Fellowship exams are notoriously difficult and there are many reasons why candidates struggle to pass them. 

For some, it may be a lack of exam preparation or failing to understand the particulars of the exam they are preparing for or often, having too many priorities so doing none well. However, for others, there may be a recurring pattern of struggling with exams, for example in high school, undergraduate courses or more recently, multiple failed attempts at their Fellowship exams in either general practice or other medical specialties.  This may be a new behaviour of being generally disorganised, missing appointments, being late regularly, missing deadlines or feeling frazzled at losing or misplacing items and things not being where they ‘should’ be. For others, this pattern is a recurring struggle which is not attributable to a lack of effort or motivation. Potential reasons for this can include unhelpful established habits (disorganised behaviours and routine), diagnosed or potentially undiagnosed mental illness or Attention Deficit Hyperactivity Disorder (ADHD), or personality factors which are more prone to being disorganised, avoidant or easily distracted. 

Do you tend to: 

  • have trouble with planning, prioritising or organising tasks and activities?  
  • have difficulties with focusing and maintaining attention on tasks, making it challenging to complete tasks or meet deadlines? 
  • fail to give close attention to detail or make careless mistakes? 
  • not follow through on instructions or fail to finish work, chores, or duties (e.g., lose focus, become side-tracked)?  
  • avoid, dislike, or are reluctant to do tasks that require mental effort over a long period of time? 
  • lose things necessary for tasks? 
  • be easily distracted and forgetful? 
  • experience these difficulties ongoingly (more than six months) and in different areas of your life (at work and home)? 

(APS, 2022)

Or do you tend to relate to few or some of these behaviours listed, but to different degrees from very mild to moderate, with changing consistency (not all the time)? If this is a new behaviour, it may be as a result of feeling stressed or overwhelmed at the coming exams. It could be an indication of feeling anxious about your exam preparation. This would be a good time to take heed of this warning sign and to reflect on your stressors and self-care, and prioritise your commitments, including those related to studying and exam preparation. Left unchecked to escalate, it could become a sign of a serious mental illness, like clinical depression or anxiety. 

If you tend to be disorganised generally and it’s been ongoing (not new), it can be a relatively harmless personality trait or a behaviour that you learnt over time. It’s also possible that it’s a neurodevelopmental condition like ADHD. It all depends on the degree and what else is happening in your life at this time. 

An estimated one million Australians live with ADHD which equates to approximately one in 20 Australians (APS, 2022; Health Direct, 2020), and many are not formally diagnosed. As a neurodevelopmental condition, characterised by differences in brain and cognitive development, ADHD affects the brain’s executive functioning — the ability to self-regulate and control thoughts, words, actions and emotions (Health Direct, 2020). ADHD is associated with age-inappropriate levels of inattention and/or hyperactivity and impulsivity (APS, 2022).  

People who have disorganised personality traits, a mental illness like depression, or have ADHD tend to experience difficulties with planning and prioritising, getting organised, and time management.

These difficulties will impact on their ability to study, work, manage responsibilities, develop and maintain social relationships. They can also negatively impact self-confidence and self-esteem. This will make preparing for important exams like those for RACGP and ACRRM Fellowship very difficult. For example, those suffering from depression or anxiety may find it extremely challenging to do things, including going to work or keeping their house or space clean, let alone study and remember knowledge needed for their exam(s). Procrastination and distraction can also be major barriers for disorganised or anxious people, both of which greatly impacts exam preparation.  

So, what to do? It’s important to differentiate between whether it’s stress-related, a personality trait, a neurodevelopmental condition like ADHD, or a serious mental illness, like depression or anxiety. Particularly if the disorganisation is new and severe which have been noticed or remarked on by your friends and family, it’s important to talk to your GP who may suggest a referral to a psychiatrist or a psychologist. Tip: Talk to your GP as a starting point. If you don’t have a GP, it is important to find one.  

So, what can you do if you are preparing for important Fellowship exams and can rule out ADHD or mental illness, yet you identify with some of the behaviours listed previously? 

Consider the following options and exam preparation strategies: 

  • Prioritise. Remind yourself of your long-term goals (e.g., passing exams, Fellowship) and revise them when necessary.  Set daily priorities to meet your goals. For example, make daily, weekly and monthly to-do lists of important tasks.  Review your daily priorities at the beginning of each day. 
  • Manage your time. But be realistic. Schedule quiet time at work to accomplish tasks that need extra concentration.  Do your most challenging work or studying when your energy is at its highest; save less demanding tasks, like rewriting notes, for other times.  If you tend to procrastinate, focus on one thing at a time and celebrate each small win (30 minutes of study per day is better than none). To-do lists are helpful as long as they are not overwhelming and overly ambiguous. Ensure your daily to-do list can actually be realistically completed in the time you have. 
  • Check your calendar daily to review your activities and avoid conflicts.  Write down all commitments rather than trusting your memory.  Use planning and scheduling apps and software to help you map out long-term projects. Assistance with organisation, such as using alarms, reminders through apps and electronic diaries can improve this skill. For example, setting a timer (on your phone or computer) can help with reminders to attend study group sessions, or better manage procrastination and forgetfulness.  
  • “Snack” studying is a useful strategy to increase focus and concentration. Snack studying refers to small ‘bite-sized’ lengths of study time so concentration does not fade. Techniques, such as the Pomodoro technique (set 25 minutes on a timer to study, followed by a 5-minute break), can make it easier to manage procrastination as you are aware that the amount of time to study is limited. 
  • A study group is another great strategy for exam preparation to assist with organisation, motivation and concentration, as well as enhancing accountability. Also, the positive and social aspects of a study group tend to be enjoyable, providing encouragement and support while working toward common learning goals.  
  • Reduce or eliminate distractions. Turn off your phone, close unnecessary tabs on your computer, and find a quiet study space. If you’re distracted by what others are doing in the house, go to the library. If you find yourself staring out the window, move your desk so you can’t see outside. You can also use noise-cancelling headphones or white noise to block out external noise.  
  • External exam assistance through courses like KFP Coach, Dr MCQ, Dr KFP and Dr CCE are useful to assist with organisation, accountability, and focus. Many courses involve follow-up calls or milestones which can help keep you on track, and much of the organisation is done for you. For example, they may include examples of study schedules or plans, or lists of readings and references, rather than needing to develop or find your own. 
  • Sleep is essential for learning and memory retention. Sleepiness and fatigue can impair attention, concentration, and working memory, potentially turning into a vicious circle. So, set up a good night-time routine by stopping screen viewing one hour before bed, complete pre-sleep activities like a cup of chamomile tea or a warm bath (train your brain to perceive those activities as a precursor to sleep), and go to bed at a consistent time.  
  • Practice self-care – this is essential for everyone who is preparing for Fellowship exams. Ensure you get enough sleep, eat a healthy diet, and engage in exercise and your favourite hobbies. Take short, frequent breaks to recharge your batteries and stay motivated by enjoying stress-reducing activities, such as yoga or active mindfulness (mindfulness while bushwalking, running or cooking). Taking care of your mental and physical health will help you stay focused, energised, and motivated. 

What if you have been diagnosed with ADHD, anxiety or depression and are sitting exams? As well as the strategies already listed above, consider: 

  • Apply for special consideration. Some candidates are eligible for special consideration when it comes to sitting the RACGP or ACRRM exams. You may be granted more time to complete the exam.  For example, a person with ADHD who struggles with concentration, more time in the exam will allow multiple short breaks to reset focus. Note that if you are considering this option, you will likely need to provide supporting evidence for any application for special consideration and ensure you request special consideration well in advance of the exam. 
  • Pharmacological interventions. Many people with ADHD and/or a mental illness have found medication helpful in managing symptoms. However, medication-based treatment decisions should always be made in consultation with your treating doctor, with choice of medication(s) and dosage regimes usually needing to be optimised over time. For example, ADHD medication should be carefully and continually monitored for its effectiveness and any unwanted side effects (ADHD Guideline Development Group, 2022; APS, 2017). So, if you do decide to try medication, it’s a good idea to commence medication as soon as possible (e.g., 6 months) prior to the exam so you are on a tested regime well in time for sitting the exam and receiving all its benefits with minimal side-effects during exam preparation. Talk to your GP to decide if appropriate and explore your options.  
  • Non-pharmacological interventions. There are many non-pharmacological interventions, such as behavioural therapy, cognitive-behavioural therapy (CBT), neurofeedback, psycho-education and lifestyle changes (e.g., diet, exercise and sleep) that can improve daily functioning for stress-related disorganised behaviours, depression and anxiety, or ADHD. Seeing a psychologist who specialises in adult ADHD and/or anxiety and depression to work on cognitive, behavioural and practical lifestyle strategies is beneficial for many. 
  • Sleep is essential for everyone for learning and memory retention. And sleepiness and fatigue can impair attention, concentration, and working memory. However, sleep related difficulties are common in people with ADHD and/or depression (APS, 2022). For example, many people with ADHD report sleep onset insomnia and delayed dim light melatonin onset (APS, 2022). It’s important to set up a good night-time routine (as outlined earlier) 
  • Note that a combination of pharmacotherapy and psychological interventions is considered optimal treatment, and more effective than pharmacotherapy alone (Young & Myanthi Amarasinghe, 2010), for conditions like ADHD, depression and anxiety. For example, multimodal treatment involving pharmacotherapy, education, behavioural/self‑management skills, counselling, coaching, and either academic or workplace accommodations is likely to promote the best outcomes for adults with ADHD (ADHD Guideline Development Group, 2022; APS, 2017). 
  • Don’t underestimate the power of support.  This can take many forms. For example, it could be support and encouragement from friends and family, outsourcing routine tasks like housecleaning, window-cleaning gardening or lawnmowing to help you stay on top of these recurring jobs, or support in the form of body doubling. Body doubling is particularly helpful for people with ADHD or those who feel overwhelmed and avoidant. Body doubling is where someone works alongside you to assist you to start, focus and finish a task. This works well with studying and exam preparation. Anything that will lighten your load can help you feel more in control and organised. 

Preparing for fellowship exams is a challenging task for any candidate, but for one who is disorganised or is managing ADHD, depression or anxiety, it can be particularly overwhelming. Set yourself up to succeed by focussing on your strengths and getting assistance with what challenges you. Using some or all of these strategies will enable you to prepare for your exams successfully.  


ADHD Guideline Development Group (2022). Australian evidence-based clinical practice 

guideline for Attention Deficit Hyperactivity. First Edition. Melbourne: Australian ADHD Professionals 


APS (2017). Attention deficit hyperactivity disorder (ADHD) practice guide. Accessed from: https://psychology.org.au/for-members/resource-finder/resources/assessment-and-intervention/clinical-guide/attention-deficit-hyperactivity-disorder-practice# on 28/2/23 at 1.20pm 

APS (2022) We’re paying attention – Evidence-based guidelines for ADHD. InPsych, Summer 2022, Vol 44 

Employee Assistance Network. Get organized at work! Accessed 6 February 2024 from: https://www.eannc.com/employees/eight-tips-to-help-you-get-organized-at-work  

Health Direct. (2020). Attention deficit hyperactivity disorder (ADHD) Accessed 1 March 2023 from: https://www.healthdirect.gov.au/attention-deficit-disorder-add-or-adhd  

Young, S., & Myanthi Amarasinghe, J. (2010). Practitioner Review: Non‐pharmacological treatments for ADHD: A lifespan approach. Journal of Child Psychology and Psychiatry, 51(2), 116-133. doi: http://dx.doi.org/10.1111/j.1469-7610.2009.02191.x