Otolaryngology Head and Neck Surgery (OHNS) Surgical Examinations Format Explained

Overall structure

A two-stage RACS examination in Otolaryngology Head and Neck Surgery. The SSE (Specialty-Specific Examination) is the basic-science gateway: 100 MCQs (Type A, B and X) plus 6 spot questions, weighted 50% applied anatomy, 25% pathology and 25% physiology. The Fellowship Examination (FEX) is the clinical exit: two 130-minute written papers plus five clinical/viva segments (Clinical Scenarios, Clinical Cases, Surgical Anatomy, Surgical Pathology and Operative Surgery).

Components and structure

The Otolaryngology Head and Neck Surgery (OHNS) Surgical Examinations is assessed across the following components:

• SSE - Multiple Choice (MCQ) — 100 questions. Type A (single best answer), Type B (statement and reason) and Type X (four true/false distractors, one mark each). Content weighted 50% anatomy, 25% pathology, 25% physiology.. Criterion-referenced basic-science gateway, sat earlier in SET training..
• SSE - Spot Questions (spot) — 6 questions, 6 stations. Eight marks each (four anatomy, two pathology, two physiology); two otology, two rhinology, two head and neck/laryngology..
• FEX Written Paper 1 (short-answer (SAQ)) — 6 questions, 130 min. Two extended-response questions (30 minutes each, two equal parts) plus four short-response questions (60 minutes). Delivered electronically and paper-based, about a month before the clinical/viva..
• FEX Written Paper 2 (short-answer (SAQ)) — 6 questions, 130 min. Two extended-response questions plus four short-response questions, including one generic non-technical-competencies question themed across all specialties..
• FEX Clinical Scenarios (viva) — 5 questions, 5 stations, 60 min. Five clinical protocols; no patients. The candidate takes a history from the examiners, describes examination technique, requests and interprets investigations, gives a differential and discusses treatment..
• FEX Clinical Cases (long case) — 8 questions, 8 stations, 40 min. Eight patients, five minutes each. Examine specified regions, elicit clinical signs and interpret investigations (imaging, audiograms and other material)..
• FEX Surgical Anatomy (viva) — 1 stations, 30 min. Anatomy-lab segment using wet specimens, dry bones and skulls, temporal-bone dissections, CT/MRI and other imaging..
• FEX Surgical Pathology (viva) — 1 stations, 30 min. Computer images of pathology specimens, histological slides and clinical photographs..
• FEX Operative Surgery (viva) — 1 stations, 30 min. Pre-operative decision-making and workup, operative technique and strategy, and management of operative/post-operative complications..

Two staged assessments. The SSE basic-science gateway is sat earlier in SET training. The Fellowship Examination has seven segments (two written papers plus five clinical/viva segments), marked on the Expanded Close Marking System against the standard of a consultant in the first year of independent practice; all segments carry equal weight. From 2026 the written component is uncoupled: failing both written segments fails the sitting before the clinical/viva. A candidate who passes all seven segments passes; one who reaches the clinical/viva and fails three or more segments fails; passing six is reviewed by the Specialty Court in Otolaryngology Head and Neck Surgery.

Structure per the official examination materials: RACS source.

What the format means for your preparation

The single most common preparation mistake is studying as if the examination only had an MCQ component. Format-aware preparation looks like this:

• MCQ components reward high question volume and pattern recognition. Read explanations, not just answers, and revisit weak domains with spaced repetition.
• Short answer / SAQ components reward a prioritised, structured response under time pressure. Practise writing complete answers in the available time, not just outlining points.
• Viva or OSCE components reward verbalised structured reasoning. Practise aloud, ideally with feedback, rather than rehearsing silently.
• Practical or image-based components reward repeated exposure under time pressure. Build a routine that includes timed slide or image interpretation.

What separates pass from fail under this format

Across multiple sittings, these failure modes recur:

• Treating the SSE as rote recall: the OHNS basic-science exam is heavily weighted to applied anatomy (temporal bone, skull base, neck spaces), where spatial relationships and clinical application score the marks, not lists.
• Underpreparing the written Fellowship papers: examiners reward structured, prioritised short and extended answers, not unstructured prose.
• Weak clinical-viva structure across subspecialties: otology, rhinology, laryngology and head and neck oncology each need a rehearsed approach to history, examination and management.
• Neglecting the operative-surgery and surgical-pathology segments, which test pre-operative decision-making, technique and specimen interpretation rather than textbook recall.

How PRIMEX maps to the format

• Curriculum-mapped MCQ practice across the SSE anatomy, pathology and physiology axes, with detailed explanations.
• SAQ practice with AI grading calibrated to RACS Fellowship written expectations, with structured feedback on each answer.
• Viva simulation across the OHNS subspecialty domains for timed clinical-reasoning practice before the clinical/viva segments.
• Spaced-repetition flashcards and study notes mapped to the OHNS curriculum so revision lands on your weak areas.

Frequently asked questions