The ACD IMG assessment is typically a structured, interview-style assessment built around clinical reasoning and safe practice. You may be asked to respond to a dermatology scenario, explain what you would do next, justify an investigation or discuss a professional decision. The assessment is not simply a test of whether you can name a rash. Your answer needs to show how you recognise risk, choose priorities and act safely in the local health system.
For ACD IMG oral exam practice, rehearse complete answers aloud rather than memorising isolated disease descriptions. A useful answer should make your reasoning easy to follow. Start with a short problem representation, state the urgency, then work through the history, examination, differentials, investigations, management and follow-up. Do not give every possibility equal weight: put time-critical diagnoses and immediate actions first.
Before preparing specific topics, check the current assessment information on the Australasian College of Dermatologists website. The official source should be used for current application requirements, assessment arrangements and any changes to the process.
The answer structure to practise
A repeatable structure reduces omissions when you are under pressure. For most clinical scenarios, use six headings:
- Problem summary and triage: What is happening, in whom, and how urgent is it?
- Key history and examination: Ask only questions that change risk, diagnosis or management.
- Differentials and red flags: Give a prioritised list, not an unranked catalogue.
- Investigations or biopsy plan: Explain what you need, why you need it and how the result will change your action.
- Management: Separate immediate treatment from longer-term treatment.
- Follow-up, safety-netting and communication: State when the patient will be reviewed, what deterioration means and who needs to be involved.
For a professionalism or systems question, switch to principles and obligations, stakeholders, immediate escalation, documentation and reflection or quality improvement. In either type of response, explain uncertainty honestly. Saying that you would seek senior dermatology or emergency advice is stronger when you also describe what information you would provide and what you would do while waiting.
The first screen to build should hold the candidate's own notes in these answer categories, rather than a long collection of disconnected facts. In MySummaries, a board for this assessment can be organised around the reasoning steps that an examiner can hear.
A board on this topic ends up looking like this:
- First sentence — patient, tempo, morphology, distribution and systemic features
- Escalate now — airway compromise, haemodynamic instability, sepsis, extensive epidermal loss or rapidly progressive purpura
- Explain concern and uncertainty; check understanding and capacity for decisions
- Document timeline, examination, medicines stopped, advice received and agreed follow-up
- Use local hospital, emergency and specialist referral pathways; escalate if access is delayed
- Recent medicines, fever, skin pain, dusky targetoid macules, blistering and mucosal erosions
- Stop suspected culprit medicines; urgent hospital assessment and multidisciplinary supportive care
- Do not wait for biopsy before escalating a clinically unstable patient
State the symptoms that require immediate return or emergency help: breathing difficulty, eye pain or visual change, inability to drink, faintness, fever or rapidly spreading skin pain.
- FBC, electrolytes, renal and liver function, glucose and inflammatory markers according to severity
- Two biopsies may be required in a blistering disorder: lesional skin for histology and perilesional skin for direct immunofluorescence
- Interpret results with the clinical pattern; discuss urgent dermatopathology advice when needed
This is a study canvas, not a script to recite word for word. The details must change with the vignette. A stable, localised blistering eruption does not receive the same triage statement as a patient with mucosal involvement and systemic illness.
Turn notes into spoken stations
Oral practice should begin with the opening question, not with a disease label. Give yourself a short period to identify the problem, then speak in headings. For example, if asked about a patient with a changing pigmented lesion, do not jump directly to “melanoma”. Describe why the lesion is concerning, ask about evolution and symptoms, examine the lesion and relevant nodes, and explain how you would arrange confirmation and onward management. Include the patient's preferences, capacity and understanding when decisions are discussed.
For a suspected serious drug eruption, your first answer should make safety visible. Mention observations and systemic stability, mucosal and ocular involvement, the medication timeline, immediate cessation of non-essential suspected drugs, and urgent escalation where indicated. Avoid claiming a diagnosis before examining the patient. A biopsy can support diagnosis, but it should not delay treatment of a patient who is unstable or deteriorating.
A station list makes it easier to vary the practice. It should include common presentations, high-risk presentations and systems or professionalism scenarios, rather than only the diseases you enjoy revising.
The oral station list can be kept beside the relevant board:
After each attempt, review whether the answer was safe and prioritised, not only whether it contained the correct diagnosis. A candidate can know the likely condition and still lose ground by burying the urgent action, requesting broad tests without a purpose or failing to say what happens if the patient worsens.
Use marking to find the missing step
A useful post-station review separates knowledge gaps from delivery problems. Did you fail to know the relevant investigation, or did you know it but omit it because your structure broke down? Did you mention referral but fail to specify urgency? Did you name consent without checking understanding or involving the patient in the decision?
For oral practice, the platform's examiner persona uses six categories: problem representation, severity assessment and urgency or triage; clinical reasoning with prioritised differentials and red flags; appropriate investigations or biopsy planning and interpretation; management, patient safety, escalation and safety-netting; communication, consent or capacity considerations and professionalism; and systems awareness, including referrals, multidisciplinary care and documentation.
A marked recording can show how one answer performed across those categories:
Examiner
A 34-year-old has fever, skin pain, dusky lesions and mouth erosions five days after starting a new medicine. Talk me through your immediate approach.
You identified a probable severe cutaneous adverse reaction and prioritised systemic assessment, mucosal involvement and urgent escalation.
ImproveState at the start that airway, haemodynamic status, ocular involvement and ability to maintain hydration determine immediate location of care.
You considered SJS/TEN first and mentioned infection and autoimmune blistering disease.
ImproveExplain which features make SJS/TEN more likely and name rapidly progressive purpura or sepsis as additional red flags.
You requested baseline blood tests and skin biopsy.
ImproveSpecify lesional histology and perilesional direct immunofluorescence when appropriate, and say that results support rather than replace urgent clinical management.
You stopped the suspected medicine and arranged urgent hospital review.
ImproveAdd medication reconciliation, supportive care and explicit deterioration advice while transfer or specialist review is arranged.
You explained that the reaction could be serious and checked the patient's understanding.
ImproveInclude a clear explanation of uncertainty and check consent before procedures where the patient's condition permits.
You mentioned dermatology referral but did not identify the wider team or documentation needed.
ImproveMention ophthalmology if eye involvement is present, relevant inpatient teams, a complete drug timeline and the advice received.
The score is less important than the repeated pattern. If investigations are consistently weaker, revise biopsy indications and specimen handling. If systems awareness is weak, practise the handover and documentation sentence. If your triage score is low, record only the first 30 seconds of each answer and listen for whether urgency appears before the differential list.
Improve wording, not just knowledge
A recorded answer often sounds less definite than the candidate intended. Replace vague phrases such as “I would refer appropriately” with a specific action: “I would arrange urgent hospital assessment, contact the relevant senior clinician and provide the timeline, examination findings, suspected diagnosis and immediate risks.” Do not promise a pathway you cannot access. Say that you would use the local referral and escalation process and document any delay and safety plan.
Likewise, “I would do bloods and a biopsy” is incomplete. Name the clinical question, the specimen or test, and how the result affects management. “I would take lesional skin for histology and perilesional skin for direct immunofluorescence if an autoimmune blistering disorder is in the differential” demonstrates a plan rather than a shopping list.
The transcript view should make one costly phrase easy to revisit:
This could be a severe drug reaction, so I would assess observations, airway, hydration and mucosal involvement first. I would stop the new medication and refer appropriately. I would also take blood tests and a biopsy, then review the patient. I would explain the concern, check understanding and give clear advice to seek urgent help if they deteriorate.
refer appropriately
The phrase does not show urgency, who you would contact, what information you would hand over or what happens if access is delayed.
Say: I would stop non-essential suspected culprit medicines, arrange urgent hospital assessment through the local escalation pathway, discuss the case with a senior dermatologist or appropriate acute-care clinician, and document a safety-net plan.Practise the replacement sentence until it sounds natural. The goal is not to produce a memorised paragraph for every case. It is to make your safest next action audible while leaving room to adapt to the patient's age, comorbidities, examination and preferences.
Build a short weekly practice cycle
A practical cycle can fit around clinical work:
- Choose one board section and review the key facts aloud.
- Attempt one station without looking at the notes.
- Listen once for urgency and once for omissions.
- Rewrite one weak sentence with an action, reason and contingency.
- Repeat the same station later, then use a different presentation to test whether the structure transfers.
Keep separate records for factual errors, prioritisation errors and communication errors. A factual error needs targeted revision. A prioritisation error needs timed speaking. A communication error needs a better sentence and another recording. This prevents rereading broad notes when the real problem is that the answer does not communicate a safe plan.
How MySummaries helps
MySummaries lets you build a board from your dermatology notes, turn high-risk details into spaced-repetition cards, generate scenario questions and record oral answers against an examiner persona matched to the ACD IMG task. Its marking categories highlight whether you missed triage, investigations, safety-netting, communication or systems awareness, while the transcript and remediation tools turn a vague response into a sentence you can practise again. You can start at portal.mysummaries.app.