In a recent press release, the National Board of Chiropractic Examiners (NBCE) announced several proposed changes to its licensing exams designed to improve student access to testing and increase exam production without increasing costs; all the while maintaining the integrity, validity and accuracy of the tests. Dr. Karlos Boghosian, NBCE president, and Dr. Norman Ouzts Jr., NBCE CEO, provided additional information in a follow-up written interview.
The first proposed change is with the computer-based tests (CBT). The board’s goal is to increase the number of testing opportunities annually for Parts I, II, III and the Physiotherapy exam. The NBCE’s proposed solution is to move toward “adaptive exam delivery,” which would provide a single score for Parts I and II, rather than scoring each domain within each test.
This will not only decrease the length of the exams, but also reduce the need to retake a specific domain, assuming that the student attains a passing score on the entire part. If the student fails the entire Part I or Part II, they will be required to retake the entire exam.
According to Dr. Ouzts Jr., “for the computer-based exams we intend to triple the number of testing opportunities by making all exams available for testing for more than two weeks a month, 9 months out of the year (excluding May, November, and December). This plan will allow us to test more examinees every month, as well as provide examinees with the flexibility to better plan their own path to licensure.”
These changes could be implemented as early as the second quarter of 2024.
The second proposed change is to Part IV. As Dr. Ouzts Jr. explains, “in the Part IV Advancement and Development project, we plan to better mimic real-world patient encounters by having each station include a complete patient interaction, from case history to technique. We also would like to move towards best practices in practical testing by introducing robust technology that would allow us to record the exam and use a completely paperless process for grading and quality assurance. By changing the format of the stations, we would be dramatically reducing the number of stations from our current model while increasing the length of each station.
“This means we are also dramatically decreasing the number of examinees we can test in each administration. If we were to stay on Chiropractic college campuses, we would need to host nine to 13 Part IV exam administrations a year at each of our current test sites to accommodate our current volume of examinees. We would also need to install and maintain the technological infrastructure required for video recording in their clinic space. For these reasons, we decided to evaluate a centralized testing location. The NBCE is proposing the move to a centralized testing location where we can increase testing opportunities without burdening the college campuses.
“Our current plan would be to offer the Part IV exam 3 days a week, 48 weeks out of the year. This not only allows us to test our current volume of examinees, but [also] adds 25% additional capacity to ensure that examinees have options when scheduling. Our current plan shows the earliest transition to a centralized testing location in mid-2025 with plans to begin pilot testing the technology and exam changes in 2024.”
As of press time, the NBCE was reaching out to its stakeholder community to explore implementation of these improvements. According to Dr. Ouzts Jr., this includes “actively communicating and soliciting feedback from Chiropractic College leadership and faculty, students, state board members, and our current test site staff. We will also provide updates to the public via our website at nbce.org/projects, where they will have the opportunity to sign up for email announcements or complete a form to provide us with feedback pertaining to our proposals. However, we will not finalize either schedule (above) until our stakeholders’ feedback has been evaluated. Specifically, we want to ensure that students have ample time to prepare for these proposed changes. The Chiropractic Colleges are essential to this process, as they provide valuable insight and assistance with the development of the communication plans and schedules for implementation.”
Perhaps of greatest concern in the minds of students is the potential increase in the exam fees that could come with these proposed improvements. According to Dr. Boghosian:
“[The] Computer-Based Testing and Part IV Advancement and Development projects have the potential to transform chiropractic licensure testing with more robust testing capabilities and superior examinee experience. When we began investigating exam improvements, one of our main goals was to stabilize or decrease exam administration or exam development costs. However, as with most technological advancements, there are investments that must be made at the beginning of these projects to build the infrastructure required for innovation.
“After a period of stakeholder engagement, and finalizing project plans that incorporate their concerns and feedback, the NBCE Board of Directors will make decisions about how to fund these projects. We want to emphasize that our goal is to implement these proposals without increasing exam costs. The Board of Directors is committed to transparent communication about any exam fee changes and will keep everyone informed of potential impacts to exam fees as we progress through the project planning process.”
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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