How to test your knowledge for the CCCPA or ASCP certification exams

Studying for the CCCPA or ASCP exam isn’t the same as studying for a university midterm. These exams don’t just check whether you memorized definitions – they test whether you can use your knowledge across multiple domains at the same time. If you walk into the exam only prepared for simple recall-style questions, you’re going to feel blindsided fast. Understanding how question difficulty actually works is one of the biggest advantages you can give yourself before writing.

The CCCPA and ASCP certification exams are designed to test your knowledge of general and systemic pathology, anatomy, autopsy and autopsy techniques, histology and histological techniques, as well as a variety of laboratory management domains.  

Most of the testing environments I experienced preceding these exams were similar to other exams I had written through undergraduate and my masters program – concepts and knowledge were tested in a fairly straightforward manner (e.g. what is… or define…).  But things change for your final certification exams – these are testing your knowledge in a foundational way that you may not have experienced before and the types of questions you will be asked are not always as straightforward as you expect or have experienced before.  If you don’t know what to expect and if you haven’t prepared for these types of questions it can be an unnerving experience which is exactly what you don’t want to be feeling while an expensive exam that can determine whether or not you receive certification.

Here is an example of the type of question you may have asked yourself while studying or may have received on an exam in school.  If the content of the question isn’t something you’ve gotten before that’s ok and that’s not the point.  The point is the question format or style.

Where is the sinoatrial (SA) node located in the heart?

1. At the apex of the left ventricle, near the interventricular septum
2. Along the lateral aspect of the junction between the superior caval vein and the right atrium
3. At the junction of the inferior vena cava and right atrium
4. In the interatrial septum near the atrioventricular node

Does this style look familiar? How comfortable are you with answering this type of question?  

(The correct answer is B by the way)

This is what I would qualify as an easy question by exam standards.  It’s straightforward and pulls knowledge from only one domain in a “what is/where is” type of format.  For a computer adaptive style exam (like the ASCP exam), easy questions like these are not going to be your bread and butter. Practice these occasionally or when you’re warming up for studying, but most of your questions will be of a medium or hard difficulty level.

Here’s another version of that same question at a slightly more complex difficulty level.

In a patient with sick sinus syndrome, careful histologic sampling at autopsy should include which of the following regions to evaluate potential nodal pathology?

1. The lateral aspect of the junction between the superior caval vein and the right atrium
2. The interatrial septum at the fossa ovalis
3. The apex of the right ventricle near the trabeculae carneae
4. The coronary sinus opening into the right atrium

This is what I would classify as a medium question. It tells you what kind of condition the patient has (sick sinus syndrome), but it requires you having some awareness of that condition to know what part of the patient’s anatomy that will be affected. From there, identifying the SA node is affected in this condition, you can apply anatomy knowledge to describe the location that needs to be sampled. 

So, if you can recognize that sick sinus syndrome is a disease which involves that node, then you can apply your knowledge of anatomy to answer the question correctly. 

(The correct answer is A, by the way)

You can expect a larger percentage of your questions to be in this format – you will be given a disease or pathology condition in part of the question, but then you have to apply that knowledge onto another domain (in this case, anatomy) to determine what areas to sample/what you should look at next.

Finally, another version of the question at a very complex level.

In an autopsy on a patient with a clinical history of slow, fast or irregular heartbeats and pauses, careful sampling at autopsy should include which of the following regions to evaluate potential pathology?

1. The apex of the right ventricle near the trabeculae carneae
2. The interatrial septum at the fossa ovalis
3. The lateral aspect of the junction between the superior caval vein and the right atrium
4. The coronary sinus opening into the right atrium

This is a hard question. The question gives you a clinical picture without specifically naming what the clinical syndrome or pathology is. In this case, the clinical history of slow, fast, or irregular heartbeats and pauses should direct you to recognize this as a disease of the sinoatrial node (additional complexity is generated in you needing to differentiate the sinoatrial node from the atrioventricular node functionality). From there, you then must apply that knowledge to anatomy to identify what area you should target for sampling.

(The correct answer is C, by the way)

Especially if you are writing the ASCP exam, you can expect a larger percentage of your questions to be in this format. Especially if you’ve answered many of the medium questions correctly. Because questions on that exam get more and more difficult with the more that you answer correctly, ideally you are being asked a larger number of questions in the medium or hard format.

Okay, let’s figure out how to apply this to testing yourself for studying. It is definitely still valuable to ask yourself those easy-style of questions. However, I wouldn’t spend the majority of my time here. It will form the foundation of your knowledge, but then you have to be able to expand on it. 

If I was to define what makes an easy, medium, and hard question, it would be something like this:

• The easy question will test direct recall of a simple fact (either anatomy or definition or simple mechanism)
• A medium question should require combining the fact with a named clinical condition, syndrome, or disease context. The question should explicitly state the disorder so you only need to connect it to the concept.
• Finally, the hard question should integrate multiple domains of knowledge – clinical signs and symptoms, pathology, and anatomy or physiology – without explicitly naming the disorder. You must infer the underlying condition and then apply the knowledge of the concept to the answer.

In previous questions about the sinoatrial node,

• The easy version of the question tested direct recall of a simple fact which was the anatomical location of the SA node in the heart.
• The medium-level question combined that fact with a named clinical condition/syndrome.
  • In this situation, I used sick sinus syndrome as the clinical condition that was related to the sinoatrial node which was then connected to the anatomical location of the node.
• The hard question integrated multiple domains of knowledge by describing clinical signs/symptoms of the underlying pathology. From that you had to infer that those were diseases of the sinoatrial node. From there you had to apply that knowledge of the concept to the anatomical location of the SA node.

When you’re first learning a new concept, easy-level questions are sufficient. But when focusing on reviewing or studying a specific concept, create questions for yourself that are at a medium or hard level or have others quiz you in this way. It takes a little bit more effort, but it will pay off when you go to finally write your certification exam(s).