RACP Adult Internal Medicine Divisional Examinations: DWE and DCE Guide

The RACP Adult Internal Medicine examination family contains two summative Basic Training assessments:

• Divisional Written Examination (DWE): assesses clinical knowledge and basic science applicable to clinical medicine.
• Divisional Clinical Examination (DCE): assesses clinical acumen, clinical examination, interpersonal skills, and clinical discussion using real patients.

Trainees must pass both examinations to fulfil the Adult Internal Medicine Basic Training requirements and progress to Advanced Training. These examinations do not themselves confer Fellowship; Advanced Training and the subsequent admission process remain separate.

This guide covers Adult Internal Medicine only. It excludes the separate Paediatrics & Child Health examination family. The examinations are administered across Australia and Aotearoa New Zealand, with country- and sitting-specific instructions for applications, venues, communications, and other administrative matters. RACP states that there are no exemptions from sitting these examinations when they are required for Adult Internal Medicine Basic Training progression.

Divisional Written Examination

The announced October 2026 DWE is a paper-based examination with two sections:

Each MCQ has four options and one response is selected. EMQs use a lead-in and option list across linked clinical scenarios, testing problem solving and clinical reasoning. The written examination may require interpretation of visual material such as plain radiographs, CT and MRI scans, ECGs, radioisotope scans, respiratory function tests, and sleep-study patterns. Other material may be presented with laboratory-style reports, including blood films, bone marrow films, echocardiograms, electromyograms, electroencephalograms, and histology sections.

Divisional Clinical Examination

The Adult Medicine DCE is conducted in a clinical setting with real patients and different patients for each case component:

Each case is assessed by at least two examiners. The DCE is criterion-referenced rather than graded against a fixed quota. Long Cases emphasize history accuracy, clinical examination, synthesis and prioritisation, the effect of illness on the patient and family, and an appropriate management plan. Short Cases emphasize interaction with the patient or family, examination technique and accuracy, interpretation and synthesis of findings, and investigations or management.

The October 2026 Adult Medicine blueprint gives target ranges for multiple-choice questions by specialty. The RACP footnote defines these figures as target numbers of MCQs; they are not published weights for EMQs or for the DCE.

Use the ranges to organize broad revision without treating them as a prediction of exact questions. Give substantial study time to the larger 8–12 and 10–14 areas, while deliberately reviewing the smaller categories so that low-volume subjects are not ignored.

The DCE is prepared through its published performance domains and timing rather than through a specialty item-count table. Practice accurate history and examination, concise synthesis, patient-centred communication, prioritisation, and safe investigation and management discussions under time pressure.

Eligibility depends on the trainee cohort, curriculum pathway, examination sitting, attempt history, and jurisdiction. The relevant sitting-specific application page is the controlling source.

Trainees who started Basic Training before 2025 follow the PREP curriculum and program requirements. First-year trainees starting from 2025 follow the new curriculum, so the terminology and progression evidence differ by cohort.

From applications for examinations in 2027, revised first-attempt eligibility is scheduled to apply. A trainee may become eligible for a first DWE attempt after successfully completing the Foundation Phase, while a first DCE attempt requires a passed DWE and successful completion of the Foundation and Consolidation phases, with the published minimum of 24 months certified FTE. The change is optional rather than an expectation to sit earlier; readiness and local training support remain important.

Build the written plan around the published format

• Separate preparation for Clinical Applications from Medical Sciences. Clinical Applications requires applied medical and therapeutic reasoning; Medical Sciences requires principles and basic science applied to clinical medicine.
• Use the specialty ranges to create a revision matrix. Prioritise the broadest categories, but schedule deliberate review of the smaller blueprint areas.
• Practise both one-best-answer MCQs and EMQs. For EMQs, work through a shared option list and compare plausible choices across related clinical scenarios.
• Include interpretation of visual and report-based material, especially ECGs, imaging, respiratory tests, sleep-study patterns, blood films, and other formats identified by RACP.
• Use the current RACP sample papers and examination-readiness resources for format familiarity without reproducing or relying on remembered examination questions.

Prepare for the DCE as a patient-based assessment

• Run complete Long Case practices using the published 60-minute review, 10-minute preparation, and 25-minute discussion sequence.
• Practise Short Cases with a two-minute stem and a focused 15-minute examination. Adapt the examination to the task and patient rather than applying a rigid routine.
• Obtain supervised feedback on history accuracy, examination technique, interaction with the patient and family, interpretation of findings, synthesis, prioritisation, and management planning.
• Rehearse concise Long Case presentations aloud. RACP notes that excessively long presentations may be interrupted, so lead with the main problems, supporting findings, priorities, and plan.
• Practise with real patients and the equipment expected for the examination. Written questions can reinforce knowledge, but they do not reproduce the DCE’s real-patient assessment.

Turn feedback into a repeatable plan

After a DWE or DCE attempt, review the official feedback with a supervisor, mentor, or Director of Physician Education. Convert specific weaknesses into recurring practice tasks rather than relying on unstructured repetition. For the DCE, keep the practice aligned to the published case domains and time limits.

• Australia and Aotearoa New Zealand: The examination family is shared, but application processes, venues, communications, fees, and sitting instructions are jurisdiction- and sitting-specific. Use the relevant official page rather than relying on a previous sitting’s arrangements.
• Travel and allocation: DCE candidates should plan to travel away from their usual workplace. Specific venue requests are not guaranteed, and candidates may be allocated to a different state or location. Do not contact or visit the allocated hospital before the examination to seek case information, inspect rooms, identify examiners, or obtain performance guidance.
• Special consideration: Raise disability, pregnancy-related, cultural, religious, compassionate, or other significant access needs as early as possible, preferably during application. Report technical or procedural problems immediately during the DCE so they can be documented. Follow the official policy for post-examination requests.
• Withdrawal: A DWE withdrawal is not counted as an examination attempt. For the DCE, withdrawal before the examination has commenced does not count as an attempt, but attending and withdrawing after the examination starts does count. Refund eligibility and reapplication are separate administrative questions.
• Attempt limits: Current attempt limits vary by cohort and prior examination history. Do not rely on a generic number; consult the applicable examination page and progression policy.
• 2027 DCE attempt change: From 2027, the maximum DCE attempts will increase from three to four for eligible current Divisional Basic Trainees who have not exhausted their attempts. The change does not apply to people who have already exited Basic Training. The DWE maximum remains four, and all attempts remain subject to the Basic Training time limit.
• Planning the transition: The 2027 first-attempt eligibility changes and the separate DCE attempt-limit change are different policies. A trainee’s eligibility also depends on curriculum phase completion, progression decisions, prior attempts, and the applicable sitting rules.