The Clinical Competency Exam (CCE) is the final exam on the pathway to fellowship of the Royal Australian College of General Practitioners (RACGP). Delivered via Zoom, the CCE is an online exam where the candidate either discusses a case with an examiner (case discussion) or roleplays a scenario with a simulated patient with an examiner observing and assessing (clinical encounter).  

This exam assesses the competencies that are considered essential for an Australian general practitioner, specifically there are 10 clinical competencies and two contextual units (available here).  

While understanding these competencies is essential for performing your best in the CCE, effective time management is just as crucial. Each station may require you to juggle a combination of tasks, such as building rapport, gathering and interpreting information, patient education, clinical examination, results interpretation, or formulating a management plan, depending on the scenario. Ideally, you can navigate these responsibilities without missing key components or feeling overwhelmed by time constraints. 

So, how do you balance different priorities in the CCE without, using a sporting analogy, ‘dropping the ball’ on any of them? Here are five tips to better manage your time in the CCE.  

Ensure that you:  

  1. Consider how much time you want to spend on each task (for clinical encounters): To make the most of your 15 minutes, plan and allocate an approximate time to the different tasks. This will vary depending on the details of the station and what you have been asked to do but as an example, you could allocate:  
  • 1-2min: Introduction/rapport & gathering initial information from simulated patient 
  • 6-7min: Detailed history questions 
  • 5-6min: Management  
  • 1-2min: Preventative healthcare & screening 

It is useful to practice this prior to the exam with a study partner as a simulated patient, as it can be easy to lose track of time when engaging with a simulated patient. Practice using a timer. While it’s important to have a structure, you also need to allow flow in the station and not cut a patient off abruptly just to move on to the next section. The key is ensuring that you’re managing time effectively so that you can complete all the necessary tasks.  

  1. Utilise reading time: Use your 5-minute reading time effectively by noting important aspects of the case, such as clinical details, your key differential diagnoses, planned history questions, and priorities for investigation and management (both pharmacological and non-pharmacological). Your note priorities will depend on the station, so focus on what is most relevant to the specific scenario. This is important planning time, so use it effectively! We recommend developing a structured format or template to guide your note taking and planning. Dr CCE has a reading/planning time template available as a part of the course. However, you cannot have pre-filled templates in the exam: you will need to create this from scratch on a blank sheet at the start of each reading time.  
  1. Prioritise Effectively: Start with the most urgent issues or clinically significant and address them first whilst leaving room for important discussions and patient concerns. Ensure you include the patient in the prioritisation of issues, so their agenda can also be addressed.  Remember, in the CCE it’s important to allow the simulated patient time to follow their script as this has important information for your management of the case. It’s also a great way to demonstrate your patient-centred approach to the examiner, optimising your marks. If time is running out, check in with the patient to ensure the most important concerns have been covered. Here are some examples:  
  • “You mentioned fatigue, joint pain, and headaches. Which of these is impacting you the most right now? Let’s start there and work through the others.”  
  • “Today I’d like to prioritise explaining your XXX results and the available options to manage XXX, as well as discussing preventative screening and vaccinations with you. Does that sound ok to you?” 
  • “From a medical perspective, I want to discuss your blood pressure readings today, but I also want to make sure we address what’s most important to you. Is there something in particular you were hoping to cover?”  
  • “I want to make sure we have enough time to go through your test results today. If there’s time at the end, we can also XXX.” 
  1. Set expectations: Near the beginning of the consultation, briefly outline your plan to the patient by signposting what you’ll be discussing. Sign-posting is an excellent communication tool that helps to set clear expectations, ensure a logical flow, and keep both you and the patient on track. It also serves as a great way to communicate your approach to the examiner-such as when outlining management or treatment options. In the CCE, signposting helps both the simulated patient and examiner anticipate what’s coming next and follow the logical progression of your plan. Here are some examples of signposting:  
  • “Today, I’d like to start by understanding more about your symptoms. Then, we’ll discuss any necessary tests or investigations, and finally, we’ll go through management options. Does that sound okay to you?” 
  • “I’d like to first explain what this diagnosis means, then we’ll go through the treatment options, and finally, we can discuss how to monitor your symptoms over time.” 
  • “Regarding the management of your symptoms, firstly I’d like to discuss prescription medication options, then some lifestyle changes, and lastly, we will talk about what we can do if these strategies don’t improve your symptoms”  
  • “Today, I’d like to understand how your symptoms have been affecting you and discuss the next steps for further investigation. I also want to check in on your medications to ensure they’re working well for you.”  
  1. Then practice, practice, practice! Knowing these strategies is just the first step – applying them consistently is what will truly improve your time management. Incorporating these techniques into your CCE preparation and practising them extensively (e.g., every time you practice CCE cases with your study partner) will enable you to integrate them so that they come automatically and naturally to you, even when under exam pressure.  

These five tips will help you improve your time management, and therefore your performance, in the RACGP CCE. And remember, if you are still struggling, get further assistance to implement these strategies with a mentor or performance coach.