Evolution of the final fellowship examination

The Royal Australasian College of Surgeons Final Fellowship or exit examination, common to nine surgical specialties, has undergone substantial change since the beginning of formal assessment in 1934. These changes reflect the altered requirements of the different specialties and developments in examination techniques and technology. Although there is now some variation between specialties in the format of each segment of the examination, consistency remains with seven segments of the examination being common to all specialties--two written papers, two clinical segments and three vivas. Approval for Fellowship, indicating success in the examination, is the responsibility of the full Court of Examiners although guided by each Specialty Court. During the past decade the examination has become more structured and objective and all candidates experience similar assessment. Considerable work has been undertaken to ensure that the examination process is appropriate and fair. A review of examination outcomes 2001-2007 shows some variation between specialties. Although the basis for this is multifactorial, some differences between Specialty Courts of Examiners in the structure of the examination and the assessment process may be small contributory factors. With an increased emphasis on competence-based assessment during training the form of this exit examination will continue to evolve.