Format of the Exam

Format of the Exam

By Kat Whitehouse, Mike Canty and Paddy Grover

Section 1

Taken in a Pearson VUE Test Centre wherever you choose. It is done on the same day as some other surgical specialties. Note that there will be people in there doing their driving tests etc. 

Paper 1 is Single Best Answer and takes 2 hours. Paper 2 is Extended Matching Items and takes 2 hours 30 minutes. They are both taken on the same day. You go to the test centre, they check you don’t have any notes etc on you, you put your belongings in a locker and then do the exam. In between the two there is a break where you can go and get some food. Note that you can’t revise or read through textbooks in the examination centre.

They tell you that it takes 2 weeks for results to come out, but, possibly because we are a relatively small specialty, it took under a week for my cohort.

Within the exam, there are some questions that will be removed at the standard-setting. All questions are analysed and anything unexpected is discussed, and if incorrect or irrelevant, questions may be removed. Therefore, when you sit the exam, if there is a question that you find difficult, or don’t understand – answer it to the best of your ability, and move on to the next one. I certainly came out of the exam thinking I had failed, but hadn’t, so don’t be disheartened straightaway.

Section 2

This is held over 2 days, somewhere within the UK. This is the clinical exam. In my case, the clinical examinations were the first day, and oral examinations on the second day. What time you have your exam is alphabetical by surname.

The marking scale is 4-8, with a 6 being a “pass”, over 84 marking events. Each section is double-marked. If you do badly in one section, you can make up the marks in the next section (there is no requirement for an aggregate pass).

The long case

This is 30 minutes long. It is somewhat like what you would expect from seeing a patient in clinic with no notes. You take a history, examine the patient, and summarise your findings. You then discuss differential diagnoses, what investigations you would request, and interpret whatever scans etc they give you (in our case, eg laminated A4 sheets with one axial cut CT). Then you discuss management options and perhaps how you would do any appropriate operation. Of course, there are marks for communication and professionalism.

The short cases

This section is 30 minutes to see 4 patients (therefore, allowing 1 minute to move from room to room, approx. 6 mins each case). These are really quick-fire, and are intended to make you target your thinking. You do not get the chance to do proper introductions etc, and the examiner will say something like “This patient has difficulty with speech, please examine this function” – you have to be fast, smooth and specific. They’ll ask for the likely diagnosis (maybe say one or two, don’t go on and on) and then ask you some pretty quick questions to test your higher thinking. The short cases are so quick-fire you come out feeling dizzy from all the spinning around between different rooms.

Day 2

There are 3 stations:

  • Operative/surgical anatomy
  • Investigation of neurosurgical patient including neuroradiology
  • Non-operative practice/applied basic sciences

So, on this second day you go to a hotel and the examiners are sat, two-to-a-table, and you circulate between them, so that you go to three of the “stations” and have 30 mins on each of the above areas. Each station has, I think 6 different topics/cases to be discussed.

Other general things

For the second exam, again, results are said to take about 2 weeks, but ours were back quicker.

The Norman Dott medal is an annual award to the most outstanding candidate at the first sitting of section 2.

For those who are unsuccessful in the exam, they receive a final performance report, so they can see where their weaknesses lie.

There is an appeal process that applies to the conduct of the examination. The appeal fee is £1250.

Full examination information with rules, regulations, and example questions is available at: