Your strategy for how to prepare for the MCCQE Part I will involve more than content revision. The MCCQE Part I is the first step in your long journey to become a licensed physician in Canada. In this blog, you will learn what the exam consists of, how to follow the exam instructions, how the exam is scored, and what to expect on the exam day. Finally, I will give you some tips on how to prepare for the MCCQE Part I.
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What is the MCCQE Part I
The Medical Council of Canada Qualifying Examination (MCCQE) Part I is a cumulative exam that assesses your medical knowledge and clinical decision-making ability as you complete your medical degree and get ready to become a medical professional in Canada. The exam is based on the Medical Council of Canada (MCC) Objectives, which are outlined under the CanMEDS roles. Successful completion of the exam at the end of medical school demonstrates your readiness to enter supervised practice.
Tip: As you are getting ready for the exam, be mindful of the CanMEDS professional roles and objectives. For example, the medical expert role, which is the overarching task of a future medical professional, covers objectives such as clinical presentation/diagnosis, population health and its determinants, ethics, legal and organizational aspects of medicine. These objectives outline what is expected from a Canadian physician. When you’re getting ready for the exam, it is important to go through each CanMEDS role and associated objectives and carefully read the related key and enabling objectives. As you’re studying, pay attention if your knowledge or skill for any of the roles or objectives is weak. If so, organize your studies to address these weaknesses.
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What is on the Exam
Students typically write the MCCQE Part I as they are finishing medical school. International medical graduates have to write this exam after passing the NAC OSCE. The MCCQE Part I is a one-day, computer-based test. The exam day is divided into two parts. You will have up to four hours in the morning session to complete 210 Multiple-Choice Questions by choosing a single best answer of 5 choices. In the afternoon session, you will have up to three and a half hours for the Clinical Decision-Making component, consisting of 38 cases with 1-4 questions per case with short-menu and short-answer write-in questions. Both sections of the exam are designed to assess your performance across two broad categories:
- Dimensions of care, covering the spectrum of medical care
- Physician activities, reflecting a physician’s scope of practice and behaviors
Each category has four domains, and each is assigned a specific content weighting on the exam. Dimensions of care include domains like health promotion and illness prevention, acute, chronic, and psychological aspects. Physician activities category has an additional four dimensions, including assessment/diagnosis, management, communication, and professional behaviors.
The Multiple-Choice Questions (MCQ)
The first component of MCCQE Part I consists of 210 questions, but 35 of them are pilot questions that will not have an effect on your total score. And while the pilot questions are not scored, they are not identified as pilots on the test. It is in your interest to do as well as you can on every question. Each MCQ consists of a question or scenario and five options, of which only one is correct. You must select only one answer. You will have a maximum of four hours to complete this section of MCCQE Part I.
The entire MCQ section will be presented in a single block, so you will see all the questions before you. You can navigate freely between the questions, go up or down in the list, or flag questions you’re unsure about and return to them at any point during MCQ portion of the exam. Certain questions will have pictorial material such as photographs, diagrams, x-rays, electrocardiograms, and graphic or tabulated material. If relevant to a question, you will be presented with the normal lab values directly in the question.
To answer a question, simply click on the text of that option. You can always change your answer by clicking on a different option. There is no penalty for answering incorrectly, so make sure to answer each question, even if you’re unsure if you’re correct. You are only required to submit the MCQ portion of the exam once, when you have completed the component and are ready to submit, or when the allotted four hours expire. Once you submit this section of MCCQE Part I, you may not go back to change your answers.
Clinical Decision-Making (CDM)
This component of the exam consists of 38 case descriptions with one or more questions. Each description and question set assesses problem-solving and decision-making skills in the resolution of a clinical case. You may be asked to:
- Elicit clinical information
- Order diagnostic procedures
- Make a diagnosis
- Prescribe therapy
Remember, it’s important that your decisions reflect the assessment of an actual patient. In total, you will be asked from 60 to 70 questions related to 38 CDM cases. The questions will be presented in a short-menu or write-in format. You will have a total of 3.5 hours to complete this portion of the exam.
All the cases and questions are presented in a single block – you will have all the questions in front of you. Some of the questions might have photographs, diagrams, x-rays, and other pictorial material. You will also be presented with the normal lab values directly in the CDM question, if necessary. Make sure you answer all the questions – there is no penalty for answering the questions incorrectly. However, you will receive a score of zero on a question if you exceed the maximum number of allowable responses or select a response that is considered harmful or dangerous to the patient. Of the 38 CDM cases, eight are pilot cases that do not count towards your total score. Remember, as with the MCQ pilot questions, CDM pilot questions are not identified in any way, so you must answer all questions you see to make sure you do not miss anything. You must submit this portion of the exam once you complete it or when the allotted 3.5 hours run out. Once you submit the exam, you cannot change the answers.
Each question will have different instructions and you must follow them precisely. For example:
1. Some questions specify the exact number of responses you need to select or type in (e.g. “List only one”). If you exceed the number of responses specified, you will be given a score of zero for the entire questions, even if your responses do include the correct answer(s).
2. Some questions place a limit on the number of responses to be selected or typed in (e.g. “select up to four”). Do not exceed the indicated number, but also do not feel that you need to select or list up to that number either. For example, the instruction may indicate that you can select up to 6 answers, but there may only be 3 or 4 correct answers. If you choose 6 answers just to build up to the allowed number of responses, you run the risk of choosing incorrect answers. If you select inappropriate investigations or treatments that could harm the patient, you will be given a score of zero for that question.
3. In some cases, you will need to select as many responses “as are appropriate.” It will be up to you to decide on the “appropriate” number of answers, which should be chosen based on what you would do in a real clinical situation. This means that you should not choose an excessive number of answers to ensure that you have included at least a small number of correct responses in your answer. A score of zero will be given in either case outlined below:
a. If you give an excessive number of responses. An excessive number may imply that you are over-investigating a patient. Do not blindly choose as many answers as possible.
b. If you provide inappropriate responses.
The short-menu question in the CDM portion of the exam are not unlike the multiple-choice questions of the first portion, but there’s a lot more choice. Instead of presenting you with a list of five possible answers like an MCQ, short-menu questions will typically have 10 to 30 answer options. You may be asked to select only one of the options, up to a specific number of options, or select as many options as seem appropriate. Tip: even though the questions are typically worded using plural words like “diagnoses” or “treatments”, there may be only one correct answer.
As you can tell from the name of this question format, you are expected to type in your answer. To ensure that your write-in answers receive the maximum credit possible, make sure to follow these rules:
Know What Counts as One Answer
To succeed on this qualifying exam, you need to know what counts as one answer. As I outlined in the section above, following the instructions precisely is one of the key elements of this exam. So, when a CDM question asks you to provide only one answer, be careful to write in only one. Writing more than one answer will result in a score of zero, even if the correct answer is included. For example, “airway assessment” would count as one answer, while “airway, breathing, circulation (ABCs)” would count as three answers.
Additionally, there are examples of terms that do not have inherent meaning and will be scored as incorrect unless you indicate what you mean by these terms in parentheses. If you include a clarification, your answer should be scored accordingly. For example, an answer like “extended electrolytes” will be considered inadequate, unless you indicate in the parentheses “magnesium, calcium, phosphorus” – however, this will count as three answers, so make sure you enter this type of answer only in questions that allow you to provide at least three answers.
Are you an international graduate looking to match into residency in Canada? Check out our video for tips:
How the Exam is Scored
As I mentioned previously, each section of the MCCQE Part I contains pilot questions that will not be scored, but nevertheless, must be answered, as you will not know which questions are pilot or not. Another thing to remember is that MCCQE Part I is scored independently of the MCCQE Part II. MCCQE Part I is a criterion-referenced exam. This means that those of you who meet or exceed the standard will pass the exam regardless of how well other participants perform on it.
Your MCCQE Part I score will be calculated by combining MCQs and CDMs scores. For both MCQs and CDM questions, each correct answer is scored 1 point and each incorrect answer is scored 0. Some CDM questions will include multiple correct elements, so you can receive more than 1 point per question. For example, for a question with four correct elements, you can receive up to 4 points. The total score is calculated using both the questions’ individual scores and their level of difficulty. Your total MCCQE Part I score is reported on a scale from 100 to 400 with a pass score of 226, which has been established using a standard-setting exercise. The test is scored on pass/fail basis. Your MCCQE Part I subscores will be presented graphically to indicate your relative strengths and weaknesses in each of the domains I outline in the above section. Your final MCCQE Part I result, i.e. either pass or fail, is based solely on where your total score falls in relation to the pass score, i.e. the score of 226. This pass score was recommended and approved in the latest standard-setting exercise. This pass score will remain in place until the next standard-setting exercise. Every few years, the MCC brings together a panel of Canadian physicians to define an acceptable level of performance and establish the pass score for the MCCQE Part I. The panel then recommends its pass score to the Central Examination Committee (CEC) for approval. The CEC, composed of physicians and medical educators from across the country, is responsible for awarding pass/fail results to MCCQE Part I candidates.
What to Expect on the Exam Day
If you’re taking the exam at a Prometric Test Center, you must register at the registration desk when you arrive. You must also disclose all items that you are taking into the exam.
Content Materials: Your medical school course notes and textbooks are a great place to start studying. You should begin reviewing these well in advance of your exam, ideally 6 months ahead of the test day. You will likely be in your final year of medical school when you are studying, and may not have much time, what with clerkship rotations and CaRMS applications taking up your time. As you're preparing your residency personal statement and going over residency interview questions, set aside time on set days of the week when you have free time and dedicate yourself to going over the content systematically. Ensure that you understand the objectives set out in your course materials for each topic before moving on to a new topic. You should also dedicate the last 2-4 weeks of study to doing a final review of all the important topics on the exam.
Hands-On Patient Encounters: The patient encounters you have during clerkship are critically important for you to learn and reflect on. These will be useful to you for passing the MCCQE Part I. Many medical schools require students to keep a log of their experiences, but even if your school does not require this, you should do it. At the beginning of every rotation, prepare part of a journal or a Word document for keeping track of presentations (both typical and atypical): what happened and how did the patient present? What questions helped you take a good history? Did you do a physical exam? Did you order investigations? What was the outcome? Learning from and reflecting on these experiences will help you immensely with the problem-solving parts of the MCCQE Part I.
Practice Materials: In addition to studying your school notes and going over your textbooks, you should look into purchasing a full-length preparatory examination featuring 210 multiple-choice questions and 38 clinical decision-making cases. The test comes with full answer keys including rationales and references. This is a pricey investment but it's be worth your money, as you will be able to familiarize yourself with the exam format. If you’re having problems with only one section of the exam, you can choose to purchase only the MCQ practice test forms or only the CDM practice test forms. I strongly encourage you to try the realistic test forms at least a couple of times while you’re studying. Remember, the format and instructions of this test will have an important influence on your success, so get to know the test before you have to take it!
Time Management: Remember that MCCQE Part I is a timed exam. You will have a set amount of time to complete each section. You do not have a time limit for each question or case but are given a total testing time of four hours for MCQ and three and a half hours for the CDM component. There will be a progress bar that tracks answered questions throughout the entire exam; it will not reset after you complete the MCQ section. If all the questions are answered, your progress bar should indicate 75% when finishing the MCQ section and 100% after finishing the CDM section. The computer will track how much time you have left. The computer’s clock cannot be stopped once you begin the exam. You will receive warnings as you approach 30 minutes, 15 minutes, and 5 minutes before the end of your exam. Your exam is over when you submit the exam or run out of time, whichever happens first. If you’re spending more than three minutes on a question, you should flag it and move on. You may return to the flagged questions at any time during the exam or wait until you complete the exam to see how much time you have left before you complete them.
Follow Instructions: I am repeating myself, but this is essential. The exam tests your professional knowledge and whether you can follow specific instructions. If the question instructs you to provide only one answer, do not exceed the number. You will score zero for this question, even if the correct answer is included. You must follow the instructions exactly.
Are you also thinking of taking USMLE Step 1 to match in the US?
1. Does everyone get the same examination?
No, there are multiple forms of the examination. However, each form is designed to be scored at the same level of difficulty. Each form will have been reviewed by a committee of clinicians for content approval.
2. How do I take the MCCQE Part I?
You must apply for the exam through your physiciansapply.ca account. Create your account if you do not have one. Once you pay your application fee, your request will be reviewed. Once approved, you will receive a message through your account and instruction on how to schedule your exam. Scheduling is on first-come, first-serve basis. There are more than 500 Prometric test centers across the globe with hundreds of remote proctors available, you should try to secure your desired date and location (if applicable) as soon as possible. If there is no date available at your preferred test center or through remote proctoring, please choose another date or test center.
3. How much is the MCCQE Part I application fee?
The application fee is CAD$1,305.
4. Will I be able to take notes during an exam?
Yes, you will be allowed two scratch papers and a pencil in the Prometric test center and in the remote proctoring environment. At the end of the exam, the remote proctor will ask you to show what is written on both sides and then monitor you destroying the two pieces of paper. This is captured on video for future investigation if required.
5. Are there breaks during the exam?
There is only one flexible 45-minute break that will start once you finish the MCQs component in the morning. You may take less than a 45-minute break if you wish to start the CDM component early, however this does not give you extra exam time. In addition, if you take more than a 45-minute break, your afternoon timed session will automatically start. For both exam modalities, you can take unscheduled breaks during the exam, to access food, drink and/or medication outside of the testing room. Unscheduled breaks must be managed within the allocated exam time as the timer on your exam will continue to count down. If you leave your exam for longer than 45 minutes, the proctor will terminate your exam. The routine security scan and the sign-in process must be completed upon re-entry to the exam and is estimated to take between 3 and 5 minutes.
Note: For exam security reasons, all candidates taking the exam remotely or in a test center must exit the exam room during the flexible 45-minute break to access food, cell phones, drink and/or medication.
6. What should I do if my internet connection breaks?
If your internet connection is disrupted, you can log back into the exam through the portal once connectivity is restored. You will return to the spot where you were disconnected.
7. Can I re-take MCCQE Part I if I do not pass?
Yes, although this does mean paying the fee again and may cause a delay or adjustments to your residency program if you have already matched. Speak to the administration at your medical school right away if this occurs to plan for next steps.
8. How do I manage stress as I study for the exam?
There are several tactics you can implement to manage your stress levels before the exam. Avoid dealing with stress by smoking, drinking, or eating junk food. Although you may spend most of your time studying, do not forget to take time to relax and have fun with friends and family. Don’t stay cooped up in your room all day and night studying – make sure to take walks and exercise regularly. The day before your exam, relax, eat well, and go to bed early. Do not stay up to study. When you sit down to start the interview, release neurotransmitters that put you in a positive state of mind. For example, bite on a pencil or pen with your back molars for 3-5 minutes or sit back in a chair with your arms behind your head and feet up. Activate your parasympathetic nervous system and decrease your sympathetic nervous system by doing breathing exercises with prolonged exhalations.
9. What’s the best way to study?
The best way to learn is to practice with realistic simulation and receive expert feedback. Try to go over any wrong answers with a resident or a preceptor.
10. There’s just so much material! How can I possibly learn it all?
This is a common feeling, as the MCCQE Part I is a comprehensive examination covering most of what you have learned in medical school. Don’t panic! Starting your study early with a plan is the best tip for covering everything. Ensure you have objectives for each topic (for example, don’t just say you will study “the endocrine system” today, focus on covering the presentation, diagnosis and treatment of type II diabetes in one study session). Move on to your next topic only when you feel you have learned the current topic sufficiently. Start early and do small amounts of study every day, leaving 2-4 weeks at the end to review everything one final time.
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