MCCQE Part II Pre-Exam Candidate Orientation

The Medical Council of Canada
Qualifying Examination Part II:
Pre-Exam Candidate Orientation

Introduction
Meet Dr. Campbell and Dr. Fournier. They will be
taking the Medical Council of Canada Qualifying
Examination (MCCQE) Part II today. Let’s follow them
as they go through the examination process.
MCCQE Part II Candidate Orientation

Purpose of the examination
The MCCQE Part II is a two-day clinical skills
assessment comprised of a series of patient-based
encounters.
The purpose of this examination is to make a fair and
accurate assessment of your clinical skills.

Items to bring to the exam Items to leave at home
Entrance card Your lunch
Lab coat Pencils/paper
Reflex hammer Electronic devices
Stethoscope Large bags or purses
What to bring
The list of items to bring to the exam is included in the
Candidate Information Sheet that will be sent to you by
mail prior to the examination.

Coat check
A coat check will be provided at the site to store your
personal items during the examination and
sequestering period.
However, as storage space will be limited, we ask that
you please leave all large bags and handbags at
home.

Candidate registration
Dr. Fournier has arrived at the examination site. Once
he has registered, exam staff will hand him an ID
badge, a pencil and a notebook before directing him to
the orientation room.

Candidate orientation
During the candidate orientation on examination day,
the facilitator will give a brief presentation and answer
your questions.

Candidate notebook
In her notebook, Dr. Campbell will find bar code labels,
blank pages, and a list of Common examples of what
is considered ONE answer for written questions (next
slide).
I can use my notebook throughout
the examination for reference and
note taking. The notebook will not be
graded.
I won’t tear out any pages because I
have to hand in my notebook INTACT
at the end of each examination day.
This includes the label backing sheet.
Each notebook contains a few extra
labels. If I lose one or two, I don’t
need to worry.

Examples of what are considered ONE
answer for written questions
LABORATORY TESTING
• Amylase OR lipase (ordering either is considered the same as ordering both)
• CBC (includes platelets, Hb, WBC, MCV, HCT, Diff)
• Coagulation studies (includes PR, INR, PTT)
• Electrolytes (includes Na+, K+, CL-, CHO3
-,/Total CO2)
• Renal Function (includes creatinine, BUN)
• Urine Analysis (includes routine and microscopic analyses)
• Urine culture and sensitivity (accepted as one answer)
• Cardiac Enzymes (includes CK-MB, Troponin T, LDH, CK)
• Lipid profile (includes total cholesterol, triglycerides, HDL, LDL)
• Serum calcium (means total and ionized)
• Lumbar puncture (includes CSF, gram stain, culture and sensitivity, glucose, protein)
DIAGNOSTIC IMAGING
• Abdominal Ultrasound
• Pelvic Ultrasound
• CT abdomen
This list will be printed
inside my candidate
notebook — I will have
access to it during the
examination.
IMPORTANT: You are not limited to the
tests and investigations on this list.
• CT pelvis
• Upper GI series (includes esophagus, stomach, duodenum)
NOTE: Ensure your answers include all the tests and investigations you deem
necessary.

Overview of the examination
The Saturday session
of the examination is
comprised of ten 10-
minute stations:
• eight patient-
encounter stations
(in blue);
• two rest stations (in
yellow).
Saturday
01
02
03
04
05
06
07
08
09
10

Overview of the examination
The Sunday session of the
examination is comprised of
ten 5-minute stations:
• Four patient-encounter
stations (in blue);
• Four written stations (in
red);
• two rest stations (in
yellow).
Sunday
01
02
03
04
05
06
07
08
09
10

Start station
Exam staff will be there to guide me
and answer my questions during the
examination.
My start station will be written on the
Candidate Information Sheet I will
receive in the mail and on my ID
badge.
On each day of the exam, I will start
at the same station number. I will
then go through the remaining
stations in numeric order.
01
02
03
04
05
06
07
08
09
10

Timing of stations
• You will have two minutes to read the
candidate instructions posted by the door
before the buzzer sounds to prompt you to
enter the room.
• You will then have ten minutes in the room.
– A warning buzzer will sound at nine minutes.
– A second buzzer will signal the end of the station. At
this point, you will have to leave the room.
• You will then get two minutes to read the
instructions for the next station, and so on.
Saturday (10-minute stations)

Timing of stations
• You will have 1 ½ minutes to read the
instructions posted by the door before the
buzzer sounds to prompt you to enter the
room.
• You will then have five minutes in the room.
– A warning buzzer will sound at 4 ½ minutes.
– A second buzzer will signal the end of the station. At
this point, you will have to leave the room.
• You will then get 1 ½ minutes to read the
instructions for the next station, and so on.
Sunday (five-minute stations)

Candidate instructions
In any given station, you may
be asked to do one or more of
the following tasks:
– Perform a physical
examination
– Obtain a history
– Manage an acute patient
problem
– Respond to a patient’s
concerns
– Counsel the patient and/or a
colleague
Before entering the
room, I will read my
instructions carefully
in order to determine
what my task is for
each station.
The instructions will
also be available in
the room.

Joseph Trans, 40 years old, presents himself to your office with a
2-hour history of abdominal pain.
IN THE NEXT 10 MINUTES:
• CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION.
As you proceed, EXPLAIN TO THE EXAMINER what you are doing
and DESCRIBE ANY FINDINGS.
GIVE 1 LABEL TO THE EXAMINER.
Sample
My task here is to conduct a physical examination.
Therefore, I won’t ask history questions to the patient.
I’ll treat the standardized patient as a real patient because
I will only get credit for tasks I complete satisfactorily.
More sample stations are available.

Bar code labels
As I walk into the room, I hand one or two bar
code labels to the examiner. The instructions
outside the door will remind me of how many
labels to give (one in the 10-minute stations
and two in the 5-minute stations)

Oral questions
In some stations, the examiner will ask me one to three brief questions
after the warning buzzer. In these stations, I will not be able to continue
interacting with the patient after the warning buzzer, even after I have
finished answering the examiner’s question(s). (If there are no oral
questions for a station, I will have the full ten minutes to interact with the
patient.)
The oral questions are related to the patient I just saw and are about
matters like diagnosis, management decisions, or ethical or legal issues.
The candidate instructions will clearly state if there are oral questions for a
station.

Medical equipment
If a station requires the use of medical equipment other
than a stethoscope and a reflex hammer, it will be
provided in the room.

Patient management stations
During the examination, you might be asked to
manage a patient problem.
In these stations, a standardized health
professional, such as a nurse, might be present in the
room.
I will direct the nurse to order any tests
or perform any procedures I believe are
appropriate for this patient.
I may be evaluated on my interaction
with the nurse.
If a standardized health professional is
present in the room, the candidate
instructions will clearly state so.
Download a
video clip of a
candidate in this
type of station

Physician examiners
• Examiners observe and assess your performance with
pre-set score sheets.
• A second observer may be present to observe
protocols and to ensure exam quality.
• In physical examination stations:
• Tell the examiner what you are doing and briefly describe your
findings.
• You must demonstrate your clinical skills. You will only get credit
for tasks completed to the examiner’s satisfaction.

Examiner interventions
Examiners may intervene:
• By asking you to reread the instructions.
• To protect the standardized patient.
• To stop you from doing genital or rectal
examinations.
– If such examinations are needed,
clearly inform the examiner that
you would perform them.
• By reporting findings if they are
available. If no findings are
reported to you, please trust the
findings from your examination of
the standardized patient.
Download a
video example
of an examiner
intervening

Standardized patients (SPs)
SPs are trained to simulate patients’ signs and
symptoms in a reliable and consistent manner.
Treat them as you would treat actual patients and
accept their simulated findings as being real. You may
be scored on the way you interact with them.

Written stations
Sunday of the examination is comprised of 10 stations
of five minutes each, alternating between patient-
encounter stations and written stations.
• Before you exit the five-minute encounter station,
the examiner will hand you the post-encounter
probe (PEP) sheet.
• There are two types of PEPs:
– Write-in
– Multiple choice
• Wait until the start buzzer before
beginning to write.

Write-in PEP
Sample form

Write-in PEP
I must write legibly if I want to get credit
for my answers.
When lines are numbered in the PEP
sheet, only the first answer on each line
will count.
If the lines are NOT numbered, the
number of answers is not limited.

Writing tasks
In the PEP, I may be asked to complete
patient-associated tasks such as writing
admission orders, a prescription, or a
SOAP note. For these questions, I am
expected to fill out the provided mark sheet or
prescription form as completely as I would in a
hospital/clinic or when filling in a prescription
pad.
For prescription-writing questions only, a
copy of the Compendium of Pharmaceuticals
and Specialties (CPS) will be available in the
room.

Multiple choice (PEP)
I will read the questions carefully
before answering them. If I fill in
more answers than specified in
the question, my score for that
question will be zero.

Rest stations
• Rest stations may be included in the examination for
each session.
• During these stations, there are no patients, no
questions and no evaluations.
• Please sit quietly. You can take this time to rest
before your next station.
I might sit through a few rest
stations during the
examination.

Sequestering
For security reasons, candidates may be required to
remain on site for up to three hours before or after the
examination session on each examination day.
• Access to personal belonging or telephones will not
be allowed during this time.
Any breach of the rules or lack
of co-operation on my part
could invalidate my examination
results and prevent access to
my future examinations.

Sign out
Before leaving after each exam day, follow the site
staff’s instructions:
• Hand in your notebook (leave all pages intact,
including the backing sheet from your bar code
labels and any unused labels);
• Hand in your ID badge;
• Sign out on the sheet.

Confidentiality reminder
During the application process, we agreed to use examination
materials solely for the purpose of completing the examination
and not to disseminate or reveal to others the examination
materials or content.
That means you CANNOT discuss or disclose
exam content (including patient portrayals and
findings, oral questions, etc.) at ANY TIME, in
ANY WAY even after the examination is over.
Examples of this include comparing patient
responses with your colleagues, sharing content
with future exam candidates, and posting case
information online.
Any breach in confidentiality of exam materials
may lead to disciplinary and legal measures,
including invalidating your results and
preventing you from participating in future
examinations.

What do I do if…
You can use the washrooms:
• Before you start the examination
• While in sequestering
If you have an urgent need at other
times, please inform site staff.
I have to go to the bathroom?

What do I do if…
Consult the site staff as soon as possible.
They are there to help you and are aware of
the protocols to follow.
It is imperative that you remain calm and
co-operative.
I lose my notebook and/or my bar code labels?
I feel ill?
I don’t know where to go?

Helpful tips
• Read your instructions carefully.
• Complete the specified task(s).
Joseph Trans, 40 years old, presents himself to your office
with a 2-hour history of abdominal pain.
IN THE NEXT 5 MINUTES:
•CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION.
As you proceed, EXPLAIN TO THE EXAMINER what you are
doing and DESCRIBE ANY FINDINGS.
At the next station, you will be asked to answer questions
about this patient.
GIVE 2 LABELS TO THE EXAMINER.

Helpful tips
Inside the station
• Demonstrate your clinical skills. You will not get credit
for simply SAYING you would do something (with the
exception of genital and rectal examinations).
• You will only receive credit for tasks
completed satisfactorily.
• Treat the SPs as you would treat
real patients.

Helpful tips
• When the number of
answers is specified in a
written question, do not
select / write more answers
than what has been asked.
• Write legibly.
Post-encounter probe (PEP)

Useful links
Medical Council of Canada
mcc.ca
Objectives for the Qualifying Examination
http://mcc.ca/examinations/objectives-overview/
Qualifying Examination Part II
http://mcc.ca/examinations/mccqe-part-ii/
MCCQE Part II interaction rating scales
http://mcc.ca/wp-content/uploads/Exams-interaction-
rating-scale-items.pdf

Questions?
And remember, site staff will be available
throughout the day to answer your
questions and guide you to your stations.
Please take the time to
review the information in
this presentation and on
the mcc.ca website. If
you have any questions
on examination day,
you can ask the
facilitator during your
Candidate Orientation.

Examination results
• Approximately eight or nine weeks after the
examination, you will receive an email notification
stating that you can verify your pass/fail result
through your physiciansapply.ca account.
• A Statement of Results and a supplemental
feedback report will be posted in your
physiciansapply.ca account shortly thereafter.
• If you have passed the examination, the MCC will
also send you a package by mail with your
Licentiate documents.

MCCQE Part II Pre-Exam Candidate Orientation

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