Exam Day

Equipment
Registration and orientation
Examination security
Candidate identification
Candidate notebooks
Complaints and conflict of interest
Discontinuation of examination
Navigating the examination and duration
OSCE stations
Saturday – 10-minute stations
Sunday- 6-minute stations
Moving from station to station
Candidate instructions
Confidentiality of examination materials or content

Equipment

You must bring with you to the examination:

  • Plain white lab coat without a university or hospital crest
  • Stethoscope
  • Reflex hammer

The equipment must be carried in lab coat pockets, as no bags will be allowed.

NOTE: All personal belongings will be collected at registration (e.g., keys, papers, pens and pencils, wallets, cell phones, PDAs, as well as coats) and stored until after the examination. While every effort will be made to store your belongings safely, the Medical Council of Canada (MCC) is not responsible for these belongings and you are encouraged to bring as few personal belongings as possible.

You will be provided pencils (with erasers) at the site. You will be required to use the pencils (with erasers) provided at the site.

Registration and orientation

If you are more than 15 minutes late for registration, you may be denied entry to the examination.

Immediately following registration on examination day, you will attend an orientation to the examination. The orientation provides you with the logistical details of the examination and an opportunity to ask questions. Each examination site is staffed to ensure that you are guided through the examination.

Once a candidate chooses to begin the examination, it will count as an attempt even if he/she cannot finish.

Examination security

  • No talking between candidates is permitted:
    • Once the OSCE has begun, up until sequestering
    • Between stations (except with staff)
  • All electronic devices are not permitted (including smartwatches)
  • Access to communication devices, including telephones or cell phones, during the exam and sequestering is not permitted

Breaking the rules may result in dismissal from the examination, may invalidate your results and you may be barred from taking future MCC examinations.

Candidate identification

Candidate identification numbers are printed on bar code labels that are distributed to you at registration. You are asked to give labels to the physician examiners as you proceed from station to station. The physician examiners, in turn, attach the labels to your scoring instruments. In addition, you are required to wear an identification badge, which also indicates your start station and track letter.

Candidate notebooks

The MCC provides a small notebook that you may use for writing notes while taking the examination. The notes in the notebook will not be scored. Your ID label is attached to the notebook cover. This booklet must be returned intact at sign-out (including unused labels), i.e., no pages or parts can be torn or ripped out.

Complaints and conflict of interest

A candidate who believes that administrative, environmental or personal health problems encountered during the course of an examination session may significantly affect his/her results must:

  1. Immediately communicate such concerns to the Deputy Registrar or Senior Staff on site at the time of the examination session in question
  2. Complete an incident report at the exam centre as soon as possible after the incident
  3. Submit a message through your physiciansapply.ca account detailing the incident within one week following the examination

Any intervention, if appropriate, is possible only if notice of the concern/problem is presented by the candidate in this manner. Concerns relating to exam day occurrences cannot be investigated after this deadline including once results have been released.

If you have concerns about a potential conflict of interest prior to the examination, you are strongly encouraged to contact the MCC before exam day. If, during the examination, you encounter an examiner or standardized patient where a conflict exists, you should:

  1. Exit the station and inform the staff immediately (once staff are notified, they will make alternate arrangements for the administration of the specific station for you)
  2. Submit a message through your account informing the MCC of the occurrence within one week of the examination

The MCC takes the view that a conflict of interest exists, without limitation, in situations where the examiner or standardized patient is (i) related by blood or marriage to the candidate; (ii) is or has been in a significant business or social relationship with the candidate, or is a professional colleague; or (iii) where a conflict of interest relating to the candidate and such examiner or standardized patient has been previously identified (e.g., there is an outstanding complaint in another context). Please note that knowing or being known to an examiner or standardized patient is not generally deemed a conflict of interest.

Discontinuation of examination

All candidates who choose to discontinue the examination will be asked to sign a standard waiver form on exam day.

Navigating the examination and duration

Remember that there is an orientation at the examination site on the day itself. Signs will be posted and a considerable effort is made to allow you to focus on your performance, not on finding the next room. Staff will always be nearby to provide directions. If in doubt, ask the nearest staff person for directions.

Both days of the examination include registration of candidates, an orientation session and sometimes a sequestering period for a total time of approximately two hours in length on Saturday and one and a half hours on Sunday.

OSCE stations

In OSCE stations, you may be required to:

  • Obtain a history and/or conduct a physical examination
  • Address patient concerns regarding results, a diagnosis or a medical problem and/or counsel the patient
  • Manage a patient problem
  • Consult with a colleague

If you finish the patient encounter early, you must wait quietly. If you remember something more that you would like to do, you may re-engage the patient at any time until the warning bell/announcement or final signal/announcement except in stations where there is an oral question.

In some stations, the examiner will ask you 1 to 3 brief questions after the first warning signal. In these stations, you will not be allowed to continue interacting with the patient after the first warning signal. If there are no oral questions in a station, you will have the full allotted time in the station to interact with the patient.)

After the final bell sounds, you must leave the station and move to the next one. You may not leave early.

You are not expected to carry out genital or rectal examinations. This is out of respect for the standardized patients and the short time allotted to each station. In a station where you believe that such an examination is appropriate, you should inform the physician examiner. If there are relevant findings needed to complete the clinical encounter, or answer the oral questions, the physician examiner will provide these findings to you.

Although it is always expected that candidates will interact directly with the standardized patients (asking questions directly, conducting a physical examination, explaining a prescription), physical examination stations require a somewhat different strategy. While conducting a physical examination, you should state briefly what you are doing and report your findings. This is critical to receiving full credit. For instance, a physician examiner cannot give credit for observing the patient unless you state that you are observing the patient. If there are findings; for example, pallor, then report this to the examiner to indicate that you have noted it. If you observe that there are no positive findings, then you can just report “Normal”. A physician examiner is not allowed to assume, for example, that a candidate is looking for pallor, inflammation, skin rashes. Likewise, credit for findings (positive or negative) cannot be given unless you report what you found.

Saturday – 10-minute stations

  • The Saturday session consists of clinical encounter stations only
    • You are given 2 minutes to read the instructions posted by the door
    • After 2 minutes, the signal will sound for you to enter the room
    • You are given 10 minutes in the room
    • A warning signal will sound at 9 minutes
    • A second warning signal will sound at the end of the station
    • At this point, you must leave the room and proceed to the next station

Sunday – 6-minute stations

  • The Sunday session consists of couplet stations, each with one clinical encounter component and one patient encounter probe (written) component. In some administrations of the examination, one of the couplet stations may be replaced with a 14-minute encounter station.
  • At the couplet station, the patient encounter probe can be done after or prior to the clinical encounter. In patient encounter probes, you may be asked to perform tasks such as, answering questions or reviewing patient-related materials prior to the clinical encounter.
    • You are given 2 minutes to read the instructions posted by the door
    • After 2 minutes, the signal will sound for you to enter the room *
    • You will be given 6 minutes in the room
    • A warning signal will sound at 5 minutes
    • A second signal will sound at the end of the station. At this point, you must leave the room and proceed to the next station
  • At the 14-minute station:
    • You are given 2 minutes to read the instructions posted by the door
    • After 2 minutes, the signal will sound for you to enter the room *
    • You will be given 14 minutes in the room
    • You will hear a warning knock at 13 minutes
      • Ignore the 5-, 6-, and 8-minute signals. Pay attention to the door knocks instead.
  • A second knock will sound at the end of the station. At this point, you must leave the room and proceed to the next station

*At a few stations, you might not have to wait to enter the room after reading the instructions. Exceptions to this timing will be clearly indicated in the candidate’s instructions.

For more information on Exam Preparation Resources, visit the following page: http://mcc.ca/examinations/mccqe-part-ii/exam-preparation-resources/

Moving from station to station

A set amount of time is allowed for moving to the next station and for reading the posted instructions. During this time, the physician examiner completes the rating instrument for the current candidate and prepares for the next candidate. Remove the bar code identification labels from the sheet, so they are ready to give to the physician examiner. At the sound of the signal, you enter the room and proceed with the required task.

Candidate instructions

Read the instructions for each station carefully. For instance, in a physical examination station, you must greet the patient and report what you are doing and report your findings (to both the patient and the physician examiner) as you carry out those examination manoeuvers that you deem appropriate. It is not appropriate to ask questions to the patient during a physical examination station unless the questions relate directly to the examination itself; for example, “Does it hurt when you raise your arm?” Patients are discouraged from answering other questions in any detail. There is no credit given for asking questions and doing so will use some of the limited time available for that station. Conversely, it is not appropriate to carry out any physical examination manoeuvers in a history station.

In a combined history/physical examination station or a management station (i.e., doing whatever tasks are necessary to manage the patient’s problem at that moment), it is up to you to prioritize the elements of the two (or more) tasks. If there is a nurse in the station, you must direct the nurse to carry out whatever tasks are expected. The nurses are not allowed to initiate actions without direction from you.

The instructions for each station are posted next to the door and are available inside each room. The instructions provide the patient’s name and age, the presenting problem, the setting (e.g., family practice clinic or Emergency Department), and the nature of the station, be it a history, a physical, a management or a counseling station. Vital signs, test results and/or elements of the family history may be provided. You are allowed to take notes while waiting to enter a station.

The following is an example of instructions to candidates for a clinical station:

 Instructions:
2 min.
Task:
5 min.
Examiner oral question(s):
1 min.
Jonathan Jones, a 65-year-old man, presents to your office because he has been experiencing abdominal pain.
  • IN THE NEXT 5 MINUTES:
    CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION
  • As you proceed with the physical examination,
    EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS
  • After the 5-minute warning signal, the examiner will ask you 2 brief questions related to this patient
  • GIVE ONE LABEL TO THE EXAMINER

A key word in the instructions is FOCUSED. You are expected to conduct a physical examination relevant to assessing abdominal pain. There is no requirement (and no marks are given) for obtaining a history; marks will only be given for the manner of the physical examination and for the specific manoeuvers that are performed.

Confidentiality – do not reveal examination materials or content

As part of the exam process, you agree not to disseminate or reveal to others the examination materials and content. This means that you cannot discuss or disclose exam content (including patient portrayals and findings, oral questions, cases, etc.) at any time in any way even after the examination ends (this includes during sequestering if applicable).

Examples of breaches in confidentiality include, but are not limited to, comparing patient responses with your colleagues, sharing content with future exam candidates and posting information online.

The MCC actively monitors for breaches in confidentiality, and will seek disciplinary and legal measures against candidates who disclose examination content. Agreeing to maintain confidentiality and then breaking that confidentiality by disseminating exam content is considered a highly unprofessional act.

Breaking confidentiality and disseminating exam content can lead to candidates being denied a standing on the examination and being barred from taking MCC exams in the future.