner reports repeat themselves from sitting to sitting. Most marks are not lost on rare facts; they are lost on how answers are written and on the same core gaps. These are the themes that come up most.

  1. Ignoring stem details (age, comorbidities, current medicines, e.g. glyceryl trinitrate despite a PDE5 inhibitor) and over-selecting in the KFP.
  2. The wrong test or premature treatment: allopurinol before gout is confirmed, a coronary artery calcium score for symptomatic angina, self-collection instead of a co-test for post-coital bleeding.
  3. Outdated Australian specifics: old asthma, diabetes and screening rules, PBS criteria and off-label use.
  4. CCE: premature closure and missed must-not-miss diagnoses, e.g. a TIA that needs urgent imaging, a new breast lump.
  5. CCE: too long on history, then a vague plan with no safety-netting or follow-up.
  6. CCE: paternalistic, directive communication; talking over the patient and ignoring their agenda.
  7. CCE: stereotyping or tokenistic cultural safety, and formulaic rote lists.
  8. Medication safety (prescribing a listed allergy), and driving and work-injury rules.

What this looks like when it is marked

A KFP question, an answer of the kind examiners see every sitting, and how a point-by-point marking guide scores it.

Question · 3 marks

Graham, 58, has had 40 minutes of central chest tightness at rest. He used sildenafil last night. Pulse 92, blood pressure 128/80. Choose the 3 most appropriate immediate actions in your clinic.

Answer

Selected: aspirin 300 mg chewed; sublingual glyceryl trinitrate 300–600 microgram; 12-lead ECG.

✓Aspirin 300 mg chewed (no allergy or active bleeding in the stem)1/1
✓12-lead ECG within 10 minutes of arrival1/1
✗Call an ambulance (000) for transfer to the emergency department: glyceryl trinitrate chosen instead, within 24 hours of sildenafil0/1

The stem told you he took sildenafil last night. Nitrates within 24 hours of sildenafil (48 hours of tadalafil) risk profound hypotension, so glyceryl trinitrate is wrong here, and it cost you the ambulance. Examiners report ignored stem details as the commonest KFP fault.

How to practise against these

Reading a list of mistakes changes little. What changes the score is writing or speaking answers under exam conditions and being marked against specific points, so you can see exactly which one you missed. Do that for every area, weakest first, and repeat the ones you got wrong until they stick.

Know the references examiners expect: RACGP Curriculum and Syllabus 2022 (5 domains + contextual units; no published blueprint weights); Therapeutic Guidelines, AMH, PBS authority rules, MBS; RACGP Red Book, Management of type 2 diabetes handbook, Silver Book; National Guide to preventive health for Aboriginal and Torres Strait Islander people; Australian Immunisation Handbook; National Cervical Screening Program; Australian Asthma Handbook; Aus CVD Risk Calculator; AUSDRISK; Austroads Assessing Fitness to Drive; Medical Board Good Medical Practice; Ahpra mandatory reporting; AJGP; RACGP gplearning practice exams.

Where do you stand?

Thirty questions across every area, scored by area with a plain verdict. Free.

Am I ready? Free check →Read a marked sample

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