If you are a student travelling to Canada for the first time: Your medical exam expires 12 months after it is completed. If you do not travel to Canada in the 12-month validity period, you must have a new medical exam completed to be able to enter Canada, even if your study permit approval is still valid. https://travel.gc.ca/travel-co
You are returning to Canada and have a valid study permit: If your medical exam (completed in support of your study permit application) is more than 12 months old, AND you have lived or travelled for 6 months or more in certain countries or territories before returning to Canada, you must have a new medical exam completed.
You can check which countries will require a new medical exam here:
You could be refused entry to Canada in either of these situations if your medical exam has expired.
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