FCP(SA) Part 2: The Complete Guide

FCP(SA) Part 2 is the exit examination for internal medicine in South Africa, set by the College of Physicians of the Colleges of Medicine of South Africa (CMSA). Where Part 1 tests the basic sciences, Part 2 tests whether you can think and act like a specialist general physician across every system, from the written papers through to the bedside and the structured oral. This guide focuses on the written component, which is the gateway to the rest of the examination, and explains how it is built, who can sit it, and how to prepare so that you reach the clinical stage with confidence.

What is the FCP(SA) Part 2?

Part 2 assesses the principles and practice of internal medicine, including applied basic science, diagnosis and treatment. It is a staged examination: you sit the written papers first, and only candidates who pass the written component are invited to the clinical cases and then the structured oral examination. Passing the whole of Part 2, together with completed training in a recognised registrar post, is what leads to the award of the Fellowship and to registration as a specialist physician with the HPCSA.

FCP(SA) Part 2 format and structure

The written component has two elements, and both are delivered digitally. The current College of Physicians regulations describe them as follows:

• Single correct answer (SCA) papers: 150 questions in total, sat as two papers of 75 questions each, in a "best of four" format.
• An Objective Test (OT): 30 constructed-response questions worth 6 marks each, built around short clinical vignettes, photographs, radiographs, ECGs, laboratory data and other problem-solving material.
• Pass marks are standard set using the Cohen method. There is no negative marking on the SCA papers, but a correction for guessing formula is applied, so the College encourages candidates to answer every item.
• To be invited to the clinical examination you need an overall pass across the SCA and OT papers combined, and you must also meet the subminimum for each.
• After the written stage come the Assessment of Clinical Competence (three short cases) and a Structured Oral Examination built on six structured clinical cases.
• The final mark is weighted 20% SCA papers, 20% Objective Test, 20% clinical cases and 40% structured oral.

If you pass the written component but not the clinical and oral stages, you are exempt from the written papers at the next sitting only. The regulations give the timing of each paper, so confirm the current durations and logistics on the CMSA website when you apply.

Who can sit FCP(SA) Part 2?

Entry to Part 2 is considerably stricter than Part 1. The regulations require a post-community service qualification to practise medicine that is registered or registrable with the HPCSA, and 30 months of full-time post-internship training as a medical registrar or clinical assistant in an approved combination of teaching hospital and satellite posts. You must have passed Part 1, or be exempt from it (candidates who have completed both parts of the MRCP(UK) are exempt). Your supervisor must approve your portfolio, and every application needs a current letter from your Head of Department confirming eligibility. Training is valid for four years from completion, and Part 2 must be passed within that window, so plan your attempts carefully. Confirm the current criteria with the CMSA before you register.

FCP(SA) Part 2 syllabus: where to focus

The College publishes a blueprint for the SCA papers that is unusually useful for planning. Most systems carry 12 questions each: cardiovascular, connective tissue and joints, emergency and critical care, endocrinology and metabolism, gastroenterology and hepatology, haematology and oncology, infectious diseases, neurology, renal with fluid and electrolytes, and respiratory. Geriatric medicine, immunology, dermatology, ethics and law, and evidence-based medicine carry 6 each. The Objective Test draws three questions each from the major systems and fewer from the rest.

• The "must know" conditions in the core syllabus, which you are expected to diagnose and manage comprehensively, from emergency care through to long-term follow-up.
• The "must recognise" conditions, where you need to identify the presentation, start initial care and refer appropriately.
• The cardinal manifestations of illness, such as dyspnoea, jaundice, fever or confusion, approached as a structured differential diagnosis.
• Data interpretation: ECGs, chest radiographs, blood gases, biochemistry and serology, which feature heavily in the Objective Test.
• South African disease patterns, including HIV, TB and their complications, alongside ethics, medico-legal practice and evidence-based medicine.

A realistic FCP(SA) Part 2 study plan

Most registrars prepare for Part 2 over several months alongside a full clinical load. A phased approach keeps the breadth manageable.

• Phase one, map the blueprint. List every system against its question weighting and rate your confidence honestly. Start with the high-weight systems you see least on your current rotation, and work through them topic by topic with questions after each one.
• Phase two, integrate and interpret. Move to mixed question sets so that you practise switching between systems, and set aside regular sessions for ECGs, radiographs and laboratory data, because the Objective Test rewards pattern recognition that only comes from volume.
• Phase three, simulate. Sit full, timed SCA blocks and practise writing concise Objective Test answers to time. Use your performance data to revisit weak systems, then taper before the written papers while keeping some clinical case practice going for the stages that follow.

Exam technique that earns marks

In the SCA papers, read the final line of the stem first so you know what is being asked, then read the vignette with that question in mind. Commit to an answer before you look at the four options. Because a correction for guessing is applied, the College's own advice is to answer every item, so never leave one blank. In the Objective Test, marks are awarded for relevant, correctly prioritised information, so lead with the most important finding or action and avoid padding an answer with everything you know. Look at every image or data set systematically before you write, because a missed second abnormality is a common way to drop marks.

The best way to revise for FCP(SA) Part 2

The written component is where most of the preparation effort goes, and question practice is the most efficient way to cover a 15-domain blueprint. The best resources mirror the CMSA style, use South African practice and disease patterns, explain why each option is right or wrong, and show you how your performance breaks down by system so you can target the gaps the blueprint will expose.

Passmed's FCP(SA) Part 2 question bank is written by qualified doctors, mapped to the CMSA internal medicine blueprint, and pairs detailed explanations with performance tracking by system. Explore the FCP(SA) Part 2 question bank →

Frequently asked questions

What does the FCP(SA) Part 2 written component consist of?

Two digital SCA papers totalling 150 "best of four" questions, and a digital Objective Test of 30 data and image-based questions worth 6 marks each. You must pass the written component overall, and meet each subminimum, to be invited to the clinical examination.

Is there negative marking in the FCP(SA) Part 2?

No, but a correction for guessing formula is applied to the SCA papers and the pass mark is standard set using the Cohen method. The College advises answering every question.

Can MRCP(UK) exempt me from Part 1?

The current regulations state that candidates who have completed both Part I and Part II of the MRCP(UK) are exempt from FCP(SA) Part 1. Confirm how this applies to you with the CMSA.

Do I have to rewrite the papers if I fail the clinical stage?

Candidates who pass the written component but fail the clinical and oral examinations are exempt from the written component at the next examination session only.

Exam format details were checked against the Colleges of Medicine of South Africa (accessed October 2026). Regulations, dates and fees change, always confirm the current details on the CMSA website before you sit.