Past Exam Questions gathered from Public reports:

CCE cases (118)
- cce-allergy (1)
- cce-atsi (8)
- cce-cardio (8)
- cce-derm (5)
- cce-endocrine (7)
- cce-gastro (8)
- cce-geris (10)
- cce-gpland (18)
- cce-men (8)
- cce-msk (10)
- cce-neuro (3)
- cce-ong (12)
- cce-opthal (1)
- cce-paeds (15)
- cce-psyh (8)
- cce-resp (9)
- cce-rural (5)

1. Purpose of the CCE

The RACGP CCE assesses:

Clinical competence
Readiness for independent GP practice
Application of clinical reasoning in real-world scenarios
Integration of communication, management, professionalism, and safety

The exam evaluates competency across multiple domains aligned with the RACGP Curriculum.

2. Exam Structure

Overall Structure

Nine Cases Across Two Days

Two case types:

Case Type	Format
Case Discussions (CBD)	Examiner discussion via Zoom
Clinical Encounters (CE)	Role-player consultation observed by examiners via Zoom

Timing Structure

Component	Time
Reading time	5 minutes
Case time	15 minutes

Reading Time

Use to:

identify task
identify key risks
form differential diagnoses
plan consultation structure

Case Time

Demonstrate:

communication
clinical reasoning
structured management
patient-centred care
professionalism
safety

3. Approximate Weighting of Competencies

Competency	Approximate weighting
Communication & consultation skills	28%
Clinical management & therapeutic reasoning	21%
Diagnosis, decision-making & reasoning	15%
Preventive & population health	12%
Clinical information gathering & interpretation	9%
Professionalism	7%
GP systems & regulatory requirements	6%
Procedural skills	1%
Managing uncertainty	1%

4. High-Yield Exam Principles

Core Principles

Communication and consultation skills carry the highest weighting.
Clinical management reasoning is also heavily weighted.
Every consultation should demonstrate:
- rapport
- empathy
- structure
- patient-centred care
- safe management
- clear follow-up
Safety-netting is essential.
Shared decision-making is expected.
Time management matters — focused consultations score better.

5. The CCE is a “Tick-Box” Competency Exam

Examiners assess whether competencies are demonstrated clearly.

Candidates must demonstrate:

communication
reasoning
management
professionalism
prevention
organisation
safety

Important Principle

Do NOT:

hyperfocus on one diagnosis
spend too long on one section
give scattergun answers

Each case tests multiple competencies simultaneously.

6. Structure (15 Minutes)

6A. Clinical Encounter (CE) Structure

What is a Clinical Encounter?

Candidate interacts directly with a role-player patient.
Examiner observes silently.
Candidate manages the consultation independently.
Simulates a real GP consultation.

Core Focus of CE Cases

Clinical Encounters primarily assess:

communication
rapport-building
consultation structure
patient-centredness
explanation skills
counselling
shared decision-making
safe management

CE Consultation Flow (15 Minutes)

Phase	Suggested Time	Main Goals
Opening	1 min	Rapport, agenda, ICE
Focused history	5–6 min	Symptoms, red flags, context
Examination discussion	1–2 min	Explain exam + rationale
Differential diagnoses	1–2 min	Likely + serious diagnoses
Investigations	2–3 min	Rationalised testing
Management	4–5 min	Immediate + long-term care
Safety-net & closure	Final minute	Follow-up + red flags

What Examiners Look For in CE Cases

Communication

empathy
active listening
non-verbal communication
plain language
rapport

Patient-Centredness

addressing ICE
shared decision-making
considering psychosocial factors
acknowledging patient concerns

Consultation Structure

organised flow
logical transitions
signposting
prioritisation

Example:

“I’d like to ask more about the chest pain first, then we’ll discuss management.”

Explanation Skills

Candidates should:

explain diagnoses clearly
avoid jargon
check understanding
use teach-back

Safety-Netting

Always include:

red flags
review timeframe
escalation advice

Common CE Pitfalls

Poor Rapport

robotic consultation
excessive interruption
lack of empathy

Missing ICE

Failure to explore:

patient ideas
concerns
expectations

Running Out of Time

Caused by:

excessive history-taking
poor prioritisation
getting stuck on one symptom

Poor Explanation Skills

medical jargon
overcomplicated explanations
failure to confirm understanding

Lack of Shared Decision-Making

Avoid:

paternalistic management
generic plans

High-Yield CE Strategies

Early Rapport

First 1–2 minutes matter heavily.

Verbalise Structure

Example:

“First I’ll ask some questions, then discuss what I think may be happening and outline a plan.”

Use Signposting

“Now I’d like to ask about…”
“Next I’ll discuss management…”

Time-Box Yourself

Avoid:

10-minute histories
delayed management discussion

Prioritise Safety

Always:

identify red flags
explain escalation
safety-net

6B. Case Discussion (CBD) Structure

What is a Case Discussion?

Discussion with examiner via Zoom.
Examiner actively asks questions.
Candidate explains reasoning and management.
Less emphasis on rapport; more emphasis on clinical reasoning and structure.

Core Focus of CBD Cases

Case Discussions primarily assess:

clinical reasoning
diagnostic thinking
investigation selection
management planning
prioritisation
safe GP decision-making
structured answers

Typical CBD Question Areas

Examiners commonly ask:

What further history would you take and why?
What are your differential diagnoses?
What examination findings would you look for?
What investigations would you order and why?
How would you manage this patient?
What are the red flags?
What are the psychosocial considerations?

Structured CBD Answer Framework

History

Structure:

presenting complaint
red flags
risk factors
relevant systems review
psychosocial context

Always explain WHY.

Example:

“I’d ask about weight loss because malignancy is a possible cause.”

Examination

Structure:

targeted examination
expected findings
rationale

Example:

“I would assess for focal neurological deficits to evaluate for stroke.”

Differential Diagnoses

Always structure as:

Most Likely

Serious Must-Not-Miss

Alternative Diagnoses

Investigations

Structure:

bedside/basic
first-line
confirmatory
specialist investigations

Explain:

why
how results affect management

Management

Structure:

Immediate

Short-Term

Long-Term

Preventive Care

Follow-Up & Safety-Netting

What Examiners Look For in CBD Cases

Structured Clinical Reasoning

logical flow
prioritisation
justification of decisions

Rational Investigations

Avoid:

scattergun investigations
unnecessary tests

Safe Management

Demonstrate:

escalation awareness
red-flag recognition
follow-up planning

Evidence-Based PracticeUse:

guideline-consistent management
realistic GP management plans

Pragmatic GP Thinking

Examiners want:

realistic primary-care management
not specialist-level over-investigation

Common CBD Pitfalls

Scattergun Answers

Listing multiple unrelated diagnoses/tests without reasoning.

No Prioritisation

Failing to distinguish:

likely diagnoses
dangerous diagnoses
incidental findings

Over-Investigation

Ordering:

excessive imaging
irrelevant blood tests
specialist tests prematurely

Failure to Explain Reasoning

Candidates lose marks if they:

state actions without rationale

Poor Structure

Chaotic answers reduce clarity and examiner confidence.

High-Yield CBD Strategies

Use Structured Frameworks

Example:

history
examination
differentials
investigations
management

Explain WHY

Always justify:

questions
investigations
management decisions

Prioritise Safety

Demonstrate awareness of:

emergencies
deterioration
escalation

Think Like a GP

Management should be:

safe
realistic
community-based
patient-centred

Verbalise Clinical Reasoning

Example:

“Pulmonary embolism is less likely because there is no pleuritic pain or tachycardia, but it still needs consideration due to the dyspnoea.”

6C. Clinical Encounter vs Case Discussion – Key Differences

Feature	Clinical Encounter (CE)	Case Discussion (CBD)
Main interaction	Role-player patient	Examiner
Consultation style	Real GP consultation	Structured discussion
Candidate control	Mostly candidate-led	Examiner-guided
Main focus	Communication & patient-centred care	Clinical reasoning & decision-making
Rapport importance	Extremely high	Moderate
Explanation skills	Critical	Important
Diagnostic reasoning	Important	Very heavily weighted
Structured answers	Important	Essential
Time pressure	Consultation flow	Rapid reasoning
Shared decision-making	Major focus	Discussed conceptually
ICE exploration	Essential	Less central
Common pitfall	Running out of time	Scattergun answers
High-yield skill	Rapport + structure	Structured reasoning

7. Reading-Time Framework (5 Minutes)

Step 1 — Clarify the Task

Identify exactly what is required:

history
counselling
management
examination discussion
differential diagnosis
explanation

Step 2 — Identify Context

Immediately note:

age
sex
Aboriginal and Torres Strait Islander status
rurality
psychosocial factors
chronic disease
vulnerability

Step 3 — Generate Differentials

Structure:

most likely
dangerous diagnoses
alternatives

Step 4 — Identify Red Flags

Ask:

what could seriously harm or kill this patient?
what cannot be missed?

Step 5 — Plan Consultation Flow

Mentally structure:

opening
history
examination
investigations
management
follow-up

8. Communication Skills

Communication Skills Expected

Candidates should demonstrate:

Active listening
Empathy
Clear explanations
Appropriate non-jargon language
Adaptation to health literacy and sociocultural context
Addressing:
- patient ideas
- concerns
- expectations
Managing difficult conversations appropriately
Motivational counselling and behaviour-change strategies
Shared decision-making
Focused consultation structure
Prioritising both patient and doctor agendas
Clear follow-up and safety-netting plans

Opening the Consultation

Build Rapport

Introduce yourself
Use patient’s name
Maintain eye contact
Calm tone and posture

Agenda Setting

Examples:

“What’s the main thing worrying you today?”
“What were you hoping we could achieve today?”

ICE Framework

Ideas

“What do you think is going on?”

Concerns

“What worries you most?”

Expectations

“What were you hoping I could do today?”

9. Clinical Information Gathering

Strong Candidates

Take systematic histories
Perform focused examinations
Identify significant positives and negatives
Differentiate important findings from incidental findings
Use information to guide diagnostic reasoning

Common Mistakes

Missing important red flags
Poorly targeted history-taking
Inadequate examination technique
Failing to interpret significance of findings

Structured History Framework

Open → Focused Questions

Begin broad, then narrow.

Symptom Analysis

Use:

SOCRATES
HEADSSS
Functional impact
Red flags

Always Include

PMHx
medications
allergies
family history
social history
smoking/alcohol/drugs
occupational risks

Functional Impact

Assess:

work
sleep
exercise
relationships
ADLs
mental health

10. Problem Representation

Structured Problem Representation Framework

Component	Focus
Who?	age, sex, risk factors
When?	duration, tempo
What?	syndrome

Example

“65-year-old smoker with COPD presenting with worsening dyspnoea and productive cough over 4 days.”

11. Diagnosis, Decision-Making and Reasoning

Strong Candidates

Use logical differential diagnosis frameworks
Prioritise likely and dangerous diagnoses
Order appropriate investigations strategically
Apply evidence-based reasoning

Common Pitfalls

Over-investigating
Ordering unnecessary tests
Weak clinical reasoning
Overreliance on investigations rather than clinical judgement

Differential Diagnosis Structure

Most Likely

Supported by:

epidemiology
positives
risk factors

Serious Must-Not-Miss

Potentially:

life-threatening
time-critical

Alternative Diagnoses

Other reasonable possibilities.

Use VINDICATE if Stuck

Letter	Meaning
V	Vascular
I	Infection
N	Neoplasm
D	Degenerative/drugs
I	Iatrogenic
C	Congenital
A	Autoimmune
T	Trauma
E	Endocrine/metabolic

12. Examination Discussion

State:

what you would examine
why
what findings matter

Example

“I would assess for clubbing and cachexia as these may suggest chronic malignancy.”

13. Investigation Structure

Initial Investigations

bedside tests
urgent investigations
screening tests

Secondary Investigations

confirmatory
specialist
advanced imaging

Rationalise Every Test

Explain:

why you are ordering it
how it changes management

Example:

“ECG to assess for arrhythmia as reversible cause.”

14. Clinical Management

Good Management Plans Should

Be holistic
Incorporate patient preferences
Consider psychosocial context
Be realistic and achievable

Include:

treatment
follow-up
escalation advice
preventive care

Common Mistakes

Unrealistic plans
Ignoring adherence barriers
Ignoring patient priorities
Missing preventive opportunities

Management Framework

Immediate / Acute

stabilisation
symptom relief
escalation

Short-Term

medications
investigations
referrals
review

Long-Term

chronic disease management
preventive care
lifestyle modification
monitoring

Management Content

Pharmacological

Include:

medication
dose
side effects
counselling

Non-Pharmacological

lifestyle
psychology
physiotherapy
education
allied health

Preventive Care

smoking cessation
alcohol reduction
vaccinations
screening
cardiovascular risk

Shared Decision-Making

Discuss:

patient preferences
affordability
adherence barriers
cultural considerations

15. Preventive and Population Health

Expected Skills

Opportunistic screening
Lifestyle counselling
Risk-factor modification
Vaccination advice
Early intervention strategies

Commonly Missed

Preventive counselling
Screening recommendations
Cardiovascular risk management
Smoking/alcohol discussions

16. Safety-Netting

Safety-Netting Structure

Red Flags

“If you develop worsening chest pain or shortness of breath, present to ED immediately.”

Review Plan

“I’d like to review you in 48 hours.”

Confirm Understanding

“Can you tell me what the plan is from here?”

17. Managing Multiple Concerns

Acknowledge

“I can see there are several important concerns today.”

Prioritise

“What is the most important issue for us to focus on first?”

Negotiate Follow-Up

“We’ll address the chest pain today and review the fatigue next week.”

18. Professionalism

Expected Competencies

Candidates are expected to demonstrate:

Respect
Confidentiality
Ethical practice
Informed consent
Cultural safety
Appropriate boundaries

Pitfalls

Cultural insensitivity
Poor handling of ethical dilemmas
Inadequate confidentiality awareness

19. Managing Uncertainty

Strong Candidates

Acknowledge uncertainty safely
Explain provisional diagnoses
Use staged investigation/management
Provide clear review plans
Avoid overtesting

Weak Candidates

Become defensive
Over-investigate
Overtreat
Fail to safety-net

Example Phrase

“There are several possible causes. We’ll begin with these tests and reassess once results return.”

20. Identifying the Seriously Ill Patient

Candidates Must Rapidly Identify

Red flags
Clinical deterioration
Emergencies
Need for escalation

Expected Actions

Stabilisation
Prioritisation
Emergency referral
Appropriate urgency

Critical Pitfall

Delayed recognition of serious illness

21. Aboriginal and Torres Strait Islander Health

Expected Competencies

Culturally safe communication
Respectful engagement
Holistic understanding of health
Awareness of health inequities
Avoidance of stereotyping

Important Principles

Avoid:

assumptions
stereotyping
formulaic responses

22. Rural Health

Candidates Should Understand

Resource limitations
Access barriers
Transport/logistical issues
Telehealth use
Pragmatic management approaches

Common Pitfall

Unrealistic metropolitan-style management plans

23. Practical CCE Strategy

During the Case

Build rapport early
Clarify agenda
Use structured history
Actively identify red flags
Verbalise reasoning
Prioritise problems
Address patient concerns
Explain management clearly
Include preventive care where relevant
Safety-net every case
Arrange clear follow-up

Avoid

Tunnel vision
Excessive detail on one issue
Over-ordering investigations
Ignoring psychosocial context
Forgetting safety-netting
Running out of time before management discussion

24. Common Pitfalls

Pitfall	Better Approach
Scattergun answers	Structured reasoning
Missing ICE	Ask early
Tunnel vision	Broaden differentials
Over-investigating	Rationalise tests
Poor time management	Time-box consultation
Missing safety-netting	Always provide red flags
Formulaic responses	Individualise care
Cultural assumptions	Patient-specific approach

25. Practical Performance Tips

Communication

steady eye contact
active listening
calm pacing
empathy
avoid jargon

Technology

stable internet
backup hotspot
Zoom familiarity
dual screens if possible

Practice Strategy

timed mock cases
peer feedback
video review
deliberate practice in weak areas

26. Exam Marking

Borderline Regression Method

RACGP CCE uses borderline regression marking.

Examiner Global Ratings

Examiners provide a global performance rating:

clearly below standard
below expected standard
borderline
at expected standard
above standard

Goal

Avoid borderline performances
Demonstrate competence consistently across domains

Candidates can fail some stations and still pass overall, but consistent performance is safest.

27. Final High-Yield Takeaways

What Examiners Want

Candidates who:

communicate clearly
structure consultations well
identify serious illness
demonstrate safe reasoning
explain management logically
show empathy
prioritise appropriately
safety-net consistently

Ultimate CCE Formula

Rapport + Structure + Safety + Reasoning + Patient-Centredness = Pass

Final Exam Mindset

Aim to demonstrate:

safe GP practice
organised thinking
patient-centred communication
realistic management
calm professionalism

Not perfection.