The Therapeutics Decision-Making (TDM) Examination is about to change, and if you’re planning to sit the exam in 2026 or beyond, you’ll need to adjust your preparation strategy.
Starting January 2026, the MCC will roll out a new TDM assessment model with updated structure, timing, and question formats. Here’s everything you need to know.
Why Is the TDM Exam Changing?
The MCC designed the TDM Exam to evaluate how well candidates can apply medical knowledge to real-life clinical decisions. The 2026 update makes the exam more structured, standardized, and reliable by replacing purely write-in questions with a combination of multiple-choice and short-menu questions.
This shift is intended to:
- Increase fairness and consistency in scoring
- Broaden the range of clinical scenarios tested
- Better reflect how Canadian family physicians make decisions in practice
The Current TDM Exam Format (Until December 2025)
- Cases: 40
- Questions: ~100 write-in (short-answer)
- Sections: 1 continuous section
- Exam time: 3 hours (plus tutorial/check-in)
- Appointment time: 3.5 hours total
- Breaks: No scheduled break (unscheduled break possible, timer runs)
The New TDM Exam Format (Starting January 2026)
Here’s a side-by-side breakdown:
| Feature | Current Format | New Format (2026 onward) |
| Cases | 40 | 55 |
| Questions | ~100 short-answer (write-in) | 110–140 questions (multiple-choice + short-menu) |
| Sections | 1 continuous | 2 sections (1.5 hours each) |
| Exam time | 3 hours | 3 hours (split into 2 timed blocks) |
| Appointment time | 3.5 hours | 4 hours |
| Breaks | No scheduled break | Optional 20-minute break between sections |
What Do These Changes Mean for Candidates?
1. More Cases, More Questions
You’ll face 55 cases instead of 40, with up to 140 questions in total. That means a faster pace and the need for tighter time management.
2. New Question Types
Instead of writing out answers, you’ll select from multiple-choice and short-menu options. This reduces ambiguity but also means you’ll need to practice recognition-based decision-making, not just recall.
3. Two Timed Sections
The exam is now split into two 1.5-hour blocks. You won’t be able to carry over time from one section to the next, so pacing becomes critical.
4. Optional Break
You’ll finally get a 20-minute scheduled break between sections — but only if you choose to use it. Skipping it means extra time to rest your brain, not more exam time.
5. Longer Appointment Time
The entire session, including check-in, tutorial, exam, break, and survey, will now last about 4 hours.
How to Prepare for the New Format
1. Train With More Cases
Since the number of cases is increasing, aim to practice at least 50+ case scenarios in your prep. This helps build the stamina needed for the new structure.
2. Get Comfortable With MCQs and Short-Menu Questions
Don’t just write out answers — practice with structured-response formats that mirror the new question types.
3. Master Time Management
- For 55 cases and ~120 questions in 3 hours, you’ll have about 1.5 minutes per question.
- Use timed practice blocks to get used to the new pacing.
4. Plan for the Break
Decide in advance how you’ll use the optional 20 minutes. Snack, hydrate, reset — but avoid distractions that could throw you off for Section 2.
5. Update Your Study Materials
Older prep resources may focus heavily on short-answer writing. Look for updated TDM prep courses that include multiple-choice and short-menu practice.
Frequently Asked Questions
When does the new TDM exam format start?
The new format takes effect in January 2026.
Will the exam be harder?
Not necessarily — but it will be different. More cases and new question types mean you’ll need to adjust your preparation style.
Can I still take the old format in 2025?
Yes. If you write the exam before January 2026, you’ll sit the current format.
Why the change to multiple-choice and short-menu questions?
To improve fairness, reduce variability in scoring, and better assess decision-making across a broader set of scenarios.
Final Thoughts
The 2026 TDM exam update is a major change, but not something to fear. In many ways, the move toward multiple-choice and short-menu questions levels the playing field and gives candidates clearer options to demonstrate competence.
The key is preparation: adjust your study plan now, train with the new format in mind, and you’ll be ready to face the exam whether in 2025 under the current model or in 2026 with the new one.
