CCFP priority topic 50 of 105
Immigrants on the CCFP exam
6 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 6 key features for Immigrants. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 6
Catch-up vaccines
When a newcomer first comes in, check which vaccines they have had and catch them up.
CFPC skill Clinical reasoningPhase History, treatmentSources Public Health Agency of Canada / NACI
On the exam
A 10-month-old refugee with no vaccine record and a mild ear infection on antibiotics. Expect a short menu (pick several from a list) of vaccines and tests for today.
Pick what to give and test today.
Common mistakes
Trusting a parent's memory or a scar, or putting vaccines off for a mild illness. Starting rotavirus vaccine at 10 months is wrong too: it is too late.
Approach
- Count only doses with dates: on a written record, or read out by the clinic that gave them. A parent's memory does not count, except for a flu vaccine given in the past year.
- No written record: treat the patient as unvaccinated. Start the Canadian schedule for their age and risk.
- Extra doses of many vaccines, such as measles, mumps and rubella (MMR), polio and hepatitis B, have shown no harm. Do not hold back to avoid a repeat.
- Vaccinate today despite a mild illness, with or without fever. An antibiotic is no reason to wait for most vaccines.
- Rotavirus: start before 15 weeks of age and give every dose before 8 months. Do not start it later.
- Only bivalent oral polio vaccine (bOPV) given abroad: give a full series of the injected polio vaccine (IPV). bOPV does not cover all three polio types.
- Schedules abroad differ. Some give measles vaccine at 9 months. Compare each dose with the Canadian schedule.
| Infection | Test first? | Then |
|---|---|---|
| Measles | No | Give measles vaccine whatever the past history. |
| Rubella | No | One dose of MMR if there is no written record of a rubella vaccine. |
| Chickenpox (varicella) | Test first in people from tropical regions | Vaccinate if not immune. They are more often non-immune. |
| Hepatitis B | Yes: the surface antigen and two antibodies (HBsAg, anti-HBs, anti-HBc) | Vaccinate if not immune and not infected. |
Key feature 2 of 6
Culture and consent
Adjust how you run the visit to fit the patient's culture and wishes.
CFPC skill Patient-centred approach, communicationPhase Treatment, history
On the exam
A husband answers every question for his wife, who wants a female doctor to examine her. Expect a short menu (pick several from a list) of next steps.
Pick how to adapt the visit.
Common mistakes
Letting the husband speak for her the whole visit, or brushing off her request. Pressing her to be examined now, against her wishes, is wrong too.
Approach
- Ask the patient what she prefers: who stays in the room, and who examines her.
- Offer a female doctor or nurse if one is free. If not, offer a chaperone, or book the exam for another day unless it is urgent.
- See her alone for part of the visit. Ask her the questions directly, with a trained interpreter if needed.
- When a partner controls the talk, ask her about safety in private. Control can be a sign of abuse.
- Ask what she thinks caused the illness and what she hopes you will do.
- Explain why an exam or test matters. Respect a refusal from a patient who understands it.
Key feature 3 of 6
Interpreters
When you share no language, get the history through a trained interpreter and know where interpreting fails.
CFPC skill CommunicationPhase History
On the exam
A mother with no English brings a thin infant. Her 12-year-old son offers to translate. Expect one best answer.
Pick who should interpret the history.
Common mistakes
Using her son, a staff member who speaks the language, or a phone app. Each misses medical terms, edits answers or breaks privacy. Yes-or-no questions instead are wrong too.
Approach
- Book a trained interpreter, in person, by video or by phone. Do not delay care for a sick infant while you wait for one in person.
- Do not use a child to interpret. A child lacks the words, filters what the parent says, and should not carry adult health details.
- Family, friends and untrained staff leave out, change or add to what is said. They also learn private details.
- Speak to the patient, not the interpreter. Use short sentences and open questions.
- Ask for every word, not a summary. A summary drops the detail and doubt in the story.
- Check understanding: ask the patient to say the plan back. A nod is not understanding.
- Any interpreter can have an agenda or something to hide. Watch for a long answer that comes back as one word.
Key feature 4 of 6
Mood and trauma
In a newcomer who is not managing, look for depression, past torture and missing supports.
CFPC skill Clinical reasoning, patient-centred approachPhase HistorySources Canadian Task Force on Preventive Health Care
On the exam
A 9-year-old refugee has stomach aches on school mornings, cries in class and misses his mother. Expect a short menu (pick several from a list) of things to ask.
Pick what to ask about first.
Common mistakes
Working up only the stomach ache with questions about acid or diet. That skips the crying and isolation of a child separated from his mother.
Approach
- Ask about mood, sleep, school and friends when a newcomer seems to be struggling.
- The Canadian Task Force advises against a routine depression questionnaire for adults. It still wants you to ask about well-being and stay alert to signs of depression.
- That advice does not cover a patient who comes with symptoms. Assess them.
- Ask in private, gently, about war, violence, torture or loss before arrival. Let the patient choose how much to tell.
- Ask who they can lean on: family here, faith or cultural groups, settlement services, school.
- In a child with distress after trauma, link the family with support at home, at school and through counselling.
- A child's distress, with a parent who is engaged and asking for help, is not by itself a reason to report neglect.
- If the family does not accept a mental health diagnosis, keep seeing them and keep offering support.
Key feature 5 of 6
Infections from abroad
When a newcomer is unwell, add infections caught before arrival to your list.
CFPC skill Clinical reasoning, selectivityPhase Hypothesis generationSources Public Health Agency of Canada / NACI
On the exam
An infant from a refugee camp has had two months of greasy, bloodless stools and poor weight gain. Expect a short menu (pick several from a list) of causes.
Pick the causes to consider first.
Common mistakes
Jumping to cystic fibrosis or milk allergy because the stools are greasy. They began in the camp, so an infection caught there comes first.
Approach
- Ask where the patient was born, lived and travelled, and when they arrived.
- Bowel symptoms or poor growth after life in a camp: think of gut parasites, such as Giardia.
- Fever in someone who lived in or visited a malaria area puts malaria on the list.
- From a country where tuberculosis (TB) is common, with no known TB history: offer a TB skin test or a TB blood test (IGRA).
- Offer every newcomer a hepatitis B blood test. Offer an HIV test to people from countries where HIV is common.
Key feature 6 of 6
Other remedies
Ask every newcomer about traditional healers, home remedies and medicines brought from abroad.
CFPC skill Clinical reasoningPhase HistorySources Health Canada
On the exam
A father gives his son a daily tablet bought abroad for stomach pain. It has no English label. Expect one best answer for the next step.
Pick the next step for the tablet.
Common mistakes
Ignoring the tablet because the pain is stable. Or stopping it before you know what it is: some medicines, such as steroids, must be tapered.
Approach
- Ask every patient about herbs, teas, home remedies, healers and medicines from home. Ask without judging.
- Ask to see the product. Have the family bring the tablets and the box.
- Look up a product sold in Canada in Health Canada's Drug Product Database, by name, active ingredient or drug identification number (DIN).
- A product bought abroad may not be listed. A pharmacist can help identify it.
- Identify an unknown drug before you stop it. Some, such as steroids, need a slow taper.
- Ask about practices that mark the skin, such as cupping, coining or moxibustion (burning herbs on the skin). The marks can look like abuse.
Flashcards
Answer it first, then check.
KF 1The mother recalls every vaccine but has no record. What do you do?
Treat the child as unvaccinated. Start the schedule for the child's age today; memory is not proof. Source: Public Health Agency of Canada / NACI
KF 1A measles dose was given abroad at 9 months. Does it count?
No. Give 2 more doses after the first birthday, at least 4 weeks apart. Source: Public Health Agency of Canada / NACI
KF 1A 10-month-old has never had rotavirus vaccine. Do you start it?
No. The first dose must come before 15 weeks, and every dose before 8 months. Source: Public Health Agency of Canada / NACI
KF 1Why test a newcomer for hepatitis B, not just vaccinate?
Testing finds chronic infection as well as immunity. Vaccinate only if not immune and not infected. Source: Public Health Agency of Canada / NACI
KF 3A 12-year-old offers to interpret for his mother. Why not?
He lacks medical words, filters what she says, and should not carry adult health details.
KF 4Should every adult newcomer fill in a depression questionnaire?
No. The Canadian Task Force advises against it. Ask about well-being and watch for signs of depression. Source: Canadian Task Force on Preventive Health Care
KF 5Measles vaccine was given last week. When can you do the TB skin test?
Wait at least 4 weeks after the measles vaccine before you do the skin test. Source: Public Health Agency of Canada / NACI
KF 6A father gives his son an unlabelled tablet from abroad. First step?
Ask to see it and identify it before you change anything.
FAQ
Do newcomers arrive with their vaccines already checked?
No. The medical exam done for immigration does not review vaccines. Check the written record at the first visit and start the catch-up then.
Which schedule do I use for catch-up?
The Canadian one, by age and risk. Schedules abroad differ, so compare each written dose with the Canadian schedule before you count it.
Should I screen every newcomer for depression?
Not with a routine questionnaire. The Canadian Task Force advises against one for adults. Ask about mood and well-being, and assess anyone who seems to be struggling.
Which interpreter should I pick on the exam?
On the exam, pick the trained interpreter, by phone or video if no one can come in. Do not pick a child, a relative or a phone app.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Canadian Immunization GuidePublic Health Agency of Canada / NACI
- Published prevention guidelinesCanadian Task Force on Preventive Health Care
- Drug Product DatabaseHealth Canada