This paper outlines the nexus between developing pedagogical content knowledge and the pressures for preparing pre-service teachers to be successful on high stakes testing. Increasing expectations about what students should know and be able to do, breakthroughs in research on how children learn, and the increasing diversity of the student population have significantly influenced the knowledge and skills teachers must have to meet educational goals for the 21st century. In mathematics undergraduate education, how pedagogical awareness is taught should relate to deeper and broader understandings of mathematical concepts for preservice teachers. A study was conducted with 193 students enrolled in their senior integrated methods block in the semester prior to beginning their student teaching. In an attempt to determine the effectiveness of the mathematics teacher preparation program, during the last week of their mathematics methods class, the students completed two assessment measures which examined their mathematics pedagogical content knowledge. Questions mirrored the pedagogical content questions on the state mandated teacher certification exam. Results indicated that previous mathematics ability was important to student success on all portions of the state mandated teacher certification exam. (Contains 30 references.) (SM)