How to Become an Orthopaedic Surgeon in New Zealand

In Aotearoa New Zealand, orthopaedic training is the Royal Australasian College of Surgeons' (RACS) Surgical Education and Training (SET) programme, with selection, training and assessment delegated to the New Zealand Orthopaedic Association (NZOA) (opens in a new tab). The route is a medical degree, two prevocational years, registrar experience in orthopaedics, NZOA selection, a minimum of five years from SET 1 to SET 5 and the RACS Fellowship Examination, leading to Fellowship of RACS (FRACS) in orthopaedic surgery. This guide sets out each step from NZOA's current regulations. For other countries, see the guide to becoming an orthopaedic surgeon.

The New Zealand pathway at a glance

Prevocational years

Graduates of accredited New Zealand and Australian medical schools complete prevocational training (opens in a new tab) as PGY1 and PGY2 doctors, collectively called interns, in programmes run by accredited training providers. The Medical Council of New Zealand requires a minimum of 12 months in each postgraduate year, and a doctor stays in that year until its requirements are met.

NZOA points junior doctors to the RACS JDocs Framework, which sets out the knowledge, skills and behaviours expected over PGY1–3 for entry to procedural specialist training. Using it as a checklist from PGY1 is the simplest way to arrive at selection with the evidence NZOA scores. Our guide to building an orthopaedic portfolio early covers the rest.

Eligibility for NZOA selection

NZOA's Selection Regulations for the 2027 intake (opens in a new tab) add specialty-specific criteria to RACS's generic eligibility. Applicants must:

• Hold New Zealand citizenship or permanent residency at the time of application.
• Be working in a New Zealand hospital.
• Have passed the RACS Generic Surgical Sciences Examination (GSSE) by the close of applications.
• Have completed at least 52 weeks in an orthopaedic rotation at registrar level or above in a New Zealand department within the 24 months before applications close. Applicants who have had full-time study, parental leave or extended sick leave in the past two years can instead show 52 weeks within 36 months plus 26 weeks in the last 12 months.
• Have completed at least 12 weeks in a hospital emergency department as a house surgeon or registrar.
• Pre-register with RACS in every year of application, even if they have applied before.

The NZOA application page (opens in a new tab) confirms that a pass in the RACS Clinical Examination is no longer a prerequisite; it earns one point in the CV's courses and examinations section, which is capped at four points. There is no limit on the number of applications.

How NZOA selection works

Selection is a two-stage process using four tools:

The structured CV is scored out of 21 points: up to 14 for core experience and up to 7 for additional expertise. Two NZOA staff score each CV independently, and discrepancies go to the Education Committee chair. Work experience as an orthopaedic registrar in New Zealand earns points by the 12-week block, up to four points a year, and only entries supported by documentary evidence are scored. Interviews are held in New Zealand.

How many places? RACS publishes the number appointed each year, including deferred offers: 14 for 2020, 12 for 2021, 15 for 2022, 11 for 2023, 20 for 2024, 17 for 2025 and 13 for 2026.

What SET training involves

NZOA's Training Regulations (opens in a new tab) set a minimum of five years full-time equivalent and a maximum of nine years to progress through the programme. Approved interruptions, including research time, are not counted towards the minimum. Trainees rotate through accredited posts in New Zealand hospitals, and RACS's Guide to SET (opens in a new tab) notes that each training year is split into four quarters, each with its own assessment requirements.

The regulations set out what each year demands:

• Assessment: at least three workplace-based assessments a quarter, mid-term and end-of-term quarterly run assessments, six feedback entries a quarter, and logbooks kept in the electronic TIMS eLog.
• Courses: ASSET, CCrISP, EMST and CLEAR by the end of SET 2, and TIPS by the end of SET 3.
• Examinations: the Orthopaedic Principles and Basic Sciences (OPBS) examination by the end of SET 3, and the RACS Fellowship Examination in SET 5.
• Teaching: training weekends each spring and autumn, a mock examination in SET 4 and a pre-examination course in SET 5.
• Research: a requirement that runs across the programme.

SET 5 consists of two six-month terms. Trainees who pass the Fellowship Examination during SET 5 are released from workplace-based assessments and feedback entries but still complete the quarterly run assessments.

The Fellowship Examination

To present for the RACS Fellowship Examination (opens in a new tab), an NZOA trainee must be in SET 5, have satisfactorily completed at least six six-month terms beyond SET 1, have finished any probationary training and be up to date with RACS fees. The examination is held twice a year in seven segments, most commonly two written papers followed about a month later by five clinical or viva segments, set at the standard of a consultant in the first year of independent practice. The May 2027 clinical and viva component for orthopaedic surgery in Aotearoa New Zealand is scheduled for Christchurch.

Our FRACS orthopaedic exam guide covers the format and preparation, and the Australian guide sets out the parallel AOA 21 programme across the Tasman.

After FRACS

Completing SET and passing the Fellowship Examination makes a trainee eligible for FRACS in orthopaedic surgery and consultant practice. Some take a subspecialty fellowship first; NZOA lists accredited fellowships in New Zealand, and our fellowship application guide covers choosing and applying. Surgeons who trained overseas follow a separate specialist international medical graduate assessment; see our guide to IMG routes into orthopaedic surgery.