RACP Paediatrics DCE Rubric Explained
What is the RACP Paediatrics DCE rubric?
The RACP Paediatrics & Child Health Divisional Clinical Examination rubric (the criteria for assessment of performance published by the college) scores each long case across five domains: accuracy of history, accuracy of the clinical examination, synthesis and prioritisation of clinical problems, understanding the impact of the illness on the patient and family, and development and discussion of an appropriate management plan. Short cases are scored across five domains of their own: interaction with the patient and family, examination technique, examination accuracy, interpretation and synthesis of physical findings, and investigations and management. Each domain is rated on a level-of-performance scale, and the college notes that not all domains are equally weighted or always applicable, because real patients vary.
The Divisional Clinical Examination (DCE) is the clinical component of RACP Basic 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, rising to four from 2027 (including trainees on a third attempt from the May/June 2026 sitting).
Long case marking domains
Examiners score each long case against the five assessment domains of the RACP Paediatrics & Child Health long case criteria for assessment of performance (the in-person format; the modular videoconference variant words the second domain slightly differently). Each domain is rated from "very poor" to "excellent" against an expected standard, and the descriptors below paraphrase what the expected standard looks like in a paediatric context:
1. Accuracy of history
- A reasonably complete, accurate and detailed history from the child and family, timely and well structured, with minimal need for the examiners to clarify details.
- Birth, developmental, immunisation, feeding and growth history where relevant to the presentation.
- Some interpretation as you go: a focus on the key issues rather than an unfiltered transcript.
2. Accuracy of the clinical examination
- Relevant examination findings presented with their significance, including important negative signs.
- Correct observations, with growth parameters plotted on percentile charts and the examination adapted to the child's age and cooperation.
- Recognition of when a sign is absent versus not assessed.
3. Synthesis and prioritisation of clinical problems
- All key problems identified and arranged in order of priority, with lesser issues still recognised.
- Differential diagnoses with supporting and refuting features, including age-specific and genetic considerations.
- A long-term view that integrates comorbidities, development and the social impact of the disease.
4. Understanding the impact of the illness on the patient and family
- The child's physical and psychological functioning described in relation to the disease, not just the diagnosis.
- The impact of treatment and prognosis on the child and the family, including school, siblings and parental wellbeing.
- Exploration of subtle psychological issues and the family's use of external supports.
5. Development and discussion of an appropriate management plan
- A sensible, balanced approach to investigations, interpreted correctly and in the context of the formulation. Investigations sit inside this domain, not as a separate one.
- A plan that addresses each active problem with a clear rationale and weight-based dosing, with risk-benefit reasoning appropriate to the child's age.
- Recognition of the family's priorities, goals of care, safeguarding concerns where relevant, and follow-up.
Communication, ethics and professional behaviour, judgement and cultural competence are not scored as a separate domain. The rubric tags them as competencies that run across the five domains, so a poorly structured or defensive presentation costs you inside the domain it affects rather than in a communication column of its own.
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. The short case rubric has five domains of its own: interaction with the patient and family (introducing yourself, preserving modesty, modifying the examination when it hurts), examination technique (systematic, fluent, completed in time without unnecessary duplication), examination accuracy (detecting the essential signs, reporting the important negatives, and not finding signs that are not there), interpretation and synthesis of physical findings (a sensible provisional diagnosis and differential that is consistent with the signs, with minimal prompting), and investigations and management (a reasonable line of investigation integrated with the findings). Compared with the long case, the weight sits on technique and accurate interpretation of signs, but candidates are still expected to propose sensible investigations for what they found.
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.
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Frequently asked questions
How is the RACP Paediatrics DCE long case scored?
Two consultant examiners assess each long case against the five RACP long case domains: accuracy of history, accuracy of the clinical examination, synthesis and prioritisation of clinical problems, understanding the impact of the illness on the patient and family, and development and discussion of an appropriate management plan. Each domain is rated on the college's level-of-performance scale against an expected standard, and the examiners' judgements are combined to an overall assessment. The college notes that not all domains are equally weighted or always applicable, because real paediatric patients vary.
What is the cut-score for the RACP Paediatrics DCE?
The RACP sets the pass standard for each DCE sitting through a standard-setting process rather than publishing a fixed numeric cut-score. Candidates are assessed against the standard for that sitting, not ranked against each other. For context, the 2025 Paediatrics DCE pass rate across Australia and New Zealand was 85.4% (RACP past DCE results), but this is a reported outcome, not a fixed pass mark.
What do RACP examiners weight most heavily in the paediatric long case?
Case formulation and management tend to carry the most weight. Examiners look for a prioritised problem list, a diagnosis that integrates the child's age, development, comorbidities and social context, and a management plan with weight-based dosing and a clear rationale for each active problem. Accurate history and examination are necessary inputs, but candidates who pass consistently demonstrate higher-order paediatric reasoning across formulation and management.
How long is the RACP Paediatrics DCE long case?
For each long case candidates spend around 60 minutes with the patient and family taking a history and examining, then about 10 minutes of independent thinking time, followed by roughly 25 minutes presenting to and being questioned by two consultant examiners. Most sittings include two long cases and four short cases.
How is the paediatric DCE short case marked compared with the long case?
Short cases assess focused examination technique on a specific body system or sign in a child, with a short stem before each station and about 15 minutes per case. Two examiners score five domains: interaction with the patient and family, examination technique, examination accuracy, interpretation and synthesis of physical findings, and investigations and management. The long case, by contrast, is dominated by history, synthesis, the impact of the illness on the family, and the management plan.
Where is the official RACP Paediatrics DCE rubric published?
The current marking criteria, domain definitions and standard-setting methodology are published in the RACP Paediatrics & Child Health Divisional Clinical Examination handbook on the RACP trainee resources portal. RACP is also implementing reforms to the Paediatric Clinical Examination following its January 2025 Review Report, so always check the handbook and update pages for the sitting you are preparing for.