The clinical decision-making (CDM) component of the exam consisted of 38 case descriptions, followed by one or more questions, which assessed problem-solving and decision-making skills in resolving a clinical case. Candidates were asked to:
Your decisions should reflect the management of an actual patient.
In total, you will be presented with 65 to 75 questions related to the 38 CDM cases. Questions are either in a short-menu or write-in format. The CDM component includes pilot questions, also called pre-test items, which are scored if they perform well psychometrically. The standard maximum time allotted for the CDM component of the exam is 3.5 hours.
All cases and questions are presented in a single block. You may navigate freely between all CDM questions. You may flag questions and return to those questions at any point during the CDM portion of the exam. Certain test items will have pictorial material, such as photographs, diagrams, radiographs, electrocardiograms, and graphic or tabulated material. If relevant to the case or question, you will be presented with the normal lab values directly in the CDM question.
Points are not deducted for incorrect answers. However, you will receive a score of zero on a question if you exceed the maximum number of allowable responses or select a response that is considered harmful or dangerous to the patient. See below for advice on how to answer CDM questions.
You are only able to submit the examination once, when you have completed your CDM component, are ready to submit, or when your allotted time expires. Once you have submitted your examination, you cannot go back to change your answers.
The following video features tips that will help you understand and prepare for the CDM component. It explores time management, question instructions, scoring and scenario details for CDM questions.
Note that the graphical elements in the video are not representative of the examination.
A short-menu question is similar to a multiple-choice question (MCQ). However, instead of presenting a list of 3 to 5 possible answers like an MCQ, a short-menu question typically offers a list of 6 to 30 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.
Note that the majority of questions are worded in the plural; e.g., “treatments,” “diagnoses,” etc. Even when you are asked to select “treatments,” there may be only one correct answer.
To select an option, click on the text of that option. You may deselect an option by clicking on it a second time. Each time you select or deselect an option, the total number of options currently selected for that question is displayed.
A write-in question asks you to type in your answer. To ensure that your write-in answers receive the maximum credit possible, follow these rules:
The instructions for each question are different and must be followed. For example:
In either case outlined above, a score of zero will be given.
The MCCQE Part I CDM component includes questions where you will need to provide written answers. Two examples of CDM questions are included in this section. You will have access to these examples on your exam day.
For some questions, you will be asked to list up to a fixed number of responses. As guidance on how to avoid exceeding the maximum allowable responses, examples of what counts and what does not count as “one” answer are included at the end of this section.
| Case 1 |
| A 13-year-old girl has a three-month history of intermittent diarrhea, weight loss, and muscle weakness despite an increased and voracious appetite. She has also experienced intermittent palpitations. Her parents report that her school performance has declined over the past few months. She also gets upset easily and is unable to concentrate well. Her sleep pattern is irregular. Physical examination detects a mild tremor of the fingers with the arms outstretched. Her palms are moist. Her blood glucose level is 4.5 mmol/L. |
Use the information above to answer the following questions.
| Question 1 What is the most likely diagnosis? List up to three | |
| 1. 2. 3. | ________________________________ ________________________________ ________________________________ |
Answer: Listing more than 3 answers – 0 points | |
| Question 2 Which initial investigations will you order at this time? Select up to three answers |
| 1. Colonoscopy 2. Endoscopic retrograde cholangiopancreatography 3. Erythrocyte sedimentation rate 4. Jejunal biopsy 5. Psychometric testing 6. Rectal biopsy 7. Serum 17 a hydroxy progesterone level 8. Serum beta-HCG 9. Serum electrolytes 10. Serum Insulin level 11. Serum T4 and T3 12. Serum vanillyl mandelic acid levels 13. Sweat chloride 14. Urine estradiol 15. Urine homovanillic acid levels |
| Answer: Selecting Serum T4 and T3 – 1 point Selecting more than 3 answers – 0 point Selecting Serum beta-HCG and Serum electrolytes and Serum T4 and T3 – 1 point |
Physical examination
Hematology
Biochemistry
Urine
Microbiology
Medications and lifestyle
Imaging
Incorrect answers*
* These are examples of terms that do not have inherent meaning and are therefore incorrect. However, if candidates indicate what they mean by these terms (for example, by adding it in parentheses), then they should be scored accordingly:
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