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

If you are a paediatric advanced trainee sitting the RACP Paediatrics Divisional Written Exam in the next 12 months, this guide is for you. It covers exam structure, what the curriculum actually examines, realistic study timelines for 4, 6 and 9 month run-ups, the failure modes that catch competent trainees, and where the PRIMEX RACP Paediatrics platform fits in. 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 RACP Paediatrics Divisional Written Exam curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

Exam structure: format, timing and logistics

The RACP Paediatrics fellowship is assessed across two examinations. The Divisional Written Exam (DWE) is the entry point. The Divisional Clinical Exam (DCE) follows. This guide focuses on the DWE while flagging where DWE preparation feeds the DCE.

Format breakdown

• 170 questions across two paper-based MCQ papers: Paper 1 is 92 MCQ + 8 EMQ (3 hr 10 min); Paper 2 is 66 MCQ + 4 EMQ (2 hr 10 min).
• 4-option single best answer MCQs plus extended matching questions. No negative marking.
• Heavy use of clinical vignettes. Stems include vital signs, growth percentiles, investigation results and management decisions.
• Held twice yearly. The Divisional Written Examination runs in February and October (the mid-year May cycle is the clinical DCE, not the written). Confirm 2026 dates against the RACP trainee portal as scheduling can shift.

Time allocation

• Paper 1 (100 questions) runs 3 hr 10 min; Paper 2 (70 questions) runs 2 hr 10 min. Total writing time is around 5 hr 20 min across the day, split by a break.
• Check the college site for the current sitting schedule as timing can shift between sittings.

Pass mark and standard setting

• The college does not publish a fixed standardised pass mark for the DWE. Standard setting is criterion referenced and the cut score is set per sitting.
• RACP publishes per-sitting pass rates by component (DWE Paediatrics 75.9 percent in February 2026, 79.3 percent Feb 2025), and rates vary by component and cycle.
• You are not competing against your cohort for a fixed quota. You are being assessed against a defined standard.

Day of logistics

• The DWE is paper-based (pen on paper, scanned) and held at approved venues in Australia and New Zealand.
• Reference material is not provided. You will not have access to BNF for Children, eTG, growth charts or paediatric guideline summaries during the exam. Whatever you can recall under time pressure is what you have to work with.
• Bring photo ID. Bring water if permitted by the venue. Check the college's venue-specific instructions for what is and is not permitted in the room.
• Travel is part of the plan. The DWE is held at a small number of approved venues in Australia and New Zealand. If you are based rurally, factor in same day or day before travel, accommodation, and the variability of regional flights so that the morning of the exam is not the morning you also troubleshoot transport.
• Because the exam is paper-based, you answer on the paper and cannot flag or revisit in the same way as a computer-based test. Read each question fully before committing, and keep a deliberate pace across both papers.

What the college actually tests

The RACP General Paediatrics Advanced Training Curriculum (the consultation draft from November 2023 that PRIMEX maps against) contains 744 learning objectives across 22 curriculum sections. That is the largest LO count of any RACP exam on the platform. The breadth is the challenge. No reasonable person can cover 744 LOs at equal depth, so the question is which areas reward depth and which reward pattern recognition only.

The mapped sections in the curriculum file include neonatal and perinatal medicine, acute care, developmental paediatrics, adolescent and young adult medicine, child safety and maltreatment, rural paediatrics, cardiology, dermatology, endocrinology and metabolic medicine, ear nose and throat, gastroenterology, genitourinary and gynaecology, haematology and oncology, immunology and allergy, infectious disease, inflammatory and rheumatological, kidney, mental health, musculoskeletal, neurology and rehabilitation, respiratory and sleep, and foundations and cross-cutting issues.

Highest yield topic areas

These are not predictions. They are the areas where the volume of mapped objectives is largest and the historical examiner reports flag recurring questions. Treat them as a baseline for breadth, not a substitute for full curriculum coverage.

• Neonatology and perinatal medicine (116 LOs). This is the single largest section in the curriculum. Hypoxic ischaemic encephalopathy and Sarnat staging, neonatal jaundice and bilirubin thresholds, group B streptococcus screening pathways, neonatal sepsis empirical regimens, retinopathy of prematurity screening criteria, congenital heart disease with duct dependent circulation, and necrotising enterocolitis Bell staging are all repeat fodder. Be careful with neonatal dosing because the same drugs in different post menstrual ages have different windows.
• Acute care (71 LOs). Paediatric sepsis recognition (the PHOENIX 2024 criteria have replaced earlier definitions), fever without focus in infants under three months and the Boston, Philadelphia and Rochester decision tools, status epilepticus protocols, paediatric anaphylaxis dosing, burns and the modified Parkland calculation, and DKA fluid management to ISPAD standards. The grader penalises adult thresholds applied to children, and so does the DWE.
• Developmental paediatrics (52 LOs). Autism spectrum disorder and surveillance tools, ADHD diagnosis and stimulant management, intellectual disability investigation pathways including chromosomal microarray, and recognition of developmental regression as a red flag. Comorbidity and the NDIS pathway also turn up.
• Endocrinology and metabolic medicine (56 LOs). Type 1 diabetes management at consultant entry level, DKA cerebral oedema risk and ISPAD fluid protocols, congenital adrenal hyperplasia and hydrocortisone sick day rules, short stature workup, congenital hypothyroidism screening, and inborn errors of metabolism with their newborn screening triggers.
• Neurology and rehabilitation (48 LOs). Childhood epilepsy syndromes including West syndrome, Lennox-Gastaut and Dravet, status epilepticus APLS protocol, bacterial meningitis and the role of dexamethasone, cerebral palsy classification (GMFCS, MACS), and neuromuscular disease in the gene therapy era including spinal muscular atrophy.
• Adolescent and young adult medicine (59 LOs). Eating disorders and MARSIPAN refeeding criteria, mental health including depression and psychosis pathways, transition of care planning for chronic conditions, and the HEEADSSS framework. Confidentiality limits and mandatory reporting thresholds are common stem twists.
• Child safety and maltreatment (31 LOs). Non accidental injury fracture patterns (metaphyseal, posterior rib, spiral), retinal haemorrhage in abusive head trauma, mandatory reporting obligations under state legislation, fabricated or induced illness, and the multidisciplinary safeguarding process. This is heavily examined and the questions often hinge on what you do next, not what the diagnosis is.

Common pitfalls that fail candidates

• Adult thresholds applied to paediatric stems. Adult sepsis criteria, adult hypertension cut offs and adult fluid resuscitation volumes are wrong in paediatrics. The DWE will rarely tell you the patient is paediatric in the option list. The vital signs in the stem are the giveaway and you have to recognise that age-stratified ranges apply.
• Weight based dosing errors. Drug dose questions hinge on mg per kilogram, capped at the adult dose. Confident mis-statement of paediatric dosing is a trap and the safer move on uncertain doses is to recognise the shape of the answer (the right order of magnitude and the right cap) rather than a memorised milligram value.
• Missing the child protection thread. A surprising number of stems hide a safeguarding concern in the social history. The question may ask about investigations or management, but the right answer turns on recognising abuse, neglect or unsafe disclosure and acting on mandatory reporting.
• Treating growth charts as decoration. If the stem gives you a growth percentile, it matters. Crossing percentiles, faltering growth, accelerated growth and short stature with disproportionate features all change the diagnostic frame. Know the difference between weight, length or height, BMI and head circumference percentiles by age.
• Skipping the genetic differential in developmental delay. Examiner reports flag chromosomal microarray as the missed step. Trainees order metabolic and infection screens and forget that a chromosomal cause is the most common identifiable aetiology in unexplained delay.
• Ignoring the year of the guideline. Paediatric guidelines move. PHOENIX has replaced earlier paediatric sepsis criteria in 2024. CFTR modulator regimens have shifted. RSV monoclonal therapy is now in the schedule. Stale notes will give you stale answers.

Realistic study timeline

Three timelines, three different volumes of weekly hours. None of them is fixed and you should adjust for clinical load, leave entitlements and how much of the curriculum you have already metabolised at registrar level. The objective is not perfection across 744 LOs. The objective is enough breadth that no question feels alien, plus sustainable depth in the highest yield areas.

Nine month run up (around 8 to 12 hours per week)

• Months 1 to 2. Build the curriculum scaffold. Read across the major sections at registrar textbook level. Aim to complete a first pass on neonatology, acute care, cardiology, respiratory and infectious disease before depth work begins. Start an MCQ library from week one but at low volume (10 to 20 questions per session). Use them to identify gaps, not to test recall.
• Months 3 to 5. Depth on the high yield sections. Subspecialty by subspecialty: neurology and epilepsy, endocrinology and DKA, haematology and oncology, nephrology, gastroenterology and hepatology. One subspecialty per fortnight is a reasonable pace. Increase MCQ volume to around 30 questions a session. Begin written reasoning practice with structured short answer prompts to lock in age stratified values.
• Months 6 to 7. Coverage of remaining sections (developmental, adolescent, child protection, mental health, dermatology, ENT, musculoskeletal, immunology and allergy, rural, foundations). Begin first timed MCQ blocks at exam pace, around 60 questions in 90 minutes.
• Month 8. Two full timed mocks, one early in the month and one late. Spend the time between mocks reviewing every wrong answer and rebuilding notes on the topics flagged.
• Month 9. Light review only. Sleep, fluid, and a light final loop through the cards you have repeatedly missed. Cramming new topics in the last fortnight rarely converts to marks.

Six month run up (around 12 to 16 hours per week)

• Months 1 to 2. Curriculum scaffold and high yield depth in parallel. Start on neonatology, acute care and endocrinology while building MCQ familiarity.
• Months 3 to 4. Depth on neurology, haematology and oncology, infectious disease, cardiology and respiratory. Move the daily MCQ count up to 40 to 60 across mixed topics.
• Month 5. Coverage on remaining sections and a first timed mock. Identify the bottom three sections by mock score and rebuild study notes on those.
• Month 6. Second timed mock around two to three weeks out. Final fortnight is consolidation, not new content.

Four month run up (around 18 to 22 hours per week, often unsustainable)

• Month 1. Triage. You will not get to all 744 LOs at equal depth. Pick the eight highest yield sections and commit to depth there. Curriculum scaffold for everything else.
• Month 2. MCQ heavy practice from day one with topic specific blocks. Treat MCQs as the primary teaching tool, not the assessment tool.
• Month 3. One timed mock at the start of the month, one at the end. Use the gap to fix the largest blind spots.
• Month 4. Final consolidation. No new material in the last two weeks. Sleep is part of the study plan.

When to start written reasoning practice

• Although the DWE is MCQ only, structured written practice (especially short paediatric reasoning prompts) is one of the best ways to lock in age stratified values, weight based doses and the named guideline references the DWE rewards.
• For a 9 month run up, start written practice in month 3. For a 6 month run up, start in month 2. For a 4 month run up, start in week 2.
• Written practice also does double duty for the DCE. The clinical reasoning structures you build for written reasoning are the same ones you use under the long case examiner pressure.

The single biggest mistake people make

The pattern that breaks otherwise competent paediatric trainees is rote memorising MCQs without rebuilding the underlying mechanism each time. You do this and it feels productive. You complete 80 questions a day. You see the same explanations on second pass. You feel familiar.

Then the exam writes a stem you have not seen, with the same physiology dressed in different clothes, and your pattern matching collapses. You guess. You move on. You do this 170 times across two papers.

The fix is unglamorous. For every question you get wrong (and for every question you get right but cannot defend cold), you write three sentences: the underlying mechanism, the next best alternative answer and why it is wrong, and the version of the question that would change your answer. Three sentences. Written, not thought. This is what the trainees who pass on first sitting do consistently in the last 10 weeks. It feels slow. It is the only thing that survives contact with a paper full of stems you have not seen before.

How PRIMEX helps

• The RACP Paediatrics MCQ engine generates DWE-format SBA questions with paediatric specific complexity, age stratified values in stems, weight based dosing in explanations, and a community answer distribution after each question so you can see how other candidates are responding.
• The PRIMEX clinical reasoning grader applies a Fail / Borderline / Pass / Distinction tier rubric, flags missing weight based doses and adult threshold misapplications, checks for child protection recognition where relevant, and references ISPAD, APLS, PALS, AAP and NICE guidelines in the model answer.
• The curriculum tracker maps your progress across all 744 learning objectives in 22 sections, so you can see exactly which presentations and topics you have not yet touched.
• The DCE long case and short case simulator is built for the clinical exam that follows the DWE. Paediatric stems with realistic age specific presentations, voice mode for spoken practice, and a debrief that explicitly flags adult thresholds incorrectly applied to a paediatric patient.
• Ask PRIMEX sits inside every study note and answers RACP Paediatrics specific questions, sourcing from the curriculum mapping rather than generic content.

Worked topic deep-dives

Three high-yield topics drawn straight from the PRIMEX RACP Paediatrics study notes. Each one is a teaser; the full note carries the complete assessment and management.

Paediatric abdominal pain

Abdominal pain is one of the most common paediatric presentations, spanning benign self-limiting conditions to life-threatening surgical emergencies. Management requires age-appropriate pain assessment, an understanding of aetiology by age, and judicious analgesia.

• Adequate analgesia does not mask surgical pathology and must not be withheld pending diagnosis.
• Distinguish visceral pain (diffuse, cramping, midline) from somatic parietal pain (well-localised, sharp, worse on movement) and referred pain.
• Functional abdominal pain disorders are diagnoses of inclusion using positive Rome IV features, not simply normal investigations.

How it is examined: cases test age-based differentials and a safe analgesia plan alongside surgical screening. Common pitfall: withholding analgesia for fear of masking a surgical abdomen.

Read the full note →

Neonatal hypoglycaemia

Neonatal hypoglycaemia is one of the most common metabolic emergencies of the newborn period and a critical part of the retrieval stabilisation bundle. Unrecognised or inadequately treated hypoglycaemia risks acute neuronal injury and long-term neurodevelopmental harm.

• It occurs in roughly 5 to 15 per cent of neonates, with higher rates in recognised at-risk groups.
• At birth the transplacental glucose supply stops abruptly; glucose falls transiently then stabilises as glycogenolysis, gluconeogenesis and fatty acid oxidation activate.
• The transport environment adds thermal instability, vibration and limited access, amplifying both risk and management difficulty.

How it is examined: cases reward systematic identification, correction and the retrieval considerations. Common pitfall: treating the neonatal threshold and counter-regulation as identical to the older child or adult.

Read the full note →

Suicidal ideation in adolescents

Suicidal ideation in adolescents spans passive thoughts of death through active ideation with plan to intent and preparatory behaviour. Recognising where an adolescent sits on this fluctuating spectrum is central to safe practice.

• The ratio of ideation to completed suicide in adolescence exceeds 2000 to 1, so accurate risk stratification is essential.
• Assess within the HEADSSS framework, which structures the psychosocial history and creates space for disclosure.
• Around 17 per cent of high school students seriously consider suicide in a 12-month period.
• Over-response harms the therapeutic alliance and autonomy; under-response risks a catastrophic outcome.

How it is examined: cases test a structured psychosocial assessment and a proportionate safety response. Common pitfall: a binary high-or-low risk label that ignores the dynamic, fluctuating nature of risk.

Read the full note →

Frequently asked questions

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