NAC Examination | Medical Council of Canada
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NAC Examination

Assessing your readiness as an international medical graduate to enter a Canadian residency program.

What is the NAC Examination?

The National Assessment Collaboration (NAC) Examination is a national, standardized exam that assesses your readiness to enter a Canadian residency program. It was developed to reduce duplication amongst provincial international medical graduate (IMG) assessment programs and offer standardized results to residency program directors across the country.

The exam tests the knowledge, skills, and attitudes essential for entrance into postgraduate training, or residency, in Canada. IMGs must take the NAC Examination to apply to the Canadian residency program with the Canadian Residency matching service (CaRMS).

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How is the NAC Examination delivered?

The NAC Examination is a half-day Objective Structured Clinical Examination (OSCE). Exam administrations are held twice a year, in the spring and fall.

For a given administration, all candidates rotate through the same series of stations. The NAC Examination consists of 12 stations, 2 of which are pilot stations that will not count toward your final score. Each station is 11 minutes long with 2 minutes between stations.

At each station, a brief written statement introduces a clinical problem and outlines your tasks (e.g., take a history, conduct and describe a physical examination). In each station, there is at least one standardized participant (SP) and a physician examiner (PE).

You can take the NAC Examination in English or French at designated centres.

What does the NAC Examination test?

The NAC examination includes a series of stations where you are presented with typical clinical scenarios. It includes problems in:

  • medicine
  • surgery
  • pediatrics
  • obstetrics and gynecology
  • psychiatry
  • preventive medicine and public health

You are assessed by PEs on up to 7 different competencies per station. These competencies include:

  • History taking
    Acquires from the patient, family or other source a chronologic, medically logical description of pertinent events, including questioning about onset, location, duration, character, severity, etc. as appropriate to the case. Gathers information efficiently in sufficient breadth and depth to permit a clear definition of the patient’s problem(s).
  • Diagnosis
    Discriminates important from unimportant information and reaches a reasonable differential diagnosis and/or diagnosis.
  • Management
    Discusses therapeutic management, including but not limited to pharmacotherapy, adverse effects and patient safety, disease prevention and health promotion when appropriate. Selects appropriate treatments (including monitoring, counselling, follow-up); considers risks and benefits of therapy and instructs the patient accordingly. Identifies medication classes, except when specific drugs and dosages would reasonably be expected in the context of the clinical problem.
  • Communication skills
    Uses a patient-centered approach: establishes trust and respect and shows sensitivity to the patient’s needs. Provides clear information and confirms patient’s understanding: encourages questions and uses repetition and summarizing to confirm and/or reinforce understanding. Respects confidentiality when appropriate. Avoids use of jargon/slang and uses tone and vocabulary appropriate to the patient. Demonstrates appropriate nonverbal communication (e.g., eye contact, gesture, posture and use of silence).
  • Physical examination
    Elicits physical findings in an efficient logical sequence that documents the presence or absence of abnormalities and supports a definition of the patient’s problem(s). Sensitive to the patient’s comfort and modesty; explains actions to the patient.
  • Investigations
    Selects suitable laboratory or diagnostic studies to elucidate or confirm the diagnosis; takes into consideration associated risks and benefits.
  • Data interpretation
    Interprets investigative data appropriately in the context of the patient’s problem(s).

Content for the NAC Examination is developed by physicians from across the country with expertise in multiple medical disciplines. Content development is overseen by subject matter experts and ensures that the content is appropriate for the expected performance of a graduate from a Canadian medical school.

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