ACJ Exam Guide 2026: Complete Guide to the Assessment of Clinical Judgement
- Scholars Dental
- 4 days ago
- 4 min read
Updated: 2 hours ago
The Assessment of Clinical Judgement (ACJ) is the second examination in the NDEB Equivalency Process for internationally trained dentists seeking licensure in Canada. It evaluates how candidates interpret diagnostic information and apply knowledge to clinical decision making rather than testing recall alone.
What the ACJ Exam Assesses
The ACJ is designed to assess three core areas:
• Formulating a diagnosis
• Making clinical decisions and treatment plans
• Knowledge in oral radiology, including radiographic interpretation and diagnosis
Candidates are evaluated on their ability to interpret information from written case histories, charts, and images, then select the most appropriate clinical judgement in response.
Exam Structure and Format
The ACJ is a computer‑based examination administered at Prometric test centres. It is a 5.5‑hour exam with one scheduled break and typically consists of 120–150 single‑answer and multi‑answer multiple‑choice questions.
Questions are presented in two formats:
Single‑answer multiple‑choice questions (one best answer)
Multi‑answer multiple‑choice questions (more than one correct answer)
All questions must be completed within the allotted time for the single examination session.
Question Types
Single‑answer questions require candidates to choose the single best option from the list provided. These are straightforward multiple‑choice questions where one answer key is correct.
Multi‑answer questions require candidates to select all correct options. These questions test more detailed judgement, and each correct and incorrect selection influences the final score for that question based on the scoring rules described in the ACJ Protocol.
The Scoring
The ACJ uses a test‑equating and re‑scaling process to ensure consistency in scoring across different exam administrations.
Key points include:
Raw scores are converted to a test‑equated, re‑scaled score.
A standardized passing score of 75 is applied to all NDEB examinations.
A test‑equated, re‑scaled score of 75 or greater is reported as a Pass; scores below 75 are reported as a Fail.
Candidates who fail receive their numerical test‑equated, re‑scaled score, but no further breakdown of results is provided.
The NDEB may also remove questions from scoring if statistical analysis shows that they did not perform as expected, which is part of the quality‑control process.
Case‑Based Nature of the Exam
All ACJ questions are presented within clinical contexts rather than as isolated facts. Candidates may be given:
Patient case histories
Dental charts and periodontal charts
Radiographic images
Intraoral and extraoral clinical photographs
Each question focuses on diagnosis, treatment planning, clinical decision making, or radiographic interpretation based on the information provided in the case. The correct response depends on how accurately the candidate evaluates and integrates the data in each scenario.
Exam Blueprint and Subject Weighting
The ACJ follows a defined examination blueprint published in the ACJ Protocol, which outlines content areas and their approximate percentage of questions. The blueprint typically includes disciplines such as:
• Periodontics
• Endodontics
• Cariology and restorative dentistry
• Oral pathology and oral medicine
• Radiology and radiographic interpretation
Each category is assigned an approximate proportion of questions, and together these components add up to 100% of the exam. Candidates should review the current ACJ Protocol for the most up-to-date blueprint before planning their preparation.
Eligibility and Exam Timing
Candidates become eligible to take the ACJ after successfully passing the Assessment of Fundamental Knowledge (AFK) as part of the NDEB Equivalency Process.
The ACJ is offered on specific dates published on the NDEB website and in the NDEB exam The next available ACJ sitting is scheduled for November 9, 2026, with a registration deadline of October 7, 2026 at 21:00 ET and registration opening on June 9, 2026 at 10:00 ET. Candidates should always confirm current dates, registration periods, and deadlines through their NDEB online profile and the official exam calendar at NDEB website.
Results are reported as Pass or Fail with a test‑equated, re‑scaled score and are typically released after the NDEB completes scoring and quality‑control procedures, as described in the scoring and equating resources.
The Structure Behind ACJ Questions
ACJ questions are developed and maintained through a structured process overseen by the NDEB. Exam items are written and reviewed to reflect current Canadian standards of general dental practice, and examination questions are updated on a regular basis as new knowledge becomes available.
After each administration, detailed statistical analyses are performed to evaluate question performance and to support the test‑equating process. This helps ensure that each version of the ACJ maintains a consistent difficulty level and that scores remain comparable across different sittings.
Passing Score and Standard Setting
The passing score on the ACJ is based on the performance expected of a minimally competent candidate, determined through a psychometric standard‑setting process.
The key elements are:
Standard setting is used to define the level of performance required for a Pass.
Test equating and re‑scaling align raw scores to a reference examination.
A standardized passing score of 75 is maintained across all NDEB examinations.
This process does not lower the level of ability required; instead, it ensures that candidates face a consistent standard over time.
How to prepare for the ACJ exam in Canada?
Because of its case-based design, preparation for the ACJ is different from studying for primarily knowledge-based exams. Candidates should focus on:
• Interpreting clinical information from charts, radiographs, and photographs
• Formulating clear diagnoses and safe treatment plans
• Applying radiographic interpretation skills to a variety of scenarios
• Working efficiently in a timed, single-sitting format
It is important to review the current ACJ Protocol, released questions, and the ACJ Question and Answer Framework available through NDEB resources to understand question styles and content distribution
FAQ
How long is the ACJ exam, and how many questions are there?
The ACJ is a 5.5‑hour computer‑based examination with one scheduled break and consists of 120–150 single‑answer and multi‑answer multiple‑choice questions
What is a passing score for the ACJ exam?
Results are reported as a test‑equated, re‑scaled score, and a standardized score of 75 or higher is required to pass the ACJ exam; scores below 75 are reported as a Fail.
Who is eligible to take the ACJ exam?
You become eligible to take the ACJ after passing the Assessment of Fundamental Knowledge (AFK) and meeting NDEB requirements in the Equivalency Process, then registering for the ACJ through your NDEB online profile.
What topics are covered in the ACJ exam blueprint?
The ACJ blueprint includes areas such as periodontics, endodontics, cariology and restorative dentistry, oral pathology and oral medicine, and radiology, each with an approximate percentage of questions detailed in the official ACJ Protocol.
How often is the ACJ exam offered?
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