MCCQE Part 1 Thoughts

[motley467]

For those who have written the exam - what did you think of it? Personally I thought the multiple choice was very difficult, to the point where I was unsure of the majority of my answers...not to mention how random and vague everything was. Hard to imagine passing based on that performance, but somehow most people do. 

[monocle]

Hey, I feel exactly the same way if that's any consolation (sat it yesterday). Not confident with it at all. To top it all off, the passing score is now >50% (it was previously ~30% in 2013 and then in the ?40s before this most recent change). Don't let old fail rates fool you, they have and will go up.

I don't think it's a very well designed exam. The new changes are also kind of unfair on the new cohort of students (they group the questions now e.g. an abdominal pain can be O&G, paeds, psychiatry, surgery etc. they only balance it so you get an even distribution of different cases, not by specialty like it was before so if you get 60 paeds questions you're SOL). I can recall about 130 MCQs and about 30 of the dubious ones I can't answer even now with the aid of Google and PubMed. You won't find the answers to these questions in a book, and your responses are mainly instinctual/gut feelings.

The time is ridiculously short for the MCQ section and I was struggling to complete it. In contrast the CDM section I had two hours to sit and mess around with.

Many questions test non-standard concepts (e.g. the most common symptom/most prevalent risk factor etc.) instead of focusing on the pathology, diagnosis and management like the USMLE. The questions aren't thoughtfully designed and include controversial subject matter (e.g. controversial treatment options, off-label drug use). There is far too much emphasis on ethical dilemmas that only a medicolegal practitioner should know..

I'm hoping and praying I pass because I don't want to go through this exam again. Even if you study for it inside out, there's still a chance you will do poorly. It's a throw of the dice on what questions you get.

[photato]

I found the questions vague and poorly written. Lots of random trivia that I would have never even thought to study. Some images were really poor quality making it hard to answer the question. Everyone I talked to said they felt their exam wasn’t evenly distributed amongst topics.  Struggled with weird ethics questions that probably don’t have a right answer. CDM was bizarre and I still don’t understand how it’s graded. 

I think difficulty was similar to practice exam. 

[monocle]

8 hours ago, photato said:

I found the questions vague and poorly written. Lots of random trivia that I would have never even thought to study. Some images were really poor quality making it hard to answer the question. Everyone I talked to said they felt their exam wasn’t evenly distributed amongst topics.  Struggled with weird ethics questions that probably don’t have a right answer. CDM was bizarre and I still don’t understand how it’s graded. 

I think difficulty was similar to practice exam. 

Yeah, the CDM part was like a fever dream, totally bizarre. I think I did OK on it, but that in itself worries me that I might have overlooked something. I also think the exam wasn't subjectively "hard", they just don't ask the bread and butter stuff you would expect on a clinical exam like this and the answer options quite often give two right answers out of which you have to choose the "best" one (and knowing the "best" one is just a gut feeling usually).

No idea how it (or the entire exam) is graded. For example, there are 210 MCQs  (180 without pilots) and 60-70 CDM (55 without pilots) questions, the MCC website says all of them are "worth" one point.

That gives you a maximum "raw" score of of 235 and leaves 165 points on the table, where do those come from? As far as I'm aware, they use some statistical method to relate the raw scores to question difficulty and then give you a final score.

[jr2]

QE1 is changing so that 3rd years will be eligible to take the test. Do you think it is ok to try and write at the end of core clerkship rotations in 3rd year to get it out of the way and have more time off before res, or is it something that should be taken at the end of 4th year (b/c of more experience/clinical exposure)? 

[monocle]

1 hour ago, jr2 said:

QE1 is changing so that 3rd years will be eligible to take the test. Do you think it is ok to try and write at the end of core clerkship rotations in 3rd year to get it out of the way and have more time off before res, or is it something that should be taken at the end of 4th year (b/c of more experience/clinical exposure)? 

I would give the practice tests and see how you do.

It can definitely be prepared for (kind of), but I personally feel hands on clinical experience is essential to success in this exam. A lot of the answers are based on your gut feeling rather than you knowing it cold. Even then, it may not help you - it's a bit of a lottery.

[medigeek]

7 hours ago, monocle said:

Yeah, the CDM part was like a fever dream, totally bizarre. I think I did OK on it, but that in itself worries me that I might have overlooked something. I also think the exam wasn't subjectively "hard", they just don't ask the bread and butter stuff you would expect on a clinical exam like this and the answer options quite often give two right answers out of which you have to choose the "best" one (and knowing the "best" one is just a gut feeling usually).

No idea how it (or the entire exam) is graded. For example, there are 210 MCQs  (180 without pilots) and 60-70 CDM (55 without pilots) questions, the MCC website says all of them are "worth" one point.

That gives you a maximum "raw" score of of 235 and leaves 165 points on the table, where do those come from? As far as I'm aware, they use some statistical method to relate the raw scores to question difficulty and then give you a final score.

Pretty sure it's percentile based... not just raw scores. So each exam would be unique in how it's scored. 226 would equate to a certain percentile, about 1.5 SD below the mean I believe. No way to know what the mean raw score is or how big the SDs are though. 

15 hours ago, monocle said:

Hey, I feel exactly the same way if that's any consolation (sat it yesterday). Not confident with it at all. To top it all off, the passing score is now >50% (it was previously ~30% in 2013 and then in the ?40s before this most recent change). Don't let old fail rates fool you, they have and will go up.

I don't think it's a very well designed exam. The new changes are also kind of unfair on the new cohort of students (they group the questions now e.g. an abdominal pain can be O&G, paeds, psychiatry, surgery etc. they only balance it so you get an even distribution of different cases, not by specialty like it was before so if you get 60 paeds questions you're SOL). I can recall about 130 MCQs and about 30 of the dubious ones I can't answer even now with the aid of Google and PubMed. You won't find the answers to these questions in a book, and your responses are mainly instinctual/gut feelings.

The time is ridiculously short for the MCQ section and I was struggling to complete it. In contrast the CDM section I had two hours to sit and mess around with.

Many questions test non-standard concepts (e.g. the most common symptom/most prevalent risk factor etc.) instead of focusing on the pathology, diagnosis and management like the USMLE. The questions aren't thoughtfully designed and include controversial subject matter (e.g. controversial treatment options, off-label drug use). There is far too much emphasis on ethical dilemmas that only a medicolegal practitioner should know..

I'm hoping and praying I pass because I don't want to go through this exam again. Even if you study for it inside out, there's still a chance you will do poorly. It's a throw of the dice on what questions you get.

Where are you getting 50% from? 

[GH0ST]

3 hours ago, jr2 said:

QE1 is changing so that 3rd years will be eligible to take the test. Do you think it is ok to try and write at the end of core clerkship rotations in 3rd year to get it out of the way and have more time off before res, or is it something that should be taken at the end of 4th year (b/c of more experience/clinical exposure)? 

Definitely think it's worth a try

That way if the worst happens and you fail you don't have to hard scramble to do it during residency and you have more time to work on improvement. 

If you pass then good on you ... one less thing to worry about. 

- G

[RichardHammond]

Mean score is 250, SD is 30, passing score is 226. Assuming normal distribution, pass rate should be around ~80%.

Also echoing others in saying the exam was horribly designed. Ambiguous questions, vague prompts, etc.

Even the MCCQE website has errors. For example, they say you have 1 minute 14 seconds per MCQ, which is incorrect (Should be 240 minutes / 210 questions = 1.14 min = 1 minute 8 seconds). Sounds trivial but you will be 19 minutes over if you follow their info. They made the same mistake again talking about CDM timing.

 

[RichardHammond]

Also: 

[monocle]

3 hours ago, medigeek said:

Pretty sure it's percentile based... not just raw scores. So each exam would be unique in how it's scored. 226 would equate to a certain percentile, about 1.5 SD below the mean I believe. No way to know what the mean raw score is or how big the SDs are though. 

Where are you getting 50% from? 

Where did you get it's "percentile based" from? Could you explain what you mean by each exam is unique in how it's scored? As far as I'm aware, there is no curve or statistical analysis being performed, it is just the raw score you personally get.

I'm getting my information from the MCCQE1 website, where they specifically mention it's a criterion referenced exam and how other people perform has zero impact on whether you pass or not, it's just whether you get the passing score. They then go on to say each question is worth a point, and the difficulty of the question somehow factors into it to be worth more or less points. 226/400 = a ~50% score. 

[medigeek]

10 hours ago, monocle said:

Where did you get it's "percentile based" from? Could you explain what you mean by each exam is unique in how it's scored? As far as I'm aware, there is no curve or statistical analysis being performed, it is just the raw score you personally get.

I'm getting my information from the MCCQE1 website, where they specifically mention it's a criterion referenced exam and how other people perform has zero impact on whether you pass or not, it's just whether you get the passing score. They then go on to say each question is worth a point, and the difficulty of the question somehow factors into it to be worth more or less points. 226/400 = a ~50% score. 

I've never heard of a board exam that isn't percentile based. It would blow my mind if it wasn't. 

Question difficulty and curving is designed based on prior experimental questions. And yes how others perform on that exam or in general has no effect because the curve is based on pre-determined difficulty. 

 

[monocle]

31 minutes ago, medigeek said:

I've never heard of a board exam that isn't percentile based. It would blow my mind if it wasn't. 

Question difficulty and curving is designed based on prior experimental questions. And yes how others perform on that exam or in general has no effect because the curve is based on pre-determined difficulty. 

 

Yeah well the term “percentile based” implies that other people’s scores (where the distribution would come from) matters, but it doesn’t.

The difficulty is determined by a panel of medical educators who are given stacks of questions and they make subjective assessments of whether it’s an easy, medium or hard question. They use the Bookmark or Angoff method I believe: https://files.eric.ed.gov/fulltext/EJ1027679.pdf. This is the only other variable that affects your score, but it doesn’t provide a positive multiplier unless you get the question right, so if your whole exam was hard, there is no benefit.

and yes, I haven’t heard of a board exam which isn’t percentile based either, which is why I am confused by this choice by the MCC. 

[medigeek]

3 minutes ago, monocle said:

Yeah well the term “percentile based” implies that other people’s scores (where the distribution would come from) matters, but it doesn’t.

The difficulty is determined by a panel of medical educators who are given stacks of questions and they make subjective assessments of whether it’s an easy, medium or hard question. They use the Bookmark or Angoff method I believe: https://files.eric.ed.gov/fulltext/EJ1027679.pdf 

and yes, I haven’t heard of a board exam which isn’t percentile based either, which is why I am confused by this choice by the MCC. 

What's the source on whether they decide what question is easy/medium/hard? 

[monocle]

1 minute ago, medigeek said:

What's the source on whether they decide what question is easy/medium/hard? 

Page 6 onwards: https://mcc.ca/media/MCCQE-Part-I_Standard-Setting-Report_July-2015.pdf

[GrouchoMarx]

The mcc part 1 is a mess of an exam. 

 

The usmle is a tightly crafted one.

 

The difference is night and day.

The mcc shouldn't exist. They serve no purpose.

[LittleDaisy]

On 5/11/2019 at 12:46 PM, monocle said:

Yeah well the term “percentile based” implies that other people’s scores (where the distribution would come from) matters, but it doesn’t.

The difficulty is determined by a panel of medical educators who are given stacks of questions and they make subjective assessments of whether it’s an easy, medium or hard question. They use the Bookmark or Angoff method I believe: https://files.eric.ed.gov/fulltext/EJ1027679.pdf. This is the only other variable that affects your score, but it doesn’t provide a positive multiplier unless you get the question right, so if your whole exam was hard, there is no benefit.

and yes, I haven’t heard of a board exam which isn’t percentile based either, which is why I am confused by this choice by the MCC. 

Just to mention that LMCC2 is not percentile based as well. A panel of physicians decides the passing score, and how you perform relatively to your colleagues does not matter at all. 

I doubt that they will ever take LMCC1 or LMCC2 out for independent practice licensing, it's just hoops that you have to jump through. 

[monocle]

Well, I don't know how, but I managed to pass with a respectable score. Thank god the written section of my MCC journey is over!

[LJT78]

I’m absolutely gutted. I failed the Part 1 today. I’m an IMG and found the exam had so many ethics questions and unusual questions. 

My score was 215. Anyone know the pass mark?

any advice would be appreciated. 

[freewheeler]

Just now, LJT78 said:

I’m absolutely gutted. I failed the Part 1 today. I’m an IMG and found the exam had so many ethics questions and unusual questions. 

My score was 215. Anyone know the pass mark?

any advice would be appreciated. 

226 is the cutoff for a passing score

[LJT78]

Thanks. Starting work tomorrow on a provisional licence and feel completely incompetent now. ☹️

[monocle]

3 minutes ago, LJT78 said:

Thanks. Starting work tomorrow on a provisional licence and feel completely incompetent now. ☹️

Hey buddy, I know this must be a really tough day for you but honestly, it's a roll of the dice. You just had a bad day. Do not be too hard on yourself.

It doesn't have any bearing whatsoever on how good a doctor you will be. You weren't that far off, just 11 points behind.

Just book it again (I think applications are open now) and go for it if you feel confident. Please note that they only allow 4 lifetime attempts of this exam, kill the ethics section next time and you'll be done.

If you need any specific help, feel free to ask!

[LJT78]

Thanks Monocle. 

Did my finals in the UK in 2002 then did my MRCGP after that so it’s been a long time since I’ve done exams. Thought I studied really hard for it. Used Canada Qbank. Didn’t study ethics and on reflection I should have. I have an old Toronto notes- from 2011 that someone gave me- is that too old? Should I buy a new one? 

Also, should I forget about LMCCs and consider USMLE? 

Congratulations on passing Monocle!

[monocle]

1 minute ago, LJT78 said:

Thanks Monocle. 

Did my finals in the UK in 2002 then did my MRCGP after that so it’s been a long time since I’ve done exams. Thought I studied really hard for it. Used Canada Qbank. Didn’t study ethics and on reflection I should have. I have an old Toronto notes- from 2011 that someone gave me- is that too old? Should I buy a new one? 

Also, should I forget about LMCCs and consider USMLE? 

Congratulations on passing Monocle!

Thank you!

As for your question, I wouldn't give up that easily - you were really close. What I would suggest is reading all the CPSO guidelines on their website (mandatory reporting, relationships with industry etc.) and read through high yield sections of the AFMC primer (the TNotes epidemiology section is based on this, just expand on your knowledge using the primer). Make sure you know those CPSO guidelines inside out. 

Secondly, it's essential that you get a new copy of TNotes. Several ethical things have changed since 2011, most notably medical assistance in dying (MAID). Considering your background as a qualified GP, medicine is the area you'd want to pay the least attention to. Focus on Psych, O&G, Paeds and selective surgery. Try to build a super strong base of the common stuff (Asthma, depression/bipolar, COPD, MIs, common infections, heart failure etc. - the big stuff) and chase unicorns later (i.e. specific glomerular diseases). 

Ditch CanadaQBank, it's garbage in my opinion. Use USMLEWorld and the practice tests on the MCC website. When you don't know the answer, look it up (esp. ethics). 

[LJT78]

Also, can I ask for advice from successful candidates which study tools they used?

Thanks in advance.