Clinical decision making (CDM)

The clinical decision making component consists of up to approximately 60 cases, with one to five questions each, for a total of up to approximately 80 questions. The maximum time allotted for this component is four hours.

This test is designed to assess problem solving and clinical decision making skills. Candidates will be presented with case descriptions followed by one or more test questions that assess key issues in the resolution of the case. Candidates may be asked to elicit clinical information, order diagnostic procedures, make diagnoses or prescribe therapy. Their decisions should reflect the management of an actual patient.

This component includes questions in both short-menu and write-in formats. To view the candidate instructions for the clinical decision making component to the MCCQE Part I, click here.

CDM Example

Case 1

A 55-year-old male company vice-president presents in your office with a copy of his recent executive physical. His personal health history and family history are negative. He is a non-smoker. As part of the evaluation, he had a random serum cholesterol done, which is reported as 7.00 mmol/L. Serum triglycerides, liver function indices and a resting electrocardiogram are all within normal limits. Examination reveals a rather obese middle-aged man: height 180 cm; weight 98 kg; body mass index (BMI) 30.2; blood pressure 140/88 mm Hg. The rest of the physical examination is unremarkable.

Use the information above to answer the following questions.

Question 1 (Case 1)
Which additional investigations, if any, would you do at this time?
Select as many as are appropriate or select #24, No investigations, if none is indicated. (N.B. There are 24 options.)

  1. Alanine aminotransferase (SGPT)
  2. Albumin
  3. Alkaline phospatase
  4. Aspartate aminotransferase (SGOT)
  5. Complete blood count
  6. Coronary angiogram
  7. Electrocardiogram
  8. Electrolytes
  9. Exercise stress test (treadmill)
  10. Fasting blood sugar
  11. Fasting serum amylase
  12. Fasting serum cholesterol
  13. Glucose tolerance test
  14. Thallium scan
  15. Thyroid-stimulating hormone
  16. Thyroxine (T4)
  17. Total protein
  18. Triglycerides
  19. Triiodothyronine (T3) uptake
  20. Ultrasound gall bladder
  21. Urinalysis (urine microscopy)
  22. 24-hour Holter monitoring
  23. 24-hour urine for total protein
  24. No investigations

Question 2 (Case 1)

Considering the information provided to you in the stem above, what would you recommend to this patient?

List up to three.

1.

  
2.  
3.