The TDM Examination, explained

What the exam is

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. It is developed and administered by the Medical Council of Canada, and most provincial Practice-Ready Assessment programs use it to select applicants — for many PRA candidates it is the single gating exam.

The format

• 55 cases, roughly 110 to 140 questions — multiple-choice and short-menu questions.
• A four-hour computer-based appointment: two sections of an hour and a half, with an optional 20-minute break.
• Delivered multiple times a year at Prometric centres in Canada and worldwide, in English and French.

What it tests

Questions sample four dimensions of care — health promotion and prevention, acute care, chronic care, and safety or adverse effects — with roughly 70% pharmacologic and 30% non-pharmacologic interventions. It is a therapy exam: diagnosis is usually given, and the question is what you do about it, at what dose of caution, in a Canadian practice context.

Where it fits in the PRA route

Provincial PRA programs list the TDM among their eligibility requirements, alongside currency of practice and language evidence. The provincial pages on this site name it wherever it applies — start from the program comparison or check your own file against every program with the free eligibility screener. Sitting windows are tracked on the Deadline Radar.