RACP Paediatrics DCE Rubric Explained

The Divisional Clinical Examination (DCE) is the clinical component of RACP Basic Physician Training in Paediatrics & Child Health. It sits after the Divisional Written Examination, which must be passed first, and consists of long cases and short cases assessed by consultant examiners on real paediatric patients. This page walks through the marking domains used in each, and how to align practice to the way examiners actually score the paediatric encounter.

Overall DCE structure

• Long cases: around 60 minutes alone with the patient and family (history and examination), about 10 minutes of independent thinking time, then roughly 25 minutes of presentation and discussion with two consultant examiners. Most sittings include two long cases.
• Short cases: focused clinical tasks with a brief stem and around 15 minutes per case, typically four short cases, each marked by two examiners.
• Long cases and short cases are scored independently and combined against the standard set for that sitting. Candidates have a maximum of three DCE attempts.

Long case marking domains

Examiners score each long case against a set of domains covering data gathering, reasoning, and management in a paediatric context. The exact descriptors evolve, but the marking framework consistently includes the following:

History taking

• Active problem identification with a coherent timeline, taken from the child and family.
• Birth, developmental, immunisation, feeding and growth history where relevant to the presentation.
• Functional, school, family and social context integrated into the formulation, not bolted on at the end.

Physical examination

• Targeted, age-appropriate examination informed by the history, not a head-to-toe ritual.
• Accurate elicitation and reporting of signs, with growth parameters plotted on percentile charts.
• Recognition of when a sign is absent versus not assessed, and adaptation to the child's age and cooperation.

Investigations and interpretation

• Selection of relevant investigations with reasoning, using age-stratified normal values, not a shopping list.
• Interpretation of available results in the context of the formulation.
• Acknowledgement of investigation limitations and what would change management.

Diagnosis, problem list and formulation

• A prioritised problem list ordered by clinical importance.
• Differential diagnosis with supporting and refuting features, including age-specific and genetic considerations.
• Integration of comorbidities, development and family context so the formulation reflects the whole child.

Management

• A plan that addresses each active problem with a clear rationale and weight-based dosing.
• Risk-benefit reasoning for each proposed intervention, appropriate to the child's age.
• Recognition of the family's priorities, goals of care, safeguarding concerns where relevant, and follow-up.

Communication and professionalism

• Clarity and structure of the presentation to examiners.
• Ability to defend reasoning under questioning without becoming defensive.
• Age-appropriate, family-centred communication during the patient encounter.

What examiners weight most heavily

Successful candidates report that formulation and management discussion carry disproportionate weight in the paediatric long case. A complete history and slick examination are necessary but not sufficient. The examiners are testing whether you can integrate age, development, comorbidities and family context into a clinical plan that another paediatrician would trust. Candidates who score poorly often present accurate data without an organising structure, or list management options without a paediatric-specific rationale.

Short case marking

Short cases assess focused examination technique on a specific body system or sign in a child. Each station is run by two examiners after a brief stem. Scoring weights examination accuracy, interpretation of findings, and clear communication with the child and family. The framework differs from the long case in that there is little formulation; the candidate is tested on technique and the ability to draw a sensible paediatric differential from what they have just examined.

Pass standard

The RACP uses a standard-setting process to set the pass standard for each sitting rather than publishing a fixed pass mark. The standard reflects the level of clinical performance expected of a paediatric trainee about to progress, not a fixed percentage, and candidates are assessed against that standard rather than ranked against each other. For context on outcomes, RACP reports per-sitting pass rates by component: the 2025 Paediatrics DCE pass rate across Australia and New Zealand was 85.4% (RACP past DCE results). That is a reported outcome, not the cut-score you are marked against.

Practice scaffolds that map to the rubric

• Practise full paediatric long cases under time, with a 60-minute patient and family encounter and a 25-minute presentation. Compressing one half always weakens the other.
• Rehearse the presentation aloud. Most candidates over-rehearse silently and under-rehearse out loud, which is the format examiners actually score.
• Maintain a problem-list discipline. After every patient encounter, write a prioritised list, with age and development threaded through it, before writing anything else.
• For short cases, drill age-appropriate examination sequences with a partner who can interrupt with examiner-style questions.
• Get feedback from at least one consultant who has examined the Paediatrics DCE recently. The hardest part to self-assess is whether your formulation actually holds together.

Frequently asked questions