Royal College — Gastroenterology
Route Overview
Internationally trained specialists enter through the Practice Eligibility Route (PER). It is a two-step process and the distinction matters for budgeting: you apply and pay for an assessment first, receive a ruling letter confirming eligibility, and then register and pay for the examination separately.
The examination is decoupled. A candidate who passes the Written but fails the Applied does not retake the Written.
Eligibility
| Requirement | Detail |
|---|---|
| Supervised practice | A minimum of two years in a continuous practice location in Canada, at least 50% in the primary discipline, attested by a Royal College Fellow |
| Documents | A letter of attestation of competence from your Programme Director or supervisor addressing the CanMEDS roles · a certificate confirming completion of specialty training · an attestation of the training period on institutional letterhead |
| Eligibility letter validity | 5 years |
| Attempts | Maximum 4 per component |
| Deadlines | Spring 30 April; Fall 31 August, of the year before. Applications accepted year-round. The deadline to register for the exam is separate from the PER application deadline |
| Minimum training | Internal Medicine 4 years · Pediatrics 4 years · General Surgery 5 years · Obstetrics & Gynaecology 5 years including 1 year basic clinical training |
Exam Centres and Sessions
Applied examinations are held in Ottawa and Toronto only. From 2027 they consolidate to a single centralised assessment centre in Ottawa. Written examinations remain computer-based at regional centres.
Registration closes 4 November for the spring session and 15 April for the fall session.
Fees
| Item | Fee (CAD) |
|---|---|
| Practice Eligibility Route assessment | $4,965 — effective 1 Jan to 31 Dec 2026 |
| Written examination | $2,565 |
| Applied examination | $2,565 |
| Combined comprehensive objective examination | $5,130 |
| Surgical Foundations examination | $965 |
| Surgical Foundations assessment of training | $0 — no fee charged since the 2023 exam year |
| Late assessment application, under 60 days after deadline | $810 |
| Late assessment application, over 60 days | $1,655 — paying it does not guarantee assessment in time |
| Formal review | $1,390 |
| Royal College Practice Ready Assessment for specialists | $1,195 — a different programme from the provincial family medicine PRA |
Payment is online by credit card in Canadian dollars. Assessment fees are non-refundable except as set out in policy. Tax receipts are issued for the year the exam is written and emailed the following February.
There is no single certification exam fee. It is the Written at $2,565 plus the Applied at $2,565.
Exam Specification
| Component | Details |
|---|---|
| Eligibility | Royal College certification in Internal Medicine (adult stream) or Pediatrics (pediatric stream) is required before the Gastroenterology examination |
| Written | Paper 1: ~45–50 Short Answer Questions (SAQ), 3 hours. Paper 2: ~45–50 Short Answer Questions (SAQ), 3 hours. Adult stream; the pediatric stream sets ~35–40 per paper |
| Applied | Structured oral, 2 hours. Station count is not published; stations are equally weighted |
| Pass mark | 70% for each component |
Content Blueprint
Official blueprint — 12 domains for the adult written examination, as ranges of marks. Hepatology and Transplantation 20–30%, Stomach 10–20%, Nutrition 10–15%, Liver Transplantation 0–10%; Pancreas, Bile Ducts, Colon (non-IBD), Endoscopy, Pharmacology, Small Bowel, Esophagus and IBD 0–10% each.
Hepatology and Liver Transplantation
Two Royal College Areas of Focused Competence (AFC) build on Gastroenterology: Adult Hepatology, and Solid Organ Transplantation, which covers liver transplantation. AFC diplomas are portfolio-based — there is no examination. The Royal College has no credential named Transplant Hepatology.
What we offer
Royal College Gastroenterology preparation mapped to the official adult written blueprint, with short-answer written practice and structured oral case scenarios.