NBCE Part IV
Practical Examination
Duties of a Part IV
Examiner
Dr. Paul Townsend, D.C.
Director of Practical Testing, Research & Development
Dr. LeRoy Otto, D.C.
Part IV Chief Examiner, NWHSU Test Site
NBCE BATTERY OF PRE-LICENSURE
EXAMINATIONS




Part I – Basic Sciences Examinations
Part II – Clinical Sciences Examinations
Part III – Written Clinical Competency
Part IV – Practical Examination for
Licensure
PART IV EXAMINATION PURPOSE
To provide a testing format in which the
candidate demonstrates his or her
ability to perform occupational tasks in
a clinical setting:
PART IV TEST DEVELOPMENT

Developing Test Items





NBCE Workshops
Chiropractic College Clinical Instructors
Technique Instructors
Certified Content Experts
Staff Consultants
PART IV TEST COMMITTEE MEETING

Cases and questions selected by state licensing
board representatives
SETTING PASS/FAIL SCORE

A panel of experts


State Licensing Board Representatives
Content Experts
HIERARCHY OF CLINICAL SKILLS
DO
PRACTICE
SHOW HOW
PART IV
KNOW HOW
PART III
KNOWLEDGE
PARTS I & II
NBCE PRACTICAL EXAMINATION
Content Areas
 Diagnostic Imaging
 Chiropractic Technique
 Chiropractic Case Management
CONTENT WEIGHING
TEC
17%
DIM
16%
DIM
CAM
TEC
CAM
67%
DIAGNOSTIC IMAGING
10 Four-minute Stations
 Candidate identifies radiological signs on plain
film x-rays
 Candidate determines most likely diagnoses
 Candidate makes most appropriate initial case
management decisions

CHIROPRACTIC TECHNIQUE
5 five-minute stations
 Candidate demonstrates two adjusting
techniques per station
 Cervical spine
 Thoracic spine
 Lumbar spine
 Sacroiliac articulations
 Extremity articulations

CHIROPRACTIC CASE MANAGEMENT







10 five-minute patient encounter stations
10 linked post-encounter probe (PEP) stations
Candidate performs focused case histories
Candidate performs focused physical examinations
Candidate evaluates patient clinical database
Candidate makes differential diagnoses
Candidate makes initial case management decisions
KEY FEATURES OF NBCE PRACTICAL
EXAMINATION


Use of standardized patients
Use of OSCE format and protocols
CASE HISTORY STATIONS
Successful candidates use organized approach
while obtaining case history information
 Successful candidates communicate effectively
with patients
 Successful candidates respect patient dignity
 Successful candidates elicit adequate historical
information

PERFORM A FOCUSED CASE HISTORY
PEP STATION INFORMATION
Post-Encounter Probe Station
PUTTING IT ALL TOGETHER
PART IV CANDIDATE NUMBERS
4500
4000
3500
3000
2500
2000
1500
1000
500
0
1996
1998
2000
2002
2004
2006
2008
PART IV STATE ACCEPTANCE
48
42
43
45
46
38
36
27
7
Co lumn 1
1996
1997
1998
1999
2000
2001
2002
2003/2004
2005
7
27
36
38
42
43
45
46
48
LOGISTICS OF PART IV
TOTAL CANDIDATES TESTED
SINCE JANUARY 1996
44,419
PART IV PERFORMANCE




Part IV provides a highly reliable assessment of the
chiropractic clinical skills required for licensure
The dependability of the pass/fail decision is consistently
at or above .90
The inter-rater reliability across the 15 rated stations is
.93 - .96
The key to these high correlations is adherence to NBCE
scoring protocols and consistent performance by the Part
IV examiners
CHIROPRACTIC EXAMINER PROFESSIONAL
REQUIREMENTS





Must have been in licensed chiropractic practice for a minimum of 5 years
Chiropractic license must be in good standing with the FCLB (vis a vis CinBad) and with the state chiropractic licensing board
There cannot be any outstanding actions against the chiropractor’s license
Chiropractors serving on state chiropractic licensing boards may be
nominated by their boards to participate on Part IV test committees or as
chiropractic examiners during Part IV exam administrations
Part IV examiners may not be currently serving on Chiropractic College
Boards of Trustees, be chiropractic college faculty members, or serve as
preceptors for students enrolled in the Part IV exam
PART IV EXAMINER
DUTIES & RESPONSIBILITIES









Reports to the Chief Examiner
Follows instructions of the Chief Examiner
Conducts himself/herself in a professional manner
Strives to be fair and objective in the assessment of examinees
Does not prompt or give unfair advantage to any examinee
Has no contact with students/examinees prior to or following the exam
Avoids any appearance of impropriety or conflict-of-interest
Consults with the Chief Examiner when any question about the exam or
exam content arises
Accepts the Chief Examiner’s decision as final
PART IV EXAMINER TRAINING
Part IV Examiners must:
 Attend the Friday evening Examiner Orientation & Training

Examiners receive training in areas that impact test site personnel relations and
examinee assessment
•
•




Sexual Harassment
Gender and Racial Bias
Examiners receive training in candidate skills assessment and checklist
marking
Examiners receive feed back on errors made in previous exam
administrations
It is absolutely essentially essential that examiners understand the NBCE
scoring protocols, and how examiner errors affect student scores
It is absolutely essential that examiners adhere to the standards set by the
NBCE
PART IV CHIROPRACTIC EXAMINER
COMPENSATION
Friday night training
50.00
3 Saturday rotations @ $125/rotation
375.00
3 Sunday rotations @ $125/rotation
375.00
$800.00
CONTINUING EDUCATION (CE)
CREDITS





Currently 47 states including Washington, DC recognize participation in the
Part IV for CE credit
CE credit ranges from 12 to 30 credits per year
Letters are mailed to participating examiners by the NBCE Department of
Practical Testing
Examiners must keep these letters on file in case they are audited
If the letter from the NBCE is not received within four weeks following the
exam, the examiner should contact Debora Beeman at dbeeman@nbce.org
or call 1-800-964-6223 Ext. 154
Questions?
If you would like to know more about
the NBCE Part IV examination,
contact Paul Townsend, D.C. at
ptownsend@nbce.org