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Format of the Comprehensive Objective Examination in Anatomical Pathology

Comprehensive objective examinations make it possible to obtain a more complete evaluation of the candidate’s strengths and weaknesses. Such examinations are considered as a “whole”. A candidate does not need to pass any one component. Success or failure is based on consideration of performance on ALL components of the examination. Therefore, if a candidate is unsuccessful on the whole, all components of the examination must be repeated within the period of candidate eligibility.

The comprehensive objective examination in Anatomical Pathology includes a written component, a practical component and an oral component. The examination assesses the candidate’s abilities to function as a consultant anatomical pathologist across the CanMEDS domains of Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional.

  1. Written Component

    The written component consists of one 3-hour paper containing 28 short answer questions (SAQ). Each SAQ normally has multiple parts.

    The subjects covered in this examination will include, but are not limited to, basic pathophysiology of disease (basic science), gross pathology, principles of surgical pathology, forensic pathology (autopsy), cytopathology, molecular pathology, special techniques and laboratory management.

    Questions may cover all competencies as described in the Objectives of Training in the Specialty of Anatomical Pathology.

    Study materials should include, but are not limited to, standard textbooks of basic pathology, diagnostic surgical pathology, forensic pathology, and cytopathology.


  2. Practical Component

    There are 2 parts to the practical component. The first part is the histopathology section during which candidates will review 48 whole-slide digital images. The images may include large tissue sections, small biopsy specimens, and special stains. Candidates will view the images using ImageScope viewing software. For each image, the patient’s age and sex will be provided; the site from which the tissue was taken will also be provided when required or useful to make the diagnosis. Other pertinent history may be provided in select cases. Candidates will be asked to state the most specific diagnosis for each image. The diagnosis can be made based on the image alone; additional information beyond that which is provided will not be required to make a diagnosis. If candidates provide more than one diagnosis, only the first diagnosis will be marked.

    The histopathology section will be set up in an OSCE style format. Aperio scanned images will be loaded onto a computer (6 images per computer), with each computer constituting a station. There will be 8 stations (for a total of 48 images), each with a dedicated series of images: 1-6, 7-12, 13-18, 19-24 etc. Candidates will not all start on the same series of images. Candidates will have 12 minutes at each station to access and review the 6 images. There will be a short break following completion of each station, allowing time to reset each computer for the next candidate and direct candidates to the next station. Candidates will rotate through each of the 8 stations to view all of the images. Once an individual station is completed, the candidate will not be able to revisit the station. Each candidate will be provided a single answer booklet to accompany the candidate throughout the histopathology exam.

    The second part of the practical component consists of the cytopathology, gross pathology, and forensic pathology sections; the total time allotment for the 3 sections is 1½ hours. Each section will include 20 cases represented by images displayed in a PowerPoint slide presentation. Each candidate will have a computer and monitor to review the presentation. The 3 sections may be completed in any order and in any amount of time, provided that all 3 sections are completed within the 1½-hour period. There will be 1 or 2 images per case. Candidates will be asked to provide the most likely diagnosis, describe an observation based on the image, and/or answer a specific question related to the case.

  3. Oral Component

    Candidates will have approximately 50 minutes to review 5 cases. Candidates will review digital images associated with these cases on a computer using ImageScope viewing software. One of the 5 cases may be a cytopathology case. Cytopathology cases may be represented by 2 digital slides, a conventional smear and a liquid-based slide, both of which will show the same diagnostic features. Candidates may choose to look at either one and do not need to review both images. A brief history for each case (including age, sex and site) will be provided. Candidates will also receive a booklet in which they may take notes while they are reviewing the digital slides. Candidates are encouraged to take notes during this approximate 50 minute review period, and to think about possible questions that may be asked. This booklet must be handed in after the digital slides have been reviewed, but the notes will not be seen by the examiners.

    A diagnosis for these cases may not necessarily be made by looking at the digital slides alone. Some cases may require the candidate to obtain additional history or clinical information that is not initially provided. Other cases may require the candidate to order or interpret ancillary studies. Topics such as history, clinical information and other diagnostic tests, including ancillary studies, may form the basis for supplementary questioning by examiners. In addition, candidates’ knowledge of the non-Medical Expert CanMEDS Roles is usually assessed in this portion of the examination.

    After the approximate 50 minute digital slide review period, candidates will be shown to a room for the actual oral examination. Each candidate will be assessed by a team of 2 examiners. This part of the examination will last approximately 50 minutes. The examiners will go through each case and will ask questions according to a script. During the questioning, candidates may take notes on new information provided during the discussion. Candidates may ask to skip a question and come back to it later, or ask examiners to clarify a question.

    Examiners are expected to appear neutral in their reactions to candidate answers, and are instructed not to provide positive or negative feedback on answers. Examiners will not be aware of candidates’ performance on any other part of the examination.

    All efforts are made to prevent potential conflicts of interest arising from previous candidate-examiner interactions. However, it is possible that a candidate may encounter an examiner with whom there has been a previous interaction. This is permissible given the multiple testing points involved in this condensed examination.

    Examiners will take notes on their standardized scoring sheets during the examination. They may refer to their watches or interrupt the candidate at times; however, this will not be reflected in the candidate’s assessment, and is simply an attempt by the examiners to ensure that the candidate has an opportunity to cover all of the material in the time available.

    Candidates may encounter other candidates in the corridor during room changes or in the waiting-room area. It is imperative that there be no communication between candidates during the oral examination process. Communication between candidates may be construed to be irregular behaviour, and may result in an invalid examination or potential denial of entry to future examinations.

    An approved observer may be present in the examination room during the oral examination. The observer will not interact with the candidate or the examiners; the sole purpose of the observer is to observe the 2 examiners and to ensure fairness of the examination process.

    When the examination is over, candidates will be asked to fill out a post-examination survey. After candidates have collected their belongings, they will be informed when they may leave the examination centre.

    Note that examiners will not provide feedback on performance during the examination; examination results will be available only via the Royal College website. Examiners should not be asked to provide examination results; the discussions of the Examination Board are strictly confidential.

Revised August 2017