Canadian exams 101

Another major aspect of your application for residency in Canada will be planning for and acing your Canadian qualifying exams. This is an area fraught with uncertainty, stress and lack of clear information and was probably among the most stressful times in my journey as an IMG.

The landscape about the qualifying exams for IMGs in Canada is rapidly changing in the last few years and so I want to take this opportunity to go over the most current information , curated from the MCC website in Aug 2018 and then talk about how one can go about preparing for these exams effectively and ensure you get a kick ass score!

Regardless if you are aiming for a residency position or if you are pursuing a practice ready stream, you will require, among other things, a LMCC which stands for Licentiate of the Medical Council of Canada. This is a designation awarded by the LMCC to a physician who has graduated from medical school and completed the required MCC examinations. Please note the LMCC is not a license to practice in Canada, however it is an important milestone on the road for independent license and required to write a Family Medicine or Royal College Speciality certifying examination.

Before you can apply for any of the below mentioned examinations, there is a lot of behind the scenes paperwork required and I will talk in more detail regarding that in the next few posts. However lets jump right into talking about the exams:

These exams are offered by the Medical Council of Canada or the MCC. You can read more about them at the MCC website.

MCCEE or Medical Council of Canada Evaluating Exam

This is developed as a screening exam for IMGs that tests basic medical knowledge at the level of a minimally competent medical student at the end of med school. It is not designed to test specifically Canadian content. It is available in over 80 countries worldwide.

It is a 4 hour exam. It is computer based. It only contains MCQ questions, usually around 180 questions. It includes Peads, OBGYN, Psych, Adult medicine (Medicine and Surgery) and Population health and ethics questions. Basic sciences are not objectively tested rather their knowledge is assumed.

From 2018 onwards, this exam is being phased out and will not be a requirement for residency application nor will it be a requirement to write any of the other exams like NAC OSCE or MCCQE1. The last MCCEE exam is available Nov 2018. This is a major change in the landscape and that is whyI would recommend every one to not bother writing this exam, rather just plan to apply without it. Even if you were aiming for the 2020 R1 match, which would open in Aug 2019, if you write the MCCQE1 and NAC OSCE early 2019 without MCCEE you should be fine and on track.

So that being said, for IMGs  there are only 2 important examsto contend with, both of which will be required before residency application can proceed. These are the MCCQE1 (Medical Council of Canada Qualifying Exam 1) and the NAC OSCE (National Assessment Collaboration Objective Structured Clinical Exam). Both exams can be taken while in final year of medical school, or after graduation. These two exams can be taken in either order.

MCCQE1 or Medical Council of Canada Qualifying Exam 1

Starting 2019, this exam will be available worldwide in 80 countries at Prometric exam centres, the same company that administers the USMLEs. However the exam is only available on certain dates, usually over 5 exam seasons in a year. The exam can be retaken up to 4 times if you fail, however cannot be retaken if you pass just to improve your score. So you should wait and prepare your best before you do it.

This exam is completed over 1 day and it has 2 parts. Part 1 is a 4 hour test of 210 MCQs. There is a break after part 1. Part 2 is a 3.5 hour long test consisting of 38 clinical cases. Each case is a clinical story provided regarding a patient and is followed by short answer questions (you have to type short answers) and short menu question (you have to pick answer(s) from a menu of options).

As this exam has replaced the MCCEE, the content of this exam is also changing starting 2019. The exam will test content at the level of someone who has graduated medical school and is ready to start residency. It will test content from the following subjects:

1. Adult Medicine and Surgery
2. Peadiatric Medicine
3. OB GYN
4. Psychiatry
5. Population health and Ethics

They don’t disclose what percentage of the question will be from each field of medicine but anecdotal evidence suggests it’s an even split among the 5 subjects. Among these subjects, the questions will be structured to assess the following aspects of diseases:

• Health promotion and injury prevention (20%)
• Acute (35%)
• Chronic (30%)
• Psychosocial aspects (15%)

Questions will be structured to test candidates regarding the following activities:

• Assessment/diagnosis (45%)
• Management (35%)
• Communication (10%)
• Professional behaviours (10%)

If the above information was confusing, here is the chart from the MCC website which will hopefully make it a bit more clear.

NAC OSCE or National Assessment Collaboration Objective Structured Clinical Exam

This is a OSCE format examination that is available only in certain cities in Canada, on certain dates only. You can take this exam up to 3 times, even if you pass the first time to improve your score.

It is a 3 hour exam consisting of 11 clinical stations, however the whole test day process takes around 7 hours. Each station will have an examiner who will guide you through what task you have to perform with a standardized patient. Tasks could include taking and history or performing a physical examination for a specific problem. Most stations will also have questions the examiner will ask you before the end of the station. The stations will be regarding scenarios dealing with Internal Medicine, Surgery, OBGYN, Paediatrics, Psychiatry, Preventative medicine and  Community health.