- What "RRA Training" Actually Covers
- The Residency Foundation: Where RRA Training Really Starts
- Three Pieces, Three Kinds of Preparation
- Training for the Didactic: Five Weighted Topics
- Training for the CBPS Simulations
- Training Through Your Case Log
- Sequencing Your Preparation Around the Domains
- Training for Exam-Day Conditions
- Training Never Fully Stops: Maintenance and LEAD
- Frequently Asked Questions
- RRA training is a multi-year pathway: residency with documented PMSR/RRA experience, then Part I, then Part II Case Review.
- Part I has two separate exams: an 80-question RRA Didactic and a 12-simulation NEW RRA CBPS.
- Surgical Procedures/Techniques carries the largest Didactic target weight at 25%; Surgical Principles, Perioperative Management and Complications each target...
- Your PLS case log is training material: at least 30 RRA-eligible cases, including eight unique-patient core cases, for 2027 Case Review.
What "RRA Training" Actually Covers
When candidates search for "RRA training," they usually mean one of two things: the clinical training that makes them eligible, or the exam preparation that gets them through board qualification. For Reconstructive Rearfoot/Ankle Surgery (RRA), issued by the American Board of Foot and Ankle Surgery (ABFAS), both matter, and they are more intertwined than in most credentials. Your residency case volume feeds your Case Review, your operative experience feeds your Didactic reasoning, and your clinical judgment is directly tested in simulation form.
This article maps the whole training arc: what residency must document, how to prepare for each Part I component, how your surgical logging works as ongoing training, and what continues after certification. If you are still orienting yourself, start with What Is RRA? and What Is RRA Certification? before returning here.
The Residency Foundation: Where RRA Training Really Starts
Formal RRA training begins long before any exam registration. The pathway requires:
- A DPM degree from a CPME-accredited four-year podiatric college.
- At least three years of accredited residency that includes the required PMSR/RRA training and surgical documentation.
- Unrestricted licensure and applicable surgical privileges.
- Foot qualification, which is required for RRA qualification. Foot certification is required for RRA certification.
That last point surprises candidates who treat RRA as a standalone credential. It is not. Your Foot-side examinations and their associated fees are additional to the RRA costs, so plan the sequencing deliberately. For a full eligibility walkthrough, see RRA Requirements 2026: Eligibility, Prerequisites & How to Qualify.
In-Training Examination Conversion
Eligible passed final-year in-training examination components may be converted for a fee. This is a useful bridge between residency and board qualification, but it does not change what the credential covers. Confirm eligibility with the issuer rather than assuming your result qualifies.
Three Pieces, Three Kinds of Preparation
The RRA pathway has a Part I made of two components and a Part II. They test different skills, so they demand different training approaches.
| Component | Format | Fee | What It Rewards |
|---|---|---|---|
| Part I: RRA Didactic | 80 computer-adaptive multiple-choice questions, 120 minutes, Pearson VUE test center | $475 | Broad recall plus applied reasoning across five weighted topics |
| Part I: NEW RRA CBPS | 12 clinical simulations, 15 minutes each, 180 minutes total | $475 | Case management: examination, workup, diagnosis, treatment |
| Part II: RRA Case Review | Eight selected surgical cases evaluated through PLS; no timed sitting | $550 | Documented surgical judgment and record quality |
There is also a $225 nonrefundable application fee, charged once per examination calendar year. Pricing details and how the fees stack up are covered in RRA Certification Cost 2026: Complete Pricing Breakdown.
Scoring is also worth understanding before you train. Each Part I component requires a scaled score of 500 on a 200-800 scale. That is not the same as 62.5% correct, so do not translate practice percentages into a pass prediction. See RRA Passing Score 2026: Exactly What You Need to Pass for the scoring mechanics.
Training for the Didactic: Five Weighted Topics
The RRA Didactic is organized around five Topics with official target weights and allowable ranges. These are the domains you can actually budget study time against:
| Didactic Topic | Target Weight | Allowable Range |
|---|---|---|
| Diagnostic Studies/Medical Imaging | 15% | 10-20% |
| Surgical Principles | 20% | 15-25% |
| Surgical Procedures/Techniques | 25% | 20-30% |
| Procedural Perioperative Management | 20% | 15-25% |
| Complications | 20% | 15-25% |
Surgical Procedures/Techniques (25% target)
The heaviest Topic and the one where residency volume pays off most directly. Expect to move beyond "which procedure" to "which technique, in which patient, and why."
- Indications, contraindications and alternatives for rearfoot and ankle reconstructive procedures
- Fixation choices, sequencing and technical pitfalls
- Relevant surgical anatomy and approaches
Surgical Principles (20% target)
The reasoning layer underneath the procedures: biomechanics, soft-tissue and bone healing, and the logic that determines why a given reconstruction is chosen.
Procedural Perioperative Management (20% target)
Preoperative optimization, intraoperative decision-making and postoperative protocols as they apply to reconstructive rearfoot and ankle cases.
Complications (20% target)
Recognition and management of what goes wrong after reconstruction. This Topic shares ground with revision surgery and wound/infection themes elsewhere in the CBPS content areas, so cross-training pays off.
Diagnostic Studies/Medical Imaging (15% target)
Choosing and interpreting imaging for rearfoot and ankle pathology. The lowest target weight, but it underpins every other Topic, since you cannot reason through treatment without reading the studies correctly.
For a deeper breakdown of how the Topics relate to the rest of the blueprint, read RRA Exam Domains 2026: Complete Guide to All 19 Content Areas.
Adaptive Testing Changes How You Should Practice
The Didactic is computer-adaptive and delivers 80 multiple-choice questions in 120 minutes. Some items may be unscored field-test questions, but there is no fixed scored/unscored split, so you cannot identify and skip them. A critical rule: completed adaptive items cannot be revisited. Train yourself to commit to an answer after careful reading rather than relying on a second pass. Practicing with timed question sets in that mode is far more valuable than untimed review. You can drill in that style with the RRA practice test.
Training for the CBPS Simulations
The NEW RRA CBPS is a separate exam: 12 clinical simulations, 15 minutes each, 180 minutes in total. Where the Didactic asks what you know, the simulations ask how you manage a patient. Preparation therefore looks different.
The CBPS is organized around four Case Management Areas with official ranges:
- Physical Examination (20-40%)
- Diagnostic procedures/labs/imaging (15-35%)
- Diagnosis (10-30%)
- Treatment (15-35%)
These overlap with ten unweighted 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.
How to Practice Case Management
- Pick a Content Area, such as Trauma or Neurovascular disorders.
- Walk a patient through all four Case Management Areas in order: what you would examine, which studies and labs you would order, what the diagnosis is, and what treatment follows.
- Time yourself against a 15-minute limit to build pacing.
- Note where you spend time on low-yield steps and tighten them.
Because the Content Areas include adult and pediatric congenital disorders, neoplasms, metabolic and inflammatory conditions, and wound/infection management, candidates who trained mainly on elective deformity correction should deliberately cover the less familiar categories.
Training Through Your Case Log
Part II is unusual because your training and your examination material are the same thing. Case Review evaluates eight selected surgical cases through the issuer's PLS system. There is no timed examination sitting. Your job is to have operated, documented and logged well enough that eight strong cases can be selected.
For 2027 RRA Case Review, the requirements are:
- At least 30 logged cases must contain an RRA-eligible procedure.
- Within those, eight selectable RRA core-procedure cases from unique patients.
- Log all required post-residency surgeon-of-record cases, not just the minimum, so you have a deep pool to choose from.
The issuer has an RRA-only logging exception for candidates who are already Foot-certified. Check it against your own situation using the current logging and eligibility pages rather than relying on older summaries. Note also that the 2027 changes should not be backdated to Spring 2026, and the current Case Review authority is the September 2026 document for 2027 Case Review. Older cover pages may conflict with it.
Key Takeaway
Start thinking about Case Review the day you become surgeon of record. Log consistently, favor unique patients when documenting core RRA procedures, and keep complete records so that when selection time comes, you have genuine choice rather than a bare minimum.
Sequencing Your Preparation Around the Domains
General study technique matters less than ordering. A sensible plan for the Didactic front-loads the highest-weighted Topic and uses the relationships between Topics to reinforce them. For a broader methodology, see RRA Study Guide 2026: How to Pass on Your First Attempt. The sample below is one RRA-specific way to sequence a focused review window:
Imaging and Surgical Principles
- Rebuild imaging interpretation first, since every later Topic depends on it
- Review principles that justify reconstructive choices
Surgical Procedures/Techniques
- Give the 25% Topic the largest block of time
- Pair each procedure with its indications, fixation and common pitfalls
Perioperative Management and Complications
- Study complications alongside the procedures that cause them
- Review perioperative decision points that prevent them
Simulation Practice and Timed Sets
- Run 15-minute case walk-throughs across the Content Areas
- Finish with timed adaptive-style questions in a no-backtracking format
Candidates often wonder how this compares with the difficulty they have heard about. How Hard Is the RRA Exam? Complete Difficulty Guide 2026 covers that question in detail, and RRA Pass Rate 2026: What the Data Shows explains how to read the published figures.
Reading the Historical Numbers Carefully
Historical cumulative pass rates through Spring 2025 are 54% (211/394) for RRA Didactic among the 2025 residency class, 89% (353/398) for that class's CBPS, and 79% (19/24) for the 2023 residency class on RRA Case Review. These are cumulative figures for specific cohorts. They are not first-attempt rates and not 2026 rates. The gap between Didactic and CBPS suggests where preparation effort should concentrate, but treat it as context, not prediction.
Training for Exam-Day Conditions
Part I is delivered in Pearson VUE test centers, and the environment has rules you should rehearse in advance:
- Bring two valid matching IDs.
- No books or study materials are permitted in the testing room.
- On the Didactic, completed adaptive items cannot be revisited.
Because official practice access is login-gated, many candidates supplement it with an independent question bank. A quick round on the main practice test in a quiet, timed setting will help you rehearse the commit-and-move-on rhythm that adaptive delivery requires. Scheduling specifics and deadlines are tracked in RRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling. Note that the currently linked Part I handbook is Board Qualification for Fall 2025 Examinations, not a verified 2026 calendar, so confirm current dates with the issuer.
Training Never Fully Stops: Maintenance and LEAD
Initial certification lasts ten years, but staying certified involves continuing education and assessment. Requirements include:
- Annual status fees: $205 for Board Qualified or $440 for Board Certified.
- Unrestricted licensure and surgical privileges.
- A recent-surgery attestation.
- 100 Category 1 and/or CPME-approved CME hours per five-year period.
- Participation in LEAD.
New time-limited cohorts complete at least 12 LEAD quarters in each five-year period and meet the applicable performance standard. RRA requires its own MDT standard but no participation quarters beyond Foot. Older cohorts follow transition schedules, so check the issuer's LEAD pages for your cohort. Certification is normally required within seven years of qualification, with exceptions for certain pre-2014 residency graduates.
Once certified, many surgeons ask what it means for their careers. Is the RRA Certification Worth It? Complete ROI Analysis 2026, RRA Salary Guide 2026: Complete Earnings Analysis and RRA Jobs cover the practical payoff.
Frequently Asked Questions
The pathway requires a DPM plus at least three years of accredited residency with documented PMSR/RRA training. Board qualification follows, and certification is normally required within seven years of qualification.
Yes. The NEW RRA CBPS is its own Part I component: 12 clinical simulations at 15 minutes each, 180 minutes total, with a $475 fee separate from the $475 RRA Didactic.
Surgical Procedures/Techniques has the largest target weight at 25% (range 20-30%). Surgical Principles, Procedural Perioperative Management and Complications each target 20%, and Diagnostic Studies/Medical Imaging targets 15%.
No. Case Review evaluates eight selected surgical cases through PLS, and candidates do not attend a timed examination sitting. For 2027, at least 30 logged cases must contain an RRA-eligible procedure, including eight unique-patient core cases.
No. Part I prohibits books and study materials in the testing room, and you must present two valid matching IDs. On the Didactic, you also cannot return to items you have already completed.