NAC OSCE Preparation Guide: Everything IMGs Need to Know (2026)

The NAC OSCE is unlike any other exam in the Canadian IMG pathway. There are no multiple-choice questions. No answer sheets. No computer screens.

Instead, you walk into a room, face a standardised patient, and have exactly 11 minutes to take a history, perform a physical exam, communicate your assessment, and demonstrate that you're ready for Canadian residency training.

It tests everything a written exam can't: how you talk to patients, how you think on your feet, and whether your clinical skills translate to the Canadian healthcare context.

This guide covers everything you need to prepare for the 2026 NAC OSCE.

NAC OSCE 2026: Key Facts

What Happens at Each Station

Every station follows the same basic structure:

1. Door instructions (2 minutes): You read a brief scenario outside the room describing the clinical situation and your tasks
2. Enter the room: Knock, introduce yourself, sanitise hands
3. Clinical encounter (11 minutes): Interact with the standardised patient as directed
4. Examiner observes: A physician examiner scores you on a checklist — you don't interact with them

Types of Tasks You'll Encounter

Clinical Disciplines Covered

Stations draw from across the medical curriculum:

• Internal medicine
• General surgery
• Pediatrics
• Obstetrics and gynecology
• Psychiatry
• Preventive medicine and public health
• Emergency medicine

You can't predict which specialties will appear on your exam day. The exam tests breadth, not depth.

How You're Scored

Each station is scored on a multi-point checklist. The examiner marks whether you performed specific actions. There's no partial credit — you either demonstrated the skill or you didn't.

Key scoring domains:

Communication and professionalism marks are available at every station. Even if your clinical knowledge is perfect, poor communication will fail you. This is the most common surprise for IMGs who excel at written exams.

How to Prepare: A Practical Strategy

Step 1: Learn the Canadian Clinical Approach (Weeks 1–2)

The NAC OSCE doesn't test your medical knowledge in isolation — it tests whether you can apply it in a Canadian clinical context. This means:

• Communication style matters. Explain what you're doing and why. ("I'd like to listen to your heart to check for any abnormal sounds — is that okay?")
• Patient-centred care. Ask about the patient's concerns, not just their symptoms
• Cultural sensitivity. Be aware of diverse patient populations
• Canadian guidelines. Use Canadian screening protocols and management approaches

If you trained outside Canada, your clinical approach may be technically correct but stylistically different from what examiners expect. Practice adapting early.

Step 2: Build a Station Framework (Weeks 2–3)

Create a consistent routine you follow at every station:

Entering (30 seconds):

1. Knock on the door
2. Sanitise hands (visibly)
3. "Hello, I'm Dr. Name. I'll be your physician today."
4. Confirm patient identity and reason for visit

History (3–4 minutes):

1. Chief complaint + HPI (onset, duration, severity, progression, aggravating/relieving)
2. Associated symptoms (positive and negative pertinent)
3. Past medical/surgical history
4. Medications and allergies
5. Social history (occupation, smoking, alcohol, living situation)
6. Family history (if relevant)
7. ICE: Ideas, Concerns, Expectations

Physical exam (2–3 minutes):

1. Explain what you'll do and get consent
2. Perform focused exam relevant to the presenting complaint
3. Verbalise your findings aloud
4. Thank the patient

Wrap-up (2–3 minutes):

1. Summarise findings for the patient
2. State your leading diagnosis in simple terms
3. Outline investigations you'd order
4. Discuss management plan
5. Ask: "Do you have any questions?"
6. Arrange follow-up

This framework fits in 11 minutes if you practise it. Without a framework, you'll run out of time.

Step 3: Practice With Real People (Weeks 3–8)

This is non-negotiable. You cannot prepare for the NAC OSCE by reading alone.

Practice options:

• Study partner or group (fellow IMG candidates)
• NAC OSCE prep courses (in-person or online)
• Practice with family members as fake patients
• Record yourself on video and review

What to focus on during practice:

• Timing. Can you complete your framework in 11 minutes?
• Transitions. Are you smoothly moving from history to physical to management?
• Communication. Would a non-medical person understand your explanations?
• Weak spots. Which stations make you freeze up?

Aim for at least 30–40 mock stations before exam day. Mix up the clinical scenarios to avoid pattern memorisation.

Step 4: Targeted Content Review (Ongoing)

While the NAC OSCE is primarily a skills exam, you still need clinical knowledge. Focus on:

• Common presentations. Chest pain, abdominal pain, headache, shortness of breath, depression, prenatal visit, pediatric fever
• Canadian-specific topics. MAID, capacity assessment, mandatory reporting, immunisation schedule
• Emergency management. ABCs, anaphylaxis, acute MI, stroke recognition
• Counselling scenarios. Smoking cessation, contraception, STI disclosure, breaking bad news

For medical knowledge review, working through MCCQE Part 1 practice questions also builds the clinical reasoning foundation you need at OSCE stations. See our best MCCQE qbanks guide for resource options.

The 5 Most Common NAC OSCE Mistakes

1. Not Sanitising Hands

Sounds trivial. Costs marks at every station. Examiners watch for this specifically. Use the hand sanitiser dispenser at the door — visibly, not subtly.

2. Using Medical Jargon With Patients

"You may have atrial fibrillation causing an embolic cerebrovascular event" means nothing to a scared patient. Say: "I'm concerned you may have had a stroke, possibly caused by an irregular heartbeat."

3. Running Out of Time Before Management

Many candidates spend 7–8 minutes on history and never reach management or counselling. This loses marks in multiple scoring domains. Practice strict time allocation.

4. Ignoring the Patient's Emotions

If the standardised patient expresses fear, concern, or sadness, acknowledge it. "I can see this is really worrying for you. That's completely understandable." Skipping emotional cues loses communication marks.

5. Not Stating Your Differential Diagnosis Aloud

Some candidates identify the correct diagnosis internally but never say it clearly. Examiners can only score what you verbalise. State your top diagnosis and 2–3 differentials explicitly.

Frequently Asked Questions

How long should I prepare for the NAC OSCE?

Most successful candidates prepare for 3–6 months, with structured practice starting at least 8 weeks before the exam. If you've recently completed clinical training, 3 months may be sufficient. If you've been out of clinical practice for several years, plan for 4–6 months with a focus on rebuilding clinical skills.

Is the NAC OSCE harder than the MCCQE Part 1?

They test completely different skills. The MCCQE Part 1 tests medical knowledge through multiple-choice questions. The NAC OSCE tests clinical skills, communication, and professionalism through live patient encounters. Many IMGs find the NAC OSCE more challenging because it can't be crammed — performance depends on repeated practice, not memorisation.

Can I take the NAC OSCE before the MCCQE Part 1?

Yes. There is no requirement to take the MCCQE Part 1 before the NAC OSCE. However, it's generally recommended to take the MCCQE Part 1 first because the knowledge base you build for Part 1 helps with clinical reasoning at OSCE stations. Many candidates take them in the same year.

What score do I need to pass the NAC OSCE?

The pass score is approximately 577 on a 500–700 scale. Scores are criterion-referenced, meaning you're evaluated against a fixed standard — not compared to other candidates. A passing score is required for CaRMS eligibility.

How many times can I retake the NAC OSCE?

There is no limit on attempts. You can retake the exam at the next available session after receiving your results. Each attempt requires a new application and fee (~$2,915 CAD).

Related Reading

• IMG Pathway to Practicing Medicine in Canada
• MCCQE Part 1 Study Plan: Complete 3-Month Guide
• MCCQE Part 1 Pass Rate: Statistics & Trends
• Best MCCQE Qbanks 2026: Complete Comparison Guide
• The Ultimate MCCQE Part 1 Guide
• Official MCC NAC OSCE Information