Exam Structure

When preparing to write the Certification Exam, it may be helpful to understand how the exam is structured.

What are the exam questions based on?

All questions are based on competencies found in the Competency Profile.

Each competency profile establishes a minimum standard for entry-to-practice, and a foundation upon which to build higher levels of proficiency.  Laboratory professional competencies and proficiency are expected to develop further, based upon experience and ongoing learning. 

The figure below illustrates in general terms how workplace performance may evolve over time. It is also known as the Competency Continuum:

Minimally Competent (Entry-Level)

A Minimally Competent laboratory professional fulfills the role professionally by:

  • Practicing safely
  • Learning from experiences             
  • Demonstrating potential for growth
  • Asking for help and support in decision-making
  • Understanding obvious points but missing the subtle points
  • Developing confidence
  • Having a limited view of the profession
  • Requiring direction in complex situations
  • Lacking initiative on occasion
  • Practicing within the standards of practice
  • Evaluating own performance with assistance and feedback
  • Recognizing an error made but may be weak in problem-solving
There is a Competency Profile for each of the 4 disciplines:
  • Medical Laboratory Technology,
  • Diagnostic Cytotechnology,
  • Clinical Genetics Technology and
  • Medical Laboratory Assistant.

What types of questions are on the exam?

Taxonomic Levels

The CSMLS uses three taxonomic levels for test questions based on Bloom’s classification; these are recall (knowledge), application (comprehension and application), and critical thinking (analysis, synthesis, evaluation).  The majority of questions on the exam test the application of knowledge.

Examination Formats

Questions on CSMLS certification Exams are in multiple-choice format.

The following Multiple-Choice Question rules apply to all Exams:

  • ONE answer is acceptable – choose the BEST one
  • ONE mark will be allotted for each correct answer
  • NO choices with – a & b, c & d, all of the above, or none of the above
  • All Exams may include validation questions
Length of Exam Number of Questions Type of Questions
2.5 hours 150
  • Multiple choice questions
  • Some may include images
  • No case studies
General MLT
3.5 hours 210
  • Multiple choice questions
  • Some may include images
  • No case studies
Diagnostic Cytology
3.5 hours 210
  • Multiple choice questions
  • Some include images
  • No case studies
Clinical Genetics
3.5 hours The Exam is broken down into three (3) sections with 180 (±10) multiple choice questions and three (3) images for karyotyping (labelling).
  • Section 1 contains 100 multiple choice questions, some with images.
  • Section 2 contains 15 case studies, with multiple choice questions, some associated with images.
  • Section 3 consists of three (3) case studies for chromosome analysis and karyotype reporting. They include multiple choice questions to be answered on the computer platform, and paper-based images for analysis (labelling).

Exam Development And Validation

Subject matter experts from across Canada, apply to form the Exam Panel, and each designation has its own sub-panel. These sub-panels are responsible for the development of the exam forms, the exam blueprint (found in each competency profile) that weighs each competency, and the development of new exam questions.

The sub-panels also validate exams to ensure that they are fair and assess the minimum skills required for an entry-level medical laboratory practitioner. Up to 20% of exam questions may be new, that is, used for the first time. All new questions will be statistically validated before they are scored on an exam.

Exam Scoring and Results Release

Every exam has a “pass mark”, which is the total percentage score a candidate must reach to pass. Anyone who achieves this mark passes the exam, there is no limit to the number of candidates who can pass.

The pass mark, which is set by the Angoff method, varies from exam to exam depending on the determined difficulty of that particular exam.

Numerous quality assurance measures are taken throughout the exam scoring process, and each exam question is statistically analyzed.

Once the exam scoring quality assurance process is complete, candidates are sent a link to the Candidate Results Dashboard where they can view their exam results.

Each candidate will also receive an official Statement of Exam Results in the mail, indicating if they have passed or failed the CSMLS National Certification Exam, as CSMLS Certificates are only available to CSMLS certified members.

This process can take up to 45 days to complete. Estimated dates of Exam Results Release can be found here:

Certification Achieved:

The results dashboard for candidates who have achieved certification will include links to CSMLS Certified membership, allowing them to receive a free CSMLS certificate. This offer is only available for a limited time (within 2 months from the exam session). Certificates are only available for CSMLS members in good standing and must be returned to CSMLS if the certificant decides not to renew their CSMLS membership (see CSMLS membership bylaw 3.7.1).

Certification Not Achieved:

For those candidates who were not successful on their exam attempt, the dashboard will contain their score so that they can determine how close they were to passing the exam, a bar chart indicating their performance in each category of the Competency Profile (some contain additional discipline specific information), and information on what their next steps will be.

Setting the Pass Mark

Health related agencies require registration/licensure for their professionals as one means of assuring the quality of practice. Currently the CSMLS examination is the national requirement for entry to practice for all medical laboratory technologists across Canada (with the exception of Quebec) and is also a requirement in some provinces for medical laboratory assistants.

Setting a pass mark for an examination is setting a standard of performance on which decisions will be made about an individual's level of competence in a given field of practice. Determination of an appropriate pass mark is essential to the effectiveness of the process. The pass mark determination is a judgment made by informed individuals (i.e., experts in the field of practice). It is arrived at through a rational discussion of the field of practice as well as an awareness of the consequences involved when a decision affecting individuals is made.

Validity and reliability must be considered, as must the variables affecting candidate performance. Unrealistically high pass marks exclude competent candidates and inappropriately low pass marks allow non-competent candidates to practice.

The pass mark is based on the content of the examination and not on an arbitrary percentage or group performance.

The Angoff Process

The exam pass point is the minimum score required to pass a certification exam. The pass point is also known as a cut score, Angoff score or passing score. Angoff scores for CSMLS certification exams vary with each exam type and session, but usually they fall between 60 and 80 per cent of all test items answered correctly. The Angoff score for each CSMLS exam type is set independently. This means that the Angoff score may be different each time certification tests are administered.

The Angoff method was developed by William Angoff in 1971. It is a study that test developers use to determine the passing score or percentage for a test. This is because a passing score shouldn’t just be randomly set, you have to be able to prove or justify it with data. In this method, subject matter experts (SMEs) are asked to assign a probability of how many minimally qualified candidates would answer each test item correctly. 

The CSMLS uses a double modified Angoff method to determine the pass point for each exam. The double modified Angoff method uses demographically selected SMEs to discuss the issues involved in determining a pass mark and to evaluate the examination by using a well-defined and rational procedure. The purpose of this Angoff method is to determine the cut score (pass rate) required to identify a minimally competent laboratory professional for each CSMLS exam. SMEs examine the content of each test question (item) and then independently predict how many minimally competent candidates will answer the item correctly. During the Angoff method a minimally competent person is defined as someone who adequately performs all entry-level job functions safely and requires no further training to do so.

The SMEs then review each exam question as a group and consensus is reached for the rating of each question. Any question that is judged to be unclear, has more than one correct answer, or has no correct answers is eliminated from the scoring process for that exam. The average of the judges’ predictions for a question becomes that question’s predicted difficulty. Therefore, the easier the test, the higher the pass point. Likewise, the more difficult the test, the lower the pass point.

The final step is to calculate the average of all the question ratings. This becomes the overall pass point. This process is then repeated for that examination providing a more accurate score. The exams undergoing the double modified Angoff method have been reviewed and accepted by the examination panel prior to this process. Each certification exam pulls questions from a test item bank and each question varies in difficulty. Because a different mix of questions is used in each exam, the overall difficulty level is not fixed. It is important to ensure the varying difficulty level is reflected in the pass point of each exam so test results are reliable. Test reliability is concerned with the reproducibility of results for each examination.

In other words, for an exam to be reliable it must yield the same result (pass or fail) for the same individual under very similar circumstances. By taking into consideration the difficulty level of the test, the double modified Angoff method significantly increases the reliability of the exams. Also, since each exam is adjusted for difficulty level, each exam has the same standard for passing.

This means that all exam candidates are treated fairly even if they take their certification exam at a different exam session (or date).There is no bell curve in this process. Exam performance is rated to the exam, not to other exam candidates, so if 100 candidates meet the pass score, all 100 candidates are certified.

By using the Angoff method, the CSMLS ensures that the passing grade of a test is determined by a recognized method which is necessary for a test to be legally defensible and meet the Standards for Educational and Psychological Testing.

Indigenous Land Acknowledgement : We respectfully acknowledge the CSMLS office, located in Hamilton, Ontario, is situated upon the traditional territories of the Haudenosaunee Confederacy, the Mississauga Nation, Anishinaabe Peoples, and the Neutral Peoples. This land is covered by the Dish With One Spoon wampum, which is a treaty between the Haudenosaunee and Anishinaabe to share and care for the resources around the Great Lakes. We further acknowledge that this land is covered by the Between the Lakes Treaty No. 3, 1792, between the Crown and the Mississaugas of the Credit First Nation.


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