Royal College Written Exam Pass Rates by Specialty (2026)
MDReview Editorial — written with input from Canadian residents and medical students.
Every year the Royal College publishes aggregate pass rates for each certification exam. This is the 2026 update, broken out by specialty, with commentary on what the numbers mean for candidates preparing this cycle.
Summary — first-attempt pass rates, 2026
| Specialty | First-attempt pass rate (Canadian) | IMG / repeat pass rate |
|---|---|---|
| Family Medicine (CCFP) | ~95% | ~72% |
| Internal Medicine | ~90% | ~65% |
| General Surgery | ~90% | ~68% |
| Diagnostic Radiology | ~89% | ~65% |
| Pediatrics | ~88% | ~70% |
| PM&R | ~88% | ~68% |
| Emergency Medicine | ~87% | ~62% |
| Obstetrics & Gynecology | ~87% | ~64% |
| Anatomical Pathology | ~86% | ~60% |
| Anesthesiology | ~85% | ~62% |
| Neurology | ~84% | ~60% |
| Psychiatry | ~82% | ~58% |
Numbers are 3-year rolling averages from Royal College and specialty-committee summaries. Specialty committees publish their own data with a 6–12 month lag; treat these as directional.
What the pattern actually shows
Three consistent findings across specialties:
- First-attempt pass rates for Canadian graduates cluster tightly (82–95%). Below-average scores usually reflect a rough week, not a bad program.
- The IMG gap is 20–30 percentage points on first attempt. It closes to ~10 points on second attempt — most IMGs pass eventually, but the first-attempt penalty is real.
- SAQ-heavy specialties (Psychiatry, Neurology, Pathology) sit at the bottom of the pass-rate table. Not because the medicine is harder, but because SAQ format punishes vague reasoning more brutally than MCQ.
Why SAQ-heavy specialties fail more candidates
The written exam's short-answer section marks against a pre-defined rubric. If the rubric says "list 3 diagnostic steps," writing 5 doesn't help — the marker takes the first 3. Writing "workup" instead of "TSH, free T4, cortisol" scores zero.
Candidates who trained on MCQ-heavy resources (Toronto Notes, US board banks) walk into an SAQ exam without the muscle memory for rubric-precise answers. That's the gap that separates 82% and 92% pass rates.
The IMG playbook
If you're an IMG writing a Royal College exam:
- Do 200+ AI-graded SAQs in your specialty across 4–6 months. AI grading is critical — self-grading misses the "vague vs specific" penalty every time.
- Do at least 3 full-length simulations in exam conditions.
- Target 70%+ SAQ accuracy in the final 2 weeks. Below that, add another 4-week SAQ-only block before rewriting.
MDReview coverage
MDReview covers 12 Royal College specialties with SAQ-rubric-graded practice: Internal Medicine, Family Medicine, Pediatrics, Psychiatry, Emergency Medicine, Anesthesiology, General Surgery, Obstetrics & Gynecology, Diagnostic Radiology, Anatomical Pathology, Neurology, and PM&R.
Same platform, separate specialty-tuned content, AI-graded SAQ practice built to the marker's rubric — not a keyword match.