RACGP

The first question a candidate should ask is, ‘What is Australian general practice?’
The answer to this question will provide insight into the knowledge, skills and attitudes that are relevant to everyday practice, and therefore the examination.

The training program curriculum was written to act as a guide to the knowledge, skills, and learning experiences that are necessary for competent, unsupervised general practice. For this reason many candidates find it useful to refer to the training program curriculum and the companion to the training program curriculum to guide their preparation for the exam.

The frequency and patterns of problems as they present to general practice should also be considered during exam preparation.  The questions used in the college examination aim to reflect the frequency of problems as they occur in Australian general practice. Candidates may therefore find it useful to compare their practice profile with that of other practitioners by reviewing their practice using a log diary of, for example, 100 consecutive patients. This may assist you to identify your learning needs.

For example, if you see very few Paediatric cases, you may wish to undertake further study in paediatrics in order to prepare for the exam. This study may include organising some sessions in a facility with a paediatric population, as well as reading journals and attending lectures and workshops.

In approaching any assessment it is important to understand not only the format, but also the objectives of each of the components. By better understanding what is being assessed in each component, preparation (and actual practice) can be geared along those lines.

Each segment has different objectives:

• The applied knowledge test assesses the breadth and depth of contextual

Knowledge required to enter unsupervised general practice.

• The key feature problems assess clinical decision making skills.
• The clinical examination assesses applied knowledge, clinical reasoning,

Clinical skills, communication skills and professional attitudes in the context of consultations and patient examinations.

Training for general practice occurs in the work setting, not in a library. Similarly, preparation for an examination of general practice should occur in the practice setting. The examination does not solely assess book knowledge. Rather, it aims to assess how this knowledge is applied to everyday situations involving patient care. The actual processes of patient care and doctors’ attitudes are also important aspects of this examination.

By honestly answering these and many more related questions, candidates can become more aware of their own performance in general practice and change any aspects they consider appropriate. By performing well in actual practice it becomes easier to translate these behaviors into the examination situations.

Other resources candidates have found useful in examination preparation include:

• Australian Family Physician (RACGP publication)
• CHECKUP (RACGP publication)
• check Program (RACGP publication)
• General practice by John Murtagh
• clinical atlases (eg. dermatology, radiology, electrocardiograms)
• Clinical Orthopedic examination by Ronald McRae
• Hutchison’s clinical methods
• The inner consultation by Roger Neighbour
• Standards for general practices (RACGP publication)
• Putting prevention into practice (RACGP publication)
• Guidelines for preventive activities in general practice (RACGP publication)
• Infection control standards for office based practices (RACGP publication)
• The training program curriculum and companion (RACGP publication)
• Videos of clinical procedures and physical examination techniques.

These resources may be purchased at most medical book suppliers. Some are available through the RACGP at a discounted rate for members. They may also be available for limited loan through the RACGP Library, undergraduate and postgraduate libraries. For more information visit the RACGP website: www.racgp.org.au

GPRA Study Tips Disclaimer:

• The following represents the views of candidates that successfully passed their RACGP fellowship exams and were happy to share their tips with you.
• It should be recognised that everybody has different learning styles and needs and therefore these tips should be taken as suggestions rather than instructions.
• Timeframes are also only a suggestion and should be varied to suit individual circumstances.

Your Mindset is Important:

• For many of us, studying can be hard work. It is helpful to know that many people regard their exam preparation as one of the most professionally rewarding challenges of your career as it is one that prepares you for independent practice.
• The increase in clinical confidence can be very satisfying so adopting a positive attitude can really shape your experience.

Early preparation (>12/12 prior)

• Start flicking through the various medical journals and magazines that are available and collecting “How to Treat” sections, good photographs and clinical guidelines:
  • Australian Family Physician (AFP) is put out by the RACGP and is free when you become a member. It is an excellent benchmark for high level competence and each edition focuses largely on one area with clinical challenge questions. Past editions are available in electronic format from the RACGP website http://www.racgp.org.au/afp
  • Medicine Today journal, Medical Observer Newspaper and Australian Doctor are all available once you begin training in general practice by contacting 02) 9562 6666 or emailing drdata@ampco.com.au
  • Australian Doctor has pull-out “How to treat” sections which are also available online http://www.australiandoctor.com.au/howtotreat.asp which have quiz’s after them and patient handouts, while Medical Observer has Clinical reviews which can be searched online. http://www.medicalobserver.com.au/clinicalreview/
• Beginning with a folder system to file these in as you go certainly helps when it comes time to getting down to some serious study.
• In your own practice begin to keep a record (either in a book or as a document on your computer) or clinical questions as they arise and make an effort to look these up as this really is such an effective way to learn.
• If you are driving a distance to and from work or while doing exercise there is a variety of audio resources that you can listen to (see link to this section)
• Attend as many of the teaching sessions provided by your RTP as possible as they have a good understanding of the curriculum
• Meet with your training advisor to identify any weaknesses and establish useful learning goals.

In the lead-up (starting 6-12 months before exam):

• Have a good “clean up” beforehand” so you can find all of the articles and resources you have been saving and have a system to put notes into.
• Setting a start date and a study timetable can be really useful. Ie create a list of topics you should cover (the RACGP examination matrix can provide a guide to how much time to spend on each topic and the Curriculum will provide an idea about the depth of knowledge required. Past candidate’s experience or lists of topics may be useful) and plot them onto a calendar on the wall, leaving the last few weeks for revision. (we could create a simple 12/12 calendar that could be printed out that has the GPRA logo on it and important dates like when to enrol, when exams are etc.)
• Liaise with your practice early about your plans to sit the exam so you can negotiate study leave if you would like to take it and the days off when not only the exam is on but any workshops you may wish to attend.
• Form a study group.
  • Most Registrars find this one of the best ways to study.
  • It is useful, but not essential, if you can find others who are planning to sit the exam at the same time and who have different areas of expertise.
  • Generally about 4-6 in a group seems to work well.
  • Plan to meet regularly eg fortnightly, then weekly as the exam nears.
  • If you are in rural areas you can discuss ideas over the phone or in chat rooms or teleconferences and meet only a few times.
  • There are several ways you can utilise the group:
    • Just to informally share resources, discussions and interesting cases
    • By splitting up topics and separately researching them and sharing them or presenting them to each other (teaching a topic often cements your learning)
    • Doing questions from Journals, GP learning and CHECK program etc.
    • Practicing clinical scenarios and examinations, especially timing them in preparation for the clinical exams
• Useful resources (there is more a problem of there being too many than too little, so try a few and find which ones work for you)
  • Self Assessment Style:
    • RACGP’s CHECK program provides clinical case style questions with in depth answers on a range of topics, to the level of competence aimed for by experienced GPs http://www.racgp.org.au/check
    • GP learning offers MCQ style questions, also with answers and explanations. http://www.racgp.org.au/gplearning
    • Australian Family Physician (AFP) have clinical challenge questions
    • Australian Doctor Newspaper has MCQ questions after their “How to Treat Sections”
  • Websites:
    • GPRA offer online exam cases which can be printed out and practiced in your study group and are of a very high quality. You can win prizes by entering your own case along the guidelines prepared as a great way to cement your knowledge of how the cases work. http://gpra.org.au/oer_main.php
    • Dermnet NZ provides free pictures and information about a huge range of dermatological disorders. http://www.dermnetnz.org/doctors/index.html
    • RRMEO have many useful programs including a “TeleDerm” program with regular cases which you can go back through that include pictures and management. They also have series on Radiology Cases which is also a common clinical exam questions. You must register to use this site and some RTPs subscribe for you. https://www.rrmeo.com/rrmeo/dls_rrmeo.pl?a=welcome
    • ECG tutorial is available via the CIAP website and is useful for practice for the clinical exam. It is under “Clinical Tools” and then “Interactive ECG Tutorial”
  • Textbooks:
    • John Murtagh’s General Practice is now in it’s fourth edition and is considered by many to be the “bible” of General Practice. It is also available in electronic form.
    • John Murtagh’s “Patient Education” is excellent for preparing for clinical examinations.
    • A good Dermatology Atlas & Ophthalmology Text are both very useful.
    • “Clinical Cases for General Practice Exams” by Susan Wearne, is considered a must for clinical exam practice. Can buy from Ramsay Books with 15% discount with GPRA financial membership: http://www.ramsaybooks.com.au
  • Audio & Podcast Resources
    • “Clinical skills scenarios cases for GP educators and learners” is a DVD with demonstration cases that was prepared by the National Rural faculty and is available for loan through the RACGP library and many RTP libraries.
    • Our podcast list

About The Exam:

• A sample exam paper is available from the RACGP once you are a member http://www.racgp.org.au/exam/assessmentpreparation
• The exam has 2 components held on different days, about 6 weeks apart:
  • The Written Component consists of 2 separate exams, held on the same day:
    • AKT (Applied Knowledge Test):
      • The objective of these questions is to test your clinical knowledge and how you can apply it
      • There are 150 questions all of equal value and you don’t lose marks for incorrect answers.
      • This is a four hour exam (previously 3 hours but extended)
      • Consist of part single best answer multiple choice questions and extended matching questions where you are given a list of answers and have to pick the best one.
    • KFP (Key Feature Problems):
      • The aim of these questions is to assess your decision making skills
      • You are given a clinical scenario and then asked a number of questions.
      • The questions may be short answer or to select a given number of responses from a list.
      • You receive no marks if you select more answers than asked, give a dangerous option or miss the essential answer.
      • There are 26 scenarios of equal marks
      • It is a 3 hour exam
  • The Clinical Component:
    • This exam aims to test the spectrum of clinical skills expected of a GP, eg applied knowledge, communication skills and examination skills.
    • It seeks to replicate a session in general practice (albeit one you would like to never repeat)
    • There are 14 cases, mostly short cases (8 min) with a couple of long cases (18 min).
    • It is not intended that you can run a “whole” consultation in this restricted time, but to demonstrate 1 or 2 aspects in a short case.
    • You are usually given 3 minutes reading time before a case with limited clinical information to prepare. You then enter the room where there is a patient (usually someone role-playing) and an examiner, who will often give you extra information as you ask for it eg clinical exam or investigation findings.
    • You will sometimes need to interpret XRays, ECGs, pictures or rashes, eyes etc
    • The exam runs for 4 hours

Some tips for doing the exam from past registrars:

• The Written Exam
  • Applied Knowledge Test (MCQs & EMQs):
    • There are so many questions, you can get a high number incorrect and still pass, so don’t let yourself lose concentration or feel depressed of you don’t know all the answers or feel that some are wrong
    • Work out a timeframe you need to stick to in order to answer all questions, ideally with some time to review difficult questions at the end
    • In EMQs, try to work out your answer first before looking at the supplied answers, so you are not misled
    • Take a ruler with you so you can make sure you circle the right answer to the 150 questions!
  • Key Feature Problems:
    • Make sure you only give the number of answers requested or you will get no points. The only tests that can go together are FBC/ESR
    • These rely on you being able to recognise what key features may discriminate between one disease and another. Keep this in mind when studying and be on the look out for defining features or diagnostic triads, such as those that feature in Murtagh’s General Practice text.
  • The Clinical Exam:
    • It is great to practice the timing of the clinical cases in your study group, complete with someone timing the buzzers, so you can get a feel for how long 8 minutes is and get used to the pace.
    • You can get practice cases from the OER Clinical Cases resource or from other books.
    • Sometimes “real patients” are used, but as their signs must be reproducible for all candidates there are limited things they can use. Often you will be asked to examine a role player, showing your examination technique, or simply to ask for the examination findings.
    • Usually the examiners have prompts to try and bring you back on track if you are straying from what they want, so just as you would listen to what your patients are telling you, listen to the examiner.
    • You may like to make a note to remind yourself to ask about things that are easily forgotten eg vital signs or office tests.
    • You need to take along your own stethoscope and pen, but all other equipment you might be asked to use is in the room. So look around and see what is there and use it if appropriate! Eg of there are scales you might want to weight the patient.
  • General Tips:
    • Obviously, the written exam will be a VERY long day, so make sure you are well rested and have sustenance for the day.
    • Be reassured by the fact that unlike some specialty exams, Registrars that are part of a training program have a high pass rate, thought to be due to the quality of the education provided by the RTPs.
  • Enrolling for the exam (usually close approx 2 months prior to the exam):
    • All of the information you need to about enrolling for the exam can be round on the RACGPs website and in their “Assessment Handbook For Candidates” http://www.racgp.org.au/exam
    • You can get this and the enrolment pack sent out via the post by contacting the Faculty in your state: http://www.racgp.org.au/exam/enrolments
    • You must check that you are eligible to sit the exam. This includes:
      • Having completed 8 active units of training including your Basic and Advanced Term. Evidence of this must be submitted and can be obtained from your RPT – don’t forget to give tem some warning
      • You must be a financial member by the closing date for enrolments. http://www.racgp.org.au/membership/
      • Completing a Basic CPR Course in the 12 months before the close of enrolments.
      • Having Current Medical Registration with your state Board.
  • Useful Courses:
    • Many RTPs provide exam preparation workshops. Check with your RLO (Registrar Liason Officer) or Medical Educator.
    • The RACGP run Pre-Exam Workshops, either as a 19 week program or over a weekend. You can purchase DVDs of these presentations if you are unable to attend. http://www.racgp.org.au/exam/workshops
    • A video “snapshot” of the exam is available for $10 from the RACGP assessment department by calling 1800 626 901.