The Competency-Based Assessment Program is an assessment tool that midwifery regulators can use to evaluate the knowledge, skills, and professional judgement of certain individuals who are seeking to practise midwifery. It supports decision makers in assessing whether a candidate is competent to practise.
A note for Ontario midwives and applicants: Most Ontario midwives and applicants will not interact with the Competency-Based Assessment Program. If you are applying as a first-time applicant to the College of Midwives of Ontario (CMO), please review the CMO’s Apply for Registration page. Certain midwives requesting a class change from inactive to general, and former registrants applying to return to practice, may be asked to complete a competency-based assessment as part of their application. This will occur where there is a considerable deficiency in meeting active practice requirements.
The College of Midwives of Ontario (CMO) developed the assessment program in collaboration with other Canadian midwifery regulatory authorities and consulted practising midwives. The program is delivered as a structured oral examination, and it evaluates a candidate’s clinical reasoning and professional judgement across key competency areas. The Canadian Midwifery Regulators Council’s (CMRC) Canadian Competencies for Midwives (2022), Appendix to the Canadian Competencies for Midwives (2024), and the CMRC Self-Assessment Tool (2024) together set out the entry-level standards for midwifery practice that this program assesses.
Why do we use a Competency-Based Assessment?
While midwives may elect to focus their practice in specific areas or settings, all registrants are expected to possess and maintain the entry-level competencies that underpin safe, ethical, and effective midwifery practice.
The competency-based assessment provides a route for evaluating whether candidates demonstrate the entry-level competencies required to practise midwifery. The assessment provides an objective and standardized approach for identifying areas of demonstrated competence and any gaps; enabling regulators to recommend a tailored pathway for each individual to meet entry-level expectations and demonstrate competence consistent with full-scope midwifery practice.
Program Components
Assessment Fee
Candidates who qualify for competency-based assessment are required to pay a fee of CAD $1,200.00* to participate in the program.
The program operates on a cost-recovery model, meaning the fee is set to recover the costs associated with delivering the assessment. The fee reflects the resources required to ensure a fair, rigorous, and standardized assessment process and is not intended to generate revenue.
*In 2026, the College of Midwives of Ontario is offering a subsidized launch rate. Accordingly, the fee listed above may not reflect the full cost of delivering the program in future years.
Assessment Format
The competency-based assessment is a structured oral examination conducted by videoconference and facilitated by a panel of trained assessors. The assessment is closed book and evaluates candidates using a consistent and standardized approach.
The assessment consists of eight pre-determined clinical scenarios. Each scenario has seven to eight questions that progress through the core Canadian midwifery competencies. The full assessment is completed within three hours, with a short break scheduled midway through the session.
Assessment Results
Following the assessment, assessors consolidate their findings into a consensus-based report that reflects the candidate’s demonstrated competencies across the assessment scenarios. The report includes competency ratings, narrative feedback, and recommends a pathway to support the candidate’s ability to provide safe, effective, and comprehensive midwifery care.
The final report is provided to both the candidate and the referring regulatory authority to support informed decision-making and next steps. In Ontario, the CMO would receive the report.
Accommodation
The CMO is committed to providing reasonable accommodations to support equitable access to the assessment process. Accommodation requests are reviewed on a case-by-case basis to ensure fairness while maintaining the validity, reliability, and security of the assessment. Accommodations will be provided up to the point of undue hardship for the CMO.
Candidates who require accommodation must submit a request at the time of scheduling their assessment by completing the CMO’s Competency-Based Assessment Accommodation Request Form. The form outlines the nature of the requested accommodation and any relevant supporting information needed to assess the request. The CMO will cover reasonable costs associated with approved accommodations.
Appeals and Procedural Fairness
Candidates may request a formal appeal where there are concerns about how the assessment was conducted or administered. The process is intended to support procedural fairness, transparency, and accountability, and to ensure that the assessment was conducted in accordance with established standards, policies, and expectations. An appeal is not a reassessment of clinical knowledge or judgement.
Appeals must be submitted in writing using the CMO’s Competency-Based Assessment Appeal Request Form following the candidate’s receipt of their assessment results. The appeal will then be reviewed by an independent fourth assessor to determine whether the assessment was conducted in a manner that resulted in a material procedural error or barrier to successful completion. The review will focus on the integrity of the assessment process, not on re-evaluating the candidate’s performance.
Following completion of the appeal review by the independent assessor, the candidate will be notified in writing of the appeal outcome and any applicable next steps.
Information for Ontario Candidates
Eligibility
Practising midwives (those in the new registrant, supervised, transitional, or general class) will not be required to complete a competency-based assessment.
Applicants seeking a change in registration class from inactive to active, as well as former registrants who apply for registration with the CMO, may be required by the Registration Committee to complete a competency-based assessment as part of the application review process.
The Registration Committee conducts this review to determine whether a requalification program is required and, where applicable, to develop an individualized requalification plan. The findings of the competency-based assessment inform the Committee’s decision and the development of any requalification requirements.
Referral Process
Full details regarding the active practice requirement, as well as the policy governing referrals for competency-based assessment, are available here.
Information for Candidates Outside Ontario
Eligibility
Each midwifery regulator determines the eligibility criteria for participation in the Competency-Based Assessment Program. Regulators assess whether the program is appropriate within their own legislative and practice framework and identify candidates who are required to participate. The referring regulator retains full authority for all regulatory decisions related to registration, supervision, and return to practice.
Referral Process
The CMO accepts referrals from other jurisdictions on a case-by-case basis, formalized through a Memorandum of Understanding.
When a referral is made, the referring regulatory authority submits candidate information to the CMO through the established referral process. The CMO works with the referring regulator to confirm acceptance and coordinate next steps, including communication with the candidate regarding assessment scheduling and any approved accommodation requests, where applicable.
Canadian midwifery regulators seeking additional information about referrals, fees, logistics, timelines, or other administrative aspects of the Competency-Based Assessment Program are encouraged to contact the CMO directly at qap@cmo.on.ca.
Outcomes
The Competency-Based Assessment Program provides standardized outcomes to support regulatory decision-making. The referring regulatory authority determines whether and how the assessment outcomes are considered or applied within its own regulatory framework and retains sole authority over any decisions related to registration, supervision, and return to practice.
The College of Midwives of Ontario acts solely as the administrator of the Competency-Based Assessment Program and does not exercise decision-making authority for program participants in other jurisdictions. Questions regarding regulatory decisions or requirements beyond the administration of the assessment should be directed to the referring regulatory authority.
Frequently Asked Questions
We’ve answered some commonly asked questions below. If you have any further questions, please contact the CMO at qap@cmo.on.ca.
Competency-based assessments are conducted by registered midwives from across Canada. Assessors are engaged by the CMO and trained to conduct assessments in accordance with established standards and processes.
Assessors are selected based on their demonstrated interpersonal, communication, and leadership skills, as well as their experience in mentorship, clinical supervision, and providing constructive feedback. They apply their professional judgement and clinical expertise to conduct evaluations that are objective, accurate, inclusive, and fair, and to assess how well candidates demonstrate the required competencies.
The competency-based assessment requires significant coordination, including the scheduling of registered midwives serving as assessors and the allocation of assessment time and resources.
As such, where a candidate cancels, requests to reschedule, or fails to attend a scheduled assessment, the CMO may apply cancellation, rescheduling, or non-attendance fees in accordance with its applicable policies and procedures, as amended from time to time. Any such fees are intended to reflect reasonable cost recovery associated with assessor time and administrative preparation.
The CMO may, at its discretion, waive or adjust such fees in accordance with its applicable policies and procedures, including in circumstances involving reasonable or extenuating factors. Any decision to waive or adjust a fee will be communicated in writing to the candidate and, where applicable, the referring regulatory authority.
The competency-based assessment process may extend overall registration timelines, as the administration of the program relies on external experts who are not full-time employees of the CMO. While the CMO makes best efforts to complete the assessment process within six weeks, timelines may vary depending on the availability of assessors and reviewers.
Unlike an objective structured clinical examination (OSCE) or a written exam, the structured oral examination is designed to assess the application of knowledge, critical thinking, ethical and professional judgement, and communication skills. Candidates are expected to describe how they would respond to specific clinical or professional scenarios and to articulate the reasoning behind their decisions.
We recognize that in clinical practice, many actions are performed intuitively and may not be easily articulated in an examination setting. For this reason, assessors may use limited prompting to elicit a candidate’s reasoning or clarify responses. Prompting is carefully controlled, as there is an important distinction between drawing out knowledge that a candidate possesses and providing guidance where the candidate lacks the required understanding. Candidates are not required to provide a correct response to every question; rather, they are evaluated in how they approach unfamiliar or complex situations, apply professional judgement, and use available resources.
Candidates are also evaluated in their demonstration of inclusive midwifery care, including trauma-informed, client-centred, comprehensive, and compassionate practice.
Through the assessment, candidates’ current, working knowledge across the breadth of entry-level competencies will be assessed. Accordingly, candidates are not required to prepare for the examination.