FACRRM (ACRRM Fellowship) Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for trainees sitting the FACRRM (ACRRM Fellowship) Exam in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 Australasian specialty exams because trainees from each specialty asked us to build for them. The FACRRM (ACRRM Fellowship) Exam curriculum on PRIMEX is maintained against the college's Rural Generalist Curriculum (Version 5.2/2022), with topic mapping reviewed for accuracy.

The exam at a glance

This guide focuses on the StAMPS oral. The ACRRM Fellowship program also includes the MCQ written assessment and workplace-based assessments; see the ACRRM site for the full structure. The FACRRM oral component is the StAMPS, the Structured Assessment using Multiple Patient Scenarios. It is the most distinctive exam in Australian postgraduate medicine because the scenarios are written about, and for, the rural generalist. You answer aloud to an examiner over Zoom, and the format is built to test the way you think under the constraints of a remote post.

StAMPS format

• Eight stations delivered as oral assessments via Zoom (not a written paper)
• 10 minutes of oral assessment per scenario with the examiner via Zoom, with reading time between scenarios
• Three structured examiner questions per station, each anchored to a specific clinical decision and scored 0–7
• Remote oral delivery via Zoom; stations are set in the fictional rural town of "StAMPSville"
• Stations assess clinical reasoning, procedural decision-making, and management under resource limitations
• Each response is graded against examiner marking criteria; the pass mark is standard-set and varies by sitting (the 2025B CGT StAMPS pass mark was 161 of a theoretical maximum of 280, about 57.5%)

Sittings, scheduling and day-of logistics

• Two sittings per year, typically February and August (confirm dates on the ACRRM website close to your run-up)
• Remote oral delivery via Zoom from your own location
• The pass mark is standard-set and varies by sitting (2025B CGT StAMPS: 161 of a theoretical maximum of 280, about 57.5%); performance is judged scenario-by-scenario against examiner criteria, then aggregated
• Have photo ID ready, and confirm your Zoom setup and the equipment specifications listed in the candidate handbook ahead of the sitting
• Recent overall pass rates published by ACRRM have ranged 59 to 71 percent per sitting (70.6% in 2025B, 65.3% in 2024B, 59.3% in 2025A, 59.8% in 2024A); see the ACRRM Public Assessment Reports for the post-sitting examiner reports and current figures

What the college actually tests

The ACRRM Rural Generalist Curriculum (Version 5.2/2022) defines 61 mapped learning objectives across 8 Domains of Rural and Remote Practice. Every StAMPS station traces back to one or more of these objectives, and the eight stations across a sitting are chosen to cover the breadth of the curriculum, not to favour any one area. A single station can pull from emergency medicine, primary care, ATSI health, and ethics simultaneously because that is what a rural generalist day looks like.

The 8 domains are: Expert Medical Care, Primary Care, Secondary Medical Care, Medical Emergencies, Population Health, Aboriginal, Torres Strait Islander and Culturally Diverse Communities, Ethics and Professional Framework, and Geographic and Professional Isolation. The objectives range from focused history-taking and prescribing through to provision of safe care without ready access to specialist support, and use of information technology for diagnosis and remote care.

A handful of clinical clusters appear repeatedly in past papers and examiner reports. These are the highest-yield topic areas based on the curriculum mapping and historical sittings:

1. Rural emergencies and the retrieval decision

Resuscitation in a small ED with limited staff, trauma without CT, paediatric resuscitation by weight, sepsis recognition before pathology returns, and the moment-by-moment retrieval decision with the RFDS or your state retrieval service. The structured judgement around when to stabilise locally, when to transfer, and when to push on with definitive care is tested in nearly every sitting. Anaphylaxis dosing, status epilepticus algorithms, and toxicology (snakebite especially) sit inside this cluster.

2. Procedural medicine and rural anaesthesia

Procedural skills expected of a rural generalist: airway management including RSI and surgical airway, intercostal catheter, lumbar puncture, point-of-care ultrasound including FAST and lung, fracture reduction and splinting, and procedural sedation with ketamine. Rural anaesthesia knowledge sits alongside this for candidates with the AST in anaesthesia. Stations test the indication, the technique, and the troubleshooting plan when something goes wrong without an anaesthetist on site.

3. Aboriginal and Torres Strait Islander health

Cultural safety, the Social and Emotional Wellbeing framework, chronic disease in remote communities, rheumatic heart disease secondary prophylaxis with benzathine penicillin, chronic kidney disease and dialysis access, ear and eye disease in children, and communication through interpreters. ATSI health is integrated across stations rather than siloed; expect cultural context to be embedded in a chronic disease, paediatric, or end-of-life scenario rather than flagged as the main topic. The CARPA Standard Treatment Manual is the canonical resource for clinical management in this domain.

4. Tropical and remote infectious disease

Melioidosis and the meropenem treatment course, dengue and dengue haemorrhagic fever fluid management, Ross River virus, scabies including community-wide treatment, snake envenomation and pressure immobilisation, marine envenomation including box jellyfish and irukandji, strongyloides, and tropical skin infections. Diagnostic and management thresholds shift when imaging and microbiology turnaround are limited. Be ready to describe empirical management while you wait for results that may take days.

5. Obstetrics and women's health in rural settings

Antenatal shared care milestones, risk stratification for transfer, pre-eclampsia and eclampsia with the magnesium sulfate protocol, postpartum haemorrhage drug doses and the surgical option ladder, emergency delivery including breech and shoulder dystocia, ectopic pregnancy management options, and contraception with LARC access in remote communities. Rural obstetrics stations frequently test the transfer decision: when does shared care stop being safe and trigger a referral to a tertiary centre.

6. Mental health, behavioural disturbance, and substance use

Suicide risk assessment in rural males, acute behavioural disturbance with sedation and de-escalation, methamphetamine presentations, alcohol withdrawal with Wernicke prophylaxis, first-episode psychosis with retrieval, and mental health legislation including involuntary treatment and RFDS transfer of detained patients. The legal and logistical context matters as much as the clinical decision; a station can fail you on documentation and transfer planning even if the drug choice is correct.

7. Chronic disease and primary care across the lifespan

Type 2 diabetes with insulin initiation in remote settings, chronic kidney disease staging and dialysis access planning, COPD spirometry and exacerbation management, hypertension targets and stepped therapy, chronic wound care under the CARPA protocols, and aged care services in remote settings. Preventive activities (immunisation, the 715 Aboriginal and Torres Strait Islander health assessment, opportunistic screening) sit inside this cluster and reflect the longitudinal care domain of the curriculum.

Common pitfalls that fail candidates

• Defaulting to a tertiary plan. Stations are set in rural and remote contexts. If you write a management plan that assumes CT, MRI, on-call surgeons, and a haematology lab on site, you have already lost the station. The marking criteria reward management that fits the resources described in the stem.
• Skipping the retrieval decision. Almost every emergency station has a retrieval thread. If you do not address the transfer question explicitly, with a timeframe and a destination, you will lose the marking points for it.
• Vague prescribing. "Give antibiotics" scores zero. "Ceftriaxone 2 g IV daily, plus azithromycin 500 mg IV daily, after blood cultures" scores. Drug, dose, route, frequency, and pre-treatment investigations are part of the marking scheme.
• Missing the cultural safety thread. ATSI health context appears in stations that look like they are about something else. Ignoring SEWB, family involvement, or community structures in your management can cost marks even when the clinical answer is right.
• Single-issue thinking. A rural generalist consults on the whole patient. Stations reward candidates who notice the comorbidity, the medication interaction, the social risk factor, and the safety-netting plan, not just the headline diagnosis.
• Documentation and consent gaps. Telehealth consent, mandatory reporting, capacity assessment, and clinical handover are explicit marking points in stations where they apply. Treat the medicolegal layer as part of the answer, not an optional extra.

A realistic study timeline

The right run-up depends on your full-time-equivalent clinical workload, your current rural exposure, and how comfortable you already are with the breadth of the curriculum. Three sample plans, in rising order of comfort:

Nine-month plan (8 to 10 hours per week)

Suits candidates working full-time clinically with limited dedicated study time, especially those who want to spread procedural and tropical revision across a longer period.

• Months 1 to 3. Read the Rural Generalist Curriculum and walk through one or two domains per fortnight. Build flashcards as you go. Cover the high-yield topics inside each domain rather than every sub-bullet. Aim for two to three short StAMPS-style stems per week, untimed, with the focus on structuring the answer correctly.
• Months 4 to 6. Increase StAMPS volume to four stations per week, mark each one against the model answer, and write down the marking points you missed. Add focused MCQ practice on tropical disease, ATSI health, and emergency drug doses. Start practising the retrieval narrative in your stations.
• Months 7 to 8. Timed StAMPS stations under exam conditions, six per week minimum. Identify two or three weak domains and target them with dedicated study notes. Begin full-paper mocks (eight stations in one sitting).
• Final month. Two full timed StAMPS mocks. Review every missed marking point. Final round of weak-domain polishing. Sleep and wind down for the last 48 hours.

Six-month plan (12 to 15 hours per week)

The standard plan for most candidates. Tight enough to keep momentum, long enough to cover the curriculum properly.

• Months 1 to 2. Walk through every domain. Cover one domain per week. Build a flashcard deck. Two to four StAMPS stems per week, untimed, focused on answer structure.
• Months 3 to 4. Timed StAMPS stems become the main work. Five to seven stems per week, marked carefully. Maintain MCQ volume across rural emergencies, tropical, ATSI, and procedural domains.
• Month 5. First full eight-station timed mock. StAMPS volume scales to eight to ten per week. Begin voice-mode practice for stations you find awkward to think through on the page.
• Final month. Two more full mocks under exam conditions. Final round of weak-domain practice. Polish your retrieval narrative and your prescribing specificity.

Four-month plan (18 to 22 hours per week)

The compressed plan. Doable if you are part-time clinical or have a study leave block. Painful otherwise.

• Month 1. Speed-read the curriculum. Two domains per week. Heavy stem volume from week one (10 stems per week minimum), even untimed.
• Month 2. Timed StAMPS stems daily. MCQ practice continues. Begin full mock papers fortnightly.
• Month 3. Full timed mocks weekly. Marking review every session. Focused work on the two weakest domains.
• Final month. Polish weak areas. Two full mocks in week one and two. Daily short-stem practice. Sleep and wind down.

When to start each component

• Curriculum reading and flashcards: from week one. Your flashcard deck should be growing throughout the run-up, not built in the last month.
• StAMPS stems, untimed: from month two at the latest. The structured-answer style takes practice and is not the same as MCQ work.
• StAMPS stems, timed: from month three. Seven minutes of reading and ten minutes of oral discussion with the examiner via Zoom forces a different kind of decision-making and you need months of reps, not weeks.
• Voice-mode and live oral stations: from month two at the latest. StAMPS is an oral exam, so the bulk of your practice should be spoken aloud once you have the structure down on paper.
• Full eight-station mocks: last six to eight weeks. Earlier than that and you have not covered enough ground for the result to be useful.

Weekly study split that actually works

Most candidates run into trouble because their week is shapeless and the easy work crowds out the work that matters. A simple template that holds up: two timed StAMPS sessions per week of 60 to 90 minutes each, one untimed deep-dive station per week with full marking review, one MCQ session of 60 minutes covering whatever cluster you are weakest on, and one curriculum reading session tied to the same weakness. Flashcards run in the background as ten-minute blocks between patients or on commutes, not as scheduled sit-downs. Protect the timed StAMPS slots the way you protect a clinical commitment; if you let them move, they stop happening.

Track what you got wrong, not what you got right. Keep a running list of missed marking points by domain. After a month you will see two or three domains that come up repeatedly and you can target them directly.

The single biggest mistake people make

You deliver your StAMPS answers like you would dictate a discharge summary. The structured questions feel familiar, you already know how to communicate clinically, and the temptation is to think out loud in the order it occurs to you. That is the most common failure mode I watch trainees make.

StAMPS marking does not reward eloquence; it rewards specific marking points hit in a structured order. If the question asks for differential diagnoses, list them as differentials with risk-stratifying features. If it asks for management, give drugs with doses, investigations with rationale, and a transfer plan with a timeframe. If it asks for what you would say to the patient, say the actual words, not a summary of the conversation. Examiners are listening for specific decisions and phrases; rambling makes the points harder to hear and easier to miss.

The fix is mechanical. Practise structuring every answer with explicit signposting aloud. "Differentials, in order of likelihood." "Immediate management, by category: airway, fluids, drugs, investigations, transfer." "Communication: I would say to the patient..." This costs you nothing in time once you are practised, and it doubles the number of marking points you reliably hit. Build the habit early. By the time you sit, the structure should be automatic and your conscious bandwidth should be spent on the clinical reasoning, not the delivery.

How PRIMEX helps

• The StAMPS simulator generates eight-station scenarios in authentic rural format and marks each response against the examiner-style criteria with a Pass, Borderline, or Fail tier per question. Open the simulator from the FACRRM page on PRIMEX.
• The MCQ library covers all 8 domains with full explanations for every option and community answer distributions after each question, set in remote and rural clinical contexts.
• The voice-mode viva runs StAMPS scenarios live: you speak your answer, the AI examiner probes your reasoning, and you get a debrief at the end of each session. Helpful for trainees who think out loud and want to rehearse the retrieval narrative aloud before sitting.
• The curriculum tracker maps every study note and flashcard to the 61 ACRRM learning objectives across 8 domains, so you can check coverage rather than guess at it.
• Ask PRIMEX is a clinical question tool that pulls answers from the rural and remote study notes and references the source guidelines (CARPA, Therapeutic Guidelines, ACRRM curriculum). Available inside the app.

Worked topic deep-dives

Three high-yield topics drawn straight from the PRIMEX FACRRM study notes. Each one is a teaser; the full note carries the complete rural approach and transfer detail.

Airway management in the rural ED

Airway failure accounts for 8 to 15 per cent of potentially preventable trauma deaths, and the rural stakes are amplified because specialist backup and retrieval are often hours away. The generalist must cover the full spectrum from basic manoeuvres to surgical cricothyrotomy.

• Oxygenation is always the primary goal; not every patient needs intubation, and a functioning supraglottic device may be continued until conditions improve.
• Every emergency airway is assumed potentially difficult, and every plan must include a plan for failure.
• A definitive airway is a cuffed device in the trachea below the cords; intubation outside arrest is done as modified rapid sequence induction.

How it is examined: the assessment tests a staged plan with explicit failure backup and the threshold for a surgical airway. Common pitfall: committing to intubation when a supraglottic device is oxygenating and definitive care is reachable.

Read the full note →

Paediatric fever and sepsis recognition

Fever is the cardinal sign of childhood infection, but not every febrile child is infected and not every seriously unwell child is febrile; hypothermia below 36 degrees C carries a poor prognosis. The rural challenge is to assess severity with limited diagnostics and decide on escalation and retrieval.

• Apply the green-amber-red traffic light framework consistently in every setting, including telehealth.
• Resuscitation takes precedence over a detailed history in the unstable child; a thorough history is the key diagnostic tool in the stable child.
• SIRS is not synonymous with sepsis: sepsis is a dysregulated host response causing organ dysfunction.
• Account for the higher burden of serious infection in Aboriginal and Torres Strait Islander communities.

How it is examined: the case rewards a structured severity assessment plus a clear escalation and retrieval decision. Common pitfall: equating SIRS criteria with sepsis rather than looking for organ dysfunction.

Read the full note →

The acute abdomen in the rural setting

The acute abdomen is one of the most demanding rural scenarios: distance to surgery, limited diagnostics and the need to distinguish conditions requiring emergency transfer from those amenable to temporising management.

• The common surgical causes are non-specific abdominal pain, appendicitis, biliary colic and cholecystitis; perforation of a viscus is the most immediately life-threatening and demands urgent retrieval.
• In surgical causes, pain almost always precedes vomiting; in gastroenteritis, vomiting is early and prominent.
• Appendicitis classically migrates from periumbilical pain to the right iliac fossa over 6 to 24 hours with early anorexia.
• Coordinate early resuscitation, analgesia, retrieval and telemedicine surgical consultation.

How it is examined: the case tests rapid diagnosis with limited resources and a defensible transfer-versus-temporise decision. Common pitfall: mislabelling a surgical abdomen as gastroenteritis when the pain preceded the vomiting.

Read the full note →

Frequently asked questions

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