You’ve failed the Clinical Competency Exam (CCE) and you’ve received feedback from The Royal Australian College of General Practitioners (RACGP) in the form of a personal bar-graph of performance in each of the competency areas, showing your results in comparison with the results achieved by your peers (who passed the exam).  

Different people will have different reactions to receiving this feedback. Some may feel disappointment or anxiety seeing their results depicted in a bar graph. Others may feel anger, directed at RACGP or themselves, to see where they did poorly in comparison to their peers. Several different feelings may arise – sadness, disappointment, shame, anger or frustration at not performing at the required level or hope and pride at seeing the areas where performance was equal or better in comparison to peers.  

Some candidates may express feeling dissatisfied with the amount of feedback received after failing the CCE, wanting more. While this disappointment is understandable, the feedback received is still very useful and can help guide the candidate in their examination preparation for future attempts. If you have failed the CCE, this feedback (your personal performance bar-graph of each of the competency areas) is very important when reflecting and planning your future exam preparation for the next CCE. But you may be struggling to understand it constructively and turn it into practical strategies for improvement. What should you do? 

Tip #1: Understand the feedback received. 

With this personal bar-graph, you now understand the score your peers received who passed the exam and are able to compare your score to theirs. This is valuable information. It allows you to understand which competencies you performed well in (passed) and which competencies you performed below expectations and to what extent. You may notice that some competencies you performed well (equal or above your peers – great feedback to receive to boost your confidence!) and a few others stand out as particularly low.  

This information is so important to guide your future study and practice cases. You need to ensure that you work on understanding and improving the specific competencies that you did not perform well in.

 Tip #2: Check what the common errors are for each competency

Avoiding common errors is a great strategy in exam preparation, if you know what they are! Luckily for you, RACGP has listed all the common CCE errors made in exams for each competency (found here). Having explored your feedback and now understanding which competencies you performed well in and which you didn’t, you are able to focus on the areas you are most in need of improving. For example, for the Clinical Competency ‘Communication and Consultation’, the most common errors are: 

  • Using inappropriate language (e.g., medical jargon) 
  • Lack of empathy and using a formulaic approach to the case 
  • Using a paternalistic, instructional approach  
  • Awkward peer-to-peer communication (e.g., in the Case-based discussion) 

Ways to avoid these errors are: 

  • Take note of the social history of the patient – for example you would not speak to a lawyer as you would to a teenager or child. Avoid jargon.  
  • Ask open ended questions first to allow the patient to tell the story in their own words, demonstrate active listening, and respond to cues (e.g., facial expression or tone of voice). 
  • Remember to make eye contact with the simulated patient (role player) or examiner. 
  • Demonstrate a patient-centred approach by exploring the patient’s agenda, involving the patient in decision-making and confirming their understanding and agreement. 
  • Be confident and express yourself clearly. 

If ‘Communication and Consultation’ is one of the competencies you want to improve in, it’s important to understand the above-mentioned errors and get personal feedback (e.g., from your supervisor or study partners) whether these are errors you are making, such as whether your approach to patients is paternalistic. In this way you will be able to learn and adapt your approach. 

Tip #3: Read the CCE report that RACGP released for your exam. 

The RACGP releases a report after each exam, including the CCE. Here is the latest report for the CCE. The public exam report is provided so that all candidates can reflect on their own performance. It is also provided so prospective candidates can see the breadth of the exam content.  

This report is important in the next step of better understanding the feedback you received. It is helpful to consider your personal graph of performance in each of the competency areas when reflecting on the item feedback in the CCE report. 

  • Firstly, check the breakdown of assessed criteria within each competency area (for example, in the 2023.2 CCE, ‘Communication and Consultation’ skills were 26% (30/114) of the marks but Procedural skills were 0% (0/114) of the marks). Understanding where marks tend to be weighted will give you a good insight into the important areas you need to practice, to optimise your marks. 
  • Secondly, read through the descriptions of each of the cases (e.g., the identified candidate performance characteristics that demonstrated competency and the common pitfalls observed). Each case assesses multiple competencies, each of which comprises multiple criteria describing the performance expected at the point of Fellowship. Ratings are recorded on a four-point Likert scale, ranging from ‘competency not demonstrated’ to ‘competency fully demonstrated’. If memory allows, reflect on how you performed in each case. Understanding your performance (self-reflections and the RACGP feedback bar-graph) in comparison to RACGP performance expectations and common errors can give you guidance on what and how to improve your performance for the next CCE.  
  • For each case, reflecting on the performance criteria that demonstrated competency and the common errors made, ask yourself questions like: How did I perform? Did I make this error? How can I demonstrate competency better? Am I demonstrating this competency to the best of my ability? Do I understand this competency? Who can I get feedback from in regards to this [characteristic / behaviour / competency / approach]?

Reflecting in this way (to learn from, rather than feel embarrassment or shame), can give you a strong direction forward to improve performance. 

Tip #4: Understand the RACGP Clinical Competency Rubric. 

The Clinical Competency Rubric should be your go-to document for all things competency related, to understand clinical performance at a Fellowship level. It lists each of the ten competencies plus two contextual units (Aboriginal and Torres Strait Islander Health and Rural health). For each competency, it has a broad description of what the competency is, and lists what is required knowledge, required attitudes and required skills, as well as the skills’ particular focus.  

This rubric could be the difference between passing and not passing the exam! Having an in-depth understanding of each competency gives you insight into the examiner’s marking grid. Understanding what each of the competencies entail and how to demonstrate the competency behaviourally (as outlined in the performance lists) is like the difference between baking a cake with or without a recipe. One almost guarantees success whereas the other is much more uncertain. 

For example, if your personal bar-graph of performance from RACGP showed that you needed to improve in the competency, ‘Professionalism’, but you were unsure what this meant or how to demonstrate competency in the exam in this area, it would be important to start by referring to the competency (number 6) in the competency rubric. This describes the knowledge required (e.g., regarding legislation, ethical principles, safe practice, duty-of-care and maintenance of appropriate therapeutic boundaries) as well as the attitudes to be demonstrated (e.g. empathy, collegiality, self-awareness, respect for patient autonomy and commitment to learning and development). The rubric then goes on to list all the behaviours the examiners could potentially expect to see when a case requires this competency demonstrated, for example, in relation to Criteria #2: 

  • Respects patient-doctor boundaries.   
  • Maintains confidentiality.   
  • Recognises professional limitations.  
  • Respects the patient’s culture and values.   
  • Care of the patient is the primary concern.   
  • Practicing medicine safely at all times.  
  • Shows honesty at all times. 
  • Takes responsibility for own actions.   
  • Respects patient autonomy.   
  • Recognising unethical behaviours by colleagues.   
  • Managing conflicts of interest. 

Focusing on this competency and asking for feedback specifically in relation to these behaviours from your supervisor or study partner(s) will enable you to develop the competency required for the exam.  

You received feedback from The Royal Australian College of General Practitioners (RACGP) regarding your CCE performance, showing your results in comparison to the results achieved by your peers.  

These four tips will help you make the most of your personal bar-graph of competency performance so that you can work towards an improved Clinical Competency Exam outcome next time. 

References 

The Royal Australian College of General Practitioners (RACGP) (2021). RACGP Clinical Competency Rubric. Accessed from: https://www.racgp.org.au/getattachment/59d66b23-bf35-48db-bc18-fe3031514220/Clinical-Competency-Rubric.aspx 

The Royal Australian College of General Practitioners (RACGP). RACGP Education: Exam report 2023.2 CCE. East Melbourne, Vic: RACGP, 2023. Accessed from: https://www.racgp.org.au/FSDEDEV/media/images/Education/Fellowship/2023-2-CCE-Public-Exam-Report.pdf  

The Royal Australian College of General Practitioners (RACGP) (2024). Tips for Clinical Competency Examination (CCE) candidates. Accessed from: https://www.racgp.org.au/education/registrars/fracgp-exams/clinical-competency-exam/cce-exam-support-resources/tips-for-clinical-competency-examination-cce-candi