By Dr. Bilal Akil, MD — Emergency Medicine, Schulich School of Medicine & Dentistry, Western University · founder of mccQbank
Short answer: The TDM (Therapeutics Decision-Making) Examination is the Medical Council of Canada’s four-hour, computer-based therapeutics exam, set at the level of an independently practising family physician. Most Practice-Ready Assessment (PRA) programs use it to select internationally trained family physicians (MCC: TDM Examination). The next session is January 13, 2027. Applications for it closed on October 26, 2026, and the MCC expects the application period for the June 2027 exam to open in spring 2027 (MCC: TDM eligibility and application). The fee is $2,850, scores run from 400 to 600 with a pass score of 484, and results arrive 5 weeks after the exam. You do not need it for a CaRMS residency.
The TDM is the exam most internationally trained family physicians meet after the MCCQE, and the one they know least about. It is not a version of the MCCQE, it is not an OSCE, and since January 2026 it follows a new assessment model, so format descriptions in older forum posts may be out of date. This guide covers who needs it, the current format, the 2026 and 2027 dates, fees, scoring and attempts, and how to prepare.
What the TDM Examination is for
The MCC describes the TDM as assessing “therapeutic knowledge and clinical decision-making at the level expected of a family physician practising independently and safely in Canada”. Its purpose is selection: PRA programs, the accelerated licensure routes offered in nine provinces, use it to decide whom to admit to their clinical field assessments. In the MCC’s words, it is used by most PRA programs “to inform applicant selection decisions for program admission”. Passing it does not by itself make you eligible for a PRA program; each program sets its own criteria. Our guide to Practice Ready Assessment by province compares them.
If your route is a residency, the TDM is not on the list: CaRMS asks IMGs to have written and passed the NAC Examination and the Medical Council of Canada Qualifying Exam (still listed there under its former Part I name), though some provinces allow exceptions (CaRMS: R-1 eligibility criteria).
The TDM exam format since January 2026
The TDM is a computer-based test at Prometric test centres in Canada and worldwide, offered in English and French. It has 55 clinical cases with roughly 110 to 140 questions in total. Questions are multiple-choice and short-menu; in both you select answers rather than writing them. The appointment is four hours; you get up to three hours of testing in two sections of an hour and a half each, with an optional 20-minute break. Remote proctoring is no longer offered.
The blueprint is published, and it tells you where the marks are. By dimension of care: health promotion and illness prevention about 15% on average, acute care about 25%, chronic care about 30%, and safety and adverse effects about 30%. By intervention: pharmacologic about 70%, non-pharmacologic about 30%. Read those together and the exam’s character is clear. Nearly a third of the marks are about what can go wrong with a drug (interactions, contraindications, monitoring, safe selection for the patient in front of you), and nearly a third of the exam is chronic care, where the question is what to start, what to add and when to stop.
TDM exam dates 2026 and 2027
| Exam date | Application window | Results (5 weeks after) |
|---|---|---|
| September 23, 2026 | Closed | Released October 23, 2026 |
| January 13, 2027 | Closed (October 26, 2026) | About February 17, 2027 |
| June 16, 2027 | Expected to open in spring 2027 | About July 21, 2027 |
| September 22, 2027 | Not yet published | About October 27, 2027 |
Source: MCC TDM scheduling and eligibility and application pages, checked October 22, 2026. Result dates are our arithmetic from the MCC’s “5 weeks after the examination date”. The MCC notes that dates are subject to change.
You apply through an online form on the MCC’s eligibility page, not through your physiciansapply.ca account, and you no longer need an invitation or approval from a PRA program. The MCC recommends submitting your medical degree for source verification early: your application is only complete once the degree’s status is “reviewed and accepted” in physiciansapply.ca. Once accepted, you book a seat with Prometric, up to 120 hours before the exam.
Fee, eligibility and attempts
The application fee is $2,850 from the September 2026 exam, with a $1,425 withdrawal fee where a refund is allowed (MCC fee schedule). Prometric charges $35 plus HST to reschedule or cancel up to 31 days before your appointment and $75 plus HST inside 30 days; if you cancel inside 120 hours or miss the appointment, your application fee is forfeited (MCC: TDM scheduling).
You are eligible with a degree from a school listed in the World Directory of Medical Schools with a Canada Sponsor Note, or from a U.S. osteopathic or allopathic school. Passing the MCCQE or the NAC is not required to apply, and the MCC sets no language or postgraduate-training requirement for the exam itself. As of September 2026 you may take the TDM a maximum of four times, pass or fail, and attempts before September 2026 count. After a fail you cannot apply to the next consecutive session, and after three consecutive fails you must wait one year from receiving the result before reapplying for a fourth attempt.
How the TDM is scored
Scores are reported on a scale from 400 to 600, with a mean of 500 and a standard deviation of 25 set on the January 2026 session; the pass score is 484 (MCC: TDM results). The exam is criterion-referenced, so you pass by reaching 484, whatever other candidates score. Your result letter in physiciansapply.ca has a Statement of Results and a Supplemental Information Report with subscores. Only your most recent result is valid, and from September 2026 the MCC no longer applies an expiry to a pass; PRA programs may set their own recency rules.
In the MCC’s 2025–26 year, 676 candidates took the TDM and 87% passed, against 412 and 91% in 2024–25 (MCC Annual Report 2025–26, p.31).
How the TDM differs from the MCCQE
The MCCQE is broad: 230 multiple-choice questions across the whole MCC blueprint, set at the level of a medical student completing their medical degree in Canada (MCC: MCCQE). The TDM is narrow and deep: family-medicine therapeutics only, presented as cases, where one patient may generate several linked questions. In our experience the work is mostly choosing and monitoring treatment, and candidates fresh from the MCCQE tend to be strong on recognising the condition and weaker on the second-line agent, the interaction with the patient’s other medications and the monitoring plan. Those are TDM marks.
The level differs too. The TDM is set at the standard of an independently practising family physician, so in our view you should expect patients with several conditions at once rather than one problem in isolation.
Preparing for the TDM exam
Start with the MCC’s own material: the eight free sample cases and the list of core TDM examination topics, so the short-menu format is familiar before exam day. Then three things make the difference. First, Canadian guidelines rather than the ones you trained on: if a treatment differs between Canadian and American or British practice, answer the Canadian way. Second, a systematic pass through adverse effects, interactions and dose adjustment for the drugs family physicians prescribe most, including adjustments for kidney function, age and pregnancy. Third, the non-pharmacologic share of the exam that candidates skip: lifestyle advice, vaccination, screening, when not to treat, and safe deprescribing.
A question bank built for the MCCQE is a sound foundation for the management and chronic-care side, because its explanations follow Canadian practice; filter to management questions and read every explanation for the second-line and monitoring detail. mccQbank has 2,600+ practice questions in English and French — start with 30 free questions.
If you are still deciding between the residency and PRA routes, our posts on what replaced MCCQE Part II and how an IMG gets licensed in Canada map which exams each route requires.
Frequently asked questions
What are the TDM exam dates for 2027?
January 13, June 16 and September 22, 2027. Applications for January 13 closed on October 26, 2026. The MCC expects the June application period to open in spring 2027; the September window is not yet published (MCC: TDM scheduling).
How much is the TDM exam fee?
$2,850, in effect from the September 2026 exam. Where a withdrawal refund is allowed, a $1,425 withdrawal fee is kept, and you cannot defer an application to a later session.
When are TDM results released?
Five weeks after the exam date, in your physiciansapply.ca account. Results for the September 23, 2026 exam were released on October 23, 2026 (MCC news).
What is the TDM passing score?
484, on a scale of 400 to 600. It stays in place until the MCC’s next standard-setting exercise.
Do I need to pass the MCCQE or the NAC before the TDM?
Not to apply for the exam. Individual PRA programs may still require them for admission, so check the program’s criteria before you book.
