Get the best RACGP KFP exam technique tips from direct analysis of the 2017.2 Public Exam Report in order to maximise your chances of obtaining the best score possible within the RACGP KFP Exam.

RACGP KFP Exam Technique Tip # 1 – Be Correct (9)

Goes without saying, but was the most common mistake. Read, know stuff, in detail. 

  • Question 4
    • Likewise, when considering the treatment of the lesions, candidates cited management options that were inappropriate when managing basal cell carcinomas.
  • Question 5
    • The investigation question specified initial investigations, with the most common error being to select secondary investigations, or investigations that were not relevant given the history provided, such as selecting serum prolactin when the history was not suggestive of a prolactinoma, in preference to other more common causes of sub-fertility.
  • Question 9
    • Candidates frequently failed to identify the restrictive pattern demonstrated in the spirometry.
  • Question 17
    • Candidates often did not show an understanding of time sequence of investigations and provided investigations that formed at later stages of the investigation process
  • Question 19
    • A common error was to assume that, given the patient had intellectual disability, she would have mental health issues and would therefore require a mental health care team to assist in history. Many candidates did not seek to ask the patient herself. While she may have minimal verbal communication, this is not a reason not to approach the patient.
  • Question 20
    • The final question requested non-pharmacological strategies to assist in ongoing management. This was not answered as well, with candidates providing either pharmacological advice or nonspecific advice, such as the commencement of vitamin D supplementation.
  • Question 24
    • The common errors in this case centred on not identifying red flag symptoms and providing only cardiovascular causes of the patient’s presentation …
  • Question 25
    • Candidates were required to provide differential diagnoses and appropriate investigations.
      Despite the information given, candidates generated differential diagnoses that would have provided dermatological signs on examination.

RACGP KFP Exam Technique Tip # 2 -Consider The Context (8)

The common theme was to consider the context of the case and of general practice.

  • Question 1
    • When looking at the possible differential diagnoses, candidates failed to answer within the context of the case and listed all causes demonstrated by the liver function results, or described the results rather than providing a diagnosis.
  • Question 2
    • In the investigation question, as with many of the investigation questions within the paper, candidates chose tests that would not assist in honing their diagnosis, but instead, selected those investigations that commonly form part of batch or baseline testing, such as full blood count, C-reactive protein, erythrocyte sedimentation rate, urea and electrolytes, liver function tests, and urine microscopy and culture. It is important that investigations are chosen rationally and are appropriate to the question.
  • Question 4
    • A common error in responding to the question of risk factors was to provide details of the lesions, such as size or progression rather than in the history as requested.
    • They also discussed long-term prevention of skin cancer rather than the management of the specific lesions shown in the clinical photograph. It is important when completing the KFP exam that candidates read the question and carefully review their answers in order to ensure the actual question has been addressed.
  • Question 5
    • The most common errors in this case centred on not reading the question and providing answers relating to a generic pre-conception consultation rather than a sub-fertility consultation.
    • It is important for candidates to consider all of the information provided in the clinical scenario, as it is pertinent to the subsequent questions.
  • Question 11
    • The suicide risk assessment was done well by the majority of candidates. The main sources of error were providing answers that would help explore her low mood, but that were not specific to assessing suicidal risk, and repeating information already provided in the case.
  • Question 13
    • The most common errors seen in this question were providing a list of all causes of shortness of breath and not focusing on the information provided, as well as providing non-specific answers. When considering which investigations to include, it is important to read the question; in this case, initial investigations were required to address the causes for the acute shortness of breath, not ongoing outpatient investigations such as stress echocardiography. Candidates need to consider which investigations will give the best return on information to assist in diagnosis, rather than selecting what are often seen as ‘baseline’ investigations.
  • Question 15
    • The KFP exam is assessing management in the context of a general practice environment. As such, when providing immediate management it is important to ensure that answers are contextualised for general practice.
    • In this case, many of the answers provided appeared to be emergency-department-focused, such as attempting to obtain intravenous access. The other common errors were not providing immediate management and failure to recognise the urgency of the situation; answers relating to reassuring the mother or educating about epiglottitis, or arranging follow-up. While these are important aspects, they did not address key elements of immediate management in general practice and thus did not properly address the question.
  • Question 22
    • The common error in this question was to not read the scenario and identify the support that was already in place in the form of family, community and Aboriginal health workers, and provide these all as a ‘rote list’ without considering the information. No mark was given for repeating information given in the case scenario.

RACGP KFP Exam Technique Tip # 3 -Be Specific and Detailed (8)

Be as specific as you can. This leads into the amount of knowledge that you have, but this is the chance to demonstrate that knowledge. It sometimes conflicts with the need to be broad, particularly when you’re not sure what level to pitch the answer at. 

  • Question 3
    • The question requested specific management, namely the appropriate dosing regimen for acute management, not merely providing the drug name.
    • While naming the drug would have gained marks, providing the appropriate regimen for each management option resulted in a higher score.
    • When referring to another health professional, candidates should consider outlining the nature and urgency of the referral.
    • In the non-pharmacological management component of this case, candidates …provided vague, non-specific answers, such as provide education or refer to various allied health professionals, without specifying the content of the education or the purpose of the referral.
  • Question 4
    • Candidates needed to be specific in their diagnosis, therefore answers such as ‘skin cancers’ or ‘sun damage’ did not score.
  • Question 10
    • The question asked for specific abnormal findings on the ECG, not diagnoses. In order to identify the changes, candidates needed to provide the specific abnormalities shown in the ECG, including the leads in which the changes can be seen. Answers such as ‘ST elevation’ or ‘PR depression’ could provide very different diagnoses depending on their location.
    • Candidates who provided less specific answers such as these were still awarded marks, but to a lesser degree than those who were specific in their responses.
  • Question 14
    • When responding to a question that asks for specific pharmacological management, simply listing medications or providing non-specific answers such as ‘titrate medication’, ‘maximise dose’ or ‘add diuretic’ will not gain marks. This was the most common error in this question and the primary reason candidates did not score well.
  • Question 20
    • The final question requested non-pharmacological strategies to assist in ongoing management. This was not answered as well, with candidates providing either pharmacological advice or nonspecific advice, such as the commencement of vitamin D supplementation.
  • Question 23
    • While the differential diagnosis was covered well by most candidates, common errors in this case centred on nonspecific answers for the management component. Writing ‘eradication’ or ‘antacids’ as an answer would not score, given the question asked for specific management strategies. A good answer constituted specific pharmacological strategies and addressed lifestyle issues raised in the clinical scenario.
  • Question 24
    • The common errors in this case centred o…giving non-specific answers such as reduced fitness or weight gain, despite the scenario stating he had lost weight. The information in the scenario is both relevant and consistent with the expected answers.
  • Question 25
    • The most common errors in this section of the case were to offer further diagnoses rather than investigations, or providing non-specific investigations such as ultrasound, biopsy or computed tomography (CT) scan without specifying further details

RACGP KFP Exam Technique Tip # 4 -Avoid Grouping Answers(4)

A common mistake is to write medications from the same class on different lines in management, and the same answer described differently in diagnoses

  • Question 3
    • The most common error in this case was not listing the range of management options, but focusing on three different nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Question 10
    • The final question in this case focused on pharmacological strategies for smoking cessation. It is important when responding to questions to consider how to group answers, in this case, providing two nicotine replacement strategies would not provide maximum marks. The patient has a history of epilepsy, so providing medication that may increase seizures did not score.
  • Question 12
    • This case identified the need to consider how answers are grouped when considering pain management.
    • Candidates who provided a list of different opiates or different NSAIDs did not score optimum marks. It is important to consider the range of management options and provide options from different drug classes. The final component of this case focused on planning for future care in the event the patient is not able to make his own decisions.
  • Question 18
    • Common errors in this question included providing similar answers over two lines, such as ‘premature ovarian failure’ and ‘early menopause’, or ‘pituitary adenoma’ and ‘prolactinoma’. Candidates only gained one mark in such an instance. It is important candidates are specific in their answers, and responses such as ‘pituitary axis failure’ are too broad and are not a diagnosis, but cover a range of specific diagnoses

RACGP KFP Exam Technique Tip # 5 – Don’t Repeat Information discussed in the stem (4)

If its in the stem, don’t repeat it, unless its specifically requested. 

  • Question 11
    • The suicide risk assessment was done well by the majority of candidates. The main sources of error were …. repeating information already provided in the case.
  • Question 19
    • In providing differential diagnoses, it was a common error to enquire about information already provided in the scenario. For example, asking about medication side effects or interactions when the scenario stated that patient is on no medications, or enquiring about hearing aid problems when there is no mention of hearing difficulties in the scenario. Candidates should utilise the information in the scenario and not create and then solve problems that are
      not listed.
  • Question 21
    • In this case, the common errors were to repeat information in the scenario, make assumptions about the patient’s exposure to illnesses due to her name, and to provide symptoms when asked for examination findings.
  • Question 22
    • The common error in this question was to not read the scenario and identify the support that was already in place in the form of family, community and Aboriginal health workers, and provide these all as a ‘rote list’ without considering the information. No mark was given for repeating information given in the case scenario.

RACGP KFP Exam Technique Tip # 6 – Pitch at the Right Level (Think Broadly) (4)

This is the one I personally always struggled with, it sounds easy but depending on the wording of the question vs your knowledge on that topic, can be difficult. It can also conceptually conflict with the need to be specific. 

  • Question 4
    • A common error in responding to the question of risk factors was to provide details of the lesions, such as size or progression rather than in the history as requested, or providing a list of different types of sun exposure rather than thinking broader and considering the range of risk factors.
  • Question 5
    • Another common error was to focus solely on the patient’s symptomatology of polycystic ovarian syndrome, rather than considering additional diagnoses underlying a failure to conceive.
  • Question 26
    • Quality answers looked at the range of presentations possible rather than just neurological presentations, and considered causes such as cardiovascular, metabolic psychological and possible substance misuse. The most common error was to list different forms of epilepsy and not consider a broader range of possibilities.
    • The second question in the case required candidates to identify key features in a history with this presentation that assist in establishing a diagnosis. Candidates needed to appreciate the range of possible causes and their underlying distinctive clinical features to elicit in the patient’s history. Had the candidate focused solely upon different forms of epilepsy in the first question, and thus only focused upon on a neurological history in the second question, this would not have provided optimum marks
  • Question 15
    • When providing differential diagnoses, it is important to provide specific diagnoses rather than a list of causative organisms given that they may cause a range of symptoms or diagnoses.

RACGP KFP Exam Technique Tip # 7 – Don’t Overcode (3) (Still the Most Important)

The classic trap. You lose 0.25% of your overall mark with every overcode. and with tight spreads, can mean the difference between success and failure. 

  • Question 8
    • Another common error was to provide explanations of answers which formed lists of responses on each line, which led to candidates being penalised for providing extra responses.
    • The new exam support modules provided by gplearning address the issues of ‘over-coding’ (ie too many answers provided). These modules provide candidates support and advice on how to approach all the RACGP Fellowship assessments by using recent exam cases. The two KFP modules explore the different style of KFP cases and take the candidate through each of the questions with correct responses, common errors and methods for avoiding them.
  • Question 9
    • In providing diagnoses, the most common errors were … listing diagnoses on each line that then led to penalties for over-coding. If candidates provide lists, use words like ‘and’/‘or’, or use forward slashes or commas, then they are providing lists and therefore extra responses, which are penalised.
  • Question 14
    • When a question asks for lifestyle factors contributing to uncontrolled hypertension, providing pharmacological causes will not score. It is important to read the question and provide answers that address the question, as well as ensuring answers are not grouped. Writing ‘smoking’ and ‘alcohol’, or ‘high-fat diet’ and ‘high-salt diet’ on one line is providing more than one answer and will thus lead to over-coding penalties.

RACGP KFP Exam Technique Tip # 8 -Read the Question (2)

Read the question and answer the actual question, not another question.

  • Question 14
    • When a question asks for lifestyle factors contributing to uncontrolled hypertension, providing pharmacological causes will not score. It is important to read the question and provide answers that address the question, as well as ensuring answers are not grouped. Writing ‘smoking’ and ‘alcohol’, or ‘high-fat diet’ and ‘high-salt diet’ on one line is providing more than one answer and will thus lead to over-coding penalties.
  • Question 22
    • Other common errors included candidates listing reasons as to why the patient’s care may not have been appropriate in hospital and the issues of that environment, rather than those faced in the home environment. This reinforces the need to carefully read the case and its questions.

RACGP KFP Exam Technique Tip # 9 -Take all the information in the stem into account (2)

If theres info in the stem, its probably important. 

  • Question 1
    • The most common error within this case was not taking all of the information into account and missing the details of the patient’s excessive use of paracetamol.
  • Question 11
    • In providing appropriate medication, candidates needed to take all of the information in the question into consideration, such as the fact the patient was taking tramadol. Candidates should therefore not prescribe medication that would interact and cause possible harm. The question also required specific dosing in addition to naming the drug chosen, and providing both name and dose regimen gained more marks than the name alone.

RACGP KFP Exam Technique Tip # 10 – Don’t Invent (2)

Again this can conflict with the need to be specific vs broad, and is easier said than done.

  • Question 3
    • In the non-pharmacological management component of this case, candidates recommended that the patient quit smoking, when there was no history of smoking.
  • Question 16
    • The most common errors were the failure to hypothesise appropriate differential diagnoses given the pattern of presentation, and to ask about aspects of history that were irrelevant, such as PR bleeding, given that the stem clearly indicated that there were no bowel or urinary symptoms.
    • In the case scenarios within the KFP exam, it is common to state that there is no past medical history of note. Consequently, any answers exploring a history of previous illnesses or, for example, enquiring about a history of asthma will not score marks. This was a common issue across the whole KFP exam paper.

RACGP KFP Exam Technique Tip # 11 – Be Safe (1)

There’s probably at least one question that will have a safety trap in it, be aware of it as you may get zero for that question or even the overall question. 

  • Question 15
    • In assessing and managing the child, the most serious diagnosis of epiglottis must always be considered. Therefore, anything that may distress the child and put the airway at risk during examination, such as examining the throat, caused the candidate to score zero for that question, but not the whole case. It is reassuring that the vast majority of candidates identified epiglottitis as a possible differential diagnosis and did not attempt to assess the airway.
    • The KFP exam may contain questions where answers are possibly considered dangerous, and such answers will result in a candidate score of zero for that question.