A 6-Week MCCQE1 Study Plan Built Around Spaced Repetition (That I'd Actually Repeat)

Updated July 2026 — refreshed with the current MCCQE1 pass mark, 2026 CaRMS timing, and links to the newest MDReview guides.

On my first MCCQE1 pass, my “plan” looked pretty on paper. I printed a colour-coded schedule, did a big push the first two weeks, and told myself I’d circle back to review. I never did. I peaked early, then dragged myself into exam day on caffeine and guilt.

Most MCCQE1 schedules fail for three reasons:

• They’re front-loaded. Too many new facts in Week 1–2, not enough room for recall.
• There’s no built-in review. You read, you highlight, then you forget.
• You peak too early. Cognitive load is highest mid-curve, but most plans don’t taper or consolidate.

I wanted a 6-week plan I could do while covering a busy CTU week and still be upright for call. This is the study plan I actually ran the second time. It’s simple, spaced, and paced. And I’d repeat it.

The Principles: Spaced Repetition Cadence and a Hard Stop on New Material

The spine of this MCCQE1 study plan is a strict review cadence: the 1-3-7-14 rule.

• Review new content after 1 day, 3 days, 7 days, and 14 days.
• If you see something at Day 3 and still struggle, you see it again at Day 4 (briefly) and keep it in the 7- and 14-day pipeline.
• If you get something right with high confidence twice in a row, it graduates and you stop babysitting it.

I learned the hard way that “I’ll review later” means “I’ll never see it again.” Most of our forgetting happens in the first 48 hours. The 1-3-7-14 rhythm catches that early slide, then rebuilds over two weeks. It’s overkill for material you already own—but exam loss leaders aren’t the easy ones.

Two more rules that saved me:

• Keep daily review blocks time-capped. I budget 60–75 minutes for all card reviews and missed-question summaries, max.
• Block new material intake. I do new content only until I hit my daily objective, then stop. Even if I’m “feeling good.”

And the one non-negotiable:

• No new material in Week 6. None. No new material in Week 6. If I can’t recite it in my own words by then, I’m not cramming it. I want consolidation, mixed timed blocks, and CDM decision-making. The exam rewards calibration and recall under time, not last-minute PDF binges.

MCCQE Part I is roughly a seven-hour day including breaks: about 210 MCQs and around 38 Clinical Decision-Making (CDM) cases. The MCQs feel like a bit over a minute per stem. You don’t beat that with last-week reading. You beat it with pattern recognition and fast discard of distractors you’ve already seen.

The Week-by-Week MCCQE1 6-Week Schedule (Targets, Systems, and CDM)

I’ve laid out the systems focus, daily MCQ targets, and what gets reviewed when. This is a schedule you can adjust for days off, call, and clinic. The start is gentle (20/day), peak is reasonable (40/day), then we taper to mixed blocks under time.

• Week 1: Cardio + Respiratory

  • Daily MCQ target: 20–25 new MCQs/day on weekdays, 10–15 on the weekend.
  • New content: Ischaemic heart disease, arrhythmias (AF anticoagulation choices: apixaban 5 mg BID vs 2.5 mg BID criteria), heart failure staging and GDMT, valvular disease murmurs and next tests, hypertension thresholds and meds, pneumonia, COPD/asthma, PE/DVT workup (Wells, D-dimer, CTPA/VQ), TB screening/treatment, oxygen devices.
  • Review: 1-3-7-14 cadence starts immediately. Spend 45–60 minutes/day reviewing yesterday’s and 3-days-ago material. Make 1–3 flashcards per missed question only.
  • CDM: One light session end of week (2–3 cases) just to see the format. Keep it low-pressure.
  • Notes from the wards: Know the CHF patient with ankle oedema, JVP 6 cm, BNP 1,200, Hb 119, creatinine 150, on furosemide 40 mg daily and ramipril 10 mg—what’s next? That scenario shows up in different clothes, again and again.

• Week 2: GI + Renal/GU

  • Daily MCQ target: 25–30 new/day. One day at 15–20 if you’re on call.
  • New content: UGIB vs LGIB triage (Hb 88, MCV 72, melena, orthostatics), PUD/H. pylori, pancreatitis severity (BISAP), LFT patterns, hepatitis serology, IBD vs IBS hits, biliary tree imaging choices, CKD staging, AKI pre/post/intra, GN vs nephrotic patterns (proteinuria >3.5 g/day, oedema), electrolytes (hypoNa workup: serum osmolality, urine osmolality, urine Na), UTIs, prostatitis, BPH medication ladder.
  • Review: Keep the 1-3-7-14 cadence. Review Week 1’s hardest 10–15 concepts on Day 7 and 14 with quick one-liners.
  • CDM: Add one 45–60 minute CDM block mid-week (3–4 cases) focused on GI bleeding, pancreatitis orders, and AKI fluids. Practice writing short, directive answers (e.g., “Start IV pantoprazole 80 mg bolus then 8 mg/h infusion”).
  • Tip: When a stem says “Na 122, serum osm 255, urine osm 600, urine Na 40, euvolaemic,” say SIADH out loud. Then ask: what’s the trigger? SSRIs? Pain? Malignancy?

• Week 3: Endocrine + Heme/Onc

  • Daily MCQ target: 30–35 new/day. This is your volume week.
  • New content: Diabetes screening/targets, DKA vs HHS initial steps (fluids first), thyroid nodules and cancer risk features, thyrotoxicosis vs thyroiditis, osteoporosis Rx thresholds (FRAX), adrenal insufficiency (AM cortisol), pituitary adenomas, anaemia algorithms (MCV-based: iron deficiency vs thalassemia vs anaemia of chronic disease), transfusion thresholds (restrictive vs liberal), anticoagulation indications, haematologic emergencies (TLS, DIC), common solid tumours with first-line therapy highlights.
  • Review: Still on cadence. This week will feel heavy—plan 60–75 min/day of review and accept that some new cards get deferred 24 hours.
  • CDM: Two sessions this week (3–5 cases each). Focus on insulin orders, DKA fluids/electrolytes replacement, transfusion orders, and cancer workups (imaging + labs).
  • Opinion: I prefer redoing yesterday’s 10 hardest mistakes before doing today’s new questions. It lowers my cortisol.

• Week 4: Neuro + Psych

  • Daily MCQ target: 35–40 new/day on two days, 25–30 on the others.
  • New content: Stroke syndromes and imaging sequences, TIA workup, seizure types and first-line meds (levetiracetam vs valproate in women of childbearing age), headache red flags, delirium vs dementia (and CAM-ICU), Parkinson disease initial therapy, common neuropathies, depression/anxiety first- and second-line meds and durations, bipolar disorder acute vs maintenance, schizophrenia positive/negative symptoms and EPS management, suicidality assessments, capacity vs competence, involuntary admission criteria (province-dependent principles).
  • Review: Keep 1-3-7-14 humming. Use two 30-minute “rapid review” sprints with whiteboard buzzwords (e.g., “LP after CT if SAH suspected and CT negative.”).
  • CDM: Two sessions. Push yourself to write concise risk assessments: “Active SI with plan, intent, and access; cannot safety plan; admits to ongoing hopelessness; involuntary admission indicated.” Practise neuro orders (CT/CTA/CTP, permissive HTN) and antiplatelet plans.
  • Real stem example: 68-year-old man, sudden dysarthria and right face/arm weakness, onset 75 minutes ago, BP 178/92, glucose 6.9. Next step? You need CT head without contrast now; if no bleed and no contraindications, alteplase. Don’t get lost in labs.

• Week 5: Peds + Obs-Gyn + Derm/MSK

  • Daily MCQ target: 30–35 new/day. Taper one day to 20 for catch-up.
  • New content: Neonatal jaundice timing and thresholds, febrile infant workups (28-day vs 29–60-day), asthma paediatric dosing, vaccine catch-up logic, growth curves and FTT, AOM first-line abx vs watchful waiting, pregnancy physiology, prenatal screening timelines, GDM screening/treatment targets, hypertensive disorders of pregnancy (severe features = MgSO4), labour stages, postpartum haemorrhage steps, contraception postpartum, common rashes (tinea, psoriasis), cellulitis vs abscess, low back pain red flags, Ottawa ankle/knee rules, septic arthritis workup.
  • Review: Prioritise 14-day reviews from Weeks 3–4. Keep a “tough ten” list and hit it every 48 hours.
  • CDM: Two sessions. Focus on antenatal visits (what to order when), preeclampsia management (labetalol/hydralazine dosing), paediatric fever orders (blood/urine/CSF cultures before abx in <28 days), and MSK investigations (don’t MRI every back).
  • My clinic brain: A 24-year-old G1P0 at 28 weeks with BP 144/92, 2+ protein, platelets 90, AST 110, RUQ pain. You need MgSO4, antihypertensive, labs for HELLP, fetal assessment, and OB consult. That shows up, often.

• Week 6: Mixed Timed Practice + CDM Blocks + Ethics/Public Health

  • Daily MCQ target: No new question topics. Do mixed 40–44 question timed blocks on 3–4 days. On other days, do 30–35 mixed under time, then CDM.
  • New content: None. This is retrieval and calibration. Clean up your “hard list.”
  • Review: Daily 45–60 minutes of flashcard reviews, but cap it. If reviews explode, suspend low-yield cards.
  • CDM: Three to four sessions this week. Aim for 12–16 cases total, including ethics, consent/capacity, reportable diseases, public health notifications, and safe prescribing. Practise writing tight answers that score: “Do not prescribe; counsel on risks; offer referral to addiction services; document impaired driving counsel; notify as per provincial duty if imminent risk.”
  • Ethics/Public Health: Know mandatory reporting (child abuse, fitness to drive in certain conditions), consent in minors (mature minor doctrine), MAiD eligibility basics, confidentiality exceptions, and vaccine counselling. MCC loves the CanMEDS Health Advocate and Professional roles.

Across the six weeks, I keep one full day off per week. I prefer Sunday. If I’m on a brutal Saturday home call with two admissions at 2 a.m., I’ll slide that day off to Monday. Flex the schedule; don’t break yourself.

A typical study day for me (post-call adjusted):

• 08:00–08:45: Reviews (1-3-7-14 cards and missed-question flashcards).
• 09:00–10:15: New MCQs (untimed, learning mode).
• 10:30–11:00: Debrief/notes from wrongs (max 5).
• 11:15–12:15: Timed block (20–22 mixed) or CDM mini-set.
• Afternoon: Rotations/workout/napping. I’m not superhuman.
• Evening: 30-minute quick review of a whiteboard list if awake.

What about total volume? If you average 30 new MCQs on 24 study days, that’s ~720 new items, plus reviews and mixed blocks in Week 6. With explanations and writing flashcards for misses, that’s plenty. Most people fail by spreading too thin, not by underexposing.

If you’re using the MDReview question bank, tag questions by system and by “missed” so Week 6 mixed blocks are easy to build.

How to Run a Spaced-Repetition Deck Without Becoming an Anki Zombie

A spaced repetition MCCQE plan lives or dies on deck hygiene. I’ve watched classmates drown under 400 daily reviews before lunch. That’s not grit; that’s bad settings.

Here’s what I actually do:

• Card cap: Hard cap total daily reviews at 150. Hard cap new cards at 25 on peak weeks, 15 on taper. If my review queue is >150, I suspend or bury low-yield duplicates and long lists (e.g., all Ottawa rules on separate cards—make one consolidated card).
• Make cards only from misses or from “I could teach this in 30 seconds” notes. That’s 1–3 cards per missed question, max. If you’re making 20 new cards for one stem, you’re writing a textbook.
• Use cloze deletions for guideline thresholds and stepwise orders: “DKA fluids: start with ____ (type/volume), then add ____ when glucose < ____.” Keep them bite-sized.
• Tag by system and by week learned. That way, your 1-3-7-14 reviews are easy: pull Week 2 tags on Week 3 Day 7, etc.
• Mature card tolerance: Be okay missing 10–15% of mature cards on first pass; hit “hard” instead of “again” unless it’s a total blank. Overusing “again” explodes your queue and your morale.
• Retire leeches. If a card fails 3–4 times, rewrite or suspend it. Don’t let one bad card hold your morning hostage.
• On-call nights: switch all decks to custom 20-minute “critical reviews” filtered by tag “tough ten.” Keep the streak alive without wrecking your sleep.

One contrarian tip: If you’re behind, reduce new card intake before you reduce mixed block practice. Processing speed under time beats one more flashcard about eschar vs slough.

Skip the Textbook Re-Read. Re-Do Your Wrong Questions Instead.

I used to re-read the endocrine chapter the last week because it felt safe. I’d highlight already-yellow lines, sip coffee, and convince myself I was studying. By exam day, I couldn’t quickly sort an adrenal incidentaloma from a pheo without a pause.

Wrong questions are laser-guided. When you miss “55-year-old with hyponatraemia, serum osm 242, urine osm 500, urine Na 50, on sertraline,” you don’t need another 18-page “Approach to Sodium” read. You need:

• The three-step SIADH workup you can say out loud.
• First-line treatments you can write from memory: fluid restriction 800–1,000 mL/day; salt tabs if symptomatic and mild; hypertonic saline only with severe symptoms, with careful correction rate (<8–10 mmol/L in 24 hours).
• The medication triggers you won’t miss again: SSRIs, carbamazepine, cyclophosphamide.

I do second and third passes of my wrongs with spaced repetition and short write-ups. A single sheet with “I miss these” saved me on exam day:

• Anticoagulation in AF with CKD (apixaban dose adjustments vs warfarin).
• Breastfeeding-safe antibiotics (cephalexin okay; avoid doxycycline in neonates).
• First seizure workup vs starting meds (no meds after single unprovoked if normal MRI/EEG and low-risk; counsel).

One more example from my notes: I kept mixing up hypercalcaemia workups. Now it’s a cloze: “High Ca, high PTH = _____; High Ca, low PTH = _____; Low Ca, low PTH = _____.” I run it twice a week. That beats re-reading a whole endocrine PDF.

Burnout-Proofing: One Day Off, No Late-Night Cramming, and Sleep as a Study Tool

The bravest decision in this plan is the day off. I protect one full day every week. No guilt. My brain consolidates better, and I stop resenting the process.

Sleep matters. There’s good evidence that memory consolidation leans on slow-wave sleep. I see it on the wards: after a string of 02:00 pages, my clinical recall is mush. Same for spaced repetition—sleep-deprived reviews don’t stick.

A few rules that kept me functional:

• Day off every week: I pick Sunday. I meal prep, call my parents, and don’t open Anki. My scores didn’t drop; my mood lifted.
• No late-night cramming. I stop new content by 19:00. If I’m awake, I’ll do a 10-minute whiteboard skim of my “tough ten.”
• Move your body. A 20-minute walk or a slow 5K resets me better than another 10 questions at 22:00.
• Eat like you’d counsel a patient: actual breakfast on exam day. I brought a banana, nuts, and water. Last thing I wanted was a sugar crash in the CDM block.
• Protect the two nights before the exam. I aim for 7–8 hours. The gains from cramming are small; the penalty for fatigue is big.

Burnout shows up in strange ways. For me, it was doom-scrolling and re-writing schedules. If I catch myself re-formatting a spreadsheet at 23:00, I shut the laptop and go to bed.

Putting It Together on Exam Day

On exam day, I sat down, took a breath, and looked at the first page like it was one of my Week 6 mixed blocks. Same seconds ticking, same rhythm. I flagged three stems out of the first 20 and kept moving.

CDM felt like my mid-week sessions. A 72-year-old with CAP not improving at 48 hours on amoxicillin? I wrote “switch to amoxicillin-clavulanate; add atypical coverage if risk factors; check sputum culture only if severe; repeat CXR not indicated unless no improvement.” Short, directive, guideline-scented.

Ethics threw me a capacity case. A 16-year-old requesting contraception without parental knowledge. I wrote a clear note: assess capacity, confidentiality limits, ensure safety, prescribe if capable, and document. That’s CanMEDS Communicator and Professional, and MCC likes to see it.

I didn’t know every answer. I knew my process. If a stem turned on an obscure derm sign, I guessed, flagged, and moved on. The points are in the common things.

FAQ

• How many hours per day should I study for the MCCQE1 in 6 weeks? I averaged 3–5 hours on weekdays and 2–3 on weekends, with one full day off. On rotation, I compressed to 2–3 focused hours: reviews, new MCQs, and either a timed block or CDM. Quality beats raw hours when you’re using spaced repetition.

• Do I need Anki for spaced repetition MCCQE studying? No. Any system that enforces 1-3-7-14 will work. You can use paper flashcards, a Notes app with reminders, or another SRS tool. I like Anki because tags and custom filtered decks make Week 6 easy, but the principle is the win.

• How many CDM cases should I do before the exam? Over six weeks, aim for roughly 30–50 cases, with most in Weeks 4–6. Do short, timed sets, then review scoring keys and rewrite any answers that were too wordy. Practise writing orders and counselling points; CDM rewards clarity over flourishes.

• Can I follow this MCCQE1 6 week schedule while on a busy rotation? Yes, if you protect the review block and keep new questions modest on long-call days. On my CTU month, I did 15–20 new MCQs and a 20-minute review most weekdays, then caught up on my day off. Flex the daily targets; don’t drop the cadence.

• What score do I need to pass the MCCQE1? The MCC uses standard setting, and the passing threshold can change between administrations. Don’t chase a number you can’t see; aim to consistently pass mixed blocks and CDM practice under time. Focus on process and calibration.

• How should I study ethics and public health for MCCQE1? Build a one-page hit list: consent/capacity in adults and minors, confidentiality exceptions, mandatory reporting, fitness to drive, duty to warn, MAiD basics, plus vaccine counselling and screening guidelines. Do a few CDM ethics cases in Week 6. Think CanMEDS roles—Communicator, Health Advocate, Professional—and write answers that reflect them.