Two papers, 205 questions, 804 marks. Where those marks actually sit, and what each question type is worth.
Two papers, 150 minutes each, on consecutive days. Anatomy on day one, pathology and physiology on day two. No reading time, so the clock starts on the first question. No negative marking, so a wrong answer costs you exactly what a blank one does.1
The two papers
Day one: anatomy
Worth approximately 50 per cent of the total mark.1
- 60 multiple choice questions in Type X format, each worth up to 4 marks
- 20 anatomy spot test questions, each worth 8 marks
Day two: pathology and physiology
Also worth approximately 50 per cent, split roughly evenly between the two subjects.1
- Pathology: 65 MCQs, being 20 Type A/B at 1 mark each and 45 Type X at up to 4 marks
- Physiology: 60 MCQs, being 12 Type A/B at 1 mark each and 48 Type X at up to 4 marks
The mark budget
RACS publishes the question counts in one place and the mark values in another, and never multiplies them together.1 We did. The result changes where your time should go.
| Component | Questions | Marks | Share |
|---|---|---|---|
| Anatomy MCQs | 60 × up to 4 | 240 | |
| Anatomy spot test | 20 × 8 | 160 | |
| Anatomy total | 80 | 400 | 49.8% |
| Pathology | (20 × 1) + (45 × 4) | 200 | 24.9% |
| Physiology | (12 × 1) + (48 × 4) | 204 | 25.4% |
| Total | 205 | 804 | 100% |
Which lands on the weighting RACS states independently: approximately 50 per cent anatomy, 25 per cent pathology, 25 per cent physiology.3 Three things follow.
- The spot test is a fifth of the exam. Twenty questions carry 160 marks, or 19.9 per cent of the paper. Under a tenth of the questions, a fifth of the marks.
- Type X carries almost everything else. 153 of the 205 questions are Type X. The 32 Type A/B questions are worth 32 marks between them, under 4 per cent of the total.
- One spot test question is worth eight Type A/B questions. Spend equal time on both and you are working at one eighth efficiency on the wrong one.
The three question types
Three formats, and they fail you in three different ways. Any of them can hang off a photograph of a specimen, a photomicrograph, a radiograph, a histology slide or a CT.5
The worked examples below are ours, written to show the shape of each format. RACS publishes its own examples of all three.5
Type A: single best answer
A stem and five options. Pick the most appropriate. More than one may be correct; one is better than the rest. One mark.5
- the viscosity of the blood
- the length of the vessel
- the radius of the vessel
- the mean arterial pressure
- the haematocrit
Answer: C. Resistance is inversely proportional to the fourth power of the radius, so radius dominates. Viscosity and length sit in the same relationship but move very little physiologically. Mean arterial pressure is the driving pressure, not a determinant of resistance. Haematocrit acts only through viscosity.
Notice that four of those five options are true statements about blood flow. Type A asks you to rank, not to sort true from false.
Type B: statement and reason
A statement (S) and a reason (R). Work out whether each is true; if both are, work out whether R actually explains S. One mark.5
| Key | Condition |
|---|---|
| A | S true, R true, and R is a valid explanation of S |
| B | S true, R true, but R is not a valid explanation of S |
| C | S true, R false |
| D | S false, R true |
| E | S false and R false |
because
R — The parathyroid glands are supplied predominantly by the inferior thyroid artery.Answer: A. Both true, and the blood supply is the reason the glands are at risk.
because
R — The appendix has a mesentery, the mesoappendix.Answer: D. S is false: the appendix is intraperitoneal, suspended by the mesoappendix. R is true.
The trap is answering A on reflex the moment both statements look true. B exists precisely for two true statements that have nothing to do with each other. Before committing to A, say the word because out loud between them and check it holds.
Type X: four independent judgements
A stem and four options, each marked true or false on its own. Up to four marks per question.5
- is a continuation of the sigmoid sinus
- lies within the carotid sheath
- lies medial to the common carotid artery in the neck
- joins the subclavian vein to form the brachiocephalic vein
Answer: A true, B true, C false, D true. The vein lies lateral to the common carotid artery. Four marks are available, one for each correct judgement.
Because the four options are marked separately, knowing two of them still scores two marks. And with no negative marking, a blank is a guaranteed zero while a guess is not. There are 153 Type X questions on the paper, each carrying four judgements, so 612 independent chances to score. Leaving the uncertain ones blank hands marks back that nobody asked you for.
Spot test questions
An illustration, and short text answers of no more than ten words. Eight marks per question, divided between its parts.5 They appear only in the anatomy paper, where 20 of them carry 160 marks.
- Name the structure labelled A.
- Name two structures passing through the hiatus labelled B.
- State the vertebral level of the structure labelled C.
- Name the nerve at risk during mobilisation of the structure labelled D.
The eight marks are split across the parts. RACS does not publish a fixed split, so the allocation shown is illustrative.
Spot questions reward precise naming, not description. Ten words leaves no room to hedge, and naming two structures where one was asked for can cost the mark.
Distribution of the anatomy MCQs
RACS publishes where the 60 anatomy MCQs sit.1
| Region | MCQs | Region | MCQs |
|---|---|---|---|
| Head and neck | 10 | Pelvis | 7 |
| Abdomen | 9 | CNS | 3 |
| Lower limb | 9 | Development | 2 |
| Upper limb | 9 | Histology | 2 |
| Thorax | 9 |
Five regions carry 46 of the 60. Development and histology carry two each, and are the classic place to lose a weekend for four marks.
How the pass mark is set
Two requirements, and you need both. A minimum score in each component of anatomy, pathology and physiology, and a minimum overall score built from the three.3 A high score in one does not rescue a low score in another.
The threshold moves. RACS reviews and adjusts the minimum scores after each sitting to account for differences in difficulty and to hold the standard steady.3 No fixed pass mark is published, and any figure presented as one is somebody’s estimate.
Every question is analysed statistically afterwards, and outliers go back to the committee.2
The Minimum Standard Pass
There is one narrow ledge below the line. Clear all three component minimums, miss the overall minimum by less than one error width, and you have not passed, but you are eligible for a Minimum Standard Pass. It converts to an actual pass only if you sit again and land in the same place a second time.3
Read that twice. It is a pass you have to earn twice to keep.
Three things to take into the room
- Answer every option. A blank scores zero and a guess might not.
- Budget by marks, not by question count. A spot question is worth twice an anatomy MCQ.
- Do not lean on your best subject. The component minimums mean your weakest one decides it.
RACS also publishes a reading list naming the texts it draws examinable material from.
References
- Royal Australasian College of Surgeons. Exam structure. Available at: https://www.surgeons.org/Examinations/generic-surgical-sciences-examination-gsse/gsse-preparation/exam-structure
- Royal Australasian College of Surgeons. The scoring process. Available at: https://www.surgeons.org/en/Examinations/generic-surgical-sciences-examination-gsse/gsse-results-information/the-scoring-process
- Royal Australasian College of Surgeons. Passing the GSSE. Available at: https://www.surgeons.org/en/Examinations/generic-surgical-sciences-examination-gsse/gsse-preparation/passing-the-gsse
- Royal Australasian College of Surgeons. Exam topics. Available at: https://www.surgeons.org/Examinations/generic-surgical-sciences-examination-gsse/gsse-preparation/exam-topics
- Royal Australasian College of Surgeons. Types of questions. Available at: https://www.surgeons.org/Examinations/generic-surgical-sciences-examination-gsse/gsse-preparation/types-of-questions
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