RACGP Fellowship Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for trainees sitting the RACGP Fellowship Exam (AKT, KFP, CCE) 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 colleges because trainees from each specialty asked us to build for them. The RACGP / FRACGP Exam curriculum on PRIMEX is maintained against the college's published 2022 syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The RACGP Fellowship Examination has three components, each delivered separately and each with its own pass requirement. You can pass one and sit the others later, but every component must be passed to achieve Fellowship.

Applied Knowledge Test (AKT)

• 150 single-best-answer multiple-choice questions
• 4 hours, computer-based, delivered at approved test centres or via remote proctoring
• Tests clinical knowledge, communication and consultation skills, and organisational and legal dimensions of general practice
• Calculator policy: a basic on-screen calculator is provided
• Sittings: typically February, May, and August (check the RACGP site for current dates)

Key Feature Problem (KFP)

• 70 independent clinical scenario stems, each a multiple-selection question
• Each stem has between 2 and 6 correct responses; you select all that apply
• 4 hours, paper bubble-sheet format from the 2025.2 sitting onwards (this is a recent change from the older free-text format)
• Tests clinical reasoning at the level of a newly fellowed GP
• Marking is item-level: each correct response scores, each missed response loses a mark

Clinical Competency Exam (CCE)

• 9 cases: 4 case discussions and 5 clinical encounters with role-players
• 15 minutes per case with 5 minutes of reading time before each
• Conducted remotely via Zoom
• Marked against three CCE domains: data gathering and interpretation, clinical management, and communication and consultation skills
• Multiple sittings per year; check the RACGP site for current windows

Pass marks and standardisation

The RACGP uses a modified Angoff method to set the pass mark for each AKT and KFP sitting, so the cut score varies by paper. There is no fixed percentage that guarantees a pass. Approximate first-attempt pass rates sit around 70 percent across all three components, although this fluctuates by cohort and sitting. The college publishes pass rates after each round; treat any single number as a rough guide only.

Independent components, separate sittings

The three components are graded and sat independently. You can pass the AKT in one round and sit the KFP and CCE in a later round without losing your AKT pass, within the validity window the college sets. Most candidates aim to sit the AKT and KFP in the same round because the curriculum overlap is high and you only have to revise the body of GP knowledge once. The CCE is often sat in a later round because the consultation skill needs separate, ongoing practice and the logistics of CCE round bookings are different.

What the college actually tests

The RACGP 2022 Curriculum and Syllabus for Australian General Practice (6th edition) defines 515 mapped learning objectives spread across 33 contextual units and 7 core units. Every AKT and KFP question, and every CCE scenario, traces back to one or more of these objectives. The contextual units cover the body systems and population groups a GP sees; the core units cover communication, applied knowledge and skills, population health, professional and ethical role, and organisational and legal dimensions.

A few areas come up disproportionately. These are the seven highest-yield clusters based on past papers, examiner reports, and the curriculum weighting:

1. Cardiovascular risk and chronic disease management

Absolute cardiovascular risk calculation, lipid targets, statin prescribing, hypertension stepped therapy, atrial fibrillation with CHA2DS2-VASc and DOAC choice, heart failure quad therapy initiation in primary care. The Heart Foundation guidelines and the RACGP Red Book are the canonical sources. Examiner reports keep flagging undercoding here, generic answers like "manage diabetes" score zero where "type 2 diabetes mellitus, HbA1c 7.5 percent, commence metformin 500 mg twice daily with meals" scores full marks.

2. Mental health in general practice

Depression with PHQ-9, anxiety with GAD-7, suicidal ideation risk assessment and safety planning, ADHD diagnosis and stimulant prescribing, perinatal mental health with the Edinburgh Postnatal Depression Scale, and Mental Health Treatment Plans (item 2715, 2717, 2712 review structure). Mental health appears in roughly every CCE round. Candidates lose marks by missing safety-netting and by not framing care around the patient's psychosocial context.

3. Women's health, pregnancy, and cervical screening

The cervical screening test pathway (HPV primary screening, intermediate-risk follow-up, colposcopy referral indications), antenatal shared care milestones, gestational diabetes screening with the OGTT, menopausal hormone therapy prescribing and counselling, contraception counselling for LARC and OCP. Antenatal care and contraception come up in both written components and the CCE.

4. Child and youth health

Developmental milestones, the Australian Immunisation Schedule, childhood asthma management with spacer technique, well-child checks, HEADSS adolescent assessment, mandatory reporting obligations, and recognition of child abuse. The CCE often features a parent presenting with a child or an adolescent presenting alone, and the consultation skill being tested is age-appropriate communication.

5. Older persons' health and palliative care

Falls multifactorial assessment, dementia cognitive screening (GPCOG, MMSE), polypharmacy and deprescribing using STOPP/START and Beers criteria, advance care planning, and palliative symptom management at end of life. Polypharmacy reviews are a recurring KFP and CCE pattern, often with an Aboriginal and Torres Strait Islander or rural context.

6. Skin cancer and dermatology

Melanoma recognition (ABCDE), biopsy decision-making for suspicious lesions, BCC and SCC management, eczema topical steroid laddering, psoriasis topical management and biologic referral criteria, isotretinoin prescribing for acne. Skin cancer in GP is a high-yield area for both KFP and AKT.

7. Ethics, medicolegal, and professional practice

Mandatory reporting (child abuse, elder abuse, impaired driver, notifiable diseases), Austroads fitness to drive guidelines, capacity and consent assessment, AHPRA notifications, Medicare item number selection (chronic disease items, MHCPs, health assessments), and confidentiality with My Health Record. Examiner reports specifically call out medicolegal questions as poorly answered. If you are working through past papers and skipping the ethics stems, stop doing that.

Common pitfalls that fail candidates

• Undercoding. Vague answers like "diabetes" or "anxiety" score nothing. Specificity wins; "type 2 diabetes mellitus" or "generalised anxiety disorder" scores. Drug names with doses beat drug classes.
• Overcoding. If the question asks for three management steps, list three. Listing six does not get you partial credit on the extras and may cost marks.
• Not contextualising to general practice. Hospital-level answers fail. The KFP and CCE want primary care management, with referral and safety-netting where appropriate, not the inpatient pathway.
• Skipping psychosocial dimensions. Cultural safety, social determinants, family context, and patient values appear in marking schemes more often than candidates expect.
• Missing red flags. Cancer red flags, cardiac red flags, and mental health safety concerns must be acknowledged and acted on. A KFP stem that walks past a red flag is a failed stem.
• Not safety-netting. Most CCE marking schemes include explicit safety-netting points. "Come back if your symptoms get worse" is not safety-netting; specific advice with timeframes and review plans is.

A realistic study timeline

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

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

This suits someone working full-time clinically, with a young family or other commitments, who wants slow steady coverage rather than a sprint.

• Months 1 to 3. Read through the 2022 curriculum and pick three or four contextual units per week. Cover the unit's high-yield topics and answer 30 to 50 AKT-style MCQs per week. Build a flashcard deck as you go.
• Months 4 to 6. Add KFP-style stems. Aim for two stems per week minimum; mark each stem against the model answer and write down which key features you missed. Continue MCQ practice. Begin one CCE-style consultation per week, ideally with a study partner.
• Months 7 to 8. Past paper AKT mocks under timed conditions. KFP practice scales up to four to six stems per week. Two CCE consultations per week minimum. Identify weak units and target them.
• Final month. Two full timed AKT mocks. One full timed KFP mock (70 stems, 4 hours, paper). Final CCE polishing across high-frequency presentations: chest pain, mental health, paediatric, women's health, ethics dilemma.

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 contextual unit. Cover one or two units per week. Build the flashcard deck. 50 to 80 MCQs per week.
• Months 3 to 4. KFP-style stems become the main work. Three to five stems per week, marked carefully. Maintain MCQ volume. Start CCE consultation practice with one to two cases per week.
• Month 5. First full AKT timed mock. KFP volume doubles. Two to three CCE cases per week, ideally with verbal feedback from a study partner or a consultation simulator.
• Final month. Two more AKT mocks under exam conditions. One full KFP mock. Final round of weak-area CCE practice.

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 to three contextual units per week, focused on weak areas. Heavy MCQ volume from week one (100+ per week).
• Month 2. KFP stems daily. MCQs continue. Begin CCE consultations twice a week.
• Month 3. Full timed mocks start. AKT mock weekly, KFP mock fortnightly. CCE practice three times per week.
• Final month. Polish weak areas. Two AKT mocks, two KFP mocks, daily CCE practice. Sleep and wind down for the last 48 hours.

When to start each component

• MCQs: from week one. They build curriculum recall and surface weak areas faster than reading.
• KFP stems: from month two at the latest. The clinical reasoning style takes practice and is not the same as MCQ work.
• CCE consultations: from month three at the latest, even on a four-month plan. Verbal consultation skill needs reps. Reading about communication does not transfer.
• Past papers and full mocks: last six to eight weeks for AKT and KFP. Earlier than that and you have not yet covered enough ground for the result to be meaningful.

Weekly study split that actually works

Most candidates run into trouble because their week is shapeless and the work that feels easy crowds out the work that matters. A simple template that holds up: two MCQ sessions per week of 60 to 90 minutes each, two KFP sessions per week of 60 to 90 minutes each, one CCE consultation per week from month two onward, and one curriculum reading session per week tied to whatever weak unit emerged from the practice. Flashcards run in the background as ten-minute blocks on commutes or between patients, not as scheduled sit-downs. Protect your CCE slot the way you protect a clinical commitment; if you let it move, it stops happening.

Track what you got wrong, not what you got right. Keep a running list of missed key features by curriculum unit. After a month you will see two or three units that come up repeatedly and you can target them directly.

The single biggest mistake people make

You leave CCE practice until the last six weeks. The written components feel concrete and tractable, so you grind MCQs and KFP stems first because the feedback is immediate and the score is a number. Then you wake up two months out, realise you have never run a timed consultation under exam conditions, and try to compress all your CCE work into the run-in.

The CCE is not a knowledge test. It is a performance under time pressure with someone watching, and the only way to get fluent at it is to do it badly thirty times before you do it well. You need the muscle memory of opening with rapport, structuring history without leading, summarising back, negotiating a management plan, and closing with safety-netting, all inside fifteen minutes. That muscle memory takes months to build, not weeks.

Start CCE practice in month one or two of your run-up. Even one case a week is enough to keep the skill alive. You can practise with a registrar at your practice, with a remote partner over Zoom, or with a consultation simulator that plays the patient. The point is reps. By the time you sit, the consultation structure should feel automatic and your conscious bandwidth should be available for the clinical reasoning.

How PRIMEX helps

• The KFP grader generates KFP-format stems and marks each response against the model answer with item-level feedback, so you see exactly which key features you identified and missed. Open the RACGP page on PRIMEX to see the format.
• The AKT MCQ bank covers all three AKT domains with full explanations for every option and community answer distributions after each question.
• The CCE consultation simulator runs nine-case rounds with voice mode, plays the patient live, and marks against the three CCE domains used by examiners. Open the simulator from the CCE feature on the RACGP page.
• The curriculum tracker maps every study note and flashcard to the 515 RACGP 2022 learning objectives, so you can check coverage rather than guess at it.
• Ask PRIMEX is a clinical question tool that pulls answers from the GP study notes and references the source guidelines. Available inside the app.

Frequently asked questions

Related study guides

• FACRRM 2026 Study Guide
• RACP BPT 2026 Study Guide