CPM written exam vs. skills assessment — which part is actually harder?

Passed the written with 76% on first attempt. The minimum passing score through NARM was 70% when I sat for it. The skills assessment was nerve-wracking in the moment but I didn't find it technically as difficult as the written sections on complications and emergency management.

I found the written exam harder than the skills assessment, but I'm coming from 4 years of apprenticeship under an experienced CPM. The documentation portion of the skills section is more about organization and completeness than clinical difficulty.

Pharmacology was maybe 12–15% of my written exam. Focus on oxytocics, antibiotics for GBS prophylaxis, and neonatal eye prophylaxis protocols.

The neonatal resuscitation questions on the written exam are very scenario-based. You need to know the NRP algorithm cold and be able to apply it in a timed, stressful question format. I drilled 200+ NRP scenarios in my last 4 weeks of prep and it made a real difference.

My practice scores were similar to yours — around 69–73% — and I ended up getting 74% on the actual exam. Pushing through 3–4 hours of practice questions daily in my last 3 weeks is what moved my scores. The format gets very familiar and the trick questions start to feel predictable.

Honestly both parts stressed me out leading up to it, but for me the written NARM exam was harder to prepare for because it felt so unpredictable. I spent way too long making flashcards for specific numbers and protocols and then the exam would ask something more clinical-judgment-based that my flashcards couldn't really touch. The thing that actually moved the needle for me was working through practice questions in timed chunks and then really digging into why I got things wrong, not just memorizing the right answer.

The skills assessment was nerve-wracking in a different way, it's more performance anxiety than actual knowledge gaps. If you've done the hands-on hours you've done the skills. What helped me was having my preceptor run me through stations cold, no warning, no setup, just go. Simulating that pressure beforehand made the real thing feel way less like a big deal. So I'd say split your energy but don't underestimate how much the written can humble you even when you feel ready.

I just got my results last month so this is fresh for me. Honestly both parts were harder than I expected, but the written NARM exam caught me off guard more than the skills assessment did. I'd been so focused on practicing my hands-on stuff that I didn't realize how deep the written questions go on things like pharmacology and emergency protocols. The thing that actually made the difference for me was doing timed practice blocks instead of just reviewing notes. Like, sitting down and doing 50 questions in 60 minutes over and over until the pacing felt automatic.

The skills assessment is stressful in a different way because it's performative and someone's watching every move you make, but if you've been in clinical hours you've already done most of it. The written exam tests stuff you might not have seen in practice at all. So if I were you with 10 weeks out, I'd spend at least 60% of my remaining study time on the written side, especially the sections that feel weirdly niche because those are exactly what shows up.