FRACS General Surgery Fellowship Examination Format Explained

Overall structure

Seven segments per specialty: two written papers plus five clinical/viva segments.

Components and structure

The FRACS General Surgery Fellowship Examination is assessed across the following components:

• Written Paper One (Spots) (spot) - 25 questions, 130 min. 25 image or photo prompts, each usually leading to 3 questions, about 5 minutes each; each question is marked pass or fail. Sat about a month before the clinical/viva. Clear pass is 18 of 25.
• Written Paper Two (SAQ) (short-answer (SAQ)) - 8 questions, 130 min. 8 short-answer questions, about 15 minutes each: 7 specialty questions plus 1 generic non-technical competencies question that counts equally; each is marked pass or fail. Sat about a month before the clinical/viva. Clear pass is 6 of 8.
• Operative Surgery viva (viva) - 30 min. A 10-minute structured operative scenario prompted by a short slide presentation, plus 5 mini-scenarios each prompted by a single clinical image.
• Pathophysiology, Critical Care & Clinical Reasoning viva (viva) - 40 min. Two 10-minute scenarios, typically with a trauma or acute-care component, plus usually 4 mini-scenarios.
• Clinical Imaging & Applied Anatomy (CIAA) viva (viva) - 8 stations, 32 min. 8 images (anatomical or operative specimens, clinical pictures or still cross-sectional images) used to discuss applied anatomy.
• Clinical 1 viva (medium cases) (viva) - 2 stations, 30 min. 2 medium clinical cases, 15 minutes each, delivered electronically with no live patients; up to 3 minutes reading per case.
• Clinical 2 viva (short cases) (viva) - 5 stations, 40 min. 5 short clinical cases delivered electronically with no live patients.

Seven segments (two written + five clinical/viva), blueprinted to the curriculum, all equally weighted. Pass all seven: the Specialty Court recommends a pass. Pass six: the Specialty Court in General Surgery discusses the candidate and recommends a pass or a fail. Fail two or more: fail. From 2026 the written and clinical/viva components are uncoupled: fail both written segments and you fail automatically and cannot sit that sitting's clinical/viva; pass both written but fail overall and you are exempt from the written at the next scheduled exam (one time only) and go straight to the clinical/viva; fail one written segment and then fail overall and you re-sit all seven segments. (RACS 2026 Notes to Candidates, §1 and §4.)

Structure per the official examination materials: RACS source.

Exam format glossary

Key assessment formats used in the FRACS General Surgery Fellowship Examination, defined. Each definition is general and applies across colleges.

Short Answer Question (SAQ)

A written question that requires a structured free-text response, marked by examiners against a model answer or rubric rather than by machine.

Viva voce

A structured oral examination in which examiners question the candidate in real time, assessing reasoning, justification and depth of understanding under pressure.

Short case

A focused clinical examination of one or more patients that tests examination technique, sign elicitation and interpretation under time pressure.

Spot test

A rapid-identification format in which candidates answer brief questions on images, specimens or anatomy within a short fixed time per item.

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

Examiner reports and feedback consistently flag these preparation pitfalls:

• Viva anxiety: oral examination performance requires structured, confident communication of clinical reasoning under examiner scrutiny.
• SAQ answers that lack prioritisation - the written paper rewards a structured management framework, not comprehensive prose.
• Subspecialty gaps: hepatobiliary, colorectal, and upper GI are consistently tested and require explicit preparation.
• Over-relying on operative experience without structured exam preparation in the final months.

How PRIMEX maps to the format

• SAQ practice with AI grading calibrated to FRACS General Surgery examiner expectations.
• Viva simulation for structured oral presentation of surgical management decisions.
• Curriculum-mapped content across all general surgery subspecialties.

Frequently asked questions