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.

Long case: an incomplete or inaccurate history from the child and parent that the examiners have to clarify, and signs missed or misreported.
Long case: problems poorly prioritised, and the impact on the child, siblings, family, schooling and social supports under-recognised.
Management plans with errors, scattergun investigations and a poor grasp of treatment complications.
Short case: an insensitive approach to the child, not adapting when the child is distressed or in pain; incomplete or repetitive examination.
Short case: essential signs missed, significant negatives not sought, a diagnosis that does not fit the signs, or needing more than minor prompting.
Growth and development not integrated: milestones not placed against age, growth not plotted or not interpreted against parental heights.
DWE: confusing the epidemiology and pharmacology fundamentals (sensitivity versus predictive value, clearance versus half-life, weight-based dosing and maximum doses) that make up a large share of Paper 2.

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 · 5 marks

Ethan is 4 years old with spastic diplegic cerebral palsy, born at 28 weeks. Present your summary and the problem list you would discuss with the examiners.

Answer

Ethan is a 4-year-old boy born at 28 weeks with spastic diplegic cerebral palsy, GMFCS level III, who walks with a walker and has had botulinum toxin to his calves. On examination he has bilateral lower limb spasticity with hip abduction limited to 30 degrees. His main problems are mobility, spasticity and possible hip subluxation, so I would arrange a hip X-ray and refer to orthopaedics…

✓Accurate summary: gestation, cerebral palsy type and GMFCS level1/1

✗Growth plotted and interpreted (weight, height, head circumference against centiles)0/1

✗Development placed against age in each domain (speech, fine motor, social, toileting) and school readiness0/1

✓Hip surveillance with a reason (limited abduction, GMFCS III)1/1

✗Impact on child and family: carer load, siblings, NDIS supports, kindergarten0/1

The examination findings were right, but the problem list stopped at the body. Examiners mark growth, development and the impact on the family as separate domains, and a list that leaves them out reads as below the expected standard even when every sign was found.

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, AMH Children's Dosing Companion and the PBS; Australian Immunisation Handbook and NZ Immunisation Handbook; RCH Melbourne Clinical Practice Guidelines and state paediatric guidelines (e.g. Children's Health Queensland); ASCIA allergy and anaphylaxis action plans; WHO (0–2 years) and CDC (2–18 years) growth charts; developmental milestones; NDIS early childhood approach; State-based mandatory reporting and child protection law; Gillick competence, adolescent consent and HEADSS; RACP Basic Training curriculum (Foundation, Consolidation, Completion phases) and Knowledge Guides.

Where do you stand?

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

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