The Complete Guide to the HKCOS Fellowship Examination 2025

The Hong Kong College of Orthopaedic Surgeons (HKCOS) Fellowship Examination represents the pinnacle of orthopaedic training in Hong Kong. It is the gateway to Specialist Registration with the Medical Council of Hong Kong. Known for its exceptionally high standards and rigorous assessment of trauma management, this exam ensures that only the most competent surgeons serve the Hong Kong public. This guide outlines the arduous 12-year journey and the final hurdle of the Fellowship Exam.

Visual Element: A timeline showing the 12-year pathway: Med School (5y) -> Internship (1y) -> BST (2y) -> HST (4y) -> Exit Exam.

What is the HKCOS Fellowship?

The FHKCOS (Fellow of the Hong Kong College of Orthopaedic Surgeons) is the exit qualification. It is a joint examination often involving external examiners from the Royal College of Surgeons of Edinburgh (RCSEd), maintaining an international standard of excellence.

Key Facts at a Glance

The Training Pathway: A Marathon

Hong Kong's medical training is one of the longest in the world.

1. Basic Surgical Training (BST) - 2 Years

After internship, trainees enter BST.

• Rotations: General Surgery, Orthopaedics, Emergency, and elective.
• Exam: Must pass the MHKICSC (Membership Examination of Hong Kong Intercollegiate Board of Surgical Colleges), which is equivalent to the MRCS.

2. Higher Orthopaedic Training (HST) - 4 Years

Upon entering HST, the focus narrows to orthopaedics.

• Rotations: 6-month blocks in Trauma, Arthroplasty, Spine, Paediatrics, Sports, Hand/Microsurgery, and Rehabilitation.
• Logbook: Strict requirements on operative numbers.
• Assessments: Half-yearly assessments by supervisors.

Trap: Failing to complete the mandatory courses (AO Basic, ATLS, Microsurgery Workshop) early in training can prevent you from sitting the final exam. Get them done in HST 1 or 2.

The Fellowship Examination

The exam tests whether you are safe to be a consultant in a high-volume public hospital.

Component 1: The Written Examination

• Format: Multiple Choice Questions (MCQ) and Short Answer Questions (SAQ).
• Focus: Heavy emphasis on Trauma. Hong Kong hospitals deal with high-energy trauma, fragility fractures, and industrial accidents.
• Academic: Questions often reference recent Journal of Orthopaedics, Trauma and Rehabilitation (JOTR) articles or local epidemiology (e.g., TB Spine is common in HK).

Component 2: The Clinical Examination

This is the heart of the assessment.

• Long Case: 20-30 minutes. Full history, exam, and management discussion.
  • Common Cases: CSM (Cervical Spondylotic Myelopathy), OA Knee, AIS (Adolescent Idiopathic Scoliosis).
• Short Cases: Rapid fire (5-10 mins each).
  • Focus: Spot diagnosis and physical signs. "Examine this hand." (Dupuytren's, Trigger finger, Nerve palsy).

Clinical Pearl: In Hong Kong, examiners value speed and precision. Do not dither. Examine the patient, state the signs, and offer a diagnosis. "This patient has a wasted thenar eminence and sensory loss in the median distribution, consistent with severe Carpal Tunnel Syndrome."

Component 3: The Viva Voce

• Trauma Viva: X-ray interpretation. Classification of fractures. Management of polytrauma.
• Elective Viva: Arthroplasty, Sports, Paediatrics.
• Basic Science / Pathology: Histology slides, implants, biomechanics.

The "Hong Kong" Context

To pass, you must understand the local healthcare landscape.

1. Tuberculosis (TB)

Unlike the West, TB of the spine and joints is still seen regularly in HK. You must know the medical management (HRZE regimen) and surgical indications (Hong Kong Operation).

2. Geriatric Trauma

Hong Kong has an aging population. The management of hip fractures (orthogeriatrics) is a major exam topic. Know the guidelines for timing of surgery (<48 hrs) and anticoagulation reversal.

3. Microsurgery

Hong Kong has a strong history of hand and microsurgery. You are expected to know the principles of replantation and flap coverage, even if you are not a hand surgeon.

Preparation Strategies

1. Joint Specialty Fellowship (JSF) Course

The College runs preparatory courses. These are essential. They bring in external examiners to give mock vivas.

2. The "Friday Afternoon" Teaching

Most Hospital Authority (HA) hospitals have rigorous weekly teaching. Presenting cases in front of senior consultants is your best practice. They will grill you harder than the real examiners.

3. Study Groups

Form a group with trainees from different clusters (e.g., QMH, PWH, QEH). Each center has different strengths (e.g., PWH for Trauma/Sports, QMH for Spine/Paeds). Sharing knowledge across clusters is vital.

Resources

• Textbooks: Apley’s, Campbell’s, Rockwood & Green.
• Local Journals: Hong Kong Medical Journal, JOTR.
• Guidelines: HKCOS Position Statements (e.g., on DVT prophylaxis).

How OrthoVellum Helps

OrthoVellum supports HK trainees with:

• Local Pathology Modules: Specific content on TB Spine, Pyogenic Spondylodiscitis, and fragility fractures.
• Viva Practice: High-yield trauma X-rays typical of HK practice.
• Microsurgery Basics: Visual guides to flaps and nerve repair principles.

Key Takeaways

1. Trauma is Paramount: You must be a safe trauma surgeon first.
2. Local Disease Patterns: Know TB and geriatric fractures.
3. Microsurgery: Do not neglect Hand/Micro topics.
4. Clinical Speed: Practice examining patients quickly and efficiently.
5. Professionalism: Hong Kong examiners value humility and safety. Never be arrogant.

Start your HKCOS preparation today with OrthoVellum.

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