FRANZCOG Written Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for RANZCOG trainees sitting the FRANZCOG Written 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. It now covers 21 Australasian specialty exams because trainees from each specialty asked us to build for them. The FRANZCOG Written Examination curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The FRANZCOG Written Examination sits late in advanced training, usually attempted by trainees in years four to five of the seven-year RANZCOG training programme. It is one of two summative barrier examinations in the FRANZCOG pathway, the other being the Structured Oral that follows in the same training year. Pass both and you progress through to advanced training, subspecialty options, and eventually the Fellowship roll. Fail one and most trainees lose their place in the rotational training year while they re-sit, which is why the Written gets the kind of preparation many trainees describe as the hardest year of their working life.

Format

• The Written Examination is sat on one day in three back-to-back sittings (7.5 hours total with breaks)
• SAQ Part 1: 6 structured clinical cases, 90 marks, 2 hours. SAQ Part 2: 6 structured clinical cases, 90 marks, 2 hours. MCQ: 100 single-best-answer questions, 100 marks, 2 hours, computer-based
• From 2026 the SAQ and MCQ are independently passable (non-compensable), each with up to 3 attempts. Failing one means resitting only that component
• Each SAQ case carries multiple sub-parts at variable mark allocations, approximately 20 minutes per case as a working average
• Cases test management, investigation, counselling, and surgical decision-making across the full RANZCOG curriculum
• Computer-based delivery at college-approved test centres in Australia and New Zealand

Sittings and timing

• Two sittings per year for the Written. In 2026 the dates are 30 January and 3 July; confirm exact dates with RANZCOG for your cycle
• Result release usually four to six weeks after the paper, with the Structured Oral following later in the same training cycle
• Re-sit opportunity at the next sitting if you are unsuccessful, subject to training year and college approval
• As of 2026, check the RANZCOG website for the current date, venue list, and any sitting-specific changes before locking in your study plan

Pass marks and standardisation

RANZCOG uses standard-setting against the marking schedule for each examination rather than a fixed percentage cut score. The college does, however, publish annual examination pass rates in its public Activities Report: in 2024 the Written Examination passed 77% (102 of 132 candidates) and the Oral Examination 91% (127 of 139). These are all-attempt rates and vary year to year. The individual candidate report (sent to the candidate) breaks down personal performance by curriculum area, which is the most useful document you will read at a re-sit because it tells you which sections cost you marks rather than guessing.

Day-of logistics

• Photo identification required, usually a current driver licence or passport
• Computer-based delivery in dedicated test rooms; you type your answers on a workstation provided by the centre
• No personal materials at the desk: no phone, no smartwatch, no paper reference cards, no own pens
• Bathroom breaks are escorted and the clock keeps running
• Reading time is built into the case duration, not added on top, so train at exam pace from the first practice case you write

What the college actually tests

The PRIMEX FRANZCOG curriculum holds 151 mapped learning objectives drawn from the RANZCOG Curriculum (4th Edition, Version 4.7, February 2026). The structure follows the RANZCOG CSKIP model: 12 Medical Expert clinical topic areas plus 7 RANZCOG Roles (Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional, and the Medical Expert role itself). Knowledge competencies are coded with K, skills competencies with S. The breadth is the point. The Written is engineered to test management across the entire scope of obstetrics and gynaecology, not depth in any single area, so a trainee who neglects gynaecological oncology, urogynaecology, or reproductive endocrinology will find a paper that punishes them.

The 12 Medical Expert clinical topic areas

The mapped sections in the PRIMEX curriculum file cover Pre-pregnancy and Antenatal Care, Early Pregnancy Care, Intrapartum Care, Postpartum Care, Neonatal Care, Critical Care in Obstetrics and Gynaecology, Gynaecological Health (menstrual disorders, contraception, pelvic pain, menopause), Reproductive Endocrinology and Infertility, Gynaecological Oncology, Urogynaecology, Pre-operative, Intraoperative and Post-operative Management, and Gynaecological Surgery. Each topic area holds between roughly six and twenty learning objectives. Topic-level reviews are linked through to study notes, structured case practice, and the flashcard pool.

The highest-yield areas to anchor your study

Antenatal care and maternal medicine

• Hypertensive disorders of pregnancy, classification under ISSHP criteria, pre-eclampsia diagnosis, and the SOMANZ management pathway including magnesium sulfate dosing for severe disease and eclampsia
• Gestational diabetes mellitus, OGTT screening thresholds, glycaemic targets, insulin escalation, and risk for the next pregnancy
• Anaemia in pregnancy across iron deficiency, folate, vitamin B12, and the haemoglobinopathies, with thresholds for intravenous iron and transfusion
• Cardiac disease in pregnancy classified by modified WHO categories, with a structured approach to pre-pregnancy counselling and anticoagulation in mechanical valves
• Venous thromboembolism in pregnancy and the puerperium, including risk-stratified prophylaxis, anticoagulation choice, and intrapartum management of women on therapeutic LMWH

Intrapartum and operative obstetrics

• Intrapartum CTG interpretation under the RANZCOG classification system, baseline rate, variability, accelerations, decelerations, and management of the abnormal CTG including escalation and fetal blood sampling
• Shoulder dystocia recognition, the HELPERR sequence, time-critical second-line manoeuvres, and clear documentation including timing and personnel
• Operative delivery decision-making between forceps and vacuum, prerequisites, complications, and the case for trial of instrumental versus immediate caesarean
• Caesarean section by category 1 to 4, decision-to-incision time targets, surgical technique principles, and the longer-term implications for the next pregnancy and VBAC counselling
• Postpartum haemorrhage by the four Ts framework, escalation including uterotonic drug ladder, balloon tamponade, B-Lynch suture, internal iliac ligation, and obstetric hysterectomy as last resort

Gynaecology and gynaecological oncology

• Heavy menstrual bleeding workup, structured medical management with the LNG-IUS, tranexamic acid, hormonal therapy, and surgical options including endometrial ablation and hysterectomy
• Endometriosis diagnosis, medical management, and surgical principles, plus the impact on subfertility and the place of multidisciplinary pelvic pain care
• Endometrial cancer, presentation, FIGO staging, surgical staging principles, the role of sentinel node biopsy, and adjuvant therapy decisions
• Ovarian cancer, the limits of CA125 and ultrasound for risk-of-malignancy stratification, primary debulking versus neoadjuvant chemotherapy, and BRCA-positive familial risk reduction
• Cervical cancer, the National Cervical Screening Programme HPV-based pathway, colposcopy thresholds, FIGO 2018 staging, and treatment by stage including radical hysterectomy and chemoradiation

Reproductive endocrinology and urogynaecology

• Polycystic ovary syndrome under the Rotterdam criteria, metabolic implications, and the structured approach to ovulation induction with letrozole and clomiphene
• Ovarian hyperstimulation syndrome recognition, classification, fluid management, and indications for inpatient care or critical care escalation
• Recurrent miscarriage workup including antiphospholipid antibody testing, parental karyotype, uterine cavity assessment, and the evidence base for anticoagulation in primary antiphospholipid syndrome
• Pelvic organ prolapse, the POP-Q examination, conservative management with pessaries and pelvic floor physiotherapy, and surgical principles including the place of native tissue repair after the mesh withdrawal
• Urinary incontinence subtypes, urodynamic indications, conservative options, intravesical botulinum toxin for refractory overactive bladder, and the surgical pathway for stress urinary incontinence in the post-mesh era

Critical care, neonatal, and consent

• Maternal collapse causes including amniotic fluid embolism, the structured ALS-O algorithm, perimortem caesarean section indication and timing
• Massive obstetric haemorrhage including activation of major haemorrhage protocols, fixed-ratio blood product resuscitation, and the role of fibrinogen replacement
• Neonatal resuscitation at the obstetric end, recognising the unwell newborn, and clear handover to the paediatric team
• Consent for operative delivery, sterilisation, and termination of pregnancy, including capacity assessment, the role of the support person, and documentation that survives a coronial review
• Sexual and domestic violence screening, mandatory reporting in paediatric and adolescent gynaecology, and trauma-informed examination practice

Common pitfalls that fail candidates

• Writing in narrative paragraphs rather than structured lists; the marking schedule rewards the candidate who organises an answer the way the schedule is organised
• Skipping the counselling component of a case because the surgical answer is easier to write; counselling sub-parts often carry the marks that separate a borderline candidate from a clear pass
• Quoting outdated guidelines, particularly older pre-eclampsia thresholds or pre-2018 cervical screening pathways, when the current SOMANZ or NCSP version is what the marking schedule was written against
• Running long on the early cases and finishing the last two cases under-developed; case-by-case time discipline is the single most reliable predictor of a finished paper
• Treating the Structured Oral as something to start preparing only after the Written, when most successful candidates are already practising station-format communication during the Written run-up
• Defaulting to a hospital-protocol answer when the case stem is set in a remote or low-resource context; examiners write rural and outreach scenarios deliberately and reward candidates who adjust transfer timing, telehealth use, and consultant escalation accordingly
• Ignoring the social and legal layer in cases involving termination of pregnancy, sexual assault, female genital mutilation, or capacity; these cases consistently appear in the paper and consistently catch candidates who only studied the medicine

Realistic study timelines

The right run-up depends on how much real obstetric and gynaecological time you have already accumulated, how strong your gynaecological oncology and urogynaecology exposure has been, and how heavy your clinical roster is during the study window. The plans below assume a working trainee on a normal full-time roster with 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 recent RANZCOG or SOMANZ guideline rather than a textbook chapter
• Months 4 to 5: start doing untimed cases from the structured case bank, one per night plus a longer block on weekends. Focus on writing in marking-schedule format from the first case
• Months 6 to 7: shift to timed cases at 20 minutes each, in blocks of three to five. Begin Structured Oral station practice once a week to keep counselling language sharp
• Months 8 to 9: full mock papers at exam pace, then review against the model answers. Re-loop on weak areas the candidate report from past cohorts has flagged
• Last two weeks: light retrieval practice using flashcards, no new content, sleep hygiene

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

• Months 1 to 2: rapid-pass through the 151 learning objectives, reading the PRIMEX study note for each and tagging the topics where your clinical exposure has been thin
• Months 3 to 4: untimed cases each weeknight, structured to your weakest tag list first; weekend blocks for guideline reading on hypertensive disorders, antepartum haemorrhage, gynaecological oncology, and urogynaecology
• Month 5: timed cases at 20 minutes each, alternated with Structured Oral station practice in voice mode for the communication and consent stations
• Month 6: two full mock papers in mock conditions, candidate report review, focused remediation on the bottom-three sections

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 cases per night without timing
• Month 2: timed cases every weeknight, weekend mock blocks of three cases at exam pace; introduce Structured Oral station practice twice a week
• Month 3: two full mock papers, candidate report review, second loop on weak areas with structured cases at exam pace
• Month 4: maintenance only. Light flashcards, sleep, and a final read-through of high-yield guidelines (RANZCOG intrapartum care, SOMANZ pre-eclampsia, RANZCOG PPH, NCSP cervical screening)

The single biggest mistake people make

The pattern that breaks competent candidates is leaving structured case practice until the last six weeks. You spend month one through month four reading textbooks and watching lectures, you build pages of beautifully organised notes, and you tell yourself the writing will come once you have learned the content. It does not work that way. Writing a FRANZCOG case under time is a separate skill from knowing the medicine, and it is the only skill the marking schedule actually rewards. If your first timed case is six weeks out from the paper, you spend the run-up rebuilding your writing speed instead of fixing content gaps. You sit the exam at the limit of how fast you can put a clinical case onto the screen, which is exactly when the marks haemorrhage. Start writing structured cases in month one. Rough, ugly, untimed cases are fine. The point is to make the format reflexive, so that on the day the medicine is the only thing you have to think about. The candidates who pass cleanly are usually the ones who wrote the most cases, not the ones who read the most chapters.

How PRIMEX helps

• Structured case grader: write a case answer, get a sub-part-by-sub-part breakdown against the marking schedule with model answers at FRANZCOG examiner standard. Available inside the app and on the public SAQ grader for unauthenticated trial use.
• Curriculum tracker: all 151 mapped learning objectives are visible on the FRANZCOG 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 RANZCOG, SOMANZ, and PSANZ content, useful when you want a quick sanity check on a management plan you are drafting.
• Structured Oral simulator with voice mode: twelve station-format scenarios across communication, counselling, clinical reasoning, and emergency management. Useful as Written prep too, because the same content drives both components.

Worked topic deep-dives

Three high-yield topics drawn straight from the PRIMEX FRANZCOG study notes. Each one is a teaser; the full note carries the complete management and exam framing.

Hypertensive disorders of pregnancy

Hypertensive disorders affect about 10 per cent of pregnancies and remain a leading cause of maternal and perinatal morbidity, spanning chronic hypertension through to severe pre-eclampsia, HELLP and eclampsia. The SOMANZ guideline is the primary Australian framework.

• Hypertension in pregnancy is a sustained BP of 140/90 mmHg or more on at least two occasions four hours apart.
• Severe hypertension is 160/110 mmHg or more and requires urgent treatment, with a post-treatment target below 135/85 mmHg.
• A rise of more than 30/15 mmHg from baseline warrants close monitoring even when absolute values are below threshold.
• HELLP is a severe variant that can occur without proteinuria.

How it is examined: the written paper tests the SOMANZ thresholds and a staged management plan including severe hypertension. Common pitfall: reassuring on absolute readings while ignoring a large rise from baseline.

Read the full note →

Heavy menstrual bleeding

Heavy menstrual bleeding is excessive loss that interferes with quality of life. The older 80 mL-per-cycle threshold has been replaced by a patient-centred, symptom-based definition, and the FIGO PALM-COEIN system structures the aetiology.

• PALM causes (polyp, adenomyosis, leiomyoma, malignancy or hyperplasia) are identified by imaging and histopathology.
• COEIN causes (coagulopathy, ovulatory, endometrial, iatrogenic, not otherwise classified) are identified by history and targeted investigation.
• Multiple causes may coexist, and structural lesions may be present in asymptomatic women.

How it is examined: the paper asks you to classify a case with PALM-COEIN and build assessment and management from it. Common pitfall: stopping at a structural lesion on imaging without excluding a coexisting coagulopathy or ovulatory cause.

Read the full note →

Normal and abnormal labour progress

Defining the stages and phases of labour underpins the diagnosis of dystocia and the partograph. Getting the active-phase threshold right prevents avoidable intervention.

• The first stage runs from onset to full dilatation at 10 cm; active first-stage labour is dilatation of 6 cm or more with regular contractions.
• The upward revision from 4 cm reflects that dilatation before 6 cm is physiologically slower; the old threshold over-diagnoses dystocia and drives avoidable caesarean.
• The partograph plots cervical dilatation and fetal descent against time to flag deviation early.
• The third stage is normally under 10 minutes, allowing up to 30 without excessive bleeding before active management.

How it is examined: the paper expects the correct active-phase definition applied to a partograph and a dystocia decision. Common pitfall: diagnosing dystocia using the outdated 4 cm threshold for active labour.

Read the full note →

Frequently asked questions

Related study guides

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