Format of the Examination in Pain Medicine – 2022

About the Exam


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 Pain Medicine 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 in Pain Medicine and the depth of knowledge required for the examination to ensure that the examination reflects relevant clinical practice in Pain Medicine. All candidates are strongly encouraged to read the blueprint and the Objectives of Training thoroughly.

Passing the Exam

The Royal College Examination in Pain Medicine 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 a proper standard for candidates entering unsupervised practice.

Overall Format of the Examination

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


Format Number of Items Total Test Time


Paper 1: SAQ


3 hours

Paper 2: SAQ ~35-50

3 hours

Written Examination

Objective of the Written Examination

The written examination measures knowledge and application of knowledge necessary to function as a competent specialist in Pain Medicine. 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).

The examination will test the candidate’s clinical competence in the evaluation, diagnosis, treatment, and rehabilitation of patients with acute and chronic non-cancer and cancer pain, as well as prevention of symptoms, in a multidisciplinary framework. The examination will encompass knowledge of pain mechanisms, patient management and basic science.

Content of the Written Examination

The content of the examination is based on a blueprint that reflects the Objectives of Training in Pain Medicine. 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.


% Marks*

1. Foundational knowledge of Pain Medicine

15 – 25

2. Psychiatry / Psychology

10 – 15

3. Addiction medicine

5 – 10

4. Sleep medicine

0 – 5

5. Musculoskeletal system and rehabilitation

15 – 20

6. Neurology

10 – 20

7. Pediatric

0 – 5

8. Acute pain management

5 – 10

9. Cancer pain management

5 – 10

10. Interventional

0 – 5

*The ranges are approximate and may vary slightly

All questions may have associated visual material.

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.

All written examinations are combined to create one overall written score. In other words, you need a combined written score of 70% to pass the written examination, but you do not need 70% on each paper.

Sample Questions from the Written Examination

Please note that this Sample Written Exam is not for the purposes of training on the exam interface functionality. It is recommended that you review the Information on written exams at hotel sites and access the Demo Exams to familiarize yourself with the different question formats and resources that you may encounter.


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Password: 56789

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, Clinical Laboratory Values, 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 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

Other Resources


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

Updated March 2022