The NBCE Part IV Examination tests individuals in three major areas:
- The DIM Examination will consist of 10 stations. Each examinee must complete all 10 stations within the allotted time (four minutes per station).
- At each station, the examinee will have the opportunity to view radiograph(s) and/or other diagnostic images of a patient. In addition, the examinee will have access to other clinical data.
- A scannable answer sheet will be provided on which the examinee will mark the answers for the questions at the 10 stations. Each station will have two extended multiple-choice questions for the examinee to answer concerning the case. Each question will have 10 choices. The examinee will be required to select two of the most correct choices.
- The examinee will be required to select findings that are presented on the radiograph(s) and that are consistent with the additional clinical data provided for each question at the station.
- The examinee may be required to identify various types of special imaging, i.e., MR, CT, radionuclide bone scan or diagnostic ultrasonography.
- The Chiropractic Technique Examination will consist of five stations with five minutes allotted to complete each station. Each examinee must complete each of the five stations within the allotted time. There will be a one-minute and 30-second passing time between each station.
- At each station, the examinee will be provided with a written description of two vertebral or extremity subluxations. The instructions will include the two chiropractic techniques to be demonstrated and points of performance that will be evaluated. The instructions will include the required patient position, doctor hand contact and segmental contact.
- The examinee will place the patient as instructed and set up for the adjustments in a manner that is consistent with the written instructions and appropriate for the vertebral or extremity subluxations described in the written case scenarios.
NOTE: For students that are taught an assisted/resisted model of technique, all of the set-ups on this portion of the Part IV Examination should be for assisted methods of adjustments.
- The examinee may also be required to demonstrate static and/or motion palpation techniques and to describe joint-related anatomical landmarks and/or normal joint motion.
- The examinee will be evaluated by an examiner (licensed chiropractor) on the points of performance described in the written instructions.
- The Case Management Examination consists of 20 stations in which the examinee will be required to carry out certain activities or answer questions related to a clinical case. Examinees will have five minutes to complete each station. There will be a one-minute and 30-second passing time between each station. Examinees must complete each of the 20 stations in the allotted time.
- At each station, the examinee will be required to perform one or more of the following activities:
- Perform a brief (focused) case history
- Perform a brief (focused) physical examination
- Perform a brief (focused) orthopedic/neurological examination
- Choose the most likely diagnoses and/or clinical impressions
- Choose the most appropriate case management procedures
- Choose the neurological signs most likely to be present
- Choose the most appropriate orthopedic/neurological tests to perform
- In those stations where examinees are asked to perform a case history, physical examination, or orthopedic or neurological test procedures, they will be observed by an examiner (licensed chiropractor). Examinees will perform these tests/procedures on a patient who has been trained to simulate a clinical condition.
- Examinees will be evaluated on their clinical skills as well as their ability to communicate with the patient. They will be expected to treat the patient as they would treat a patient in their own practice. Examinees will respect the patients’ dignity at all times.
- The case history stations are case specific. Examinees will be evaluated on their ability to fully explore the parameters of the patient’s condition and to elicit specific clinically relevant elements of the history from the patient. This specific historical information enables the examinee to form a clinical impression and to rule in or rule out conditions of a similar nature or with similar presentation.
- The examination stations involve demonstration of clinical tests and procedures on patients who exhibit physical signs and symptoms of specific conditions. Examinees will be evaluated on their ability to perform these procedures within the context of a specific case, and their ability to elicit all necessary clinical signs and symptoms from the simulated patient for each of the procedures demonstrated.
- Certain stations may require examinees to interact with the examiner to explain the clinical significance of a procedure or to report the examination findings of a procedure. This will be specifically explained in the station instructions, and the notation (verbal component) will follow the named test or procedure. The examinee will perform the procedure on the simulated patient and then follow the instructions for the verbal component.
- At the post-encounter probe (PEP) stations that immediately follow the simulated patient stations, the examinee will be required to answer two questions related to the clinical condition exhibited by the patient. At these stations, several pages of additional clinical information related to the case will be provided, as well as patient imaging.
- Time is very important in the Case Management Examination. Five minutes will be allotted to complete the required tasks at each station. One minute and 30 seconds will be allotted to pass from one station to the next. Examinees will move from station to station upon hearing an audible/verbal signal. When the signal is given, they will immediately move to the next station.
NOTE: Success in this examination will depend on the examinee’s efficient and skillful performance of the required tasks, as well as on the effective use of the allotted time.