Part IV Advancement and Development – Updates Pages

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Updates posted as received
Currently Updated As of 3:30 PM MT 3/01/2021:

Posted on March 1st, 2021

Introducing the Part IV Advancement and Development Project

In 2019, after a year of successful computer-based exam administrations, the NBCE decided to turn its focus to evaluating the current state of the Part IV exam. We performed a preliminary analysis of our current Part IV in comparison to Objective Structured Clinical Examinations (OSCE) given to other healthcare professionals. The NBCE’s Board of Directors saw a need to further investigate best practices in the field of OSCE testing and formed a project team with the following objectives:

  1. Perform an evaluation of all OSCE exam trends by researching a benchmark group.
  2. Engage stakeholders to gather feedback about the current state of the NBCE’s Part IV exam and gauge interest in improvements.
  3. Perform a psychometric analysis of the current Part IV exam to identify areas of strength and areas that could be improved.

In 2020, the NBCE connected with other testing organizations. We extensively researched other OSCEs, and created preliminary budgets to evaluate the cost of potential changes. We sent a survey to examinees to get their opinion about the current state of the Part IV exam (a summary of the results can be found here), and held a focus group with state board members about potential changes to the exam. Ultimately, we developed a list of “trends”, which are potential improvements to the NBCE’s Part IV exam that were discovered through our benchmark analysis. When evaluating potential improvements to the NBCE’s Part IV exam, we used the information gathered to evaluate the trends based on the following criteria:

  • How well is the trend represented in the benchmark group (considered a best practice)?
  • Will it impact the validity or reliability of the Part IV exam?
  • Is it financially feasible to implement the trend?
  • Will it impact the standardization of the exam?
  • How will it impact the NBCE’s stakeholders?
  • How feasible is implementation?

Through the evaluation of these criteria, we were able to identify eight potential changes that could improve the NBCE’s Part IV exam and should be evaluated for implementation.

  1. Comprehensive Examinee-Guided Station Format: Combining the single-point stations (Case history, Ortho/Neuro, Physical exam, and Technique) into one comprehensive station that better mimics a real-world patient encounter.
  2. Adding a Documentation Component: Examinees would be required to create a patient note (after the patient-encounter station) documenting their findings, assessment, and plan for that patient.
  3. More External Contribution to Item Development: Develop a method for collecting exam content from a wider variety of people within the chiropractic community (academics, practicing DCs, and state board members).
  4. Adding Video Recording to Stations: Requiring patient-encounter rooms to be set up with video recording equipment that can accurately capture the examinee’s performance for remote review.
  5. Moving DIM to Written Exams: Since DIM is a Computer-Based Test (CBT), we could incorporate the content into the Part III exam, eliminating the Friday testing day.
  6. Eliminating Cross Country Sequestration: Removing the sequestration requirement, which currently requires us to hold examinees until the exam is completed across the country.
  7. Patient Grading Component: Standardized patients rate the examinee on the “humanistic” components of the station.
  8. Paperless Exam: Adding computerized testing equipment for the examinees and evaluators to eliminate scantron answer sheets.

As we kickoff this project, and enter the Discovery and Design phase, we plan on continuing to research these best practices while gathering stakeholder feedback about the impact of these changes. We plan on forming an Advisory Board, made up of members from Chiropractic education and the regulatory agencies who use NBCE’s exam to assist them in making licensing decisions. In order to stay informed of important project updates, please join our mailing list (link found on the project homepage). If you have any questions or comments about the Part IV Advancement and Development project, please reach out to us at


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