Format of the Examination in General 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 General 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 General Pathology and the depth of knowledge required for the examination to ensure that the examination reflects relevant clinical practice in General Pathology. All candidates are strongly encouraged to read the blueprint and the Objectives of Training thoroughly.

Passing the Exam

The Royal College examination in General Pathology consists of a written and an applied component. The pass score on each component is 70%. To pass overall, you must pass both 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:

Written Examination

Objective of the Written Examination

The written examination measures knowledge and application of knowledge necessary to function as a competent specialist in General 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 General Pathology. The content is balanced to ensure an appropriate representation of the relevant domains. Typical areas of knowledge assessment and a range of percent marks on the examination are included in the table below.

Table 1: Paper 1 Blueprint

Table 2: Paper 2 Blueprint

*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.

All written examinations are combined to create one overall written score. In other words, you need a combined written score of 70% to pass the written component, but you do not need 70% on each paper.

Sample Questions from the Written Examination

[ SAMPLE SAQ QUESTIONS ]

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).

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

The content of the examination is based on a blueprint that reflects the Objectives of Training in General Pathology. The content is balanced to ensure an appropriate representation of the relevant domains. The applied examination may include stations that cover:

• Histopathology
• Forensic Pathology
• Cytopathology
• Medical Microbiology
• Medical Biochemistry
• Hematological Pathology

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

• Telephone consultation with technical and medical staff related to laboratory tests
• Visual recognition (laboratory reports, illustrations, scans)
• Critical appraisal of a laboratory test result with its specificity and sensitivity.
• How to come to a diagnosis through utilization of additional testing.
• Application of knowledge related to laboratory safety
• Laboratory management and adequate decision making in various scenarios.
• Ethical issues related to laboratory testing.
• Demonstrate adequate knowledge and skills required to perform duties as Director of Blood Transfusion Services at a regional hospital.
• How to guide technical staff through issues in a particular situation
• A written clinical vignette (with or without images) followed by questions from the examiner including, but not limited to, discussions on diagnostic testing, differential diagnosis, limitations, and advantages additional tests and/or natural course of disease.
• Demonstrate decision-making skills based on the case scenario and the interpretation of data
• 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 – Clinical, imaging and laboratory
• Data Interpretation
• Clinical Reasoning/Judgement (Synthesis/Integration of data)
• Diagnosis and Differential Diagnosis
• Knowledge
• Investigations
• Patient Safety
• Organization, Logic and Flow
• Evidence Based Decision Making (Scholarly Knowledge)
• Intrinsic CanMEDs roles – Collaborator
• Intrinsic CanMEDs roles – Health Advocate
• Intrinsic CanMEDs roles – Leader
• Intrinsic CanMEDs roles – Professionalism
• Intrinsic CanMEDs roles – Communication – e.g. clarity of expression, rapport building and / or information delivery / counseling skills

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.

Sample Station from the Applied Examination

[ SAMPLE STATION ]

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.

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.

Canadian/North American Guidelines are the primary reference for Royal College exams. Where those don’t exist, candidates may reference guidelines from other recognized international organizations, if relevant.

Study materials include, but are not limited to:

Sample textbooks

• Goldblum J et al. Rosai and Ackerman’s Surgical Pathology. 11^th ed.
• Mills SE et al. Sternberg’s Diagnostic Surgical Pathology. 6^th ed.
• Kjeldsberg CR. Perkins SL. Practical Diagnosis of Hematologic Disorders. 5^th ed.
• Burtis CA. Bruns DE. Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. 7^th ed.
• Mahon CR. Lehman DC. Textbook of Diagnostic Microbiology. 6^th ed.
• Swerdlow SH et al. WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Revised 4^th ed.
• Rifai N. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6^th ed.

Sample Journals

• American Journal of Clinical Pathology
• The American Journal of Surgical Pathology
• Clinical Biochemistry

Sample Guidelines

• Diabetes Canada Clinical Practice Guidelines, http://guidelines.diabetes.ca/cpg
• 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Canadian Cardiovascular society guidelines. CJC 2021. 37 (8): 1129-1150.

Other Resources

• Pathology Outlines, https://www.pathologyoutlines.com/
• Medscape, https://emedicine.medscape.com/

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