FRCS (Tr & Orth) Section 1 Exam Guide

What is FRCS (Tr & Orth) Section 1?

The Intercollegiate Specialty Examination in Trauma & Orthopaedic Surgery leads to the FRCS (Tr & Orth), the specialty fellowship examination for trauma and orthopaedic surgeons in the UK and Ireland. It is run by the JCIE on behalf of the four surgical Royal Colleges and is taken in two sections: Section 1 is written, Section 2 is clinical and oral.

The naming causes confusion. The JCIE calls the written component Section 1. Candidates usually call it Part 1, and sometimes Part A. All of these describe the same two written papers.

Format

Section 1 is two single best answer (SBA) papers, Paper 1 and Paper 2, sat on the same day. Each paper has 120 questions and lasts 2 hours 15 minutes, which is a little over a minute per question. Both papers are computer-based and delivered at Pearson VUE test centres. This has been the JCIE format for all Section 1 examinations since 1 January 2021, when extended matching items were dropped.

Each question has five options and one best answer, and there is no negative marking, so no question should be left blank. The four options that are not best are usually plausible, and often right for a different patient, so the paper tests discrimination rather than recall.

The standard

The examination is set at the standard of a day-one consultant in the generality of trauma and orthopaedics. That phrase explains two things about the paper. It is broad: a hand surgeon is expected to answer questions on paediatric hips and spinal emergencies. And it is practical: questions ask what a competent general orthopaedic consultant would recognise, do next or refer, rather than for subspecialty detail.

Section 1 and Section 2

Section 1 tests knowledge and judgement on a screen. Section 2 tests the same judgement face to face, in clinical and oral examinations. Under the JCIE’s regulations a candidate must be successful in Section 1 before proceeding to Section 2.

The overlap is deliberate. The classifications, approaches, biomechanics and guidelines you learn for Section 1 are what you will be asked to apply aloud in Section 2, so thorough Section 1 revision is not wasted.

Eligibility, attempts, dates and fees

We do not quote these. Eligibility criteria, the number of attempts allowed and the period in which they must be taken, the dates of each sitting, application windows and fees are all set by the JCIE and are revised from time to time. Read the current regulations and the examination calendar on jcie.org.uk before you plan around a sitting, and arrange your references early.

What the paper tests

The scope of the examination is the trauma and orthopaedic curriculum. The JCIE’s Trauma & Orthopaedic Surgery Syllabus Blueprint 2023 lists the topics that may be assessed. Our question bank is mapped to that blueprint in ten domains:

• Applied basic science: tissues, bone metabolism, biomechanics and biomaterials, anatomy and approaches, infection, statistics and ethics
• Musculoskeletal oncology: staging and biopsy, benign and malignant bone tumours, soft-tissue tumours, metastatic disease
• Trauma: polytrauma, open fractures, compartment syndrome, fixation principles and regional injuries
• Hip: arthroplasty and its complications, the young adult hip
• Knee: arthroplasty and osteotomy, ligament, meniscal and patellofemoral problems
• Foot and ankle: forefoot, the diabetic foot, ankle and hindfoot
• Spine: degenerative disease, emergencies, deformity and the inflammatory spine
• Shoulder and elbow: cuff, instability, arthroplasty and the elbow
• Hand and wrist: nerve, arthritis, Dupuytren’s disease, the carpus and the brachial plexus
• Paediatric orthopaedics: the hip, the foot and lower limb, neuromuscular conditions, trauma and infection

The blueprint gives no number of questions per area, so be wary of anyone who quotes exact weightings. The grouping into ten domains and the number of questions our bank holds on each are our editorial judgement, not an official weighting. Breadth is the safe assumption.

How the questions are written

The JCIE publishes sample questions with reasoning, and they show the style. Stems are lean clinical vignettes. The lead-in usually asks for the most likely diagnosis or the most appropriate next step. The options come from the same category — five implants, five nerves, five investigations — so you cannot eliminate by type. Some of the JCIE’s sample questions include an exhibit such as a radiograph, a clinical photograph or a graph.

How to choose a question bank

Every bank describes itself as comprehensive. These are things you can check in ten minutes, before you pay:

Our own answers are set out on the editorial standards page, including the fact that specialist review of our content is still pending.

How to use the bank

Start with questions, not textbooks: a timed block shows where you are weak, and reading then fills those specific gaps.

• Follow a structure: the 14-week revision plan maps weeks to the ten domains and can be compressed or stretched.
• Sample the style: free questions with full explanations, no account needed.
• Know the scope: the syllabus lists every topic and subtopic our questions are mapped to.
• Rate your confidence on every answer, and review the confident wrong answers first: they are the misconceptions you would otherwise carry into the exam.
• Fill gaps with short reads: the learning library covers recurring principles such as the open fracture standard and fracture healing.
• Rehearse the day: sit at least one full two-paper mock exam under exam timing before the real thing.