Medical Council of Canada



The Therapeutics Decision-Making (TDM) Examination is a criterion-referenced exam. This means that a pass or fail result is determined by comparing your individual performance to a performance standard, but not to the performance of other candidates.

When an exam is criterion-referenced, the only thing that really matters is your performance relative to the passing standard. For the TDM Examination, passing is considered as “acceptably competent.” A passing candidate who scored a few points higher is not necessarily more “acceptably competent” than someone who passed with a few points lower, or vice versa.

How the TDM Examination is marked and scored

Your written responses to the TDM Examination questions are evaluated by physician markers. Physician markers are trained to use the pre-established and validated scoring keys, established by the TDM Test Committee, and follow a standardized marking process that is supported through orientation, practice and discussion.

All the cases, and embedded questions, are marked twice by two physician markers and they do so independently, i.e., without consulting each other. Any differences in marking are resolved by a third marker (usually a physician subject-matter expert who was involved in developing the exam and answer keys). Your marking data is entered electronically and reviewed by following a stringent, quality assurance procedure.

The scoring is done through two independent, but parallel processes using the Statistical Analysis System (SAS®). The results from the two processes are compared and they must match before being released to the Practice-Ready Assessment (PRA) programs and exam candidates.

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How the TDM Examination pass score is established

The pass score for this exam is 62. It is established through a rigorous standard-setting exercise by a panel of physician subject-matter experts from across the country.

The pass score represents the minimum required level of therapeutic clinical knowledge and decision-making skills for International Medical Graduates to enter a practice-ready clinical over-time assessment. This is one of the means of assuring patients that their doctors have met a common Canadian standard, regardless of where they received their medical education.

In March 2018, this standard was recommended by a panel of eight family medicine physicians from across the country through a rigorous standard-setting exercise and subsequently approved for implementation by the National Assessment Collaboration Practice Ready Assessment (NAC PRA) Committee.

How a TDM Examination pass/fail decision is made

Your final TDM Examination result (e.g., pass, fail) is based solely on where your total score falls in relation to the pass score.

A total score equal to or greater than the pass score is a pass, and a total score less than the pass score is a fail. This means that you will pass if you meet or exceed the pass score regardless of how well other candidates perform.

Only the pass/fail result (not the total score) will be reported to PRA programs and candidates. This is to discourage using the TDM Examination scores to rank candidates or comparing candidates based on small score differences.