Format of the Comprehensive Objective Examination in INTERNAL MEDICINE

Due to the COVID-19 pandemic, the Royal College is evolving the way we deliver the 2021 exams, while keeping the safety of residents, examiners, staff and the public in mind. We are committed to providing you with information as it becomes available. Please bookmark this page and check back often as information may change. Thank you for your patience during these unprecedented times.

The Royal College Examination in Internal Medicine is a two component examination consisting of a written component and an OSCE component. The written component of the examination will be taken in early Spring, and eligibility to challenge the OSCE component will be based on performance on the written component. Only those candidates passing the written examination will be invited to the OSCE examination. The pass score is 70% for each component.

Internal Medicine has a Written-Before-Oral (WBO) format. The exams have now been decoupled, and due to the standalone nature of each exam component, candidates will not be required to retake the written after a successful result. Internal Medicine will begin using this format starting with the 2020 examinations. Therefore, a candidate that is successful at the written component but not successful at the OSCE will not be required to retake the written component on their subsequent attempts.

The Internal Medicine comprehensive objective examination assesses candidates' competence to function as an Internal Medicine consultant across the CanMEDS domains of medical expert, communicator, collaborator, leader, health advocate, scholar and professional. It consists of two components:

1. Written Examination

2. Objective Structured Clinical Examination (OSCE)

The combined written and OSCE examination is developed using a blueprint to ensure that components are well balanced. Questions are classified to a primary discipline and more than one classification may apply for a specific question. For example, hypertension can be classified under multiple disciplines including cardiology, endocrinology, and/or nephrology. The relative frequencies (in alphabetical order) with which the various disciplines are sampled across the examination are:

I. Written Component

The written component measures knowledge and application of knowledge necessary to function as a competent specialist in Internal Medicine. Most questions will concentrate on the medical expert and scholar role, but some can also assess the intrinsic competencies (Communicator, Professional, Health Advocate, Leader, and Collaborator).

A. Scheduling of the exam:

The written component takes place over a period of two days in the regional written centres across the country. For both French and English candidates, this component occurs in early spring.

B. Format:

The written component consists of two three-hour papers, with candidates completing one paper on each day of the exam. Each paper consists of approximately 95-110 multiple choice questions. Some questions will be case vignettes, which will include pertinent data from the history, physical examination, and investigations. Normal values for laboratory tests will be provided in both SI and US/Imperial units (see Appendix A).



II. OSCE Component

Due to the COVID-19 pandemic, the applied 2021 component of the examination for Internal Medicine will be delivered remotely through a computer-based platform. The format of the exam will include 4 virtual stations of 15 minutes duration. There may be more than one cases covered in a station. The remotely administered stations will all have an examiner present in addition to any relevant material. The material may include static images, videos or documents (e.g. handouts with lab results, etc…)

Examiners may also role-play during the examination to simulate an interaction with a patient or colleague.

In advance of the exam, we will provide candidates with detailed instructions about:

Objective of the Applied Examination

The OSCE component is designed to assess all the CanMEDS competencies required to function as an Internal Medicine specialist in an ambulatory setting and in the emergency department, hospital ward and critical care settings of a hospital.

Content of the Applied Examination

At each station, candidates will be asked to address one or two clinical scenarios:

Clinical scenarios - These scenarios may test skills in data gathering, data interpretation, knowledge use and interpretation of the physical examination, case synthesis, investigative strategy, interpretation of investigations, patient management, clinical reasoning and/or application of evidence. Some scenarios will require interpretation of data rather than collection of data.

Examiners are responsible for monitoring time and moving candidates along to ensure all the material and questions are covered. Examiners may take notes throughout the examination to document performance. They may appear neutral in their reactions to answers. They have been instructed not to give any positive or negative feedback to candidates.

Scoring of the Applied Examination

A global rating will be used to assess relevant aspects of care demonstrated during the station. Global rating scales will be suited to the stations 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 can vary, but most likely include:

There can be different and multiple foci, including all the medical expert foci, but also how to come to a diagnosis, how to choose the appropriate care, how to prepare the patient, family and institution for the appropriate care, how to follow up on this care, etc. Questions may, on occasion, focus on very technical aspects of care. To see the generic behavioral anchors for these domains, please see GRS template. Note that the anchors for your specialty may vary somewhat from these.

Possible Resources for studying for the examination:

Candidates from prior examination years have been surveyed about the resources that they found useful for studying for the examination. Here are the results of the survey. The resources listed are not exhaustive and are provided to you to help guide you in your preparation for the examination.


Revised March 2021