For Canadians studying at US medical schools and who are planning to return to Canada – this is an uncertain time. Apart from the ongoing choppy relationship between Canada and the United states, we will also be the first cohort of US MD graduates now considered to be IMGs for the purposes of the 2026 CaRMS match.
While USMDs have always had to take the MCCQE Part 1 to be eligible to match back to Canada, there’s another exam – a $3000+ practical skills assessment called the NAC – that US MD students may just have to take.
The problem? US MD students are technically not even eligible to register for the exam, as of May 2025, with the end of the registration window fast approaching. Even CaRMS – the body responsible for running the match – doesn’t know if we have to take it yet!
What’s the NAC?
The National Assessment Collaboration (NAC) Examination is a half-day OSCE – or practical skills exam – that costs $3,320.00 to take. It’s intended to evaluate International Medical Graduates to ensure their clinical skills are appropriate to participate in a Canadian residency program.
Here’s the snag; this is the current eligibility criteria from the Medical Council of Canada:
To take the National Assessment Collaboration (NAC) Examination, you must be a graduate from, or a student who is expected to complete all medical degree requirements within 12 months of the date of the exam from:
- A medical school outside Canada or the U.S. that is listed in the World Directory of Medical Schools and identified by a Canada Sponsor Note indicating it is an acceptable medical school in Canada; or
- A U.S. School of Osteopathic Medicine
You’ll note that MD schools in the United States are not included as eligible to take this exam. Given that the NAC is only offered twice per year and we’re not currently eligible and there’s no guidance on whether it’s actually required – we’re in a tough spot.
Should US MD graduates have to take the NAC exam?
In my biased opinion – absolutely not.
If there had been significant advance notice of the change, equal ability to register for the exam and clear guidance from CaRMS or MCC, I could understand it. However, that has not been the case.
Canadians who studied medicine in the United States and who want to return to Canada to serve our home communities are now being faced with additional barriers, cost and a lack of clarity. There has been no changes to the academic and clinical rigour of American MD institutions since the 2025 CaRMS match where the NAC was not required.
What to do?
I’d encourage my fellow Canadians at US MD institutions hoping to return to Canada for residency to reach out to CaRMS, the MCC and your programs of interest to inquire about the NAC exam requirement, and to share what you’ve learned.
This post will be updated if any new information becomes available.