The TDM Examination

The Therapeutics Decision-Making (TDM) Examination assesses therapeutic knowledge and clinical decision-making at the level expected of a family physician practising independently and safely in Canada.

Most Practice-Ready Assessment (PRA) programs use it to inform their applicant selection decisions for program admission. The TDM Examination helps PRA programs identify applicants who are most likely to succeed in supervised practice and safe independent family medicine practice in Canada.

What the TDM is and how PRA programs use it: the TDM explainer

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 It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act.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

What the TDM is and how PRA programs use it: the TDM explainer

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 a medical school Canada accepts. You apply on an online form during a set application window, not through your physiciansapply.ca account.

Who can take it

To take the Therapeutics Decision-Making (TDM) Examination you must be a graduate 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.

When and how to apply

Each session has its own application window. For the January 2027 TDM Examination, the MCC expects applications to open on October 5, 2026 and close on October 26, 2026. You complete and submit the form online, because you cannot submit a TDM application through your physiciansapply.ca account.

Your medical degree

Asked whether your medical degree needs to be source-verified before you can take the TDM Examination, the MCC answers No. It then says that the required documentation must be approved and the status of your medical degree must be "reviewed and accepted" in your physiciansapply.ca account for your exam application to be complete. Both statements are the MCC's own. Check where your degree stands in your account before you count on a session date.

What the TDM is and how PRA programs use it: the TDM explainer

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

Eligible candidates can apply for the exam through the MCC during the designated application period, without an invitation or approval from the Practice-Ready Assessment (PRA) programs. Before applying for the TDM Examination for admission to a PRA program, it is important to review the program's requirements to determine your eligibility.

Official source: Medical Council of Canada: Eligibility and application Checked 2026-09-29

What the TDM is and how PRA programs use it: the TDM explainer

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

A computer-based exam in a four-hour appointment, at a Prometric test centre. You cannot take it remotely. It runs several times a year, in Canada and worldwide.

The format

Multiple-choice and short-menu questions: 55 cases, for a total of approximately 110 to 140 questions.

The dates

The MCC says dates are subject to change, so confirm them before you plan around them. 2026: January 14, June 2, September 23. 2027: January 13, June 16, September 22.

Where you sit it

At available Prometric test centres, in Canada and worldwide. Remotely proctored appointments are no longer offered, so you must schedule an in-person appointment at a Prometric test centre.

What the TDM is and how PRA programs use it: the TDM explainer

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 eight free sample cases reflect the style and format of the Therapeutics Decision-Making (TDM) Examination.

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

What the TDM is and how PRA programs use it: the TDM explainer

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

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.

What the TDM is and how PRA programs use it: the TDM explainer

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

Results come 5 weeks after the exam. You get a pass or a fail, with no score. On the MCC's side a pass no longer expires. You can take the exam up to 4 times.

When results come

5 weeks after the examination date. Your results letter is uploaded to your physiciansapply.ca account.

What the result says

The TDM Examination currently reports only a pass or fail result. Scores are not reported to candidates or to PRA programs at this time.

How long a pass lasts, and which result counts

Only your most recent result is valid, regardless of previous pass or fail results. Results are valid across the jurisdictional PRA programs that require the TDM Examination, no matter which province you took it in. The MCC says that as of September 2026 the MCC-applied validity period for a TDM pass result is eliminated. PRA programs may still choose to set recency requirements based on their own assessment criteria, and that is no longer determined by the MCC.

How many times you can take it

As of September 2026, a maximum of 4 attempts, whether you pass or fail. After three consecutive fail attempts you must wait 1 year from the time you receive the result before reapplying for your fourth attempt. Exam attempts before September 2026 count toward the total limit.

What the TDM is and how PRA programs use it: the TDM explainer

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

TDM Examination application: $2,850.00. The full fee is non-refundable. In certain circumstances, you may be eligible for a refund; however, a $1,425.00 withdrawal fee would be charged. These application and withdrawal fees will be in effect starting with the September 2026 exam.

Official source: Medical Council of Canada: Examination and service fees Checked 2026-09-29

What the TDM is and how PRA programs use it: the TDM explainer

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

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.

What the TDM is and how PRA programs use it: the TDM explainer

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