Medical Council of Canada

Information for residency program directors

Information for residency program directors

The National Assessment Collaboration (NAC) Examination assesses the readiness of an international medical graduate (IMG) for entrance into a Canadian residency program. It is a pan-Canadian, standardized examination that provides residency program directors with objective information on the skills, attitudes and knowledge level of IMGs applying for postgraduate training in Canada.

The NAC Examination is currently delivered in Alberta, British Columbia, Ontario, Manitoba, Nova Scotia , Saskatchewan and Quebec.


The NAC Examination was developed to reduce duplication amongst provincial IMG assessment programs and offer standardized results to residency program directors across the country. The exam results provide a comprehensive assessment of an IMG’s skills, attitude and knowledge as compared to the level of a recent Canadian medical graduate and its readiness for entry into postgraduate training.

This information should be used with other information – such as a residency application letter or results from the Medical Council of Canada Qualifying Examination (MCCQE) Part I – to obtain a comprehensive view of an applicant’s skill set.

Scope and format

The NAC Examination is a clinical skills examination that consists of 12 different 11-minute clinical stations, each with a standardized patient and a physician examiner.

In total, the duration of the exam is approximately three hours. However, the candidate may be on site for a longer period of time for administrative reasons.

Visit our station description page for more detailed information on the format of the NAC Examination.

Evaluation and scoring

The pass/fail result is based on whether a candidate’s examination score is equal to or higher than the established cut score for the NAC Examination. The standard is based on the level of performance compared to a graduate from a Canadian medical school.

Candidates are rated by physician examiners on up to seven different competencies per station. These competencies include:

  • History taking
  • Physical examination
  • Diagnosis
  • Data interpretation
  • Investigations
  • Management
  • Communication skills

A candidate’s score for each station is the average of all competency ratings measured on the station. A candidate’s score for the entire exam is the average of the station scores.

More detailed information on NAC examination scoring can be found on the Scoring page.

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Content development

Content for the NAC Examination is developed by physicians from across the country with expertise in multiple medical disciplines. Content development is overseen by the NAC Examination Committee (NEC) who ensures that the content is appropriate for the expected performance of a graduate from a Canadian medical school.

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