Format of the Examination in Psychiatry –  2024

About the Exam

Purpose

The purpose of the examination is to assess the candidate’s clinical competence and readiness to enter clinical practice. The exam is developed and reviewed by the Psychiatry examination board, which is made up of practicing Canadian physicians who are recognized content experts. In addition, the exam is reviewed by a 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 Objectives of Training/Competencies in Psychiatry and the depth of knowledge required for the examination to ensure that the examination reflects relevant clinical practice in Psychiatry. All candidates are strongly encouraged to read the blueprint and the Objectives of Training/Competencies thoroughly.

Passing the Exam

The Royal College examination in Psychiatry consists of a written and an applied component. The written component of the examination will be taken before the applied, and only those candidates passing the written examination will be invited to the applied examination. The pass score is 70% for each component.

The examination is decoupled, and due to the standalone nature of each exam component, a candidate that is successful at the written component but not successful at the applied will not be required to retake the written component on their subsequent attempts.

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 a proper standard for candidates entering unsupervised practice.

Overall Format of the Examination

The format of the examination is provided in the table below:

For more information on the breakdown of the station time (for example, if there is reading time) please consult the Candidate Information Session document for your specialty at Information on applied exams at hotel sites closer to your exam date.

Written Examination

Objective of the Written Examination

The written examination measures knowledge and application of knowledge necessary to function as a competent specialist in Psychiatry. Most questions will concentrate on the Medical Expert role, but some can also assess the other 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 Objectives of Training/Competencies in Psychiatry. The content is balanced to ensure an appropriate representation of the relevant domains. Typical areas of knowledge assessment and a range of percent marks on the examination are included in the table below.

*The ranges are approximate and may vary slightly

The subjects covered in this examination will include, but are not limited to: general adult psychiatry (inpatient, outpatient, and community), child psychiatry, geriatric psychiatry, forensic psychiatry and medicolegal issues, consultation-liaison psychiatry and neurology, severe and persistent mental illness, addictions, emergency psychiatry, psychotherapy (supportive, psychodynamic, cognitive-behavioural therapy, family therapy, group therapy, dialectical behaviour therapy, interpersonal therapy, mindfulness, motivational interviewing, , relaxation and other evidence-based psychotherapies), psychopharmacology, somatic therapies, complementary therapies, physiology, genetics, normal/abnormal development, normal aging, neuroanatomy, neurochemistry, neuroimaging, investigations, psychological testing, phenomenology, epidemiology, statistics, research methodology, public health principles, ethics, health care legislation, and clinical issues arising in patient care.  Psychiatric disorders that may appear on the exam include, but are not limited to: Anxiety Disorders; Bipolar and Related Disorders; Depressive Disorders; Neurocognitive Disorders; Obsessive-Compulsive and Related Disorders; Personality Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Substance-Related Disorders; Trauma- and Stressor-Related Disorders; Disruptive, Impulse-Control and Conduct Disorders; Dissociative Disorders; Elimination Disorders; Feeding and Eating Disorders; Gender Dysphoria; Neurodevelopmental Disorders; Paraphilic Disorders; Sexual Dysfunctions; Sleep-Wake Disorders; Somatic Symptom and Related Disorders.

The whole exam is reviewed by an exam quality reviewer before it is deemed by the exam board to be acceptable. This person is a Psychiatrist who has recently passed the exam and has completed several years of practice. The purpose of this review is to determine if the length and difficulty/content is appropriate for the purpose of the examination.

Scoring of the Written Examination

Each multiple-choice question is created with a single best answer. Scoring is an automated computer process through the online exam platform.

Sample Questions from the Written Examination

SAMPLE MCQ QUESTIONS

Applied Examination

Objective of the Applied Examination

The applied examination is designed to evaluate higher order thought processes and clinical reasoning compared to knowledge and application of knowledge assessed in the written component. Stations can assess different and multiple CanMEDS roles (Medical expert, Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

Due to the number of candidates, the applied exam will be delivered on multiple days. The stations for each day will be designed to be equivalent in difficulty, based on the blueprint, but will consist of different clinical scenarios.

Examiners may interrupt the candidate to probe for answers, as well as to move the station forward so that the candidate is able to demonstrate their knowledge/clinical reasoning in the allotted time. Examiners may take notes during the stations and have been instructed to appear ‘neutral’ in their reaction to answers. They have been instructed not to provide feedback directly to the candidates. Observers may be present during some stations of the examination. These observers will not interact with the candidate or the examiners, or contribute to the candidate’s scores in the station. They are there to observe the conduct of the examination process.

The format of the applied exam allows candidates to be examined by multiple examiners across a number of stations. For this reason, you may be examined by an examiner from your center. Significant conflicts (e.g. a program director or mentor) are identified and avoided in scheduling your examination.

Content of the Applied Examination

The content of the examination is based on a blueprint that reflects the Objectives of Training/Competencies in Psychiatry. The content is balanced to ensure an appropriate representation of the relevant domains. At each station, candidates may be asked to address multiple clinical scenarios. The applied examination may include stations that cover:

• Recognition of phenomenology
• Diagnostic skills
• Risk assessment skills
• Mental status examination skills
• Physical examination skills
• Case formulation skills
• Interpretation of radiological studies or laboratory investigations
• Clinical Reasoning
• Ethics
• Development of a management plan
• Prescribing treatment and writing orders
• Counseling skills and psychotherapeutic skills
• Writing consultation letters or reports
• Oral presentation skills
• Communication skills
• Evaluation of scientific literature
• Critical appraisal
• Collaboration, Health Advocacy and Leadership

Some of the issues that you may encounter in the exam include:

• There may be a video for the candidate to watch and then proceed to answer questions from the examiner related to the video.
• There may be a written clinical vignette followed by questions from the examiner.
• Stations may also involve interpretation of laboratory or medical imaging reports or creation of a consultation note or set of orders for a case.
• Stations will likely require the candidate to answer a series of questions based upon the case/video/lab results.
• There may be some role-playing scenarios with the examiner. Example: explaining how one would counsel a patient regarding the side-effects of medications.
• Further instructions will be given to the candidate during the station when they are necessary for the understanding of the task.
• There will not be any simulated patients present at the OSCE examination.
• Videos may be of simulated or volunteer patients who have given appropriate consent.
• These stations may include role play with Family Physicians, healthcare or other professionals, patients or family members.

This section of the examination is designed to evaluate more complex thought processes; management concepts with cases from the whole realm of the Objectives of Training/Competencies at the depth of expertise may be covered. It will also delve further into some of the intrinsic CanMEDs roles.

To ensure relevance and clarity, the exam questions and scenarios are all developed and reviewed by the examination board consisting of practicing Canadian Psychiatrists. Before being deemed acceptable the cases are vetted and edited by a panel. All questions are supported from inception by literature references. They are categorized by the CanMEDs roles they evaluate as well as by primary and secondary categories of information being evaluated. The examination is then assembled based on a blueprint designed to cover an appropriate variety of pertinent topics, i.e. all aspects of the Objectives of Training/Competencies are covered.

Scoring of the Applied Examination

A global rating scale (GRS) will be used to assess relevant aspects of care demonstrated during the station. The GRS will be suited to the station and will focus on the candidate’s ability to systematically work through a case, with a focused, rational and efficient approach.

The domains measured in the stations may vary, but most commonly include a selection from the following:

•  Clinical Reasoning/Judgement (Synthesis/Integration of data)
•  Differential Diagnosis
• Clinical/Patient Management
• Evidence Based Decision Making (Scholarly Knowledge)
• Intrinsic CanMEDs roles – Communication – e.g. clarity of expression, rapport building and / or information delivery / counseling skills
• Knowledge
• Intrinsic CanMEDs roles - Health Advocate
• Diagnosis
• Patient Safety and Risk Assessment
• Formulation
• Ethics
• Data Interpretation
• Investigations
• Intrinsic CanMEDs roles - Collaborator
• Intrinsic CanMEDs roles - Leader
• Intrinsic CanMEDs roles - Professionalism

To see the generic behavioural anchors for these domains, please see the GRS template. Note that the behavioural anchors for your specialty may vary somewhat from these.

Each station is weighted equally; station scores are combined and averaged to create an overall score for the applied examination.

Expected answers to all questions are produced for each case. They are then reviewed by the board to ensure that any acceptable alternate answers are noted for acceptance. There is a further meeting of the exam board to train the examiners in all possible answers that could be presented and how to guide the candidate back to the oral stem such that an unexpected but acceptable answer doesn’t disadvantage the candidate as they progress through the case.

Sample Station from the Applied Examination

SAMPLE STATION

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, conflicts 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.

Reference and Study Materials

For sources with multiple editions, please refer to the most recent edition. In the event that a textbook or guideline 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

• Kaplan and Sadock's Comprehensive Textbook of Psychiatry (2017) Benjamin J. Sadock, Virginia A. Sadock, Pedro Ruiz MD
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Sample Journals

• The Canadian Journal of Psychiatry

Sample Guidelines

• Canadian Clinical Practice/Treatment Guidelines
• American Psychiatric Association Treatment/Practice Guidelines

Other Resources

• DSM-5 and DSM-5-TR. In all components, candidates are advised to be familiar with the DSM classification systems in Psychiatry. Both the DSM-5 and DSM-5-TR will be accepted for the 2024 exam.

        Please note that only DSM-5-TR will be accepted for the 2025 exam.

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: April 2024