Practice Review is a mandatory component of the Quality Assurance Program at the College of Medical Laboratory Technologists of Ontario (CMLTO). The purpose of the Practice Review is to provide an objective assessment of a Registrant’s practice in relation to the Standards of Practice of the profession. Registrants are randomly selected or requested by the Quality Assurance Committee (QAC) to complete the Practice Review. 

The Practice Review consists of 30 multiple choice and true/false questions that directly assess a Registrant’s knowledge, skill, and judgement of the CMLTO Standards of Practice. The Practice Review administration follows the guidelines detailed in the Practice Review Blueprint. It is an open-book assessment that is completed and submitted online by a specific deadline date. Registrants are encouraged to reference the Professional Practice Learning Modules to prepare for the Practice Review. Each year questions are selected in alignment with the blueprint below. 

If a registrant fails to meet the Practice Review assessment cut score on their first attempt, they are provided one additional attempt. The Practice Review is offered in French and English. 

CMLTO Practice Review Blueprint

CMLTO Standard of Practice Category Weighting # of questions
Professional Conduct and Accountability 25 – 30% 8 – 10
Knowledge and Skill 15 – 20% 5 – 6
Application of Knowledge and Skill 40 – 45% 12 – 13
Quality Management 10 – 15% 3 – 4
Total 100% 30

Practice Review Sample Questions

For further information please reference CMLTO’s Practice Review process infographic.

Mary is an MLT working as a phlebotomist in a private laboratory. A woman comes in with her 16-year-old daughter who has a requisition for follicular stimulating hormone, luteinzing hormone (LH), estradiol and human chorionic gonadotropin (hCG). The daughter tells Mary that she is willing to have some of the tests on the requisition performed but not the CG. The mother shakes her head and reminds the daughter that the tests are necessary for a diagnosis by the doctor. What should Mary do?
  1. Follow the request of the mother because she is the parent and responsible for the care of her underage child.
  2. Follow the request of the daughter because she seems capable of making decisions on her own and there is no set age of consent.
  3. In an effort to maintain consent, Mary should contact the patient’s physician.
  4. Proceed with the venipuncture because the requisition itself is consent enough.
Which of the following is not a controlled act within the Regulated Health Professions Act, 1991 (RHPA)?
  1. Communicating with patients or their representatives about the diagnosis.
  2. Setting or casting a fracture of a bone or a dislocation of a joint.
  3. Weighing a patient.
  4. Prescribing a hearing aid.
Alice, an MLT who is working in a community laboratory, receives a phone call from a lawyer requesting copies of their client's test results. The lawyer says that the request is urgent as their client is to appear in court the next day. What should Alice do?
  1. Alice should release the results to the lawyer immediately.
  2. Alice should tell the lawyer that the laboratory can only release information to the physician who ordered the tests and direct them to the physician.
  3. Alice should refuse to release the results.
  4. Alice should ask the lawyer to submit their request in writing and upon receipt of the request, release the results.
While assisting with a blood collection on a 26-year-old female patient who is unconscious, Heidi, an MLT, overhears Roger, one of the nurses assisting with the patient, making inappropriate sexual remarks about the patient's body. What should Heidi do?
  1. Heidi should report what she has witnessed to the hospital and also file a report regarding Roger’s comments with the College of Nurses.
  2. Heidi does not have to do anything, after all the patient is unconscious and therefore not aware of what is being said.
  3. Heidi should confront Roger and tell him his behaviour is inappropriate.
  4. Heidi should not do anything as Roger often makes inappropriate comments.
The hospital where Mary works is planning to install Point of Care (POC) testing for several analytes in the emergency department; the lab will be responsible for validating and maintaining the instruments but the nursing staff will be doing the testing. The general consensus in the lab is that the nurses don't have the background required to perform POC testing and it would be better if it was assigned to the MLTs. Mary, a senior MLT, has been asked to train several of the nurses on how to use the equipment, she is reluctant because she agrees that testing should stay in the lab. What is the next step for Mary?
  1. Ask for the opportunity to present her concerns to upper management and to point out that the lab staff are already trained to use the equipment and will need little orientation before testing can start. This would be a cost saver for the hospital.
  2. Ask for the opportunity to present her concerns to upper management and cite improved patient care as a reason to assign POC testing to the laboratory.
  3. Look at the training assignment as an opportunity to collaborate with nursing staff and to help them understand the role of the Medical Laboratory Technologist in patient care.
  4. Ask for the training to be assigned to another MLT, someone who needs the experience more than she does.

Answers:

  • Option #3: In an effort to maintain consent, Mary should contact the patient’s physician.
  • Option #3: Weighing a patient.
  • Option #2: Alice should tell the lawyer that the laboratory can only release information to the physician who ordered the tests and direct him to the physician.
  • Option #1: Heidi should report what she has witnessed to the hospital and also file a report regarding Roger’s comments with the College of Nurses.
  • Option #3: Look at the training assignment as an opportunity to collaborate with nursing staff and to help them understand the role of the Medical Laboratory Technologist in patient care.
When would I be required to submit a Practice Review?

You will be required to submit a Practice Review under the following criteria: 

  • Practising registrants who have held practising certificates of registration for more than two (2) years will be randomly selected once in every ten-year cycle.
  • All Practising registrants within their first two (2) years of CMLTO registration. 
  • A registrant who changes their class of registration from Non-Practising to Practising will complete the Practice Review within two (2) years of the change.
  • A registrant suspended for non-payment of fees and who reinstates as Practising will complete the Practice Review within two (2) years of reinstatement. 
  • A registrant who resigns or is revoked and reapplies to the CMLTO as Practising will complete the Practice Review within two (2) years of re-registering.
  • A registrant who changes their class of registration (i.e., Resigned, Non-Practising, suspended, or revoked) after being randomly selected for the Professional Portfolio or Practice Review audit will complete the Practice Review assessment within 60 days of returning to Practising status. 
  • If requested to do so by the Quality Assurance Committee.

Each Practice Review question links to a specific CMLTO Standard of Practice for Medical Laboratory Technologists. The CMLTO Quality Assurance Committee (QAC) reviews the blueprint every three years.

What are the assessment conditions?

The assessment is open book, and online based. The assessment must be completed and submitted by a specific deadline, and the score for each question are added together in order to define the overall assessment cut score. Each Practice Review question links to a specific CMLTO Standard of Practice for Medical Laboratory Technologists. The CMLTO Quality Assurance Committee (QAC) reviews the blueprint every three years.

What is the format of the questions?

The assessment is made up of 30 questions that are linked with the CMLTO Standards of Practice, applicable to all MLTs. They are a mixture of true/false and multiple choice questions. Each multiple-choice question has four options. 

Questions are randomized between registrants. In other words, the assessment’s questions are the same throughout the year but the way in which they are ordered differs on each registrant’s assessment. Lastly, assessment questions are selected at random from the question bank each year and are based on  the PR Blueprint outlined above. 

What are the outcomes of the assessment?

If a Practising registrant’s score meets or exceeds the overall assessment cut score, they are provided with a summary report containing supportive comments within 60 days of the assessment. 

If a Practising registrant’s score does not meet the cut, their case handled in compliance with Quality Assurance Committee policies including QAC Policy 106 (which you can access here: here / pour une copie française, cliquez ici) Practice Review Reattempt. If your case is referred to the Quality Assurance Committee they may exercise their rights under the Regulated Health Professions Act, 1991 section 80.2

To successfully pass the Practice Review audit, a registrant must achieve a score that meets or exceeds the overall assessment cut score. Every year, the QAC reviews and approves the audit cut-score. If a Practising registrant’s score does not meet or exceed the cut score on their first attempt, they will be provided a second attempt to meet the cut score in accordance with If the registrant does not meet the audit cut score after their second attempt, their case is referred to the QAC for review and deliberation who may exercise one or more of their powers under the Regulated Health Professions Act, 1991 section 80.2.

Have any further questions or concerns?

Contact CMLTO Quality Assurance Program staff at qualityassurance@cmlto.com.