FREQUENTLY ASKED QUESTIONS

Ethics and Boundaries Examination

What is the E&B?

The Ethics and Boundaries Examination (E&B) gives state boards a tool to assess the examinee's understanding of ethics and boundaries issues as they apply to chiropractic practice. The examination is designed to be administered to licensed or previously licensed chiropractors in special circumstances.
The E&B test plan is based on survey responses of state chiropractic licensing boards regarding the importance of understanding ethics and boundaries issues to practicing chiropractic in an ethical and legally appropriate manner. Successful completion of the E&B Examination requires that examinees demonstrate an acceptable level of understanding and judgments pertaining to appropriate relationships and interactions required in unsupervised chiropractic practice.

When should the E&B be used?

Each individual licensing board has the sole authority to determine how to utilize E&B examination results in its licensing and/or disciplinary decisions. The E&B examination is administered only at the request or requirement of a state board. Circumstances in which these exams might be used include (but are not limited to):

  • Disciplinary action, including the knowledge of ethics and boundaries issues.
  • Suspension, revocation or licensure relapse (depending on the requirement of the state board).
  • State-to-state reciprocity/endorsement (depending on the requirement of the state board).

When should the E&B NOT be used?

  • The E&B is not to be used to assess students nor for those who are entering practice for the first time.
  • E&B is not used for initial licensing purposes.
  • E&B is not designed for routine license renewal.
  • E&B does not replace NBCE Parts I, II, III, and IV.
  • E&B is not to be used in place of SPEC, but may be used in addition to SPEC.
  • E&B is not to be used as a diagnostic psychological evaluation.

Who can take the E&B?

Eligible applicants must meet all of the following criteria:

  • Hold or have held a license to practice chiropractic.
  • Provide written authorization from a state licensing agency in the form of a requirement or a request
  • Complete the NBCE application process and submit required fees and documentation prior to published deadlines.

Downloadable information brochures, applications and all required forms are available on this website. Examinees should contact the state(s) in which they are interested in seeking licensure for specific requirements.

How do applicants apply for the E&B?

Applicants should print the Post-licensure Examination brochure and application from this website and read and follow instructions. Candidates must also print and complete the application and required forms and then submit them to the NBCE along with the required fees.

When can applicants take E&B?

The E&B is currently offered six times per year at computerized testing centers nationwide.

After verification and processing of the application is complete, the NBCE will mail a confirmation letter to the applicant. The letter contains specific contact information regarding test site location and schedules. See the NBCE Examination Information brochure for the post-licensure examinations for more information about testing dates and deadlines.

What is the format of the E&B?

The NBCE Ethics and Boundaries Examination is a computer-based essay test requiring a written four-part response to five case scenarios. The essay response must focus on the ethical or boundary issue assigned to each scenario. Each case scenario will address a specific topic as selected from the E&B Essay Test Plan by individual state board committees. The test requires that the examinee demonstrate an understanding of the appropriate clinical protocols and judgments necessary in unsupervised chiropractic practice.

Scoring is based on the relevance and thoroughness of the examinee's responses to each of the five case scenarios. Content and expression of ideas are more heavily weighted in the grading than grammar, punctuation, or spelling. Please refer to the "Interactive Sample Essay Writing Exercise" for more information.

The examinee will be allowed a maximum of 40 minutes to compose a type-written response for each case scenario. Test appointments are scheduled for up to a total of 4 hours to allow for: a brief introductory tutorial; three hours and 20 minutes for the essay writing; two 15-minute breaks; and a post-test survey.

What is covered on the E&B?

The E&B test plan covers the following areas:

1. Boundary Violations

  • Doctor with Patient
  • Doctor with Staff

2. Fraud

  • Billing and Coding
  • Kickback/Steering Schemes

3. Doctor's Duties and Office Protocols

  • Standards of Care
  • Patient Records/Documentation

4. Unprofessional Conduct

  • Alcohol/Substance Abuse
  • Negligent/Inappropriate Behavior

How do potential candidates know if their state utilizes the E&B?

For the most current information on state licensing requirements, candidates should contact their state licensing authority for more information.

What is a passing score on the E&B?

The NBCE recommends that examinees must pass all five essays to receive credit for completion of the examination. Each E&B essay has a possible maximum of 16 points; 12 points is a passing score. Detailed E&B scoring criteria are available on the NBCE website.

Attaining an NBCE recommended passing score does not under any circumstances guarantee acceptance by a state licensing agency. The use of SPEC and/or E&B scores for any purposes is at the discretion of state licensing boards.

E&B Essay Retake Policy
  • An examinee scoring below 12 points on three or more essays will retake the entire examination from topics originally designated by the state board with new scenarios randomly selected.
  • An examinee scoring 12 points or above on three or more essays will retake only failed portions of the examination; topics will be as originally designated by the state board with new scenarios randomly selected.

How do examinees learn of their scores on the examination?

The NBCE verifies scores and mails them directly to examinees and licensing authorities, approximately three weeks after the examination administration. The NBCE issues no certificate of completion for its post-licensure examinations (SPEC and E&B). Examinees will not receive a score from the testing center at the end of the examination.

How do examinees request a transcript of their E&B results?

By submitting a E&B application, an examinee gives the NBCE express authorization to provide a transcript of his or her examination results to the state chiropractic licensing agency or other licensing authority that requested or required the examination. This transcript will include only the most recent E&B score, irrespective of the score result.

The NBCE will release a E&B transcript only to the licensing authority that initially requested or required that candidate to take the E&B. The NBCE will not release a transcript to any additional state without receiving a written request or requirement directly from that state along with an examinee’s written authorization to release score results. In some instances, a state may request or require a licensure candidate to retake the E&B to provide a more current score.

One complimentary E&B transcript is included in the E&B fee. Each subsequent transcript request that meets the above requirements costs $25, paid to the NBCE in U.S. guaranteed funds. Examinees should allow two weeks for processing of a transcript.