RRA Study Guide 2026: How to Pass on Your First Attempt

What You Are Actually Studying For

Reconstructive Rearfoot/Ankle Surgery (RRA) is the rearfoot and ankle credential offered through the American Board of Foot and Ankle Surgery (ABFAS). It is not a single exam. It is a pathway with a Part I qualification stage, made up of an RRA Didactic exam and a NEW RRA CBPS (clinical simulation) exam, followed by a Part II RRA Case Review that evaluates your own operative cases. If you are still orienting yourself, the explainers on what RRA is and what RRA certification is cover the basics, and RRA requirements details who may sit.

The first mistake candidates make is treating the whole pathway as one big test and building one big study plan. The components reward different skills: rapid recall and judgment under adaptive pressure for Didactic, structured clinical reasoning for CBPS, and meticulous documentation for Case Review. A first-attempt pass comes from preparing for each on its own terms. This guide walks through all three and shows how to sequence the work.

The Four Components and What Each One Tests

Some Didactic questions may be unscored field-test items, but no fixed scored/unscored split is assigned, so you cannot safely coast on any question. Treat all 80 as live.

Reading the Didactic Blueprint Without Misreading It

The RRA Didactic is organized into five Topics, each with an official target weight and an allowable range. The allowable ranges mean the actual mix on your form can drift from the target, so do not study as though the percentages are exact question counts.

The practical read: Surgical Procedures/Techniques is your single biggest lever, but four of the five Topics sit at 20% or more of the target, so a weak spot anywhere is costly. For a broader map, see the full RRA exam domains guide.

CBPS: Case Management Areas vs. Content Areas

This is the section where site-wide confusion is most common, so read it carefully. The nineteen domains listed on this site are serialized source headings, not one official 19-domain exam blueprint. They actually fall into three different classifications:

• Domains 1-5: the RRA Didactic Topics with the target weights above.
• Domains 6-9: separate CBPS Case Management Areas, each with an official range: Physical Examination (20-40%), Diagnostic procedures/labs/imaging (15-35%), Diagnosis (10-30%) and Treatment (15-35%).
• Domains 10-19: overlapping, unweighted CBPS Content Areas: Complications/Revision, Congenital disorders (pediatrics), Congenital disorders (adult), Deformities, Perioperative management, Neoplastic disorders, Neurovascular disorders, Trauma, Wound/Infection, and Metabolic, rheumatologic, and inflammatory disorders.

What this means for preparation: in CBPS you are tested on process as much as knowledge. The Case Management Areas reward a disciplined sequence, which is examine, order the right studies, reach a diagnosis, then treat. The Content Areas tell you which clinical territory the case may come from. Prepare for the process once, then rehearse it across all ten content territories.

Fifteen minutes per simulation is tight. Rehearse out loud against a clock until your sequence is automatic.

Sequencing Your Preparation by Domain

Generic study methods matter less than where you spend each week. Here is one way to order the work, tied to the structure above. Adjust the length to your own calendar and the testing window you choose; see RRA exam dates for scheduling.

Spaced review fits naturally here: revisit Complications every week even after you move on, because it is the Topic that intersects with every other one.

Surviving a Computer-Adaptive Didactic

Two format facts should drive your test-taking habits. First, the Didactic is computer-adaptive, so question difficulty responds to your performance. Second, completed CAT items cannot be revisited. There is no flagging and returning at the end.

• Commit and move. With 80 questions in 120 minutes, you have roughly a minute and a half per item on average. Deliberate, but do not stall.
• Do not read difficulty as failure. In an adaptive format, questions that feel harder can simply reflect that you are answering well. Do not let a tough run shake your pacing.
• Treat every item as scored. Because some may be unscored field-test items and you cannot tell which, any question may count.
• Eliminate with the principle. When two answers look plausible, ask which one a surgical principle, indication or complication-avoidance rule actually supports.

Case Review: Your Logging Is Your Study Plan

Part II Case Review has no timed sitting. Eight selected surgical cases are evaluated through PLS, and the quality of that evaluation depends on documentation you build over time. This is the component where early habits pay off most.

• For 2027 RRA Case Review, at least 30 logged cases must contain an RRA-eligible procedure.
• Among those, eight must be selectable RRA core-procedure cases from unique patients.
• Log all required post-residency surgeon-of-record cases, not just the minimum. A larger pool gives you better cases to select from.
• The issuer has an RRA-only logging exception for candidates who are already Foot-certified, so check whether it applies to you.

Do not backdate the 2027 changes to Spring 2026. Use the current September 2026 Information and Requirements document for 2027 Case Review together with the issuer's eligibility and calendar pages, and be cautious with older summaries, which can contain stale or self-referential prerequisite wording. Record complete operative detail, follow-up and outcomes as you go, because reconstructing a case from memory years later is where documentation quality collapses.

Scores, Pass Rates and What They Mean for You

Each Part I component requires a scaled score of 500 on a 200-800 scale. That is not 62.5% correct, and you should not try to convert it into a raw percentage. Because the Didactic is adaptive, scaled scoring accounts for the difficulty of the questions you actually saw. The details are in the RRA passing score guide.

On historical results, ABFAS publishes cumulative pass rates through Spring 2025:

Fees, Eligibility and Registration Mechanics

Budget before you apply, because several fees stack. The issuer lists the following:

Prerequisite Foot examinations and their associated fees are additional, so the total is higher than the RRA lines alone. The full picture is in the RRA certification cost breakdown.

Eligibility requires a DPM from a CPME-accredited four-year podiatric college, at least three years of accredited residency with required PMSR/RRA training and surgical documentation, unrestricted licensure and applicable surgical privileges. Eligible passed final-year in-training examination components may be converted for a fee; this does not change what RRA covers. One timing note: the currently linked Part I handbook is titled Board Qualification for Fall 2025 Examinations, so it is not a verified 2026 calendar. Confirm current dates directly with ABFAS before you plan.

Exam-Day Logistics

Part I is delivered by Pearson VUE in test centers. Plan the practical details early:

• Bring two valid matching IDs. A mismatch can end your day before it starts.
• No books or study materials are permitted in the testing room.
• Arrive early enough to absorb check-in without rushing into a 120-minute adaptive exam.
• For CBPS, expect 12 back-to-back simulations over 180 minutes, so manage energy as well as content.

Official practice resources are login-gated, so verify what is available to you through your ABFAS account and supplement with timed practice from the practice test platform. A one-page recap of the high-yield facts lives in the RRA cheat sheet.

After You Pass: Certification Window and Maintenance

Qualification is a step, not the finish line. Certification is normally required within seven years of qualification, with exceptions for certain pre-2014 residency candidates. Once certified, the initial certification lasts ten years. Maintenance includes annual fees, unrestricted licensure, privileges, a recent-surgery attestation, 100 Category 1 and/or CPME-approved CME hours per five-year period, and LEAD participation.

For newer time-limited cohorts, LEAD means at least 12 quarters in each five-year period plus meeting the applicable performance standard. RRA requires its own MDT standard but no participation quarters beyond Foot. Older cohorts have transition schedules, so check the issuer's LEAD requirement pages for your own cohort. If you are weighing the long-term payoff, read the RRA certification ROI analysis, the salary guide and the overview of RRA jobs.

Frequently Asked Questions