Royal College Internal Medicine Exam Guide
The Royal College Internal Medicine exam is the certifying assessment for internists in Canada. It has a written component and an OSCE. This guide covers the format, blueprint, timeline, and a realistic 12-month prep plan.
By Dr. A. Chen · MD, FRCPC (Internal Medicine)
Exam format
The Royal College Internal Medicine certification exam has two parts: a two-day written exam and an objective structured clinical exam (OSCE). The written exam is a mix of multiple-choice questions and short-answer questions (SAQs).
Both parts must be passed for certification. Most candidates write both in the same spring sitting after PGY-4.
- Day 1 of written: approximately 200 MCQs across the AIM blueprint
- Day 2 of written: SAQs requiring structured written answers
- OSCE: 10–12 stations of standardised patients and data interpretation
The AIM blueprint
The Adult Internal Medicine (AIM) Objectives of Training define what the Royal College exam tests. Cardiology, respirology, gastroenterology, nephrology, endocrinology, hematology, infectious disease, rheumatology, and general internal medicine make up the bulk of the written blueprint.
MDReview's Royal College Internal Medicine bank is topic-mapped to the AIM blueprint so your practice mirrors the exam distribution.
Timeline
Most candidates begin structured question-bank practice at the start of PGY-4, roughly 12 months before the exam. Serious review typically escalates in the final 6 months, with a full-length mock exam in the last 4 weeks.
A 12-month prep plan
The plan below assumes 60 minutes of daily practice, scaled up in the final months.
- Months 1–3: 30 questions per day, cover cardiology → respirology → nephrology sequentially
- Months 4–6: 40 questions per day, add endocrinology, GI, hematology; start SAQ practice
- Months 7–9: 50 questions per day, mixed topics, weekly SAQ drills
- Months 10–11: 60 questions per day, timed blocks, mock OSCE stations
- Month 12: full-length written mock, targeted weak-topic review, taper the final week
Scoring
The written exam and OSCE are scored separately and both must be passed. Score reports include a pass/fail decision and diagnostic feedback by blueprint category.
FAQ
When is the Royal College Internal Medicine exam offered?
The written exam is offered once per year in the spring, with the OSCE typically the following month.
How does MDReview align to the AIM blueprint?
Every vignette is tagged to an AIM Objective of Training, and the bank distribution mirrors the written exam blueprint so timed practice matches the real distribution.
Does MDReview include a mock exam?
Yes. The Royal College Internal Medicine Exam-Year Pass includes a full-length timed mock written exam.
Ready to start practising?
MDReview turns this guide into daily practice: staff-authored vignettes, spaced repetition, and a full-length mock exam.