Exam technique

How the exam works

• 230 multiple choice questions in two sections of 115, with up to 2 hours 40 minutes for each section and an optional break between them. It is one day, on a computer, at a Prometric centre in Canada or abroad.
• Each question has three to five options and one best answer.
• Some of the 230 are pilot questions that do not count. You cannot tell which, so treat every question as if it counts.
• Wrong answers do not lose marks. Never leave a question blank.
• Some questions include photographs, diagrams, X-rays, ECGs or tables. Normal lab values are given in the question when they matter.
• Results are reported on a scale of 300 to 600, and the pass score is 439. It is criterion referenced, so you are measured against a standard, not against the other candidates.
• Since April 2025 the exam is multiple choice only; the short-answer clinical decision-making cases have gone.

The section rules

• Inside a section you can move freely. You can skip a question, flag it, and come back to it before you submit the section.
• Once a section is submitted, you cannot go back to it. Check your flags before you submit.
• The break comes between the two sections. Use it: eat, drink water and walk, even if you feel fine.
• MCC Vault's full mocks follow the same rules, so you practise them in weeks 7, 11 and 15 and twice in week 20.

Pacing

• 2 hours 40 minutes for 115 questions is about 83 seconds a question.
• Checkpoints in each section: about question 40 at 55 minutes, question 80 at 1 hour 50 minutes.
• Aim to finish your first pass with about 15 minutes to spare for flagged questions.
• If a question has taken more than about 2 minutes, choose your best answer, flag it and move on. Time on one hard question is taken from easier ones later.

How to use flags

• Always answer before you flag. If time runs out, a flagged question with an answer can still score; a blank one cannot.
• Flag only real doubt between two options. Flagging half the section leaves no time to review.
• On review, change an answer only for a clear reason, such as a detail you missed in the stem. A vague feeling is not enough.

Reading a question

1. Read the last line first. "Most likely diagnosis", "most appropriate next step" and "most appropriate initial management" are different questions with different answers.
2. Read the stem once, carefully. Note the age, the setting (family practice, emergency department, rural clinic), the vital signs and how long things have been going on.
3. Predict the answer before you look at the options. If your prediction is there, it is usually right.
4. Then read every option. More than one can be partly right. Choose the best one for this patient, now.
5. Eliminate. Rule out options that are wrong, unsafe or not available in this setting, then choose between what is left.

Choosing between two good options

• An unstable patient: airway, breathing and circulation come before tests and before definitive treatment.
• "Next step": the answer is often the action or test that has to come first, not the final treatment.
• Canadian practice: choose what Canadian guidance would do, such as Hypertension Canada, Diabetes Canada, the Canadian Cardiovascular Society, the SOGC, the Canadian Paediatric Society, the Canadian Immunization Guide and CANMAT. Where Canada differs from the US or UK, the Canadian answer is right.
• The law and the system: for consent, reporting and the health system, answer with Canadian law and the principles the Medical Council of Canada's objectives describe, not the rules of another country.

Population health, ethics and law

• This is about one sixth of the exam. Questions test what a safe new physician would do: respect a capable patient's choice, report when the law requires it, disclose errors, and protect confidentiality except where a clear exception applies.
• Look for the least harmful, most honest option that respects the patient, then check it is legal.

The week before and the day

• In the last week, do a full rehearsal at the same time of day as your exam, with the break.
• Sleep matters more than one more topic. Stop heavy study the evening before.
• Bring the identification the Medical Council of Canada asks for, arrive early, and check the current rules on mcc.ca and in your physiciansapply.ca account.