TDM exam applications move to the MCC in September 2026

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The Okunola Clinical Review
The Okunola Clinical Review

The Medical Council of Canada (MCC) has changed who you apply through, who can sit the Therapeutics Decision-Making (TDM) Examination, and how many times you can take it. The new model starts with the September 2026 session.

What changed

Until now, the MCC delivered the TDM on behalf of Practice-Ready Assessment (PRA) programs, and each program ran the application process for its own applicants. From September 2026 you apply to the MCC yourself, and a PRA program no longer has to approve you before you can sit the exam.

Rule
Before
From September 2026
How you apply
Through your Practice-Ready Assessment (PRA) program
Directly through the MCC
PRA program approval
Programs approved applicants for the exam
Not required to take the exam
Attempts
A limit on attempts with a pass result
Four attempts in total, pass or fail, with a waiting period after three consecutive fails
Result validity
Three years
The three-year validity period is removed
Before you apply
Handled by your program
Your medical degree submitted for source verification in your physiciansapply.ca account

The MCC has not published the length of the waiting period between a third and fourth attempt on its announcement. If you are approaching a fourth attempt, confirm it with the MCC before you plan your date.

What stays the same

The exam itself does not change with the new application model:

  • It is still delivered through Prometric, at test centres across Canada and worldwide, in English or French.
  • It is a four-hour, computer-based appointment: two sections of one and a half hours each, with an optional 20-minute break.
  • It has 55 cases with approximately 110 to 140 multiple-choice and short-menu questions.

Who this affects

The old application model and policies stayed in place up to and including the June 2, 2026 TDM Examination. Anyone sitting from September 2026 onward applies under the new model, whether or not you are attached to a PRA program.

What to do now

  1. Check that your medical degree has been submitted for source verification in your physiciansapply.ca account. The MCC needs it before you can apply.
  2. Look up the session dates and fees on the MCC TDM Examination page, then book your Prometric appointment once you are approved.
  3. Treat every sitting as one of four. With a fixed total, it pays to be ready before you book rather than using an attempt to see the exam.
  4. Study to the blueprint. The MCC weights the exam by dimension of care: health promotion and illness prevention 10 to 20%, acute 20 to 30%, chronic 25 to 35%, and safety and adverse effects 25 to 35%. Pharmacologic interventions make up about 70% and nonpharmacologic about 30%.

Where our guide fits

Rx Marks the Spot is our visual textbook of therapeutics for the TDM, organised around those same dimensions of care, with mnemonics for the high-yield prescribing decisions and a TDM-format practice exam. It is in clinical review now; the opening chapter on the exam itself is free to read in the online reader.