Histopathology Part 2 exam tips
The Part 2 exam comprises 6 components, which will be discussed in further detail below:
- frozen sections
- short surgical cases
- long cases
- non-gynae cytology
- objective structured practical examination (OSPE)
- macros.
On day 1, all components will be attempted, apart from the short surgical cases which are undertaken on morning of day 2. In the morning of day 1, you will attempt either frozen, long cases and OSPE 1 or macro, OSPE 2 and non-gynae cytology. In the afternoon, you will swap around.
All components of the exam are centrally selected and set, with strict marking schemes, therefore every candidate gets exactly the same exam cases for every component of the exam, and there are no locally selected components. Only viva components are marked locally; all written components are marked centrally.
You need to achieve 50% in each section to pass overall. There is no minimum number of candidates that pass; therefore, the pass rate varies on each exam. If you fail any component, then the overall result will be a fail. On average, the pass rates for the frozen, macro and OSPE components are over 95%, while the short surgical cases, long cases and non-gynae cytology are usually 75%+. The most recent pass rate for the exam was 52% in April 2026.
On review of performance post the exam timetable changes, there does not appear to be any detrimental effect on pass rates in any section of the exam, apart from 2 sittings in April and October 2025. Several reasons for the poor pass rates for these sittings were explored:
- that candidates coming through at this time likely started their training during the COVID-19 pandemic
- that outsourcing had removed the day-to-day cases that candidates could start independently reporting on
- that outsourcing changed the lens of reporting in-house to more malignant cases
- and that candidates appear to lack the breadth and depth of knowledge and experience compared to their peers in previous settings.
Case selection
Cases for the exam are selected on central setting days, where a group of examiners (usually 15+) come together to review cases that are selected for the exam. Cases are blueprinted to the curriculum – i.e. if the curriculum is heavy in skin and gastrointestinal, then there will be more cases of these.
Cases are selected on the basis that they are a good example of the diagnosis or differential diagnosis, that a workable marking scheme can be created that differentiates good and poor candidate answers, and that the case will survive the minimum number of sections (including additional work) so that candidates receive excellent quality slides, with the same material on each slide. Cases are not educational cases, or ones requiring multiple opinions or specialist opinions. Any cases that cause controversary when discussed within the group are rejected.
The group of examiners are a mixture of people, some of whom are sub-specialised and others who are generalists. They are all able to diagnose the H&E slide within seconds of it being presented. Once cases are selected, all components of the exam are then subjected to a rigorous process of quality checking and sharing between a select panel to make sure the questions, for components such as the OSPE, are fair and clear.
Frozen sections
The frozen sections component includes 6 cases divided into 2 groups of 3 cases. You will be given a sheet with the histories, and space to make notes. You will have 20 minutes to review each set (therefore, 2 sets of 20 minutes). Then, you go to a viva room to discuss the cases with 2 examiners. Please take your notes with you to the viva rooms. You will be marked on your viva performance only, against a strict marking scheme that is set centrally.
All frozen sections are quality checked centrally to make sure they are the best quality. The marking scheme is out of 5 – the top mark on offer is 4, and the lowest mark is 1. You need 15 points overall to pass (2.5 x 6 = 15). All cases have been selected so that you should be able to give a clear report, i.e. you should not need to defer any cases.
Short surgical cases
This component includes 20 cases divided into groups of 2 cases. You will be given a sheet with the histories. You will have 20 minutes to review each set, so 10 sets at 20 minutes each. The cases are marked against a strict marking scheme that is set centrally. The same questions are marked by the same examiners (i.e. question 1 is marked by the same examiner to ensure fairness to all candidates).
All sections are centrally quality checked to make sure they are the best quality, and the diagnosis is clearly present on every slide. Again, the marking scheme is out of 5 with a top mark of 4 and lowest mark of 1. The marking schemes do give points for a good microscopic description, so please do not just give a diagnosis. You need 50 points overall to pass (2.5 x 20 = 50).
Hint 1: Lay out your report clearly. Bullet points are fine. The suggestion is a microscopic description, extra work (things you need to do to sign the case out, e.g. ER/HER2 in breast core), diagnosis or differential (with a preferred), and then comments/pearls (what do you know about the diagnosis).
Hint 2: Read the history carefully, including age and sex. There are lots of hints and tips in the history. There are also lots of examples of candidates making simple mistakes, such as describing a male immuno panel for a metastatic adenocarcinoma when the history tells you it’s a female.
Long cases
This component includes 4 cases, with 20 minutes for every case. You will be given a sheet with the history. Please read this carefully, as there might be additional information such as a macro description or immunohistochemistry (positive and negative).
You will be provided with H&E and additional stains, up to 8 slides in total. In the renal case, you will also receive electron microscopy photos and immunofluorescence. The cases will compromise 1 medical renal, 1 medical liver, 1 lymphoma or sarcoma and 1 other. The cases are marked against a strict marking scheme that is set centrally. The same questions are marked by the same examiners.
All sections are centrally quality checked to make sure they are the best quality, and the diagnosis is clearly present on every slide. The marking scheme is a mark out of 20, with a top mark of 15 and lowest mark of 7. The marking schemes do give points for a good microscopic description, so please do not just give a diagnosis. You need 40 points overall to pass (10 x 4 = 40).
Hint 1: Lay out your report clearly. Bullet points are fine. The suggestion is a microscopic description, description of the immunohistochemistry (positive/negative), extra work (e.g. in a lymphoma case, is there any immunohistochemistry you would do), diagnosis and then comments/pearls (what do you know about the diagnosis).
Hint 2: Read the history carefully, including age and sex, as well as the additional information provided.
Non-gynae cytology
This section has 8 cases, with 2 cases for every 20 minutes. You will be given a sheet with the histories. Please write your answers in a separate answer booklet. Cases have been selected and checked centrally. Please lay out your answer similar to short surgical cases. Cases are marked out of 5, with the highest mark at 3.5 and the lowest mark at 1.
Hint 1: Check that you have looked at everything. On the question sheet, the slides you are expecting (i.e. 1xDQ and 1xPAP) will be specified.
Hint 2: You shouldn’t need to refer to cell block in every case. Cases have been chosen as they are diagnostic on the slides provided.
OSPE
The OSPE is divided into 2 parts. It is the combined score from both parts that determines a pass or fail.
OSPE 1 is a face-to-face viva. You will be taken to a room with 2 examiners and provided with a question sheet with a clinical scenario and up to 7 questions. You will have 20 minutes to go through this. Please take your time to read through the information and then let the examiners know when you are ready. They will take you through the questions and will mark you on your viva performance against a marking scheme that was set centrally. Topics that can be covered are governance, screening programmes, MDTs, ethics and errors. The marking scheme is out of 10 with the highest score of 8 and lowest of 3.
OSPE 2 is a written component and usually concentrates on datasets, molecular and processes with the laboratory. You will get an answer booklet with the questions and space to write your answers. Each question has in brackets the number of points on offer. The answer sheets will be marked centrally with a centrally set marking scheme, and by a small team of examiners who will mark all the OSPE 2 for all candidates to ensure fairness. The marking scheme is out of 10 with the highest score of 8 and lowest of 3.
Hint 1: No matter how badly you think you did in OSPE 1, you can recover your score in OSPE 2 and pass overall.
Hint 2: In OSPE 1, your overall approach is assessed, i.e. you might give an answer to 1 question that covers another area in the scenario.
Hint 3: Please make sure you answer all the questions in OSPE 2. In several cases, people have missed the last couple of questions.
Macros
You will receive pictures and questions for 4 cases, in groups of 2 (i.e. 20 minutes for 2 cases, 40 minutes in total). The cases have been chosen as you should have had exposure to these cases by the level of an ST4 (4 years of training). The cases are selected centrally, and everyone receives the same cases.
Please read through the questions and write some notes in the space provided. The usual questions are: 1) describe; 2) suggested diagnosis; 3) blocks; 4 and 5) other questions related to the specimen. After 40 minutes, you will be taken to a viva station and be marked on your viva performance only. Please take your pictures and notes with you. The examiners have a strict marking scheme that is set centrally. They will only ask the questions that have already been set. The marking scheme is out of 10, with a highest score of 8 and lowest of 3. You need to achieve 20 marks overall (5 x 4 = 20) to pass.
Hint 1: Take a marker pen with you to mark the blocks on the pictures, to help jog your memory when you are in the viva.
Hint 2: Write as much information on the answer sheets to the questions so you don’t forget anything in the viva.
Marking schemes
All marking schemes are created with the following in mind (specific marks here are given for short surgical cases but is the same principle across all sections):
- 1 or 1.5 – unsafe answer, usually benign/malignant reversal
- 2 – borderline fail, i.e. safe answer but incorrect
- 2.5 – a safe, correct answer or a safe approach to solve a differential
- >3 to 4 – additional information on diagnosis.
Central marking
All written components of the exam; non-gynae cytology, long case, short surgicals, and OSPE 2 are marked centrally.
Each component is marked by the same 2 examiners, i.e. question 1 for short surgicals are marked by the same 2 consultants for all candidates, with a strict marking scheme, to ensure fairness. Marking for all components follows the same process: each question is marked by an examiner independently and then a consensus mark is agreed. If any changes are required to the marking scheme for a question, this can then be applied consistently across all candidates’ answers.
Quad marking
Any candidate who is a borderline fail for any written component of the exam has their answers remarked by another set of examiners to try to pass as many candidates as safely as possible. If a candidate only fails 1 component of the exam, their answer paper is remarked for a third and possibly fourth time (i.e. by up to another 6 examiners) to ensure that the fail is warranted.
Conclusion
The exam is a tough couple of days, but cases are selected for the level of someone who has completed 4 years’ specialist training. All cases are centrally selected, checked and then go through a strict process of quality control so that everyone has the best quality exam.
The pass rate of the viva components is consistently high, and the pass rate for other components is usually very consistent in the mid-70s. Usually, candidates who fail have failed several components, rather than a single section, and every possible effort is made to try and safely pass candidates who only fail 1 section. Where candidates fail, it is usually due to either a lack of breadth and depth in experience or confidence in their answers.
Remember, you need to demonstrate you are safe, and we can only mark what is written/expressed, rather than anything that is implied. Examiners really want to pass candidates: there is absolutely no interest to fail anyone and, if everyone got the magic 50%, then we would pass everyone!
Hint: The best preparation for this exam is not using slide sets, black boxes or exam courses, but rather time behind the microscope doing day-to-day reporting and starting independent reporting through graded responsibility to allow confident and safe reporting to grow. That’s what the exam is testing: are you a safe pathologist?
All that is left for me to say is good luck!