FRCS Orth Part 1 Complete Guide

The FRCS Orth Part 1 is a written paper and forms the first part of the exam for the Fellowship Examination of the Royal Colleges of Surgeons Orthopaedics, that assesses whether trauma and orthopaedic trainees have the knowledge, skills, clinical competence and experience expected at the end of their trauma and orthopaedic specialty training. The second part is a clinical and viva voce exam (Part 2). This FRCS Orth Part 1 complete guide provides comprehensive guidance on applying, preparing for and undertaking FRCS Orth Part 1 and we have just launched our FRCS (Orth) Complete Bundle which contains thousands of practice questions.

FRCS Orth Guidelines

Part 1 is the written component of the Intercollegiate Examination in Trauma and Orthopaedic Surgery. In 2018 the Joint Committee on Intercollegiate Examinations (JCIE) agreed to phase out extended matching item (EMI) questions. When compared to single best answer (SBA), EMI questions were less able to differentiate candidates and were difficult to construct. Subject to General Medical Council (GMC) approval, EMI questions will not feature in the FRCS (Tr & Orth) examinations from January 2021 onwards.Part 1 exams are currently held at Pearson VUE Test Centres at multiple locations throughout the United Kingdom and Ireland. Candidates can choose their preferred centre during registration. These test centres often host unrelated tests (e.g. driving theory, USMLE) that take place alongside the Part 1 exam. Computer stations are separated by dividers to help minimise visual distraction. Be prepared to focus so as not to be distracted by the movements of others. Some candidates may choose to travel further to utilise quieter test centres. Candidates should bring photographic identification on the day of the exam. This is checked at registration and again before entry into the examination room. Exam conditions are strict. Bags and all but essential items will be stored in the lockers provided at most centres. Unsurprisingly, no mobile devices are permitted in the examination room. Video surveillance of candidates is common. Depending on the location, it is recommended to bring lunch, as some centres do not have local facilities to purchase food. Paper and a pencil are provided for making notes.The computer-based questions include multimedia images such as radiographs and clinical photographs. Candidates are not permitted to read ahead but will be able to flag difficult or ambiguous questions for later review.

FRCS Orth Part 1 Exam Format

The FRCS Orth Part 1 exam consists of two papers as follows:

• Paper 1 (2 hours 15 minutes)
• Single best answer (SBA) – 120 questions
• Paper 2 (2 hours 15 minutes)
• Single best answer (SBA) – 120 questions
• Total: 4 hours 30 minutes – 240 questions

Candidates will have a 2-year period from their first attempt to pass the Part 1 exam, with a maximum of four attempts with no re-entry. Details are available on the JCIE website (www.jcie.org.uk). Candidates with proven dyslexia may be eligible for the Part 1 examination times to be extended and this should be highlighted in advance of the exam.There is no negative marking; therefore, all questions should be attempted. Sample questions can be viewed on the JCIE website. Experienced examiners perform a formal process of standard setting to decide the final pass mark for each paper. The SBA questions are subject to quality assurance procedures, including feedback from both examiners and candidates. Difficulty level, content, discrimination index and internal consistency are analysed. Ambiguous questions or those deemed insufficient to differentiate between candidates are removed through this process.The SBA questions consist of an introductory theme, a question stem and five possible responses (listed A–E), of which one is the most appropriate answer. SBA questions are exactly what the name suggests: candidates choose the best from five possible answers. It is important to note that this is not a ‘single correct answer’ but a ‘single best answer’. Moreover, all five possible answers could be considered correct, but candidates are asked which is best, or most appropriate, given the information provided. As questions are designed to test higher order thinking, this could mean that limited or irrelevant information is provided. Questions require a judgement based on interpretation of the available evidence. Questions that candidates later complain about, for example, ‘there was more than one correct answer’ or that a question was ‘too ambiguous’, can often prove the best performing questions. Although the standard is widely publicised to be set at the level of a day one consultant working in the generality of trauma and orthopaedics, candidates should appreciate that some questions will appear more niche and stretch them more than others.

FRCS Orth eligibility criteria

Applicant must hold a medical qualification recognised for registration by the General Medical Council of the United Kingdom or the Medical Council of Ireland. The applicant must have been qualified for at least six years. Applicants must provide evidence of having reached the standard of clinical competence defined in the Intercollegiate Surgical Curriculum either for the award of the Certificate of Completion of Training (CCT) by the General Medical Council Postgraduate Board or for the award of Certificate of Specialist Doctor (CSD) by the Irish Surgical Postgraduate Training Committee (ISPTC). The required standard may have been achieved through training or qualifications, and experience considered together. The passing of the Intercollegiate Specialty Examination alone does not imply that the CCT, CSD (Ireland) or placement on the Specialist Register will be automatic; the Examination will form only part of the evidence required. This evidence must consist of three structured references in the format prescribed by the Joint Committee on Intercollegiate Examinations (JCIE). These references must be completed by the appropriate senior colleagues with direct experience of the applicant’s current clinical practice in the appropriate specialty as defined in the Guidance Notes for Referees. Candidates will have up to a maximum of 7 years to complete the examination process with candidates having a two year period from their 1st attempt with a maximum of 4 attempts to pass Part 1 with no re-entry.

FRCS Orth Application

Much of the knowledge and judgement required for the FRCS (Tr & Orth) exam will have been acquired during training; however, the T&O syllabus is extensive, and the exam requires lots of preparation. Applications are made through the JCIE website where guidance notes, eligibility criteria and future dates for Parts 1 and 2 (termed Sections 1 and 2) can be reviewed. Candidates should plan their preferred date or ‘diet’ for Part 1 after considering their likely personal and professional circumstances and, for UK trainees with a National Training Number (NTN), the date of their ST6 ARCP. NTN trainees must achieve an Outcome 1 at their ST6 ARCP before they are eligible to apply. Those not in training are required to demonstrate a level of competence and knowledge equivalent to that achieved by NTN trainees at the end of ST6. Be sure to read the JCIE ‘Guidance Notes for Applicants’ document far in advance of making an application.

Step 1

• ST6 – ARCP Outcome 1 required
• Apply online at JCST website - https://www.jcie.org.uk/conten...
• Calendar of examination dates here - https://www.jcie.org.uk/calend...
• International Applicants Apply online: https://www.jscfe.co.uk/Conten...
• Calendar of dates: https://www.jscfe.co.uk/calend...

Step 2 Complete the Structured Reference form – you need to print 3 copies and get two consultants and your TPD to complete them. Scan the reference forms into your online application.

Step 3 Complete payment of £550 for Part 1 and select an exam date.

FRCS Orth Part 1 Dates

The FRCS Orth Part 1 exam is normally held three times per year, in February, June and November.

FRCS Orth Part 1 Test Locations

Part 1 exams are currently held at Pearson VUE Test Centres at multiple locations throughout the United Kingdom and Ireland. Candidates can choose their preferred centre during registration. These test centres often host unrelated tests (e.g. driving theory, USMLE) that take place alongside the Part 1 exam. Computer stations are separated by dividers to help minimise visual distraction. Be prepared to focus so as not to be distracted by the movements of others. Some candidates may choose to travel further to utilise quieter test centres. Candidates should bring photographic identification on the day of the exam. This is checked at registration and again before entry into the examination room. Exam conditions are strict. Bags and all but essential items will be stored in the lockers provided at most centres. Unsurprisingly, no mobile devices are permitted in the examination room. Video surveillance of candidates is common. Depending on the location, it is recommended to bring lunch, as some centres do not have local facilities to purchase food. Paper and a pencil are provided for making notes.

FRCS Orth Part 1 Results

The standard for the FRCS Part 1 exam is set using the ‘Angoff procedure’.When you complete the FRCS Orth Part 1 exam, your marks for both papers will be combined to give you a total mark for Part 1 of the assessment. Following the exam, you’ll receive a breakdown of your marks, but no further feedback is provided.The date on which you’ll be able to access your results will be specified on your JCIE exam documentation or provided when you complete the exam. Results will then be published on the JCIE website, through which you sat the exam, on the date given. Following this, you’ll also receive written confirmation of your results.

FRCS Orth Part 1 Questions

To gain an understanding of the knowledge and skills assessed as part of the FRCS Orth exam, you should familiarise yourself with the FRCS Orth syllabus. The ‘competence based’ curriculum identifies the applied and theoretical knowledge and practical skills, and professional behaviours, you’ll be required to demonstrate within the FRCS Part 1 exam.The syllabus is divided into three key areas subdivided by subspecialties which you’ll be assessed on during the FRCS exam:

• Basic Sciences
• Elective
• Trauma

Resources

FRCS Orth practice questions and mock exams will be the most valuable resources for preparing for the MRCS exam. Using a mixture of practice questions and mock exams will ensure that you’re familiar with the types of questions you’ll be asked, have the opportunity to develop your responses and grow accustomed to dealing with the time pressure and demands of a full MRCS exam.To help you to prepare for the MRCS Part A questions, the MRCS candidate guidance provides detailed information on the MRCS syllabus, including the objectives and knowledge relating to each of the modules above.We have also just released our beta version of the MRCS Part A Question Bank. Our artificial intelligence powered, adaptive question bank that will take your MRCS preparations to the next level, is coming soon. Using state of the art algorithms, questions are tailored to you and focus on your areas for development, to help you to progress faster and make more effective use of your MRCS preparation time.

FRCS books

Postgraduate Orthopaedics – The Candidate’s Guide (3rd edition) This comprehensive textbook helps to prepare candidates for the clinical and viva voce aspects of the Part 2 exam. It utilises concise prose, graphics, illustrations and case-based examples to consolidate knowledge gained during preparation for Part 1. Cases are designed to reflect those in the exam. Insights from recent candidates helps to demonstrate good and bad practice during the viva voce exam. Although this textbook is oriented towards Part 2, the core topic sections will provide a useful revision aid for the questions found in Part 1.

• Postgraduate Paediatric Orthopaedics Although oriented towards the Part 2 exam, this textbook is packed with diagnostic and surgical tips that will aid success in both parts. The dysplasias section offers a structured methodology when approaching any skeletal dysplasia, and the cerebral palsy section touches on gait analysis with clear graphs of the types that could be asked in both parts of the exam.
• Miller’s Review of Orthopaedics (7th edition) This comprehensive textbook presents the breadth of T&O surgical practice in one volume, including anatomy and the basic sciences. The book is aligned with the American Board of Orthopaedic Surgery exam but remains very popular for FRCS (Tr & Orth) revision, especially when preparing for Part 1. Recent editions are easier to read and include colour illustrations, clinical photographs and tables. Candidates may choose to focus on specific sections or chapters, read it in its entirety or use it as a reference alongside other resources.
• Basic Orthopaedic Sciences (2nd edition) This popular textbook for both parts of the exam aims to cover the basic sciences that underpin T&O surgical practice. Topics include biomechanics, biomaterials, immunology, pharmacology, imaging techniques and statistics. Some chapters read more clearly and accurately than others.

Tips For The FRCS Orth Part 1

The Part 1 exam seeks to test background knowledge and judgement that will have developed during daily clinical work, rather than abstract facts from a book. The exam, and the preceding revision period, will be stressful and exhausting. Candidates should ensure that they are physically and mentally prepared. Eating a well-balanced diet, keeping hydrated, minimising alcohol intake and taking regular breaks during revision are all advised. Engaging with regular physical activity will also help to improve concentration and well-being. It will prove helpful to allocate an evening or afternoon per week to spend with family and friends. Concentrate on sleep patterns in the weeks and months leading up to the exam. Remember that caffeine has a half-life of 4–6 hours, meaning that it will take up to 24 hours for it to be cleared. Additionally, maintain a clear distinction between revision and relaxation by avoiding bedroom-based revision. After completing a bank of questions, it is important to allocate sufficient time to review the answers, which can take far longer than expected. With this in mind, consider supplementing evening revision with early morning revision. Every candidate will have different home circumstances and revision preferences, so it is important to create a personal schedule that suits you. Identify areas of knowledge that are lacking and tackle these subjects head-on. Avoid wasting time by reading around answers to questions that were answered correctly and with relative certainty. There is insufficient time for this feel-good approach, given the breadth of the T&O curriculum. It is a valuable revision strategy to review correctly answered questions that were based on a lucky or best guess. Reviewing these questions will help consolidate your knowledge. Many candidates soon realise that practicing questions has to be prioritised over reading or making detailed notes. The following advice may be useful:

• Troublesome questions are made more difficult if candidates are underprepared. Understand the breadth of the T&O curriculum and practise the SBA question format to develop the required exam technique.
• Confront difficult areas of the curriculum early and avoid burying topics for the few weeks preceding the exam, as this consolidation stage is associated with its own stresses.
• One mark can make the difference between a pass and a fail. Practice questions at the correct knowledge level and under timed conditions. Some websites permit a time limit for each question. At the start of your revision, consider allocating 70–80 seconds per question and reduce this to 50–60 seconds as your knowledge and familiarity improve.
• Efficient time management during the exam is important. Go fast. Candidates have only one minute to read and interpret each question, consider the options and indicate an answer. Some questions will present cases with a long stem.
• Each question carries a 1 in 5 chance of being correct, so be sure to provide an answer for every question. There is no negative marking.  If an answer is not immediately clear, flag the question, mark a best guess and move on promptly with the foresight that returning later may not be possible. Flagging a question electronically will help expedite later review. Marking a best guess will avoid the common error of running out of time and throwing away marks.
• Read questions carefully and understand fully what the question stem is asking. All of the options presented may not be ideal, but one must be selected from the options available. Additionally, the answer to questions requesting the ‘most appropriate management’ may differ from those asking the ‘next most appropriate step in management’.
• Candidate feedback suggests that around 20% of questions are straightforward. These test standard textbook knowledge, with answers easily narrowed down to perhaps two options (level 1). The remaining questions are less obvious, with detailed or ambiguous stems and similar answers requiring a more considered judgement (levels 2 and 3).
• Do not assume that ambiguous questions will be removed during the final quality assurance process, as very few questions are actually removed.
• In recent exams there has been a greater emphasis on higher order anatomy questions. Consider reading an anatomy textbook and practice anatomy questions.