The Complete Guide to the FRCS (Tr & Orth) Examination 2025

The FRCS (Tr & Orth) is the Everest of UK orthopaedic training. It is the Intercollegiate Specialty Examination that signals the transition from trainee to consultant. Recognized globally as a hallmark of surgical excellence, passing this exam requires not just knowledge, but the poise, judgment, and communication skills of a senior surgeon. This guide offers an exhaustive look at the 2025 examination structure, curriculum, and tactics for success.

Visual Element: A graphic showing the "JCIE Pyramid": Section 1 (Knowledge) at the base, Section 2 (Clinical Judgment) in the middle, and "Consultant Practice" at the peak.

What is the FRCS (Tr & Orth)?

Administered by the Joint Committee on Intercollegiate Examinations (JCIE), this exam unites the four Royal Colleges (Edinburgh, England, Glasgow, Ireland). It is the exit exam for ST7/8 trainees and a requirement for CCT (Certificate of Completion of Training).

The "Gold Standard"

The FRCS (Tr & Orth) is famous for its rigor. It doesn't ask "What is this?" It asks "What will you do? Why? What if that fails?" It tests higher-order thinking.

Key Facts at a Glance

Examination Structure

You must pass Section 1 to be invited to Section 2.

graph TD
    A[Apply via JCIE] --> B(Section 1: Written)
    B -->|Fail| A[Re-apply]
    B -->|Pass| C(Section 2: Clinicals)
    C -->|Pass| D[FRCS (Tr & Orth) Awarded]
    C -->|Fail| E[Re-sit Section 2 Only]

Section 1: Written Examination

This is a test of breadth. It covers the entire ISCP curriculum.

Format

• Papers: 2 Papers.
• Questions: 120 Single Best Answer (SBA) questions per paper (Total 240).
• Time: 2 hours + 15 mins per paper.
• Delivery: Pearson VUE centers (Computer-based).

The SBA Art Form

SBA questions are tricky. Often, 3 answers are "correct," but one is "most appropriate." Example: A 70-year-old lady has a displaced intracapsular hip fracture. She is independently mobile. What is the management? A. Cannulated Screws B. DHS C. Uncemented Hemiarthroplasty D. Cemented Hemiarthroplasty E. Total Hip Replacement (Answer: E - per NICE guidelines for independent mobilizers, THA is superior. But D is also "correct" for many patients. You must know the guideline specific to the vignette.)

Content Breakdown

• Trauma: 25% (Know BOAST guidelines!)
• Adult Pathology: 20%
• Upper Limb: 15%
• Hand: 10%
• Paeds: 10%
• Basic Science: 10% (Stats, tribology, biomechanics)
• Spine: 10%

Trap: Ignoring Basic Sciences. You will get questions on "p-values," "screws pull-out strength formula," and "viscoelasticity." These are easy marks if you study them, and impossible if you don't.

Section 2: Clinical & Oral Examination

This is where you earn the Fellowship. It is held over 2-3 days at a host center in the UK or Ireland.

Day 1: Clinicals (The "Patients")

• Upper Limb Station: 15 mins. Examine a patient (e.g., Shoulder, Elbow, Hand).
• Lower Limb Station: 15 mins. Examine a patient (e.g., Hip, Knee, Foot).
• Technique: Introduce, Wash hands, Expose, Inspect, Palpate, Move, Special Tests.
• Discussion: "Based on my examination, this patient has... I would investigate with... My management would be..."

Clinical Pearl: Be gentle. If a patient is in pain, acknowledge it. "I will not move your arm further if it hurts." Examiners mark you down for causing pain.

Day 2: The Vivas (The "Tables")

Four oral stations, 30 minutes each (15 mins per examiner).

1. Adult Elective: Hips, Knees, Foot & Ankle.
2. Trauma: Polytrauma, Pelvis, Open fractures.
3. Paediatrics & Hand: The "Specialty" table.
4. Applied Basic Sciences: Anatomy, Biomechanics, Pathology.

The "Hot Seat" Technique

• Listen: Answer the specific question asked.
• Structure: "History, Exam, Investigations, Management."
• Controversy: If asked about a controversial topic (e.g., approach for THA), say: "There is debate. The posterior approach offers X, the anterior Y. In my hands/training, I would use..."
• Guidelines: Quote NICE (National Institute for Health and Care Excellence), BOAST (British Orthopaedic Association Standards for Trauma), and GIRFT (Getting It Right First Time). These are the currency of the exam.

Evidence Corner: BOAST Guidelines are mandatory knowledge. You must know the antibiotic protocol for open fractures (Co-amoxiclav + Gentamicin), the timing for hip fracture surgery (36 hours), and the management of cauda equina (MRI within 1 hour of request).

Preparation Strategies

1. Resources

• OrthoPass / UKite: Essential for Section 1 SBAs.
• Miller's Review: Good baseline, but American.
• Postgraduate Orthopaedics (Banaszkiewicz): The "Bible" for the FRCS. The Viva book is legendary.
• Exam Corner (OrthoVellum): Our high-yield guideline summaries.

2. The "Revision Course" Circuit

Most candidates attend at least one clinical course:

• Miller Course (Oxford): Great for theory.
• Bridgend / Chesterfield: Famous for clinicals.
• Wrightington: Excellent for upper limb.

3. Study Partners

Find a "buddy." You cannot practice vivas alone. You need someone to interrupt you, challenge you, and simulate the stress.

4. Know Your "Unknowns"

You will get a case you've never seen (e.g., rare dysplasia).

• Strategy: Go back to first principles. "This is a skeletal dysplasia affecting the epiphyses. I would assess the mechanical axis..." You don't need the name; you need a safe plan.

High-Yield Guidelines (Must Know)

1. NICE CG124: Hip Fracture Management.
2. BOAST 4: Open Fractures.
3. BOAST: Cauda Equina Syndrome.
4. NICE OA: Management of Osteoarthritis (Core treatments vs Surgical).
5. GIRFT: Infection prevention in arthroplasty.

How OrthoVellum Helps

OrthoVellum is specifically tuned to the UK curriculum:

• Guideline Tracker: We have summaries of every active BOAST and NICE orthopaedic guideline.
• SBA Bank: 4,000+ UK-style SBAs (not just US recycles).
• Clinical Cases: Videos of clinical examinations on real patients with signs.

Key Takeaways

1. It's a Consultant Exam: Act like one. Be safe, sensible, and structured.
2. Guidelines are Law: Know the UK national guidelines verbatim.
3. Section 1 is a Hurdle: Don't underestimate the breadth. Practice SBAs daily.
4. Clinical Polish: Your examination routine must be slick and automatic.
5. Ethical Practice: Always consider the patient's comorbidities and social situation. "Treat the patient, not the X-ray."

Start your FRCS preparation today with OrthoVellum's UK-focused modules.

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