The TDM exam Canada — the Medical Council of Canada‘s Therapeutics Decision-Making Examination — 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 is not the short-answer written paper described in older forum posts. This guide covers who needs it, the 2026 format, the 2026 and 2027 dates, the fee and attempt limits, and how to prepare for it alongside a question bank.
What the TDM Examination is for
The MCC describes the TDM exam 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: Practice-Ready Assessment programs — the accelerated licensure routes for experienced family physicians that operate in nine provinces — use it to decide who is admitted to their clinical field assessments. Moreover, in the MCC’s words, most PRA programs in family medicine require a pass on the TDM as part of their eligibility criteria. If your route is CaRMS residency, you do not need it. If your route is PRA, you almost certainly do, and the program will tell you which session’s result it accepts.
The 2026 format of the TDM exam Canada
From the January 2026 session the exam changed. It is now a computer-based test at Prometric centres, in English or French, made up of 55 clinical cases with roughly 110 to 140 questions in total. Questions are multiple-choice and “short-menu” — you select answers from a list rather than writing them, which is what allows the MCC to release results faster than the old handwritten format. The appointment is four hours: two 1.5-hour sections with an optional 20-minute break between them.
The blueprint is published and worth memorising, because it tells you where the marks are. By dimension of care: health promotion and illness prevention about 15%, acute conditions about 25%, chronic conditions about 30%, and safety and adverse effects about 30%. By intervention: pharmacologic about 70%, non-pharmacologic about 30%. Moreover, read those two lines 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, dose adjustment in renal or hepatic impairment, pregnancy and lactation, the elderly), and nearly a third of the cases are chronic disease management 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 |
|---|---|---|
| September 23, 2026 | Closed | About 5 weeks after the exam — late October 2026 |
| January 13, 2027 | Expected October 5 – 26, 2026 | About 5 weeks — mid/late February 2027 |
| June 16, 2027 | To be announced (by pattern, ~March 2027) | About 5 weeks — late July 2027 |
| September 22, 2027 | To be announced (by pattern, ~June 2027) | About 5 weeks — late October 2027 |
Source: MCC TDM scheduling and eligibility pages, September 2026. Application windows are short — three weeks — and close well before the exam; the January 2027 window is the only one the MCC has published so far.
Fee, eligibility and attempts
The application fee is $2,850 from September 2026, with a $1,425 withdrawal fee if you withdraw under the MCC’s conditions. Eligibility is a medical degree from a school listed in the World Directory of Medical Schools with a Canada Sponsor Note, or a U.S. osteopathic or allopathic school. As of September 2026 you may take the TDM a maximum of four times, pass or fail, and after three consecutive failures you must wait a year. Additionally, the MCC does not publish an expiry on TDM results, but PRA programs set their own currency rules for exams and for clinical practice — check the program’s criteria before you book.
How the TDM differs from the MCCQE
The MCCQE is broad: 230 multiple-choice questions across every discipline and the full blueprint of assessment, management, communication and professional behaviour, scored on a 300–600 scale. Meanwhile the TDM exam Canada is narrow and deep: family-medicine therapeutics only, presented as cases, where a single patient may generate three or four linked questions — the diagnosis is usually given, and the work is choosing and monitoring treatment. Additionally, the candidates who have just passed the MCCQE tend to be strong on recognizing 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 other difference is the level. The MCCQE is set at the standard of a graduating medical student; the TDM is set at the standard of an independently practising family physician. Moreover, questions assume you can manage a patient with diabetes, hypertension, atrial fibrillation and depression at once, not one condition in isolation.
Preparing for the TDM Exam
Three things make the difference. First, Canadian guidelines, not the ones you trained on: Diabetes Canada, Hypertension Canada, the Canadian Cardiovascular Society, the Canadian Thoracic Society for asthma and COPD, Choosing Wisely Canada, the Canadian Paediatric Society, the Canadian Immunization Guide, and the provincial formularies’ first-line choices. If a treatment differs between Canadian and American or British practice, the Canadian version is the answer. Second, a systematic pass through adverse effects and interactions for the hundred or so drugs family physicians prescribe most — anticoagulants, antihypertensives, diabetes agents, antidepressants, antibiotics, analgesics, inhalers, hormonal therapies — with dose adjustments for kidney function, age and pregnancy. Third, the non-pharmacologic third of the exam, which candidates skip: lifestyle prescriptions, vaccination, screening intervals, when not to treat, and safe deprescribing.
A question bank built for the MCCQE is the right foundation because its management and chronic-care questions are written to the same Canadian guidelines; filter to management, chronic and health-promotion questions and read every explanation for the second-line and monitoring detail. mccQbank’s bank has 2,400+ bilingual MCQs with analytics by blueprint domain and weekly guideline updates — start with 30 free questions. For the exam itself, also read the MCC’s TDM sample cases so the short-menu format is familiar before January.
If you are still deciding between the residency and PRA routes, our post on what replaced MCCQE Part II maps which exams each route requires.
Sources: MCC — TDM Examination overview, “Changes to the TDM Examination in 2026”, TDM scheduling page, TDM eligibility and application page, fee schedule. Checked September 2026; the MCC notes that dates are subject to change.
