The Assessment of Clinical Judgement is the second Equivalency Process exam. It asks you to diagnose, plan and decide from cases, charts and radiographs. This guide covers its format, content, scoring and sittings, and how it differs from the AFK.
Quick answer
The Assessment of Clinical Judgement tests diagnosis, treatment planning, clinical decisions and radiograph interpretation, on a computer.
A test equated, re-scaled score of 75 passes. You can sit the ACJ 3 times, and the fee is $1,350 CAD per sitting.
The AFK comes first. 62.44% of 892 candidates passed the ACJ in 2025.
Where the ACJ sits and how it differs from the AFK
The ACJ comes after the AFK and before the NDECC. By-law 2 says a candidate must pass the AFK to proceed to the ACJ and the ACJ to proceed to the NDECC, and it describes the ACJ as one exam in a one day session. NDEB's page says the ACJ assesses your ability to formulate a diagnosis and make clinical decisions, and your knowledge of oral radiology and your ability to interpret radiographs and diagnose from them. The pathway guide shows where it fits in the full route.
The AFK tests biomedical and applied clinical science knowledge, while the ACJ tests diagnosis and decisions on cases. This table sets the two exams side by side, using NDEB's 2026 protocols and pages.
The AFK and the ACJ compared
Feature
AFK
ACJ
What it tests
Biomedical science and applied clinical science knowledge
Diagnosis, treatment planning, clinical decisions and radiograph interpretation
Questions
200 single answer multiple choice questions
Single answer and multi-answer questions, about 150 per the protocol
Time
2 parts of 2 hours, one break
Five hours per the protocol, 5.5 per NDEB's page, one break
Blueprint
9 areas
6 areas
Delivery
Paper at Canadian sites, or computer at Prometric
Computer at Prometric and NDEB hosted sites
Offered
February and August
May and November
Fee
$1,000 CAD
$1,350 CAD
Attempts
3
3
Pass rate, 2025
52.29%
62.44%
Both exams use the same passing standard, a test equated, re-scaled score of 75. Read the AFK format page and the scoring page for the other half of this table.
The ACJ is a 5.5 hour exam with one scheduled break and 120 to 150 single-answer and multi-answer multiple-choice questions on case-based diagnosis, treatment planning, clinical decisions and radiograph interpretation. The 2026 ACJ Protocol says the ACJ is computer based, with approximately 150 single answer and multiple answer multiple choice questions, in five hours with one scheduled break.
The two NDEB documents disagree on the length and the question count, and NDEB does not say which governs. The 2026 protocol took effect on 19 January 2026, and NDEB's page is the one that lists 5.5 hours and 120 to 150 questions. Plan for the longer day and read your registration memo, which carries the schedule for your site. NDEB gives no length for the one scheduled break.
The ACJ is given at Prometric test centers and at NDEB hosted sites. A candidate who registers for an NDEB hosted site does not schedule a seat with Prometric. NDEB says a computer exam can have short technical delays and that the time allotted already accounts for them. NDEB says the AFK and ACJ Electronic Exam Orientation should be viewed before the ACJ.
Questions come in two types. A question marked "Select ONE correct answer" has one correct answer, the one most likely to be correct. A second type, marked "Select ONE OR MORE correct answers", has its own scoring, which the section on scoring explains. NDEB also defines the words it uses in stems. The ACJ Protocol defines "immediate management" as the management needed at this appointment, "management" as all patient-centered therapies for the case, "most appropriate management" as the most suitable management for the case, which can include more than one answer, and "most likely" as the most probable correct answer.
ACJ blueprint, 2026 protocol: approximate share of questions
Oral Medicine/Oral Pathology, Oral Surgery25 ± 5%
Pharmacotherapeutics, Medically-Complex Patients, Medical Emergencies, Geriatrics, Local Anesthesia22 ± 5%
Cariology/Restorative Dentistry18 ± 5%
Periodontics15 ± 5%
Endodontics10 ± 5%
Orthodontics, Pediatric Dentistry10 ± 5%
Each share is approximate and can differ by 5 points either way. The bars run from 0 to 30%.
Each section has case-based questions on diagnosis, treatment planning and clinical decision making, and radiographic interpretation questions. Case histories, dental charts and relevant images, including radiographs, may be provided. The blueprint above gives the content areas. Oral Medicine, Oral Pathology and Oral Surgery together carry the largest share, about a quarter of the questions. The second area bundles pharmacotherapeutics, medically complex patients, medical emergencies, geriatrics and local anesthesia, and it carries about 22%. The remaining four areas, Cariology and Restorative Dentistry, Periodontics, Endodontics, and Orthodontics with Pediatric Dentistry, carry 18%, 15%, 10% and 10%.
Radiographic interpretation questions evaluate the ability to prescribe, assess and interpret radiographic images and to establish diagnoses from them. The 2026 protocol says each section of the ACJ holds both case-based questions and radiographic interpretation questions. ACJ questions are developed from the Knowledge, Skills and Abilities of a beginning dental practitioner in Canada, a document on NDEB's exam resources page.
Cases follow a fixed layout: patient information, blood pressure, heart rate, respiration rate and temperature, chief complaint, dental history, medical history, medications, allergies, social and family history and a clinical examination, with extra findings supplied as needed. ACJ periodontal charts list probing depths in millimeters from mesial to distal, recession below them, bleeding on probing with a dot, and mobility (Miller classification, 1 to 3) and furcation class (I to III) for the whole tooth. Missing teeth are grayed out and implants are identified. All NDEB exams use the FDI two-digit tooth numbering system. Our tooth numbering converter turns FDI numbers into Universal and Palmer ones.
A question marked "Select ONE OR MORE correct answers" can have one or several correct answers. Every question scores at most 1 and at least 0. Each answer has a value, so choosing some of the correct answers earns part of a mark, and choosing one answer with a negative value gives 0 for the question. Rarely, an answer has a value of 0 and does not affect the score. This is the part of the ACJ that differs most from anything on the AFK, where every question is single answer and a wrong answer costs nothing.
In NDEB's caries example, three correct answers are worth 0.33, 0.33 and 0.34, one answer is worth 0 and the other answers are worth -1. A candidate who picks all three correct answers scores 1. A candidate who picks two correct answers and the zero-value answer scores 0.66, because the zero-value pick does no harm and the third correct answer is missing. A candidate who picks three correct answers and one -1 answer scores 0.
NDEB's example of three candidates on one multi-answer question (three correct answers worth 0.33, 0.33 and 0.34, one answer worth 0, wrong answers worth -1)
Candidate
What they picked
Score
1
All three correct answers
1
2
Two of the correct answers and the zero-value answer
0.66
3
Three correct answers and one wrong answer
0
Our reading of this is practical. A confident partial answer earns part marks, a zero-value pick does no harm, and one wrong pick wipes the marks out. The protocol's example is an illustration, and the protocol does not say how many correct answers a question can have or whether a question states how many to choose.
ACJ results are normally released within eight weeks as Pass or Fail. A candidate below 75 also receives the test equated rescaled score. A candidate who fails has 30 days from release to request a verification of the score and never sees the questions or answer sheets. A panel of dentists from across Canada reviews every question and sets the score a minimally competent dentist would earn. That passing score is rescaled to 75.
NDEB exams are not graded on a curve and are not built to pass or fail a set share of candidates. A rescaled 75 is not 75 percent of the questions correct, and a score of 74 can be one or several questions away from passing. Test equating is a standardized statistical process so that each version of an exam is of equal difficulty and results from different versions are comparable. Questions that did not perform as expected statistically may be removed. The AFK scoring guide goes through the same process in more detail, because the ACJ and the AFK share it.
A candidate who fails sees the score and nothing else. NDEB says no further breakdown of results is available. Verification of the score costs $200 CAD. If a verification gives a passing result, the registration for that exam is withdrawn and the exam fee is refunded.
The ACJ is offered twice a year, in May and November. Registration for the ACJ has three steps: log in to the NDEB online profile to register and pay, wait for NDEB's email after the deadline with Prometric scheduling instructions, then book on Prometric.com with "find my exam". Exams can fill before the registration deadline.
Monday 9 November 2026 (Canada). Registration is closed.
Tuesday 10 November 2026 (Australia and New Zealand). Registration is closed.
Tuesday 4 May 2027 (United States and Canada). Registration opens 8 December 2026 and closes 5 April 2027, 21:00 ET.
Tuesday 2 November 2027 (Canada). Registration opens 8 June 2027 and closes 4 October 2027, 21:00 ET.
The exam dates page has the AFK calendar. The next section of the pathway guide shows the ACJ and Virtual OSCE sittings together.
The ACJ costs $1,350 CAD for each sitting, in Canadian dollars. Three sittings would cost $4,050 CAD in exam fees. NDEB charges 50% of the fee to withdraw before the registration deadline and 100% after it or for failing to appear, with 25% for serious medical or unanticipated exceptional circumstances. If you do not attend the examination, you will not lose an attempt. The fees page and the pathway cost calculator add up the whole route.
NDEB's results page says 892 candidates sat the ACJ in 2025 and 62.44% passed. First-time takers passed at 61.12% (393 of 643) and repeat takers at 65.86% (164 of 249). The annual report, which counts by fiscal year, gives 61.36% of 854 candidates for 2024-25.
Compared with the AFK, the ACJ pass rate is higher and the pool is smaller, because only candidates who passed the AFK reach it. NDEB's report says that higher success rates in the ACJ were one reason the NDECC filled up. NDEB does not explain what moves the ACJ rate from year to year. The pass rate page has the AFK years.
At check-in a candidate shows current government-issued photo identification in English or French that matches the online profile. At Prometric sites a candidate may be scanned with a metal detector wand, fingerprinted, and asked to raise pant legs and shirt sleeves and empty and turn out all pockets.
On exam day all recording or transmitting devices and all watches are prohibited and stay in a designated area, even during the break. Water is allowed in a transparent bottle with the label removed. NDEB supplies ear plugs, scratch paper, a pencil and an eraser, all returned at the end. A candidate cannot leave and re-enter the room unattended.
A candidate who has a health issue or personal circumstance before the start that will stop them from showing their ability must withdraw. If you believe a serious medical circumstance during the exam kept you from showing your ability, you can send a compassionate appeal through NDEBConnect within seven days. An irregularity in how the exam was run is reported to staff at once, and an appeal of the conduct of the exam also goes in within seven days and costs $1,200 CAD.
NDEB points ACJ candidates to the ACJ Sample Questions and Answers (updated October 2024), the AFK and ACJ Electronic Exam Orientation video, the released question bank and the reference text list, all on its exam resources page for personal use only. NDEB is not affiliated with and does not endorse any third-party provider of test preparation courses, and it forbids using NDEB exam content, including released questions, for commercial purposes.
A practical order is to read the protocol first, then work through NDEB's ACJ sample questions to see how stems and multi-answer questions are written, and then practice cases against the six blueprint areas. NDEB gives no recommended study time for the ACJ. Released exam materials are for personal use only. Using NDEB exam content commercially is prohibited, including the released materials on its website.
MolarPath is an independent study app and is not affiliated with NDEB. Our questions follow the AFK blueprint, so they build the biomedical and clinical knowledge that the ACJ also draws on, and we do not claim they cover the ACJ. A free mini mock shows where your AFK knowledge stands today.
Yes. By-law 2 says a candidate must pass the AFK before proceeding to the ACJ. NDEB's ACJ page says that once you pass the AFK you are eligible to register for the ACJ.
How many questions are on the ACJ?
NDEB gives two figures. Its ACJ page says 120 to 150 single-answer and multi-answer questions in 5.5 hours. The 2026 ACJ Protocol says approximately 150 questions in five hours. NDEB does not explain the difference, so read the protocol and your registration memo.
Is there a penalty for a wrong answer?
On a single answer question NDEB says to select the answer most likely to be correct. Every ACJ question scores at least 0 and at most 1, so a wrong answer scores 0 and takes nothing from other questions. A multi-answer question works differently. A question marked "Select ONE OR MORE correct answers" can have one or several correct answers. Every question scores at most 1 and at least 0. Each answer has a value, so choosing some of the correct answers earns part of a mark, and choosing one answer with a negative value gives 0 for the question. Rarely, an answer has a value of 0 and does not affect the score.
What score do I need?
A test equated, re-scaled score of 75. A rescaled 75 is not 75 percent of the questions correct, and a score of 74 can be one or several questions away from passing. NDEB gives a candidate who fails the score and no breakdown by topic.
How many times can I take the ACJ?
3 times. A candidate who fails the ACJ three times ceases to be an Equivalency Candidate and cannot be redesignated as one. If you do not attend an exam you registered for, you do not lose an attempt, and withdrawal fees apply.
Can I see my answers or the questions after the exam?
No. NDEB says you never have access to your answer score sheets or the exam questions. A candidate who fails can ask for a verification of the score within 30 days of the release of results, for $200 CAD.
Is the ACJ on paper or on a computer?
On a computer. The ACJ is given at Prometric test centers and at NDEB hosted sites. A candidate who registers for an NDEB hosted site does not schedule a seat with Prometric.
MolarPath is an independent study app. It is not affiliated with, endorsed by or sponsored by the NDEB. The figures here come from NDEB pages, linked at the end of each section, and NDEB can change them.