By Dr. Bilal Akil, MD — Emergency Medicine, Schulich School of Medicine & Dentistry, Western University · founder of mccQbank
Short answer: For IMGs, the NAC Examination is first an eligibility gate: CaRMS’s 2027 R-1 summary marks it as required in every provincial column, including Quebec, where a footnote explains that Quebec’s medical schools “continue to require it as a criterion for admission to residency” (CaRMS). Beyond the pass, programs differ. Some publish that they screen or rank on the NAC score, two say they do not consider or evaluate scores in their file review, and none of the descriptions we read publishes a numeric NAC cut-off. The only way to know how your program uses the score is to read its own program description.
What the NAC score actually tells a program
Since May 2023 the NAC total score is reported on a 500–700 scale with a pass score of 577, and a total score “equal to or greater than the pass score is a pass” (MCC). The exam is criterion-referenced, so candidates who meet the standard pass “regardless of how well other candidates perform.” Your total score is the average of your 10 scored station scores; 2 of the 12 stations are pilot stations.
You receive two documents: a Statement of Results (SOR) with your result, total score and the pass score, and a Supplemental Information Report (SIR) with subscores. The MCC also says the NAC result has no time restriction, and if you took the exam more than once, “the most recent result will be the only valid result.”
The MCC is explicit about what the pass score is for. Its score-interpretation guidance says the NAC pass score “is intended to screen IMGs who are not ready for entry into a residency program,” and that “Selection decisions should not be based on a single assessment tool” (MCC). It also warns that SIR subscores “should not be used to compare candidates’ performance.”
If you want to place your score, the MCC gives one reference point. For the May 2023 session the mean was 600 and the SD was 25, and the MCC states that a score of 602 is 1 SD above the pass score, while 622 is 1.8 SDs above it. That is a measure of distance from the standard, not a program cut-off.
Which provinces require a NAC pass for the 2027 R-1 match?
CaRMS’s IMG table for the 2027 cycle lists the MCCQE and NAC requirements by province, plus exams accepted in their place. Read your province’s column before you plan a retake or a first sitting.
- NAC accepted alternatives: Newfoundland and Labrador lists MCCQE Part II or the LMCC; Ontario lists MCCQE Part II.
- Quebec: the table marks the NAC as required, with a footnote that it “is no longer required by the Collège des médecins du Québec to obtain MD equivalency,” but Quebec’s medical schools still require it for residency admission.
- Program-level rules can be stricter. Western’s London Family Medicine IMG stream, for example, requires “A passing score of NAC from exam sessions after March 2013.”
Provincial IMG offices add their own rules. The Alberta International Medical Graduate (AIMG) Program requires a “PASS standing” on the NAC for its 2027 cycle and asks applicants to share the NAC Statement of Results through physiciansapply.ca by November 20, 2026 at 3:30 PM MT (AIMG). If more eligible candidates want AIMG’s MMI than there are seats, AIMG says candidates “will be ranked by their MCCQE Part 1 score” for invitations (AIMG). In British Columbia, UBC’s IMG office says the NAC score “will not be used to select candidates for a CAP position in 2026” because of results timing, while IMGs applying to the CaRMS R-1 match “are still required to pass both the NAC Examination and the MCCQE Part 1” (UBC IMG office).
What named programs publish about the NAC score (2027 R-1)
We read the 2027 R-1 first-iteration program descriptions on CaRMS (CaRMS) on 15 October 2026. Each row quotes or closely follows the program’s own words. Descriptions can change during the match, so check the live version.
| Program (stream) | What its 2027 description says about the NAC | Score used beyond pass? |
|---|---|---|
| Ontario Family Medicine IMG streams (Western, McMaster, Toronto, Queen’s, Ottawa, NOSM, TMU) | “Approximately 600-700 candidates with top scores in the NAC and MCCQE1 will be invited for interviews.” A joint panel reviews applications. | Yes, for interview offers |
| University of Manitoba Family Medicine (IMG streams) | Rank lists use the MCCQE z-score plus the better z-score of the NAC or MCCQE Part II at “20% weighting”, alongside file review (30%), FMProC (10%), social accountability (10%) and interview (30%). | Yes, published weight |
| McMaster Internal Medicine, Hamilton (IMG) | “Candidates with top scores on the NAC and MCCQE1 and with recent clinical experience will undergo a comprehensive file review” by a faculty and resident committee and the program director “to determine final interview offers.” | Yes, to select files for full review |
| University of Saskatchewan Internal Medicine, Saskatoon (IMG) | Screening criteria “including MCCQE1and NAC scores, may be applied” to reduce the number of files reviewed in depth. | May be used to screen |
| McGill Internal Medicine (Regular stream) | “High scores on the MCCQE 1 +/- MCCQE 2 or NAC-OSCE exams are given significant weight in the file scoring process”; the application “will still be considered in absence of NAC exam score.” | Yes, not mandatory |
| University of Calgary Internal Medicine (IMG) | Applicants who fail to submit the NAC supplemental feedback report “will NOT be considered further,” but its file-review criteria for examinations say: “Scores are not evaluated.” | No, document required but scores not evaluated |
| University of Toronto Medical Genetics and Genomics (IMG) | Requires the NAC “as a provincial requirement but we do not consider scores in the file component.” | No, says it does not |
Two things stand out. First, none of these descriptions names a numeric NAC cut-off: the language is “top scores”, “significant weight” or a percentage weighting of a combined exam score. Second, the same exam can feed 20% of a rank list in one program and not be evaluated at all in another’s file review, so averages from forums cannot tell you what your program does. Once an offer arrives, our guide to CaRMS interviews for IMGs covers the 2027 dates, the format and a preparation plan.
A five-step check for your own programs
- Confirm the gate. Find your province in the CaRMS 2027 summary and note any accepted alternative exam.
- Read the “Examinations” section of each program description. Note whether it asks for the score only, or the score and documents. CaRMS explains that when a program requests documents you must also “upload or transfer the document(s)” and assign them to that program (CaRMS Help Centre).
- Look for selection language. Words like “top scores”, “screening criteria”, “weighting” or “do not consider scores” tell you how that program uses the NAC. If none appears, the description does not say, so do not assume.
- Check document deadlines. Programs and provincial offices set their own dates, such as AIMG’s November 20, 2026 cut-off for the NAC SOR.
- Decide on a retake only with the validity rule in mind. The MCC says that if you take the exam more than once, only the most recent result is valid.
For the full list of 2027 dates, see our CaRMS 2027 timeline for IMGs. If you have not yet applied for the exam, start with NAC exam eligibility and application, and for reading your SOR and SIR, see understanding your NAC results.
Frequently asked questions
What NAC score do I need for CaRMS?
The published requirement is a pass, which is 577 on the 500–700 scale. Some programs then favour “top scores”, but none of the 2027 descriptions we read states a numeric cut-off.
Do all provinces require the NAC for IMGs?
Yes. CaRMS’s 2027 IMG table marks the NAC as required in every provincial column. Quebec’s cell carries a footnote: the Collège des médecins du Québec no longer requires it for MD equivalency, but Quebec’s medical schools still require it for residency admission. Newfoundland and Labrador and Ontario list MCCQE Part II as an accepted alternative.
Does a higher NAC score improve my ranking?
Only where a program says it uses the score. Manitoba Family Medicine publishes a 20% combined exam weighting; University of Toronto Medical Genetics says it does not consider scores in its file review, and University of Calgary Internal Medicine says exam “Scores are not evaluated.”
If I retake the NAC, which score do programs see?
The MCC says “the most recent result will be the only valid result.”
Can programs compare candidates on NAC subscores?
The MCC says SIR subscores “should not be used to compare candidates’ performance,” although some programs still ask for the SIR as a required document.
If you are preparing for the NAC, OSCE-R gives you a station scoring rubric for every station and a progress tracker. See OSCE-R.
