Information for residency program directors

The National Assessment Collaboration (NAC) examination assesses the readiness of an international medical graduate (IMG) for entrance into a Canadian residency program. It is a pan-Canadian, standardized examination that provides residency program directors with objective information on the skills, attitudes and knowledge level of IMGs applying for postgraduate training in Canada.

It is developed by the NAC Examination Committee, a group of physicians and medical educators from across the country with expertise in assessment and clinical content.

Background and rationale

Prior to the creation of the NAC examination, a number of provinces developed and delivered individual clinical examinations to assess IMGs. The NAC examination was developed to reduce duplication between provincial IMG assessment programs and offer standardized results to Canadian residency program directors across the country. The exam results provide residency program directors with a comprehensive assessment of an IMG’s skills, attitudes, knowledge and readiness at the level of a recent Canadian medical graduate for entry into postgraduate training. This information can be used in concert with other information – such as a residency application letter or results from the Medical Council of Canada Evaluating Examination (MCCEE) – to obtain a comprehensive view of an applicant’s skill set.

Scope and format

The NAC examination is a clinical evaluation that consists of up to 12 different 11-minute clinical stations, each with a standardized patient and a physician examiner.

In total, the duration of the exam is approximately 2.5 hours. However, the candidate may be on site for a longer period of time for administrative reasons.

Visit our OSCE station page for more detailed information on the format of the NAC examination.

Evaluation and scoring

The pass/fail result is based on whether a candidates’ examination score is equal or higher than the pass score established for the NAC examination. The standard is based on the level of performance compared to a graduate from a Canadian medical school. The NAC examination also collects information from physician examiners on the candidate’s ability to demonstrate ethical and professional behaviour.

OSCE component scoring

Candidates are rated by physician examiners on up to nine different competencies per station. These competencies include:

History taking Communication skills Data interpretation
Physical examination Language fluency Investigations
Organizational skills Diagnosis Therapeutics and Management

A candidate’s score for each station is the average of all competency ratings measured on the station. A candidate’s score for the entire OSCE is the average of the station scores.

In awarding the final result on the examination, consideration is given to any observations made by the physician examiner at each of the stations regarding the candidate’s ability to demonstrate the ethical and professional behaviour needed to enter postgraduate training.

More detailed information on NAC examination scoring can be found on the Scoring page.

Content development

Content for the NAC examination is developed by the NAC Examination Committee – a group of physicians from across the country with expertise in multiple medical disciplines. The Examination Committee meets on a regular basis to develop and review content and set standards based on the expected performance of a graduate from a Canadian medical school.

Learn more about the NAC Examination Committee.

Testing locations

The NAC examination is currently delivered through provincial IMG assessment programs in Alberta, British Columbia, Ontario, Manitoba, Nova Scotia and Quebec.