Clinical decision-making component
Instructions to candidates
Over the next three and a half hours, you will be presented with a series of 38 case descriptions, followed by one or more questions to assess key issues in the resolution of the case.
Of those 38 cases, eight are pilot cases that do not count towards your total score. While the pilot cases and questions are not scored, they are not identified as non-scored in the exam. We encourage you to do as well as you can on every case and question. In total, you will be presented with 60 to 70 questions.
All the cases and questions are presented in a single block. Questions are either in a short-menu or write-in format. You may navigate freely between all questions. You are only required to submit the clinical decision-making (CDM) examination once, when you have completed your CDM component and are ready to submit, or when your allotted time expires. You may not go back once you have submitted your examination.
You may be asked to elicit clinical information, order diagnostic procedures, make diagnoses, or prescribe therapy. Your decisions should reflect the management of an actual patient.
Certain test items will have pictorial material presented in the form of photographs, diagrams, x-rays, 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 response or if a response selected is considered harmful or dangerous to the patient. For the CDM write-in component, only place one answer in each available line.
If you experience any technical difficulties, please notify the site staff immediately. The site staff and the MCC are in direct contact throughout your examination to resolve any possible issues. We are also actively monitoring every computer running the exam. If we notice a loss of connection with a computer, your site will be contacted to reestablish a connection. Any time lost during the interruption will be noted, and we will also provide some additional time to allow you to reacclimatize and start back where you left off.
How to respond to questions
The instructions for each question are different and must be followed. For example:
- Some questions specify the exact number of responses to be typed in or to be selected (e.g., “List only one”). Exceeding the number of responses requested will result in you being given a score of zero for the entire question, even if your responses include the correct answer(s).
- Some questions place an upper limit on the number of responses to be typed in or selected (e.g., “Select up to six”). Do not exceed that number. However, you may not need to select or list that number either; a question instructing you to “Select up to six” may have a correct answer consisting of only three or four responses. Guessing to build your answer up to the permitted number of responses presents the risk of selecting some of the wrong responses. If you select inappropriate investigations or treatments that could harm the patient, you will be given a score of zero for that question.
- Some questions leave it to your judgment to select as many responses “as are appropriate.” What you deem to be the “appropriate” number should be dictated only by what you would do in the actual clinical situation. You should not be tempted, for example, to provide an excessive number of responses in an effort to ensure that you have included the correct response. The scoring keys for this type of question:
- Set limits on the maximum number of acceptable responses as an excessive number may imply that you are over-investigating a patient
- Penalize inappropriate responses
In either case, a score of zero will be given.
A short-menu question is similar to a multiple-choice question.
However, instead of presenting a list of five possible answers, a short-menu question typically offers a list of 10 to 40 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. Please 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.
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 supply an answer by typing it in. To ensure that your write-in answers receive the maximum credit possible, follow these rules:
- Record only one response in each of the boxes provided. If a question instructs you to “List four diagnoses,” four boxes will be provided, one for each response. Typing in more than one response in a box will result in you being given a score of zero.
- Be specific. For example, “thyroid disease” is an unacceptable diagnostic response when “hyperthyroidism” is the correct diagnosis.
- If you are asked to list drugs or medications, use generic names. Read such questions carefully to determine if you are also required to specify the route of administration and dosage.
- Word your responses carefully. Correct answers typically consist of single words or short phrases.