The Canadian Entry-to-Practice (CETP) Exam 

Note from the editors: With the new entry-to-practice exam (i.e. CETP), many are wondering how the experience taking the exam has been for our recent SLP graduates. Below is an opinion piece written anonymously by two alumni.

Take yourself back to when you were a student, freshly out of graduate school.
You have just passed a highly-competitive and intensive program, coupled with completing at least 350 supervised clinical hours. Now imagine just months before you graduate, a new licensing exam is created: The Canadian Entry-to-Practice Exam (CETP) for new graduates in speech-language pathology (SLP) and audiology (AUD).

This is not a foreign concept: several other professional colleges have this as a requirement for registration — such as law, accounting, and even occupational and physical therapy. Especially amid a global pandemic and the last-minute adaptation to unconventional learning approaches, it is perhaps wise to begin to enforce an exam to ensure standardization across new clinicians entering the workforce. To the public eye, it may also appear impressive that all college constituents have been rigorously trained and evaluated to ensure optimal care and best practices. Although studying for and writing an exam is not how most students would celebrate the end of their formal education, the arguments for a certification exam are logical. So what’s all the commotion about? What could explain this uproar of petitions and disagreements  between CASLPO and recent graduates in SLP and AUD? Let’s consider the following:

You may have completed your master’s immediately after your undergraduate degree, and may have thousands of dollars in student loans, or perhaps a family to support or other financial commitments. On top of the initial registration and annual CASLPO and SAC fees, you must also now pay for an exam that costs $1135. The unfortunate reality is that education is expensive (including the cost of formal training and the opportunity costs of obtaining a master’s degree) and we must consider the affordability of the career path we choose. We did not budget for the cost of this exam, which entails additional loans and less time working in order to adequately study. We did not have the option to choose whether we could afford this additional cost.

Let’s pretend the CETP was free of charge and posed no direct financial strain. That brings us to the next obstacle to overcome: CASLPO’s mandate that if a failing score is obtained, your license will be revoked 30 days upon learning of this news, resulting in loss of mentorship, employment, and ultimately less clinicians eligible to work. The idea of a novel certification exam to “protect the public” would be more digestible if it did not contain the reverse logic of reducing the number of clinicians available to provide services. It is paramount to ensure that only proficient clinicians can practice, but does a written multiple-choice exam have the power to evaluate this? This poor logic only compounds the devastation of losing employment and ultimately income.

Let’s imagine now that the CETP was free of charge and licenses were not revoked upon failure (for example, since mentorship is still required). Unlike other entry-to-practice exams, the CETP offered no guidance or materials on how to study other than 10 practice questions and general information on writing a multiple-choice style exam. Think back to all the theoretical and clinical knowledge you learned during your master’s degree, and how much time and effort was required to prepare for a single course exam: how would you go about studying all that information at once, without any direction?

SLPs are stereotyped for being “Type A”, and our approach to schoolwork is no exception.
We thoroughly took notes on lectures, reading materials, and excelled in our master’s coursework. Likewise, given the high stakes of the CETP, many of us spent months studying said notes and course readings, the American Praxis exam study guides, SAC position papers, and other resources. Needless to say, we prepared in excess and entered the exam feeling that we had done everything we could. 

Unfortunately after the fact, many of us felt that no amount of studying could have prepared us for this exam. The questions were unclear and missing information, and multiple-choice response options were ambiguous; it felt that the exam was written in a rush. Importantly, many questions necessarily required in-depth clinical experience — details that one should not expect a new graduate to know unless they had a clinical placement in that setting . This seems especially unjust for new graduates who studied during a pandemic and had limited clinical experiences (e.g., missed days due to outbreaks). Given the lack of guidelines on what would be covered by the CETP, one would logically conclude that the exam would prioritize breadth over depth. On the contrary, we were asked a disproportionate amount of questions from highly specialized populations that were not representative of a typical SLP caseload. 

The CETP was not a pass-or-fail exam, but rather a scaled score, determined by using a modified Angoff method. Eight questions from the exam were deleted, without providing any information on the methodology. Concerns about the exam’s validity, the idea of not being able to practice with a failed result, and the concerns of introducing the exam during a global pandemic, were brought to CASLPO via a petition and private letters and phone calls. The response was that “only 6% of students failed” and that this exam is imperative to “protect the public”. In a field that is dealing with staffing shortages and SLP burnout, this response is disheartening. Even if one clinician did not pass the exam, is it unfair to penalize them after receiving no preparation materials, and after they successfully passed their program, placements and their mentorship. 

We do not reject the idea of requiring an entry-to-practice exam. There are many arguments for its function and what it could bring to our profession. It is, however, ill-conceived to implement an entry-to-practice exam during a global pandemic that costs an immensely high fee, with high stakes if failed, and little preparatory material to prevent said penalties. Most importantly, although we are very new to the field, this multiple-choice exam did not accurately capture the clinical knowledge that we hold and represent who we are as clinicians.