MCCQE Part 1 2026: The 100% MCQ Format & Test Preparation Guide

If you are currently browsing forums or using older study materials, you might still believe the MCCQE Part 1 involves a section called Clinical Decision Making (CDM). We need to stop you right there.

As of April 2025, the Medical Council of Canada (MCC) radically changed the game. The CDM section was permanently removed. For the 2026 session, you are facing an exam composed of 100% Multiple Choice Questions (MCQs).

Many students wrongly think: "No writing? Great, the exam is easier!" This is a trap. Here is why the 2026 exam is actually a more unforgiving test, and how you need to adjust your MCCQE Part 1 test preparation.

The Loss of "Free Marks" and Old Advice

The old CDM section was often a lifeline. Clinical cases allowed you to bank easy points if you knew the basic protocols (e.g., "Order TSH").

If you look at some outdated MCCQE Part 1 review sites, they might still tell you to balance your study time between cases and questions. This is dangerous advice for 2026.

With the shift to all-MCQ:

Reduced Margin for Error: MCCQE1 MCQs are famous for their "distractors" (wrong answers that look incredibly plausible). Without the CDM cases to boost your average, your MCQ reasoning must be flawless.
Mental Endurance: Previously, switching sections offered a "mental break." Now, you must power through 230 MCQs with constant intensity. Decision fatigue becomes your worst enemy.

The 2026 Exam Structure

Forget the old 9-hour marathon with different question types. Here is what your day looks like in 2026:

Total Questions: 230 MCQs.
Morning (Session 1): 115 Questions – 160 minutes (2h 40m).
Lunch Break: 45 minutes (Mandatory, and crucial for recharging).
Afternoon (Session 2): 115 Questions – 160 minutes (2h 40m).

Note: The exam is now linear. The difficulty level no longer adapts in real-time as it did in the past, ensuring total fairness among candidates.

How to Adjust Your MCCQE Part 1 Test Preparation

Since the format changed, your study resources must evolve. Using a generic QBank isn't enough anymore.

1. Shift Your Focus to High-Volume MCQs

Don't waste a minute on "short answer" features or clinical case writing drills. Your MCCQE Part 1 test preparation should be 100% focused on recognizing patterns in multiple-choice scenarios. You need to expose yourself to thousands of MCCQE 1 practice questions to develop the intuition needed to spot the correct answer instantly.

2. Aim for the "Next Best Step"

The new MCQs penalize indecision. You don't just need to know that imaging is required; you need to know exactly why you would choose an MRI over a CT Scan in a specific emergency scenario. High-quality MCCQE Part 1 sample tests will test this specific type of clinical reasoning.

3. Simulate the Marathon

Endurance is key. At least twice before exam day, do a full set of 115 questions in one sitting using MCCQE Part 1 preparation exams. If your brain "fogs up" at question #80, you need to know that now, not on exam day.

For more interactive ways to test yourself, checking out our interactive medical exam simulations can be a game-changer for building this stamina.

Choosing the Right Resources

With so many options out there, it's vital to pick resources that reflect the current 2026 format.

Official Resources: Always start with the official MCCQE evaluation practice exam from the MCC website to understand the baseline difficulty.
Modern Qbanks: Ensure your Qbank offers MCCQE Part 1 practice exams that mirror the linear, all-MCQ format.
AI-Driven Tools: Leverage modern technology. See how artificial intelligence in medical prep is changing how students review for high-stakes exams.

Conclusion

The MCCQE Part 1 in 2026 isn't simpler than before; it's just different. By respecting the increased difficulty of the MCQs and ignoring old advice about CDM cases, you will start with a significant advantage. Focus on high-quality MCCQE 1 practice questions, build your endurance, and trust in your preparation.

For a complete overview of the MCCQE Part 1, including eligibility requirements, content coverage, scoring system, and comprehensive preparation strategies, read our complete MCCQE Part 1 guide.