There is a lot of variability in the field of diagnostic medical sonography and this can potentially have a negative impact upon the delivery of high-quality patient care. Bernhardt and associates (2003) commented on the lack of widespread acceptance for specialized accreditation in health education and Babcock (2016) mentioned the lack of research on effectiveness as a possible reason why. This outcomes-focused analysis, which compared exam performance by sonography educational pathway, was purposefully designed to begin to address this research gap. The Lumina Foundation Quality Credentials Task Force's Conceptual Model of Credential Quality: From Design to Outcomes (Humphreys et al., 2019) guided this study. This framework highlights quality assurance by integrating individual and societal outcomes with educational design, policies, and practices focused on student success, equity, and cross-sectional collaboration (Humphreys et al., 2019). Credentialing exam performance, as an individual outcome, was the focus of this study and this provided insights into sonographer entry-level knowledge. This awareness about entry-level knowledge, in turn, may have an impact on the quality of sonograms provided to patients, a societal outcome. This was a quantitative, secondary data analysis that was conducted on a nationwide, high-quality dataset obtained from a sonography credentialing agency to compare the credentialing exam performance of applicants through different educational pathways. This study included three primary and two secondary research questions and the aim was to determine if there were differences in exam performance by educational pathway, specialty exam, exam year, age, gender, and geographical location. The dataset included pass rates and exam scores for 70,403 first-time abdomen, adult echocardiography, breast, obstetrics/gynecology, and vascular technology specialty exam test-takers from 2012 to 2018 who had applied through five prerequisite pathways. Descriptive and inferential statistics were completed, with the inferential analyses including both chi-square and ANOVA tests. The findings demonstrated many statistically significant differences in first-time exam performance. The first-time test-takers who possessed a bachelor's degree in sonography or completed a sonography program with specialized accreditation consistently achieved the highest pass rates and/or mean exam scores. In addition, many analyses showed that exam performance significantly increased over time and that exam performance was significantly impacted by applicant geographical location. A number of analyses also showed that exam performance decreased as the age category increased and that females outperformed males. These findings have important implications for sonography students, educators, professional societies, credentialing agencies, employers, and patients and the study led to noteworthy recommendations for practice and policy. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]