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Prepare for exams

How exams are developed

Each specialty and subspecialty has an examination board comprising content experts from across Canada. Editors, translators, linguistic reviewers, item creators, item reviewers and other content experts are involved in the exam development process.

Exam Development
Topic Information
Objectives of Training or competencies The exam is based on the Objectives of Training or competencies of the specialty or subspecialty. To access this document, visit the Information by discipline.
Create exam blueprint A blueprint of the exam is created based on the Objectives of Training or competencies. The blueprint for your specialty or subspecialty may be found in the Exam Format document.
Create exam items Items are created by content experts.
Items reviewed by examination board Items are reviewed and edited by the Examination Board for accuracy and clarity.
Items are edited and translated Items are edited and translated for readability and appropriate language.
Items are reviewed by linguistic reviewer Items are reviewed by a linguistic reviewer who is also a content expert and part of the examination board.
Exam is reviewed as a whole The exam is reviewed as a whole by members of the examination board.
Exam administration The exam is administered to candidates.
Psychometric analysis During this process, questions that were overly difficult, non-discriminating, or for which new evidence emerged between the time of question writing and exam administration are reviewed. As a result of this review process, some questions may be deleted from the final exam score for all candidates.
Data verification A thorough process of data verification and quality assurance of exam results is conducted during and after the exams.

Exam Format

The Exam Format document will detail the exam components, process and timing, reference materials and practice questions, if applicable.

Information by Discipline

To access this document, visit the Information by discipline. Choose your specialty or subspecialty from the dropdown menu. Click on the “Exam Format” document.

Written exams

Written exams could refer to a Multiple Choice Question (MCQ) exam and/or a Short Answer Question (SAQ) exam. For information about the format of your specialty or subspecialty examination, review the Exam Format document.

Written-before-Applied (oral/OSCE)

Anticipating the transition to Competence by Design (CBD), examination components are being blueprinted independently for the written and the applied (oral/OSCE) examinations in certain disciplines. Therefore, beginning in 2020 the Royal College will be carrying forward successful results at the written component of a specialty examination for subsequent years, if the candidate is not successful on the applied exam i.e. if a candidate is successful at the written component, and in the case of a fail or inability to challenge the applied component, they will not be required to challenge the written component again - they will only be required to register for the applied component in any subsequent year, until such time as their eligibility expires.

Aligned with this practice, candidates who are not successful on the written examination will NOT be invited to challenge the applied examination and will be refunded that portion of the examination fee.

Who does this affect?

The written-before-applied format applies to the following specialties in 2020:

  • Internal Medicine
  • Psychiatry
  • Pediatrics
  • It will apply to other specialty examinations in the future, at latest when the first CBD cohort presents to the examination.

Multiple-choice question exam information

The Royal College's examinations are used to determine if a candidate has reached an acceptable level of competence based on the objectives of training of their specialty. Multiple-choice questions are used to assess candidate's knowledge and ability to apply this knowledge over a wide range of content areas.

What should you expect? A description of RCPSC Multiple-Choice Questions

Royal College multiple-choice questions consist of a stem and four options. Of these options, there is only one correct answer and three distractors. An answer sheet will be provided for you to record the best response for each question.

Typically, the questions conform to a format similar to that of Example 1 below:

Example 1

Which of the following pulmonary function tests is increased in patients with advanced pulmonary fibrosis and emphysema?

  1. Vital capacity
  2. Maximum breathing capacity
  3. Tidal volume
  4. Residual volume

(Correct answer is 4.)

Each page of the multiple-choice question booklet consists of both English and French versions of the same questions.

Helpful Hints

  • Since all multiple-choice questions are marked by an optical scanner, use only the pencil provided to completely blacken the answer sheet oval with your chosen responses to ensure that the scanner can properly identify your answers. If you choose to change an answer, erase completely.
  • Any question with more than one marked answer will be considered incorrect.
  • Manage your time wisely. Note the number of questions and the time allotted for the examination. You may want to skip over questions that you may find difficult for further consideration after you finish the rest of the questions.
  • If you don't know the answer to a question, guess. There is no penalty for incorrect answers.
  • Do not be late for the examination.
  • Pay attention to the examination instructions that the invigilator will provide prior to the exam administration.

Short answer question exam information

The Royal College’s examinations are used to determine if a candidate has reached an acceptable level of competence based on the objectives of training of their specialty.

What are Short-Answer Questions (SAQs)?

Many Royal College specialty examinations have an SAQ component. SAQs are questions that can be answered in a few short words or phrases. Typically, these questions contain words such as ‘list’ or ‘name’ suggesting that a series of short responses are required.

Each SAQ will usually consist of the question, a space where the candidate can provide his or her answer as well as the mark allocation for the question.

Different Kinds of SAQs

Short-answer questions can vary in terms of complexity. For example, the following question requires recall of factual knowledge at a low level of complexity:

Example 1:

List THREE medical specialties with Royal College certification exams. Total Marks
a) 2
b) 2
c) 2

More complex questions are usually based on case scenarios (sometimes called clinical vignettes). These questions can elicit application of knowledge or clinical reasoning. As well, a series of questions may be based on these scenarios building on case information.

Example 2:

51 year old man is diagnosed with Barrett’s esophagus. Total Marks
a) What is the BEST treatment option that should be pursued? 2
b) List 4 steps in the pathogenesis of Barrett’s esophagus. 4
c) List one ongoing clinical issue that needs to be addressed pertaining to the long-term health of this patient of enrolling him in a surveillance program. 2

How are SAQs marked?

Each short-answer question is created with a list of anticipated ‘model’ responses. This list is used to guide the markers as to the value of the responses when scoring the question. Partial marks may be allocated for some responses.

Example 3 below contains a question with a model response list.

Example 3:

Question: You see a 45-year-old man in your office for headaches. The headaches started one year ago and have been increasing in frequency. They now occur four to six times per month. With each headache he misses three to four days of work. You suspect he suffers from migraine. Total Marks
a) List FOUR clinical features of migraine. 2
List TWO prophylactic medications for migraine. 2
Model responses for Example 3:
a) One-half mark for each (maximum two marks)
  • throbbing
  • associated with nausea/vomiting
  • associated with photo/phonophobia
  • hemicranial pain
  • preceding aura
  • inability to continue with daily activities
  • relieved by sleep
b) One mark for each (maximum two marks)
  • amitriptyline
  • propranolol
  • flunarizine
  • valproic acid

The use of a model response list helps guide the markers to assess the responses with little or no interpretation. With this in mind, candidates should provide the answers that are most obvious and correct.

Helpful Hints

  • Make sure your handwriting is legible. Examiners can only give credit for what they can read.
  • Avoid rambling answers. Answers to SAQs are to be concise and direct. An essay answer is neither required nor recommended.
  • Carefully re-read the question and the answer. Ensure that the response you provide is the best answer to the question
  • Note the number of questions and the time allotted for the examination. Manage your time wisely. You may want to skip over questions that you may find difficult for future consideration after you finish the rest of the questions.
  • Do not be late for the examination.
  • Pay attention to the examination instructions that the invigilator will provide prior to the exam administration.

Applied (Oral/OSCE/practical) exams

Applied exams take place in Ottawa at the Royal College or La Cité. Applied exams are sometimes referred to as “live exams” and may include an oral, OSCE, and/or practical examination.

For information about the format of your specialty or subspecialty examination, review the Exam Format document.

Applied exam information What happens at a typical applied examination?
  • At registration, you will be asked to present a piece of government-issued photo ID and all electronic devices (cell phones, digital/smart watches) will be collected. Wallets, keys and other loose belongings will also be collected. All other personal belongings, such as purses, bags, suitcases, can be placed in cabinets provided at the reception on the exam floor. Please note that study materials are not permitted in the waiting room after you have registered.
  • After registration, you will be shown to the waiting room. Royal College staff will give you a 5-10 minute warning before orientation is scheduled. Washrooms will be available at this time.
  • A candidate orientation information session will take place with the chair or director of the examination board and the Royal College exam lead.
  • After the information session, you will be escorted to the exam floor by Royal College staff and will be placed in front of your first examination room.
  • All personal belongings will be returned to you upon completion of the exam or at the end of the sequestering period, if applicable.

When is sequestering required?

Sequestering may be required following the examination in order to ensure that candidates do not communicate the content of the examination to others preparing to take the examination.

Please note that all personal belongings including electronic devices will not be accessible until the sequestering period is finished. Respect the sign in times on the appointment letter to ensure the sequestering period is as short as possible for all candidates.

Pass rates

Fully Canadian trained, first-attempt Candidates
Spring and Fall Sessions 2017-2019

The following table summarizes the average pass rates for residents in Canada, in percentages, for all Royal College specialties and subspecialties certification examinations over the last three years.

Note: *This data reports only the pass rate for those candidates with MD from Canadian universities AND FITERS completed in Canadian programs AND those taking the examination for the first time. This is referred to as the CMDPG category. In previous years, the CRAFT candidate group was used as reference. If this report is compared to previous years, the average number of CMDPG candidates may be considerably less than previous CRAFT candidate groups.

*Only specialties and subspecialties that had an average of five or more CMDPG candidates registered at the certification examinations for the last three years have been posted.
Due to the limited number of candidates for some specialties, average pass rate statistics cannot be reported in order to maintain confidentiality.

CMDPG Candidates only

Three-year average



Standard Deviation


Adolescent Medicine

- - -

Anatomical Pathology

97.4 2.3 26


95.0 0.9 113

Cardiac Surgery

94.4 9.6 6

Cardiology (adult)

94.2 3.4 46
Cardiology (pediatric) - - -

Child and Adolescent Psychiatry

93.3 11.5 26

Clinical Immunology and Allergy

100.0 0.0 13

Clinical Pharmacology and Toxicology

- - -

Colorectal Surgery

94.4 9.6 8

Critical Care Medicine (adult)

96.9 2.7 34
Critical Care Medicine (pediatric) 85.6 10.6 7


98.1 1.7 33

Developmental Pediatrics

- - -

Diagnostic Radiology

96.9 0.5 85

Emergency Medicine

99.0 0.9 69

Endocrinology and Metabolism

95.5 5.4 33

Forensic Pathology

- - -

Forensic Psychiatry

90.0 17.3 10


100.0 0.0 32

General Internal Medecine

93.1 2.5 98

General Pathology

- - -

General Surgery

96.1 2.4 88

General Surgical Oncology

100.0 0.0 6

Geriatric Medicine

96.8 2.8 21

Geriatric Psychiatry

100.0 0.0 13

Gynecologic Oncology

96.3 6.4 7

Gynecologic Reproductive Endocrinology and Infertility

91.5 7.5 9

Hematological Pathology

- - -


93.8 2.4 31

Infectious Diseases

92.5 10.4 29

Internal Medicine

97.5 1.6 554

Interventional Radiology

- - -

Maternal-Fetal Medicine

- - -

Medical Biochemistry

- - -

Medical Genetics

- - -

Medical Microbiology

96.3 6.4 12

Medical Oncology

95.4 4.0 42

Neonatal-Perinatal Medicine

83.8 7.7 7


95.8 4.6 25


98.4 2.8 44


- - -


- - -


98.1 3.2 14

Nuclear Medicine

92.5 6.6 8

Obstetrics and Gynecology

98.5 1.3 89

Occupational Medicine

- - -


100.0 0.0 38

Orthopedic Surgery

96.9 1.5 56

Otolaryngology - Head and Neck Surgery

95.3 5.5 29

Pain Medicine

83.8 14.7 8

Palliative Medicine

- - -

Pediatric Emergency Medicine

98.1 3.2 15

Pediatric Surgery

- - -

Pediatric Hematology/Oncology

- - -

Pediatric Radiology

78.8 17.1 7


93.9 4.8 134

Physical Medicine and Rehabilitation

96.3 3.4 20

Plastic Surgery

98.6 2.4 23


98.2 0.9 133

Public Health and Preventive Medicine

87.7 0.3 19

Radiation Oncology

97.9 3.6 15

Respirology (adult)

93.8 2.8 33
Respirology (pediatric) - - -


97.7 2.1 28

Surgical Foundations

94.2 3.0 319

Thoracic Surgery

- - -


94.3 4.3 30

Vascular Surgery

94.2 5.0 10

Studying for the exam

The Objectives of Training document contains useful information regarding the content for your specialty or subspecialty examination. Also, the Exam Format document will often list reference materials and practice questions that are specific to your specialty or subspecialty.

To access these documents, visit the Information by Discipline. Choose your specialty or subspecialty from the dropdown menu. Click on the “Objectives of Training” or “Exam Format” document displayed at the bottom.

Exam Tips

Tips for writing the Exam
Exam Type Information
MCQ Tips for the Multiple Choice Question (MCQ) exam:
  • Ensure each mark completely fills the circle. See an example of a poorly-filled out scantron sheet.
  • Completely erase a mark you wish to change.
  • Make no stray marks on the answer sheet.
  • Mark only one answer for each question. Multiple marks will be counted as wrong.
  • Ensure you identification number is correctly recorded.
  • Only answers on the answer sheet will be scored.
  • It is to your advantage to answer every question, even if you are not satisfied that you know the correct answer.
SAQ Tips for the Short-Answer Question (SAQ) exam:
  • Use a ball-point or fountain pen only.
  • Write or print as legibly as possible.
  • Be as brief and as direct as possible, making use of the space provided after each question.
  • If a specific number of answers is requested (e.g. list FOUR), do not list more than requested as they will not be marked (e.g. if four are requested, only the first four will be marked).
  • Please make sure that you have completed all pages of the exam booklets.
  • Please affix your candidate number sticker in the space provided on the COVER PAGE of each booklet.

Recommended study tools

Take a look at this guide that has recommended study tools to help you prepare for your Royal College exam.

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