Your journey as an ITD in Canada will involve the Assessment of Clinical Judgment (ACJ) exam. This is a 5 ½ hour-long examination with only a short 30-minute break. It takes a deeper look at your clinical judgment, including testing how you diagnose, treat, and make decisions about your future patients.
As you can imagine, this is a fundamental step to prove to the national dental examining board that you have the skills and knowledge required to become a fully qualified dentist capable of serving Canada. Before you can take the ACJ exam, you must have already taken and passed the Assessment of Fundamental Knowledge (AFK). A passing scaled score is a 75 or more. The entire test has around 120-150 single-answer multiple-choice questions, and you can sign up by logging into your NDEB profile to register and pay the fee.
General Tips to Pass the NDEB Canada ACJ Exams
Let’s start by saying the ACJ is not nearly as scary as some may say. Studying for this exam is different compared to the AFK because this is less about memorization and more about critical thinking and problem-solving. The entire exam is divided into cases and x-rays. This is information you would typically learn over time in a dental degree program and may require you to revisit some older texts to refresh your memory.
The goal is to assess how well you approach each case. The national dental examining board wants to ensure that you have the proper approach for orthodontic, pathology, endodontic and other cases.
For example, let’s say you have a Pathology case involving an ulcer in the mouth. You should be able to question the patient's medical history to see if they have a previous autoimmune disease or related issue. Another would be to determine if a patient was exposed to a chemical due to their career and if you are trying to uncover their medical history. The goal is to show you understand how to discover those diagnostic details that will create a quality outcome for the patient.
You should expect a lot of questions about smoking. Everyone from ITDs immigrating to Canada to those students entering their first year should have a solid understanding of the effects of smoking. Knowing how to clarify your patient smokes 10 packs a day compared to 10 individual cigs will drastically affect how you should plan treatment for them.
1 - Take Advantage of Practice Questions
If you are a member of a prep school, then you will be exposed to the different styles of questions on the NDEB Canada ACJ exam. Otherwise, you should try the practice exams as much as possible. There will be tricks and examples designed to throw you off your game. You have to remember that you are being tested for your problem-solving capabilities and not just memorization of facts.
Dedicate a space and time every single day to studying for your exam. You want to make your practice habits a ritual that prepares your mind for the task at hand. This way, your brain will recognize what you are doing when sitting for the exam and make you more relaxed as you answer questions because it will feel familiar.
2 - Study X-Rays/radiographs in Detail
Use any resource possible to study up on x-ray film. A good portion of the Canada NDEB ACJ exam relates to how you interpret film from different patients. You will need to be able to diagnose what is happening and propose a treatment plan aligned with the radiographs and medical and dental history of the patient
3 - Think About the Big Picture
The ACJ exam focuses on patient care and treatment. It requires problem-solving and critical thinking. Read each question on the exam slowly to yourself, so you take in every piece of information possible. There are trick questions designed to send you in one direction toward a diagnosis when in reality, you need to pivot to a different outcome. The only way to catch these tricks is to slow down and focus on the big picture of patient care.
4 - Lean into Your Weaknesses
There are multiple topics like pathology, periodontology, endodontics, radiology, anesthesiology, etc. Every ITD will have a strength in specific areas and probably a weakness or two in others. That requires you to budget your study time, so you focus a bit more on the areas you need more help. Once you are confident you have a topic under your belt, move that to a “quick review” focus and double your efforts on weaker topics.
5 - Seek Out Resources
The beauty of the internet is that there is so much free information readily available for your review. From YouTube to Reddit boards to social media, there are endless resources that will help you gain insight into what to expect on the ACJ exam.
ACJ Exam Advice from Dr. Luca Salvador
Dr. Luca is the founder and President of the Internationally Trained Dentist’s Association of Canada. He was awarded his Doctor of Dental Surgery from Poznan University of Medical Sciences in 2018 and was happy to contribute some advice of his own about the ACJ exam.
Start by taking the time to prepare for this exam, but do not overthink the questions when you get to the testing day. Trust your judgment and be confident. People score lower because they overthink and do not rely on their training and knowledge. This is all about stress management and overcoming mental barriers so you can access the information required, offer a solid diagnosis, and then move on to the next question.
Take care of yourself as you prepare for this exam. Be sure to exercise, eat well, meditate, and do anything else that lowers your stress and improves your mental capacity.
We highly recommend reading our article on improving your memory and concentration as there are excellent tips in there for exam prep.
You may also want to reduce caffeine intake on exam day so you can remain calm as you move from question to question.
As long as you work through cases and radiographs/images available online or reference textbooks consistently, you should do well. You should start about 3 months out from the exam date and be sure to balance your study with your regular life. A prep course will help because they condense the information you need to learn for the exam instead of trying to cover so many textbooks on your own. At the end of the day, it is all about finding what works best for you, so you stay cool and collected during the ACJ exam.
ACJ Exam Advice from Dr. Zeina Naous
She is an ITD that scored exceptionally well on the ACJ and offered a unique insight into what worked best for her study methods and habits leading up to the big day. Her most significant point was to remember that the ACJ is not purely memorization. It is problem-solving and considering the whole patient care plan. That is why she suggests reading a lot of cases, so you get used to the style of questions and medical treatment in Canada.
Zeina also talked about using elimination as a crucial tool in the ACJ exam. Going through each answer and removing those answers you know cannot be possible because they do not fit the scenario is an excellent way to start. From there, your goal is to get as close to a proper diagnosis as possible. This is especially helpful for the X-ray questions.
You may want to create a booklet that summarizes different chapters or examples of specific medical cases related to standard x-rays. Unlike case-based questions, x-rays are about what you do or do not see. Therefore, you need to learn how to identify the pathology that appears in the radiographs.
The biggest thing to be aware of during the ACJ is that you are answering questions from the “Canadian point of view.” For many ITDs, this will be a different way of thinking because it involves a modern diagnostic method. In that regard, you need to read each question as carefully as possible to ensure you understand the full breadth of the topic.
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What Comes After the ACJ Exam?
Once you have successfully passed the ACJ exam, it is time to move on to the NDECC. First, congratulate yourself as you are halfway through the exams involved in the NDEB. That by itself is quite the achievement.
The NDECC is a new exam that replaced the previous ACS. It is known as the National Dental Examination of Clinical Competence. As you can tell from the title, this is a fairly important exam that will evaluate your judgment through a series of clinical situations.
This exam began in 2022 and is a two-day process where you will perform seven clinical requirements on simulated patients under 10 situational judgment requirements. You can register for this exam once you have completed the ACJ through the NDEB website.
Wrapping it Up
From all of us at Beautiful Smiles & Teeth, we wish you the best of luck in this exam. If you have made it this far, we believe you can power through to a successful practice in Canada. We want to extend a special thank you to Dr. Zeina Naous and Dr. Luca Salvador for their excellent insight into this article.
We know there is a lot of information to digest for this process and want to reassure you that the best course of action is to study, prepare mentally, create a space for your practice, and maintain a well-balanced lifestyle, so you are healthy and mentally capable of success. With a bit of preparation, you can move one step closer to your dream of being a dentist in the great country of Canada. Trust your instincts. You’ve got this!
About the Author
Karen Nunez was born in Valenzuela, Philippines. She received her Doctor of Dental Medicine degree from Centro Escolar University in Manila.
Karen currently is a practicing oral health care professional based in Alberta, Canada; and runs a website where she writes a slew of articles to empower internationally trained dentists to integrate into Canadian dentistry.
Read more of her blogs here.