ATLS Study Plan: How to Prepare for the Course and Post-Test (2026 Guide)

Know what you're preparing for before you plan anything

ATLS isn't a board exam, and treating it like one is the fastest way to over-study the wrong material. Course completion has two components, and both are pass/fail. There's a written multiple-choice post-test, where the American College of Surgeons publishes a minimum score of 75% for CME purposes. And there's the practical side — the skills stations and the initial-assessment scenario, where you have to demonstrate the right skills, knowledge, and attitudes in front of faculty.

You can ace the written portion and still not finish the course. Plenty of strong test-takers have been surprised by the scenario, because reading about the primary survey and running one out loud, in order, under time pressure, with an instructor interrupting you, are different skills. Your plan needs to build both. If you want the scoring detail spelled out, we cover it separately in what the passing score for ATLS actually means.

Step one: confirm your course format and work backward

ACS lists ATLS 11 in several formats, and the format determines how much of your prep is self-directed. Traditional runs as a 2-day fully in-person course. Hybrid moves the didactic content online ahead of a shortened in-person portion — roughly a 1.5-day or 1-day format. Refresher runs 1-day or 0.5-day for clinicians renewing status. Every format, without exception, is preceded by required online modules and a pretest, and every format includes hands-on skills and scenario work in person.

The practical consequence: if you're booked into a Hybrid course, more of the knowledge load lands on you before you ever walk into the room. The in-person time is compressed and mostly hands-on. Plan for that. Courses are scheduled through ACS-approved (verified) course sites via the local site or learning.facs.org — there's no fixed national test-date calendar — so once you have a date from your host site, that's your anchor.

The phased plan

Phase 1 — Do the pre-course work properly, not at the last minute

The online modules and pretest aren't a formality. They're the scaffolding for everything the faculty will assume you already know. Work through them in sittings you can actually finish, and take notes in the format you'll need later: algorithms, not prose. When the pretest flags a weak area, write it down rather than moving on. That list becomes your Phase 3 priority order.

Phase 2 — Make ABCDE automatic

This is the single highest-yield thing you can do. The primary survey with resuscitation — Airway with cervical spine protection, Breathing, Circulation with hemorrhage control, Disability, Exposure and environmental control — has to come out of your mouth in the same order every time, without hunting for the next step.

Rehearse it out loud. In the car, walking to the unit, whatever. Say the step, say what you're looking for, say what you'd do about it, then move on. Then rehearse the version where something goes wrong at Airway and you have to fix it before you're allowed to proceed. Faculty are watching for exactly that: do you resuscitate as you find problems, or do you race to the end of the list? Then layer the secondary survey on top, and know when it happens relative to the primary survey.

Phase 3 — Sweep the topics by system

Once the algorithm is solid, go topic by topic through the material organized in the ATLS 11th Edition manual. Give more time to the areas your pretest exposed. Item weighting per topic isn't published, so don't try to guess which sections "matter more" — cover them all, but at different depths depending on your own gaps and your day job. An anesthesiologist and a rural general surgeon walk in with very different blind spots.

A fuller breakdown of these areas lives in our piece on the topics covered on the ATLS exam.

Phase 4 — Rehearse the scenario, not just the facts

Find a colleague, ideally one who's already ATLS-verified, and run mock initial assessments on each other. One person plays the patient and changes the vitals mid-scenario; the other leads. Ten minutes of this is worth an hour of re-reading. You're training the thing the skills stations actually assess: can you run a coherent, spoken, prioritized survey while the situation moves.

Phase 5 — Final review before the in-person days

Taper. The night before isn't for new material. Re-run the primary survey out loud, skim your gap list, review your GCS and shock classification tables, sleep. Show up ready to attend the full in-person portion per the course site's schedule — attendance isn't optional, and missing part of it can cost you completion regardless of how you scored.

What ACS doesn't publish — and how to plan around it

A lot of confident numbers float around online. Be careful with them.

• Question count: ACS does not publish the number of items on the ATLS written post-test; third-party sites commonly cite "~40 multiple-choice questions," but that is not an ACS figure. More on that in how many questions are on the ATLS exam.
• Scored items: not published by ACS. The post-test is scored pass/fail against a 75% minimum, but ACS does not disclose a scored-item count.
• Pilot items: not applicable — the post-test is a course quiz, not a standardized board exam, and ACS publishes no unscored or field-test item count.
• Time limit: ACS publishes course lengths but not a fixed clock time for the written post-test. Treat any specific minutes figure you see as unverified.
• Pass rate: ACS does not publish a national ATLS pass rate. It's a competency-based course with on-site remediation, not an exam with a reported pass-rate statistic.
• Fee: there's no single national price published by ACS; cost varies by the verified course site or host institution, so confirm with your specific course center.
• Retakes: ACS does not publish a public numeric retake or attempt limit. If you don't meet a course requirement, you're directed to your local course coordinator or director and the ATLS policy manual for remediation and retesting.

One planning note that follows from all this: since remediation is handled locally and in person, the sensible move is to be honest with faculty early if you're struggling with a station, rather than hoping it goes unnoticed.

Common ways prepared people still stumble

Cramming the online modules the night before the course. Memorizing lists but never saying the survey out loud. Skipping the pretest feedback. Reverting to specialty habits — the anesthetist who lives at the airway and never gets to Circulation, the surgeon who mentally jumps to the OR before Disability. And underestimating team function and communication, which faculty absolutely assess.

The other one: assuming a higher written threshold than the published one. The 75% minimum post-test score is the figure ACS states on its official course pages. Don't let a number you read somewhere else set your target — set it higher than the minimum because you want margin, not because you've heard a different rule. If you want a read on overall difficulty, see how hard the ATLS exam is.

Plan for renewal while you're at it

ATLS verification status is current for four years from the date you complete a Traditional, Hybrid, or Refresher course, with a 6-month grace period after expiration. A Refresher course renews it. Put the expiry in your calendar the week you pass, because Refresher seats at approved sites fill up and re-taking a full course because you missed the window is a bad use of two days.

If you're planning to teach later, ACS also runs dedicated Instructor courses, and ATLS Educators are required to teach at least four ATLS Instructor courses within a four-year period to stay verified in that role.