MCCQE1 exam advice

The MCCQE1 exam is a computer-based exam you have to pass if you want to work as a doctor in Canada. I wrote these notes at the end of 2019. They were written for UK GPs, but others may find them useful. They may not be up-to-date.

I’ve just passed the MCCQE1, and thought it might be helpful to summarize what I learnt about how to do it. I’m grateful for advice from others, especially Sundeep Grewal, who guided me through the process.

If you’re a competent, up-to-date, UK-trained GP, you shouldn’t find it hard. Things aren’t much different in Canada. I had to brush up on some hospital stuff, including perioperative medicine, obstetrics, infectious diseases, hospital paediatrics, and Canada-specific things: ethics and professional conduct, law, public health, screening programs, etc.

Everything you need to know about the exam itself is on the MCC website. Read the MCCQE1 pages. Watch the videos. Find and read the most recent MCCQE1 Annual Technical Report.

You’ll have four hours for the MCQ (210 questions) and three and a half hours for the clinical decision-making (CDM), with around sixty questions. Someone sitting next to you doing the same exam will have a different set of questions. The exam is not (now) adaptive: in other words, the later questions you’re given don’t depend on how you did on the earlier questions. There are a few unmarked questions that they are piloting, but you won’t know which they are.

I blocked out two weeks immediately before the exam for full-time, intensive study, and that was enough.

I’d recommend two resources: the MCC practice exams, and Toronto Notes. Both are expensive and worth it.

Start with the MCCs full practice exam. Do the whole thing, and then go through your answers and their explanations carefully. You’ll get three things from this. First, identify where you need to focus your study. Second, understand what they’re looking for (sensible, pragmatic, evidence-based care) and a better understanding of how the exam is marked (e.g. in the CDM section, while you may be able to give three differential diagnoses, they may be looking for only one). Finally, you’ll get an idea of how to manage your time in the exam — though the practice exams are, unhelpfully, easier than the real thing.

(Note that for only the full practice exam can you see how you did on each question and read an explanation — not for the shorter practice tests the MCC offers. This is annoying and unhelpful.)

Then study what you need to study, using Toronto Notes. I ended up with about twenty pages of typed notes, which I memorised in the days immediately before the exam.

Toronto Notes: order it in good time. If you buy it from the University of Toronto’s online bookshop you can ensure you get the version focused on the MCCQE1, not the US-focused version. Beware, it’s huge. There’s no way you can read the whole thing. But you shouldn’t need to.

There’s another book specifically for the MCCQE1, available on Amazon. But, having a look at the preview on Amazon, it didn’t seem to offer anything beyond the resources above. I didn’t buy it.

I don’t think I’d recommend Canada QBank. I thought the questions were badly written, excessively specialist and obscure, sometimes simply wrong, and unbalanced — they tended towards over-investigation and over-treatment, where the approach of the MCC practice exam was better medicine.

Worth reviewing the MCC practice exam shortly before you do the exam, to remind yourself of what they’re looking for.

How is your revision going? Hard to tell. The marks for the exam itself are scaled such that the mean is 250, the standard deviation 30, and the pass-mark 226. (If you assume a normal distribution you can therefore calculate a z-score for any given mark and work out its percentile. Yes, I’m a statistics geek.) The MCC practice tests simply give you a raw mark, with no indication of what a pass-mark would be. Canada QBank benchmarks you against other people using Canada QBank, but you don’t know how good they are. What I can tell you, in case it helps, is that, before two weeks of intensive revision, I scored 67% on the MCC practice exam; I was generally scoring around the benchmark on QBank; and I got a good mark in the exam itself.

There’s no negative marking, so answer all the questions. But you will score zero for a CDM question if you give a dangerous answer, or if you pick too many choices (e.g. from a list of investigations). The write-in answers are simple (e.g. a diagnosis): if you feel you need to explain your answer, you’ve probably got it wrong.

The exam itself is a bit harder than the MCC practice exams so, even if you had ample time at home, you may have to manage your time more carefully in the exam. Seven and a half hours gazing at a computer answering question after question is gruelling. Feels like the worst clinic you’ve ever done. My brain was pretty addled for the last hour or two. The 45-minute lunch break starts as soon as you finish the MCQ, even if you finish early, and the CDM session timer will start 45 minutes later, whether or not you’re sitting in front of the computer. Read that sentence again so you’re not surprised on the day.

Everyone seems to come out of the exam feeling deflated and with no idea of how they’ve done. Don’t worry about that — and don’t get downhearted in the exam if you find yourself puzzled by a lot of the questions. I think the questions are meant to be hard, to generate a spread of marks.

They tell you the results will be released seven weeks after the end of the exam session (remember your exam day may not be the last day of your exam session), but my results took only five weeks. I understand that’s common.

Good luck!