The FRACS Orthopaedic Exam: Format, Eligibility and How to Pass

The FRACS orthopaedic exam, formally the Orthopaedic Surgery Fellowship Examination of the Royal Australasian College of Surgeons (RACS), is the summative exit examination of orthopaedic training in Australia and Aotearoa New Zealand. RACS sets the standard as competence equivalent to an orthopaedic surgeon in the first year of independent practice: safe, broad and able to assess, investigate and manage common conditions without supervision.

This guide covers who can sit, what each of the seven segments involves, dates, fees and pass rates (all taken from RACS and AOA documents linked below), and then how to prepare and the mistakes that most often fail capable candidates.

Who can sit the FRACS orthopaedic exam?

RACS runs the examination, but the orthopaedic Surgical Education and Training (SET) programme is administered by the Australian Orthopaedic Association (AOA) in Australia and the New Zealand Orthopaedic Association (NZOA) in Aotearoa New Zealand (RACS orthopaedic surgery page (opens in a new tab)).

Under the RACS eligibility rules (opens in a new tab) you must be an accredited RACS trainee, or a Specialist International Medical Graduate (SIMG) whose assessment requires the exam, and you must have met the specialty-specific training requirements set by your training board. The RACS regulation REG-2069 (opens in a new tab) adds that you need AHPRA or Medical Council of New Zealand registration without conditions. The board confirms eligibility each time you register, which takes about three weeks after registrations close.

In Australia the route is the AOA 21 Training Program, launched in 2018 as a competency-based programme. It runs in three stages (Introduction to orthopaedics, Core orthopaedics, Transition to practice), and progression depends on demonstrated competence rather than years served. The AOA lists two formal examinations within it: the Orthopaedic Principles and Basic Sciences (OPBS) examination and the Fellowship Examination (AOA curriculum framework (opens in a new tab)). Because AOA 21 is not year-based, there is no fixed "exam year"; the stage requirements set by your training board decide when you can present.

RACS also asks a question worth taking seriously: even if you meet every requirement, are you ready? It advises against sitting "as a practice or if underprepared".

The earlier barrier exams

Two examinations come before the fellowship exam:

• Generic Surgical Sciences Examination (GSSE): tests a minimum standard in anatomy, pathology and physiology, both within each discipline and across them (RACS GSSE page (opens in a new tab)). RACS lists it as a prerequisite for the OPBS.
• OPBS: two papers on consecutive days, each two and a half hours with 100 Type X questions (a stem and five true/false statements, one mark per statement) (OPBS structure (opens in a new tab)). The syllabus covers anatomy, bacteriology, biomaterials, biomechanics, embryology, imaging, kinesiology, pathology, pharmacology and statistics. The recommended reading (opens in a new tab) includes Last's Anatomy, AAOS Orthopaedic Basic Science (5th edition, the reference text from the June 2024 exam) and Hoppenfeld's Surgical Exposures in Orthopaedics.

Basic science does not disappear after the OPBS. Biomaterials, biomechanics and statistics reappear in the fellowship MCQs and vivas, which is why notes kept from OPBS revision are worth keeping.

What is the format of the FRACS orthopaedic exam?

The Orthopaedic Surgery Notes to Candidates (2026) (opens in a new tab), written by the senior examiners, sets out seven segments: two written and five clinical/viva. The written papers are delivered electronically, and the clinical/viva segments run over a Saturday and Sunday at a single venue.

Written Paper 1: X-type MCQs

Each of the 75 questions has a stem and five statements, each marked true or false. That is 375 separate decisions in 130 minutes, a little over 20 seconds each. There is no negative marking, so leave nothing blank. The format rewards knowing each fact on its own merit: you cannot eliminate your way to an answer as you can with single best answer questions.

Written Paper 2: essays, generic questions and ISAWEs

The two essays test "a comprehensive knowledge level and sound reasoning" in an area of common orthopaedic practice. Headings carry an essay: definition and classification, assessment, investigations, management options with indications, complications and outcome. A question on the infected knee replacement, for example, is marked on whether you diagnose against accepted criteria and match the operation to the timing of infection (see the periprosthetic joint infection topic), not on prose.

The ten ISAWEs each pair an illustration (radiograph, clinical photograph, scan or histology) with a short series of questions. Answer in short lines, not sentences, and answer only what is asked.

The two generic surgical competency questions are short responses on professional, ethical, safety and organisational topics common to all surgery. Fifteen minutes covers both, so budget about seven minutes each.

Clinical Cases 1 and 2

Since the 2026 changes both segments last 36 minutes. Clinical Cases 1 uses four video-based scenarios at nine minutes each. Clinical Cases 2 uses three live patients at twelve minutes each. Twelve minutes for history, examination, findings and plan is not long; a routine that is fast because you have repeated it many times is what makes it fit.

The CIM viva

Five computer-based scenarios in 30 minutes, about six minutes each. The emphasis, in the examiners' words, is on "the logical progression of the case, clinical imaging and investigation and broad management principles". Describe before you diagnose: name the image, the bone, the location in the bone, the pattern of destruction, the margin and zone of transition, matrix and periosteal reaction, then give the differential. The describing a bone tumour radiograph topic sets out that sequence.

The Operative Surgery vivas

Both are computer-based, with five management scenarios in each 30-minute viva. The Notes state that any of these can be examined: non-operative versus operative management, preoperative planning, the procedure itself, postoperative care and rehabilitation. A complete answer for a tibial shaft fracture therefore starts with indications and alternatives and ends with rehabilitation and complications, not with the entry point (compare your answer with the tibial intramedullary nailing operative guide).

How is the exam marked?

Each segment is marked by a pair of examiners using the Expanded Close Marking System against a set number of marking points. Segments are marked without reference to each other and all carry equal weight. Examiners do not know your results in other segments until the Specialty Court meets.

Two practical consequences follow. A single weak segment can be survivable but two cannot, so no subspecialty can be written off. And because the written papers are now a hurdle, RACS advises booking refundable or flexible travel for the clinicals.

RACS texts candidates when results are uploaded to eHub, on the Monday of the clinical weekend in Australia and the Sunday in Aotearoa New Zealand (RACS results page (opens in a new tab)). Unsuccessful candidates receive a letter naming the failed segments and a Senior Examiner's report within two weeks, and should meet their board chair and supervisor within four weeks. Passing does not make you a Fellow automatically: you apply for admission separately.

Dates, venues and fees

The exam runs twice a year. The written papers are sat four to five weeks before the clinicals in Adelaide, Brisbane, Hobart, Melbourne, Perth, Sydney, Auckland or Wellington. The clinicals are held in one city, usually in hospitals, and the location usually rotates on a two-year cycle (RACS dates and locations (opens in a new tab)).

Late registrations are not accepted. Dates change, so confirm them on the RACS page before booking anything.

The 2026 fees (opens in a new tab) were A$10,465** (excluding GST) in Australia, **NZ$12,875 (including GST) in Aotearoa New Zealand and NZ$11,205 for New Zealand non-residents, split equally between the written and clinical/viva components.

Pass rates and attempts

The RACS Activities Report 2024 (opens in a new tab) gives the most recent published orthopaedic figures:

The 2023 figures are from the Activities Report 2023 (opens in a new tab). Within five years nearly every trainee passes: all 60 orthopaedic trainees who first sat in 2019 had passed by 2024.

REG-2069 sets no fixed limit on attempts. After a first failure you must meet your supervisor; after a second or later failure the training board chair interviews you and may set a remediation plan. Failing five or more of the seven segments is classed as poor performance and can affect approval to present again. Trainees must also complete their training requirements within the maximum term allowed by RACS training regulations.

How to prepare for the FRACS orthopaedic exam

The written papers come first and are now a hurdle, so plan backwards from the written date, not the clinical weekend.

Twelve to nine months out: rebuild the base. Re-read surgical approaches with the nerves at risk for each, revisit OPBS basic science, and form a study group of three to five people whose work rate matches yours. A large messaging group of anxious candidates is a source of noise, not knowledge.

Nine to four months out: work through the subspecialties. Allocate time in proportion to weakness, not interest. Cover trauma, hip and knee, paediatrics, spine, upper limb, foot and ankle, and oncology and infection. Learn the conclusions and populations of the landmark trials you would quote. Start written practice now: RACS provides past papers and a model examination for orthopaedics through its practice exams page (opens in a new tab), and strongly encourages candidates to sit one on the electronic platform.

Four months to the written papers: output under time. Timed MCQ blocks, timed ISAWE sets, and full 30-minute essays marked by your group. Keep an error log: for every question you got wrong or guessed, record the concept, why the distractor caught you, and the fact you need. Review it weekly. Doing more questions without reviewing them builds speed, not knowledge. Active recall beats rereading; active recall for surgical exams covers the method.

The four to five weeks between the written papers and the clinicals: talk. Vivas are passed out loud. Practise CIM and operative scenarios aloud daily, with peers and with consultants who will interrupt you. How to practise viva answers alone helps when no one is free. The senior examiners' own advice is to treat every patient you see in the lead-up as a potential short case and to stay in clinical work rather than disappearing into books.

AOA 21 trainees also have regular Bone School teaching, which follows a residential Bone Camp at the start of training (AOA curriculum framework).

Viva and clinical technique

The Notes to Candidates (opens in a new tab) are unusually direct about what examiners want, and most of the useful advice comes from them:

• Say what you would actually do. The examiners say they want to hear your real practice, "not what you perceive they might want to hear", and that they can usually tell whether you have managed a situation yourself.
• Admit inexperience, then reason. If asked about an operation or complication you have not seen, say so and describe your management from reading and planning.
• Follow prompts. If an examiner suggests you reconsider, trust it. If you are moved on, it is either because you have scored what was available or because you have exhausted the topic; neither is a verdict.
• Ask for clarification rather than answering a question you have guessed at.
• Treat it as a conversation with colleagues. Examiners address you by candidate number, not name, and observers may be present who are assessing the examiners, not you.

A structure for any clinical scenario: summarise the key findings, give a provisional diagnosis and differential, then manage in order (resuscitation or acute care, investigations, definitive treatment, rehabilitation and follow-up). Speak in short sentences, signpost ("there are three options"), finish the point, then stop. Silence lets the examiner move to the next marking point. Passing the orthopaedic viva works through answer structures in more detail.

For the patient-based clinical cases:

• Introduce yourself, explain, gain consent, expose adequately and keep the patient comfortable.
• Inspect from a distance first, including gait or resting posture, then look, feel, move and perform special tests.
• Examine the region, not just the painful joint, and compare with the other side.
• Narrate what you find as you go, and watch the patient's face throughout.
• Perform the special tests the history points to, not every test you know.
• Close with a summary and a provisional diagnosis that your findings support.

If one station goes badly, reset. Each segment is marked separately by different examiners who do not know how you did elsewhere. Managing exam performance anxiety covers techniques for that reset, and what to expect on exam day covers the logistics.

Common pitfalls in the FRACS exam

The unsafe answer. Proposing major surgery before addressing the patient is the fastest way to fail a station. In a polytrauma or mangled limb scenario, start with ATLS priorities and physiological stability. Damage control orthopaedics explains when definitive fixation should wait. Do not miss the time-critical diagnoses: compartment syndrome, cauda equina syndrome, septic arthritis and haemodynamically unstable pelvic injury.

Subspecialty depth at the expense of breadth. The standard is a first-year consultant, not a fellowship-trained subspecialist. For rare conditions, know the presentation, the safe first steps and when to refer to a specialist centre, such as a sarcoma unit.

Avoiding weak subjects. All seven segments carry equal weight, and two failed segments fail the exam. Spending evenings on your strongest area feels productive but does not protect you. Give your weakest subjects the most time.

Treating the written papers as a formality. Candidates who fail both written segments never reach the clinicals. Practise both papers under time from months out.

Poor time management in Paper 2. Overrunning the essays costs ISAWE marks that are easier to earn. Set time limits per section and stop when they run out.

Rambling. Marks come from specific points. A long unstructured answer that never reaches management loses the marks for management.

Passive revision. Rereading and highlighting feel like learning. Closing the book and writing out a classification, investigations and treatment algorithm from memory, then checking, is what produces recall under pressure.

Starting late. The syllabus is the whole of general orthopaedics. Twelve to eighteen months of steady work is easier than six months of strain.

Exhaustion. Protect sleep and exercise and take regular days off. A candidate who arrives exhausted recalls less, whatever the hours logged.