Royal College — General Surgery
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 |
|---|---|
| Surgical Foundations | 2 papers, ~125–150 MCQs each, 3 hours each. 70% pass. May be taken after a minimum of one year of training. All candidates must pass it to be eligible for the specialty examination |
| Written | Paper 1: ~100–110 MCQs, 3 hours. Paper 2: ~100–110 MCQs, 3 hours |
| Applied | Structured oral, 2 hours |
| Pass mark | 70% for each component |
Content Blueprint
Official blueprint — 15 domains. Gastrointestinal tract 25–35%, Hepatobiliary and pancreatic 10–25%, Breast 10–20%, Trauma 10–20%.
What we offer
Royal College General Surgery preparation mapped to the official 15-domain blueprint, plus Surgical Foundations preparation at the two-paper format.