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FCS(SA) Primary: The 2027 Exam Guide

By Certiva · Updated 1 October 2026 · ~10 min read

The FCS(SA) Primary is the first examination of the Fellowship of the College of Surgeons of South Africa, run by the Colleges of Medicine of South Africa (CMSA). It is two three-hour multiple-choice (MCQ) papers with no oral: Paper 1 tests anatomy, including embryology, and Paper 2 tests physiology, pathology and pharmacology/principles.

If you are a community service doctor, medical officer or between posts and you want a surgical registrar post in South Africa, this is the exam that turns your interest into a credential. It is a pure basic-science exam, so the doctors who do well are usually the ones who rebuild their anatomy and physiology deliberately rather than relying on what they remember from theatre. This guide covers the format, the blueprint, who can enter, the references worth using and a 12-week plan you can fit around clinical work.

FCS(SA) Primary key facts

Here is everything official about the exam on one table, taken from the CMSA's own pages.

What is the FCS(SA) Primary exam format?

The FCS(SA) Primary is two written MCQ papers of three hours each, with no oral examination.

• Paper 1: anatomy. 120 questions covering surgical anatomy, including embryology.
• Paper 2: physiology, pathology and pharmacology/principles. 120 questions, split roughly 40 per area.

Two things follow from this structure. First, anatomy carries a whole paper on its own, so half of your exam depends on one subject. Second, Paper 2 rewards breadth: you cannot afford a blind spot in pharmacology or pathology when each carries around a third of the paper. Because there is no oral, your entire result is decided by how accurately and quickly you answer MCQs under time pressure, which makes timed practice part of the preparation rather than an extra.

What does the FCS(SA) Primary cover?

The FCS(SA) Primary covers the basic sciences of surgery: anatomy and embryology in Paper 1, and physiology, pathology and pharmacology/principles in Paper 2.

The CMSA publishes an official FCS(SA) Primary blueprint, and it should be the first document you download. Read it before you open a textbook so that your reading is anchored to what is actually examined. The weighting by paper looks like this:

Certiva's FCS question bank breaks this material into eight sections so that you can work and track topics at a finer level:

These are Certiva's study sections, not official CMSA headings. Use the blueprint to decide what is examined and the sections to organise your practice.

How many questions are in the FCS(SA) Primary?

There are 240 questions in total: 120 in Paper 1 and 120 in Paper 2, with three hours for each paper.

That gives you an average of about a minute and a half per question. It sounds generous until you meet a run of long applied-physiology stems or an anatomy question that needs you to trace a nerve from root to muscle in your head. Practicing at exam pace, rather than at reading pace, is how you find out whether you have enough time to spare.

When is the FCS(SA) Primary written?

The CMSA sets the date of each sitting in its written examination timetable, so check there for the next exam and the closing date for entries.

Work backwards from that date. If you want a full 12-week plan (below), your start date is three months before the paper, and your entry needs to be in before the CMSA's closing date, which usually comes well before the exam itself.

Who can write the FCS(SA) Primary?

You need a post-internship qualification registered with the HPCSA or another medical council.

You do not need to hold a registrar post to enter. Many doctors write the FCS(SA) Primary as medical officers or between posts, and a pass on your CV shows a selection panel that you have already done the hardest basic-science work of surgical training. If you are unsure whether your registration category qualifies, check the regulations on the CMSA FCS(SA) page or contact the CMSA directly.

The exam is also shared across surgical disciplines: the FC Orth(SA) and FC Urol(SA) regulations refer candidates to the FCS(SA) Primary. If you are aiming for orthopaedics or urology, this guide applies to you too.

Applying for posts at the same time? Certiva's free CV builder helps you put together a clean, professional CV for registrar applications.

Which textbooks should I use for the FCS(SA) Primary?

Keep your reading list short and anchored to the blueprint. These are the references used in Certiva's FCS bank:

• Raftery, Basic Science for the MRCS: the reference for anatomy and embryology, physiology, pathology, microbiology and immunology, and haematology in the bank.
• Raftery, Applied Basic Science: the reference for pharmacology and for perioperative and critical care.
• Statistics at Square One: the reference for biostatistics, evidence-based medicine and diagnostic tests.
• CMSA ethical guidelines: the reference for ethics and law.

One well-annotated book that you return to is worth more than four that you skim. Read a topic, answer questions on it the same day, and go back to the page referenced for every question you get wrong.

Are there FCS(SA) Primary past papers?

No. The CMSA has not published past papers since 2021.

That leaves a gap for candidates who used to rely on recalled papers. The honest alternative is a question bank mapped to the official blueprint, with explanations that teach the concept behind each answer and a reference you can check, plus timed mock papers to rehearse the real thing.

How should I study for the FCS(SA) Primary?

Give anatomy the most time because it is a whole paper, cover every Paper 2 area without gaps, and finish with timed mocks.

The 12-week plan below is built on the CMSA weighting (half the exam is anatomy) and on Certiva's eight bank sections. It assumes roughly 10 to 12 hours a week alongside clinical work. Stretch it if your rotation is heavy, but keep the order.

Four habits that make the plan work

1. Question from day one. Reading feels productive but does not test recall. Interleave questions with every topic you read.
2. Read every explanation. Including the ones you got right. A good explanation teaches the neighbouring facts too: the radial nerve question also teaches you where the axillary nerve is at risk.
3. Track subtopics, not just your total. A healthy overall score can hide a weak area in acid-base or embryology. Revise where the marks are being lost.
4. Rehearse the clock. Sit full timed papers before the exam so that pacing is a habit, not a surprise.

How Certiva helps you prepare for the FCS(SA) Primary

Certiva gives you an 800-question FCS bank, organised into eight sections with explanations, references and timed mocks.

• 800 questions in eight sections, 100 per section, mapped to the CMSA syllabus.
• Explained and referenced answers: every question has a teaching explanation and the textbook reference behind it.
• Smart revision and a weakness tracker that flag the subtopics where you are losing marks, so your next session goes where it matters.
• Two timed mocks of 100 questions in 3 hours each, to rehearse pacing (a Certiva practice format, not the official paper length).
• A free 5-question sample with no account and no card.
• Refund or more time: on a once-off Exam Pass, if you complete the question bank and both timed mocks before your sitting and do not pass, you can choose a full refund or another access period of the same length. Conditions apply; read the exam refund conditions.

See the FCS(SA) Primary question bank for the full topic list, compare options on the pricing page, and pick up free accredited ethics CPD on Certiva's CPD courses while you study.

Frequently asked questions

More CMSA exam guides

• FCPsych Primaries guide
• FCP(SA) Part 1 guide
• FCPaed(SA) Part 1 guide
• FCOG(SA) Part 1 guide
• Dip PEC(SA) guide

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