How Our Questions Are Written and Reviewed

Our standard for a question

We write to the structure of the JCIE’s published Trauma & Orthopaedic Surgery sample questions. In practice that means:

• A lean clinical vignette. Every clause in the stem either sets the scene or changes the answer. Basic science is asked through a patient, an implant or a decision, not as a bare fact.
• Five same-category options. Five implants, five nerves, five investigations, five next steps, so the answer cannot be found by eliminating options of the wrong type.
• One defensible best answer. Several options may be plausible; exactly one is best for this patient under current UK practice, and the explanation says why the others are not.
• A clear lead-in. Which is the most likely diagnosis, which structure is at risk, which is the most appropriate next step.
• Syllabus mapping. Every question is mapped to a topic and subtopic of our map of the JCIE syllabus blueprint, so you can see coverage and performance by domain on the syllabus.

Difficulty is calibrated to the standard the examination is set at: a day-one consultant in the generality of trauma and orthopaedics. A question is hard because its best options are close — separated by a threshold, a classification or a detail in the stem — not because the stem is obscure.

Questions are text-only for now. Where the real paper might show a radiograph or a clinical photograph, our stems describe the finding in words. We will not use images we do not hold the rights to.

Explanations

Each explanation says what the question is testing, justifies the best answer, explains why each distractor is wrong or less good for this patient, and ends with a reference. Where the question turns on a number — a timing in a standard, an angle, a threshold in a guideline — the explanation gives it and says where it comes from.

How the bank is proportioned

The JCIE publishes a syllabus blueprint for Trauma & Orthopaedic Surgery but no question weightings. The bank is therefore mapped to the blueprint, not weighted to it. The number of questions we hold on each domain is an editorial judgement of how broad that domain is, and we do not present it as the proportion of the real paper.

Where the facts come from

Explanations are referenced to current UK guidance and standard texts, including:

• The British Orthopaedic Association’s Standards (BOASTs)
• NICE guidelines, including those on fractures, hip fracture, joint replacement, the diabetic foot and low back pain
• Miller’s Review of Orthopaedics
• Basic Orthopaedic Sciences (Ramachandran) for applied basic science
• Rockwood and Green’s Fractures in Adults for trauma
• Campbell’s Operative Orthopaedics
• Tachdjian’s Pediatric Orthopaedics for paediatrics and Green’s Operative Hand Surgery for the hand
• Primary papers, where a classification or a principle rests on one

We write to the current version of UK guidance, because the examination is set to present-day UK practice. Where a textbook and current UK guidance differ, the guidance is the answer; where two standard texts differ, the explanation says so and names the one we follow.

Review and sign-off

Questions are drafted and typeset to our house style, then checked by the editorial team against the reference each explanation cites: the best answer, the discriminator and any figures quoted must match current UK guidance or the named text.

The free sample on free questions is drawn from the same bank and held to the same standard, so it is representative of what you get when you subscribe.

How we use AI

We use AI tools openly, for two jobs: drafting questions and explanations to a written house style, and keeping a bank of this size consistent in format, terminology and referencing across ten domains. AI is never the final word. It does not decide what is correct; the cited reference and the human checker do.

AI drafts can contain errors, as can human ones. That is why every item is checked against its reference, why the review status above is published rather than assumed, and why the correction process below exists.

Reporting an error

If you think a question is wrong, out of date or ambiguous, flag it in the app so you can find it again and tell us through the contact form, with enough detail to identify the question and your reasoning, ideally with a reference. Every report is triaged. Where an error is confirmed, the question is corrected or retired and the change is logged.

Spelling and typography

Questions and explanations use UK English spelling and UK drug names. Ranges take an en-dash (2–3 weeks), dimensions take a multiplication sign (3 × 2 cm), and units are written the way UK results are reported. None of this changes an answer, but consistency means you are never slowed by the page.

What we will not claim

• No guaranteed pass. No question bank can guarantee a result, and we will not suggest otherwise.
• No pass-mark percentages. We do not quote a pass mark for Section 1.
• No official weightings. The JCIE publishes none, so we do not say the bank is weighted to the examination.
• No invented exam frequencies. We do not say that a topic ‘comes up every year’.
• No recalled or official questions. Our questions are original. We are independent of the JCIE and the Royal Colleges.
• No review we have not had. Specialist review is pending; we do not claim consultant or named-reviewer sign-off that has not taken place.
• No fake reviews. We do not publish invented testimonials, ratings or pass rates.