How to Become an Orthopaedic Surgeon in Canada

Becoming an orthopaedic surgeon in Canada takes a medical degree, a place through the CaRMS R-1 Main Residency Match, and a five-year residency accredited by the Royal College of Physicians and Surgeons of Canada, which ends in the Royal College examination in Orthopedic Surgery. Unlike the UK or Australia, there is no core surgical training stage to complete first: Canadian graduates match directly into orthopaedics from medical school. This guide sets out each stage with the official numbers. For how Canada compares with other countries, see the hub guide to becoming an orthopaedic surgeon.

The Canadian route at a glance

How does the CaRMS R-1 match work?

The Canadian Resident Matching Service (CaRMS) (opens in a new tab) runs the R-1 Main Residency Match for entry-level postgraduate positions at Canadian medical schools. Applicants submit an application to each programme, are interviewed, and then rank programmes; programmes rank applicants, and the match pairs the two lists.

The match has two iterations. In 2026, first-iteration Match Day was 3 March 2026; 356 positions were left unfilled (opens in a new tab) and moved automatically into the second iteration, whose Match Day was 21 April 2026. Unmatched applicants receive instructions for the second iteration by email.

How competitive is orthopaedic surgery in Canada?

The CaRMS 2026 R-1 match data overview (opens in a new tab) gives the clearest picture:

• 73 orthopaedic surgery positions were available in the first iteration across all streams; 72 filled.
• In the Canadian medical graduate (CMG) stream there were 65 positions, or 0.66 positions for every CMG who ranked orthopaedics first. Ten disciplines had a lower ratio, among them neurosurgery, urology, plastic surgery and dermatology.
• Orthopaedics was the first-choice discipline of 3.2% of CMGs in 2026, up from 2.2% in 2022.
• 12 CMGs whose first choice was orthopaedics matched to family medicine in 2026, up from 8 in 2022.

The practical consequence is that a CaRMS application should be built for orthopaedics and for a back-up discipline at the same time. Programme descriptions on CaRMS list each school's selection criteria, required documents and interview format; read them for every programme you rank, because they differ.

Routes for international medical graduates

International medical graduates (IMGs) apply through the same R-1 match but must pass the Medical Council of Canada Qualifying Examination (MCCQE), formerly MCCQE Part I. According to the Medical Council of Canada (opens in a new tab), passing it is a requirement for IMGs applying for entry into a Canadian residency programme.

The MCCQE is a one-day, computer-based examination of 230 multiple-choice questions in two sections of 115, delivered at Prometric centres in Canada and over 70 other countries during four sessions a year. It tests critical medical knowledge and clinical decision-making at the level expected of a graduating Canadian medical student. A pass is also one of the criteria for the Licentiate of the Medical Council of Canada (LMCC), which provincial and territorial regulators may require before granting a licence.

IMG eligibility differs between programmes, so check each CaRMS programme description before applying. Our guide to IMG routes into orthopaedic surgery compares Canada with the other main systems.

What does Royal College residency involve?

Orthopaedic surgery residency is accredited by the Royal College and delivered under Competence by Design (CBD), its competency-based model. Progression depends on demonstrating entrustable professional activities (EPAs) rather than on time served. The Orthopedic Surgery Training Experiences (2025, version 2.0) (opens in a new tab), which apply to residents starting on or after 1 July 2025, describe four stages.

The Royal College states that orthopaedic surgery "is planned as a five-year residency program" and that there is no mandated period in each stage; the faculty, competence committee and programme director decide individual duration. The guidance to postgraduate offices caps the total at five years in the normal course.

Surgical Foundations runs alongside the early stages. It is a common curriculum shared by nine Royal College surgical disciplines, and proof of attestation in Surgical Foundations is required before a resident can be promoted into the Core stage of orthopaedic surgery. Residents may "reach ahead" into Core activities, but formal promotion waits for that attestation.

Required training experiences in the Foundations stage include orthopaedic rotations covering arthroplasty, trauma and paediatric orthopaedics, with inpatient, consultation, clinic, operative and after-hours work. A surgical logbook is recommended from the first stage.

The Royal College examination and certification

Royal College certification in orthopaedic surgery requires all three of the following, per the training experiences document (opens in a new tab):

1. Proof of attestation in Surgical Foundations.
2. A pass in the Royal College examination in Orthopedic Surgery.
3. Completion of the Orthopedic Surgery Portfolio, the list of EPAs across all four stages with their national assessment standards.

The examination has a written component and an applied component. The Royal College runs them decoupled, with the written sat before the applied; dates and registration windows by CBD cohort are on its 2026 exam dates page (opens in a new tab). For the structure, standard and preparation, see our FRCSC orthopaedic surgery exam guide.

Certification is separate from licensure. To practise, you also need a licence from the medical regulatory authority of the province or territory where you will work, and that authority may require the LMCC.

Fellowship after residency

A fellowship is not among the Royal College requirements for certification, so a certified surgeon can practise general orthopaedics. Residents who want subspecialty training in areas such as arthroplasty, trauma, spine, sports medicine or paediatrics apply for fellowships in Canada, the United States or overseas. Our orthopaedic fellowship application guide covers timing, applications and interviews.

The Canadian route compared

Canada combines direct entry from medical school (as in the United States) with a national certifying examination set by a single college. A Canadian resident is in an orthopaedic programme from the first postgraduate year. For a side-by-side table of nine countries, see the hub guide to becoming an orthopaedic surgeon, and for the US system, which shares the match model, read how to become an orthopaedic surgeon in the United States.