Format of the Examination in Anatomical Pathology - 2023

Learn more about the format and procedures involving visual material (slides and microscopy) for the written exam.

About the Exam

Purpose

The purpose of the examination is to assess the candidate’s clinical competence and readiness to enter clinical practice. The exam is developed and reviewed by the Anatomical Pathology examination board, which is made up of practicing Canadian physicians who are recognized content experts. In addition, the exam is reviewed by a quality reviewer, a linguistic reviewer for translation accuracy, and a Royal College editor.

The content of the examination is based on a blueprint that reflects the Objectives of Training in Anatomical Pathology and the depth of knowledge required for the examination to ensure that the examination reflects relevant clinical practice in Anatomical Pathology. All candidates are strongly encouraged to read the blueprint and the Objectives of Training thoroughly.

Passing the Exam

The Royal College examination in Anatomical Pathology consists of a written and an applied component. The pass score is 70% for each component of the examination. To pass overall, you must pass both the written and applied components. If a candidate is unsuccessful on the examination as a whole, all components of the examination must be repeated within the period of candidate eligibility.

Questions that were overly difficult, poorly-discriminating, or for which new evidence emerged between the time of question writing and exam administration are reviewed. As a result of this review process, some questions may be deleted from the final exam score for all candidates. The exam scores are then reviewed psychometrically by a panel of subject matter experts in a standard setting process and adjusted, if appropriate, to ensure the exam is set at a proper standard for candidates entering unsupervised practice.

Overall Format of the Examination

The format of the examination is provided in the table below:

Component	Format	Topic	Number of Items	Total Test Time
Written	Paper 1: SAQ	Basic Science and Applied Knowledge of Pathology	~25-35	3 hours
Written	Paper 2: SAQ	Virtual Microscopy and Static Image Based Practical	~80-90	3 hours
Applied	Structured Oral		5 stations x 10 minutes each and 60 minutes candidate content review	2 hours

Written Examination

Objective of the Written Examination

The written examination measures knowledge and application of knowledge necessary to function as a competent specialist in Anatomical Pathology. Most questions will concentrate on the Medical Expert role, but some can also assess the other intrinsic CanMEDS roles (Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

Content of the Written Examination

The content of the examination is based on a blueprint that reflects the Objectives of Training in Anatomical Pathology. The content is balanced to ensure an appropriate representation of the relevant domains. Paper 1 will cover basic science and applied knowledge of pathology. Paper 2 will be an assessment of diagnostic ability based on review of digitized histologic slides and static images. Typical areas of knowledge assessment and a range of percent marks on the written examination are included in the tables below.

Table 1: Paper 1 Blueprint

Classification	% Marks*
1. Basic Science of Pathology/General Pathobiology	5 – 15
2. Laboratory Management	0 – 5
3. Laboratory Quality	5 – 10
4. Laboratory Professionalism	0 – 5
5. Laboratory Techniques	0 – 5
6. Pediatrics	0 – 5
7. Autopsy	0 – 5
8. Multi-organ Syndrome	0 – 5
9. Forensics	0 – 5
10. Cytology	0 – 5
11. Head and Neck	5 – 15
12. Gastrointestinal	5 – 15
13. Hepatobiliary - Pancreas	0 – 5
14. Female Genital	5 – 15
15. Male Genital	5 – 15
16. Urinary	5 – 15
17. Lung-Pleura-Thorax	5 – 15
18. Cardiovascular	5 – 15
19. Lymph Node - Hem. Path.	5 – 15
20. Endocrine	5 – 15
21. Nervous System	5 – 15
22. Soft Tissue - Bone	0 – 5
23. Breast	5 – 15
24. Skin	0 – 5
25. Intra-operative Consultation Skills and Handling of Gross Specimens	0 – 5

Table 2: Paper 2 Blueprint

Classification	% Marks*
Histopathology	45 – 50
Cytopathology	15 – 20
Forensic Pathology	15 – 20
Gross Pathology	15 – 20

*The ranges are approximate and may vary slightly

All questions may have associated visual material.

Scoring of the Written Examination

Each short-answer question is created with a list of model answers. This list is used to guide the markers as to the value of the responses when scoring the question. Partial marks may be allocated for some responses. Members of the Examination Board score short-answer questions, and discuss with their colleagues to ensure any correct responses outside of the anticipated model answers are given appropriate marks. If a candidate provides more responses than requested, only the first responses corresponding to the number of answers required will be considered in marking.

Sample Questions from the Written Examination

SAMPLE SAQ EXAM

Applied Examination

Objective of the Applied Examination

The applied examination is designed to evaluate higher order thought processes and clinical reasoning compared to knowledge and application of knowledge assessed in the written component. Stations can assess different and multiple CanMEDS roles (Medical expert, Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

Candidates will be given one hour to review five digitized slides. The next hour of the examination will be spent rotating through five 10-minute stations with examiners. The slides will not be available during this part of the examination so the candidate is encouraged to keep notes on each case as it is reviewed and think about their approach to the case.

Examiners may interrupt the candidate to probe for answers, as well as to move the station forward so that the candidate is able to demonstrate their knowledge/clinical reasoning in the allotted time. Examiners may take notes during the stations and have been instructed to appear ‘neutral’ in their reaction to answers. They have been instructed not to provide feedback directly to the candidates. Observers may be present during some stations of the examination. These observers will not interact with the candidate or the examiners, or contribute to the candidate’s scores in the station. They are there to observe the conduct of the examination process.

The format of the applied exam allows candidates to be examined by multiple examiners across a number of stations. For this reason, you may be examined by an examiner from your center. Significant conflicts (e.g. a program director or mentor) are identified and avoided in scheduling your examination.

Content of the Applied Examination

Clinical Presentation of Disease
Diagnoses and Differential Diagnoses
Diagnostic Approaches (Data Acquisition & Interpretation, Interpretation, Clinical and Laboratory Investigations, etc.)
Clinical Reasoning and Judgement (Synthesis/Integration of data)
Quality Assurance and Patient Safety
Intrinsic CanMEDs roles
Others

Some of the issues that you may encounter in the exam include:

Managing complex cases with difficult or unclear diagnoses
Correcting and investigating errors in laboratory diagnosis
Understanding the importance of appropriate clinical-pathologic correlation
Implementing quality assurance and patient safety
Critical appraisal
Communicating clearly with other physicians regarding urgent and uncertain diagnoses
Structured oral encounters
Short verbal questions
How to come to a diagnosis
Technical aspects of care
Ethical issues
Utilize diagnostic imaging studies, laboratory investigations or results of other tests
Demonstrate decision-making skills based on the case scenario and the interpretation of data
Provide a diagnosis and differential diagnosis
Demonstrate competency in communication with health team members
Others

Scoring of the Applied Examination

A global rating scale (GRS) will be used to assess relevant aspects of care demonstrated during the station. The GRS will be suited to the station and will focus on the candidate’s ability to systematically work through a case, with a focused, rational and efficient approach.

The domains measured in the stations may vary, but most commonly include a selection from the following:

Data Acquisition
Data Interpretation
Clinical Reasoning/Judgement (Synthesis/Integration of data)
Diagnosis
Differential Diagnosis
Knowledge
Investigations
Quality Assurance and Patient Safety
Organization, Logic and Flow
Evidence Based Decision Making (Scholarly Knowledge)
Intrinsic CanMEDs roles

To see the generic behavioural anchors for these domains, please see the GRS template. Note that the behavioural anchors for your specialty may vary somewhat from these.

Each station is weighted equally; station scores are combined and averaged to create an overall score for the applied examination.

Additional Information

To access examination dates, view Deadlines, dates and locations.

To access information on online exams, how exams are developed, exam format, pass rates, and tips on how to study for the exam, view Prepare for exams.

To access information on what to expect on exam day: FAQs, identification requirements, conflicts of interest, candidate conduct, Clinical Laboratory Values, and more, view Exam day.

To access information on results dates, how to access your results, data verification, and more, view Results.

Terminology used in the Examination

All candidates should be aware that regional differences in terminology may not be reflected in the exam. The terminology used in the exam has been vetted by the Royal College’s team of language professionals in close collaboration with a linguistic reviewer, who is a physician. It reflects standard terminology appropriate for your specialty.

Royal College exams routinely include abbreviation and acronym definitions. However, abbreviations and acronyms that are common knowledge to clinicians are not spelled out (e.g. MRI, CT, ECG, IV, BMI, HIV, CBC, etc.). The same practice applies for clinical trial names, with exceptions for when candidates are being asked to define or explain the trials themselves.

Below is a table that includes explanations of specific terms used in exam questions.

MOST likely	refers to the response most likely for that clinical scenario
INITIAL	refers to the first step you would take in that specific clinical scenario
NEXT	refers to the next step you would take in that specific clinical scenario
ASSESSMENT	refers to the assessment for that scenario, which would include history, findings on the slide, pertinent negative and positive findings
INVESTIGATIONS	refers to all investigations for that differential diagnosis, including immunohistochemistry, other clinical information, molecular studies etc.
MANAGEMENT	refers to the steps you would take in the assessment, investigations, and/or treatment for that specific scenario

Reference and Study Materials

For sources with multiple editions, please refer to the most recent edition. In the event that a textbook or guideline has been published in the last 12 months, answers will also be accepted from the previous edition of the textbook.

The Royal College exams follow the Canadian and/or American “standard of care” for clinical practice, and clinical practice guidelines published in Canada and the United States. In the absence of Canadian or American guidelines and when relevant, candidates may reference guidelines from other international organizations.

Study materials include, but are not limited to:

Sample textbooks

Robbins & Cotran Pathologic Basis of Disease
Rosai and Ackerman’s Surgical Pathology
Mills and Sternberg’s Diagnostic Surgical Pathology
Cytology: Diagnostic Principles and Clinical Correlates
Gross Pathology Handbook: A Guide to Descriptive Terms
Manual of Surgical Pathology
Diagnostic Pathology: Intraoperative Consultation
Forensic Pathology
WHO Classification of Tumours
Laboratory Management: Principles and Practices
Quality Management in Anatomic Pathology: Strategies for Assessment, Improvement, and Assurance

Sample Journals

Journal of Clinical Pathology
American Journal of Surgical Pathology
Histopathology
Archives of Pathology and Laboratory Medicine

Sample Guidelines

CAP (College of American Pathologists) synoptic reporting templates
Canadian Association of Pathologists clinical practice guidelines

Questions?

To ensure fairness to all candidates, all of the information that can be shared about the format of the examination is available in this document. If you require clarification on the content of this document, please contact credentials@royalcollege.ca.

Updated November, 2022