About the Exam
The Canadian Midwifery Regulators Council sets and administers the Canadian Midwivery Registration Exam (CMRE) twice a year. This exam is designed to assess Canadian-educated and internationally-educated applicants for midwifery registration to ensure they meet entry-level competency standards set out in the Canadian Competencies for Midwives. The goal of the CMRE is to ensure that midwives gaining registration are competent and safe practitioners providing a consistent standard of care across Canada.
Examination Dates and Sites
In 2019, the CMRE is scheduled to take place on May 2 and October 31. In 2020, the dates are May 7 and October 29.
The following cities have offered CMRE sittings in the past: Vancouver, Edmonton, Calgary, Kugluktuk, Saskatoon, Winnipeg, Halifax, Toronto, Sudbury, and Montreal. The provincial/territorial regulatory authorities select the host cities, and these can change.
The examination consists of case-based and independent multiple choice questions totalling between 210-230 questions. Exam questions come from the CMRE exam databank according to the CMRE Blueprint and content is based on the Canadian Competencies for Registered Midwives.
The percentage of questions on the exam from each competency is noted here:
- General Competencies 5-10%
- Education and Counselling 5-10%
- Antepartum 25-30%
- Intrapartum 25-30%
- Postpartum – Maternal 10-15%
- Postpartum – Newborn 10-15%
- Well-Woman Care 1-5%
- Professional & Legal 1-3%
- Professional Development 1-3%
In order to represent the range of care a Canadian midwife is expected to provide, slightly more than half of the questions will be set in an out-of-hospital setting with the remainder in a hospital setting.
The examination is available in either English or French. Candidates can also have access to the exam in both languages.
Examination Pass Score
The passing score for the CMRE is developed through a standard setting process that ensures that the pass mark accurately reflects the acceptable level of midwifery proficiency in Canada. Examination forms are validated and subject to a statistical check of reliability. The CMRE uses an item writing and standard setting procedure that promotes comparability and fairness across candidates, test forms and yearly administrations. Therefore, the specific passing score may change slightly from one sitting to the next.
Examinations are scored using automated scoring and checked through hand scoring. Examination score reports (Pass or Fail) are mailed by the provincial regulatory authority within six weeks of the exam date.
Candidates are eligible to take the exam multiple times. After three (3) sittings, candidates must provide evidence of additional relevant education to the CMRE prior to registering again for the exam. All re-write fees are the same as initial fees.
The CMRE is open to Canadian-educated and internationally-educated midwives. Canadian-educated midwifery candidates are eligible to write the CMRE if they have successfully completed or are currently enrolled in good standing of the final term of a Canadian Baccalaureate Midwifery Education Program approved or recognized by one of the provincial or teritorial midwifery regulatory authorities. Internationally-educated midwifery candidates are eligible to write the CMRE if they have successfully completed or are currently enrolled in good standing in the final stage of a Canadian bridging or gap training program approved or recognized by one of the provincial or territorial midwifery regulatory authorities. Please contact firstname.lastname@example.org with any questions regarding exam eligibility.
The first step towards becoming a registered midwife is to complete and submit the CMRE Registration Form, available from provincial and territorial midwifery regulatory authorities and from Canadian baccalaureate Midwifery Education Programs.
- Complete the CMRE Registration Form for the province or territory to which you will be applying for registration.
- Submit the registration form along with a recent passport size photo and fee to the midwifery regulatory authority in the province to which you are applying. Forms AND payment must be received by the exam registration deadline. (Check with your local regulatory authority for acceptable payment methods.)
- Additional information, including the location of the exam, will be sent to you after your registration has been processed.
- The goal of the CMRE is to ensure that you are competent in all aspects of midwifery as outlined in the Canadian Competencies for Midwives. In order to best understand what is covered on the exam, you should read that document closely.
- The CMRE Blueprint describes the structure of the exam, including how many questions cover each general topic area. Ensure that you read this closely and understand what is being covered and the standards used.
- If you are not familiar with multiple-choice questions, you should look for opportunities to practise taking exams in that format.
Each question is designed to test a specific entry-level competency from the Canadian Competencies for Midwives. Questions are developed by teams of experienced Canadian midwives with reference to at least two valid, current resources.
Multiple Choice Questions
The questions on this exam are in a multiple choice format. All questions have a stem and four possible answers. For example:
Iron absorption is inhibited by:
- orange juice
- wholegrain bread
- root vegetables
Candidates should select the ONE best answer to the question presented. You will receive one point for each correct multiple choice question. (Note: If a candidate selects more than one option, no points will be awarded for that question.)
Each question should be answered in an average of 1.4 minutes. If you spend more than that on a question, you are taking time away from other questions. If you are unsure of an answer, leave it and go back to it later to ensure that you have time to cover all the questions you do know.
You should use your best judgment and try to answer every question as you are not penalized for wrong answers (they receive 0 points).
Answers are recorded on a multiple choice answer sheet, similar to the one below. You must completely fill in the circle with the correct answer. Please make use of the rulers provided to ensure that you record the answers on the correct lines.
Most of the questions are case-based. This means that a case, or midwifery scenario, is presented in a sentence or paragraph followed by between three and five questions. All of these questions relate to the information provided in the case, and candidates must read the case to fully understand each question. A sample case is below:
- Kiko, 32 yrs, is visiting the midwife for her first prenatal appointment in this pregnancy. She has had two previous pregnancies. The first, at 16 yrs, was a vaginal delivery at term. Four years ago, she had a baby by cesarean section for breech presentation at 36 weeks.
The exam is a total of 7 hours in length and is divided into two 3.5 hour parts.
Some Common Errors on Midwifery Written Exams in Canada
- Missing key words in the question, such as "most" or "not", and therefore misunderstanding what is being asked.
- Inadequate knowledge of the scope of practice of a Canadian midwife, especially when to consult or transfer care.
- Inadequate understanding of the principle and practice of informed-choice and inability to use appropriate phrases when counseling a client.
- Incorrect knowledge of drug dosages.
- Insufficient knowledge of common complications of the newborn.
SAMPLE Case-Based Multiple Choice Questions:
Susan is at home in active labour and her midwives are in attendance.
Questions 1 and 2 refer to this situation.
- Susan is lying on her back on her bed. One of her midwives performs an internal exam and feels a small triangular fontanel at a location of one o’clock and a suture line running diagonally from the fontanel to a location of seven o’clock. What is the position of the fetal head?
- Left occiput anterior
- Right occiput posterior
- Right sinciput anterior
- Left sinciput posterior
Correct answer is A. The triangular fontanel represents the posterior fontanel. If the posterior fontanel is at one o’clock with the sagittal suture running toward seven o’clock, the occiput is anterior and left.
- The baby’s head is born. On the next contraction, the head turns so that the baby is facing Susan’s right thigh. This reflects:
- The descent of the head past the ischial spines
- The rotation of the baby’s shoulders
- The delivery of the posterior shoulder
- The rotation of the baby into an occiput posterior position
Correct answer is B. The baby’s head is born by extension, after which it restitutes by rotating 45 degrees to the left or right in alignment with the shoulders. The shoulders then rotate to the anterior-posterior position in order to navigate the pelvic outlet. The head then rotates another 45 degrees to face the maternal left or right thigh.
Competency: Intrapartum IV, A, 1. the normal process of labour including the mechanisms of labour and delivery.
Suggested Study Resources for the Exam
In preparing for the Canadian Midwifery Registration Examination (CMRE), we strongly suggest that you ensure the midwifery textbooks and other resources you are studying are comprehensive and less than five years old. The textbooks you use should contain information that covers the full spectrum of knowledge required of the entry-level midwife as set out in the Canadian Competencies for Midwives. Please note that we cannot suggest a single “best” text for review.
You should also consult Canadian midwifery and maternity care resources such as the Association of Ontario Midwives, Society of Obstetricians and Gynaecologists of Canada and the BC Reproductive Care Program Clinical Practice Guidelines.
We also recommend that you study the Canadian policies and guidelines related to the provision of care (e.g. Consult and Transfer, Drug and Diagnostic Testing Schedules, etc.) in the jurisdiction where you will be applying to register, as appropriate. Only those requirements that are the same across all Canadian regulated jurisdictions will be tested on the CMRE.
You may also wish to review the Association of Ontario Midwives' Emergency Skills Workbook or the Regroupement les sages-femmes du Quebec's Formation en urgences obstetricales, as these workbooks reflect the generally accepted standard for emergency care for Canadian midwives.
Practice Exam (PESA)
The Midwifery Pre Exam Self Assessment (PESA) is a set of sample exam questions that form a short self-administered online test. All questions are in the style of the questions found on the Canadian Midwifery Registration Examination (CMRE). Some of the questions have been used in previous versions of the CMRE. Like the CMRE, the PESA is available in English and French.
The PESA allows users to obtain some direct experience with questions that mimic the format, style, language level, and difficulty level of questions on the CMRE. The specific set of questions has been chosen to also demonstrate the range of content and types of questions found on the CMRE. Finally, by taking the time-limited PESA, users can also experience the approximate pace of the CMRE.
Important Note: The PESA is NOT a comprehensive study tool and it is NOT intended to replace other study techniques (e.g. reading relevant texts, study groups, etc.)
Is it exactly the same as the CMRE?
Not exactly. Firstly, the PESA is online and the CMRE is a paper-based exam. Second, the PESA contains only about 1/3 of the number of questions. Although some questions were previously used on the CMRE, none will be included in future versions of the CMRE.
The PESA does include questions that are similar to those you will find on the CMRE and it is designed to enable candidates to experience the type of entry-level multiple choice questions that are on the CMRE, including the proportion of questions from each competency area and the appropriate balance of different midwifery care scenarios such as hospital/out-of-hospital settings and normal/abnormal situations.
Who can use the PESA?
The PESA is used by internationally-educated midwives who are participating in a Canadian midwifery bridging program and by senior students of Canadian midwifery education programs. Canadian midwifery education programs can provide the PESA code to these individuals.