The NAC OSCE: information for residency program directors

The National Assessment Collaboration (NAC) Objective Structured Clinical Examination (OSCE) assesses the readiness of an international medical graduate (IMG) for entrance into a Canadian residency program. It is a national, standardized examination that provides residency program directors with objective information on the skills, attitudes and knowledge level of IMGs applying for postgraduate training in Canada.

It is developed by the National Assessment Collaboration (NAC) OSCE Test Committee, a group of physicians and medical educators from across the country with expertise in assessment and clinical content.

This webpage provides information on the exam’s:

Background and rationale

Prior to the creation of the NAC OSCE, a number of provinces developed and delivered individual clinical examinations to assess IMGs. The NAC OSCE was developed to reduce duplication between provincial IMG assessment programs and offer standardized results that can be accepted and understood by Canadian residency program directors across the country. The exam results provide residency program directors with a comprehensive assessment of an IMG’s strengths, weaknesses, language proficiency and readiness for entry into postgraduate training. This information can be used in concert with other information – such as a residency application letter or results from the Medical Council of Canada Evaluating Examination – to obtain a comprehensive view of an applicant’s skillset.

Scope and format

The NAC examination is a clinical evaluation that consists of an OSCE and a therapeutics knowledge component.

  • The OSCE component currently features 12 different 11-minute clinical stations, each with a standardized patient and a physician examiner.
  • The therapeutics knowledge component of the examination, which lasts 55 minutes, consists of short-answer questions and single best answer multiple-choice questions.

In total, the exam takes three hours to complete though the candidate may be on site for a longer period of time for administrative reasons.

Visit our examination station descriptions and therapeutic question examples pages for more detailed information on the format of the NAC OSCE.

Evaluation and scoring

A “pass” mark is any total exam score equal to or higher than the mark that would be expected of a graduate from a Canadian medical school. Total scores are reported to candidates on a scale with a distribution that ranges from 0 to 100 and has a fixed pass mark of 65. The NAC also considers observations made by physician examiners on the candidate’s ability to demonstrate ethical and professional behaviour.

OSCE component scoring

The OSCE component makes up 75 per cent of the total examination score. Candidates are rated by physician examiners on up to nine different competencies per station. These competencies include:

  • History taking
  • Communication skills
  • Data interpretation
  • Physical examination
  • Language fluency
  • Investigations
  • Organization skills
  • Diagnosis
  • Management

A candidate’s total score for each station is the average of all competency ratings on the station. A candidate’s total score for the entire OSCE component is the average of the total scores from the 12 stations.

Therapeutics component scoring

The therapeutics component makes up 25 per cent of the total examination score. A minimum of four physician examiners mark each candidate’s answer booklet and make a global assessment of the candidate’s performance. The final score on the therapeutics component will be the average of the scores of all therapeutics questions.

In awarding the final standing on the examination, the NAC Central Coordinating Committee also considers any observations made by the physician examiner at each of the stations regarding the candidate’s ability to demonstrate the ethical and professional behaviour needed to enter postgraduate training.

More detailed information on NAC OSCE scoring can be found on the examination scoring page.

Content development

Content for the NAC OSCE is developed by the NAC OSCE Test Committee – a group of physicians from across the country with expertise in multiple medical disciplines. The test committee meets on a regular basis to develop and review content and set standards based on the expected performance of a graduate from a Canadian medical school.

Learn more about the NAC OSCE Test Committee.

Testing locations

The NAC examination is currently delivered through provincial IMG assessment programs in Alberta, British Columbia, Ontario, Manitoba and Quebec.

If you are a residency program director and have specific questions about the NAC OSCE, please email us at nac@mcc.ca.