FRCS (Tr & Orth) Section 1: The Written SBA Exam

FRCS (Tr & Orth) Section 1 is the written half of the Intercollegiate Specialty Examination in Trauma & Orthopaedic Surgery: two computer-based papers of 120 single best answer (SBA) questions, each lasting 2 hours 15 minutes. You must reach the required standard to be granted eligibility to proceed to Section 2. The short answer to passing it: cover the whole curriculum, practise at exam pace, and learn how JCIE builds its questions.

Eligibility, fees, Section 2 and the full revision timeline are in the FRCS (Tr & Orth) exam guide. This post goes deeper on the written paper. Facts were checked against the JCIE Trauma & Orthopaedic Surgery page (opens in a new tab) and calendar on 2 October 2026.

What is the format of FRCS Section 1?

The JCIE regulations (opens in a new tab) (SR11 v8.0, August 2025) describe Section 1 as two SBA papers, with the pass mark set by standard setting carried out by trained examiners. The format has applied since January 2021; before that, one paper used extended matching items. Older books, question banks and at least one college webpage still describe the extended matching paper, so ignore any advice built around it.

At 135 minutes for 120 questions you have about 67 seconds per question.

JCIE publishes what you will see on screen. The specialty information page (opens in a new tab) has the computer-based testing tutorial, glossary of terms and list of abbreviations shown during Section 1. In May 2026 JCIE also updated the sample questions for every specialty, available from the Trauma & Orthopaedic Surgery page. Read all three documents and the sample paper before the day so nothing on screen is new.

How does JCIE write a Section 1 question?

JCIE's SBA writing guidelines, adapted from the US National Board of Medical Examiners item-writing manual by Case and Swanson, tell question writers to:

• Present a single, clearly formulated problem in the stem, often as a patient vignette with age, presenting complaint, history, findings and investigations.
• Write a lead-in that can be answered without looking at the options, and that cannot be answered if the stem is hidden.
• Give five options (A to E) of similar length, on a continuum, all plausible, in a logical order where possible.
• Make the question answerable in about one minute.
• Aim at interpretation and clinical judgement, not recall. Example lead-ins in the guidance are "What is the most likely diagnosis?", "What is the most useful investigation to carry out at this stage?", "What is the most appropriate first step in the management of this patient?" and "In this procedure, which structure is most at risk in this patient?"

That design tells you how to answer. Read the lead-in first, then the stem, and form your own answer before you look at the options. If your answer is among the options, choose it and move on. If it is not, the stem holds a detail you missed: an age, an activity level, a comorbidity or a timing such as "at this stage". Every distractor is meant to be plausible, so "this is also true" is not a reason to change your answer. The question asks for the best option for this patient.

Distractors are often built from the numbers in the stem. Take this statistics question:

A new test for periprosthetic joint infection is evaluated in 1,000 patients with painful hip replacements. The prevalence of infection in the group is 10%. The test has a sensitivity of 90% and a specificity of 80%. What is the positive predictive value of the test in this group?

• A. 10%
• B. 33%
• C. 50%
• D. 80%
• E. 90%

The answer is B. Of 100 infected patients, 90 test positive; of 900 uninfected, 180 test positive (20% false positives). The positive predictive value is 90 of 270, or 33%. Options A, D and E are the prevalence, specificity and sensitivity from the stem, there for candidates who recognise the numbers but cannot work with them. Drawing a two-by-two table answers this kind of question well inside a minute.

What does Section 1 cover?

The scope is the whole trauma and orthopaedic curriculum. The regulations group it under three headings:

• Elective orthopaedics: orthopaedic disease in children and adults, including congenital, genetic, metabolic, degenerative and neurological disorders, from diagnosis to rehabilitation, with standard operations and their complications, investigations, and subspecialty areas such as spine and hand.
• Trauma: musculoskeletal trauma from resuscitation to reconstruction and rehabilitation, including spinal and pelvic injuries, soft-tissue and nerve injuries, hand injuries and multiple injuries, plus enough visceral, neurosurgical and skin trauma to make a primary diagnosis and start treatment when specialist help is not immediately available.
• Basic science: surgical anatomy; musculoskeletal development, physiology and biochemistry; pathology including tumours, arthritis, metabolic bone disease and fracture healing; bacteriology, theatre design and antibiotics; tissue transplantation; genetics; the physics of radiography, CT, ultrasound, MRI and electrophysiology; biomechanics of tissues, implants and gait; prosthetics and orthotics; and statistics.

The syllabus blueprint (opens in a new tab) (2023) maps every curriculum item to Section 1, Section 2 or both. JCIE does not publish the proportion of questions from each subspecialty. Any percentage breakdown you see, including in commercial question banks, is an estimate.

Dates, deadlines and results

The JCIE calendar (opens in a new tab) lists three Trauma & Orthopaedic Section 1 sittings in 2027:

An application still incomplete at the closing date is moved to the next sitting. First-time applicants upload three structured references, a CV, an operative summary and photographic ID, and JCIE confirms eligibility within four weeks of the closing date.

Results arrive within six weeks; JCIE extended this from four weeks in September 2025. The letter from the Board Chair includes a breakdown of your performance and says whether you have reached the standard to proceed. If you have not, your principal referee receives a copy if you agreed to this on your application. JCIE gives no other feedback, so the breakdown is the only guide to where you lost marks.

The Arthur Edward Burton Memorial Prize is awarded each year for the highest mark in Section 1 at the first attempt.

Four attempts in two years

The regulations allow four attempts at Section 1 within two years of your first attempt, with no re-entry. The two years are pro rata for less than full-time trainees, and attempts at the Joint Surgical Colleges Fellowship Examination count towards the four. Resitters inside the window do not need new references; the resit fee comes out of the fee account you paid into when you first applied.

Three sittings a year means four attempts can fit inside two years, but only if you resit at the next available diet each time. Count back from your two-year deadline before you defer a sitting.

What are the Section 1 pass rates?

The JCIE results tables (opens in a new tab) give pass rates for every sitting by trainee type. Totals count sittings, not individual candidates.

Across all 6,540 Section 1 sittings since 2009, 67% passed: 81% of CCT trainee sittings and 49% of sittings by candidates out of training.

Two patterns stand out. CCT trainees pass more often at every sitting. And in each of the last three years the February sitting has had a lower overall pass rate than the November before it (54% against 65%, 57% against 76%, 64% against 69%). In 2025 and 2026 the February sittings also had a smaller share of CCT trainees. Judge your readiness by your own timed papers rather than by the diet's pass rate.

How should you revise for Section 1?

Use a question bank as the syllabus. Questions show you what is examined and how. Read the explanation for every question, including the ones you got right by luck, and keep an error log by topic. When a topic keeps appearing in the log, go back to a textbook for it rather than doing more questions.

Study why the distractors are wrong. Each wrong option is a plausible alternative. Knowing when it would be the right answer, for a different patient or at a different stage, is often worth more than knowing the correct answer.

Give basic science protected time. Statistics, biomechanics, biomaterials, imaging physics and pathology are listed in the regulations and are learnable in a way that clinical judgement is not. The approach in how to revise basic science for orthopaedics fits Section 1 well.

Revise from your clinical work. Treat each patient in clinic or on the trauma list as a possible question: the most likely diagnosis, the most useful next investigation, the most appropriate first step. Read up that evening on anything you could not answer.

Practise at exam pace. From about three months out, sit full 120-question papers in 2 hours 15 minutes. Mark questions you are unsure of, answer every question before you review, and keep moving: no question is worth three minutes. The different formats you may meet across exams are compared in orthopaedic exam question types explained.

Start Section 2 preparation before your result. Results take up to six weeks, and Section 2 can follow within a few months. Begin examination practice and mock orals once the written paper is done; the format and preparation are covered in the Section 2 clinicals and vivas guide.