The study focuses on the cognitive assessment of certification examination in medicine. The purpose was to investigate the relationship between the structure of the examination questions and the examinees' written responses. The responses from three groups of residents with undergraduate degrees from McGill (3), Toronto (2) and Manitoba (2) medical schools were used. A sample of one basic science and two clinical question in Endocrinology were selected. The responses were analyzed using cognitive methods which provided a qualitative assessment of subjects' knowledge structures relative to task.