The Complete Guide to the FRACS Orthopaedic Examination 2025

The Fellowship of the Royal Australasian College of Surgeons (FRACS) Orthopaedic Surgery examination is widely regarded as one of the toughest and most comprehensive specialist exit exams in the world. It is the culmination of the Australian Orthopaedic Association (AOA) and New Zealand Orthopaedic Association (NZOA) SET training programs. This guide dissects every component of the 2025 examination cycle, providing a strategic roadmap for trainees aiming not just to pass, but to excel.

Visual Element: A "Roadmap to Fellowship" infographic showing SET 1-5 progression, the barrier exams (GSSE, OPBS), and the final FEX timeline (Written in May, Clinical in May/June).

What is the FRACS Orthopaedic Examination?

The FRACS exam is the gatekeeper to independent consultant practice in Australia and New Zealand. It certifies that a surgeon is safe, competent, and capable of managing the full breadth of orthopaedic pathology without supervision.

The "Day 1 Consultant" Standard

Examiners are instructed to ask themselves one question: "Would I be happy for this candidate to treat my family member tomorrow, unsupervised?" This means safety is paramount. Heroic surgery in the exam often leads to failure; safe, principled decision-making leads to success.

Key Facts at a Glance

The Barrier Exams: Prerequisites

Before you can face the final boss, you must clear the mini-bosses.

1. GSSE (Generic Surgical Sciences Examination)

Usually taken in PGY-2/3 or SET 1. It tests anatomy, pathology, and physiology.

• Focus: Anatomy is the killer here. Know your Last's Anatomy.

2. OPBS (Orthopaedic Principles and Basic Sciences)

Taken early in SET training (SET 2/3).

• Content: Biomechanics, statistics, trial design, basic science of bone/cartilage/muscle.
• Strategy: This is pure bookwork. AAOS Basic Science is the text. Do not leave this until you are busy with registrar on-call shifts.

The Fellowship Examination (FEX): The Main Event

The FEX is split into two grueling days.

Day 1: The Written Papers (Friday)

Paper 1: MCQ (Morning)

• Time: 2 hours.
• Format: 75 Questions, "Type X" (True/False).
• Structure: Each question has a stem and 5 distractors. You must mark each distractor True or False. That’s 375 decisions in 120 minutes (~19 seconds per decision).
• Difficulty: High. The "Type X" format punishes guessing. If you know 4 options but guess the 5th wrong, you lose marks.

Trap: Do not guess wildly on Type X questions if negative marking is applied (check current year rules). Even without negative marking, the cognitive load is immense.

Paper 2: The "Mixed Bag" (Afternoon)

This 2.5-hour paper is a marathon of clinical reasoning.

1. iSAWE (Image-based Short Answer Written Examination): 10 questions, 6 mins each.
   • Format: Clinical photo/X-ray + 3 specific questions.
   • Strategy: Bullet points only. "Diagnosis: Osteosarcoma." "Staging: MRI entire bone, CT Chest, Bone Scan." Speed is key.
2. Generic Surgical Questions: 2 questions, 15 mins each.
   • Topics: Ethics, consent, statistics, WHO checklist, mass casualty principles.
3. Essays: 2 essays, 30 mins each.
   • Topics: Deep dives into major topics (e.g., "Discuss the management of the infected total knee replacement").
   • Structure: Use headings. Introduction, Pathophysiology, Classification, Management (Non-op/Op), Complications, Conclusion.

Day 2: The Clinicals & Vivas (Saturday/Sunday)

This is where the exam is won or lost. You rotate through a circuit of terror and triumph.

1. CIM (Clinical Investigations and Management) Viva

• Duration: 30 mins.
• Format: 5 cases.
• Content: You are shown investigations (MRI, Bone Scans, Histology) and asked to interpret and manage.
• Key Skill: "Reading" the test. Don't just see a tumor; describe the zone of transition, the matrix, the periosteal reaction.

2. Operative Surgery Vivas (The "Table Vivas")

• Duration: 2 sessions of 30 mins each (Total 1 hour).
• Format: You sit across from 2 examiners. They ask: "How do you do a Tibial Nail?"
• The "Model" Answer:
  • Setup: "Supine on traction table, image intensifier on contralateral side."
  • Approach: "Midline tendon-splitting incision."
  • Entry Point: "Medial to lateral tibial spine, in line with medullary canal."
  • Reduction: "Use a blocking screw if proximal third fracture."
  • Fixation: "Ream 1.5mm over nail diameter."
  • Closure: "Deep and superficial layers."

Clinical Pearl: If you get stuck, go back to principles. "I would pause, check imaging in two planes, and ensure my reduction is anatomical." Never "wing it" with a dangerous maneuver.

3. Clinical Stations (The "Patient" Exams)

• Duration: 2 sessions of 35 mins each.
• Format: Real patients (or highly trained actors).
• Task: "Examine this man's shoulder."
• Execution:
  • Look: Scars, wasting, deformity.
  • Feel: Temperature, tenderness (landmarks).
  • Move: Active vs Passive (know the difference!).
  • Special Tests: Only do relevant ones. Don't do a full cuff exam for a clear instability case.
  • Summary: "I examined Mr. Smith. On inspection... findings are consistent with specific pathology."

Visual Element: A photo of a candidate performing a "Thomas Test" on a patient, with annotations showing correct hand placement to obliterate lumbar lordosis.

Subspecialty Coverage

You cannot hide. You must be competent in:

• Upper Limb: Shoulder, Elbow, Hand/Wrist.
• Lower Limb: Hip, Knee, Foot & Ankle.
• Trauma: Everything. Pelvis to Phalanges.
• Spine: Red flags, Cauda Equina, radiculopathy vs myelopathy.
• Paediatrics: The "limping child," DDH, SUFE, Perthes.
• Tumor: Principles of biopsy, staging.

Preparation Strategies

The "Study Group"

You cannot pass this exam alone. Form a group of 4-6 trusted peers. Meet weekly. Grill each other. Be brutal but constructive. "You failed that station because you missed the nerve palsy."

The "Bone School"

The AOA runs a structured teaching program (Bone School). Attend religiously. The lecturers are often the examiners. They are telling you what they want to hear.

Recommended Texts

• Hoppenfeld: Surgical Exposures. Memorize the nerves at risk.
• Miller: Good for MCQ facts.
• OrthoVellum: Use our specific FRACS modules for iSAWE practice.
• Journal Club: Read the last 5 years of JAAOS review articles. They are high-yield for essay topics.

Mental Game

The FRACS exam is a pressure cooker.

• Stamina: It’s a physical marathon. Get fit.
• Resilience: If you bomb a station, you must reset immediately. The next station is a fresh start.
• Confidence: Sounding like a consultant is half the battle. Speak slowly, clearly, and decisively.

How OrthoVellum Helps

OrthoVellum is built by FRACS graduates for FRACS candidates.

• iSAWE Simulator: We have the only dedicated iSAWE practice tool that mimics the exact time pressure (6 mins per case).
• Viva Cards: Digital flashcards for Operative Vivas. "Describe the approach to the Posterior Acetabulum."
• Clinical Exam Videos: High-definition videos of the perfect "Examine the Knee" routine, timed to perfection.

Key Takeaways

1. Safety is King: Better to be safe and conservative than aggressive and dangerous.
2. Practice Vivas: Reading books won't help you speak. You must talk for hours every week.
3. Time Management: In the written papers, strict time-keeping is essential.
4. Know the Rules: Understand the passing criteria (how many segments you can fail and still pass).
5. Support System: Your family and friends need to support you. It’s a hard year.

Start your FRACS preparation today with OrthoVellum's comprehensive exam modules.

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