Our Commitment to Stakeholders
in the Next Phase of Part IV
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A Closer Look at the Redesigned
Part IV Exam
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      Updated: September 2025
INTRODUCTION
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
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 the right>>
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
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Technique Station Grading
• Musculoskeletal System
• Neurological Conditions
• Cardiovascular/Pulmonary Conditions
• Gastrointestinal Conditions
• Endocrine Conditions
• Renal/Urological Conditions
• Malignant Conditions
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.
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 ExamÂ
July 27, 2024 – University of North Texas Health Sciences Center in Fort Worth, Texas