Clinical Decision Making (CDM)

The Clinical Decision Making component of the exam consists of up to approximately 45 to 55 cases, with one to four questions each, for a total of up to approximately 80 questions. The exam questions are grouped by the following disciplines: Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, Psychiatry, and Population Health, Legal, Ethical and Organizational Aspects of Medicine. Content pertaining to Family Medicine is covered in all six disciplines. The maximum time allotted for this component is four hours.

This test is designed to assess problem solving and clinical decision making skills. Candidates will be presented with case descriptions followed by one or more test questions that assess key issues in the resolution of the case. Candidates may be asked to elicit clinical information, order diagnostic procedures, make diagnoses or prescribe therapy. Their decisions should reflect the management of an actual patient.

This component includes questions in both short-menu and write-in formats.

The following is a video featuring tips that will help you understand and prepare for the CDM component of the MCCQE Part I. Time management, question instructions, scoring and scenario details are themes explored in this video.

Please note that the graphical elements in the video are not representative of the examination.

We have also prepared candidate instructions for the clinical decision making component to the MCCQE Part I.

CDM example

Case 1

A 13-year-old girl has a three-month history of intermittent diarrhea, weight loss, and muscle weakness despite an increased and voracious appetite. She has also experienced intermittent palpitations. Her parents report that her school performance has declined over the past few months. She also gets upset easily, and is unable to concentrate well. Her sleep pattern is irregular. Physical examination detects a mild tremor of the fingers with the arms outstretched. Her palms are moist. Her blood glucose level is 4.5 mmol/L.

Use the information above to answer the following questions.

Question 1 (Case 1)

What is the most likely diagnosis? List up to three.



Hyperthyroidism (Graves’ disease) – 1 point
Listing more than 3 answers – 0 points
NOT ACCEPTABLE – Listing “Thyroid disease” as an answer

Question 2 (Case 1)

Which initial investigations will you order if at this time?
Select up to three answers.

  1.  Colonoscopy
  2.  Endoscopic retrograde cholangiopancreatography
  3.  Erythrocyte sedimentation rate
  4.  Jejunal biopsy
  5.  Psychometric testing
  6.  Rectal biopsy
  7.  Serum 17 a hydroxy progesterone level
  8.  Serum amphetamine levels
  9.  Serum beta-HCG
  10.  Serum electrolytes
  11. Serum growth hormone level
  12. Serum Insulin level
  13.  Serum T4 and T3.
  14.  Serum vanillyl mandelic acid levels
  15.  Sweat chloride
  16.  Urine estradiol
  17.  Urine homovanillic acid levels
  18.  Urine screen for cannabinoids


Selecting Serum T4 and T3 – 1 point
Selecting more than 3 answers – 0 points