RACP Basic Training Divisional Written Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for advanced trainees and senior residents sitting the RACP Basic Training Divisional Written Examination 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 RACP Basic Training Divisional Written Examination curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The Divisional Written Examination, usually shortened to DWE, is the written gate at the end of Basic Physician Training. Pass the DWE and you sit the Divisional Clinical Examination. Pass the DCE and you progress to Advanced Training in your chosen subspecialty. Most BPTs sit the DWE in the second or third year of Basic Training, with the Clinical Exam in the year after.

Format

• Two papers on the same day, paper-based at college-approved test centres
• Paper One: 100 single-best-answer multiple-choice questions, 3 hours
• Paper Two: 70 single-best-answer multiple-choice questions, 2 hours
• Total of 170 MCQs across the day, no SAQ component
• Some sittings include a small set of extended matching questions inside the MCQ count
• Closed book, no calculator unless explicitly provided in the question

Sittings and timing

• Two sittings per year: one in late February or early March, one in late August or early September
• Result release usually six to eight weeks after the paper
• Re-sit available the following sitting if you are unsuccessful, subject to training time available
• As of 2026, check the RACP website for the current date and venue list before locking in study plans

Pass marks and standardisation

The RACP uses standard-setting against the candidate cohort to determine the cut score. The college does not publish a fixed percentage that guarantees a pass. Recent overall pass rates for first-attempt candidates have sat in the range of fifty to sixty percent depending on cohort and paper. Treat any single quoted figure as approximate. The college publishes a candidate report after each sitting that breaks down performance by discipline, which is useful at re-sit if you want to know where the holes were.

Day-of logistics

• Photo identification required, usually a current driver licence or passport
• Pencils and erasers provided at most centres, but bring spares
• No personal materials at the desk: no phone, no smartwatch, no calculator, no water bottle in some venues
• Bathroom breaks are escorted and the clock keeps running
• Reading time is built into the examination duration, not added on top, so train at exam pace from the start

What the college actually tests

The PRIMEX RACP BPT curriculum holds 320 mapped learning objectives across 16 clinical domains, drawn from the college's published Basic Training Curriculum for Adult Internal Medicine. The breadth is the point. The DWE is engineered to test recognition and management across the whole of internal medicine, not depth in any one subspecialty. Cardiology and respiratory medicine carry the heaviest single-discipline weighting in most sittings, but a candidate who neglects haematology, endocrinology, or infectious disease will find a paper that punishes them.

The 16 clinical domains

The mapped domains in the PRIMEX curriculum file cover Cardiovascular, Respiratory, Renal and Electrolytes, Gastroenterology and Hepatology, Endocrinology, Haematology, Oncology, Infectious Disease, Neurology, Rheumatology, Immunology and Allergy, Dermatology, Geriatric Medicine, Acute and Critical Care, Psychiatry and Mental Health, and General Internal Medicine. Each domain holds between roughly fifteen and forty learning objectives. Topic-level reviews are linked to study notes, MCQ pools, and flashcards.

The highest-yield areas to anchor your study

Cardiovascular medicine

• Heart failure with reduced and preserved ejection fraction. Quad therapy. Acute decompensation triggers. Indications for ICD and CRT
• Acute coronary syndromes. STEMI versus NSTEMI pathway, troponin interpretation, antiplatelet selection, reperfusion timing
• Atrial fibrillation. Rate versus rhythm control, CHA2DS2-VASc and HAS-BLED, DOAC selection in renal impairment
• Valvular heart disease, particularly aortic stenosis grading and timing of intervention
• ECG interpretation including conduction blocks, long QT, Brugada and inherited arrhythmia syndromes

Respiratory medicine

• COPD stepwise management, exacerbation triggers, criteria for non-invasive ventilation
• Pulmonary embolism. Pre-test probability, CTPA decisions, choice of anticoagulant, massive PE pathway
• Interstitial lung disease patterns on high-resolution CT, the workup for IPF, antifibrotic indications
• Asthma severity assessment and step-up therapy with biologics for the eosinophilic phenotype
• Pleural disease, Light's criteria, indications for pleural biopsy and indwelling drainage

Renal and electrolytes

• Acute kidney injury, KDIGO staging, pre-renal versus intrinsic versus post-renal patterns
• Chronic kidney disease, CKD-MBD, anaemia management, indications and modalities of renal replacement therapy
• Glomerulonephritis. Nephritic versus nephrotic syndromes, biopsy indications, immunosuppression decisions
• Hyponatraemia approach, SIADH workup, osmotic demyelination risk and correction caps
• Hyperkalaemia ECG changes and emergency management with insulin-dextrose, calcium and dialysis

Endocrinology

• Diabetic ketoacidosis pathway, fluid and insulin titration, identifying precipitants
• Type 2 diabetes pharmacotherapy, GLP-1 receptor agonists, SGLT2 inhibitor benefits in heart failure and CKD
• Thyroid disease across the spectrum: thyrotoxicosis, thyroid storm, myxoedema, nodule investigation
• Adrenal insufficiency including the Addisonian crisis and steroid sick-day rules
• Hypercalcaemia of malignancy versus primary hyperparathyroidism, biochemical workup and acute management

Haematology, oncology and infection

• Anaemia algorithms, iron studies, intravascular versus extravascular haemolysis
• Anticoagulation in special populations including renal failure, pregnancy, mechanical valves, antiphospholipid syndrome
• Haematological malignancy frameworks: acute leukaemia presentation, lymphoma staging, myeloma diagnostic criteria
• Sepsis bundles, source control principles, antimicrobial stewardship for febrile neutropenia and intra-abdominal infection
• HIV management including antiretroviral classes, opportunistic infection prophylaxis, and immune reconstitution syndrome

Neurology, rheumatology and the smaller domains

• Stroke pathway including thrombolysis windows, thrombectomy criteria, secondary prevention and atrial fibrillation workup post-event
• Demyelinating disease, Guillain-Barre and myasthenia gravis presentation, investigation and acute management
• Vasculitis classification by vessel size, ANCA-associated patterns, giant cell arteritis as an emergency presentation
• Crystal arthropathies and systemic lupus erythematosus including renal involvement and pregnancy considerations
• Geriatric medicine through the lens of polypharmacy, deprescribing, falls assessment, and the differential for delirium in the older inpatient

Common pitfalls that fail candidates

• Treating the DWE as a recall test. Many questions present clinical reasoning vignettes and reward pattern-matching against syndromes, not isolated facts
• Neglecting the smaller domains. Dermatology, immunology, and psychiatry of medicine collectively make up enough of the paper to swing a borderline pass
• Memorising drug names without doses or monitoring. The paper rewards specifics: target INR ranges, dose adjustments in renal impairment, what you check before starting a biologic
• Skipping ECGs and imaging stems. Visual interpretation questions appear consistently and a candidate who cannot read a basic ECG or chest film will lose easy marks
• Assuming therapeutic guidelines knowledge is enough. Australian therapeutics is necessary but the BPT scope is wider than community practice and includes guidelines from cardiology, respiratory, and renal specialty bodies
• Underestimating perioperative medicine, medicine in pregnancy, and adolescent medicine, which all sit inside the General Internal Medicine domain and reliably appear in two or three questions per paper
• Overusing third-party flashcard decks built for North American board exams. The pharmacology, scoring systems, and guideline emphasis are different in Australia and you will lose marks if you commit those reflexes to memory

How to read the curriculum file like a study plan

• The PRIMEX curriculum tab groups every learning objective by clinical domain. Filter by domain to get a finite list per session, rather than trying to hold the whole 320 in your head at once
• Each learning objective links to a study note, a flashcard pool and an MCQ pool. Treat the learning objective as the unit of work for a sitting, not a topic name from a textbook
• Mark every objective with a status: not started, working, confident. Re-rate every fortnight. The visible delta tells you whether your study is producing learning or just hours
• Use the domain-level progress bar as a triage tool. Two domains stuck below sixty percent confidence in the final two months are where mock-paper performance will collapse

A realistic study timeline

Most BPTs work full-time clinical jobs alongside study. The plans below assume that. Cut hours back where you have to and protect sleep ahead of caffeine.

Nine-month plan

• Months one to three. Read through every clinical domain at a head-of-topic level. About ten to twelve hours a week. The aim is breadth and the formation of a mental index, not mastery. Take rough notes per topic so you have something to revisit later
• Months four to six. Step up to fifteen hours a week. Begin spaced-repetition flashcards across domains. Start question banks at low intensity, around forty to sixty MCQs a week, untimed, with full reasoning written out per question
• Months seven to eight. Twenty hours a week. Switch question banks to timed conditions. Begin past-paper-style three-hour blocks once a fortnight. Identify your weakest two domains from a quarter-mark mock and rebuild them
• Final month. Pull back to twelve to fifteen focused hours a week. Mocks under exam conditions. Sleep, exercise, and rehearsal of the day-of routine. No new content in the final ten days

Six-month plan

• Months one to two. Fifteen to eighteen hours a week. Read across all sixteen domains. Start flashcards at the end of week two so that revision compounds
• Months three to four. Twenty hours a week. Steady MCQ practice at sixty to ninety questions a week. Write out reasoning. Start using PRIMEX clinical reasoning prompts to articulate management plans in long form
• Month five. Twenty-five hours a week. Timed conditions. First full mock at the end of the month. Targeted re-read on weakest domains
• Final month. Twenty hours a week. Two more mocks. Refine flashcard decks. Drop into recovery mode in the final week

Four-month plan

• Month one. Twenty-two to twenty-five hours a week. This is brutal alongside clinical work; build it into protected weekends and one weekday morning. Sweep through every domain with summary notes, no deep dives
• Month two. Twenty-five hours a week. Full flashcard rotation, hundred-MCQ blocks twice a week, write a structured reasoning paragraph for every single question you get wrong
• Month three. Continue at twenty-five hours, add timed three-hour blocks once a week. Run two short mocks. Triage: focus only on domains where your performance is below the cohort average
• Final month. Pull back to twenty hours. Two full mocks. Last fortnight is consolidation, not new content. Treat the final week as a taper

How to use past papers

• Past papers from the college are gold. Don't burn them in the first month. Save at least two complete sets for timed conditions in the final eight weeks
• For each past-paper question, force yourself to write a single sentence reasoning the right answer before checking the key. The sentence is the learning, not the tick
• Track recurring stems across multiple past sittings. The college reuses themes (heart failure quad therapy, AKI on CKD, anticoagulation reversal, hypercalcaemia of malignancy, sepsis source identification). These are reliable marks you cannot afford to lose
• If a question relies on a guideline that has been updated since the paper was written, learn the current version. The college tests current practice, not historical answer keys

Mocks under exam conditions

• Run at least three full mocks before the real day. One at the halfway point of your study window, one four weeks out, and one ten days out
• Replicate the conditions: same start time, same chair and table, same total duration with reading time built in, no phone, no music, no toilet break in the first hour
• Score yourself honestly and break performance down by domain. The discipline-by-discipline breakdown is more useful than the headline percentage
• Treat the post-mock debrief as a study session in itself. Two hours of structured review of a mock paper is worth more than four hours of fresh content

The single biggest mistake people make

The pattern that breaks competent BPT candidates is rote-memorising MCQ answer keys without reconstructing the underlying mechanism. You do enough question banks, you start to recognise the look of the right answer. It feels like progress because your scores climb. Then you sit a paper where the stem is rewritten just enough that the surface cues you trained yourself on are gone, and the question becomes about whether you actually know why mineralocorticoid antagonists help in heart failure with reduced ejection fraction, why you choose a non-dihydropyridine over a beta-blocker in a specific arrhythmia, why glomerular filtration estimates differ between the formulas. The fix is uncomfortable and slow. For every MCQ you do, write a one-sentence reason for the right answer and a one-sentence reason each wrong option is wrong. Five sentences per question. It halves the questions you can do in a session and triples what you retain. Do this from week one and the cohort that practices in volume without reasoning falls behind you in the final two months.

How PRIMEX helps

• The PRIMEX curriculum tracker for the RACP BPT covers 320 mapped learning objectives across 16 clinical domains, with progress tracked per topic and per domain. Available inside the PRIMEX app
• The clinical reasoning grader gives tier-marked feedback on structured-answer practice for cases you might face in the long case viva, with marking points across diagnosis, investigation, and management. The public version sits at PRIMEX grader
• Ask PRIMEX is the in-app tutor that takes any question or topic name and returns a sourced, BPT-level answer with discriminating differentials and named guidelines
• The DCE Long Case and Short Case simulator runs voice-interactive practice for the clinical exam with structured examiner probing across problem list, investigations, and management. Available alongside the written exam tools on the RACP Adult Medicine page

Building the routine that actually holds for nine months

The trainees who pass the DWE on the first sitting almost all share a small set of habits. None of them is glamorous. They protect three weekday mornings a week with a non-negotiable two-hour study block before clinical work, they keep flashcards open on a phone for ten-minute gaps between ward rounds, and they rebuild the weekend block on the same days each week so the partner, the housemate, the children all know the rhythm. They batch-cook on Sunday so weekday dinner is fifteen minutes instead of an hour. They tell the registrar group what they are doing so colleagues understand the absences from the post-shift drinks. They use the long blocks for new content and timed practice, and the short blocks for spaced-repetition flashcards and question banks. The routine is more important than the volume.

What breaks routines is not laziness, it is unrealistic ambition. A plan that requires twenty-five hours a week of study while you are working full clinical hours plus a sixty-hour-a-week registrar rotation is a plan that fails by week four. Build the schedule around the clinical roster you actually have, not the one you wish you had. If a fortnight contains a stretch of seven on-call nights, write zero study hours into that fortnight and accept it. The candidate who studied for twelve hours in week six and zero in week seven and beat themselves up about it ends up doing less than the candidate who planned for ten in week six and zero in week seven and showed up.

Frequently asked questions

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