Clinical Competency Examination (CCE)

1. Purpose of the CCE:
   • The CCE assesses clinical competence and readiness for independent practice as a specialist General Practitioner (GP).
   • It evaluates how candidates apply their knowledge and clinical reasoning skills across various clinical scenarios (referred to as “cases”).
   • The exam covers a range of competencies aligned with the RACGP Curriculum for Australian General Practice.
2. Skills Assessed:
   • Candidates must demonstrate clinical skills, communication skills (including inter-professional and patient-centered communication), and professional attitudes within the context of each case.
3. Exam Structure:
   • The CCE consists of nine cases, delivered in short sessions over two days.
   • There are two types of cases:
     1. Case Discussions:
        • Connected to examiners via Zoom.
        • Candidates have five minutes to read case information and instructions.
        • 15 minutes of exam time to discuss the case, with possible prompting and probing questions from examiners.
     2. Clinical Encounters:
        • Connected to role-players via Zoom, observed by examiners.
        • Candidates have five minutes to read case information and instructions.
        • 15 minutes of exam time to interact with the role-player, demonstrating active listening and appropriate communication
   • The exam is conducted entirely remotely via Zoom.
   • Both types of cases (case discussions and clinical encounters) are mixed over the two exam days.
4. Preparation and Reflection
   • Case Development:
     • Cases are developed by experienced GPs using real patient encounters and aligned with the RACGP Curriculum.
     • Reviewed and approved by QA examiners and the Council of Censors.
   • Performance Assessment:
     • Examiners rate performance using a four-point Likert scale from ‘competency not demonstrated’ to ‘competency fully demonstrated’.
     • Candidates are assessed by different examiners across stations to ensure broad sampling and minimize bias.

Competency Areas

1. Communication and Consultation Skills:
   • Focus on patient-centered communication, empathy, sensitivity, and appropriate explanation of diagnoses or management plans.
   • Effective communication, especially in difficult consultations, is emphasized.
2. Clinical Information Gathering and Interpretation:
   • Gathering, interpreting, and using information from history, clinical records, physical exams, and investigations.
   • Hypothesis-driven information gathering to confirm or exclude likely diagnoses.
3. Diagnosis, Decision-Making, and Reasoning:
   • Structured approach to making diagnoses and decisions.
   • Demonstration of accurate reasoning and reflection on decision-making processes.
4. Clinical Management and Therapeutic Reasoning:
   • Management of common, serious, urgent, and chronic conditions.
   • Patient-centered management plans and therapeutic reasoning.
5. Preventive and Population Health:
   • General practice care that supports effective use of the healthcare system.
   • Disease prevention, health promotion, and management of public health issues.
6. Professionalism:
   • Knowledge of ethical principles, duty of care, and maintaining therapeutic boundaries.
   • Openness to feedback and willingness to change.
7. General Practice Systems and Regulatory Requirements:
   • Understanding of primary care organization, statutory, and regulatory requirements.
   • Effective use of administration, IT systems, record keeping, and clinical handover.
8. Procedural Skills:
   • Appropriate diagnostic and management procedures considering benefits, evidence, risks, and costs.
   • Demonstration of a range of procedures suitable for general practice.
9. Managing Uncertainty:
   • Structured approach to managing undifferentiated conditions and associated uncertainties.
   • Rational and balanced choice of investigations.
10. Identifying and Managing the Patient with Significant Illness:
    • Early identification and management of potentially life-threatening conditions.
11. Aboriginal and Torres Strait Islander Health Context:
    • Culturally appropriate communication and understanding of social, cultural, and trauma impacts.
    • Optimizing health outcomes through effective management.
12. Rural Health Context:
    • Understanding general practice in rural and remote settings.
    • Ethical management of therapeutic boundaries and appropriate referral pathways.

Candidate Clinical Performance: General Comments

Successful Candidate Traits

• Empathic and Non-Biased Approach: Successful candidates demonstrate empathy and avoid bias in patient management, considering the patient’s unique context.
• Non-Judgemental: Competent candidates maintain a non-judgemental attitude toward all patients, avoiding stereotypes and assumptions.

Common Pitfalls

1. Stereotyping and Assumptions:
   • General stereotyping and making assumptions about patients are inappropriate.
   • A lack of understanding of the individual patient context can lead to incorrect conclusions.
2. Formulaic and Scattergun Responses:
   • Responses that are formulaic or scattergun do not show clinical reasoning or understanding of individual patient needs.
   • A scattergun approach involves addressing multiple potential issues without clear clinical reasoning.
3. Cultural Insensitivity:
   • Assumptions and formulaic responses to specific cultural groups without considering individual circumstances can lead to errors.
4. Lack of Practical Experience:
   • Examiners noted instances where candidates had not previously managed certain types of presentations in practice, leading to a formulaic approach rather than a patient-centered one.
   • Reflecting on and addressing unfamiliar areas of practice is crucial for exam preparation.
5. Invention of Resources:
   • Making up non-existent resources or support groups is unacceptable both in practice and in the clinical exam.
   • Candidates should rely on accurate and available resources.

Recommended Approaches

• Structured and Systematic Approach:
  • A structured and systematic approach helps candidates cover important potential diagnoses and guide their history-taking, examination, investigations, and management.
  • Such an approach ensures that candidates consider all relevant factors and provide thorough, patient-centered care.