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

The questions on the CSMLS exams are in multiple-choice format. Both Diagnostic Cytology and Clinical Genetics exams include questions linked to images.Clinical Genetics includes both cytogenetic and molecular genetic images for analysis.  

Multiple-Choice Question Format

  • ONE answer is acceptable – choose the BEST
  • 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

How long is the exam?

  Effective June 2019 and beyond

MLT Exam Diagnostic Cytotechnology Exam Clinical Genetics Technology Exam MLA Exam
3.5 hours 3.5 hours 3.5 hours 2.5 hours
  *Includes up to 60 images with the multiple choice questions *Includes cases with related images and karyotype images for labelling

Exam Development And Validation

The Professional Standards Council chooses certified subject matter experts from across Canada to form exam panels. These panels are responsible for the development of exams, exam plans (the blueprint) and new questions.They also validate exams to ensure that they are fair and that they assess the skills they are supposed to. New questions are included in examinations and assigned a mark of zero for statistical validation in the technologist examinations. The exam may contain up to an additional 20% of new test items.

Exam Scoring/Results

Every exam has a “pass mark”, which is the total percentage score you must reach to pass. Anyone who achieves this mark passes the exam, and 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 difficulty of that particular exam. 

After each exam, exam material is shipped back to the CSMLS office from across the country. Each exam package is opened and checked to ensure that all documents have been returned and the security agreement has been signed. Once each exam is accounted for, the scoring process can begin.

Computer answer sheets (also called bubble sheets) are electronically scanned. Numerous quality control measures are taken throughout this process, and each exam question is statistically analyzed. When all the steps in the process are complete, examination results are generated and they are packaged for mailing. Results are mailed out to all exam candidates at the same time with a document indicating if they have passed or failed the certification exam.

This process can take up to 45 days to complete.

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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