How to Become an Orthopaedic Surgeon in South Africa

To become an orthopaedic surgeon in South Africa you complete the MBChB, register with the Health Professions Council of South Africa (HPCSA) for two years of internship and one year of community service, win a registrar post on a university training rotation, and pass the three-part FC Orth(SA) examinations of the Colleges of Medicine of South Africa (CMSA) while completing a university MMed. Registrar training lasts at least four years. This guide sets out each stage from the HPCSA, CMSA and university documents. For how South Africa compares with other countries, see the hub guide to becoming an orthopaedic surgeon.

The South African route at a glance

Internship and community service

The HPCSA registers graduates as interns, then for community service, then for independent practice. Its registration guidance (opens in a new tab) sets the sequence for doctors: practitioners start community service after completing 24 months' internship in medicine, and start independent practice after completing 12 months of community service. Registration and each change of category are now done online.

Registration for independent practice is the point at which a doctor meets the first entry requirement for an orthopaedic registrar post.

How do you get an orthopaedic registrar post?

Registrar (specialist trainee) posts are numbered, HPCSA-accredited posts on university-affiliated rotations, and each academic department runs its own selection. The UKZN Discipline of Orthopaedic Surgery (opens in a new tab) publishes typical requirements. Its minimum entry requirements are:

• MBChB or equivalent.
• Current HPCSA registration as an independent practitioner, which means internship and community service are complete.
• A pass in the CMSA FC Orth(SA) Primary.
• 12 months' experience in orthopaedics.

UKZN lists as added advantages a pass in the Intermediate, medical officer time in a recognised orthopaedic department, rural or peripheral orthopaedic experience in KwaZulu-Natal, and the ATLS, Basic Surgical Skills and AO Basic courses. Supernumerary registrars also need ECFMG certification, evidence of English-medium training or an IELTS pass, and registration with their home regulator, and must register for the UKZN MMed. Requirements differ between universities, so check each department's published criteria.

The FC Orth(SA) examinations

The CMSA regulations for the FC Orth(SA) (opens in a new tab) (June 2023) describe three components: the FCS(SA) Primary, the FC Orth(SA) Intermediate and the FC Orth(SA) Final. The Final must be passed within eight years of passing the Intermediate.

The Primary and Intermediate may be attempted at the same sitting, but if the Primary is failed and the Intermediate passed, no credit is given and both must be retaken. A dedicated trauma unit or a plastic surgery unit can count as the "general surgery" rotation if the full three months is spent there.

How the Final is marked

Only candidates who pass the written papers proceed to the clinical scenarios and orals, which the regulations describe as a virtual examination run over video link, with two examiners agreeing a consensus mark for each station. To pass you need:

• 50% or more in each of the three papers.
• 50% or more in at least two of the three clinical scenarios, with an overall average of 50% or more.
• 50% or more in at least two of the three orals, with an overall average of 50% or more.

The written papers, clinical scenarios and orals carry equal weight. The Edelstein medal goes each year to the Final candidate with the highest average across the three components, provided it is at least 70%.

Work-based assessment and the logbook

From 1 January 2023 the College introduced work-based assessments (WBAs) in 15 core procedures. A local consultant examiner watches the registrar plan and perform the operation and scores entrustment from 1 (observe only) to 4 (day-one consultant); a score of 3 or more passes the module. Candidates must complete them pro rata at two per semester, so that from 2027 every candidate needs all 15 before registering for the Final. Registrars must also log every case in the LogBox app and submit the consolidated portfolio when they register for the written examination.

Candidates may register for the Final for up to three years after leaving their registrar rotation; after that they need two more years of recognised registrar training before another attempt. For preparation strategy and the syllabus, see our FC Orth(SA) examination guide.

The MMed and specialist registration

Registrar posts are tied to a university Master of Medicine (MMed) in orthopaedics. At UKZN the programme "aims to allow registration as an independent practitioner in orthopaedic surgery with the HPCSA", and its completion requirements are:

1. The CMSA Primary, Intermediate and Final orthopaedic examinations.
2. The MMed research component: a passed dissertation, or an article published or accepted for publication.
3. Five years of prescribed training in an HPCSA-accredited institution.
4. Demonstrated competence across the seven CanMEDS roles.

The CMSA awards the Fellowship only to candidates trained in a CMSA-recognised registrar post. Candidates who sit the examination at the HPCSA's request as a condition for inclusion on the specialist register receive a letter confirming their result instead of the Fellowship.

After qualification

Once registered as a specialist, surgeons can apply for subspecialty fellowships in South Africa or abroad in areas such as arthroplasty, spine, hand, sports or paediatric orthopaedics. Our orthopaedic fellowship application guide covers how to choose and apply.

The South African route compared

South Africa requires three years of internship and community service before a registrar post, compared with direct entry from medical school in the United States and Canada. Registrar training then runs at least four years, with a national three-part examination set by a single college and a university research degree alongside. For the side-by-side comparison, see the hub guide to becoming an orthopaedic surgeon.