What the ACD IMG assessment is testing
The Australasian College of Dermatologists IMG Assessment is typically a structured, interview-style assessment. It commonly uses clinical scenarios and questions that require you to explain your reasoning rather than simply name a diagnosis.
The assessment focuses on whether you can:
- recognise common and serious dermatological presentations
- identify red flags and decide how urgently a patient needs care
- choose appropriate investigations without ordering unnecessary tests
- propose safe, defensible management
- explain when and how you would escalate
- communicate clearly with patients and colleagues
- work within Australian and New Zealand referral and health-system settings
- demonstrate professional judgement, including consent and capacity considerations where relevant
This means that ACD IMG preparation should not be a collection of isolated disease summaries. You need a repeatable method for answering an unfamiliar scenario. Your answer should show what you would do first, what could harm the patient if missed, what information you need, and how you would arrange follow-up.
The answer structure to practise
For a clinical scenario, use the same broad sequence each time:
- Problem summary and triage — restate the important facts and decide whether the patient is stable, urgent or potentially time-critical.
- Key history and examination — ask only questions that change your differential, urgency 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 would change your action.
- Management — separate immediate treatment from longer-term management.
- Follow-up, safety-netting and communication — state who will review the patient, when, and what should prompt earlier help.
You do not need to force every answer into six long sections. A short scenario may need only a few sentences. The purpose is to make your priorities visible.
For a professionalism or systems question, a different structure is useful:
- principles and obligations
- people and services involved
- immediate action and escalation
- documentation and communication
- reflection or quality improvement
Avoid beginning with a long list of rare diagnoses. Begin with the dangerous possibility and the action needed to protect the patient.
Use an Australian clinical frame
When discussing referral, escalation or shared care, make your pathway explicit. For example, you might say that you would assess the patient immediately, discuss the case with a senior clinician, arrange urgent specialist input or emergency transfer according to the clinical risk, and document the advice and plan.
Do not assume that naming a service alone demonstrates systems awareness. State what information you would include in the referral: the working diagnosis, severity, relevant photographs or pathology, treatment already given, comorbidities, medications, allergies and the specific question for the receiving service.
For consent, explain the proposed examination or procedure, its purpose, material risks, alternatives and the consequences of not proceeding. Check understanding and capacity where relevant. If there is disagreement or uncertainty, escalate rather than treating consent as a formality.
Set up your preparation around boards
Build one revision board for each substantial area of ACD IMG preparation. A board should contain the material you expect to use in an answer, not every fact you have ever read. Useful board sections include:
- presentations requiring urgent assessment
- morphology and problem representation
- investigations and biopsy decisions
- first-line and escalation management
- referral, follow-up and safety-netting
- communication, consent and professional judgement
For every condition or presentation, add a short prompt that makes you retrieve the decision. “What are the investigations for rash?” is too broad. “What would make this patient with a rapidly progressive blistering eruption require same-day escalation?” is more useful.
A board on this topic ends up looking like this:
- Start with stability — airway, breathing, circulation, mental state and systemic toxicity where relevant
- Describe the lesion — morphology, distribution, tempo, symptoms and mucosal involvement
- Prioritise urgency — rapidly progressive, painful, blistering, necrotic or systemically unwell presentations need escalation thinking
State immediate treatment, the senior or specialist discussion required, the destination of care and what must be documented. Separate treatment of the likely diagnosis from measures that protect the patient while the diagnosis remains uncertain.
- Pain out of proportion or rapidly spreading erythema: consider a deep or necrotising infection
- Mucosal involvement, skin tenderness or epidermal detachment: consider a severe cutaneous adverse reaction
- Changing pigmented lesion: assess for melanoma and arrange an appropriate biopsy or specialist pathway
- Explain the working diagnosis and uncertainty in plain language
- Give specific return precautions and a named review plan
- Check understanding, address consent and capacity, and communicate with the GP or receiving team
- Choose tests that answer a clinical question; do not order a broad panel without a reason
- For suspected infection, select microbiology based on the site and presentation and take samples before treatment when this is safe
- For a suspected melanoma, document the lesion carefully and arrange a biopsy plan that allows assessment of the entire lesion where appropriate
This board is deliberately organised around decisions. A candidate who can describe a lesion but cannot explain urgency, escalation or follow-up has not yet converted knowledge into an assessment answer.
Keep a short “must not miss” core
Your core should be small enough to revise repeatedly. It is not a substitute for reading clinical guidance; it is a set of prompts that stops you overlooking safety-critical steps during a timed response.
For each item, learn the reason behind the action. “Escalate” is weaker than “escalate because the patient has systemic toxicity, rapidly progressive skin failure or possible airway involvement”. Exact treatment choices should be checked against current Australian guidance and local protocols rather than memorised from an old question bank.
The core for this board might be:
Read the core aloud before practising a case. Then deliberately leave one item out in some drills and see whether you notice the gap when reviewing your answer. The aim is not to recite a script; it is to make safe habits automatic while keeping the content specific to the scenario.
Practise the oral assessment, not just dermatology facts
An interview-style assessment rewards the quality of your reasoning as you speak. Practise with a timer and record yourself. Listen for three problems:
- you give the diagnosis before establishing whether the patient is unwell
- you list several possibilities without ranking them
- you end after the management decision without follow-up or safety-netting
A strong opening could be: “This is a patient with an acute, painful, rapidly progressive eruption and possible mucosal involvement. I would first assess physiological stability and look for features requiring urgent escalation, while taking a focused medication and infection history.” That opening demonstrates representation, risk and action without pretending that the diagnosis is already certain.
In MySummaries, an examiner persona can be used to rehearse this structure against the platform’s preparation criteria:
The exact official assessment process can change, so check the College’s website for current candidate instructions. Your practice should reflect the verified broad format: structured clinical reasoning, safe practice, triage, investigation, management and professional judgement.
One station: an acute blistering eruption
Before speaking, take a few seconds to identify the immediate danger. A patient with widespread blistering, skin pain or mucosal involvement may require urgent assessment, and a new medicine may be relevant. Do not make a confident diagnosis from one feature alone.
A recorded response could be marked against the following preparation criteria:
Examiner
A 54-year-old develops fever, skin pain and blistering two weeks after starting trimethoprim-sulfamethoxazole. There are erosions on the lips. Talk me through your approach.
You identified a potentially severe cutaneous adverse reaction and assessed systemic illness, but you did not explicitly mention airway, ocular and genital mucosal assessment.
ImproveState the immediate ABC assessment and look specifically for ocular, oral, genital and respiratory involvement.
You prioritised a severe drug reaction and mentioned infection as a dangerous alternative. The ranking was clear.
ImproveName the features that would make toxic epidermal necrolysis, staphylococcal scalded skin syndrome or another emergency more likely, while acknowledging the adult context.
You proposed blood tests and dermatology review but did not explain the role or timing of a skin biopsy.
ImproveSay that investigations should support severity assessment and diagnosis, and that urgent specialist review would guide biopsy of an appropriate lesion and any further sampling.
You stopped the suspected medicine and arranged escalation, but the immediate destination and monitoring plan were not definite.
ImproveState urgent senior and dermatology involvement, appropriate monitored care, medication review, supportive management and reassessment for deterioration.
You explained uncertainty and checked the patient’s concerns. Consent for examination and photographs was not addressed.
ImproveExplain why urgent assessment is needed, seek consent where possible and document the suspected reaction and discussion.
You mentioned dermatology but not the information needed for a safe handover.
ImproveInclude the medicine name, dose and timing, allergies, comorbidities, examination findings, observations, treatment and response in the referral and record.
A strong answerThis patient has a febrile, painful blistering eruption with lip involvement after a new medicine, so I would treat this as a potential severe cutaneous adverse reaction requiring urgent escalation. I would assess airway, breathing, circulation, observations, hydration, skin detachment and ocular, oral and genital mucosal involvement, and obtain a complete medication timeline. I would stop the suspected medicine, involve a senior clinician and dermatology urgently, and arrange monitored care with supportive management while considering infection and other blistering disorders. I would organise targeted investigations guided by the clinical picture and specialist advice, including appropriate sampling or biopsy, and document the reaction clearly. I would explain the concern and uncertainty to the patient, seek consent for examination and photographs where possible, and provide a clear handover, review plan and safety-net.
That is a MySummaries station, filled with ACD IMG material. Yours is written from your own notes. Start free
Notice that the model answer does not depend on naming a treatment regimen from memory. It shows what must happen next, what information is needed and who should be involved. If a question asks for a specific medicine or protocol, check current Australian guidance and local policy during your study rather than relying on an unverified dose.
Make your wording precise
Replace vague phrases with actions and time points:
- Instead of “I would refer”, say who you would contact, how urgently and what you would include.
- Instead of “I would investigate”, name the clinical question and the test or sample that answers it.
- Instead of “I would follow up”, say when review would occur, what would be reassessed and what the patient should do sooner.
- Instead of “I would reassure”, explain the uncertainty, check understanding and agree the next step.
For IMG candidates, this clarity is particularly important. Your clinical knowledge may be sound, but an assessor cannot award credit for reasoning that remains implied. Speak in a sequence that a colleague could safely act on.
Add an audio review loop
Audio is useful after you have built the board and attempted cases. Listen for whether your answer has a beginning, middle and end. The beginning should establish risk; the middle should justify investigations and management; the end should protect the patient after the consultation.
A ten-minute lecture can turn one weak section into a short revision session rather than another broad reading task. For example, a lecture on triage should compare the features that alter urgency across several presentations and finish with a verbal checklist.
Transcript · tap any word to jump there
Start by saying what the patient has, how sick they might be and what feature changes the urgency. A painful, rapidly progressive eruption with mucosal involvement is not introduced as an ordinary rash; it is introduced as a possible emergency that needs immediate assessment.
Next, ask only questions that change your action. The timeline of medicines, systemic symptoms, eye or mucosal involvement, immunosuppression and recent infection may change both your differential and your destination of care. Investigations should answer a question and should not delay urgent stabilisation or escalation.
End with the plan after the consultation. Name the reviewing service, the reassessment time, the information handed over and the warning symptoms explained to the patient. A safe answer remains safe even while the diagnosis is uncertain.
After listening, answer a new scenario without looking at the board. If you cannot explain why a question, test or referral changes the plan, move that item back into your active study set.
A repeatable weekly method
Use a cycle that produces evidence of performance:
- Session 1 — build or refine a board: organise your own notes into presentations, red flags, investigations, management and follow-up.
- Session 2 — retrieve the core: speak the must-not-miss items without reading, then correct omissions.
- Session 3 — answer two timed scenarios: record both answers and mark whether you covered triage, differential, investigation, management, communication and systems.
- Session 4 — repair one weakness: read current guidance, update the board and create prompts for the specific gap.
- Session 5 — repeat under variation: use a similar presentation with a different age, medicine, comorbidity or level of urgency.
Keep a log of recurring omissions. “Weak at dermatology” is not actionable. “Fails to mention ocular involvement in blistering eruptions” is actionable and can become the target of the next drill.
How MySummaries helps
MySummaries can turn your own PDFs, slides and photographed notes into revision boards, then generate flashcards, written mock exams, audio lectures and recorded oral practice around those boards. For ACD IMG preparation, use the board to organise clinical scenarios and Australian referral reasoning, the core to retrieve safety steps, and oral practice to rehearse prioritised answers and follow-up. Open MySummaries.