Exam Day

This page provides an overview of what to expect on the day you take the National Assessment Collaboration (NAC) Examination.

What to bring to the NAC Examination

  • A plain white lab coat without a university or hospital crest
  • A stethoscope
  • A reflex hammer

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

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

Registration and orientation

Prior to examination day you will be provided with an Entrance Card via an Exam Package in your physiciansapply.ca account. You must print this card and bring it to gain admission on exam day.

At registration, we will collect your personal belongings such as keys, papers, wallets, cell phones, PDAs, as well as coats. They will be stored until after the examination. While every effort will be made to store them safely, the Medical Council of Canada (MCC) is not responsible for these belongings. Please bring as few of them as possible.

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

Immediately following registration, you will attend an orientation covering the logistical details of the examination. You will be able to ask questions.

Once you choose to begin the examination, it will count as an attempt even if you cannot complete the exam.

Examination security

You will not be allowed to talk to other candidates once the exam has begun. Access to communication devices, including telephones or cell phones, during the exam and the sequestering period is not permitted.

If you break the rules, you may be dismissed from the exam and your results may be invalidated. You may also 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 a label to the physician examiners as you proceed from station to station. In addition, you are required to wear an identification badge that will be provided to you at registration, which indicates the number of your start station.

Candidate notebooks

We will provide a small notebook that you may use for writing notes while taking the examination. Only one notebook will be provided and no pages can be added. The notes in the notebook will not be scored. Your ID label is attached to the notebook cover, and your bar code labels are included inside the notebook. This notebook must be returned intact at sign-out (including unused labels). No pages or parts can be torn or ripped out.

Complaints and conflict of interest

If you believe that administrative, environmental or personal health problems encountered during the exam may significantly affect your results, you must:

  1. Immediately communicate such concerns to the Chief Examiner on site at the time of the examination session.
  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 in this manner. Concerns relating to exam day occurrences cannot be investigated after this deadline.

If you have concerns about a potential conflict of interest, 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 physiciansapply.ca account informing the MCC of the occurrence within one week of the examination.

The MCC takes the view that a conflict of interest exists in situations where the examiner or standardized patient is:

  • Related by blood or marriage to the candidate
  • Is or has been in a significant business or social relationship with the candidate, or is a professional colleague; or
  • Where a conflict of interest relating to the candidate and such examiner or standardized patient has been previously identified (there is an outstanding complaint in another context).

Knowing or being known to an examiner or standardized patient is not generally deemed a conflict of interest.

Discontinuation of examination

Once you start the examination, it will count as an attempt even if you cannot finish. If you choose to discontinue the examination, will be asked to sign a standard waiver form on exam day.

Navigating the examination and duration

Signs will be posted to help you navigate the exam, and staff will always be nearby to provide directions. The examination includes registration of candidates, an orientation session and sometimes a sequestering period for a total time of approximately six and a half to seven hours. Of the total time, the Objective Structured Clinical Examination (OSCE) is approximately three hours in length.

Performance at the OSCE

In an exam station, 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
  • Manage a patient problem in a family practice clinic or in an emergency department setting

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 11-minute buzzer/announcement depending on the station.

After the oral questions begin, you may not return to the patient encounter, even if there is time remaining before the end of the station. After the final bell sounds, you must leave the station and move to the next one. You may not leave early.

Do not carry out genital, rectal or breast examinations. 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.

Moving from station to station

A set amount of time is allowed for moving to the next station and for reading the instructions. During this time, remove one bar code identification label from the sheet, to have it ready to give to the physician examiner. At the sound of the buzzer, 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 examination manoeuvers. You should not 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?” Conversely, it is not appropriate to carry out physical examination manoeuvers in a history station.

In a combined history/physical examination station or a management station (i.e., completing tasks that are necessary to manage the patient’s problem at that moment), it is up to you to prioritize the tasks.

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 (family practice clinic or emergency department), and the type of station. Vital signs, test results and/or elements of the family history may be provided. You can take notes while waiting to enter a station.

The following is an example of the candidate instructions:

Jonathan Jones, a 65-year-old man, presents to your office because he has been experiencing abdominal pain.
  • IN THE NEXT 8 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 8-minute warning buzzer, the examiner will ask you some 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, only 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.

Examples of breaches in confidentiality include, but are not limited to:

  • Comparing patient responses with your colleagues
  • Sharing content with future exam candidates
  • 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 being denied a final result on the examination and being reported to regulatory authorities and other medical organizations as well as being barred from taking MCC exams in the future.