Adult medicine guides · Examiner reports

Why candidates lose marks in the RACP exams

RACP 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. Long case: an incomplete or inaccurate history that examiners have to clarify, and signs missed or misreported (examiners re-examine the patient themselves).
  2. Long case: a list of diagnoses rather than a prioritised problem list, with the problem that matters most to the patient undervalued and no long-term view.
  3. Long case: little on function, psychosocial impact, carers, adherence and fitness to drive.
  4. Management plans with errors, scattergun or unnecessary investigations, and no account of treatment side effects and complications.
  5. Short case: an unsystematic or rough examination, not asking permission, or causing pain.
  6. Short case: reporting signs that are not there, or a diagnosis that does not fit the findings presented.
  7. Short case: needing more than minor prompting, and choosing or misreading the wrong investigations.
  8. DWE: October sittings have passed far fewer candidates than February; use the per-topic score report to target a retake, not more of the same questions.

What this looks like when it is marked

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

Question · 8 marks

Mrs H is 81, lives alone and has had three falls in two months. She has type 2 diabetes on gliclazide, an estimated glomerular filtration rate of 32, atrial fibrillation on apixaban, and osteoarthritis. Give your summary and prioritised problem list.

Answer

Mrs H is an 81-year-old woman with type 2 diabetes, chronic kidney disease stage 4, atrial fibrillation and osteoarthritis. Her problems are: 1. type 2 diabetes, 2. chronic kidney disease, 3. atrial fibrillation, 4. osteoarthritis, 5. falls.

✓Medical problems listed accurately, with current treatment2/2
✗Leads with what threatens her most now: recurrent falls in a woman living alone and anticoagulated0/2
✗Links the problems: gliclazide with an eGFR of 32 causing hypoglycaemia, plus postural hypotension, as causes of the falls0/2
✗Impact on function, independence, driving and who supports her at home0/2

A list of diagnoses in textbook order is not a problem list. Examiners score synthesis and prioritisation: start with the problem that matters most to the patient, show how her conditions and medicines interact, and say what it means for her life at home.

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: Therapeutic Guidelines (eTG) and the Australian Medicines Handbook; PBS prescribing rules; Australian Immunisation Handbook; Austroads 'Assessing Fitness to Drive'; Heart Foundation and CSANZ, ADS, KDIGO, COPD-X, ASCIA and eviQ guidance; State capacity and guardianship law; NDIS; My Aged Care; RACP Basic Training curriculum (Foundation, Consolidation and Completion phases; Knowledge Guides).

Where do you stand?

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

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Next: The RACP exams explained: format, timing and how they are passed →

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