FRACS General Surgery (SET) Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for general surgery SET trainees sitting the FRACS General Surgery Fellowship Exam 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. It now covers 21 colleges because trainees from each specialty asked us to build for them. The FRACS General Surgery (SET) Exam curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The FRACS General Surgery Fellowship Exam, sometimes called the Fellowship Examination or the Final Fellowship, sits at the end of the SET (Surgical Education and Training) programme in general surgery. Most candidates attempt it in SET 4 or SET 5, after enough operative volume and subspecialty rotations to argue the breadth at viva standard. It is the gateway between trainee and Fellow. The exam is co-administered by the Royal Australasian College of Surgeons and the General Surgeons Australia / New Zealand Association of General Surgeons board, and it is set against the GSA SET General Surgery Curriculum, all modules. Pass it and you finish training; fail it and most candidates extend training to re-sit at the next available sitting, which usually adds at least six months to the path to Fellowship.

Format

• Two written components on the same day or block: a Spots paper based on visual stems (anatomical specimens, histology slides, imaging, surgical instruments, operative photographs) and a Structured Answer Question (SAQ) paper
• Five oral viva stations, each examined by two consultant surgeon examiners: Anatomy (32 minutes, image and specimen-based), Operative Surgery (30 minutes, one extended scenario plus shorter mini-scenarios), Clinical and Trauma (40 minutes, ED-style scenarios), Pathophysiology (30 minutes, mechanism-driven), and Clinical Reasoning (30 minutes, diagnostic uncertainty)
• Spots paper around 80 image-based items in roughly two hours, covering surgical anatomy, pathology specimens, plain films and cross-sectional imaging, ultrasound, endoscopy stills, and instruments
• SAQ paper of 6 to 8 questions over approximately three hours, with each question scoped to a single clinical scenario probed across investigation, operative decision-making, technique, and complications
• Vivas conducted face-to-face with examiners rotating between candidates; image stations use prepared specimens and digital displays
• Held in person at college-approved examination venues across Australia and New Zealand, typically Sydney, Melbourne, Brisbane, Adelaide, Perth, and Auckland in rotation

Sittings and timing

• One full sitting per year for the combined written and viva components, usually clustered in a defined examination period
• Eligibility requires SET training year completion, satisfactory operative logbook volume, and college sign-off; check the RACS and GSA websites for the current cycle requirements before applying
• Re-sit at the next annual sitting if unsuccessful, usually with a structured remediation plan agreed with your training board
• As of 2026, confirm the current sitting dates, fees, and venue list directly on the RACS website before locking in your study plan

Pass marks and standardisation

RACS does not publish a fixed numerical pass mark for the General Surgery Fellowship Exam in the way some colleges publish a percentage cut score. The exam is criterion-referenced against examiner consensus on what a safe consultant general surgeon needs to demonstrate, with standard-setting performed within each domain. Recent first-attempt pass rates for the written component have hovered around 60 percent per sitting; viva pass rates vary by station and by sitting. Treat any single quoted figure as approximate. The college does publish a candidate report after each sitting that outlines themes; that report is the most useful document a re-sit candidate will read because it tells you which domains the cohort lost marks in.

Day-of logistics

• Photo identification required at every component, usually a current driver licence or passport, plus your college candidate number
• Spots and SAQ are paper-based or computer-based depending on venue; expect on-screen image presentation with timed advance for the Spots paper and free-text typed answers for the SAQ
• No personal materials at the desk: no phone, no smartwatch, no books, no operative logbooks, no own pens unless permitted
• Vivas use prepared specimens, digital images on screens, and occasional physical instruments; bring nothing into the viva room except your candidate number
• The day is long: expect a full written day plus a separate viva day with multiple back-to-back stations. Sleep, hydration, and a planned eating window between sessions matter more than people admit

What the college actually tests

The PRIMEX FRACS General Surgery curriculum holds 111 mapped learning objectives drawn from the GSA SET General Surgery Curriculum, all modules (2016, updated 2024). The structure follows the GSA modular framework: 17 modules across abdominal wall and retroperitoneum, breast, colorectal, emergency surgery, endocrine, gastrointestinal endoscopy, sepsis and critically ill patient, skin and soft tissue, small bowel, surgical oncology, transplantation, trauma, upper GI oesophago-gastric, hepatic / pancreatic / biliary, bariatric, vascular, and head and neck. Each module holds between roughly four and nine learning objectives. The breadth is the point. The exam is engineered to test that the candidate can reason as a safe consultant general surgeon across the full scope of acute and elective practice, not as a subspecialist in any one organ system.

The 17 modules in the curriculum

The mapped sections in the PRIMEX curriculum file cover Abdominal Wall, Retroperitoneum and Urogenital; Breast Surgery; Colorectal Surgery; Emergency Surgery; Endocrine Surgery; Gastrointestinal Endoscopy; Sepsis and the Critically Ill Patient; Skin and Soft Tissue; Small Bowel Surgery; Surgical Oncology; Transplantation Surgery; Trauma Surgery; Upper GI Oesophago-gastric Surgery; Hepatic, Pancreatic and Biliary Surgery; Bariatric Surgery; Arterial, Venous and Lymphatic Systems; and Head and Neck Surgery. Each topic is linked through to a study note, image-based flashcards, and viva and SAQ practice stems.

The highest-yield areas to anchor your study

Hepatobiliary, pancreatic and upper GI oncology

• Pancreatic head adenocarcinoma workup, resectability criteria using CT pancreatic protocol, vascular involvement classification, role of staging laparoscopy, and the Whipple procedure step by step including pancreatic anastomosis options and management of postoperative pancreatic fistula by ISGPS grade
• Cholangiocarcinoma classified by Bismuth-Corlette, the role of MRCP, biliary drainage decisions, hilar dissection, and the principle of R0 resection with hepatectomy where indicated
• Hepatocellular carcinoma staged under Barcelona criteria, transplant eligibility under Milan, and the place of liver resection, ablation, transarterial chemoembolisation, and systemic therapy across stage
• Oesophageal and gastric carcinoma staging, neoadjuvant FLOT for gastric and CROSS-protocol chemoradiotherapy for oesophageal, Ivor-Lewis versus transhiatal approach, and the principles of D2 lymphadenectomy
• Acute pancreatitis under the revised Atlanta classification, severity scoring, walled-off pancreatic necrosis management, and indications for step-up necrosectomy

Colorectal surgery and lower GI

• Colorectal adenocarcinoma staged with TNM and managed by site: right hemicolectomy, anterior resection with total mesorectal excision, abdominoperineal resection, and the role of neoadjuvant chemoradiotherapy in locally advanced rectal cancer
• Diverticular disease classified by Hinchey, with the modern shift toward primary anastomosis with proximal diversion in selected perforated cases and laparoscopic lavage in Hinchey III where appropriate
• Inflammatory bowel disease surgical indications, restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis, and bowel-sparing strategies in Crohn's disease including stricturoplasty
• Acute large bowel obstruction caused by sigmoid volvulus, malignant obstruction, and the role of colonic stenting as a bridge to surgery
• Anorectal pathology including the Parks classification of fistula-in-ano, fistulotomy versus seton, sphincter-preserving approaches, and the operative management of complex haemorrhoidal disease

Trauma and emergency general surgery

• ATLS primary and secondary survey, team leadership, simultaneous assessment, and the decision to deviate from textbook sequence in the haemodynamically unstable patient
• Damage control surgery indications under the lethal triad of hypothermia, acidosis and coagulopathy, with a stepwise approach to packing, temporary closure, ICU stabilisation and a planned relook at 24 to 48 hours
• Trauma laparotomy sequence: midline incision, four-quadrant packing, sequence of exploration, vascular control before operating in haemorrhage, and timely closure or open abdomen with a vacuum dressing
• Perforated viscus management, with Graham patch repair for the perforated peptic ulcer in the unstable patient and Hartmann's procedure or primary anastomosis with diversion in perforated diverticulitis
• Acute mesenteric ischaemia recognised early on the strength of pain out of proportion to examination, acidosis and lactate, with arterial embolus, arterial thrombosis and venous thrombosis distinguished and a planned second-look laparotomy in selected cases

Breast, endocrine and skin oncology

• Breast cancer triple assessment, TNM staging, sentinel node biopsy with Z0011 implications for completion axillary dissection, and the role of breast-conserving surgery with radiotherapy versus mastectomy under EORTC 10853
• Differentiated thyroid cancer surgical principles, total thyroidectomy with central neck dissection where indicated, recurrent laryngeal nerve monitoring, parathyroid preservation, and adjuvant radioactive iodine
• Primary hyperparathyroidism workup with sestamibi and ultrasound localisation, minimally invasive parathyroidectomy versus four-gland exploration, and intraoperative PTH monitoring
• Phaeochromocytoma preoperative alpha-blockade with phenoxybenzamine before beta-blockade, the principle of laparoscopic adrenalectomy, and intraoperative haemodynamic management
• Cutaneous melanoma staged under AJCC eighth edition, wide local excision margins by Breslow thickness, sentinel node biopsy under MSLT-II implications, and the place of adjuvant immunotherapy

Vascular, hernia and surgical critical care

• Abdominal aortic aneurysm screening at the 5.5 cm threshold, EVAR versus open repair, and the management of the ruptured AAA in the haemodynamically unstable patient
• Acute limb ischaemia under the Rutherford classification, embolectomy versus bypass decision, and the indication for fasciotomy in compartment syndrome
• Inguinal hernia repair using Lichtenstein versus laparoscopic TEP and TAPP approaches, with mesh fixation principles, the management of the recurrence, and the role of the female inguinal hernia and femoral hernia in the same anatomical territory
• Incisional hernia repair with component separation and biological mesh in the contaminated field, and the rationale behind the European Hernia Society guidelines for primary versus complex repair
• Sepsis and the critically ill surgical patient, with source control as the central operative principle, time-to-antibiotic targets, the open abdomen technique, and nutritional optimisation including immunonutrition

Common pitfalls that fail candidates

• Vague anatomy in viva. Examiners do not accept "the bile duct"; they want the common hepatic duct, named at its position above the cystic duct take-off, with the relations of the right hepatic artery and the portal vein in Calot's triangle stated correctly
• Treating operative steps as a list to recite rather than a sequence with decisions inside it. The viva probes the moment between two steps, not the steps themselves: when do you convert, when do you abandon, when do you call for help
• Quoting outdated staging systems. TNM eighth edition for colorectal, gastric and breast is the working standard; older Dukes-style references for colorectal should not be the primary framework
• Failing to cite landmark trials by name. Z0011 for axillary management, MSLT-II for melanoma sentinel node, COLOR II and CLASSIC for laparoscopic colectomy, CROSS for neoadjuvant chemoradiotherapy in oesophageal cancer, and FLOT for perioperative chemotherapy in gastric cancer all come up
• Talking around complications instead of through them. An anastomotic leak is not "a complication that may occur"; it is a clinical entity with a mechanism, an imaging signature, a decision tree of conservative versus reoperative management, and a named time window
• Defaulting to a metropolitan tertiary answer when the case stem is set in a regional or rural context. Examiners write rural scenarios deliberately and reward candidates who adjust transfer timing, telehealth use, retrieval logistics, and consultant escalation accordingly
• Running short on rare but high-stakes topics. Phaeochromocytoma preoperative blockade, MEN syndromes, biliary anatomical variants, and the principles of transplantation immunology all reliably appear and reliably catch candidates who studied only the bread-and-butter cases

Realistic study timelines

The right run-up depends on how much elective and acute operative time you have already accumulated, how strong your subspecialty rotations have been, and how heavy your on-call roster is during the study window. The plans below assume a working SET trainee on a normal full-time roster with consultant-of-the-week or registrar-on-call commitments, not a study-only year. Adjust honestly. If your week genuinely contains no protected hours, the four-month plan is not for you.

Nine-month plan, around 8 to 10 hours per week

• Months 1 to 3: read across the curriculum at a topic-a-day pace, building a one-page summary for every PRIMEX study note. Anchor each summary on a current GSA, RACS or international society guideline rather than a textbook chapter alone
• Months 4 to 5: start untimed SAQs from the structured question bank, one per night plus a longer block on weekends. Focus on writing in surgical-framework format from the first answer: anatomy, pathophysiology, investigation, operative decision, technique, complications, evidence
• Months 6 to 7: shift to timed SAQs at exam pace, in blocks of three to five. Begin viva practice at one station per week, alternating between Anatomy, Operative, Clinical and Trauma, Pathophysiology, and Clinical Reasoning
• Months 8 to 9: full mock papers at exam pace plus a viva day per fortnight at full station length. Re-loop on weak areas the candidate report from past cohorts has flagged
• Last two weeks: light retrieval practice using flashcards on TNM staging, named trials, anatomical variants, and operative steps. No new content. Sleep hygiene

Six-month plan, around 12 to 15 hours per week

• Months 1 to 2: rapid-pass through the 111 learning objectives, reading the PRIMEX study note for each and tagging the topics where your operative exposure has been thin. Be honest about the modules you avoided as a junior registrar
• Months 3 to 4: untimed SAQs each weeknight, structured to your weakest tag list first; weekend blocks for guideline reading on colorectal cancer staging, pancreatic resection, damage control surgery, and breast cancer surgical management
• Month 5: timed SAQs at exam pace, alternated with viva station practice in voice mode for the operative and pathophysiology stations. Begin Spots paper drills using anatomical specimen images
• Month 6: two full mock papers and two full viva days under examination conditions, candidate report review, focused remediation on the bottom-three modules

Four-month plan, around 18 to 22 hours per week

• Month 1: triage your weakest five clinical areas, read the relevant study notes, and start writing two structured SAQs per night without timing. Begin daily Spots-style image identification, ten images a session
• Month 2: timed SAQs every weeknight, weekend mock blocks of three SAQs at exam pace; introduce viva station practice three times a week with a mix of anatomy and operative cases
• Month 3: two full mock papers and a full mock viva day, candidate report review, second loop on weak areas with operative scenarios at exam pace
• Month 4: maintenance only. Light flashcards on TNM staging and named trials, sleep, and a final read-through of high-yield guidelines: GSA position statements, ATLS principles, ERAS Society colorectal guidelines, and current Australian breast and colorectal cancer pathways

The single biggest mistake people make

The pattern that breaks competent candidates is treating the viva as a knowledge test rather than a decision-making test. You spend month one through month four reading textbooks and watching operative videos, you build pages of beautifully organised notes, and you tell yourself that knowing the operation cold will be enough. It is not. The viva is engineered to find the moment between two steps where the candidate has to commit to a decision under time pressure, and most candidates have never rehearsed the talking part of the operation before they walk in. You can name the steps of a Whipple procedure perfectly and still fail the operative viva, because the examiner asks what you do when the portal vein is unexpectedly involved, when the pancreatic remnant is friable, when the patient is hypotensive on the table at hour six. The candidates who pass cleanly are the ones who practised speaking through cases out loud, with a partner who pushed back on every vague answer, from month one. Start saying the operation. Rough, ugly, hesitant talk-throughs are fine in week one. The point is to make the verbal sequence reflexive, so that on the day the medicine and the anatomy are the only things you have to think about, not the words.

How PRIMEX helps

• SAQ and Spots grader: write an FRACS-format SAQ answer or interpret a Spots image, and get a marking-point-by-marking-point breakdown with model answers at examiner standard. Available inside the app and on the public SAQ grader for unauthenticated trial use.
• Curriculum tracker: all 111 mapped learning objectives are visible on the FRACS General Surgery app page with progress tracking by topic, so you can see at a glance which sections have been studied and which need attention.
• Ask PRIMEX: a question-and-answer interface that returns guideline-aligned answers across GSA, RACS, NCCN and current Australian oncology guidelines, useful when you want a quick sanity check on a management plan or operative principle you are drafting.
• Five-station viva simulator with voice mode: separate Anatomy, Operative, Clinical and Trauma, Pathophysiology and Clinical Reasoning station formats, each timed to the real exam length, with a structured debrief after each session. Speak your answers out loud and have an AI examiner probe further. Available through the FRACS General Surgery study tools.

Frequently asked questions

Related study guides

• FRACS Orthopaedics 2026 Study Guide
• RACS GSSE 2026 Study Guide