smleOctober 31, 2026• 3 min read

SMLE Topic Difficulty Report 2026: 31,828 Answers Analysed

Written by Dr. M. Salar Raza — MBBS, MSRA (RCGP), IMC Certified

Which SMLE topics do candidates find hardest? We analysed 31,828 first-attempt answers on SMLEREVISE practice questions (April 2026 to October 2026). This report ranks 27 clinical topics by the share of questions candidates answered correctly on their first try.

Key findings

Overall, candidates answered 65% of questions correctly on their first attempt.
The hardest topic was Critical Care at 55.4% correct, followed by Dermatology (56.1%) and Urology (58.9%).
The easiest was Neurology at 77% correct.
There is a 21.6-point gap between the hardest and easiest topics.
These are practice-question results, not official SCFHS exam statistics.

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SMLE topic difficulty ranking

Topics are ordered from hardest (lowest first-attempt accuracy) to easiest. Only topics with at least 300 first-attempt answers are included.

Rank	Topic	% correct (first attempt)	First-attempt answers	Questions
1	Critical Care	55.4%	994	77
2	Dermatology	56.1%	522	37
3	Urology	58.9%	428	49
4	Neonatology	59.6%	312	24
5	General Surgery	59.8%	2,120	189
6	Infectious Disease	59.8%	1,731	188
7	Breast & Endocrine Surgery	61.4%	505	54
8	Pediatrics	63.3%	2,511	181
9	Gastroenterology	63.4%	1,944	187
10	Ophthalmology	63.7%	339	43
11	Internal Medicine	63.8%	470	53
12	Orthopedics	63.8%	417	59
13	Obstetrics	64%	3,437	346
14	ENT	64.1%	526	68
15	Cardiology	64.7%	2,787	164
16	Trauma & Emergency Surgery	65.3%	861	124
17	Endocrinology	65.4%	1,722	128
18	Gynecology	65.7%	1,826	135
19	Psychiatry	66.4%	544	60
20	Emergency Medicine	67.4%	772	57
21	Nephrology	68.7%	983	90
22	Hematology	69.3%	1,042	133
23	Pulmonology	72.5%	1,585	162
24	Ethics	72.9%	310	24
25	Basic Sciences	73.5%	619	92
26	Rheumatology	76.6%	445	49
27	Neurology	77%	832	115

The five hardest topics

Critical Care (55.4%), Dermatology (56.1%), Urology (58.9%), Neonatology (59.6%), General Surgery (59.8%). These topics had the lowest first-attempt accuracy in our question bank. If your exam is close, they are reasonable candidates for extra timed practice and careful review of explanations.

The five easiest topics

Neurology (77%), Rheumatology (76.6%), Basic Sciences (73.5%), Ethics (72.9%), Pulmonology (72.5%). Higher accuracy here does not mean these topics can be skipped. It means candidates in this sample tended to answer our questions on them correctly more often.

Method

Source: anonymised answers from 49 candidates to SMLEREVISE question-bank questions between April 2026 to October 2026.
First attempt only: for each candidate and question, only the first answer is counted. Reset and repeat answers are excluded.
Privacy: no names, emails or user identifiers were exported. Topics with fewer than 300 first-attempt answers or fewer than 10 contributing candidates are not reported.
Measure: % correct = correct first-attempt answers ÷ all first-attempt answers in that topic.

Limitations

These figures describe how SMLEREVISE users performed on SMLEREVISE practice questions. They are not official Saudi Commission for Health Specialties (SCFHS) data and do not predict your official SMLE score, which is reported on a 200–800 scale with 560 to pass. Topic difficulty also reflects how our questions are written. Candidates who use a question bank may differ from all SMLE candidates.

How to cite this data

You are welcome to quote these figures with a link to this page. Suggested citation: SMLEREVISE (October 2026). SMLE Topic Difficulty Report 2026. https://smlerevise.com/blog/smle-topic-difficulty-report-2026

To try questions from these topics yourself, start with the free SMLE practice questions. To understand the official scoring scale, read SMLE passing score and score to percentage.

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Dr. M. Salar Raza

MBBS, MSRA (RCGP), IMC Certified

Dr. Muhammad Salar Raza holds an MBBS, is registered with the Irish Medical Council, has passed MSRA in the UK, and is the author of multiple peer-reviewed publications in medical journals. He reviews all clinical content to ensure accuracy for SMLE students.

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