The FRCS (Tr & Orth) Exam: Format, Eligibility, Pass Rates and How to Prepare

The FRCS (Tr & Orth) is the exit examination of trauma and orthopaedic training in the UK and Ireland. Formally the Intercollegiate Specialty Examination in Trauma & Orthopaedic Surgery, it is run by the Joint Committee on Intercollegiate Examinations (JCIE) (opens in a new tab) for the Royal Colleges of Surgeons of Edinburgh, England, Glasgow and Ireland. The pass mark is set at the level of a day one consultant in the generality of the specialty. The short answer: pass a computer-based written section, then a clinical and oral section, within a fixed number of attempts.

This guide covers eligibility, both sections, dates, fees, attempt limits and pass rates, then a revision timeline and the reasons candidates fail. The written paper and the clinicals each have their own deep-dive: Section 1, the written paper and Section 2, the clinicals and vivas.

The FRCS (Tr & Orth) at a glance

You must reach the required standard in Section 1 to be granted eligibility to proceed to Section 2. Pass Section 2 and you have passed the examination. A candidate who is already a Member of one of the four colleges is then promoted to that college's Fellowship unless they choose otherwise.

The regulations also name two prizes. The Sir Walter Mercer Medal goes to the candidate with the highest mark in the whole examination at the first attempt, who is also invited to become the British Orthopaedic Association Young Ambassador. The Arthur Edward Burton Memorial Prize goes to the highest first-attempt mark in Section 1.

Who is eligible to sit the FRCS (Tr & Orth)?

The Trauma & Orthopaedic Surgery regulations (opens in a new tab) set three conditions for every applicant:

• A medical qualification recognised for registration by the General Medical Council (GMC) or the Medical Council of Ireland, held for at least six years.
• Evidence of clinical competence at the standard of the Intercollegiate Surgical Curriculum for a Certificate of Completion of Training (CCT) in the UK, or the Irish equivalent.
• Three structured references on the JCIE form from senior colleagues who know your current practice.

Passing does not make a CCT or specialist registration automatic. The regulations state that the examination forms only part of the evidence; how it fits with the rest of training is covered in the orthopaedic curriculum and CCT explained.

UK and Republic of Ireland trainees. The Guidance Notes for Applicants (opens in a new tab) require your current Training Programme Director as principal referee, plus two consultant trainers who have seen your practice in the last two years. You must either have completed Phase 2 of the curriculum with an ARCP Outcome 1, or be no more than two whole-time-equivalent clinical years before your indicative CCT date with an ARCP Outcome 1 at that point.

Applicants not in training. Since 1 October 2023 the revised criteria require an MRCS from one of the four surgical Royal Colleges, at least four years of appropriate training in the areas examined in Section 2, and at least one year of that in the UK or Ireland, registered on ISCP and meeting the GMC or Medical Council of Ireland requirements for maintaining professional competence. The principal referee is your lead clinician, head of department or medical director, and in the UK the form is countersigned by the trust's Director of Medical Education.

All three referees must be on the UK or Irish medical register and in good standing. You must also be in good standing with the GMC yourself; an interim order, conditions or suspension must be reported to JCIE, or a result can be declared void.

What you upload. The application page (opens in a new tab) lists the three structured references, a CV, a summary of operative experience and photographic identification. Applications close at 5pm UK time on the published date, and an application still incomplete at that point is moved to the next sitting. JCIE confirms eligibility by email within four weeks of the closing date, and an applicant refused eligibility gets a full refund.

Section 1: the written examination

Section 1 is two papers of 120 SBA questions, each 2 hours 15 minutes, delivered by computer at Pearson VUE centres in the UK and Ireland. This has been the format since January 2021, when the GMC approved replacing the earlier SBA and extended matching item papers. Older books and some college pages still describe the extended matching paper, so check the date on anything you read.

Each paper allows about 67 seconds per question. JCIE's question-writing guidance asks for questions that can be read and answered in about a minute, with five plausible options (A to E) and a stem that can be answered before you look at the options. Questions are pitched at interpretation and clinical judgement rather than recall.

The scope is the whole trauma and orthopaedic curriculum. JCIE publishes a syllabus blueprint (opens in a new tab) mapping each curriculum item to Section 1, Section 2 or both, but it does not publish a percentage weighting by subspecialty, so treat any such breakdown as an estimate. The regulations list the applied basic science in detail: surgical anatomy, musculoskeletal development and physiology, pathology including tumours and fracture healing, bacteriology and theatre design, tissue transplantation, genetics, imaging physics, biomechanics, prosthetics and orthotics, and statistics.

A typical higher-order question looks like this:

A 74-year-old woman sustains a displaced intracapsular fracture of the femoral neck. She lives alone, walks two miles a day without aids, is cognitively intact and has well-controlled hypertension. What is the most appropriate definitive management?

• A. Cannulated screws
• B. Sliding hip screw
• C. Uncemented hemiarthroplasty
• D. Cemented hemiarthroplasty
• E. Cemented total hip replacement

The answer is E. NICE hip fracture guidance favours total hip replacement for patients who are independently mobile, not cognitively impaired and medically fit, and every clue in the stem points there. The neck of femur fracture topic covers the evidence, including the HEALTH trial's finding that the functional gain over hemiarthroplasty is modest.

Results arrive within six weeks with a breakdown of your performance. The Section 1 guide covers question technique, revision for each subject and the per-sitting pass rates.

Section 2: clinicals and orals

Section 2 is the clinical component: structured interviews on clinical topics, some scenario-based and some built around volunteers, who are past or present patients recruited by the host examiner. The format in force since August 2022 is:

Every scoring opportunity is marked on the JCIE 4 to 8 scale. The JCIE marking descriptors (opens in a new tab) (G38 v3.0) define each grade across basic knowledge, higher-order processing, clinical skills and professionalism:

Six is the safe day-one consultant. Results come within two weeks. In May 2026 JCIE added a 12-minute video on what to expect before, during and after Section 2, linked from the JCIE news page (opens in a new tab). Case-by-case preparation, examination routines and oral technique are in the Section 2 guide.

When is the FRCS (Tr & Orth) held?

Section 1 now runs three times a year. The JCIE calendar (opens in a new tab) lists these Trauma & Orthopaedic Surgery sittings:

Section 1 applications close about three months before the paper. You state a preferred Section 2 sitting when you apply for Section 1. JCIE normally confirms your Section 2 date within six weeks of Section 1, allocates places in order of receipt of Section 1 applications, and cannot guarantee your first choice.

Fees, withdrawals and results

The JCIE FAQs (opens in a new tab) give the fee as £2,000 (£580 for Section 1, £1,420 for Section 2) for examinations up to 31 December 2026, rising to £2,070 (£600 and £1,470) from 1 January 2027. The full amount is paid when you apply for Section 1 and held in a fee account, and the cost of any resit is deducted from it.

The fees and penalties document (opens in a new tab) sets the withdrawal rules:

• Before the closing date: full fee for that section refunded or transferred.
• After the closing date, up to 21 working days before the exam: 50% may be refunded or transferred.
• Within 20 working days, or not attending: no refund, except in exceptional circumstances at JCIE's discretion, with a £50 administration fee.
• Changing your preferred Section 2 sitting: free if you email JCIE before your Section 1 date; after that, penalties apply plus an administration fee of half the Section 2 fee.

Arriving late or on the wrong day is not counted as an attempt, but you lose the fee. Results come as a letter from the Board Chair with a breakdown of your performance; if you fail, a copy goes to your principal referee if you consented on your application. JCIE provides no other feedback.

Attempt limits and the seven-year window

The regulations give you up to seven years to complete the examination:

• Section 1: a maximum of four attempts within two years of your first attempt, with no re-entry.
• Section 2: a maximum of four attempts, with no re-entry.

The time limits are pro rata for less than full-time trainees. The four-attempt limit applies across the JCIE examination and the Joint Surgical Colleges Fellowship Examination combined, so attempts at either count. Leaving an examination part-way through counts as an attempt and is normally a fail, unless you are taken ill and send a medical certificate dated that day within five working days. Section 1 resitters within the two-year window do not need new references.

What are the FRCS (Tr & Orth) pass rates?

JCIE publishes results for every sitting since 2009 on its examination results page (opens in a new tab). The figures count sittings, so a candidate who sits twice appears twice.

Pass rates swing between sittings. Section 1 ranged from 57% to 76% across the six main sittings from November 2024 to June 2026, after lows of 35% in June 2022 and 38% in February 2023. Section 2 ranged from 62% to 77% over the same period.

The more useful number is the gap. CCT trainees pass Section 2 more than twice as often as candidates out of training. If you are applying through the non-training route, plan for more than one attempt and build supervised clinical examination practice into your preparation.

A revision timeline that fits a full-time job

You will probably revise around an on-call rota. Plan in the order the exam runs: written breadth first, then clinical and oral performance, with the Section 2 work starting before your Section 1 result arrives. Fitting study around clinical work is covered in more detail in balancing exam study with a clinical job.

Before you apply (about four months before Section 1). Ask your referees early; the application cannot be submitted without all three references. Choose your Section 2 sitting with leave and rotations in mind, because changing it later costs money.

Six months out: breadth. Audit yourself against the curriculum and the syllabus blueprint and spend most time on the subspecialties you have not worked in recently. Use a question bank as your syllabus: set a daily quota you can sustain around your rota (for example 30 to 50 questions), read the explanation for every question, including the ones you got right, and keep a log of recurring errors to direct your reading. Protect one longer block each week for a subject read in depth. Common core texts include Postgraduate Orthopaedics: The Candidate's Guide to the FRCS (Tr & Orth) Examination, with Miller's Review of Orthopaedics for quick reference (it follows US practice) and a dedicated basic science text. The approach in how to revise basic science for orthopaedics applies directly to the basic science content.

Three months out: timed papers. Sit full 120-question papers in 2 hours 15 minutes so that a pace of about one question a minute becomes automatic, and review every paper the same week.

Four months before Section 2: clinical fluency. Examine normal and abnormal joints until your routines are automatic, in clinics outside your own subspecialty. Form a study group of three or four people sitting the same diet and meet weekly. Practise presenting findings in a single summary sentence; the method is in presenting an orthopaedic short case.

Two months before Section 2: simulate. Take study leave for courses and mock circuits. Ask consultants and recently passed fellows to examine you in timed 15-minute cases and 30-minute orals, and to interrupt and push you to your limit the way examiners do. Record yourself and correct the habits you see.

Final week: taper. Stop adding new material, revise your own notes and rehearse openings for the common scenarios. Plan travel and accommodation for the host centre early. What happens on the day, and how to manage nerves, are covered in exam day: what to expect and managing exam performance anxiety.

Why do candidates fail the FRCS (Tr & Orth)?

The marking descriptors show what a fail looks like. Each common reason for failing matches a phrase in the 4 and 5 descriptors.

Unsafe suggestions. A course of action that would harm a volunteer is a 4. Missing a compartment syndrome, an unsafe approach or forgetting the neurovascular examination in trauma are the classic examples. When unsure, state the safe option and how you would get help.

Needing to be dragged through the answer. "Poor responses which required significant prompting" is a 5. Orals are built from open, higher-order questions that escalate in complexity, often with "what if" and "and why" follow-ups. Candidates who wait for each prompt run out of time on a 30-minute oral. Lead with a structure: summary, priority, investigation, decision, justification. The method is in passing the orthopaedic viva.

Hedging instead of deciding. Limited decision-making is a 5. Listing every option without choosing one reads as a registrar, not a consultant. Commit to a plan for this patient, say why it beats the alternatives, and adapt when the examiner changes the scenario (the patient smokes, the fixation fails), rather than starting again.

Recalling instead of applying. JCIE tells its question writers to avoid recall questions such as "list" and "define". Textbook lists without the patient's age, demands and comorbidities score poorly. Revise each topic as a clinic patient, not as a chapter.

Neglecting basic science. It has its own 30-minute oral and runs through Section 1. Candidates who leave it until last lose marks they could have banked.

Poor rapport with volunteers. The professionalism column of the descriptors marks empathy, rapport and responses to verbal and non-verbal cues. Hurting a patient during a special test and carrying on is visible to every examiner. Watch the patient's face and stop if you cause pain.

Revising alone. Solo revision hides weak structure and verbal habits. Mock orals under time pressure expose them before the examiners do.

Administrative errors. Incomplete applications roll over to the next sitting, and lateness forfeits the fee. Neither costs an attempt, but both cost months.

Guidelines and trials to know

Examiners expect UK practice. Know the British Orthopaedic Association Standards for Trauma (BOAST), the relevant NICE guidance and the Getting It Right First Time (GIRFT) recommendations for your common topics. Read the current versions rather than summaries, because their timings and thresholds are revised.

Quote trials accurately. DRAFFT (2014) randomised 461 adults with dorsally displaced distal radius fractures to K-wires or a volar locking plate and found equivalent outcomes at lower cost with wires. HEALTH compared total hip replacement with hemiarthroplasty for displaced femoral neck fractures; WHiTE 5 supports a cemented stem for hemiarthroplasty; FAITH found sliding hip screws and cancellous screws broadly equivalent for femoral neck fixation; LEAP found similar long-term function after limb salvage and amputation for severe lower-limb trauma. Getting a trial's comparison wrong costs more than not quoting it at all.

For how the FRCS compares with FRACS, ABOS and EBOT, see the global orthopaedic board exam atlas.