The College of Physicians and Surgeons, Pakistan initiated its examination process by organising MCPS examination in six specialities in the year 1965 and FCPS-II examination in two specialities in 1967. The College now offers 53 specialities and sub specialities, for FCPS and 10 for MCPS. The College has discontinued its Membership diploma program and replaced it with a 2-year College diploma, DCPS, which is being offered in 14 disciplines.

Being  primarily an examining body, the "Examination Department" is the principal department of CPSP. The department performs its function by conducting examinations held in the College premises at Karachi, and by supervising the examinations held at other centres like Lahore, Rawalpindi, Peshawar, Quetta, Multan, Bahawalpur, Faisalabad and Hyderabad. This department is headed by a Chief Controller of Examinations and is assisted by a Deputy Chief Controller, a  Deputy Controller and several Assistant Controllers. 

Besides this set up at the head office, the Examination Department is represented at each of the other 13/14 Regional Centres of CPSP throughout Pakistan by a Regional Controller of Examinations who is assisted by a Joint Controller.

The affairs of the Examination Department are over seen by a committee of ten Councillors known as "Examination Committee". This Committee also selects panel of paper setters, assessors and examiners for various examinations. 

Six examiners are employed in each of FCPS Part I and Part II examinations and four in the MCPS examinations. They are usually changed after every two years.

The examination format is developed by the relevant faculties of the College and it is changed from time to time. The system of evaluating the knowledge of the examinee is made as objective as possible. No single person has the absolute authority to pass or fail the candidates. Computers are used for optical scanning of the answer sheets of candidates to evaluate the candidates' Multiple Choice Questions (MCQ) response card wherever MCQs are used, taken up from the MCQ Bank. The senior most of the examiners is appointed as the Adjudicator, with the authority to make examiners re-assess a candidate who fails or passes marginally, to avoid any likelihood of negative or positive bias.

The College invites senior examiners of the Royal Colleges of U.K., from time to time, to examine candidates for FCPS Part-I and Part-II along with local examiners. This offers to them  an opportunity to assess and compare the standard of our examination with their own.