How to Become an Orthopaedic Surgeon in the UK

The UK route to consultant practice in trauma and orthopaedic surgery (T&O) runs through four supervised stages: the two-year Foundation Programme, two years of core surgical training with the MRCS, national selection to ST3, and an indicative six years of specialty training that ends with the FRCS (Tr & Orth) and a Certificate of Completion of Training (CCT). On indicative times that is ten years after graduation. This guide sets out each stage with the requirements published by the bodies that run them. For the same pathway in other countries, see the guide to becoming an orthopaedic surgeon.

The UK pathway at a glance

Foundation Programme

The UK Foundation Programme (opens in a new tab) is a two-year, work-based programme that bridges medical school and specialty training. Satisfactory completion of F1 earns the Foundation Year 1 Certificate of Completion and a recommendation to the GMC for full registration. Completing F2 earns the Foundation Programme Certificate of Completion, which signals readiness to enter core or specialty training. The four UK health departments set the number of places each year.

The Foundation years are the time to start a logbook, join a departmental audit and attend a regional orthopaedic meeting, because ST3 selection later asks for evidence of each. Our guides to building an orthopaedic portfolio early and keeping a surgical logbook cover how.

Core surgical training and the MRCS

Core surgical training is phase 1 of all UK surgical training and, under the ISCP core surgical training curriculum (opens in a new tab), is normally completed in an indicative time of two years. Trainees rotate through surgical specialties; programmes may be themed or generic.

Recruitment in England, Scotland and Wales is run centrally with the Royal College of Surgeons of England. For the 2026 recruitment round (opens in a new tab), applicants applied on Oriel and sat the Multi-Specialty Recruitment Assessment (MSRA). Only the top-scoring 1,200 applicants at MSRA were invited to interview and upload portfolio evidence, and the final ranking combined the MSRA and interview scores. Northern Ireland publishes separate guidance.

The Intercollegiate MRCS is common to the four surgical Royal Colleges. Under the January 2025 regulations (opens in a new tab):

• Part A is a five-hour multiple-choice examination in two papers; candidates must reach a minimum standard in each paper as well as overall.
• Part B is an OSCE of normally 17 examined stations of nine minutes each.
• Candidates have up to six attempts at Part A and four at Part B, and must pass Part B within seven years of passing Part A.

Our MRCS exam guide covers preparation for both parts.

Getting an ST3 national training number

Entry to T&O specialty training is at ST3, through national selection on Oriel. Successful applicants receive a National Training Number and enter what the curriculum calls phase 2. The 2026 ST3 person specification (opens in a new tab) sets the entry criteria.

Eligibility (all required):

• A primary medical degree (MBBS, BMBS or equivalent).
• Full GMC registration at application and a licence to practise when the post starts.
• Evidence of core surgical competences by one of three routes: current UK core surgical training due to finish by the start date, completed UK core surgical training with a satisfactory ARCP, or the Alternative Certificate of Eligibility to Enter Higher Surgical Training.
• The MRCS by examination, passed by the round's initial offers date.
• Not already holding, or eligible for, a CCT or specialist registration in T&O.

T&O-specific essential criteria include demonstrable, up-to-date competences in advanced trauma life support at interview and a validated logbook of surgical experience.

Desirable criteria include academic achievements (degrees other than an intercalated BSc, prizes, publications, presentations), at least eight months' experience in two related specialties such as plastic surgery, neurosurgery, vascular surgery, ENT, emergency medicine, intensive care or general surgery, a practical course in orthopaedic casting, relevant meetings and skills courses, and a defined career plan for T&O.

Those desirable criteria are the scoring targets. A candidate who plans core training around them, keeping evidence for each, arrives at ST3 selection with a portfolio that maps to the specification line by line.

What six years of specialty training contains

The ISCP trauma and orthopaedic surgery curriculum (opens in a new tab) is approved by the GMC for UK programmes and also followed in the Republic of Ireland. Version 3 applies from August 2026; the accompanying summary says only trainees below ST6 are expected to transition to it. Under the version 3 curriculum document (opens in a new tab), training has an indicative length of six years:

• Phase 2 (four years) covers the eight main areas of the specialty: hand and wrist, shoulder and elbow, spine, hip, knee, foot and ankle, paediatric orthopaedics and major trauma. Most attachments last six months, with a minimum of three. A critical progression point at the end of phase 2 makes the trainee eligible to sit the FRCS (Tr & Orth).
• Phase 3 (two years) continues general trauma training and adds two special interest placements, usually of at least six months each, in any of the eight areas or, with the training programme director's agreement, a less common area such as tumour or peripheral nerve surgery.

Trainees who progress exceptionally fast can finish earlier than the indicative time; less-than-full-time training is extended pro rata.

What certification requires. Appendix 4 of the curriculum sets an indicative 1,800 operations in the logbook, of which 1,260 as first surgeon, with three level 4 procedure-based assessments in each index operation group from two or more trainers. Trainees must also complete or supervise three audit or quality improvement projects, reach level IV (day-one consultant) in every capability in practice, and pass the specialty examination. An outcome 6 at the final ARCP allows a recommendation to the GMC for certification and entry to the specialist register.

The JCST's quality indicators for T&O (opens in a new tab) describe what a training post should provide: on average at least three consultant-supervised theatre sessions and two outpatient clinics a week, and involvement with emergency patients at least one day a week.

The FRCS (Tr & Orth)

The specialty examination is set by the Joint Committee on Intercollegiate Examinations (opens in a new tab) on behalf of the four surgical Royal Colleges. Under the curriculum's assessment rules:

• UK trainees become eligible for Section 1 after an ARCP outcome 1 at the end of phase 2.
• Section 1 is a computer-based assessment of two single-best-answer papers on the same day.
• Section 2 is the clinical and oral component: structured interviews on clinical topics, some scenario-based and some patient-based.
• There are four attempts at each section. Section 1 must be passed within two years of the first attempt, and the whole examination within seven years.

The JCIE fee (opens in a new tab) is £2,000 (£580 for Section 1, £1,420 for Section 2) for examinations up to 31 December 2026, and £2,070 from 1 January 2027. Section 1 results are issued within six weeks and Section 2 results within two weeks. Our FRCS (Tr & Orth) exam guide covers the format and preparation in detail.

After the CCT

The CCT and entry to the specialist register complete training. Some surgeons then take a subspecialty fellowship in the UK or abroad before a consultant post; our fellowship application guide covers timing and selection.

Doctors who did not train in a UK programme can join the specialist register through the portfolio pathway (formerly CESR). The JCST's guidance for T&O applicants (opens in a new tab) lists the intercollegiate FRCS as the expected knowledge evidence. International graduates weighing the UK against other systems should read our guide to IMG routes into orthopaedic surgery.