Therapeutic Decision Making Exam

The application of knowledge in the pharmacological and non-pharmacological management of medical disorders is referred to as therapeutics. Therapeutic decision making is a complex process healthcare professionals undertake when determining the most appropriate course of treatment for a patient. The Therapeutics Decision Making (TDM) exam serves as a crucial evaluation for International Medical Graduates (IMGs) specializing in Family Medicine. It is offered by the Medical Council of Canada (MCC) and plays a pivotal role in ensuring that IMGs possess the necessary clinical skills and knowledge to meet the standards expected of physicians in Canada. By standardizing the selection process for Practice Readiness Assessment (PRA) programs nationwide, the TDM exam holds a significant position in the medical licensing landscape.

IMGs who are eligible for the Provisional Register or hold Recognized Training and Certification Outside Canada through the College of Family Physicians of Canada are exempt from the TDM exam requirement. This exemption streamlines the pathway for qualified individuals to practice medicine in Canada.

History of TDM

The history and requirements of the TDM exam trace back to March 1, 2018, when the College of Physicians and Surgeons of Alberta (CPSA) mandated IMGs in Family Medicine, not eligible for their General Register, to successfully pass the TDM exam before pursuing independent practice in Alberta. As of October 1, 2020, IMGs aspiring to practice autonomously in Family Medicine in Alberta must meet the requirements for the Provisional Register and undergo a Review of Qualifications before undertaking the TDM exam.

To facilitate a smoother transition for physicians seeking to practice in Alberta, this change in protocol aims to expedite the recruitment process and provide greater clarity to applicants regarding CPSA eligibility before embarking on the TDM exam journey, while also aligning more closely with PRA programs nationally.

Applying for TDM

Applying for the TDM exam involves a series of steps to ensure eligibility for independent practice. Applicants are advised to carefully review the Family Medicine eligibility requirements and submit their application accordingly. The TDM exam is conducted multiple times a year, and applicants should stay updated on MCC’s website for application opening dates.

Upon successful application submission, candidates will undergo a review process to determine their eligibility to write the TDM exam. If deemed eligible, candidates will be directed to pay the exam fees online to secure their examination slot. Throughout this process, candidates will receive communications outlining the subsequent steps. In the event that an eligibility letter expires before the exam date, applicants will need to reapply for independent practice.

By adhering to these guidelines and staying informed, IMGs can navigate the TDM exam process effectively and work towards fulfilling their aspirations of practicing medicine in Canada within the Family Medicine field.

What to do when applying for TDM

When preparing to register for the Therapeutic Decision Making (TDM) exam, it is essential to use the same email address that was provided on the Review of Qualifications Form. If you encounter an error message such as “oops” on the Oats Tracking System while attempting to apply for the exam, you can troubleshoot by clearing your web browser’s cache, refreshing the browser with ‘Ctrl+R,’ and starting a new attempt.

Candidates who are deemed eligible to take the online TDM exam will receive a notification from the Medical Council of Canada (MCC) through their account a few weeks before the exam date. This message will contain vital information, including their Authorization to Test (ATT) number, instructions on scheduling the exam, and the commencement date of the scheduling period.

Exam Format

The TDM exam is delivered online at Prometric testing centers or remotely using ProProctor. The exam consists of write-in questions. Each test form includes 40 cases, with one to four questions per case, resulting in approximately 100 questions per form. Candidates are typically given 3 hours to complete the exam.

The TDM exam focuses on assessing clinical decision-making skills within the specific context of Family Medicine. Your skills will be tested in the following ways:

  • Your skill in gathering relevant patient information through history taking and physical examination.
  • Your ability to identify and consider various potential diagnoses based on the presented clinical information.
  • Your ability to evaluate the appropriate selection and interpretation of diagnostic tests to confirm or rule out potential diagnoses.
  • Your ability to formulate effective treatment plans, considering evidence-based approaches, medication management, and referrals as needed.
  • Your ability to effectively communicate with patients, explain diagnoses and treatment options in a clear and understandable manner, and address patient concerns and anxieties.

Scheduling and Fees

Scheduling for the exam is conducted on a first-come, first-served basis at available Prometric test centers globally. Alternatively, candidates can opt for remote proctoring using Prometric’s ProProctor system. It’s important to note that the MCC does not manage the scheduling or rescheduling of exam appointments, which are strictly available within the designated exam sessions.

The fees associated with the TDM exam are outlined clearly for candidates to consider. The exam fee varies throughout the year, and it is crucial to promptly pay the fee once your application is approved by the College of Physicians and Surgeons of Alberta (CPSA) to secure your spot. Withdrawal from the exam incurs a fee, with specific refund policies based on the timing of withdrawal.

Exam Tips

To best prepare for the TDM exam, candidates are encouraged to utilize the resources and guidance provided by the MCC, including candidate information sheets and preparation materials outlining exam details, withdrawal policies, exam-day expectations, scoring criteria, results, and test accommodations. Candidates can also visit CanadaQbank, a comprehensive and online repository of past questions of this and various exams.

At the end of the Exam

After successfully passing the TDM exam, candidates will receive a congratulatory result letter via email, which must be uploaded to the Application Tracking System for review by the Registration Team. The next steps involve obtaining Alberta Health Services (AHS) sponsorship, if not secured already, to proceed with registration on the Provisional Register.

In the event of an unsuccessful TDM exam attempt, candidates have a limited number of opportunities for reexamination and are required to meet specific criteria for reapplication. Timely access to updated information and guidelines, such as those provided by the MCC, can aid candidates in navigating the TDM exam process effectively and efficiently.


Understanding the exam will ensure that you ace your exams by using these preparation strategies to help you stay organised and prepare ahead. Also remember that to be on your A-game for the exam, your mental and physical health should be in top shape.

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