Saudi Commission for Health Specialties
The Saudi Fellowship in Endocrine and Breast Surgery examines two fields in one paper, and it does something most surgical examinations do not: it publishes its blueprint by domain rather than by organ. Anatomy and physiology, pathology, diagnostic tests, indications and technique each carry seventeen per cent. That single design decision should reshape how a candidate revises, and this guide explains why.
Content reviewed 25 August 2026 against current guidelines.
The Saudi Commission for Health Specialties runs this fellowship as a single programme covering both endocrine and breast surgery, entered after Saudi Board certification in general surgery or a recognised equivalent. Candidates are examined on both fields together.
The final written examination is one paper of between eighty and one hundred and twenty single-best-answer multiple-choice questions. Up to ten per cent additional unscored items may be added for pretesting, so the paper you sit may be slightly longer than the number that counts.
The pass score is seventy per cent. If fewer than seventy per cent of candidates reach it, the Commission lowers the pass score one mark at a time, aiming either for a seventy per cent pass rate or a sixty-five per cent pass score, whichever comes first — and it states that under no circumstances will the score fall below sixty-five per cent. In other words, the standard is criterion-referenced with a floor, not a curve.
Final Written Examination
Blueprint by domain
The Commission publishes a blueprint for the written paper but not, as far as we can find, for the final clinical examination of this fellowship. Any description of the clinical stations you read elsewhere — including ours — is inference from how SCFHS structures its other surgical fellowships, not a published fact. Confirm the current format directly with the Commission.
Anatomy and Physiology
Seventeen per cent. Breast vascular and lymphatic anatomy, the axilla and its nerves, thyroid and parathyroid embryology, recurrent and superior laryngeal nerve variants, adrenal venous drainage, and the endocrine physiology behind every biochemical test you order.
Pathology
Seventeen per cent. Breast histology and receptor biology including HER2-low, B3 lesions and their upgrade risk, the Bethesda system, follicular-patterned lesions and NIFTP, Weiss criteria, and parathyroid and adrenal pathology.
Diagnostic and Investigational Tests
Seventeen per cent. BI-RADS and TI-RADS, image-guided biopsy and localisation, molecular testing of the indeterminate nodule, parathyroid localisation in sequence, adrenal biochemical workup and venous sampling, and functional imaging.
Surgical Indications
Seventeen per cent. When to operate and when not to, across benign and malignant breast disease, thyroid nodules and cancer, primary hyperparathyroidism and the functioning or suspicious adrenal mass.
Techniques of Surgery
Seventeen per cent. Oncoplastic and axillary technique, mastectomy and reconstruction planning, thyroidectomy and central compartment dissection, focused and bilateral parathyroid exploration, and adrenalectomy approaches.
Surgical Complications
Ten per cent. Post-thyroidectomy haematoma and airway compromise, recurrent laryngeal nerve injury and the loss-of-signal algorithm, hypocalcaemia protocols, and the breast complications from flap necrosis to lymphoedema.
Pharmacology
Five per cent, and the domain most often skipped entirely. Antithyroid drugs and thyroid storm, alpha and beta blockade before phaeochromocytoma surgery, mineralocorticoid receptor antagonists, calcimimetics and bone agents, and endocrine therapy in breast disease.
The examination follows the SCFHS annual calendar, with the written paper preceding the clinical component. Application windows and fees are published by the Commission.
The pass score, the blueprint weighting and the number of items are all published in the Commission’s own blueprint document, currently in its 2024 version one. Percentages and content are stated to be subject to change at any time — check scfhs.org.sa for the version that governs your sitting.
Anatomy, physiology, pathology and pharmacology together carry thirty-nine per cent of this paper. Most fellowship revision is built around management decisions, because that is what clinical practice rewards and what most question banks contain. A candidate who revises only management is leaving nearly two fifths of the paper to whatever they happen to remember from residency.
The second consequence is subtler. Because the blueprint is by domain rather than by organ, every domain is examined across breast, thyroid, parathyroid and adrenal disease. Preparing organ by organ leaves blind spots at the intersections — adrenal pharmacology, parathyroid anatomy, breast pathology reporting — which is precisely where a domain-weighted paper concentrates its marks.
One written paper of 80 to 120 single-best-answer MCQs, to which up to 10% unscored pretest items may be added. The pass score is 70%; if fewer than 70% of candidates pass, SCFHS lowers it one mark at a time, but never below 65%.
Anatomy and physiology, pathology, diagnostic and investigational tests, surgical indications and techniques of surgery each carry 17%, surgical complications 10% and pharmacology 5%. Each category may vary by up to five percentage points, and research, ethics, professionalism and patient safety are embedded across domains.
Because the blueprint is organised by domain rather than by disease, a purely oncological revision leaves gaps: anatomy, physiology and pharmacology alone account for over a fifth of the paper. Cover breast, thyroid, parathyroid and adrenal disease through each of the seven domains in turn.
Yes — 50 practice questions are free, with no credit card required.
Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. SCFHS-EBS sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
SurgBoardsQ&A provides more than 2,900 practice questions mapped to the exam syllabus, each with a detailed explanation and guideline citation.
Start practising
50 questions free, no credit card required. Filter by board, topic, or difficulty. Explanations cite ESMO and NCCN.