ANZCA Fellowship Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for senior anaesthetic trainees sitting the ANZCA Fellowship Examination in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary, and the Fellowship-stage curriculum was added as that cohort progressed. The Fellowship curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The ANZCA Fellowship Examination is the final hurdle before Fellowship. Unlike the Primary, which tests basic sciences, the Fellowship tests clinical anaesthesia at the depth a junior consultant would be expected to demonstrate on day one of independent practice. It has three components, sat in sequence.

Written paper (SAQ)

• Structured short-answer questions covering clinical anaesthesia, perioperative medicine, and the major subspecialties
• Time-limited paper, marked against published model answers and a marking grid
• Tests integration across patient factors, surgical factors, and anaesthetic conduct — not isolated recall
• Sittings are advertised on the ANZCA website — check the current candidate handbook for dates

Medical viva

• Structured oral examination focused on medical comorbidities and their implications for the perioperative period
• Examiners draw from cardiology, respiratory, neurology, endocrinology, renal, haematology, and other relevant systems
• Tests the candidate's ability to reason from a medical diagnosis to an anaesthetic plan
• Run in person at college venues across Australia and New Zealand

Anaesthetic viva

• Structured oral examination focused on the conduct of anaesthesia: assessment, planning, technique, monitoring, recovery, and complications
• Stations span general anaesthesia, regional anaesthesia, obstetric anaesthesia, paediatric anaesthesia, and crisis management
• Tests verbal performance under time pressure on the bread-and-butter of clinical anaesthesia
• Run in person, distinct from the medical viva in structure and emphasis

Pass marks and standardisation

ANZCA publishes examiner reports after each sitting that describe candidate performance and the patterns behind the result. There is no fixed percentage that guarantees a pass; each station and each SAQ is marked against the grid for that question. Treat any single pass-rate figure you see online as a rough guide and read the most recent examiner report in full — the report tells you which subspecialties were tested, which SAQs were poorly answered, and what the markers were looking for.

Sequential components

The Fellowship is not three parallel exams. The written paper is sat first, and only candidates who pass progress to the medical and anaesthetic vivas in the same sitting cycle. The viva stage is therefore best understood as a continuation of the same exam, not a fresh start. The clinical reasoning you built during written prep is exactly what the vivas test, just in a different format. Trainees who treat the written-to-viva gap as recovery time rather than transition time often arrive at the viva under-prepared for the verbal mode.

What the college actually tests

The Fellowship syllabus is built around clinical anaesthesia and perioperative medicine, with subspecialty content layered on top of a general anaesthesia core. The questions are written by senior consultants and they reward candidates who can think like a consultant — assessing risk, choosing technique, anticipating complications, and explaining the choice. The high-yield clusters below come up year after year.

1. Preoperative assessment and risk

Functional capacity, cardiac risk stratification, respiratory assessment, the high-risk patient pathway, frailty assessment, anaemia and iron, day-of-surgery cancellation thresholds, informed consent, shared decision-making, and optimisation. The Fellowship tests whether you can build an anaesthetic plan that starts at the assessment, not the induction.

2. General anaesthesia and the routine list

The conduct of anaesthesia for the common cases: laparoscopic surgery, day-stay procedures, the elderly patient, the obese patient, the diabetic patient, the patient on anticoagulants, the patient with a difficult airway. This is the largest single block in the SAQ paper and the anaesthetic viva. Candidates who under-prepare general anaesthesia in favour of subspecialty content are the ones who fail.

3. Obstetric anaesthesia

Labour analgesia, anaesthesia for caesarean section, the parturient with comorbidities, obstetric emergencies (massive haemorrhage, eclampsia, amniotic fluid embolism, failed intubation), and shared decision-making with the obstetric team. The obstetric topics appear in both the SAQ paper and the anaesthetic viva and they are heavily examined in examiner reports.

4. Paediatric anaesthesia

The well child for routine surgery, age-appropriate dosing and equipment, the child with comorbidities, parental presence and consent, paediatric airway, paediatric emergencies, and the threshold for transfer to a specialist centre. Paediatric stations test confidence under uncertainty — the candidate who cannot speak through a paediatric anaesthetic plan loses marks even if the clinical knowledge is there.

5. Regional anaesthesia and pain

Neuraxial techniques, peripheral nerve blocks, ultrasound-guided blocks, local anaesthetic systemic toxicity, postoperative pain management, the chronic pain patient, the opioid-tolerant patient, multimodal analgesia, and acute pain service models. Regional anaesthesia appears in both written and viva components.

6. Cardiothoracic, neuro and vascular

Anaesthesia for cardiac surgery (CABG, valve, off-pump), thoracic surgery and one-lung ventilation, neurosurgery (craniotomy, awake craniotomy, spinal surgery), and vascular surgery (carotid endarterectomy, AAA repair). Subspecialty content appears in both the SAQ and the anaesthetic viva but it sits on top of the general anaesthesia base; trainees who only have subspecialty knowledge and a shaky general foundation fail.

7. Crisis management and human factors

The crisis algorithms (Can't Intubate Can't Oxygenate, malignant hyperthermia, anaphylaxis, local anaesthetic toxicity, massive transfusion), structured communication under pressure, team leadership, debriefing, and the human factors literature relevant to anaesthesia. Crisis stations are heavily marked on verbal structure and decision-making, not just clinical knowledge.

Common pitfalls that fail candidates

• Over-preparing on subspecialties. Candidates who spend their run-in deep in cardiac or paediatric content and neglect the general list lose marks on the SAQ questions that draw from the bread-and-butter of the routine list. Subspecialty depth is a multiplier on a general anaesthesia foundation, not a substitute for it.
• Vague answers under SAQ time pressure. The written paper rewards structured, specific answers. "Optimise the patient" scores nothing where "delay surgery for two weeks to optimise iron, target Hb above 100, restart prophylactic LMWH on day one post-op" scores marks.
• Not separating medical viva from anaesthetic viva. The two vivas test different reasoning. The medical viva starts from a comorbidity and asks for the anaesthetic implications; the anaesthetic viva starts from a clinical scenario and asks for the conduct. Trainees who run a single viva style across both lose ground on whichever one they did not rehearse.
• Skipping obstetric content because it feels niche. It is heavily examined. It is not niche.
• Failing to integrate communication and human factors. Crisis stations are marked on structured communication as well as clinical action. "I would call for help" without specifying who, how, and what they need to know is partial credit at best.
• Burning the written-to-viva gap. The viva stage is part of the same sitting cycle, not a fresh exam. Trainees who treat the gap as recovery time arrive at the viva under-rehearsed in the verbal mode.

A realistic study timeline

The right run-up depends on your clinical workload, your subspecialty exposure, and how comfortable you already are with the bread-and-butter list. Three sample plans, in rising order of intensity:

Nine-month plan (8 to 10 hours per week)

This suits someone working full-time clinically, with on-call and other commitments, who wants slow steady coverage rather than a sprint.

• Months 1 to 3. Anchor on general anaesthesia and perioperative medicine. Cover the core curriculum systematically and build a flashcard deck against the published learning objectives. Begin SAQ-style practice from week three (one structured answer per week minimum). Maintain MCQ practice at modest volume to keep recall active.
• Months 4 to 6. Layer subspecialty content on top of the general core: cardiac, neuro, obstetric, paediatric, regional, pain. SAQ practice scales to three to five structured answers per week. Begin viva practice with one medical viva and one anaesthetic viva station per week.
• Months 7 to 8. Past paper SAQ mocks under timed conditions. Viva volume scales up to three or four stations per week across both viva formats. Identify weak subspecialties or weak verbal patterns and target them.
• Final month. Two full timed SAQ mocks. Daily viva practice across medical and anaesthetic formats. Stop new content two weeks before the sitting and consolidate the high-frequency general anaesthesia material you already know cold.

Six-month plan (12 to 15 hours per week)

The standard plan for most candidates. Tight enough to keep momentum, long enough to cover the syllabus properly.

• Months 1 to 2. Work through general anaesthesia and perioperative medicine. Build the flashcard deck. Begin SAQ-style practice from week two.
• Months 3 to 4. SAQ practice becomes the main work. Layer subspecialties on top. Three to five structured answers per week. Begin viva practice with one to two stations per week, alternating medical and anaesthetic format.
• Month 5. First full SAQ timed mock. Viva volume doubles. Two to three stations per week of each format, ideally with verbal feedback from a study partner or a voice viva simulator.
• Final month. Two more SAQ mocks under exam conditions. Daily viva practice across both formats. Final consolidation on weak topics.

Four-month plan (18 to 22 hours per week)

The compressed plan. Doable if you are part-time clinical or have a study leave block, painful otherwise.

• Month 1. Speed-read general anaesthesia and the major subspecialties. Heavy SAQ-style practice from week two (five to seven answers per week).
• Month 2. SAQ daily. Begin viva practice three times per week, alternating medical and anaesthetic.
• Month 3. Full timed mocks start. SAQ mock weekly. Viva practice four to five times per week across both formats.
• Final month. Polish weak subspecialties. Two SAQ mocks, daily viva practice. Sleep and wind down for the last 48 hours before the written.

When to start each component

• SAQs: from week two or three. The structured-answer skill is its own muscle and it takes weeks to build.
• Medical viva: from month two at the latest. The reasoning style — from comorbidity to anaesthetic implication — needs reps before it feels natural.
• Anaesthetic viva: from month two. The verbal performance of a routine anaesthetic plan needs the same kind of reps as the medical viva, despite feeling easier.
• Past papers and full mocks: last six to eight weeks for the written. Earlier than that and you have not yet covered enough ground for the result to be meaningful.

Weekly study split that actually works

A simple template that holds up: two SAQ sessions per week of 60 to 90 minutes each, one medical viva and one anaesthetic viva station per week from month two onward (scaling up after month four), and one reading session per week tied to whatever weak subspecialty emerged from the practice. Flashcards run in the background as ten-minute blocks between cases or on commutes, not as scheduled sit-downs. Protect both viva slots the way you protect a clinical commitment; if you let them move, they stop happening.

Track what you got wrong, not what you got right. Keep a running list of missed marking points by subspecialty. After a month you will see two or three subspecialties that come up repeatedly and you can target them directly.

The single biggest mistake people make

You over-prepare on subspecialties at the expense of general anaesthesia. The subspecialty content is shinier and feels more "Fellowship-level," so the run-in fills with cardiac modules, neuro lists, and obstetric textbooks. Then you sit the SAQ and find that the paper is dominated by questions on the routine list — the elderly patient for a hip, the diabetic on day-stay, the obese patient for laparoscopic surgery — and your subspecialty depth does not help you score them.

The college tests subspecialties because consultants need to be safe across the breadth of practice, but the marks live in the bread-and-butter. The candidate who can speak fluently about the routine list, with structured assessment, structured plan, anticipated complications, and explicit communication, scores more highly than the candidate with encyclopaedic cardiac knowledge and a shaky general anaesthesia answer.

The fix is to anchor your study plan on the general core first — for two or three months, depending on your timeline — before layering subspecialties on top. Use subspecialty content as breadth, not as the centre of gravity. When you practise SAQs, deliberately weight your selection towards the bread-and-butter topics. When you run viva stations, alternate a routine general anaesthetic case with a subspecialty case, not the reverse. The exam tests both, but it weights general higher.

How PRIMEX helps

• Sourced study notes mapped to the ANZCA Fellowship curriculum, weighted towards the high-yield clinical topics that examiner reports flag most often. See the free preview notes.
• An AI SAQ grader that marks structured answers on a Fail / Borderline / Pass / Distinction tier with examiner-style feedback, against the structure used in real Fellowship marking.
• A voice viva simulator that runs both medical viva and anaesthetic viva stations, plays the examiner live with medical-grade speech recognition, and marks against the verbal structure used in the real viva. Open it from the viva feature on the ANZCA Fellowship page.
• Spaced-repetition flashcards mapped to the published learning objectives so coverage is checkable rather than estimated.
• A curriculum tracker with a readiness score per topic, so you know which subspecialty to target next without guessing.

Frequently asked questions

Related study guides

• ANZCA Primary 2026 Study Guide
• CICM Fellowship 2026 Study Guide
• ACEM Fellowship 2026 Study Guide