What the ACD IMG assessment requires
The Australasian College of Dermatologists IMG Assessment is typically a structured, interview-style assessment using clinical scenarios. It tests how you reason through dermatological presentations rather than how many isolated facts you can recall.
The scenarios may require you to:
- recognise a common presentation and identify what could make it dangerous;
- assess urgency and decide where the patient should be managed;
- select useful investigations, including when a biopsy is appropriate;
- propose safe immediate and longer-term management;
- explain your plan clearly to a patient or colleague;
- use appropriate Australian or New Zealand referral and escalation pathways; and
- demonstrate professional judgement, consent awareness, documentation and follow-up.
The College may update its requirements, so check the official ACD website for the current application information and assessment description before fixing your preparation schedule. The plan below is designed around the clinical reasoning and safe-practice format described above, not around assumed question numbers or a predicted list of cases.
How to use this plan
Set aside six weeks if you can study consistently. A suitable baseline is 8–10 hours each week, divided into sessions of 60–120 minutes. If you work full-time, protect shorter sessions rather than relying on one long weekend block.
Use one repeatable answer structure for most clinical scenarios:
- Problem summary and triage — state what you think is happening and how urgently you would act.
- Key history and examination — ask only questions that can change risk, diagnosis or treatment.
- Differentials and red flags — prioritise dangerous alternatives before less serious possibilities.
- Investigations or biopsy plan — explain what you need, why you need it and what you would do with the result.
- Management — cover immediate treatment, longer-term care, escalation and patient preferences.
- Follow-up and safety-netting — say who reviews the patient, when, and what should prompt earlier help.
For professionalism and systems questions, use a different structure: principles and obligations, stakeholders, immediate actions and escalation, documentation, and reflection or quality improvement.
Do not memorise these headings as a script. They are prompts to stop you jumping straight to a diagnosis or treatment before establishing severity.
Week 1: Build the assessment framework
Total: 8 hours
Session 1 — 90 minutes: establish the boundaries
Read the current information from the College and write down what is confirmed about the assessment. Keep a separate list of unknowns rather than filling gaps with assumptions. In particular, do not invent a question count, time limit, pass mark or fixed station list.
Create a one-page answer template with the six clinical headings above. Under each heading, leave space for examples from your own notes.
Session 2 — 2 hours: triage and red flags
Create short notes for presentations where delay could cause serious harm. Your list might include:
- a rapidly progressive blistering or erosive eruption with mucosal involvement;
- suspected Stevens–Johnson syndrome or toxic epidermal necrolysis;
- severe drug eruption with systemic features;
- rapidly progressive infection or necrotising infection;
- a changing pigmented lesion suspicious for melanoma;
- a painful or ulcerated lesion that may represent malignancy; and
- an immunosuppressed patient with an unusual or rapidly worsening eruption.
For each, record the first safe action, the escalation destination, the information you would gather, and the safety-net advice. Avoid writing “refer urgently” without stating what makes it urgent and what you would do while arranging help.
Session 3 — 90 minutes: communication and professionalism
Practise explaining uncertainty without sounding indecisive. Use phrases such as, “My immediate concern is…”, “I would first exclude…”, and “If that finding were present, I would escalate by…”.
Review consent, capacity, confidentiality, interpreter use, shared decisions and documentation in the Australian setting. The aim is not to recite legislation. It is to show that the patient understands the plan and that you know when to seek senior or multidisciplinary support.
Session 4 — 2 hours: first recorded response
Choose two common dermatology scenarios and one high-risk scenario. Give yourself six minutes per answer, record your response, then listen once without stopping. Mark whether you identified urgency, justified investigations, included a safety-net and explained follow-up.
Session 5 — 2 hours: feedback and correction
Rewrite only the parts that were missing. Do not rewrite the entire answer into a polished essay. The assessment is an interview, so practise saying the key decisions in a clear order.
A useful first-week target is not “know all dermatology”. It is “make a safe, prioritised opening statement within 30 seconds”.
Week 2: Turn your notes into a working board
Total: 9 hours
Divide your material into boards or sections that match decisions an examiner could ask you to make. Useful sections include acute red flags, pigmented lesions and skin cancer, inflammatory disease, infections, drug reactions, investigations and biopsy, and Australian systems and professionalism.
For each section, write short, testable points. A note such as “consider biopsy” is too vague. Replace it with the decision it supports: what lesion or clinical uncertainty makes biopsy necessary, what information to provide, and how the result changes management.
MySummaries can be used here to organise your own PDFs, slides and photographed notes into a board before you start drilling them.
A board for this assessment should contain decisions rather than a textbook index:
- SJS/TEN concern — widespread epidermal detachment, mucosal involvement or systemic illness requires urgent escalation and medication review
- Rapidly progressive infection — assess toxicity, pain out of proportion, crepitus and immunosuppression; escalate immediately if suspected
- Explain the working diagnosis, treatment purpose, expected response and important adverse effects
- State who will review the patient and which symptoms require earlier presentation
- ABCDE — asymmetry, border, colour, diameter and evolution guide concern but do not replace full assessment
- Changing or suspicious lesion — document morphology, examine relevant nodes and arrange timely specialist assessment or biopsy pathway
- Use an interpreter where needed and check understanding
- Document assessment, advice, escalation, consent and follow-up arrangements
Choose tests that answer a clinical question. For a suspicious lesion, document site and morphology, select the appropriate biopsy approach with senior or specialist input, and arrange result review and communication.
Use the board to find gaps in your source material. If you cannot explain how an investigation changes your next step, the note is not ready to become a flashcard.
Week 3: Practise investigation and management decisions
Total: 9–10 hours
Session 1 — 2 hours: investigation choices
Take ten presentations and answer three questions for each:
- What information would change my urgency?
- What investigation is justified now?
- What result would change my management?
Include situations where the best answer is not to order a broad panel of tests. For example, a typical uncomplicated presentation may be managed clinically, while atypical, severe, treatment-resistant or systemically unwell cases may need targeted investigations or specialist review.
For suspected malignancy, practise describing lesion documentation, examination of relevant lymph nodes, biopsy considerations, pathology follow-up and communication of results. Do not imply that every lesion is managed identically; explain what depends on site, morphology, size, diagnostic uncertainty and specialist advice.
Session 2 — 2 hours: management plans
For each scenario, separate immediate management from longer-term management. Include medication review, contraindications, comorbidity, pregnancy where relevant, patient preferences and practical access to care.
Then add safety-netting in plain language. “Return if worse” is weak. Say what worsening means, where the patient should go, and how quickly.
Sessions 3 and 4 — 2 hours each: paired practice
Ask a colleague to interrupt with changes: fever develops, mucosal involvement appears, the patient declines a biopsy, the patient cannot access the proposed follow-up, or the initial treatment fails. Respond by reprioritising rather than defending the first plan.
Session 5 — 1–2 hours: review the due queue
End each study day by reviewing due cards. Keep cards to one decision or fact. If a card requires a paragraph, split it.
In the second half of the plan, your review queue should show whether you are retaining safe actions, not merely recognising disease names:
Do not try to clear every queue by guessing. Grade a card honestly and return to the source note when you are uncertain.
Week 4: Build oral answers under pressure
Total: 10 hours
Session 1 — 90 minutes: the opening minute
Practise starting with a concise problem representation: age and context, key morphology or symptoms, the main risk, and your immediate triage. For example: “This is a patient with a rapidly progressive blistering eruption and mucosal symptoms, so I would treat this as a potentially serious drug reaction requiring urgent assessment, medication review and escalation.”
The exact wording will vary with the case. The important features are prioritisation and a defensible first action.
Sessions 2 and 3 — 2 hours each: full scenarios
Complete four scenarios per session. Allow six to eight minutes per response, then spend the same amount of time reviewing it. Score yourself against these preparation criteria:
- problem representation, severity and urgency;
- prioritised differentials and red flags;
- appropriate investigations or biopsy planning;
- management, escalation and safety-netting;
- communication, consent and professionalism; and
- systems awareness, referral, documentation and multidisciplinary care.
These are useful platform practice criteria, not a claim about the College’s official marking scheme.
Session 4 — 2 hours: examiner interruptions
Ask your partner to use short prompts: “Why?”, “What would make you escalate?”, “What would you tell the patient?”, and “What if the result is negative?” The purpose is to practise answering the question asked before returning to your structure.
Session 5 — 2 hours: Australian context
Map your proposed actions to the local system you will practise in. Know how you would contact a senior dermatologist, emergency service, hospital team, general practitioner and relevant allied health professional. Check the precise local pathway rather than assuming that one state or territory uses the same process as another.
Week 5: Find and repair weak sections
Total: 9 hours
Complete a mixed set of scenarios without choosing the topic in advance. Keep a simple record of the marks or criteria you earned. Then rank sections by repeated errors, not by how uncomfortable they feel.
Common patterns include jumping to treatment before triage, ordering tests without explaining their purpose, omitting medication review in a severe eruption, and ending without follow-up. Repair each pattern with one short checklist and three spoken practice cases.
A useful weakness report might look like this:
Spend the next two sessions on the first two rows. Do not respond by rereading every dermatology topic. A weak section improves when you repeatedly make the missing decision in varied scenarios.
Week 6: Simulate, review and taper
Total: 8 hours
Session 1 — 2 hours: timed mixed circuit
Complete a sequence of unfamiliar clinical and professionalism scenarios in one sitting. Use the current information available from the College to make your simulation as realistic as possible, without inventing details that are not confirmed.
Session 2 — 90 minutes: review errors
Classify each error:
- knowledge gap;
- failure to identify urgency;
- unclear investigation rationale;
- incomplete management or safety-netting;
- communication or consent omission; or
- system and documentation gap.
Only knowledge gaps require new reading. The other errors require spoken repetition.
Session 3 — 2 hours: second simulation
Repeat the circuit with different cases. Aim for answers that are ordered and concise, not artificially fast. Leave enough time to acknowledge uncertainty and state how you would obtain senior advice.
Session 4 — 90 minutes: final core review
Review your high-risk red flags, escalation steps, investigation principles, biopsy follow-up, common management frameworks and professionalism notes. Check all current administrative information on the official website.
Session 5 — 1 hour: light oral practice
Give two calm answers and stop. In the final days, prioritise sleep, reliable recall and clear communication over adding large amounts of new content.
A weekly review rule
At the end of every week, answer four questions:
- Which clinical decision can I now explain clearly?
- Which red flag did I miss or underweight?
- Which investigation did I choose without a clear purpose?
- What will I say about follow-up and safety-netting next time?
This keeps the plan directed at performance. The aim is to show a safe, prioritised approach to an unfamiliar dermatology scenario, with appropriate escalation and communication, rather than to deliver a memorised lecture.
How MySummaries helps
MySummaries lets you build the ACD IMG board from your own material, turn decisions into spaced-repetition cards, generate written cases for review, and practise recorded oral scenarios against criteria covering reasoning, urgency, investigations, management, communication and systems awareness.