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  • Writer's pictureRahul Monga

"Unlocking ACJ Excellence: A Guide to Assessment Of Clinical Judgement Success"

Updated: Oct 2, 2023

It was August 2015. I would never forget that hot summer day at 'Rona', the contractor store, where I drove a forklift to earn living. Most of my earnings were used up to pay for the fees to write NDEB Equivalency examinations.


I have just finished half of my day's work, and proceeded to the lunch room to refresh myself with the meal my wife has packed for me. Some days we were so exhausted, we never get a chance to check our phones. After a 12 hour shift, some days I return with 95% phone charge still remaining. That day I took my phone out, and saw an email from National Dental Examining Board Of Canada, saying that results have been out. I shakingly opened my profile, and was elated to find that I have passed.



ACJ: Assesment Of Clinical Judgement
ACJ Delivery Format Has Substantially Changed


The examination process went through an overhaul since 2015. I remember we had to make diagnosis based on the x-ray images from a paper based question format. The benefits of computer display, like brightness, contrast, resolution were nonetheless available. Everything was dependent on your visual acuity, intuition when it came to assessing radiographs. But now, things have become much easier. In this article, I will show you how you can prepare and be successful for Assessment Of Clinical Judgement Exam.


What is ACJ?


The ACJ is a 5.5 hour examination with one scheduled 30 minute break. The ACJ consists of 120-150 single-answer and multi-answer multiple-choice type questions. Each section of the ACJ will contain case-based diagnosis, treatment planning and clinical decision-making questions, and radiographic interpretation questions.


Case-based diagnosis, treatment planning and clinical decision-making questions evaluate your ability to formulate a diagnosis and to make clinical decisions. Case histories, dental charts, radiographic images, and photographs may be provided.


Reasons Why You Can Pass ACJ:



1. You Have Practiced A Number Of Questions: Practice makes better & not 'perfect'. Let's not fall into the world of 'perfect'. All you need to pass ACJ is to understand the concepts of clinical dentistry. Perfectionism stays unattained. If you are reading this, means you already are oriented with the exam, or exploring further. Both ways, you have accepted that you will do what it takes to be successful. When you practice numerous questions, including radiology and case studies, you will find yourself repeatedly referencing the similar or same material.


In the amygdala of your brain, you are now 'laser focused'. Your subconscious has now been imprinted with information you need to be successful. Don't believe me? Read " You Are The Placebo" by Dr. Joe Dispenza.



2. You Understand How Case Studies Are Framed: Exceedingly large number of choices confuses the human brain. This is where mental resilience is tested along with academic understanding. Dental Boards such as National Dental Examining Board Of Canada capitalizes on this limitation.


I would say that choosing from multiple options is not a new concept. Consider your 'Netflix' account, or cable television. We spend more time scrolling than watching. Or consider choosing food from a multi-cuisine menu. You want to satisfy hunger as well as want to eat healthy. Decision comes, but it requires time and energy.


Let's talk about ACJ exam. When more than 10 choices are given in a case scenario, divide all options into 3 categories as follows:

- Beneficial

- Neutral

- Harmful


If you can't decide upon an option, may be write 'unsure' against it to tackle it later. Now, let your subconscious understanding that you have achieved through training, take charge of the situation. At the back of your mind, you know what options are beneficial, and options that are harmful to the patient. Now, choose the ones relevant to the question. This is one of the ways you can start preparing for case studies and start training your mind.


3. You Understand Examiner's Perspective: If someone have to manage hypertension it requires regular blood pressure monitoring and doctor visits. This is where one start to understand themselves better. Social habits, physical activity, stress level etc.


Here, I suggest you take an inventory of your academic deficiencies. Make a list of ACJ topics that you hate the most. If you do that, you will automatically have a list of topics, that Examiners love the most. They know that this is where you could be challenged to the core.


Some example topics are:

- Antibiotics used in odontogenic infections

- Analgesics Contraindications

- Case scenarios with periodontal charts

- Questions related to latest periodontal classification

- Offering treatment options according to the extent of caries ( Radiology ) etc.





- Always remember, examiners and evaluators perform a dual role. They not only help people integrate into Canadian dentistry, but they also stop internationally trained dentists from practicing, who are not competent enough.



I wrote my ACJ exam in University Of Alberta, Edmonton. An hour before the exam started, I met a guy who flew all the way from Vancouver to write this exam. He was carrying a large rectangular dark green bag on his shoulder. After sharing some information about each other, I asked him, " What's this bag on your shoulder''. He said, "it's my lunch box''. I got curious and commented "I could barely sleep last night for the fear of exam, and you are brave enough to worry for your lunch."


He replied, " My dear friend. I am a diabetic. I have sought special provisions to eat during my exam or I could faint."


This was one of worst moment of embarrassment for me. I realized, we have become so habitual of making a judgement, that we quickly loose the idea of uniqueness applicable to each one of us.


Some of you could be better at radiology, some may know the pharmacology by heart, while others may master case scenarios. This is the whole concept of uniqueness. Our biggest and most powerful commonality is exchanging kindness, and our chief goal is to pass ACJ exam. You can seek help, give help, form a team, do research, find mentors, utilize contacts, and learn from each other.


I learnt from my experience that, in the bigger scheme of things, 'we all are connected'.


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