Fixation on Histology

How to Make the Most of Your HT/HTL Practice Exams


The American Society of Clinical Pathology (ASCP) is the only organization that certifies histotechnicians and histotechnologists. ASCP certification is required, or preferred, by a majority of employers, and may be required for state licensure depending on the state. ASCP certification is your way of showing potential employers that you have the knowledge needed to work in the anatomic pathology field.

The exam can be intimidating. There is so much to know about so many topics, and studying for it can be a huge task. But, there are ways to focus your time for the best payoff.

Practice exams are the best way to study and prepare.

Research has shown that one of the best ways to study is to take practice exams on a regular basis. Testing your knowledge and forcing you to recall concepts helps strengthen your understanding of those concepts. Whether you’re using a book, online practice exams, or questions you write yourself, you’re forcing yourself to recall and apply concepts instead of passively reading about them.

Taking practice exams is only the beginning of your study strategy. You need to be able to review your answers and use them to improve your understanding and overall score. To do that, you need to understand how the ASCP exam is scored.

The ASCP exams are scored differently than other exams.

The ASCP exam not a regular exam where you get a percentage score based on the number of questions you get correct. This exam is a computer adaptive test (CAT). That means that the exam is different for every student. The exam will adapt to you based on your answers.

If you get a level 1 question correct, the next question in that category will be a more difficult level 2 question. If you get that correct, you’ll get a level 3 question. If you get a question wrong, the exam will give you an easier question. Once you’ve completed all the questions on your exam, the questions are scored by difficulty so that the total possible score is 999. A 400 out of 999 is required to pass. A 400 out of 999 doesn’t seem like a very high score, but this exam is constantly adapting to find the limits of your knowledge. The idea is to make sure that limit is above the minimum standard for an entry-level HT or HTL.

This makes analyzing your practice exams a little more difficult. You might get the same percentage of questions correct, but do better on the exam. For example:

Level 1 questions

Level 2 questions

Level 3 questions

Overall score

Practice exam 1





Practice exam 2





In this example, the overall score is the same for both exams, but the overall difficulty of the exam increased. The exam scaled earlier, and there were more level 2 and level 3 questions given. This would result in a higher calculated score for the second exam over the first exam.

Analyzing your practice exams

When you’re going over your practice exam results,  categorize each question by difficulty and category. Most of the practice exams and study guides will already have that information for you. Some of them will do it on a scale of 1-3 like the ASCP exam, and some will have different difficulty scales, such as a 1-9 scale. You can lump those together into three levels (for instance, 1-3, 4-6, 7-9.)

A spreadsheet is a great way to break this down. I have a spreadsheet that I use for my students which allows them to enter their results by category and difficulty. Let’s see what a breakdown would look like for our example:



Level 1

Level 2

Level 3

Practice Exam 1


8/12 (67%)

3/8 (38%)

0/2 (0%)


4/5 (80%)

3/4 (75%)

2/3 (67%)


4/6 (67%)

4/5 (80%)

2/5 (40%)


15/18 (83%)

13/15 (87%)

5/8 (63%)

Lab Operations

4/4 (100%)

2/3 (67%)

1/2 (50%)


35/45 (78%)

20/35 (57%)

10/20 (50%)

Practice Exam 2


4/6 (67%)

5/10 (50%)

1/3 (33%)


4/5 (80%)

5/7 (71%)

2/4 (50%)


4/5 (80%)

6/8 (75%)

2/5 (40%)


10/11 (91%)

11/16 (69%)

3/10 (30%)

Lab Operations

3/3 (100%)

3/4 (75%)

2/3 (67%)


25/30 (83%)

30/45 (67%)

10/25 (40%)

In this example, we can see that fixation is scoring lower than the other categories. The student is getting more level 1 and 2 fixation questions, and not advancing to harder questions. Overall, the student improved their ability to advance to higher level questions, but fixation is still a place to focus on. They also had some difficulty with the level 3 staining questions.

Your analysis can help you use your time wisely and get the best improvement on your score

Once you have your information from your practice exam, you can use that to direct what to focus on. You want to raise the level of difficulty of questions, and improve your overall score.

The categories aren’t all equal. Staining can be 30-40% of the exam, while lab operations is only 10-20%. If you have difficulty with the higher-impact categories, you can raise your score dramatically by focusing on those sections. That’s not to say that the other categories aren’t important. They can boost your score.

Consider which category is going to give you the best improvement. In our example, fixation and staining are two areas the student should focus on. Studying staining to get more level 3 questions correct could make an impact. Staining is a big category, and improving that would require a lot of study of the higher-level concepts to get a higher score. Fixation, however, would probably be easier to improve. Studying some basic fixation concepts and improving the level 2 score would have a huge impact on the score. Processing, embedding, and lab operations would be a small impact for the amount of time it would take to improve. I would recommend that the student focus on fixation as the highest priority, with staining as a second priority until they do better on the level 2 fixation questions.

Focus on the best return of investment of your time. Remember that it will take much more time to improve your score on higher-level questions than for easy or moderate difficulty questions. All the categories are important, and your goal should be to move each one up to a higher level of difficulty.

The exam is just the beginning of your journey in the field

The board exam isn’t like a regular exam. There will almost certainly be questions that stump you or challenge you – that’s the point. You want to show that you have the foundation of knowledge that you need to start your career in the field. By approaching your practice exams wisely, you can identify those areas that will pay off the most and fill in the gaps in your knowledge.

Remember that a passing score doesn’t mean you know all you need to know. It just means that you have a good foundation to start from. We all have more to learn, and you will continue to gain knowledge as you develop in your career.

I’ve included an example of the spreadsheet I use with my students for their practice exam analysis. You can enter your results in the first tab, and see the calculations in the second tab. 

Simulation Exam Breakdown

Don't forget to check out some of NSH's exam prep resources: HT/HTL Prep Course & Histology Exam Simulator.

Best of luck on your board exams, and keep learning!

Written By: Trey Moody, Histotechnology Program Director, Central Texas College