Your Input, Our Action: Shaping the Future of Chiropractic Testing Together

As the chiropractic profession advances and grows in complexity, the expectations placed on new practitioners have increased, requiring stronger clinical skills, sound judgment, and readiness to meet the demands of today’s healthcare environment. Patients, regulators, and institutions demand not only safe and effective care but also evidence-based, real-world clinical decision-making from the moment a chiropractor enters practice.

The National Board of Chiropractic Examiners (NBCE), the organization charged with upholding public safety and professional standards, is approaching this period of change with a renewed focus on modernization and open communication. In response to feedback from across the profession, NBCE is making a concerted effort to share the reasoning behind its reforms, engage more openly with stakeholders, and ensure that licensure testing continues to serve both the chiropractic community and the public with integrity.

By leveraging technology, data, and stakeholder input, NBCE is creating a testing system that enables a faster path to licensure and safeguards the future of the profession by aligning more closely with clinical practice, educational standards, and public expectations.

Modernizing the Path to Chiropractic

NBCE is actively modernizing its Computer-Based Testing (CBT) for Parts I, II, III, and Physiotherapy, delivering a more efficient, student-centered experience while maintaining the integrity and rigor of the exam process. This includes:

• Expanded Test Access: Examinees now benefit from more frequent testing windows, with CBT offered at least 14 days each month (excluding May, November, and December). This shift reduces wait times and gives examinees more flexibility in scheduling.
• Streamlined Exams: Test length has been reduced from 300 to 255 items, saving examinees approximately an hour per session without compromising content validity.
• Holistic Scoring: The transition from six domain-specific scores to a single, comprehensive score offers clearer results and aligns more closely with modern chiropractic curricula.
• Meaningful Outcomes: These changes are already showing results contributing to a more direct, accelerated path to licensure.

These advancements aren’t simply updates to the test experience. They address specific concerns raised by examinees and institutions, from scheduling limitations to unclear scoring models. Every adjustment reflects NBCE’s effort to build a licensure process that is more fair, more practical, and more reflective of how chiropractors are trained and expected to practice today.

Reimagining the Part IV Practical Exam

NBCE’s most comprehensive evolution to date is the advancement of the Part IV Practical Assessment. This necessary shift marks the most significant evolution in chiropractic testing in decades. The transformation is the result of the Advancement & Development Project, a multi-year initiative launched in 2021 and shaped through deep collaboration with educators, licensing boards, students, and practitioners across the country.

By conducting surveys and interviews, listening to a diverse range of voices, and benchmarking against best practices in healthcare assessment, NBCE is working hand in hand with the profession to create a more relevant, equitable, and forward-thinking exam experience.

The redesigned Part IV will feature several major improvements, including:

• Modernized Exam Format: Instead of isolated skills-based tasks, each exam station now simulates a full patient encounter, from patient history and examination to technique and clinical decision-making. This structure prioritizes depth over quantity, with fewer but more holistic stations that better reflect real-world chiropractic practice.
• Centralized Assessment Center: Beginning in 2026, all Part IV exams will be administered at NBCE’s headquarters in Greeley, Colorado, offered up to 48 weeks per year, which is a significant increase from the current twice-a-year schedule. Centralizing the process allows for more frequent testing, consistent quality, streamlined operations, and easier implementation of future innovations.
• Cost Control and Examinee Support: Despite significant capital investment, Part IV exam fees will remain unchanged. This is made possible through a shared funding model, which keeps costs 64% lower than if regional testing were maintained. NBCE is also planning to offer travel support for examinees, including airport shuttles, hotel partnerships, airfare discounts, and possibly bundled travel insurance.
• Operational Efficiencies: The move enables consolidated staffing, standardized environments, and a more scalable testing infrastructure.

These updates are essential for more effectively assessing clinical competence, speeding up the path to licensure, and creating a clearer, more consistent testing process, laying the groundwork for renewed public trust and ensuring Part IV remains a meaningful measure of real-world readiness.

Embracing Technology and Quality Assurance

In support of its modernization efforts, NBCE is investing in technology to raise the bar for fairness, accuracy, and transparency in chiropractic assessment.

To support this evolution, NBCE is implementing several forward-looking initiatives to the Part IV, including:

• Paperless Grading and Video Recording: NBCE is transitioning to a fully digital grading process, supported by secure video recordings of exam encounters. This not only improves grading efficiency and consistency but also enhances quality assurance and provides a transparent record for appeals and ongoing evaluator training source.
• Pilot Testing for the Future: Ahead of full implementation, NBCE launched pilot programs to test digital workflows and revised station formats. These pilots have informed the development of streamlined, tech-enabled exam delivery, paving the way for a full rollout by 2026.
• Designed for Continuous Innovation: The centralized assessment model makes it easier to introduce new technologies, assessment tools, and evidence-based improvements in real time, ensuring NBCE’s exams stay responsive to the profession’s evolving needs.

These innovations create a process that can be better trusted, better understood, and provide more responsive feedback. Video recording, digital workflows, and real-time quality controls are designed to increase fairness, ensure consistency, and give examinees and institutions a clearer window into how performance is evaluated.

Grounded in Stakeholder Collaboration

At every step of its transformation, NBCE has prioritized collaboration with the chiropractic community, recognizing that meaningful reform must reflect the voices of those it serves.

This spirit of collaboration is evident in the following efforts:

• Broad Stakeholder Engagement: From the earliest phases of reform, NBCE has actively engaged with a wide range of stakeholders, including state licensing boards, chiropractic colleges, educators, students, and regulators, to ensure that changes are grounded in the realities of the profession.
• Transparent Test Development: To maintain high standards and build trust, NBCE regularly convenes Test Development Committees composed of practicing doctors and educators. These collaborative workshops, such as the April 2025 Part II workshop held in Greeley, play a central role in ensuring the exams remain relevant, valid, and defensible.
• Ongoing Dialogue Through Webinars and Forums: To ensure transparency and engagement, NBCE has hosted webinars and open forums to preview major changes, including the redesigned 2026 Part IV exam. These sessions give stakeholders opportunities to ask questions, offer feedback, and better understand what’s ahead.

By fostering open dialogue and inviting diverse perspectives, NBCE is building a more inclusive, transparent, and responsive testing system that reflects the shared commitment of the entire chiropractic community to excellence and integrity.

Building a Stronger, Smarter Path Forward

At the heart of these reforms is NBCE’s core responsibility: To ensure every licensed chiropractor meets a standard that protects patients, reflects current clinical expectations, and supports long-term trust in the profession. A stronger, more consistent path to licensure ultimately protects the public while strengthening the future of industry. These reforms are delivering tangible benefits to those who rely on the licensing system most.

• For Examinees: With more flexible testing schedules, clearer and more holistic scoring, and a streamlined path to licensure, examinees experience less stress and fewer repeat exams, making the transition from education to practice more efficient and supportive.
• For Institutions and Regulators: Centralized testing and standardized processes bring greater consistency and reliability to licensure outcomes. Institutions also gain valuable data insights to inform curriculum development and student support.
• For the Public: Patients can feel confident knowing their care is in the hands of chiropractors who have met rigorous, transparent, and modernized standards, reinforcing trust in the profession as a whole.

These improvements make a meaningful difference across the chiropractic field, helping students advance more smoothly into practice, giving schools and regulators clearer, more consistent results, and ensuring the public is cared for by well-qualified professionals.

NBCE’s transformation doesn’t end here. This is just the beginning. NBCE is positioned to continue investing in new technologies, modern testing platforms, and improvements that contribute to the continued advancement of the chiropractic field for generations to come.

To learn more about NBCE’s ongoing reforms, explore upcoming milestones, and find opportunities to get involved, please visit: https://www.nbce.org/adv-dev-2025/.