TDM Examination
Assessing candidates at the level required of a family physician practising independently and safely in Canada for use by NAC PRA programs in their selection of candidates.
What is the TDM Examination?
The Therapeutics Decision-Making (TDM) Examination aims to assess the competence of candidates at the level required of a family physician practising independently and safely in Canada. The content is developed by the Medical Council of Canada (MCC), and the examination is administered by the MCC on behalf of the Practice-Ready Assessment (PRA) programs for use in the selection of candidates into PRA programs.
How is the TDM Examination delivered?
The TDM Examination is a four-hour appointment, computer-based exam that is delivered in Canada and worldwide multiple times a year. Candidates have the option to take their exam at any available Prometric test centre or through remote proctoring. This exam is offered in English and French.
The examination consists of multiple-choice and short-menu questions. It features 55 cases, for a total of approximately 110 to 140 questions. Candidates are allowed up to three hours to complete two sections of one hour and a half, with an optional 20-minute break.
What does the TDM Examination test
The term therapeutics is defined as the application of knowledge in the pharmacologic and nonpharmacologic management of medical conditions. It consists of patient-based scenarios representing common or important clinical presentations and problems that family physicians practising in Canada should be able to competently manage in the following dimensions of medical care: health promotion and illness prevention, acute, chronic, and safety and adverse effects.
The questions assess your critical-thinking and decision-making skills. You will be assessed on your ability to make specific treatment decisions, to manage common adverse effects and drug interactions, and to advise a patient regarding the management of their medical issue. Cases and questions also assess your awareness and understanding of alternative therapies, respect for negotiating a therapeutic agreement, and recognition of drug misuse and substance use disorders.
The exam is based on a blueprint that assesses candidate performance across two broad categories: dimensions of care and therapeutic interventions. The blueprint specifications outline the specific content weighting assigned to each of the four domains under the dimensions of care and to each type of therapeutic intervention on the exam.
Dimensions of care
Health promotion & illness prevention
Health promotion is the process of supporting and empowering people to increase control over their health and its determinants and thereby improve their health. It includes education, advocacy, care strategies, and programs intended to reduce harms and overcome barriers to good health at both individual and population levels.
Illness prevention includes measures not only to prevent the occurrence of illness or injury but also to arrest its progress and reduce its consequences once established. It includes but is not limited to:
- Psychological and social determinants of health
- Health impacts of all forms of oppression and discrimination, including those related to intersecting identities
- Risk factor identification and risk reduction
- Periodic health examination and screening programs
- Protection from neglect and abuse
- Harm reduction strategies
- Patient education and advocacy
- Community and population health
Approx.
10–20% of the exam
(on average 15%)
Acute
This is a brief episode of illness spanning from initial presentation to transition of care. It includes but is not limited to:
- Urgent, emergent, and life-threatening conditions
- New conditions and exacerbation of underlying conditions
Approx.
20-30% of the exam
(on average 25%)
Chronic
A chronic condition refers to an illness of prolonged duration that may be stable, progressive, or periodically exacerbated, or to a natural biological state that may require medical care or intervention. It includes but is not limited to:
• Chronic illness:
– Mental illness
– Physical illness
– End-of-life care
• Natural biological state:
– Pregnancy
– Infertility
– Gender dysphoria
– Menopause
Approx.
25-35% of the exam
(on average 30%)
Safety & adverse effects
This dimension includes the unintended or harmful effects resulting from a medication or other intervention. Reactions may occur in susceptible individuals or in anyone. It includes but is not limited to:
- Drug interactions and adverse reactions
- Ongoing monitoring to promote medication safety
- Knowledge of absolute versus relative contraindications
- Safe medication selection for patient’s unique presentation
Approx.
25-35% of the exam
(on average 30%)
Therapeutic interventions
Pharmacologic interventions
These are interventions that introduce chemical substances into the human body. This dimension involves understanding the different classes of drugs—how they are used therapeutically, how their mechanisms of action function, and how they are handled by the human body. Additionally, this dimension involves knowledge of contraindications to the use of chemical substances. Prescribed and nonprescribed interventions are included in this dimension.
Approx.
65–75% of the exam
(on average 70%)
Nonpharmacologic interventions
These are therapeutical interventions that do not involve medication and are beneficial to the health and well being of the patient (e.g., counselling, exercise, splints).
Approx.
25–35% of the exam
(on average 30%)
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