Congratulations! You have passed your Royal Australian College of General Practitioners (RACGP) written exams and are now preparing for your Clinical Competency Exam (CCE). As you may have read in the RACGP Candidate guidelines for the CCE, this exam is designed to assess your competence and readiness for independent practice as a specialist GP. It assesses how you apply your knowledge and clinical reasoning skills when presented with a range of clinical scenarios or cases. It enables you to demonstrate your abilities in the ten competencies and two contextual units mapped to the RACGP general practice curriculum. The competency level expected is set at the point of Fellowship (e.g. working unsupervised anywhere in Australia, in any context).  

To achieve fellowship, you are expected to showcase your clinical and communication skills, particularly your inter-professional and patient-centred communication and professional attitudes in the context of each of the nine cases presented over two weekends. This includes case-based discussions and clinical encounters; the latter involves you interacting with a role-player (simulated patient) while the examiner observes and assesses your competency. 

Cases are written to be representative of typical general practice presentations and settings across Australia, using examples from actual patient encounters, with the intention of training you to be able to work anywhere in the country. However, they may not necessarily be representative of your typical patient base or demographics. So, how can you show competency in the exam context in areas you may have limited or no experience? Common areas where GPs feel they have inadequate experience include Palliative Care, Rural Health, Aged Care and Aboriginal Health but this will vary from person to person. 

Tip: If unsure where your experience gaps are, reflect on your typical patient-consult week or month and calculate what type of cases you mostly see. Compare this to the full range of possible General Practice presentations in the Australian context, you can use the RACGP curriculum to guide you.  This will assist you to identify your experience gaps. Still unsure? In Dr CCE, there is a knowledge self-assessment tool that can assist you to identify your experience gaps.  

Increasing knowledge  

The most common method of improving competency in areas of less experience is by increasing your knowledge and understanding of the area in question. Learning more about Palliative Care, Aged Care, Rural Health or Aboriginal and Torres Strait Islander Health will assist you to increase your competency in these areas by better understanding what is best-practice. For example, a good place to start to increase your understanding of Aboriginal and Torres Strait Islander Health is the RACGP’s guidelines and the Five steps towards excellent Aboriginal and Torres Strait Islander healthcare resources. Studying to increase your knowledge will help increase your confidence when needing to answer questions in, say, a case-based discussion regarding a case with an Aboriginal patient. Knowledge is an important basis for comprehension and therefore must be the foundation of improving competency and skill.  

Free online resources  

Taking advantage of free online resources can be a simple way to expand your knowledge. Watching educational YouTube videos on a certain topic, listening to medical podcasts while driving to work or cooking, reading available RACGP guidelines and resources or taking part in free online courses can be your first step into increasing your knowledge in the required area. For example, if communication is an area you wish to improve, try Doctors speak up, a multimedia resource developed to address the language and communication needs of international medical graduates (IMGs) working in Australia. 

Tip: GPEx offers a free online course for healthcare professionals regarding sexual and gender diversity and working in an inclusive and supportive manner called Understanding LGBTIQ. 

However, is knowledge enough for the CCE?  
We say it is not. Although knowledge forms a good foundation for passing exams, the CCE is based on demonstrating competencies, not just testing your knowledge.  You need to be sure that you are demonstrating your clinical reasoning skills, which often comes from experience. So if you do not have experience in some areas of General Practice, what should you do? 

Gain experience at work 

On-the-job-training or work experience is a great way to learn while doing your current job. This strategy however is clinic-dependant, in that it depends on the opportunities available to you at work and the colleagues you work with, and the area you wish to focus on. To make the most of this strategy, it’s important to understand the experience your colleagues have and how to benefit from it. For example, if you wish to gain experience in palliative care, with patient consent, you could ask to shadow a colleague who has lots of experience and consults with palliative patients by asking to sit in, observe and discuss cases afterwards. Discussions on the advantages or disadvantages (rationale) of different actions or decisions they made will enable you to get better insights into the area.  You could also arrange (with the Practice Manager or receptionist) to see any new patients in the areas you wish to gain more experience in, under the informal supervision of your more experienced colleague(s), if required. A GP colleague may also visit one of the local residential aged care homes and you could ask to shadow them for an afternoon. This strategy allows you to gain experience in your identified areas with the support of your clinic and/or colleagues. If unable to observe (e.g., no consent), then discussions with your colleague(s) about the nuances of working in a particular area will give you practical tips and a deeper understanding that reading guidelines alone will give.  

Volunteer 

Can’t get experience at work? Then consider volunteering. Many doctors volunteer, for example at their kid’s football games as a first-aid provider or their local schools or community centres due to cultural or community connections. As volunteering is often personal, many people overlook it as an exam preparation strategy. However, it is a great way to build skills and experience in otherwise unfamiliar areas. Volunteering is a great option to learn transferable skills in action. Many volunteering positions will also provide you with relevant training that you can take additional learning from and utilise in your exam. If time and circumstances allow, consider formal volunteering opportunities, like with the Rural Doctors Foundation or Global Health Gateway.  

You may ask – Why can’t I just work in the area and get paid? Volunteering, as opposed to working in the area, allows you added flexibility that a paid role will unlikely be able to offer. For example, depending on the time you have prior to the exam, you could choose to volunteer ½ day per fortnight on a day of the week that suits you, your work commitments and family. It will be more difficult to find a job that gives you the same flexibility. Volunteering gives you the opportunity to learn from others, have a role within the community, meet new people and potentially find hidden skills and passions, all of which will ultimately benefit your CCE preparation.   

Tip: Unsure how or where to volunteer? Read up about it, check out websites like the Rural Doctors Foundation or identify facilities in your area, such as Nursing homes or Aboriginal Health Centres, and ask about opportunities to volunteer and/or shadow their medical practitioners. 

Seek Mentorship  

Calling upon your peers can open endless possibilities. Utilising your professional networks, contacts or previous supervisors and colleagues for advice gives you the benefit of learning from the experience of others. Most people are open to discussing their roles or how they perform in different contexts. If you have a more senior colleague, supervisor or someone you aspire to work alongside, ask if they could give you feedback, shadow them at work, or if they could be your mentor (even if only for a short time). For example, record yourself completing a CCE case and ask for feedback. Learning from others can help shape the way you work and perform, thereby increasing your competency for the CCE.   

Tip: If nervous about asking someone to be your mentor or to give you feedback, remember: Worst case scenario, they say no, and you are no worse off. 

Teach Others 

Teaching others allows you to consolidate your knowledge as well as motivates you to ensure you fully understand the topic you wish to teach. For example, if there are any medical students or less experienced GP registrars in your clinic (e.g. not eligible for fellowship yet), you could suggest mentoring them. If there are any opportunities in your workplace for leading case-based discussions or education sessions, volunteer for them. Helping others to learn a topic, concept or procedure gives you the opportunity to consolidate your own knowledge by forcing you to be able to explain it in ways that others understand and can follow. It forces you to think of their learning, to think of examples or metaphors to explain the concepts, as well as guiding questions to help them understand and learn. This process in turn consolidates your own knowledge and understanding. It is also a great memory enhancing technique which makes recall in the exam that bit easier. 

Roleplay 

Practicing relevant cases with a study partner or group, ideally under exam conditions, is the best CCE preparation strategy. Practice testing is one of the best exam preparation and learning strategies, particularly when you receive feedback on your performance, so you understand what you did well, what you need to do differently, and how to improve. Practicing all types of cases is beneficial, but particularly in areas you have less experience in. For example, if Aged Care is an area you are struggling with, seek out cases that will test your knowledge in this area. Not only will it assist you in identifying your knowledge gaps, it will also help you cement your understanding and knowledge through repetitive clinical reasoning exercises, with valuable feedback for improvement.  

Ideally, “smart buddy”. Find a study partner who sees a different demographic to you so you can teach each other your areas of experience. For example, you may not see a lot of women’s health, but you have a friend who does. Ask them to write down some interesting cases and turn them into case-based discussions. This allows you to learn from each other’s strengths.  

Also, FLEX the cases to involve different demographics that you don’t often see. For example, consider:  

  • How would your approach to menorrhagia differ in a 16-year-old female compared to a 45-year-old female? 
  • How would your management of a fractured radius differ in a remote area versus an urban area?  
  • How would diabetes management differ in an Aboriginal patient versus a non-Aboriginal patient? 

Tip:  Practicing under exam conditions not only improves your confidence and familiarity with the CCE format, it also allows you to improve your time management and organisational skills (e.g. giving well-structured responses).  

It is important for you to identify the areas in which you feel under-experienced. Some of the common areas in which GPs feel they do not have enough clinical exposure include Palliative Care, Aged Care, Rural Health and/or Aboriginal and Torres Strait Islander Health, however this will differ for each individual. Learning in context, through increasing your experience in the areas of you identified as deficits, allows you to take advantage of the benefits of this type of exam preparation, including: 

  • Increasing your confidence. 
  • Facilitating active learning about the topic. 
  • Providing a more enjoyable and engaging way to learn.  
  • Providing a more effective and efficient way to learn. 
  • Facilitating more effective memory retention (it is easier to recall patients and situations than text). 
  • Learning automatically through daily work routine (rather than needing to set study time).  
  • Feeling the progress you are making. 
  • Enhancing your commitment and motivation when meeting someone (compared to studying alone). 
  • Reducing problematic background distractions (in comparison to studying alone). 

Furthermore, when considering these strategies to increase your competency in a particular area, remember that it may not be necessary to choose only one form of learning over the other. Consider a combination of these strategies that complement each other and fit best into your exam preparation plan. Good luck! 

Are you worried about areas you haven’t worked? We have great tips to improve your knowledge and gain experience to develop competency to be your CCE best. 

References

The Royal Australian College of General Practitioners (RACGP). (2024) Candidate guidelines for the Clinical Competency Exam. East Melbourne. Accessed from: https://www.racgp.org.au/getattachment/6fa6dac8-bb54-4f1a-99b3-0e83b821582c/Candidate-guidelines-for-the-Clinical-Competency-Exam.aspx  

Incidental Learning: Learning Without Trying to Learn. Accessed 8/4/24 from: 
https://effectiviology.com/incidental-learning/#:~:text=Examples%20of%20incidental%20learning%20include,a%20TV%20show%20for%20entertainment. 

 Overcoming a lack of experience. Accessed 8/4/24 from: https://careers.myworldofwork.co.uk/getting-a-job/advice-on-common-challenges/overcoming-a-lack-of-experience  

7 strategies for learning new skills. Accessed 8/4/24 from: https://zapier.com/blog/learning-new-skills/#find-a-mentor