2. Purpose of this presentation
To give you an overview of the RACP Divisional Clinical Examination
To explain how the the scoring grid and bands are used.
We will talk about:
The purpose / format of the clinical examination
How pass and fail results are determined
The scoring grid and bands

3. Statement of Purpose of the Clinical Exam
The purpose of the RACP Divisional Clinical Examination is to assess the clinical skills, clinical acumen and interpersonal skills to inform whether trainees have reached the standard for completion of Basic Physician Training.
(TW) Both long case and short case are important. We want candidates to be good at both.

4. Examination Format The Divisional Clinical Exam consists of:
Two (2) Long Cases
Focus on history, clinical examination, synthesis and prioritisation of clinical problems, impact on patient/family, appropriate management plan.
Four (4) Short Cases
Focus on physical examination technique and accuracy, interpretation and synthesis of findings, interaction with patient/family and investigation and management.
Real patient situations.
Two (2) examiners per case.
Each case is rated on a six-point scale (see Purpose and Rubric video on the RACP website). The two examiners mark individually and then come to a consensus score after a discussion.

5. How are pass and fail results determined?
Does the candidate meet the expected standard?
Overall performance across the whole exam
Combination of candidate’s long case scores and short case scores

6. Divisional Clinical Examination
Score Grid Guidelines
The Divisional Clinical Examination must be considered as one examination that includes both Long and Short cases.
The sufficient differences between competencies assessed in the long and short cases mean that a minimum standard must be achieved in at least one long and one short case.
The overlap between competencies assessed means that a weaker performance in one case may be compensated by a stronger performance in another.

7. Considering Long Cases
Long Case #1 Score 1 2 3 4 5 6
Long Case #2 Score
Below Standard
Above Standard

8. Considering Long Cases
Long Case #1 score
Long Case #2 score 1 2 3 4 5 6
Candidates who score less than 3 on both long cases have not demonstrated that they meet the required standard. Therefore, the grid classifies all candidates whose scores for both long cases fall within the 9 squares that include squares 1–3 across and 1–3 down (i.e. scores  of less than or equal to 3 on each long case) as not having passed the examination.
Candidates who score 1 and 4 on each long case respectively also are not classified as meeting the required standard. It has been  determined that a passing score of 4 on one long case does not compensate sufficiently for a score of 1 on the other long case.

9. Combining performance on short cases and long cases…
Balance of performance on all cases.
When looking at short cases, we need to consider:
The number of short cases passed (over 4)
Sum of performance (or ‘Aggregate’) on all four short cases.
Stronger short case (SC) performance should compensate for weaker long case (LC) performance and vice versa

10. Divisional Clinical Examination Banded Model

11. Overview Long cases on axes
Diagonal progression of ‘bands’ differing requirements of short case performance
Poorer long case performance requires better short case performance
The bands are consistent except for long case scores of 3 and 3 as both long cases have not met the standard (so Band 0, not Band 1)
The bands are symmetrical. For example long case scores of (5 and 2) are identical to (2 and 5)

12. Examples
To illustrate how this model works, we have provided a few examples using a 2-step process.
Step 1:
Determine the Band
based on Long Cases
Step 2:
Apply the Band Rules
based on Short Cases

13. Long Case Scores Short Case Scores
Example 1
Long Case Scores
Short Case Scores
5,5
4,4,4,4
Step 1: Determine Band
Band: 4
Step 2: Apply Band Rules
SC Passed: 4
SC Aggregate: 16
Outcome
PASS

14. Long Case Scores Short Case Scores
Example 2
Long Case Scores
Short Case Scores
4,4
4,4,4,4
Step 1: Determine Band
Band: 3
Step 2: Apply Band Rules
SC Passed: 4
SC Aggregate: 16
Outcome
PASS

15. Long Case Scores Short Case Scores
Example 3
Long Case Scores
Short Case Scores
4,4
2,4,2,4
Step 1: Determine Band
Band: 3
Step 2: Apply Band Rules
SC Passed: 2
SC Aggregate: 12
Outcome
FAIL

16. Long Case Scores Short Case Scores
Example 4
Long Case Scores
Short Case Scores
6,3
3,3,2,4
Step 1: Determine Band
Band: 4
Step 2: Apply Band Rules
SC Passed: 1
SC Aggregate: 12
Outcome
FAIL

17. Long Case Scores Short Case Scores
Example 5
Long Case Scores
Short Case Scores
2,4
4,6,5,4
Step 1: Determine Band
Band: 1
Step 2: Apply Band Rules
SC Passed: 4
SC Aggregate: 19
Outcome
PASS

18. Long Case Scores Short Case Scores
Example 6
Long Case Scores
Short Case Scores
3,4
4,2,4,6
Step 1: Determine Band
Band: 2
Step 2: Apply Band Rules
SC Passed: 3
SC Aggregate: 16
Outcome
PASS

19. More information
For more information about the Divisional Clinical Exam and the 2019 rubric see the accompanying video
The 2019 rubric for the Divisional Clinical Examinations in Adult Medicine and Paediatrics & Child Health can be downloaded at: