1.2 Exam Format and Scoring
Key Takeaways
- The Core examination has 110 multiple-choice items: 90 scored and 20 pretest, with 2 hours allowed.
- The Specialty Simulation has 5 problems: 4 scored and 1 pretest, with 90 minutes allowed.
- Candidates must pass both the Core and the Specialty Simulation; passing only one part is not sufficient for certification.
- Passing standards are criterion-referenced using a modified Angoff method — there is no curved rank-order pass rate published as a fixed percentage.
- Score reports provide Core performance by content category and Simulation performance for Information Gathering (IG) and Decision Making (DM).
Understanding the ACM exam architecture prevents wasted study time. Unlike single-sitting multiple-choice certifications, ACM requires competence on two separately timed parts. You can be strong on knowledge recall and still fail if simulation Information Gathering and Decision Making are weak — or the reverse.
All structure and scoring facts below follow the ACM Candidate Handbook (effective January 1, 2024). Confirm current scheduling and delivery-partner logistics on ACMA's official ACM pages before you test, because delivery vendors can change even when exam blueprints stay stable.
The Two Required Parts
| Part | Format | Item counts | Time | Must pass? |
|---|---|---|---|---|
| Core | Multiple-choice | 110 total (90 scored + 20 pretest) | 2 hours | Yes |
| Specialty Simulation | Clinical simulation problems | 5 problems (4 scored + 1 pretest) | 90 minutes | Yes |
The handbook states that the multiple-choice and simulation exams are administered in a random order. Do not assume you will always see Core first. Build stamina for either sequence.
Those who meet eligibility and achieve the required passing scores on both parts are awarded ACM-RN or ACM-SW.
Pretest items: why they exist and how to handle them
Pretest questions and the pretest simulation problem are unscored. They exist so examination committees can collect statistics on new items before those items become scored content on future forms. You will not be told which Core items or which simulation problem is pretest during the exam.
Practical implication: Treat every item and every simulation as if it counts. Spending five minutes hunting for "the pretest problem" is a self-inflicted time loss.
Core Multiple-Choice Structure
The Core is shared across RN and SW tracks. According to the 2024 handbook blueprint, scored Core content weights approximately as follows:
| Domain | Approx. share of scored Core |
|---|---|
| Screening and Assessment | ~42% (about 38 of 90 scored items) |
| Care Coordination, Intervention, and Transition Management | ~50% (about 45 of 90 scored items) |
| Process Improvement and Evaluation | ~8% (about 7 of 90 scored items) |
These are handbook domain weights, not guesses from third-party "four domain" outlines. Older marketing outlines that invent separate Planning/Evaluation percentages that conflict with the 2024 handbook should be discarded for study planning.
Timing strategy for the Core
Two hours for 110 items is roughly about one minute per item if you use the full clock evenly. In practice:
- Answer straightforward knowledge items quickly.
- Flag multi-step regulatory or scenario items for a short return pass.
- Leave a few minutes to review flagged items — do not leave blanks if the interface allows selection changes.
Because 20 items are pretest, your pass/fail decision rests on the 90 scored items only. Still, you cannot skip "suspicious" items hoping they are pretest.
Specialty Simulation Structure
The Specialty Simulation presents five problems. Four are scored; one is pretest. Problems are discipline-specific (RN or SW). Within simulations, candidates work through clinical scenarios by selecting actions related to:
- Information Gathering (IG) — what data, assessments, consultations, and clarifying facts you seek
- Decision Making (DM) — what interventions, plans, communications, and next steps you choose
Options in simulations are weighted (commonly on a scale that can include negative weights for harmful or inappropriate choices and positive weights for essential actions). Your IG selections produce an IG score; your DM selections produce a DM score. Content experts set a minimum pass level (MPL) for IG and for DM on each problem; overall simulation pass/fail depends on meeting the combined IG and DM standards across the scored problems.
Critical simulation scoring rule
Candidates must achieve passing performance in both IG and DM. Strong IG with failing DM (or the reverse) does not produce an overall simulation pass. Score reports help you see IG versus DM performance so you know which skill to remediate if you retest.
Scenario: why "knowing the right discharge plan" is not enough
On a simulation, a candidate who jumps straight to arranging SNF placement without gathering functional status, payer authorization status, patient goals, and caregiver capacity may rack up negative or zero-weight IG omissions even if the eventual placement idea was reasonable. Conversely, a candidate who gathers endlessly but never initiates the indicated notices, referrals, or team communications can fail DM. ACM simulation rewards disciplined information gathering followed by accountable decisions, not one without the other.
You Must Pass Both Parts
Certification requires passing scores on:
- The Core multiple-choice examination, and
- The Specialty Simulation examination
Passing only Core or only Simulation is not enough. If you fail one part, handbook policy allows you to retest the failed section(s) rather than automatically forcing a full rewrite in every case — fee details appear in Section 1.3. Study plans should therefore allocate deliberate simulation practice, not only multiple-choice drilling.
Criterion-Referenced Scoring and Modified Angoff
ACM uses a criterion-referenced standard. That means the passing point reflects the level of competence subject-matter experts judge necessary for safe, effective beginning-level certified practice — not a quota that fails a fixed percentage of candidates each form.
The handbook describes a modified Angoff approach: content experts estimate the probability that a minimally competent candidate would answer each scored item (or meet simulation standards) correctly; those judgments are analyzed and refined statistically. Because forms differ, the exact numeric passing point can vary by form even though difficulty is kept parallel through careful form assembly.
What this means for you
- There is no official published "you need 70%" figure to treat as gospel for ACM Core.
- Comparing your unofficial practice-test percentage to a friend's score is less useful than mastering blueprint topics to a "minimally competent hospital case manager" standard.
- Do not memorize or invent a pass rate — ACMA/NBCM do not require you to know an unpublished pass percentage, and fabricating one is misleading.
Score Reports: Content Categories, IG, and DM
After testing, score reporting is designed to support remediation:
- Core: performance feedback by content category/domain, so you can see whether Screening and Assessment, Care Coordination/Transitions, or Process Improvement needs work.
- Simulation: separate insight into Information Gathering (IG) and Decision Making (DM) performance.
Use the report operationally. If Core Care Coordination is weak, prioritize utilization, placement, notices, and interdisciplinary planning chapters. If simulation DM is weak, practice choosing interventions and communications after you have enough data — not endless data collection alone.
Testing Delivery Partner: Confirm Before You Schedule
Historically, ACM examinations have been delivered through PSI. ACMA's more recent (2026) candidate-facing pages have discussed transition activity involving DRC / Pearson VUE. Delivery partners can change while the handbook's exam structure remains the candidate's content truth.
Action step: Before you pay expedited fees or book travel, confirm the current authorized delivery partner, identification rules, and scheduling portal on ACMA's official ACM website. Do not rely on outdated third-party blogs that still list only PSI or only Pearson without checking the live ACMA source.
Key Takeaways for Section 1.2
- Core = 110 MC (90 scored / 20 pretest) in 2 hours; Simulation = 5 problems (4 scored / 1 pretest) in 90 minutes.
- Both parts required; IG and DM both matter on simulation.
- Modified Angoff criterion-referenced standard; score reports guide remediation by category and IG/DM.
- Verify today's delivery partner on ACMA's site before scheduling.
Which statement correctly describes the ACM Core examination structure under the January 1, 2024 handbook?
A candidate passes the Core but does not meet the simulation Decision Making standard even though Information Gathering looks strong. What is the certification outcome?
How is the ACM passing standard best described?