About the exam
The General Surgery Fellowship Examination (FEX) is run by the Royal Australasian College of Surgeons (RACS). It assesses candidates at the standard expected of a general surgeon in their first year of independent specialist practice.
The exam has seven components: two written exams and five clinical/viva exams. Content is based on the General Surgery curriculum and tests surgical knowledge, clinical reasoning, operative decision-making and applied anatomy.
Exam format and marking
| Exam | Format | Time | Marking | Pass level (ECMS grade 3) |
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| Written 1 – Spot questions | 25 questions, usually image-based | 130 min | Each question marked pass/fail by 2 examiners | 18 or more of 25 questions passed |
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| Written 2 – Short answer questions | 8 structured questions | 130 min | Each question marked pass/fail by 2 examiners | 6 or more of 8 questions passed |
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| Viva – Operative surgery | 1 extended scenario (10 min) and 5 mini-scenarios | 30 min | 3 marking points for the extended scenario (knowledge, application, global assessment) and 1 per mini-scenario: 8 per examiner, 16 in total | 12–14 of 16 marking points graded 3 or more |
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| Viva – Pathophysiology, critical care and clinical reasoning | 2 extended scenarios (10 min each) and 4 mini-scenarios (5 min each) | 40 min | 3 marking points per extended scenario (knowledge, application, global assessment) and 1 per mini-scenario: 10 per examiner, 20 in total | 15 or more of 20 marking points graded 3 or more |
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| Viva – Clinical imaging and applied anatomy | 8 image sets: 4 single images and 4 multislice radiological image sets | 32 min | 1 marking point per image set per examiner: 16 in total | 12–14 of 16 marking points graded 3 or more |
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| Viva – Clinical 1 (medium cases) | 2 clinical cases (15 min each) | 30 min | 4 marking points per case per examiner (clinical presentation, knowledge, application, global assessment): 16 in total | ECMS grade 3: adequate performance across the key domains |
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| Viva – Clinical 2 (short cases) | 5 clinical cases (8 min each) | 40 min | 2 marking points per case per examiner (clinical presentation, global assessment): 20 in total | ECMS grade 3: adequate performance across the key domains |
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The written exams are usually held about four weeks before the clinical/viva exams. The five viva segments take place over two consecutive days.
Clinical cases are presented electronically using photographs, videos, investigation results and clinical information. Live patients aren't used.
How the exam is marked
The exam uses the Expanded Close Marking System (ECMS). Two examiners assess each candidate independently, and each segment receives a final consensus grade.
| Grade | Standard |
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| 4 – Excellent | Complete and expert knowledge |
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| 3 – Pass | Appropriate and adequate knowledge, addressing the key issues |
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| 2 – Borderline | Errors or omissions in several areas |
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| 1 – Fail | Significant errors or omissions |
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In the written exams, each question is marked pass or fail, and the number of questions passed sets the segment grade.
In the vivas, each marking point is graded from 1 to 4. A grade of 3 or 4 is at or above the passing standard.
Overall result
Each of the seven segments receives an ECMS grade from 1 to 4. These are added to give an overall score out of 28, with each segment counting equally.
| Total ECMS score | Outcome |
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| 21 or more out of 28 | Pass |
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| 19–20 out of 28 | Detailed review by the General Surgery Specialty Court |
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| 18 or less out of 28 | Fail |
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A total of 21 is the same as a passing grade of 3 in all seven segments. Overall performance, including the number of failed segments, is considered when deciding the final result.
Candidates with borderline overall scores are considered further by the General Surgery Specialty Court. Its recommendations go to the full Court of Examiners, which ratifies the final results.
Moving from the written exams to the vivas
The written exams must be completed before the clinical/viva exams.
- Candidates who fail both written papers don't progress to the clinical/viva exams at that sitting.
- Candidates who pass both written papers but then fail the overall exam get a one-time exemption from the written papers at the next scheduled sitting.
- Candidates who fail one written paper and then fail the overall exam must repeat both the written and clinical/viva components at their next attempt.
Official exam information
Check these for current exam dates, applications, eligibility and regulations. To be eligible, candidates also submit Patient History and Clinical Examination assessments with a letter of support.
This is a general guide. The detailed viva marking allocations and thresholds come from past examiner presentations. The exam format, marking and regulations may change between sittings, so always check the current GSA and RACS guidance.