Dr. Stevens Norvell initiated and developed this examination in order to test and measure residents’ General Surgery-specific knowledge. Now known as the CAGS Exam, all General Surgery residents in Canada take the test through their program office, at their respective universities. The exam is also offered at the annual Canadian Surgery Forum for those who wish to challenge themselves and help assess areas of strength and weakness. In previous years, the Stevens Norvell award had been awarded to the highest and second highest scoring residents in each postgraduate training year.


The CAGS examination is a formative assessment tool for residents and program directors that can be used to modify teaching and learning activities throughout residency.

The goals of the exam are to:

  1. Improve learning processes
  2. Provide specific feedback to residents and Program Directors facilitating modification of learning activities and clinical experiences with a focus on identified clinical deficiencies
  3. Identify or remediate group or individual learners
  4. Move the focus away from achieving passing grades to improving specific learning processes
  5. Improve residents’ metacognitive awareness of how they learn
  6. Permit ongoing assessment for fine-tuning of instruction and resident focus on progress

This exam should not constitute a summative assessment and should not be used in decision making related to promotion. Rather than simply yielding a test score, the CAGS exam is designed to provide topic specific feedback and to provide high-quality information to residents and programs to produce a powerful effect on resident learning and motivation.

Structure and Content

The CAGS exam is a multiple choice examination (MCQ). MCQs have long been used in the assessment of medical knowledge as they have been shown to be valid and reliable as well as time and cost-effective.

The exam will be administered as a computer-based examination.

The content of the exam is linked to the Royal College goals and objectives of training in General Surgery. The questions are clinically based and are designed to assess knowledge specific to Surgical Foundations (Years 1 and 2) and Core training (Years 3 and 4). Complex decision / management issues at the fellowship candidate level (R5) will not be included. Although basic science knowledge will be important in answering the questions basic science content specific to the Surgical Foundations examination will not be included.

The exam will contain both English and French versions of the same question.

Feedback on examination performance will be provided to residents and Program Directors within one month of completing the exam. The information provided will be as specific as possible in order to facilitate identification of clinical academic deficiencies.

The questions are referenced from current textbooks in surgery and current practice reference sources.

Guidelines for Exam-Taking

  1. The exam will be administered across Canada in February.
  2. Programs will have identified a resource room with adequate computer access for the entire residency program.
  3. We encourage all residents to arrive approximately 30 minutes prior to start of the examination.
  4. The exam will be invigilated.
  5. Similar to the process at the Royal College, residents are to surrender their iphones and electronic devices before entering the examination. They will not have access to personal laptops or reference texts.
  6. The exam duration is 2.5 hours.
  7. A retake date will be rescheduled within each program.
  8. At the conclusion of the exam, there is a short post-exam survey that all residents are encouraged to complete in order to improve the examination process.

Note on Confidentiality

The results of CAGS exam will help yield information about residents’ current progress and help set goals for improvement. Benefits for residents are to allow them to take responsibility for their own learning and become users of assessment alongside the residency program. It is not meant to be a high-stakes process. There are no cash prizes linked to performance. Program directors are discouraged from using test scores for resident promotion. Disclosure of test scores to fellowship programs or credentialing bodies is discouraged. Test scores are for the personal use of the resident or program where it pertains directly to resident or program improvement. Similarly, questions on this exam should not be reproduced in any form by a resident(s) as the exam process is an intellectual exercise meant simply to enhance learning. Residents are not expected to benefit in any way by copying or distributing the examination content. Doing so should be considered as a breach of professionalism by the residency Training Program.

CAGS Examination Preparation

Source books are available FREE from the CMA website.

  • Source 1: CURRENT Surgical Diagnosis and treatment.
  • Source 2: ACS Surgery Principles and Practice.

To access go to CMA web site. Log on.

  • Click Clinician Resources.
  • Click A-Z textbooks.
  • Log in again with SAME password.
  • Click Surgery General.
  • Click either ACS Surgery or CURRENT Surgical Dx and Tx.
  • Download the chapters you need to your computer or tablet or read from the screen.


Each module is expected to require 2-6 hours to complete. The entire series is intended to cover the major clinical components of the CAGS in training exam. It does not cover the non-clinical aspects (“which of the following is NOT released by a platelet”) or the anatomy questions (“label the brachial plexus”).

Credit is double the hours used to complete. The series if completed will take 50 hours and generate 100 credits. Any portion of it can be used for credit. It can easily be done in a year or quicker depending on your time.

For practicing surgeons:

What is an ESP?

“ESPs” = Exam Study for Practicing Surgeons

Know what you don’t:

Don’t take the CAGS exam to pass or fail. Take it to recognize unperceived gaps in knowledge that may have evolved since your training finished. Don’t do breast? Don’t study it…and don’t fret about your mark in the breast section. Do breast? Then pay attention to your scores there. Your marks are your own and the feedback may prove invaluable for your patients and their care.

The series can be done for credit and the exam.

Module Overview:
Section Source 1 (CURRENT) Source 2 (ACS)
1) peri-op care Ch 3/4/5 1.4/1.5/1.6/1.7/10.32
2) Anaesthesia Ch 11 1.3/10.31
3) Fluid/nutrition Ch 9/10 8.22/8.24
4) infection Ch 8 1.1/1.2/8.4/8.15
5) Shock Ch 12 8.3
6) trauma/thermal * 13/14 7.1/7.4/7.5/7.6/7.14/7.15
7) Thyroid/parathyroid 16 2.3/2.9/2.10
8) Breast 17 3.1/3.9
9) Upper GI/sm bowel* 20/23/29 4.1/5.5/5.8/5.11
10) Acute abd/appendix 21/22/28 5.1/5.2
11) Liver/biliary/pan* 24/25/26 5.3/5.9/5.10/5.21/5.39/5.40
12) Large bowel 30 5.6/5.12/5.13/5.14
13) Anorectal 31 5.17/5.36/5.37
14) Hernia 32 5.27/5.28
15) Adrenal/oncology 33/44 3.4/3.8/5.38/10.29
16) Vascular 34/35 6.4
17) peds/transplant 43/45 9.2/10.12/10.13
18) spleen/obesity 27 (spleen) 5.7 (obesity surgery)

(* denotes larger module up to 4 hours)