The NAC Examination

The National Assessment Collaboration (NAC) Examination is a national exam that assesses your readiness to enter a Canadian residency program. It is a half-day Objective Structured Clinical Examination (OSCE): 12 stations, 11 minutes each. Expect to be at the exam centre for about five hours.

What it tests

The knowledge, skills and attitudes essential for entrance into postgraduate training, or residency, in Canada. It includes problems in medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and preventive medicine and public health. Physician examiners assess you on up to 7 different competencies per station: history taking, diagnosis, management, communication skills, physical examination, investigations and data interpretation.

The format

12 stations, 2 of which are pilot stations that do not count toward your final score. Each station is 11 minutes long, with 2 minutes between stations.

How long you are at the centre

About five hours. That includes candidate registration and orientation, the exam itself (approximately 3.5 hours, including two to four waiting stations), and deregistration, where you return the exam material before leaving.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Yes. The MCCQE and the TDM Examination can be booked in English or French, and the NAC Examination can be taken in English or French at designated centres.

The MCCQE

You choose English or French when you book: go to the MCCQE Prometric landing page and find the section for the language you want for your appointment.

The TDM Examination

The TDM Examination is offered in English and French. You book it the same way, through the section for your language on the TDM Examination Prometric landing page.

The NAC Examination

The NAC Examination can be taken in English or French at designated centres.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Plan on both the MCCQE and the NAC Examination, and then check the criteria for the province you are applying to, because each province sets its own exam requirements.

What the MCC says

The MCC says passing the MCCQE is a requirement for international medical graduates applying for entry into a Canadian residency program. For the CaRMS R-1 Main Residency Match it says international medical graduates, graduates from a U.S. School of Osteopathic Medicine, and graduates from a U.S. School of Allopathic Medicine who graduated on or after July 1, 2025 need to provide results for both the MCCQE and the National Assessment Collaboration (NAC) Examination. For the 2027 R-1 match it says you can take the NAC Examination and the MCCQE in the order you prefer.

What CaRMS says

CaRMS says the MCC exams required for the R-1 match are set by each province. They can vary by province and from one year to the next, so what you need depends on where you wish to apply. For a future match, CaRMS can only go by the exam requirements for the current matches, because the provinces may change their requirements from one year to the next.

The last sessions that count for the 2027 R-1 match

CaRMS sets these out in a table, as an image in its article. For the first iteration: the MCCQE from the April 22 to May 30, 2026 session or the August 19 to October 21, 2026 session, and the NAC Examination of September 19 and 20, 2026. The January 19 to February 11, 2027 MCCQE session does not count for the first iteration. For the second iteration: any of those three MCCQE sessions, and the same September 2026 NAC Examination. CaRMS says some provinces may allow exceptions, and points to its R-1 Summary of MCC Examination Requirements.

Outside the residency match

The MCC says the MCCQE is also used by some Practice-Ready Assessment programs as an eligibility criterion, to select internationally trained physicians into their programs.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

It varies by province. The MCC says most provincial PRA programs use the MCCQE as a screening requirement, some use the National Assessment Collaboration (NAC) Examination, and most require a pass on the Therapeutics Decision-Making (TDM) Examination as part of their eligibility criteria.

British Columbia, Manitoba and Nova Scotia do not list the MCCQE as required. NS PACE in Nova Scotia is the only program with no MCCQE, NAC Examination or TDM Examination requirement.

By province

• British Columbia (PRA-BC): the MCCQE and the NAC Examination are not required, but you must have passed the TDM Examination within the previous three years before PRA-BC can refer you to health authorities for interviews.
• Alberta (PRA-AB): you need a registration exam: a nationally recognized standardized examination, such as the MCCQE, or one from an approved jurisdiction as approved by the Registrar. Family medicine applicants must also pass the TDM Examination.
• Saskatchewan (SIPPA): a pass on the MCCQE, plus the NAC Examination (or the MCCQE Part II taken in 2021 or before), plus the TDM Examination.
• Manitoba (PRAMB-FP): a pass on the NAC Examination or the MCCQE Part II, and the TDM Examination, which top-ranked candidates are nominated to sit. The MCCQE is not listed. Applicants first apply to CPSM through physiciansapply.ca; eligible applicants are referred to the University of Manitoba for shortlisting and interviews.
• Ontario (Practice Ready Ontario): a pass on the MCCQE with the Licentiate of the Medical Council of Canada (LMCC), plus the NAC Examination (or the MCCQE Part II taken in 2021 or before). Shortlisted candidates sit the TDM Examination.
• Quebec (restrictive permit): a pass on the MCCQE, the USMLE Step 2 CK, or the former MCC Evaluating Examination (taken before 2019). Quebec accepts the USMLE Step 2 CK on its own; other provinces that accept the USMLE ask for Steps 1, 2 and 3. Quebec does not use the TDM Examination.
• New Brunswick (PRA-NB): a pass on the MCCQE. Preference is given to candidates who have also passed the NAC Examination. The TDM Examination is required if not previously passed.
• Nova Scotia (NS PACE): no MCCQE, NAC Examination or TDM Examination requirement.
• Newfoundland and Labrador (PRA-NL): a pass on the MCCQE (needed for the CPSNL eligibility letter), plus the NAC Examination (or the MCCQE Part II taken in 2021 or before), plus the TDM Examination in phase 1.

More on this site: Eligibility Screener

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

You can take it if you graduated from, or will graduate within 15 months of the exam date from, a medical school Canada accepts. You can take it a maximum of 3 times.

Who can take it

You must be a graduate of, or a student who is expected to complete all medical degree requirements within 15 months of the date of the exam from:

• a medical school outside Canada that is listed in the World Directory of Medical Schools and identified by a Canada Sponsor Note indicating it is an acceptable medical school in Canada; or
• a U.S. School of Osteopathic Medicine; or
• a U.S. School of Allopathic Medicine, only if you graduated on or after July 1, 2025.

If you graduated from a U.S. School of Allopathic Medicine before July 1, 2025, you are not eligible to apply.

How many times

A maximum of 3 attempts, whether you passed or failed your previous attempts. You cannot take it in consecutive sessions. For example, a candidate who took the May 2024 NAC Examination can only retake it in May 2025 or later.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

A test accommodation is a change to the standard administration of an exam to address a human rights-related functional limitation. Examples you may request include additional testing time, break time, and access to assistive equipment, assistive personnel, or personal items (for example, breast pumps).

Requesting one for an MCC exam

If you have a documented functional limitation and associated accommodation need, you request the accommodation when you apply for the exam. As well as indicating in your application that you need one, you must complete the Request for test accommodations form and gather the required supporting documentation. A granted accommodation is valid for one exam only, so you must submit a new request with each future exam application. If you did not indicate the need when you applied, your request is considered a late request: the MCC reviews requests received at any time, but late requests cannot be guaranteed.

The MCCQE

An MCCQE application with an accommodation request can take up to 9 weeks to process, once all the eligibility requirements have been fulfilled and all the required supporting documentation has been received.

The NAC Examination

You request the accommodation when you submit your NAC Examination application. An application that includes an accommodation request is processed only once all the eligibility requirements have been fulfilled and all the required supporting documentation has been received.

MCC preparatory products

Accommodations cannot be granted for the MCC preparatory products, because they are self-administered.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Only in Canada, twice a year, at a limited number of exam centres. You cannot take it remotely and you cannot take it in another country.

It is a half-day objective structured clinical examination, offered in the spring and the fall, typically in May and September. The September 2026 exam is on September 19 and September 20, 2026, and those results are released in late November 2026. All dates are subject to change.

The centres for September 2026

Alberta: Edmonton, Calgary. Manitoba: Winnipeg. Ontario: Hamilton, London, Ottawa, Toronto, Windsor. Saskatchewan: Saskatoon. The exam is offered in English at all centres, and Ottawa also offers it in French. Centres are subject to change.

If you live outside Canada

The MCC notes that many candidates travel on a visitor visa for the exam and return to their country of residence afterward. Residency program directors accept results regardless of where you take the exam, so you do not have to take it in the province where you will apply for residency.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

These free resources are designed to help you understand the NAC Examination format and what to expect on exam day. Sample cases offer insight into how stations are structured and assessed and can be used for practice with peers.

The resources (orientation video and sample cases) are on the MCC page linked below.

Official source: Medical Council of Canada: Free NAC Examination resources Checked 2026-09-29

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

Quoted from the official source on the date shown, trimmed and selected by me. Rules change: confirm on the official page before you act. This is not official or legal advice, and I take no responsibility for decisions made on it. Disclaimer

Plain white lab coat with no university or hospital crest (you may cover with tape); Stethoscope; Printed copy of your Entrance Card (does not have to be printed in colour); Printed and signed Candidate Confidentiality Agreement page from your Entrance Card.

Official source: Medical Council of Canada: Exam day Checked 2026-09-29

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

Quoted from the official source on the date shown, trimmed and selected by me. Rules change: confirm on the official page before you act. This is not official or legal advice, and I take no responsibility for decisions made on it. Disclaimer

If you are more than 15 minutes late for registration, you may be denied entry to the examination.

Official source: Medical Council of Canada: Exam day Checked 2026-09-29

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

Quoted from the official source on the date shown, trimmed and selected by me. Rules change: confirm on the official page before you act. This is not official or legal advice, and I take no responsibility for decisions made on it. Disclaimer

You are not to perform genital, rectal, vaginal, breast, reflexes, or other sensitive examinations. If such examination is required, clearly inform the examiner.

Official source: Medical Council of Canada: Exam day Checked 2026-09-29

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

Quoted from the official source on the date shown, trimmed and selected by me. Rules change: confirm on the official page before you act. This is not official or legal advice, and I take no responsibility for decisions made on it. Disclaimer

Four things, all free on the MCC's own site: practice questions, a study guide, the lab reference values used on its exams, and a curated list of over 90 further resources.

Free practice questions

The MCC offers 55 free MCC-style practice questions, designed to reflect those on the MCCQE. They are for personal study and non-commercial use. The way the free questions are presented does not reflect the tools and layout you will see during the MCCQE itself.

A study guide for the MCCQE

The MCC publishes a study guide that offers a structured, evidence-informed approach to exam preparation. It includes a sample study plan, which the MCC encourages candidates to adapt to their own knowledge and the time they have to prepare.

The normal lab values used on MCC exams

The MCC publishes the table of reference values it provides for the interpretation of laboratory results in its exams. All the values apply to adults.

Over 90 further resources

The MCC also curates a list of more than 90 freely available resources on Canadian medical practice and culture, drawn from credible sources across Canada.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Your total score is reported on a scale from 500 to 700, with a pass score of 577. Results come out about 8 weeks after the session ends. Your most recent result does not expire.

How it is scored

A total score equal to or greater than the pass score is a pass, and a total score less than the pass score is a fail. Each station is worth the same as every other station. Your total score is the average of your 10 station scores.

When results come out

Approximately 8 weeks after the last day of the NAC Examination session.

Whether a result expires

Only your most recent result on the examination remains valid. It is valid indefinitely and does not expire.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

No. Programs only see your latest result and what you consent to share. When you connect physiciansapply.ca to CaRMS, the MCC lists "only the latest" MCCQE and NAC Examination results, and "only the most recent examination document" is added to your CaRMS account. You then choose whether each exam is shared with programs, and separately whether to share it if the result is a pass, a fail or other. Programs filter the scores you share by how far they sit above the pass score; there is no filter for attempts.

Programs also rarely ask about failed exams. In my census of all 875 program descriptions for the 2027 R-1 match, none asks how many attempts you took, and one program, University of Saskatchewan Pediatrics (its Regina and Saskatoon streams), asks for an explanation and a remediation plan if an exam was unsuccessful.

Previous unsuccessful matches: CaRMS says it "is not able to provide previous year match results" to programs. 39 of the 875 program descriptions ask you to explain an unmatched cycle: Dalhousie Family Medicine and Family Medicine integrated Emergency Medicine, Simon Fraser Family Medicine, and anesthesiology and pathology at Saskatchewan and Calgary.

One open question: documents from an earlier match stay in your CaRMS account, and CaRMS has not said whether a fail transferred in an earlier match year is replaced when a newer pass comes in. Many programs also ask you to explain failures during medical school, which your transcript and MSPR show. If a program or a form asks about your exam history, answer truthfully.

Correction, September 2026: I first answered that most programs ask you to mention a failed exam or a previous unmatched cycle. A follower questioned it, I checked the program descriptions and the CaRMS help centre, and they were right.

Official source: Medical Council of Canada: physiciansapply.ca transfers to CaRMS Online (MCC guide, November 2020) Checked 2026-09-30

• CaRMS: Why does my MCC exam say "Incomplete Record"? (sharing consent for pass, fail and other)
• CaRMS: How do I assign any examination scores and documents to my applications?
• CaRMS: Why were the MCCQE examination filters changed in CaRMS Online?
• CaRMS: Can our program access match results from a previous match year?
• CaRMS: Will my documents still be available if I participate in a future match?
• CaRMS: R-1 program descriptions (2027 match)

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

The NAC Examination application fee is $3,320.00. The full fee is non-refundable, and full refunds of application fees are not available.

Withdrawing

If you withdraw before the deadline, you can get a partial refund, but a $538.00 withdrawal fee is charged. The MCC's Examination and service fees page calls this the withdrawal deadline; its Withdrawing page calls it the withdrawal with partial refund deadline. If you withdraw after the deadline, you forfeit your full application fee.

Being absent on exam day

The two MCC pages state this differently.

The MCC's Withdrawing page says that if you are absent on the day of the exam, you forfeit your full application fee. It does not mention an exception.

The MCC's Examination and service fees page says that if you are absent on the day of the exam due to extenuating circumstances, you may be eligible for a refund, but an administration fee of $1,660.00 would be charged.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

No. For both the NAC Examination and the TDM Examination, deferral to another session is not possible. To take the exam at a later session, you must withdraw from your current session, then reapply and pay the application fee for the new session.

Study method, station approach and resources for the NAC: NAC: A Complete Strategy Guide

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer