CCFP priority topic 59 of 105
Learning (Patients/Self) on the CCFP exam
8 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 8 key features for Learning (Patients/Self). 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 8
Ask about school
At routine visits, check how each child is coping at school, so reading trouble is caught early.
CFPC skill Clinical reasoningPhase HistorySources Canadian Paediatric Society
On the exam
A well-child visit at age 6. Expect a short menu (pick several from a list) of questions to add.
Pick the questions that screen for reading trouble.
Common mistakes
Asking only about growth and shots because no one raised school. Or waiting for the teacher to flag it. Reading trouble can be spotted from age 4.
Approach
- Ask how school is going at every child visit. Ask whether reading keeps pace with siblings and classmates.
- Between ages 4 and 7, screen for reading trouble at well-child visits.
- Ask about early signs: late speech, trouble naming letters or their sounds, trouble rhyming, guessing words from the pictures.
- Ask about risk: a parent or sibling with reading or spelling trouble, speech delay, few books or little reading at home.
- A home language other than English or French adds risk too.
- A 2 to 3 minute reading check in the office can back up a concern.
- Encourage parents to read, talk and sing with their child from infancy.
Key feature 2 of 8
Find the cause
When a child struggles at school, use the history to pin down which cause is behind it.
CFPC skill Clinical reasoningPhase History, hypothesis generationSources Canadian Paediatric Society
On the exam
An 8-year-old struggles to read and asks for repeats. Expect a short menu (pick several from a list) of questions.
Pick the history that narrows the cause.
Common mistakes
Asking about birth order, handedness or sugar: none points to a cause. Or a rating scale for attention before a hearing test. Hearing loss can look like inattention.
Approach
- Pin down the skill: reading, spelling, writing or math. Look at schoolwork and teacher reports.
- Ask about ear infections, ear tubes and asking for repeats. Get hearing and vision tested to rule them out.
- Ask whether the trouble shows up everywhere. Attention-deficit hyperactivity disorder (ADHD) needs symptoms across settings.
- Inattention only during reading points to a learning disorder. A child who cannot follow the lesson looks inattentive.
- Ask about mood, worry about school, avoiding school, sleep, bullying and trouble at home.
- Ask about very early birth, brain injury, genetic conditions and seizures. Ask who in the family had trouble learning.
- For an inattentive child, order blood tests, a brain wave test (EEG) or a scan only if the history or exam points to one.
| Cause | Clue | Next step |
|---|---|---|
| Hearing loss | Ear infections or tubes, asks for repeats | Hearing test first |
| Learning disorder | Trouble limited to reading, spelling or math; family history | School supports, then a psychologist's assessment |
| ADHD | Inattention at home, at school and at play | Rating scales from parents and teachers |
| Anxiety or low mood | Avoiding school, worry, low mood | Ask the child directly |
| Poor sleep | Tired in class, snoring | Ask about sleep and snoring |
Key feature 3 of 8
How it affects them
Keep checking how the learning disorder weighs on the child, the parents and the siblings.
CFPC skill Patient-centred approach, communicationPhase Hypothesis generation, follow-upSources Canadian Paediatric Society
On the exam
A girl with a reading disorder now cries before school and calls herself stupid. Expect one best answer.
Pick what explains her new distress.
Common mistakes
Calling it separation anxiety, defiance or depression. She still sleeps, eats and enjoys sport. Her distress sits with reading, now that she sees she struggles.
Approach
- Ask the child how school feels. Poor reading raises the risk of anxiety, low self-esteem and acting out.
- Watch for red flags: avoiding school, low mood, worry about school, and a big gap between effort and marks.
- Ask parents about homework fights, stress at home and how siblings are coping.
- Name the child's strengths and praise effort. It protects confidence.
- Check for conditions that often come with it: ADHD, anxiety, oppositional defiant disorder, and clumsiness that gets in the way of daily tasks.
- Recheck at follow-up visits, not only at diagnosis.
Key feature 4 of 8
Getting support
Make sure the child and family can reach the help on offer at school and nearby.
CFPC skill Patient-centred approach, clinical reasoningPhase Treatment, referralSources Canadian Paediatric Society
On the exam
Her assessment confirms a reading disorder. Money is tight and she is newly upset. Expect one best answer.
Pick the next step for support.
Common mistakes
Referring to psychiatry or holding her back a grade. Her distress comes from reading, so the school reading help her report recommends treats the cause.
Approach
- Push for school reading help early. A letter, a call or a school meeting can speed it up.
- School help steps up in intensity, up to one-on-one support, as the child needs it.
- Help parents ask for an assessment by a psychologist. Public waits can be 2 years or more.
- Private testing costs a lot and is often only partly covered. Ask whether the child qualifies for funding.
- Point families to the Learning Disabilities Association of Canada, AboutKidsHealth, tutoring and library programs.
- At home: daily shared reading, enough sleep, screen limits and family meals.
| Where | What it gives | Your part |
|---|---|---|
| School | Reading help that steps up as needed | Write, call or meet the school |
| Psychologist | The assessment that makes the diagnosis | Help parents ask for it; explain the report |
| Funding | Jordan's Principle for some First Nations children, the Child First Initiative for some Inuit children, funds for children in care | Ask whether the child qualifies |
| Community | Learning Disabilities Association of Canada, AboutKidsHealth, tutoring, libraries | Name a local option |
| Home | Shared reading, sleep, screen limits, family meals | Coach parents on routines |
Key feature 5 of 8
Pitch the information
Find out how much the patient wants to know, then fit the detail to what they can follow.
CFPC skill Patient-centred approach, communicationPhase Diagnosis, history, treatmentSources Canadian Paediatric Society
On the exam
A mother who reads with difficulty brings her daughter's long assessment report. Expect one best answer.
Pick the best way to explain the report.
Common mistakes
Handing her a pamphlet or a copy of the report: she reads with difficulty, so paper changes nothing. Reading out every test score is wrong too.
Approach
- Ask what the patient already knows and how much they want to hear today.
- Ask how they like to get information: talking, pictures or written notes.
- Go through the assessment with the family. Turn the results into a plan for supports.
- Use plain words and a few key points at a time. Skip the jargon.
- Ask them to say it back in their own words. That checks your teaching, not them.
- Some patients do not want details yet. Respect that, and offer to come back to it.
Key feature 6 of 8
Find your gaps
Keep looking for what you do not yet know or do well enough.
CFPC skill ProfessionalismPhase NA
On the exam
You missed a diagnosis that a colleague caught. Expect a short menu (pick several from a list) of ways to find gaps.
Pick ways to find your gaps.
Common mistakes
Choosing courses on topics you already enjoy. Or trusting your own sense of what you know: it can miss the gaps that matter.
Approach
- Write down the questions from visits that you could not answer.
- Audit your own charts against a guideline, such as screening or prescribing.
- Ask for feedback from colleagues, staff and patients.
- Treat near misses, errors and complaints as clues to a gap, not as blame.
- Watch for new guidelines and for changes in the patients you see.
Key feature 7 of 8
Close the gap
Choose learning that fits each gap, and fill it from trusted, current sources.
CFPC skill Professionalism, selectivityPhase NA
On the exam
A patient asks about a new treatment you have not heard of. Expect one best answer.
Pick the best way to answer the question.
Common mistakes
Trusting a drug rep, one new study or a web search. Or giving up for lack of time. A focused question and a trusted summary can be quick.
Approach
- Turn the gap into a clear question: which patient, which choice, compared with what, which outcome.
- Start with a current Canadian guideline or a summary that is checked and kept up to date.
- Check the date, who wrote it and who paid for it.
- Match the method to the gap: reading for facts, hands-on training for skills, chart audits for habits.
- Plan your learning across the year, not one course at a time.
Key feature 8 of 8
Change your practice
Put what you learn to work in patient care, then check that it made a difference.
CFPC skill ProfessionalismPhase NA
On the exam
A new guideline changes a screening interval. Expect a short menu (pick several from a list) of steps.
Pick the steps that make the change stick.
Common mistakes
Reading the guideline and stopping there. Knowing is not doing. Without a reminder, a team plan or a re-audit, care stays the same.
Approach
- Decide what you will do differently, and for which patients.
- Build it into your system: a reminder in the electronic record, an order set, a handout or a flow sheet.
- Tell your team, so staff and colleagues work the same way.
- Weigh the new advice against each patient's wishes and situation.
- Re-audit your charts later to see whether care changed.
Flashcards
Answer it first, then check.
KF 1At what ages should well-child visits screen for reading trouble?
Between 4 and 7. Ask about early signs and think about a brief reading check. Source: Canadian Paediatric Society
KF 2A child had ear tubes and asks for repeats. Which test comes first?
A hearing test. Hearing and vision are checked to rule out a medical cause. Source: Canadian Paediatric Society
KF 2A child is inattentive only during reading period. What does that point to?
A learning disorder. ADHD needs symptoms across settings, and a child who cannot read can look inattentive. Source: Canadian Paediatric Society
KF 3Name four conditions that often come with a learning disorder.
Any four of: ADHD, anxiety, oppositional defiant disorder, autism, coordination disorder, epilepsy. Source: Canadian Paediatric Society
KF 4Who usually diagnoses a learning disorder, and when is testing usually done?
A psychologist, usually from grade 2 on, after school supports have been tried. Source: Canadian Paediatric Society
KF 5A parent cannot read the report you hand over. What do you do?
Talk it through in plain words, a few points at a time. Then have them say it back.
KF 6How do you find a gap you do not know you have?
Audit your charts, log the questions you could not answer, and ask for feedback.
KF 8You read a new guideline. What makes the change stick?
A change to your system, such as a record reminder, then a re-audit to see if care changed.
FAQ
Is learning disability the same as specific learning disorder?
Yes. Specific learning disorder is the newer term. It affects specific school skills, such as reading, writing or math, alone or together. It affects 5 to 10% of school-age children in Canada.
Does the family doctor make the diagnosis?
Usually not. A psychologist makes it after testing thinking and school skills. You look for the cause, rule out hearing and vision problems, push for school help and explain the report.
Should a child wait for testing before getting help?
No. Schools can start reading help before testing and step it up as needed. Public testing waits can run 2 years or more, so help should not wait for the label.
How is self-learning tested when there is no patient?
Through a scenario about your own practice: a missed diagnosis, a new guideline, a question you cannot answer. Marks go to finding the gap, using a sound source and changing what you do.
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
- Position statements and practice pointsCanadian Paediatric Society