Our Commitment to Stakeholders

in the Next Phase of Part IV

Your feedback is invited. Please complete the survey here.

A Closer Look at the Redesigned

Part IV Exam

Your feedback is invited. Please complete the survey here.

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.

Last updated: September 2025

2026 Part IV Exam

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 or the button below>>

Goal of the Part IV Exam

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.

Part IV Exam FAQs

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)

Testable Content Areas

Musculoskeletal System

Neurological Conditions

Cardiovascular/Pulmonary Conditions

Gastrointestinal Conditions

Endocrine Conditions

Renal/Urological Conditions

Malignant Conditions

Grading Domains

Patient Evaluation – Perform a focused case history.

Patient Examination – Perform case appropriate examination procedures based on the chief complaint and information gathered from the case history.

Clinical Decision Making and Case Management -Provide a brief report of findings providing patient with next steps in their care.

Interpersonal and Communication Skills/Clinical Professionalism -Professionally interact and effectively communicate with the patient.

Documentation – Accurately create a SOAP note for the patient encounter.

Technique Stations

Examinee will be graded on proper set up of ten (10) chiropractic adjustments including doctor position, patient position, and line of drive.

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.