Medical Council of Canada

Candidate instructions

Clinical Decision Making - instructions to candidates

This component of the MCCQE Part I assesses problem-solving and Clinical Decision Making skills. You will be presented with approximately 45 to 55 case descriptions. Each of them is followed by one to four questions that assess key issues in the resolution of the case. Of the 45 to 55 cases, approximately 10 are pilot cases that are not used in the calculation of your final score. There is an average of approximately 80 questions to answer in this component of the exam. You may be asked to elicit clinical information, order diagnostic procedures, make diagnoses, or prescribe therapy. Your decisions should reflect the management of an actual patient. All questions are either in a short-menu or write-in format.

Short-menu questions

A short-menu question is similar to a Multiple-Choice Question. However, instead of presenting a list of four or five possible answers, a short-menu question typically offers a list of 6 to 40 options. You may be asked to select only one of these options, select up to a specified number, or select as many as are appropriate. Please note that the majority of questions are worded in the plural; for example “treatments”, “diagnoses”, etc. Even when you are asked to select “treatments”, there may be only one correct answer.

Write-in questions

A write-in question asks you to supply your answer by typing it in.

To ensure that your write-in answers receive the maximum credit possible, follow these rules:

  • Record only one response in each of the boxes provided. If a question instructs you to “List four diagnoses,” four boxes will be provided, one for each response. Typing in more than one response in a box will result in you being given a score of zero.
  • Be specific. For example, “thyroid disease” is an unacceptable diagnostic response when “hyperthyroidism” is the correct diagnosis.
  • If you are asked to list drugs or medications, use generic names. Read such questions carefully to determine if you are also required to specify the route of administration and dosage.
  • Word your responses carefully. Correct answers typically consist of single words or short phrases.
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How to respond to questions

It is essential that you follow these instructions for each question. The instructions are reflected in the scoring criteria for the questions.

For example:

  • Some questions specify the exact number of responses to be typed in or to be selected (for example, “List only one”). Exceeding the number of responses requested will result in you being given a score of zero for the entire question, even if your responses include the correct answers.
  • Some questions place an upper limit on the number of responses to be typed in or selected (for example, “Select up to six”). Do not exceed that number. However, you may not need to select or list that exact number either; a question instructing you to “Select up to six” may have a correct answer consisting of only three or four responses. Guessing to build your answer up to the permitted number of responses presents the risk of selecting some of the wrong responses. If you select inappropriate investigations or treatments, you could be given a score of zero for that question.
  • Some questions leave it to your judgment to type in or select as many responses “as are appropriate”. What you deem to be the “appropriate” number should be dictated only by what you would do in the actual clinical situation. You should not be tempted, for example, to provide an excessive number of responses in an effort to ensure that you have included the correct response. The scoring keys for this type of question:
    • Set limits on the maximum number of acceptable responses as an excessive number may imply that you would over-investigate a patient
    • Penalize inappropriate responses.

In either case, a score of zero will be given.

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