CGM / DGM: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Frailty and Comprehensive Geriatric Assessment (CGA)
• Dementia — diagnosis, behavioural symptoms, anti-dementia drugs, anti-amyloid therapies
• Delirium — recognition (4AT), causes, prevention bundles, antipsychotic use in older adults
• Falls and fragility fractures — multifactorial assessment, postural hypotension, bone health
• Polypharmacy and prescribing — STOPP/START v3, anticholinergic burden, deprescribing
• Movement disorders — Parkinson's disease, atypical parkinsonism, drug-induced
• Continence — urinary and faecal, post-stroke continence
• Stroke and TIA in older adults — secondary prevention, post-stroke rehabilitation
• Capacity, MCA, DoLS/LPS, advance care planning, ReSPECT
• End-of-life care — anticipatory prescribing, opioid conversion, symptom control
• Acute presentations in older adults — sepsis, AKI, AF in frailty, syncope, electrolytes
• Nutrition, pressure ulcers, sarcopenia, dysphagia
• Service models — intermediate care, hospital at home, virtual wards, frailty front-door

Mapped to the published DGM syllabus and prioritised using item-density signals across the iatroX bank.

• Comprehensive Geriatric Assessment (CGA) — the organising principle of geriatric medicine. Domains: medical (problem list, active diagnoses, medication review), functional (Barthel ADLs, IADLs), cognitive (4AT for delirium, MoCA/AMTS for cognitive assessment), psychological (Geriatric Depression Scale), social, nutritional (MUST). Evidence base from Cochrane.
• Delirium — 4AT vs CAM differentiation, distinguishing from dementia (acute onset, fluctuating attention), TIME bundle for prevention, antipsychotic use in older adults (risks, indications, when avoided in DLB), 4AT score interpretation (0 unlikely, 1-3 cognitive impairment, ≥4 possible delirium)
• Falls — multifactorial assessment per NICE NG161, postural hypotension thresholds (drop ≥20 mmHg systolic or ≥10 mmHg diastolic), medication review (anticholinergics, sedatives, opioids, antihypertensives), STEADI framework. Bone protection in fracture prevention.
• Anti-dementia therapies — donepezil, rivastigmine, galantamine (AChE inhibitors), memantine (NMDA antagonist), when to start, when to stop. Emerging anti-amyloid therapies (lecanemab, donanemab) and ARIA-E/ARIA-H monitoring intervals, APOE-ε4 genotyping, eligibility (early symptomatic AD with biomarker confirmation).
• STOPP/START version 3 (2023) — anticholinergic burden, drug-disease interactions, deprescribing thresholds. Differs from Beers criteria. Version 3 includes new categories for emerging medications.
• Parkinson's disease management — levodopa wearing-off (entacapone, opicapone, safinamide, istradefylline), deep brain stimulation criteria, psychosis (quetiapine, clozapine, pimavanserin), end-of-life Parkinson's care including non-oral medication.
• Mental Capacity Act — functional test (understand, retain, weigh up, communicate), best interests, IMCA referrals, attorneys (LPA-health-and-welfare) vs deputies. Liberty Protection Safeguards (LPS) framework rolled out from 2024 replacing DoLS — both are examined.
• End-of-life prescribing — anticipatory medications, opioid oral-to-subcutaneous conversion (typically 2:1 ratio for oral morphine to subcutaneous), midazolam for terminal agitation, glycopyrronium for secretions, hyoscine alternatives.

Observations from UK trainees and recent DGM candidates. Verify against current NICE, BGS and MCA Code of Practice guidance.

Candidate-reported observations — not official guidance.

1. STOPP/START version — version 3 published 2023 with anticholinergic burden scoring and new deprescribing rules. Older revision sources teach version 2 criteria. Use the current version.
2. Dementia subtype recognition — DLB (neuroleptic sensitivity, visual hallucinations, REM sleep behaviour disorder, fluctuations), FTD behavioural variant (disinhibition, executive dysfunction), vascular cognitive impairment vs Alzheimer's. Frequently muddled.
3. DoLS vs LPS — the Liberty Protection Safeguards framework began rollout in 2024 and replaces DoLS. Both are examined. Knowing which deprivations require authorisation in domestic vs care home vs hospital settings.
4. Anti-amyloid therapies — lecanemab, donanemab. ARIA-E and ARIA-H monitoring intervals, who is eligible (early symptomatic AD with biomarker confirmation), APOE-ε4 genotyping. Newly tested topic since 2024.
5. Frailty scoring — Clinical Frailty Scale (Rockwood) levels and meaning, electronic Frailty Index for primary care, PRISMA-7, gait speed thresholds. Different scales tested in different domains.
6. Continence subtypes — stress vs urge vs mixed vs overflow vs functional. Anticholinergic burden in older adults — mirabegron preferred over oxybutynin/solifenacin where possible.
7. OSCE Station 3 (Ethical and Legal Principles) — capacity assessment, breaking confidentiality, end-of-life decisions, allegations of abuse, testamentary capacity, powers of attorney. This station differentiates pass and fail candidates more than the clinical stations.
8. Format change November 2024 — the OSCE structure changed (4 stations not 5, 15 minutes not 14). Older revision materials describe the previous format. Use current RCP DGM regulations.

A suggested sequence for the CGM knowledge assessment and separate DGM clinical work.

1. Weeks 1–6

   Foundation pass across all 13 blueprint topics. 30 questions/day with the iatroX adaptive engine. Review current authoritative guidance for dementia, falls, end-of-life care, delirium and multimorbidity alongside weak topics.

2. Weeks 7–10

   Targeted weak-area drilling. Map STOPP/START v3 criteria. Daily MCA capacity scenario practice. Anti-amyloid therapy and recent BGS position statements. Continence and Parkinson's management depth.

3. Weeks 11–13

   Use the official CGM structure of 50 questions in 90 minutes per paper as the reference for pacing practice. Check the available count and timing of your selected practice set. Prepare clinical assessment and communication with observed feedback.

4. Weeks 14–16

   Review unresolved knowledge errors and the current candidate instructions. For DGM, continue observed clinical practice and confirm your individual booking, report time and venue.

Dedicated CGM / DGM question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

These RCP/BGS credentials are for statutorily regulated healthcare professionals. The CGM has experience requirements; the DGM clinical assessment requires CGM completion and current registration in good standing. Check the RCP requirements for your own route.

The RCP publishes separate CGM and DGM calendars. Check the actual application period and your individual admission details; a listed examination date does not mean applications remain open.

The CGM knowledge assessment has 200 best-of-five questions in four papers, each containing 50 questions over 90 minutes. The separate DGM clinical assessment has four live stations and lasts about 1.5 hours at The Spine, Liverpool.

Yes. The RCP requires CGM completion before applying for the DGM. It gives candidates four years from notification of the CGM knowledge pass to pass the clinical assessment.

Check the current regulations for the component you are entering. The RCP describes an additional educational-evidence process after six unsuccessful DGM attempts; individual eligibility and any further attempt need its confirmation.

The DGM (Diploma) is open to GPs, AHPs and other MDT members in addition to doctors — and is pitched at the standard of a competent practitioner in older people's care. The SCE in Geriatric Medicine is a UK specialty trainee CCT requirement for geriatricians, with greater depth across all subspecialty areas. Many GPs with care-home interest hold the DGM; geriatrics trainees hold the SCE.

Full CGM / DGM bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.