Before you stop doing new questions for the RACP Divisional Written Examination in Adult Medicine, you should be able to prove coverage rather than assume it. This article is a checklist, not a timetable: it sets out the minimum evidence a basic physician trainee needs before saying the blueprint is covered, the blind spots that self-selected practice tends to hide, and a stop-or-continue decision tree keyed to your measured gaps. iatroX is used here as the written-knowledge and unseen-measurement layer only; it is not the clinical exam.
The direct answer, as a checklist
You have covered RACP Adult Medicine when you can answer yes, with evidence, to all of the following: every blueprint domain has enough recent, unseen, correctly answered questions; your first-attempt accuracy on unseen timed blocks is stable across domains, not just in your strong areas; you have calibrated against the RACP's own sample material; your high-confidence errors are rare; you retain previously missed items after a spacing gap; and you have a separate, deliberate plan for the clinical examination, which no written bank prepares you for. Until every box is ticked, you are not finished, however high your bank percentage reads.
Current exam snapshot (last checked 20 July 2026)
Verified against racp.edu.au on 20 July 2026, the Divisional Written Examination for Adult Medicine is a paper-based exam, with the venue booked through Pearson VUE, made up of two papers.
| Paper | Questions | Duration |
|---|---|---|
| Clinical Applications | 100 (predominantly single-best-answer MCQ, four options, with a small number of extended-matching questions) | 3 hours 10 minutes |
| Medical Sciences | 70 (same item types) | 2 hours 10 minutes |
Each correct answer scores one mark, and there is no penalty for a wrong answer, so leave nothing blank. The two papers total 170 questions. The separate Divisional Clinical Examination, built around a long case and short cases, follows and is assessed live; verify current counts, durations and dates on racp.edu.au, as these are updated per diet. The authoritative content source is the RACP Basic Training Curriculum for Adult Internal Medicine, not any vendor's syllabus.
Build a blueprint coverage table
The core artefact of coverage is a table you fill in yourself, one row per domain, so gaps become visible instead of hiding behind an overall average.
| Domain | Official emphasis | Questions attempted | First-attempt accuracy | Last reviewed | Confidence |
|---|---|---|---|---|---|
| Cardiology | High | ||||
| Respiratory and sleep | High | ||||
| Gastroenterology and hepatology | High | ||||
| Endocrinology and diabetes | High | ||||
| Nephrology | High | ||||
| Neurology | High | ||||
| Haematology | Medium | ||||
| Medical oncology | Medium | ||||
| Infectious diseases | High | ||||
| Rheumatology | Medium | ||||
| Immunology and allergy | Lower | ||||
| Clinical pharmacology and toxicology | Medium | ||||
| Geriatric medicine | Medium | ||||
| Palliative and end-of-life care | Lower | ||||
| Acute and intensive care medicine | Medium | ||||
| Medical sciences underpinning (physiology, pharmacology, genetics, immunology, statistics) | High (own paper) |
Emphasis is indicative and should be checked against the current RACP curriculum; the point of the table is not the labels but the discipline of recording accuracy and recency for every domain. Completion of a bank is not coverage of this table.
Ten domain-level blind spots
These are the areas most likely to remain hidden when you choose your own questions, because candidates gravitate to what they already enjoy. Each should be checked by someone who knows the exam before you conclude you are ready.
- The Medical Sciences paper as a whole, especially physiology and pharmacology mechanisms, which clinically confident trainees under-practise.
- Biostatistics, epidemiology and critical appraisal, which are testable and routinely neglected.
- Clinical pharmacology, therapeutics and toxicology, including interactions and antidotes.
- Genetics and genomics in adult medicine, an expanding and under-revised area.
- Immunology and allergy, often skipped because it feels peripheral until it appears.
- Dermatological signs of systemic disease, which reward pattern recognition few candidates drill.
- Palliative and end-of-life care, including symptom control and the ethics around it.
- Geriatric medicine: delirium, falls, polypharmacy and deprescribing in the Australasian context.
- Ethics, law and professional practice as they apply in Australia and New Zealand.
- Less-common but high-yield emergencies, such as endocrine crises and haematological malignancy presentations, that are easy to leave until last and then never reach.
Format checklist for the clinical exam
The written papers do not prepare you for the Divisional Clinical Examination, and pretending otherwise is the most expensive error a trainee makes. Verify that you have deliberate, supervised practice at the long case, structured to a clear framework and timed; at the short cases, with real examination technique observed and corrected; at oral reasoning under pressure, articulating a differential and a management plan aloud; and at doing all of this in the Australian and New Zealand practice context. A question bank, iatroX included, builds the knowledge these depend on but cannot rehearse the live performance. Book supervised practice early.
Interpretation checklist
Confirm you have specifically practised the data-interpretation skills the papers test, not just the recall: electrocardiograms across the common and the dangerous patterns; chest and other radiographs at the level a physician is expected to read them; laboratory trends over time rather than single values; clinical calculations done under time; and any statistics or ethics items framed as data or scenarios. Interpretation is a distinct skill from knowledge, and it is where high-confidence errors cluster.
Recency checklist
For every guidance-sensitive topic, record the date and the jurisdiction of your source, because Australasian practice and the underlying evidence both move. Flag anything where guidance has changed recently, for example in anticoagulation, diabetes therapy, heart-failure management, sepsis and antimicrobial stewardship, and confirm you are revising the current Australian and New Zealand position rather than an older or overseas one. A correct answer to last year's guideline is a wrong answer this year.
Performance checklist
Coverage of content is necessary but not sufficient; you also need performance evidence. Confirm you have sat unseen, timed, mixed blocks rather than only topic sets; that your pace matches the exam's, roughly two minutes per question on the longer paper; that your high-confidence errors are rare, since these are the ones that harm you most; that you retain previously missed items after a genuine spacing gap; and that you have calibrated against the RACP's own sample questions, which are the closest thing to the real standard. Overall percentage is not on this list, and for good reason.
Stop or continue: a decision tree
Read your table and your performance evidence, then choose the smallest sufficient action rather than defaulting to more questions.
- If one or more domains are still thin or low-accuracy: continue new questions, but only in those domains, and teach before you re-test.
- If coverage is broad but accuracy is unstable across sittings: stop adding volume and consolidate; review errors and re-test misses until accuracy steadies.
- If accuracy is stable and high on unseen items: stop new questions and simulate; do full-length timed mocks and calibrate against official material.
- If the gap is speed or high-confidence errors, not knowledge: stop learning content and drill timed interpretation and error review.
- If the written side is solid but the clinical exam is unrehearsed: shift effort to supervised long and short case practice; the written bank has done its job.
- If you are exhausted and your accuracy is falling: rest. Fatigue-driven errors are not knowledge gaps and are not fixed by more questions.
A one-page checklist and a worked example
Copy this into your notes as a single page: every domain has recent, unseen, correctly answered questions; first-attempt unseen accuracy is stable across domains; calibrated against RACP samples; high-confidence errors rare; misses retained after spacing; interpretation skills drilled; recency and jurisdiction recorded for guidance-sensitive topics; and a separate, booked plan for the clinical exam.
Worked example, using invented data. A trainee has attempted 2,600 questions and reads 78 per cent overall, and feels ready. The table tells a different story: cardiology 82 per cent, respiratory 80 per cent, but medical sciences 61 per cent, statistics 55 per cent and genetics not attempted in eight weeks. High-confidence errors sit at 12 per cent. The overall figure was hiding two thin domains and a stale one. The correct action is not to stop, and not to grind all domains, but to teach and re-test medical sciences, statistics and genetics, drill the high-confidence errors, and only then move to full-length mocks. The percentage said finished; the checklist said not yet.
Why self-selected practice hides gaps
When you choose your own questions, you tend to choose comfort. Trainees over-sample the domains they enjoy and the presentations they meet at work, and they under-sample the Medical Sciences paper, the statistics, and the subspecialties they rarely rotate through. The result is an overall percentage that looks reassuring while two or three domains quietly stay thin. Randomised, mixed, unseen blocks counter this directly, because they stop you steering toward strength; so does an external check, whether a colleague setting your questions or a second bank whose contents you did not curate. The blind spots that fail candidates are rarely the topics they already know they are weak in, which at least get attention; they are the ones they never chose to test, and so never saw coming.
Calibrating against the official material
The RACP's own sample questions are the closest thing you have to the real standard, and they are finite, which makes them precious rather than expendable. Do not burn them early as ordinary practice. Save a portion to sit late, under timed conditions, as a calibration check: if your accuracy and pace on the official items match your accuracy on your commercial bank, that bank is behaving as a fair proxy; if the two diverge, trust the official items and adjust your sense of where you stand. Because official material is limited, a commercial bank still supplies the volume you need for breadth across both papers, but the official set is what anchors your judgement of what "ready" actually feels like under exam conditions.
Turning the checklist into a weekly review
A checklist only helps if you run it on a schedule rather than once, in a panic, at the end. Once a week, spend twenty minutes updating the coverage table from that week's blocks: refresh each domain's attempted count, first-attempt accuracy and review date, and flag anything that has now gone stale. Then run the six performance questions in order: were your blocks unseen and timed, did your pace hold, did high-confidence errors fall, did last week's misses stick after the gap, have you calibrated against official material recently, and is the clinical examination still on track. The whole review takes less time than a single question block, and it is precisely what converts a growing pile of practice into a defensible claim of readiness. Skipping it is how trainees reach the exam with three thousand questions attempted and no idea which domains are actually safe.
Bottom line
The RACP Adult Medicine written examination rewards demonstrated coverage, not completed banks. Build the coverage table, fill it with recent, unseen, correctly answered questions across every domain including the Medical Sciences paper, calibrate against the College's own material, and watch your high-confidence errors and your pace rather than your headline percentage. Then, and only then, decide whether to continue, consolidate, simulate or stop. And throughout, keep in view what the written bank cannot do: it does not sit the long case or the short cases for you, so book supervised clinical practice long before the written score looks finished.
Frequently asked questions
How do I know whether I have covered the full RACP Adult Medicine blueprint? You know from a completed blueprint-coverage table, not from finishing a bank. Every domain in the RACP Adult Internal Medicine curriculum, including the Medical Sciences paper, needs enough recent, unseen, correctly answered questions, with accuracy and recency recorded. If any domain is blank, stale or low-accuracy, you have not covered it, whatever your overall percentage suggests.
Can one question bank be enough for RACP Adult Medicine? One strong, curriculum-mapped bank can carry most of the written preparation if it genuinely spans both the Clinical Applications and Medical Sciences content and you measure by domain. But a single bank is rarely enough on its own: you need the RACP's official samples for calibration and, ideally, a second, unseen bank so a good score reflects transfer rather than familiarity. And no bank covers the clinical examination.
What should I measure instead of my overall Q-bank percentage for RACP Adult Medicine? Measure first-attempt accuracy on unseen, timed, mixed blocks by domain; your pace against the papers' pace; your rate of high-confidence errors; and your retention of missed items after a spacing gap. Your overall percentage rises simply from re-seeing questions and is a poor guide to exam-day performance, as our percentage article explains in detail.
When should I stop doing new RACP Adult Medicine questions? Stop when your coverage table is complete and your first-attempt accuracy on unseen items has plateaued across domains, with remaining errors careless rather than knowledge-based. At that point new volume adds little, and your time is better spent on timed full-length mocks, targeted error review and, importantly, the supervised clinical-exam practice the written bank cannot provide.
Which RACP Adult Medicine resource should I use for my weakest component? Match the resource to the weakness. For a weak written domain, use a curriculum-mapped bank and teach that domain before re-testing; iatroX's RACP Adult Medicine items work well as the unseen measurement check. For weak interpretation, drill ECGs, imaging and laboratory trends under time. For the clinical examination, use supervised long and short case practice with consultant feedback, because that is a performance skill no question bank reproduces.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 20 July 2026; exam-format figures are taken from racp.edu.au on that date and are updated by the College per diet, so verify the current question count, duration and delivery mode before you rely on them. Disclosure: iatroX operates a RACP Adult Medicine written-question bank, so its role in this checklist is confined to the written-knowledge and unseen-measurement layer; it is explicitly not the Divisional Clinical Examination, and this article says so plainly. Corrections are welcome via the feedback route on iatrox.com. References: RACP Divisional Written Examination (racp.edu.au); RACP Basic Training Curriculum, Adult Internal Medicine (racp.edu.au); iatroX, "Your Q-Bank Percentage Is Not Your Exam Score"; iatroX, "Question Bank Completion Is Not Coverage"; and iatroX, "Best Question Banks for the RACP Written Exam."