Format of the Examination in Clinical Pharmacology and Toxicology - 2023
About the exam
Purpose
The purpose of the examination is to assess the candidate’s clinical competence and readiness to practice. The exam is developed by the Clinical Pharmacology and Toxicology examination board which is made up of experts in the field. All questions are reviewed by members of the examination board, made up of practicing Canadian physicians. In addition, the exam is reviewed by an exam quality reviewer, a linguistic reviewer for translation accuracy, and a Royal College editor.
The content of the examination is based on a blueprint that reflects the Competencies in Clinical Pharmacology and Toxicology and the depth of knowledge required for the examination to ensure that the examination reflects relevant clinical practice in Clinical Pharmacology and Toxicology All candidates are strongly encouraged to read the blueprint and the Competencies thoroughly.
Passing the Exam
The Royal College Examination in Clinical Pharmacology and Toxicology is a written-only examination. The pass score is 70%.
Questions that were overly difficult, fail to distinguish between low and high scoring candidates, 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. The exam scores are then reviewed by a panel of subject matter experts in a standard setting process and adjusted, if appropriate, to ensure the exam is set at an appropriate standard for candidates entering unsupervised practice.
Overall Format of the Examination
The format of the examination is provided in the table below:
Component | Format | Number of Items | Total Test Time |
Written | Paper 1: SAQ | ~45-55 | 3 hours |
Written Examination
Objective of the Written Examination
The written component measures knowledge and application of knowledge necessary to function as a competent specialist in Clinical Pharmacology and Toxicology. Most questions will concentrate on the Medical Expert role, but some can also assess the intrinsic CanMEDS roles (Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).
Content of the Written Examination
The content of the examination is based on a blueprint that reflects the Competencies in the Specialty of Clinical Pharmacology and Toxicology. The content is balanced to ensure an appropriate representation of the domains relevant to Clinical Pharmacology and Toxicology. Typical areas of knowledge assessment and percent marks on the examination are included in the table below.
Classification | % Marks* |
1. Pharmacokinetics | 5 – 10 |
2. Pharmacodynamics | 5 – 10 |
3. Drug safety and ADR | 5 – 10 |
4. Drug interactions (CYPs, transporters) | 5 – 10 |
5. Research methodology (clinical trials, N-of-1 trials and observational studies) | 5-10 |
6. Pharmacoepidemiology and Pharmacosurveillance | 5 – 10 |
7. TDM plus analytical methodology | 0 – 5 |
8. Drug development including phases | 0-5 |
9. Substance use | 5-10 |
10. Research ethics | 0 – 5 |
11. Adherence/compliance | 0 – 5 |
12. Industry influence | 0 – 5 |
13. CAM | 0 – 5 |
14. Pharmacogenetics | 5-10 |
15. Tolerance and withdrawal | 0-5 |
16. Toxicology | 10 – 15 |
17. Therapeutics | 20 – 25 |
*The ranges are approximate and may vary slightly
Scoring of the Written Examination
Each short-answer question is created with a list of model answers. 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. Members of the Examination Board score short-answer questions, and discuss with their colleagues to ensure any correct responses outside of the anticipated model answers are given appropriate marks. If a candidate provides more responses than requested, only the first responses corresponding to the number of answers required will be considered in marking. Marks are only awarded for correct answers; no marks are deducted for incorrect responses. Be as brief and direct as possible.
Sample Questions from the Written Examination
Additional Information
To access examination dates, view Deadlines, dates and locations.
To access information on online exams, how exams are developed, exam format, pass rates, and tips on how to study for the exam, view Prepare for exams.
To access information on what to expect on exam day: FAQs, identification requirements, conflict of interest, candidate conduct, and more, view Exam day.
To access information on results dates, how to access your results, data verification, and more, view Results.
Terminology used in the Examination
All candidates should be aware that regional differences in terminology may not be reflected in the exam. The terminology used in the exam has been vetted by the Royal College’s team of language professionals in close collaboration with a linguistic reviewer, who is a physician. It reflects standard terminology appropriate for your specialty.
Royal College exams routinely include abbreviation and acronym definitions. However, abbreviations and acronyms that are common knowledge to clinicians are not spelled out (e.g. MRI, CT, ECG, IV, BMI, HIV, CBC, etc.). The same practice applies for clinical trial names, with exceptions for when candidates are being asked to define or explain the trials themselves.
Below is a table that includes explanations of specific terms used in exam questions.
MOST likely | refers to the response most likely for that clinical scenario |
INITIAL | refers to the first step you would take in that specific clinical scenario |
NEXT | refers to the next step you would take in that specific clinical scenario |
ASSESSMENT | refers to the clinical assessment for that scenario, which would include history, physical examination, bedside point of care testing (but would not include lab investigations) |
INVESTIGATIONS | refers to all investigations for that specific clinical scenario, and may include laboratory, diagnostic imaging, ECG, referral to other specialties/ subspecialties, etc. |
TREATMENT | refers to all therapies for that specific clinical scenario and may include pharmacological treatments, non-pharmacological treatments, surgical therapies, fluids and electrolytes, nutritional therapies, education, counseling, and follow-up |
MANAGEMENT | refers to the steps you would take in the clinical assessment, investigations, and/or treatment for that specific clinical scenario |
Reference and Study Materials
For sources with multiple editions, please refer to the most recent edition. In the event that a textbook has been published in the last 12 months answers will also be accepted from the previous edition of the textbook.
The Royal College exams follow the Canadian and/or American “standard of care” for clinical practice, and clinical practice guidelines published in Canada and the United States. In the absence of Canadian or American guidelines and when relevant, candidates may reference guidelines from other international organizations.
Study materials include, but are not limited to:
Sample textbooks
- Goodman and Gilman
- Goldfrank’s Toxicologic EmergenciesClinical Epidemiology: The Essentials 2020 Katzung Basic and Clinical Pharmacology
Sample Journals
- Clinical Pharmacology and Therapeutics
- British Journal of Clinical Pharmacology
- Clinical Toxicology
- Journal of Medical Toxicology
Other Resources
Questions?
To ensure fairness to all candidates, all of the information that can be shared about the format of the examination is available in this document. If you require clarification on the content of this document, please contact credentials@royalcollege.ca.
Updated June 2023
