General surgery guides · Examiner reports

Why candidates lose marks in the RACS exams

RACS examiner reports repeat themselves from sitting to sitting. Most marks are not lost on rare facts; they are lost on how answers are written and on the same core gaps. These are the themes that come up most.

  1. Describing what you would look for instead of stating what you found, including the key negatives (e.g. "I would examine the hernial orifices" rather than "the femoral and inguinal orifices are clear").
  2. Answering a neighbouring question: giving the workup when asked for immediate management, or the operation when asked for the indications.
  3. Deferring the decision ("I would discuss with my consultant", "I would refer") when the examiner wants what you, as the consultant, would do.
  4. Guessing or steering towards topics you know poorly, and not correcting an error once you realise it.
  5. Written papers: unstructured lists, not reading the question, and overspending time on one question when extra detail earns no extra marks.
  6. Dwelling too long on a single short case or spot and running out of time for the rest.
  7. Operative vivas without a decision point: no named bail-out (e.g. subtotal cholecystectomy, Hartmann's) and no plan for when things go wrong.

What this looks like when it is marked

A Paper 2 question, an answer of the kind examiners see every sitting, and how a point-by-point marking guide scores it.

Question · 5 marks

A 68-year-old man is day 5 after a laparoscopic anterior resection. He has new lower abdominal pain, a heart rate of 118 and a C-reactive protein of 290 mg/L. Outline your immediate management.

Answer

I would resuscitate him with fluids, take bloods and cultures, and discuss him with my consultant. I would arrange for the radiology team to review him and decide on imaging, and consider involving ICU…

✗States anastomotic leak as the working diagnosis until proven otherwise0/1
✓Resuscitation: large-bore access, fluids, bloods including lactate, cultures, catheter and fluid balance1/1
✗Starts broad-spectrum intravenous antibiotics now (e.g. piperacillin–tazobactam), not after imaging0/1
✗Orders CT abdomen and pelvis with intravenous and rectal contrast, and states the decision: contained collection → percutaneous drainage; peritonitis or ongoing sepsis → return to theatre0/2

The answer describes a process and hands every decision to someone else. The paper is set at the level of a consultant: name the diagnosis, start the antibiotics, order the scan yourself and say what result takes him back to theatre.

How to practise against these

Reading a list of mistakes changes little. What changes the score is writing or speaking answers under exam conditions and being marked against specific points, so you can see exactly which one you missed. Do that for every area, weakest first, and repeat the ones you got wrong until they stick.

Know the references examiners expect: RACS surgical competencies and the General Surgery SET curriculum (GSA and NZAGS); EMST (ATLS equivalent), CCrISP, ASSET, CLEAR and DSTC courses; ANZASM (Australian and New Zealand Audit of Surgical Mortality); Therapeutic Guidelines: Antibiotic (surgical prophylaxis, intra-abdominal infection); Australian Commission on Safety and Quality in Health Care: Australian Open Disclosure Framework; National Blood Authority Patient Blood Management Guidelines (critical bleeding and massive transfusion); Cancer Council Australia and eviQ guidelines; BreastScreen Australia; ASERNIP-S reviews, RACS position papers, ANZ Journal of Surgery.

Where do you stand?

Thirty questions across every area, scored by area with a plain verdict. Free.

Am I ready? Free check →Read a marked sample

Next: The RACS exams explained: format, timing and how they are passed →

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