TDM Exam Complete Guide: Steps to Success for International Medical Graduates

The Therapeutic Decision Making (TDM) Examination is a crucial step for internationally trained family physicians seeking licensure through Practice-Ready Assessment (PRA) programs in Canada. This comprehensive guide walks you through everything you need to know.

What the TDM Exam Is

Purpose of the Exam

The TDM Examination is a clinical assessment designed to measure your ability to make therapeutic decisions at the level of a family physician practicing safely and independently in Canada. The exam evaluates your clinical judgment, prescribing skills, and ability to manage drug interactions and adverse effects.

Who Takes It

The TDM exam is mainly required for internationally trained family physicians (IMGs) aiming for licensure via provincial Practice-Ready Assessment (PRA) programs. If you’re pursuing the PRA pathway in Alberta or other provinces, this exam will be part of your assessment requirements.

Exam Format

The TDM is a comprehensive computer-based assessment with the following characteristics:

Question Types: Multiple-choice and short-menu questions based on clinical cases
Structure: Typically two sections of case-based questions
Total Items: Approximately 110-140 items
Languages: Offered in both English and French
Delivery: Available at Prometric centres or via remote proctoring

The exam focuses on real-world clinical scenarios that family physicians encounter in Canadian practice, testing your ability to make safe and appropriate therapeutic decisions.

Key Steps to Complete the TDM Exam

1. Confirm Eligibility

You must be deemed eligible by a Practice-Ready Assessment (PRA) program before applying to the TDM exam. Your PRA program will:

Review your qualifications and credentials
Assess your training and experience
Issue an eligibility letter (typically from CPSA for Alberta candidates)

Important: You cannot register for the TDM exam until you have your eligibility letter from the provincial regulatory authority.

2. Apply via PRA / Regulatory Program

Once you receive confirmation of eligibility:

Submit your application through the designated provincial PRA (such as CPSA)
Monitor your physiciansapply.ca account for updates
Receive your Authorization to Test (ATT) number
Follow specific instructions provided by the Medical Council of Canada

The ATT number is essential for scheduling your exam and will be sent once your application is processed.

3. Schedule Your Exam

With your ATT number in hand, you can schedule your exam:

Booking System: Schedule online through Prometric
Availability: First-come, first-served basis
Options: Choose an in-person test centre location or opt for remote proctoring
Flexibility: Multiple dates and locations typically available

Pro Tip: Schedule as early as possible, as popular testing dates and locations fill up quickly.

4. Prepare for the Exam

Effective preparation is crucial for TDM exam success. Focus on these key areas:

Study the Exam Blueprint & Clinical Content

The TDM exam covers four major care dimensions:

Health Promotion/Illness Prevention
- Preventive care strategies
- Screening guidelines
- Immunizations
- Risk factor modification
Acute Care
- Emergency presentations
- Acute illness management
- Urgent care decisions
- Immediate therapeutic interventions
Chronic Care
- Chronic disease management
- Long-term medication management
- Monitoring and follow-up
- Complications prevention
Safety/Adverse Effects
- Drug interactions
- Adverse effect recognition
- Medication safety
- Contraindications and precautions

Practice Clinical Scenarios

Build your skills in:

Making safe therapeutic decisions
Prescribing appropriately based on patient factors
Managing drug interactions and contraindications
Recognizing and responding to adverse effects
Adjusting medications based on patient response

Recommended Resource: canadaqbank.com offers practice questions specifically designed for the TDM exam format.

Review Official Resources

Complete the official exam tutorials provided by MCC
Familiarize yourself with the exam interface and navigation
Practice with the different question types (multiple-choice and short-menu)
Understand the time allocation and exam structure

5. Take the Exam

On exam day, be prepared for the following:

At the Test Centre

Arrive at least 30 minutes before your scheduled time
Bring valid government-issued identification
Follow all Prometric centre protocols
Leave personal belongings in designated areas

Remote Proctoring Setup (if applicable)

Ensure your computer meets technical requirements
Test your internet connection in advance
Prepare a quiet, private testing space
Have your ID ready for verification

During the Exam

Duration: Approximately 4 hours in total
Break: Optional break available between sections
Pacing: Monitor your time to ensure you complete all questions
Focus: Read each case carefully before answering

6. After the Exam

Following your exam completion:

Results Timeline: Results are typically released several weeks after the exam date
Score Delivery: Results are uploaded to your physiciansapply.ca account
Next Steps: Successful results are used in your overall licensure assessment
Follow-up: Your PRA program will provide guidance on subsequent steps

Summary Checklist

✅ Confirm eligibility with your regulatory/PRA program

✅ Apply through the PRA/regulator and receive your Authorization to Test (ATT)

✅ Schedule your exam with Prometric (book early for best availability)

✅ Prepare thoroughly using official resources, practice questions, and advisory support

✅ Take the exam (computer-based at test centre or remote proctoring)

✅ Receive results and proceed with your licensure pathway steps

How B&Y Advisors Can Help

Navigating the TDM exam and PRA pathway requires strategic planning and comprehensive preparation. Our team provides:

Eligibility Assessment: Guidance on PRA program requirements and documentation
Exam Strategy: Personalized study plans based on your clinical background
Practice Resources: Recommendations for high-quality TDM preparation materials
Pathway Coordination: Integration of TDM exam timing with your overall licensure timeline
Post-Exam Support: Next-step guidance after receiving your results

Ready to start your TDM exam preparation? Book a free consultation with our team to develop a strategic approach tailored to your unique background and licensing goals.