Updated: April 2025
INTRODUCTION
The National Board of Chiropractic Examiners (NBCE) has actively sought feedback from all stakeholders to assess and align our vision for the future. Through these efforts, NBCE identified ‘Key Learnings’—a list of commonly requested innovations aimed at providing the highest quality exam products for the lowest possible costs while increasing testing opportunities for all students.
Following the collection of these objectives, NBCE initiated an in-depth examination of testing procedures employed at Doctor of Chiropractic Programs (DCPs). Simultaneously, we conducted assessments of various healthcare testing organizations to glean insights into prevailing best practices in pre-licensure testing. From this research, we developed multiple implementation models to discern the most fitting modifications and optimal approaches for implementation that align with our objectives, while ensuring the continued validity and reliability of our exams and minimizing the financial implications of the changes.
After identifying the solutions that best met these objectives, NBCE presented the proposed exam changes to state board members, leadership at chiropractic education institutions, and students. Following the collection and analysis of feedback from all stakeholders, the NBCE implemented changes to Parts I, II, III, and Physiotherapy in August 2024. The changes to Part IV will be implemented in 2026.
2026 Part IV Exam
FAQs: To see more frequently asked questions and answers regarding NBCE’s planned changes to be implemented in 2026 for the Part IV Exam, click here.
Goal:
Produce a more efficient exam that better mimics real-world patient encounters while maintaining fairness, reliability, and validity of the exam and providing more testing opportunities.
Solutions:
- Stations that mimic a complete patient encounter, from patient history to a treatment decision.
- Replacing the multiple-choice post encounter station with a station where examinees will be required to write a patient note.
- Video recording of every patient encounter station.
Testable Content Areas
Grading Domains
Technique Station Grading
• Musculoskeletal System
• Neurological Conditions
• Cardiovascular/Pulmonary Conditions
• Gastrointestinal Conditions
• Endocrine Conditions
• Renal/Urological Conditions
• Malignant Conditions
Seven Case Management Encounters
Patient Evaluation – Examinees ability to perform a focused case history.
Patient Examination – Examinees ability to perform case appropriate examination procedures based on the chief complaint and information gathered from the case history.
Clinical Decision Making and Case Management – Examinees ability to provide a brief report of findings providing patient with next steps in their care.
Interpersonal and Communication Skills/Clinical Professionalism – Examinees ability to professionally interact and effectively communicate with the patient.
Documentation – Examinees ability to accurately create a SOAP note for the patient encounter.
Examinee will be graded on proper set up of ten (10) chiropractic adjustments including doctor position, patient position, and line of drive.
Exam Construct and Timing
Seven case management encounters include:
-2 minute pre-encounter door chart review
-14 minute patient encounter
-6 minute post encounter for SOAP note documentation
Technique Station encounter includes:
-2 minute pre-encounter door chart review
-14 minute patient encounter to perform 10 adjustment set ups
-No post encounter – no SOAP note
Part IV Pilot Exam Orientation Video
First Part IV Pilot Exam
July 27, 2024 – University of North Texas Health Sciences Center in Fort Worth, Texas
Centralized Assessment Center
A centralized assessment center in Greeley, Colorado will result in better cost containment over time as opposed to our current distributed testing model. This investment allows for more efficient utilization of resources and reduces cohort sizes to better manage variable costs. Innovations such as robust technology, will allow us to provide a more standardized and higher quality exam experience with 48 weeks of exam appointments available versus the current format of twice per year. The assessment center is scheduled for completion during the first quarter of 2026.
