Candidates sitting the CCFP written examination in 2026 face a genuinely hybrid assessment: traditional write-in management answers alongside multiple-choice questions and short-menu selections, all within the same four-hour session. This hybrid structure demands a genuinely hybrid preparation approach, and candidates who focus exclusively on one response format leave a real, predictable gap in the others.
The cognitive differences between the three formats
Each format demands a genuinely different cognitive process, even when testing the same underlying clinical knowledge. Free recall, required by write-in responses, demands generating an appropriate answer entirely from memory and clinical reasoning, without any prompt or option list to recognise from. Recognition, the process underlying MCQ answer selection, involves identifying the correct option from a presented set, a genuinely easier cognitive task than free recall even when testing identical knowledge. And selection from a constrained clinical list, the process short-menu questions require, sits between the two, demanding judgement about which of several presented options are genuinely appropriate, without the further step of generating those options unaided.
Translating the same case into all three formats
A particularly effective preparation technique is deliberately working through the same underlying clinical case in all three formats, to build genuine fluency across the full hybrid structure rather than practising each format in isolation.
A worked example: new atrial fibrillation
Consider a patient presenting with newly diagnosed atrial fibrillation. In write-in format, a candidate must generate, unprompted, the appropriate investigations and management steps, organising their own response within the space and structure the question allows. In single-best-answer MCQ format, a candidate might be asked to select the single most appropriate immediate management step from several presented options, requiring recognition and discrimination rather than open generation. In short-menu format, a candidate might be asked to select three appropriate initial investigations from a longer list of options, some clearly appropriate, others plausible but less immediately relevant, and some clearly inappropriate. The underlying clinical knowledge required is identical across all three versions; the cognitive task demanded by each format is genuinely different.
Why relying entirely on historical SAMP books creates a gap
Candidates who prepare exclusively using historical, write-in-focused SAMP preparation material risk being underprepared specifically for the discrimination and selection skills the new MCQ and short-menu formats demand, even where their underlying clinical knowledge is strong. Recognition-based tasks reward a different kind of practice, working through plausible-but-wrong options and understanding precisely why each falls short, than free-recall practice alone builds.
Why relying entirely on MCQ practice creates the opposite gap
Equally, candidates who prepare exclusively through MCQ-format practice, without maintaining genuine write-in SAMP practice, risk underdeveloping the concise management recall that free-text responses specifically demand. Given that most 2026 cases will still be write-in format, this is a genuinely consequential gap for candidates sitting that particular year.
A weekly hybrid-practice schedule
A reasonable weekly structure for 2026 candidates specifically combines dedicated write-in SAMP practice, maintaining the concise, prioritised management writing skill the majority-format still demands, with regular MCQ and short-menu practice, building fluency with the newer formats that will represent a meaningful minority of cases. Neither should be dropped in favour of the other while the hybrid structure remains in place.
Using iatroX for the MCQ and reasoning components
iatroX's Standard and Tutor modes are well suited to building the MCQ-format knowledge and reasoning components of this hybrid preparation, while dedicated, separate written SAMP practice, ideally reviewed against CFPC's own marking guidance, should be retained specifically to protect the free-recall writing skill the majority of 2026 cases will still require.
Estimating a realistic practice ratio for the 2026 sitting
Given that up to a quarter of 2026 cases will use the new formats, a reasonable, though approximate, guide is allocating roughly a quarter of written-format practice time to MCQ and short-menu material, with the remaining three-quarters devoted to traditional write-in SAMP practice. This ratio is not a precise prescription, since the exact proportion of new-format cases in any specific sitting is described as "up to 25%" rather than a fixed guarantee, but it offers a defensible starting point that avoids the two extremes of ignoring the new formats entirely or over-investing in them relative to their actual likely weight in the 2026 paper.