Where do we start?
Is your registrar a little lost on where to start in studying for their RACGP exam?
What is your knowledge of the RACGP exams?
Did you sit them a long time ago?
Or have you simply blocked them out of your memory!
The idea of this article is to assist supervisors in understanding the RACGP exams, provide advice on ways to assist your registrar in preparing for their exams, and highlight materials which can be used in exam specific teaching sessions. A large amount of this information is available on the RACGP website; however this article is designed to give you a more rapid overview as we are all time poor and sometimes just need the key features!
What is involved in the RACGP exam?
The RACGP exam involves three sections:
- Applied knowledge test (AKT) (Think a multiple choice paper but based on applying clinical rote knowledge to clinical situations)
- 150 questions
- 4 hrs
- Mix of
- “Choose best answer” (eg. normal multiple with 5 answers)
- “Extended matching question” (One question, many possible answers – pick one.)
- Key Feature Problems (KFP)* (A short answer type paper with a VERY strong focus on being able to prioritise important features in a clinical case and be able to portray them in KEY words)
- 26 Clinical Cases
- 3:30 hrs
- Mix of
- Write in answer (Short answer style)
- Completion questions (Select best from a list)
The written exams occur generally 2 months before the live exam (OSCE). From 2017 candidates will need to pass both the KFP and AKT before sitting the OSCE. (Currently this is only the AKT).
- Objective Structured Clinical Exam (OSCE) (A viva type exam which is meant to mirror a busy (and quite stressful) morning in general practice)
- 14 Clinical cases
- 4 hrs
- Mix of
- 8 Minute stations (one FEATURE of a clinical consult eg. STD screening)
- 19 Minute stations (Usually either a full consult or 2-3 small features)
*I realise there has been controversy about types of exams (KFP), structures, marking etc. I am going to assume the registrar has no choice and has to sit this exam to finish their fellowship and will therefore avoid discussion on political views, exam literature etc. I will just focus on practical tips!
How do most successful candidates prepare?
Seeing patients is obviously highly important and supplies endless material for teaching and learning. Clinical case discussions, analysing difficult consults, or reviewing situations where the registrar had to ask for help, are all great ways to direct learning.
However, the exams require specific study to be able to pass. This is because the exams are based upon the Australian RACGP curriculum which incorporates the BEACH data (the 100 most common presentations to General Practice in Australia) and also involves rare but critically important scenarios. The clinical exposure the registrar has in a clinical setting may not always match this curriculum. For example, if they work in a clinic that sees a large amount of acute patients, but does not see chronic disease management, then this will require specific focused study. If their community does not have any aboriginal people then knowing specific health requirements for this community group is very important for exam study.
I suspect the exams have become more difficult over time. Perhaps this is to highlight an increasing complexity of Australian General Practice and to help maintain the very high standard of care that we provide with increasing amount of candidates now sitting their exams. Either way, registrars need to spend focused time on the exams and take their exam study seriously.
Most registrars will spend between 6-9 mths doing focused study 2-3 hrs per day (prior to the initial written exams (AKT/KFP)) and then practice in study groups with cases in the two months prior to the OSCE. They will use a mix of materials including: Murtagh’s text, Check programs, GPlearning, Medical observer (clinical updates), Australian Doctor (how-to-treat), and exam preparation books including the GPRA “The General Practice Exam Book”.
In preparation for the OSCE exam they may use the GPRA “Clinical cases” book, and Susan Wearne’s “Clinical Cases for General Practice Exams”. For the OSCE exam, good candidates will use their daily clinical practice as practice exams. They will perform clinical examinations as perfectly as they can, they may extend their average consult times and have their supervisor observe their consults, and they will practice with other registrars to help them ‘bench mark’ their preparation stage.
Registrars will generally have a study group. This is a group of registrars who can assist each other in their learning, help in practicing cases, act as a benchmark for where their knowledge should be, and can also be a great social support. This can be done face-to-face or may even be done online (eg. Skype®).
Registrars should be encouraged to do the online practice exam (released by RACGP currently five weeks prior to the exams (though this is mooted to be earlier soon)). They may also want to participate in exam focused education eg. RACGP exam preparation courses. These are very useful in ensuring there are no technique limitations that may impact the registrar’s success rate.
Is there anything I can do to help facilitate my registrar passing?
There is no perfect answer to this question. Each individual registrar, clinic, teaching set up, patient base, is always different.
Here is a quick top 3 things you could consider:
- Support the registrars well being
- The registrars are generally very well internally and externally motivated to study for their exams. These can be very stressful times and can be even more difficult if the registrar has a family at home, other work commitments etc. My first recommendation is checking in to make sure they are ok, ensuring they are taking some social time for themselves, and looking after their own health (eg. exercise, alcohol etc). Registrars have generally done many exams and are pretty good at them. They are less stellar at looking after themselves.
- Structure teaching sessions around exam materials
- Practicing exam questions from the exam books, or Check programs, or other practice questions they have, can be very helpful. This can help highlight weak areas. If you then discover a knowledge deficiency through this, you can both then look for cases in the clinic/hospital which reflect that knowledge area. Discussing these cases aloud in detail is very helpful. When the registrar is approaching the OSCE, consider practicing cases with them to gauge their clinical prowess and provide constructive feedback.
- Focus teaching for the KFP particularly on clinical reasoning
- The National Assessment Advisor (writer/co-ordinator) of the KFP points out that registrars who fail the KFP are generally failing because of poor clinical reasoning skills. He suggests “Random Case Analysis” as the best way to practice these skills. The basic structure is looking at the registrars notes about a random patient they have seen, and then get them to step through one step at a time how they arrived at their diagnosis, investigation/management plan etc. This can give AMAZING insights into the thinking of the registrar and can quickly highlight strengths or deficiencies in their thinking patterns. For more detail on this, there is a link to a recent AFP article here.
Where can we go for practice materials?
Here are some of the key recommended sources:
- Australian Doctor (How to treat articles)
- Medical Observer (Clinical update articles)
- Murtaghs Text
- The General Practice Exam Book (GPRA)
- The training provider may have some you can borrow – send email
- The General Practice Clinical Cases Book (GPRA)
- The training provider may have copies
- The training provider may have copies
- Clinical Cases for the General Practice Exam (2nd ed) – Susan Wearne
- Medicine Today
- Life in the Fast Lane (free online emergency education) (www.LITFL.com)
- FOAM4GP (free online general practice education) (www.foam4gp.com)
- UpToDate (though beware this is American based)*
- BMJ Online (Beware British)*
- onexamination.com – BMJ questions – Suggestion from Minh Le Cong – “This has exam style practice questions similar to RACGP written.” (Beware British.)
- PassTest (Beware British)*
- Every guideline (you can google these)! A good place to start is the “Guide to Algorithms and Guidelines” on the FOAM4GP website
- Red book, white book, green book etc
- AHF guidelines (eg. HTN, Hypercholesterolaemia), SA Perinatal guidelines, RCH paediatric clinical practice guidelines, COPDx, Asthma handbook, GP diabetes handbook etc etc.
* The exam is VERY specifically written for Australian guidelines and practice. Overseas materials may not always correlate. Be aware.
RACGP’s exam preparation courses are highly recommended. All exams have certain nuances that can help candidates pass. This is the nature of assessment. Attending an RACGP exam course (in person or online), or signing up to the GPRA exam webinars, are both HIGHLY beneficial to make sure the registrar’s exam technique will not limit their ability to demonstrate their clinical prowess.
What shall I do if my registrar fails?
Once again this has no clear answer. A few general suggestions however include:
- A debrief and reflection session
- Consider their self esteem, mood, possible anger or irritation
- Suggest they take a period off study to rest and recuperate
- Review their previous study / exam plan
- Create a list of strengths and weaknesses in that plan
- Can base knowledge areas upon the RACGP Curriculum document or by reviewing the BEACH data
- Ensure appropriate respect and time was dedicated
- Consider exam-taking limitations eg. Anxiety issues, depression, exam technique problems. Address these as per their specific needs. Exam technique is discussed below.
- Re-motivate the registrar that they can pass and that this extra time of study will make them even better doctors
- Monitor their new study plan and consider making contact more regularly to specifically talk about the exams
- Suggest they enrol in an exam course to eliminate exam taking deficiencies which may have impacted upon their result – RACGP is providing more and more of these.
Where can I go for more information?
If you are further interested in the exams and their structure/process, the RACGP website is the place to start. In the start of 2016 RACGP is very excited to be releasing an easy to read and informative new candidate handbook for information about the exam process. This will provide plenty more information.
If you have registrar specific education difficulties, I would suggest talking to your local Medical Educator. If these are exam specific difficulties, talk to your local training provider exam educator.
Hope this has all been of some help. I am more than happy to be contacted to answer any questions or give advice for supervisors/registrars in their preparations for exams.
Dr Rob Park
Co-Author of GPRA – The General Practice Exam Book (2015)
New Fellow position on RACGP Board of Assessment
Board member on RACGP Post Fellowship Education Board
Editor/Writer for FOAM4GP
TMT Medical Educator / Exam educator
DISCLAIMER: The views and advice expressed here is solely Dr Rob Park’s opinion. It is not representative of any views held by any of the associations or committees with which Rob is involved.