Internal Medicine: the Practice Eligibility Route
Requirements as published by the Royal College. Last reviewed August 2026.
Internal Medicine at a glance
- Required time in training
- 4 yearsSTR: Four (4) years of approved residency training
- 2026 exam timing
- Written in the Spring; Applied in the Spring (same year)
- Apply for assessment of training
- by April 30 of the year before your exam
- Register for the exam
- September 1 – November 4 of the year before
- Exam attempts
- Maximum 4 attempts per component within a 5-year eligibility period
The Royal College reads your postgraduate training and practice record in Internal Medicine against the published Specialty Training Requirements. Those requirements are set out in full below, so you can see how your own training compares before you apply.
What licence can I get, and when?
Certification is national. Licensure is provincial. You do not need Royal College certification (FRCPC) to be licensed. Several provinces license you at an earlier PER stage, and the earliest any province accepts is the eligibility letter alone. The table applies to every specialty that reached exam eligibility through the PER.
Full province table: MCCQE, job offer and licence type
| Province | MCCQE | RC written | RC applied | Licence issued | Job offer |
|---|---|---|---|---|---|
| Alberta | Required | Required | Required | Full | Not required |
| British Columbia | Not required | Required | Required | Provisional | Required |
| Saskatchewan | Required | Required | Required | Provisional | Required |
| Manitoba | Not required | Required | Required | Provisional | Required |
| Ontario | Not required | Required | Not required | Provisional, 3 years | Required |
| Nova Scotia (a) | Not required | Not required | Not required | Defined, 6 to 24 months | Required |
| Nova Scotia (b) | Not required | Required | Required | Full | Required |
| New Brunswick | Not required | Not required | Not required | Special, then Defined | Required |
| Newfoundland & Labrador, PEI | Required* | Not required | Not required | Provisional | Required |
* The MCCQE may be waived where the candidate has five or more years of independent practice abroad. Case by case, never guaranteed.
Educational only. Rules change, and each regulator decides on factors that may not be listed here; Filipe Santos MD does not make licensure decisions. Checked October 9, 2026 against each regulator's pages; Ontario confirmed with the CPSO in October 2026. Confirm with the regulator before you act.
Province notes (Alberta, Nova Scotia, New Brunswick, and the MCCQE) are in the PER guide.
How training is structured
The Royal College sets out the training for Internal Medicine in the blocks below. An internationally trained specialist is assessed on whether their own training and practice record is comparable in structure and content.
Requirements document: 2015, Version 2.0 (applies to those who begin training on or after July 1st, 2015)
Required experiences9
Specific experiences the Royal College names for this discipline.
- A.1 A minimum of thirteen (13) blocks of general Internal Medicine training
- A.1.1 A minimum of six (6) blocks of general Internal Medicine in-patient care in Clinical Teaching Units or preceptorships (a defined period of training organized around focused immersion in a single preceptor's practice)
- A.1.2 A minimum of three (3) blocks or equivalent longitudinal experience in consultations to other services, including all of: A.1.2.1 other in-patient services (e.g. surgery, gynecology, obstetrics, internal medicine); A.1.2.2 emergency department; A.1.2.3 ambulatory care
- A.1.3 A minimum of one (1) block of community-based general Internal Medicine
- A.2 A minimum of four (4) blocks in the care of critically ill patients
- A.2.1 A minimum of two (2) blocks of adult Critical Care Medicine
- A.2.2 A minimum of one (1) block of Cardiology, including acute coronary care in a coronary care unit
- A.3 Fifteen (15) blocks or equivalent of selectives, including at least eight (8) of: 3.1 Cardiology; 3.2 Clinical Immunology and Allergy; 3.3 Clinical Pharmacology and Toxicology; 3.4 Critical Care Medicine; 3.5 Dermatology; 3.6 Endocrinology and Metabolism; 3.7 Gastroenterology; 3.8 General Internal Medicine; 3.9 Geriatric Medicine; 3.10 Hematology; 3.11 Infectious Diseases; 3.12 Medical Biochemistry; 3.13 Medical Oncology; 3.14 Nephrology; 3.15 Neurology; 3.16 Occupational Medicine; 3.17 Palliative Medicine; 3.18 Physical Medicine and Rehabilitation; 3.19 Respirology; 3.20 Rheumatology
- B.1 Up to one (1) year of further residency in Internal Medicine, including: B.1.1 minimum one (1) block of adult Critical Care Medicine; B.1.2 minimum one (1) block of community-based general Internal Medicine; B.1.3 minimum one (1) block (or longitudinal equivalent) of ambulatory care; B.1.4 minimum two (2) blocks in a junior consultant role, in preparation for transition to independent practice
Flexible or selective components4
Where the requirements allow a choice.
- A.4 Up to six (6) blocks or equivalent of electives: A.4.1 any of the above selectives; A.4.2 a maximum of three (3) blocks of research; A.4.3 a maximum of three (3) blocks of other approved training
- B.1.5 Up to seven (7) blocks of electives within the further Internal Medicine residency
- B.2 Up to one (1) year of clinical residency in any of the subspecialty areas listed under A.2 or A.3
- B.3 Up to six (6) blocks of approved training in other areas such as health services research, clinical epidemiology, medical education, basic sciences, or clinical/basic research
Common questions
More questions about specialists trained abroad, each answered once with its official source, are in the IMG FAQ Center.
What is the Practice Eligibility Route in Internal Medicine?
The Practice Eligibility Route (PER) is the Royal College process by which an internationally trained specialist can be assessed for eligibility to sit the certification examination in Internal Medicine without repeating a Canadian residency. The Royal College reads your postgraduate training and practice record against the published Specialty Training Requirements for the discipline.
What training does the Royal College expect in Internal Medicine?
The Specialty Training Requirements describe four (4) years of approved residency training. The full block-by-block structure is set out on this page, taken from the Royal College document for this discipline.
Does meeting the training requirements guarantee eligibility?
No. Eligibility is a committee decision made on your individual file, and other factors are considered. This page reproduces the published requirements so you can see how your own training compares before you apply; it is not an eligibility ruling.
Where do I start?
Read the seven steps in the PER guide, then have your training mapped against the Specialty Training Requirements before you pay any fees. The free PDF for this specialty carries the steps, the document checklist, and the Internal Medicine requirements in one file.
The Internal Medicine guide as one PDF
The seven PER steps, your document checklist, and the Internal Medicine training requirements in a single file. Free. Not sure the PER is your route? The screener checks your file against every route in about two minutes.
Other specialties27
Canadian clinical fellowships in Internal Medicine are in the Fellowship Finder.
Adapted from the Royal College of Physicians and Surgeons of Canada Specialty Training Requirements for Internal Medicine. Not affiliated with or endorsed by the Royal College; every application is reviewed individually and final decisions rest solely with the Royal College. Verify current requirements at royalcollege.ca.